Endocrine

Question 1

What level of TSH is considered low-risk for concerning thyroid nodules?

Answer 1

LOW TSH

Question 2

If a patient has LOW TSH, what scan should then be done to assess for a thyroid nodule?

Answer 2

Radioactive Iodine uptake

Question 3

Treatment for a Hot thyroid nodule?

Answer 3

Resect

Question 4

Treatment for a Cold thyroid nodule?

Answer 4

Fine Needle Aspiration to assess for malignancy!

Question 5

What level of TSH is considered High-risk for thyroid nodules?

Answer 5

HIGH TSH

Question 6

If a patient has HIGH TSH, what test should be done to assess for a thyroid nodule?

Answer 6

Ultrasound

Question 7

If a thyroid nodule is larger than 1 cm, what should be done?

Answer 7

Fine Needle Aspiration to assess for malignancy

Question 8

What 2 types of thyroid nodules are the most concerning for malignancy?

Answer 8

Cold nodules
Large nodules

Question 9

What 2 types of thyroid nodules are the most concerning for malignancy?

Answer 9

Cold nodules
Large nodules

Question 10

A Gastrinoma secretes Gastrin which causes?

Answer 10

Parietal cells to secrete lots of acid

Question 11

What is the sign that someone may have a Gastrinoma?

Answer 11

Peptic Ulcer Disease that fails to improve

Question 12

What 2 diagnostic images can diagnose a Gastrinoma?

Answer 12

Somatostatin Receptor Scintigraphy
CT scan

Question 13

How will a patient with an Insulinoma present?

Answer 13

Hypoglycemia even when fasting
– sweating, syncope, tachycardia

Question 14

What 2 things will be HIGH with an Insulinoma?

Answer 14

Insulin
C-PEPTIDE!! (endogenous insulin)

Question 15

What should you screen for if someone is presenting similar to an Insulinoma?

Answer 15

Sulfonylureas – taking these cause excess insulin secretion

Question 16

Levels of PTH, Calcium and Phosphate with Primary Hyperparathyroidism?

Answer 16

HIGH PTH and Calcium
LOW Phosphate

Question 17

What specific scan detects Primary Hyperparathyroidism?

Answer 17

Sestamibi scan

Question 18

What is a potential transient post-op complication following resection of Primary Hyperparathyroidism and why?

Answer 18

LOW Calcium
– The parathyroid glands left behind intially under-function because the over-functioning one is gone

Question 19

What metabolic changes will be present with Primary Hyperaldosteronism?

Answer 19

HTN
LOW K+
LOW Renin

Question 20

What metabolic changes will be present with Renal Artery Stenosis?

Answer 20

HTN
LOW K+
HIGH Renin

Question 21

What test should be done to ensure correct lateralization of primary hyperaldosteronism/pheochromocytoma?

Answer 21

Adrenal vein sampling

Question 22

How is Renal A. Stenosis diagnosed?

Answer 22

US doppler or CTA

Question 23

How is Primary Hyperaldosteronism diagnosed?

Answer 23

CT/MRI

Question 24

What do Pheochromocytomas produce? In what fashion?

Answer 24

Catecholamines in a pulsatile fashion

Question 25

What are the symptoms of a Pheochromocytoma?

Answer 25

5 P's - Paroxysms of symptoms - Pressure is up (BP) - Pain (headache) - Palpitations - Perspire

Question 26

What are the symptoms of a Pheochromocytoma?

Answer 26

5 P's - Paroxysms of symptoms - Pressure is up (BP) - Pain (headache) - Palpitations - Perspire

Question 27

What is often diagnostic of a Pheochromocytoma?

Answer 27

Urinary VMA and Metanephrines over 24 hours

Question 28

What is the unique treatment for a Pheochromocytoma?

Answer 28

1. Alpha blocker first 2. Beta blocker second 3. Resecetion

Question 29

What are the signs of Cushing's? What is elevated?

Answer 29

HIGH Cortisol = Buffalo hump, moon facies, abdominal striae and truncal obesity

Question 30

If Cushing's is suspected, what test should be done first?

Answer 30

LOW-dose dexamethasone cortisol suppression test

Question 31

If someone has Cushing's Syndrome is present, what is the result of the Low-dose dexamethasone suppression test?

Answer 31

Fails to suppress cortisol

Question 32

Following the LOW-dose dexamethasone suppression test, what should be measured?

Answer 32

ACTH

Question 33

If ACTH is LOW, that means what?

Answer 33

ACTH independent elevated cortisol

Question 34

If the ACTH is HIGH, that means what?

Answer 34

ACTH dependent elevated cortisol

Question 35

With a Primary Adrenal Tumor, what will be the level of ACTH?

Answer 35

LOW

Question 36

If ACTH is HIGH, what test should then be done?

Answer 36

HIGH-dose dexamethasone suppression test

Question 37

With the HIGH-dose dexamethasone suppression test, if cortisol fails to suppress, what is the diagnosis?

Answer 37

Ectopic tumor secreting ACTH

Question 38

With the HIGH-dose dexamethasone suppression test, if cortisol is suppressed, where is the tumor?

Answer 38

Pituitary tumor

Question 39

Cushing's Disease vs. Cushing's Syndrome

Answer 39

Disease = pituitary tumor Syndrome = signs of excess cortisol

Question 40

Treatment for a Pheochromocytoma?

Answer 40

1. Alpha blocker 2. Beta blocker 3. Resection