endocrine

Question 1

POS diagnosis

Answer 1

2 of the following:

irregular ovulation
elevated levels of androgens
appearance of polycystic ovaries on ultrasound

Question 2

PCOS is a risk factor for

Answer 2

cardiovascular disease
insulin resistance
hyperlipidemia

Question 3

PCOS symptomatology

Answer 3

menstrual abnormalities
hyperandrogenism - hirsutism
infertility
obesity
diabetes

Question 4

PCOS meds

Answer 4

PO contraceptives
Clomiphene if trying to conceive

metformin

Question 5

synthroid dosing

Answer 5

initial 25-75 mcg PO daily

increase by 25 mcg q 1-2 weeks

goal TSH 0.4-2.0mU/L

pt>60 - start low, go slow!

Question 6

myxedema coma s/s

Answer 6

AMS - stupor, delirium, seizures, coma
extreme hypothermia
hyponatremia
respiratory depression
hypotension
bradyarrhythmias

Question 7

myxedema coma treatment

Answer 7

check TSH, but start therapy before lab results

synthroid 400 mcg IV x1, then 50-100 mcg IV daily

hydrocortisone

Question 8

hyperthyroidism management

Answer 8

propranolol 10-80 mg PO for symptom relief

thiourea drugs (methimazole, propylthiouracil)

radioactive iodine

thyroidectomy

Question 9

hyperthyroid red flags

Answer 9

fever
tachycardia
hypertension
neurologic/GI abnormalities

Question 10

hyperthyroid red flags

Answer 10

fever
tachycardia
hypertension
neurologic/GI abnormalities

Question 11

thyroid storm management

Answer 11

D5 IVF resuscitation
ABCs
beta blockers
high-dose PTU, methimazole

avoid aspirin!!!

Question 12

Cushing’s triad

Answer 12

hypokalemia
hyperglycemia
leukocytosis

Question 13

Cushing’s diagnosis

Answer 13

elevated plasma cortisol in AM
high urine cortisol

ACTH normal

Question 14

Cushing’s treatment

Answer 14

high-protein diet
tumor resection
gradual withdrawal of glucocorticoids if that’s the cause

long term f/u - osteoporosis, immunosuppression, DM, HTN, risk for adrenal crisis (stress dose steroids in acute illness)

Question 15

primary cause of Addison’s disease

Answer 15

autoimmune destruction of adrenal gland

Question 16

Addison’s triad

Answer 16

hypoglycemia
hyponatremia
hyperkalemia

Question 17

Addison’s s/s

Answer 17

weakness, fatigue, weight loss, anorexia, N/V/D

hyperpigmentation
orthostatic hypotension
scant body hair

Question 18

Addison’s diagnosis

Answer 18

plasma cortisol <3mg/dL at 8pm
low ACTH

Question 19

Addison’s treatment

Answer 19

supplemental glucocorticoids

will need to increase doses in times of stress

Question 20

diabetes insipidus

Answer 20

insufficient vasopressin (ADH)

passage of large volume (>3L/24h) of dilute urine (<300mOsm/kg)

Question 21

diabetes insipidus s/s

Answer 21

thirst
polyuria
weight loss, fatigue
LOC change
dizziness

febrile
tachycardia, hypotension
poor skin turgor

Question 22

DI lab findings

Answer 22

hypernatremia
elevated BUN/Crt
serum osmolal >300
urine osmolal <100
USG <1.005

central - plasma vasospressin <1

Question 23

TBW deficit calc

Answer 23

0.6 * weight in kg * (Na/140 - 1)

Question 24

DI fluid replacement

Answer 24

give fluids hypoosmolar to serum

Na > 150 - D5W
Na < 150 - 0.45% or 0.9% NS

try to decrease Na by 0.5 mmol/L/h

Question 25

DI treatment

Answer 25

central - DDAVP nephrogenic - thiazide diuretic or indomethacin fluids

Question 26

SIADH

Answer 26

excess ADH excess water hyponatremia`

Question 27

SIADH s/s

Answer 27

headache, seizures, coma, cold intolerance, decreased DTRs weight gain, edema

Question 28

SIADH labs

Answer 28

hyponatremiaa serum osmolality <280 urine osmolality >100 urine Na >20

Question 29

SIADH treatment

Answer 29

if Na >120: 1L fluid restriction if Na 110-120 w/o symptoms: 500 ml fluid restriction if Na <110 or neuro symptoms: isotonic or hypertonic saline 3% at 0.5ml/kg/hr & lasix 0.1-1mg/kg

Question 30

pheochromocytoma syndromes

Answer 30

- von hippel-lindau (VHL) syndrome - multiple endocrine neoplasia type 2 (MEN2) - neurofibromatosis type 1 (NF1)

Question 31

s/s of pheochromocytoma

Answer 31

HA polydipsia, polyphagia anxiety palpitations diaphoresis weight loss dyspnea labile HTN hyperglycemia postural hypotension

Question 32

pheochromocytoma diagnostics

Answer 32

plasma free metanephrines 24 hour urine for metanephrines

Question 33

pheochromocytoma treatment

Answer 33

tumor resection BP control - <140/90 alpha adrenergic blockers - phentolamine