Endocrine Flashcards
(149 cards)
1
Q
Orphan annie, psammoma bodies
A
Papillary
2
Q
Most common thyroid malignancy
A
Papillary
3
Q
Ground glass, pale nuclei w/ inclusions and central grooving
A
Papillary
4
Q
Ret gene
A
Papillary & Medullary
5
Q
Amyloid stroma
A
Medullary
6
Q
HypoCa, RET gene
A
Medullary
7
Q
Calcitonin, C-cells
A
Medullary
8
Q
Invasion of tumor capsule & blood vessels
A
Follicular carcinoma - adenoma does not invade capsule
9
Q
Dense fibrous capsule
A
Follicular adenoma
10
Q
RAS gene
A
Follicular
11
Q
Hematogenous spread, no needle bx thyroid Ca type?
A
Follicular
12
Q
NON-tender thyroiditis, very low RAIU
A
Subacute LYMPHOCYTIC
13
Q
Tender thyroid, very low RAIU
A
Subacute/De Quervains Granulomatous
14
Q
Firm thyroid
A
Riedel’s fibrosing
15
Q
Chvostek & Trousseau sign
A
HypOCa d/t PT resection/hypothyroidism, CKD –> dec 1,25OH
16
Q
Diffuse inc RAIU uptake –> most likely to develop hypOthyroidism
A
Grave’s (vs. subacute or exogenous=dec/low, tumor = patchy)
17
Q
Scalloping of colloid
A
Grave’s - Ab to TSH-Receptor
18
Q
SE of RAI tx for Graves’ (#1 choice)
A
Worse proptosis (10%) (pre-tx w/ steroids), perm hypOthyroidism (80%)
19
Q
Use of anti-thyroid drugs for Grave’s
A
PTU in preg, PTU –> vaculitis, Both PTU & MMI –> agranulocytosis
20
Q
Risks/SE of thyroid surgery
A
Laryngeal nerve damage, hypoCa
21
Q
Low TSH, Inc T4, hot RAIU uptake
A
Functioning nodule –> I2 ablation or ?lobectomy
22
Q
Low TSH, inc T4, cold RAIU next step?
A
U/S FNA –> usually tx w/ RAI?
23
Q
Unsure US FNA, non-functioning RAIU scan
A
Cancer –> surgery
24
Q
Low TSH, high T4,3, low RAIU, next step?
A
Measure Ig - low = exogenous, high = thyroiditis, extraglandular production
25
Chronic inflammation of germinal centers w/ Hurthule cells
Hashimoto's (microsomal abs)
26
Lymphocytic infiltration of thyroid
Hashimoto's (microsomal abs)
27
Hurthle cells
Hasimoto's & Follicular thyroid CA
28
Anti-TPO Abs --> transient hyperthyroidism
Hashimoto's
29
Hx of Hashimoto's --> enlarging thyroid = ?
Marginal B-cell lymphoma/thyroid lymphoma ---> core needle bx
30
Hypothyroidism, donut sign on CT, voice change, pseudocyst on US
Thyroid lymphoma
31
Pancreas (insulin or gastrinoma), Parathyroid, Pituitary
MEN I - Ca stones
32
Medullary, Parathyroid, Pheo
MEN IIA --> metanephrine measure + PCR DNA testing
33
Medullary, Marfan or mucosal/intestinal neuromas, Pheo
MEN IIB
34
Ret gene
MEN IIA/B
35
Thyroid nodule 1st step
PE + TSH +US
36
Thyroid nodule w/o hypoechoic, calcification or vascularity next step
High TSH = FNA ; Low TSH --> RAIU
37
Inc T4, Normal/High TSH, hyperthyroidism
Pituitary adenoma --> TSH
38
Very low TSH, tachy, weight loss - control Sx?
Propanolol for hyperthyroidism --> iodine tx/dx of Grave's
39
Pregnancy THs
Inc total, bound T4,3, TBG, Dec TSH, Same free
40
Untx hyperthyroidism --> ?
Osteoporosis
41
Myalgias, proximal weakness, slow reflexes
Hypothyroidism - TSH, free T4 --> EMG --> Bx
42
Growth /yr, goiter, myxedema, amenorrhea, umbilical hernia, hypothermia
Hypothyroidism
43
Poor feeding, lethargy, constipation, large ant. Fontanelle, protruding tongue
Hypothyroidism
44
Apathy, weakness, hypotonia, large tongue, slow movements, constipation
Hypothyroidism
45
Low T3,4 Low TSH, hypothyroidism
Secondary (pituitary) or tertiary hypothyroidism
46
Inc T3,4 Normal TSH, hypothyroidism
Resistance to thyroid hormones
47
#1 cause of congenital hypothyroidism
Thyroid dysgenesis (90%)
48
Sensorineural hearing loss, hypothyroidism
Penred syndrome
49
Other cause of congenital hypothyroidism
PTU in pregnancy, Maternal auto-immune
50
Tachy, warm, vitiligo, alopecia, can't concentrate, gyecomastia in boys
Hyperthyroidism
51
#1 congenital hypothyroidism in US
Thyroid dysgenesis; Iodine deficiency worldwide
52
Reduce decline in GFR/macroproteinuria in DM
Tight BP control - ACE
53
DKA acute tx
Normal saline + regular insulin --> D5 +K when BG 200-250
54
DM BP goal
<130/80
55
DM goals
A1c <7, LDL 70-100, low carbs, low sat fat,
56
Gestational DM screening
50g 1hr GCT @24-28wks
57
GCT >130 next step
100g 3hrs GCT >95, 180, 155, 140 = abnormal
58
Dx criteria for DM
Random >200, fasting >126, A1c >6.5
59
DM maintenance tests
Lipids, Cr, Microalbumin, eye exam, foot exam, EKG, TSH in type 1
60
Metformin CI
Renal insufficiency Cr >1.5men, 1.4 women --> lactic acidosis
61
TZDs MOA
Inc insulin sensitivity in muscle, fat, dec gluconeogenesis
62
TZDs SE
water retention --> renal compromise, CHF, slow onset
63
Drug best for erratic eating habits, dec post-prandial glucose
alpha-glucosidase inhibitors
64
Pramlintide MOA
amylin --> inhibits glucagon after meal
65
GLP-1 agonists (exaenatide, glitazone) MOA
Stim insulin release --> hypog w/ sulfonylurea, acute pancreatitis
66
DPP-4 inhibitor (-gliptin) MOA
Stim insulin synthesis in glucose dep manner, dec glucagon
67
Hypoglycemia Tx
IM glucagon or D50
68
7 y/o weight loss, polydipsia, polyphagia, glucose 500 work-up
DM-1 diabetic ketoacidosis --> Hospital, IVF, Insulin
69
Gesational DM fetal risks
Macrosomia, polyhydramios, shoulder dystocia (also pre-gestational)
70
Pain, tingling in feet, falls, hyperreflexia, + babinski next step?
Spine MRI - upper motor neuron/?compression - DM prone to epidural abscess
71
Osteomyelitis adjacent to foot ulcer mech?
Contiguous spread
72
DKA hyperK w/ delepted K stores pathogenesis
Infection --> cortisol --> hyperglycemia --> diuresis of K --> K out of cell
73
Anti-glutamic acid decaroxylase Abs
Indolent late-onset DM-1
74
Weight loss, deep rapid breathing (acidosis), Viral GE, excessive thirst
DKA --> check glucose --> CBC, ABG,
75
Age to start screening w/ no DM risk factors
45
76
Elevated insulin, c-peptide + hypoglycemia
Beta cell tumor
77
Low insulin, c-peptide, high IGF-II + hypoglycemia
Non-beta cell/mesenchymal tumor
78
High insulin, LOW c-peptide + hypoglycemia
Exogenous insulin
79
1st line drug of obesity (not DM)
Orlistat - up to 4yrs
80
Contributing factor in diabetic foot ulcers
Neuropathy
81
Blurred vision in uncontrolled DM
Infection --> cortisol is anti-insulin --> dehydration & hyperosmolar state
82
Erythematous papules, DM, diarrhea, weight loss, normocytic anemia
Glucagonoma (>500pg) --> CT
83
Islet cell Abs, Insulin Ab, Glutamic acid decarboxylase Ab
DM-I
84
Evening insulin too high --> hypoglycemia --> EPI, glucagon --> high BG, ketones AM
Somogyi effect
85
DKA + sudden AMS
Cerebral edema - >100mg/hr drop - addD5 <250
86
Thin boy fever, vomiting --> sleep w/o food --> AM seizure
Ketotic hypoglycemia
87
Poor weight gain, polydipsia, polyuria, enuresis, nocturia
DI
88
HyperNa, dilute urine + inc serum Na and osmolarity, morning urine <1.018
DI
89
Water deprivation test inc serum osmolarity + dilute urine
DI --> DDAVP for CDI
90
No response to ADH
NDI
91
Bone scan in presence of DI?
R/O Langerhans histiocytosis
92
High IGF-1, fail to suppress oral glucose
Acromegaly
93
*Signs of hyperprolactinoma 1st steps?
Check TSH ---> CT (unless mass effect then CT 1st)
94
Low LH, testosterone, TSH, thyroxine, elevated prolactin
Pituitary adenoma
95
Prolactinoma Tx
DA agonists - Cabergoline or Bromocriptine
96
Dec GnRH, Dec LH, FSH, Dec sperm, Normal T + gynecomastic, acne
Anabolic steroid use
97
Hypoglycemia, microphallus, cleft palate
Congenital hypopituitarism*
98
Inc ACTH, dec cortisol
Primary adrenal insufficiency
| - #1 = auto-immune adrenalitis
99
Anorexia, weakness, dec Na, inc K, hypotension, inc pigment, *Eosinophilia*
Primary adrenal insufficiency - cortisol
100
FTT, salt craving, dec Na, inc K
Primary adrenal insufficiency - aldosterone
101
Hx Hashimoto, hypotn, hyperpigmented, hypoNa, hyperK, high ACTH
Primary adrenal insufficiency (Addison) = Auto-immune (80% of all)
102
Causes of primary adrenal insufficiency
CMV, TB, sepsis + Warfarin, malignancy
103
Primary adrenal insufficiency causes
Addison, CAH, adrenoleukodystrophy
104
ACTH stim --> cortisol <2x
Primary adrenal insufficiency
105
Adrenal insufficiency Tx
D5 + NS, steroids
106
Normal K, hx steroid use (#1)
Secondary adrenal insufficiency
107
Secondary adrenal insufficiency causes
Langerhans, Pituitary tumor, craniopharyngioma
108
Ambiguous genitalia, hypotension, Dec Na, Inc K, Inc T
CAH (21 B-OH) = 17-OH
109
HTN, HyperNa, HypoK, virilization, Inc T
CAH (11 B-OH) = Compound S
110
Salt-wasting crisis, ambiguous genitalia
CAH (3 B-OH) = DHEA & 17-OH
111
7 y/o acne, facial hair w/o inc testicular volume
Non-classical CAH (21-OH)
112
Tx CAH
Cortisone , fluorocortisol (if low), follow growth
113
Lymphocytic infiltrate into adrenal cortex
Addison
114
Type 1 polyglandular syndrome
Addison, Hashimoto's, DM-I
115
Type 2 polyglandular syndrome
Addison, Hypoparathyroid, candidiasis
116
Delayed bone age, moon facies, bruising, HTN
Cushing (cortisol excess)
117
Obesity, easy bruising, high 24hr cortisol, ACTH, high dexa --> dec cortisol
Cushing disease
118
Weakness, weight gain, hyperglycemia, easy bruising electrolyte abnormalities
Cushing disease --> aldosterone --> hypoK, hyperNa
119
ACTH low
Exogenous cortisol or Primary adrenal tumor
120
ACTH high
Pituitary or ectopic tumor --> high dose dexa
121
Low dose dexa --> suppression
Fat person
122
Low dose dex --> NO suppression + high 24 urine cortisol next step?
Proceed to high dose dexa
123
High dose dexa --> suppression
Pituitary = Cushing Disease/adrenal adenoma
124
High dose dexa --> NO suppression
Ectopic ACTH production - pituitary, small cell, pancreatic, carcinoid CA
125
Obese, striae, easy bruising, 24hr cortisol 1000, ACTH high, high dexa no chg
Ectopic ACTH production - pituitary, small cell, pancreatic, carcinoid CA
126
Obesity, striae, hypotension, low ACTH
Exogenous steroids, B/L AH, adrenal adenoma
127
HTN, hypoK, Low renin: high Aldo >20, cramps, polyuria, inc aldo standing
Primary hyperaldosteronism (Conn) ---> Oral saline load --> epelerone
128
Inc aldo standing vs. lack of response in Conn syndrome
Hyperplasia vs. adenoma of adrenal gland
129
Paroxysms, Pressure, Pain, Palpitations, Perspiration
Pheochromocytoma --> 24 urine VMA, metaneprine
130
Pheo Tx
alpha blocker phenoxybenzamine, BBs inc BP
131
Aldo:renin <10, HTN, hypoK
US + doppler --> Renal artery stenosis
132
Young woman w/ fibromuscular dysplasia intervention
Arteriogram + stent OR ACE + aldo blockers if old man
133
B/L Adrenal calcification
TB
134
Accumulation of long chain FA in young male, adrenal insufficiency
Adrenoleukodystrophy
135
High DHEA-S, normal T
Androgen producing adrenal tumors
136
Normal DHEAS, high T
Ovarian tumor
137
Moon facies, steroid use, hypoNa, weakness, fatigue, orthostasis
3 adrenal insufficiency --> suppresses CRH, ACTH, cortisol, inc ADH
138
Tx NDI
HTCZ
139
Tx SIADH
Demeclocycline
140
Short stature
2SD or evaulate RATE
141
Normal growth rate
2"/yr 3 y/o --> puberty
142
Delayed bone age, late puberty, 2"/yr
Constitutional short stature
143
Normal U/L ratio, /yr, abn velocity
Pathologic short stature - proportionate
144
Causes of proportionate short stature
Chr, genetic, viral, malnutrition, abuse, organ dz
145
Bone age = real age disproportionate SS causes
familial, IUGR, Turner, skeletal dysplasia
146
Bone age < real age disproportionate SS causes
Constitutional, dec thyroid, inc cortisol, dec GH
147
Dec GH, 1 central maxillary incisor, cleft palate 1st step
MRI (craniopharyngioma), IGF-1 --> GH injections
148
Visceromegaly, umbilical hernia, ear crease, inc insulin + hypoglycemia
Beckwith-Wiedmann syndrome
149
Abdominal mass NOT cross midline, hematuria
Wilms tumor --> CT + contrast --> lung mets?
