Endocrine 2 Flashcards

Question

👉🏼 In a patient taking PTU who develops **fever** and **sore throat**, what is the immediate **next step**?

Answer 1

✅ **Stop PTU and check CBC immediately** 🧠 These are red flags for agranulocytosis ⚠️ Delay in diagnosis can lead to sepsis and death

Answer 2

✅ **Subclinical hypothyroidism** 💡 Defined by **elevated TSH** with **normal thyroid hormone levels** 🧠 May progress to overt hypothyroidism, especially with positive TPO antibodies

Answer 3

✅ **Assess the patient’s pregnancy plans** 🧠 Treatment is **recommended if**: * TSH >10 * Positive TPO antibodies * Pregnant or planning pregnancy * History of infertility or miscarriage

Answer 4

* **TSH >10** * **Positive TPO antibodies** * **Pregnant or planning pregnancy** * **History of infertility or miscarriage** ✅ Treatment decision depends on context, especially reproductive plans

Answer 5

⛔️ PTU is used to treat **hyperthyroidism**, not hypothyroidism ⚠️ Giving PTU would **worsen** the thyroid function

Answer 6

⛔️ No thyroid nodule or mass is suspected ⛔️ No indication for surgery or imaging in asymptomatic, stable patients ✅ Ultrasound is reserved for **palpable nodules or goiter**

Answer 7

✅ **Hyperosmolar hyperglycemic state** (HHS) 🧠 Seen in type 2 diabetes 💡 Characterized by: * **Severe hyperglycemia** (600–1200 mg/dL) * **Altered mental status** * **Volume depletion** * **Minimal or no ketosis**

Answer 8

✅ **0.9% saline (normal saline)** 🚩 Used to restore **hemodynamic stability** 💡 Corrected sodium = 125 + [(1050–100)/100 × 2] = 143 → no true hyponatremia ⚠️ Delay in fluid resuscitation can worsen renal perfusion and increase mortality

Answer 9

⛔️ Used **afte**r stabilization or when **Na⁺ >150 mEq/L** 💡 In hypotensive patients, it’s **too hypotonic** for initial resuscitation ✅ Use **normal saline first** to restore blood pressure

Answer 10

⛔️ Used only in **severe symptomatic hyponatremia** with neurologic symptoms and true Na⁺ <120 🧠 This patient has **pseudohyponatremia due to hyperglycemia** → corrected Na⁺ = normal

Answer 11

⛔️ Only considered in **severe acidosis** (pH <6.9) in **DKA**, not HHS 💡 No indication in this case

Answer 12

⛔️ Potassium replacement is done **after fluids** and **before insulin** if K⁺ <3.3 💡 Not given first unless hypokalemia is documented

Answer 13

✅ **NO**,GLP-1 analogs **don’t** cause hypoglycemia 💡 They enhance glucose-dependent insulin secretion via **incretin effect** 🧠 Therefore, they don’t stimulate insulin release when glucose is low → **no hypoglycemia**

Answer 14

⛔️ The most common side effect is **nausea**, not abdominal pain ⚠️ Other GI symptoms (e.g., vomiting) may occur but are less frequent

Answer 15

⛔️ Animal studies showed an association with **C-cell tumors** 🚨 Contraindicated in patients with** personal or family history of medullary thyroid cancer or MEN 2 syndrome**

Answer 16

⛔️ TZDs cause **fluid retention and weight gain** ⚠️ Can **worsen or trigger heart failure**, especially in NYHA class III–IV 🧠 TZDs are **contraindicated** in CHF

Answer 17

⛔️ That dose is typical for **type 1 diabetes** ✅ Type 2 diabetes usually starts with **oral agents**, or **basal insulin only** if needed 💡 Lower insulin doses are used in early type 2 DM

Answer 18

✅ **Toxic thyroid adenoma** (hot nodule) 💡 Solitary autonomously functioning thyroid nodule causing **primary hyperthyroidism** 🧠 High uptake in nodule, low uptake elsewhere = suppressed normal thyroid tissue

Answer 19

✅ **Antithyroid treatment followed by radioactive iodine (RAI) ablation** 💡 Antithyroid drugs (e.g., methimazole) used short-term to stabilize thyroid function 🚩 **Definitive treatment** is RAI — targets hyperfunctioning tissue while sparing normal thyroid | RAI= radioactive iodine

Answer 20

⛔️ **Not curative** and carries risk of **side effects** (e.g., agranulocytosis, hepatotoxicity) 🧠 Antithyroid drugs are **bridge therapy** before RAI or surgery

Answer 21

⛔️ Surgery (lobectomy) is **more invasive** and **reserved for:** Very large nodules Suspicion of cancer RAI contraindications (e.g., pregnancy) ✅ **RAI is safer, less invasive, and effective in most toxic adenomas**

Answer 22

✅ **0.45% saline (half-normal saline)** 👉🏼 Used to continue rehydration once patient is stable 💡 Preferred if corrected serum sodium is **normal or low**

Answer 23

⛔️ Normal saline is for **initial resuscitation** only (if hypotensive) 💡 After stabilization, it may contribute to **hypernatremia or fluid overload**

Answer 24

⛔️ Reserved for **severe symptomatic hyponatremia** ⚠️ HHS typically causes **pseudohyponatremia** or normal sodium 🧠 Hypertonic saline has **no role** here

Answer 25

⛔️ Potassium is replaced **only if serum K⁺ is low** (<3.3 mEq/L) ⚠️ Always correct potassium **before** starting insulin if needed 💡 In this scenario, fluid therapy takes priority first

Answer 26

⛔️ Sodium levels in HHS are altered due to **hyperglycemia-induced water shifts** 💡 No need to give sodium directly unless true hyponatremia exists ✅ Use **saline fluids** to manage sodium indirectly

Answer 27

✅ **ACE inhibitor, statins, and oral antidiabetic** 🧠 Because: * HbA1c >7% = uncontrolled diabetes → add or adjust **oral antidiabetic** * LDL >100 = start **statin** * Proteinuria = needs **ACE inhibitor** to slow nephropathy progression

Answer 28

⛔️ Insulin is not yet indicated unless oral agents fail or if HbA1c is >10% ⛔️ Bezafibrate lowers triglycerides but does **not replace statins** for CV risk 💡 Statins are first-line for diabetic dyslipidemia

Answer 29

🔍**Statins** not fibrates

Answer 30

🔍**ACE inhibitors** not ARBs as losartan.

Answer 31

⛔️ **He has:** * Uncontrolled DM * Proteinuria * High LDL & TAGs ⚠️ Untreated, this leads to **cardiovascular & renal complications** ✅ Requires **multi-factorial intervention**

Answer 32

✅ **Primary hypothyroidism** 🧠 **Classic symptoms:** fatigue, cold intolerance, dry skin, weight gain, constipation, bradycardia, slow reflexes, and hair thinning

Answer 33

✅ **Increased prolactin levels** 💡 Due to increased **TRH**, which stimulates both **TSH** and **prolactin** secretion from the anterior pituitary

Answer 34

⛔️ Hirsutism is associated with **androgen excess** (e.g., PCOS, adrenal disorders) 🧠 Hypothyroidism typically causes **hair loss**, not excess hair growth

Answer 35

⛔️ Hypothyroidism causes **decreased libido** and possible **menstrual irregularities** ⚠️ It can also cause infertility if untreated

Answer 36

⛔️ Hypothyroidism causes **delayed reflexes** (especially ankle reflexes) ⛔️ It also leads to **weight gain**, not weight loss ✅ **Weight loss and brisk reflexes** are features of hyperthyroidism

Answer 37

✅ **Post-surgical hypocalcemia due to hypoparathyroidism** 🧠 Accidental removal or injury to the parathyroid glands is a **common complication** of total thyroidectomy

Answer 38

✅ **Calcium supplementation** 🚨 Symptomatic patients need **IV calcium gluconate** 💡 Oral calcium can be used if symptoms are mild and stable

Answer 39

⛔️ Calcitriol (activated vitamin D) is reserved for **chronic or refractory hypocalcemia** ✅ It is added **only when high doses of calcium or vitamin D are required**

Answer 40

✅ Focus should be on correcting **calcium first** 💡But we should monitor Mg level →Severe hypomagnesemia (<1.2) can impair PTH release→not the cause here because they were accidentally removed during surgery.

Answer 41

⛔️ Recombinant PTH is for **long-term use** in **refractory chronic hypoparathyroidism** 💡 It’s **not** used acutely or as first-line therapy ✅ Use **calcium ± vitamin D** for most cases

Answer 42

✅ **GLP-1 receptor agonist** 💡 Helps with **weight loss**, **HbA1c reduction**, and **cardiovascular protection** ⚠️ Avoid if patient has medullary thyroid cancer, pancreatitis, or severe renal impairment

Answer 43

⛔️ Patient has **recurrent UTIs** and SGLT2 inhibitors increase risk of **urinary & genital infections** 💡 Also cause **polyuria**, **dehydration**, and are avoided in moderate renal impairment

Answer 44

⚠️ Adding another agent in the same class increases **hypoglycemia risk** 💡 Sulfonylureas also contribute to **weight gain**

Answer 45

⛔️ TZDs cause **fluid retention**, making them **dangerous in heart failure** (NYHA III-IV) ⚠️ Can also cause **weight gain**, **bone fractures**, and **macular edema**.

Answer 46

✅ Promote **weight loss**, ✅lower **postprandial glucose**, ✅reduce **CV events**, ✅**don’t cause hypoglycemia** 🧠**MODE OF ACTION**: * Work by increasing insulin, * decreasing glucagon, * delaying gastric emptying, * improving satiety

Answer 47

✅ **Pheochromocytoma** 💡 **Classic triad:** headache, palpitations, sweating + paroxysmal or sustained hypertension

Answer 48

✅ **Urinary catecholamines** (and/or metanephrines) 🧠 These assess for **catecholamine excess**, which is diagnostic of pheochromocytoma

Answer 49

⛔️ 5-HIAA is the breakdown product of **serotonin**, used to diagnose **carcinoid tumors**, not pheochromocytoma

Answer 50

⛔️ Neither test evaluates for **catecholamine excess** ⚠️ Electrolytes are for volume/acid-base disorders ⚠️ Proteinuria suggests **renal or urothelial** pathology

Answer 51

✅ **Imaging** (CT or MRI) to localize the tumor 💡 After diagnosis, begin **alpha-blockade** before surgery

Answer 52

✅ **Hypocalcemia** 💡 Sudden drop in PTH leads to decreased bone resorption → ↓ serum calcium ⚠️ Often transient, but must be monitored postoperatively

Answer 53

✅ Removal of hyperfunctioning parathyroid tissue → **sudden PTH drop** 💡 "Hungry bone syndrome" can also cause prolonged hypocalcemia due to rapid calcium uptake by bones

Answer 54

⛔️ These are **indications** for parathyroidectomy (not complications) in hyperparathyroidism ✅ Surgery corrects high calcium levels → reduces risk of stones and bone loss

Answer 55

⛔️ Parathyroid hormone does not regulate potassium ✅ Potassium levels remain **unaffected** by this surgery

Answer 56

✅ **Calcium and vitamin D supplementation** 💡 Monitor serum calcium daily post-op ⚠️ Educate patients on symptoms: tingling, cramps, Chvostek/Trousseau signs

Answer 57

✅ **156 mEq/L** 💡 Use formula: **Corrected Na⁺ = Measured Na⁺ + [1.6 × (Glucose - 100) / 100]** = 140 + (1.6 × 10) = 156

Answer 58

✅ **Switch to 0.45% saline** 💡 To avoid **worsening hypernatremia** and allow gentler rehydration

Answer 59

⛔️ Normal saline may **increase sodium further** in a hypernatremic patient ⚠️ Use **0.45%** once **hemodynamically stable and sodium >150**

Answer 60

⛔️ Potassium correction comes **after insulin is started** ⚠️ Only correct immediately if **hypokalemia is confirmed** (<3.3)

Answer 61

⛔️ 3% saline is used for severe symptomatic **hyponatremia**,not hypernatremia

Answer 62

⛔️ Rarely indicated ✅ Only if **severe acidosis** (pH <6.9), which is more typical in **DKA** than HHS

Answer 63

✅ 1) **Rule out hormone secretion** ✅ 2) **Assess malignancy risk** (mainly by size) 💡 >6 cm = ↑ malignancy risk; <4 cm = usually benign

Answer 64

✅ Blood/urine **metanephrines** → Pheochromocytoma ✅ **Dexamethasone suppression**, **midnight cortisol**, or **24h urinary cortisol** → Cushing ✅ Aldosterone/renin ratio (if HTN or hypokalemia) → Hyperaldosteronism

Answer 65

is **NOT** ⛔️ This is not used in adrenal evaluation; it’s relevant in **hypercalcemia** or** kidney stone workup**

Answer 66

✅ If the mass is: 👉🏼 **Hormone-secreting** 👉🏼 **≥4 cm in size** 👉🏼 **Suspicious imaging features** ⚠️ Masses >6 cm carry higher malignancy risk

Answer 67

✅ **Hypothyroidism** 📌 Occurs in up to 13% of patients 📌 Due to high iodine content + inhibition of thyroid hormone conversion

Answer 68

✅ **Continue amiodarone at the same dose and start levothyroxine** 💡 Amiodarone is often essential in arrhythmia control 🩺 TSH should be monitored during therapy

Answer 69

🚫 **No**, unless absolutely necessary ✅ Thyroid hormone replacement (LT4) is usually sufficient

Answer 70

❌ Changing the dose does **not correct hypothyroidism** ❌ May compromise control of atrial fibrillation( amiodarone is an antiarrhthymic )

Answer 71

✅ **Anti-TPO antibodies** 📌 Common in autoimmune thyroiditis

Answer 72

🔍**Empagliflozin** (SGLT2 inhibitor)

Endocrine 2 Flashcards

(229 cards)