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Flashcards in Endocrine Deck (149)
1

Orphan annie, psammoma bodies

Papillary

2

Most common thyroid malignancy

Papillary

3

Ground glass, pale nuclei w/ inclusions and central grooving

Papillary

4

Ret gene

Papillary & Medullary

5

Amyloid stroma

Medullary

6

HypoCa, RET gene

Medullary

7

Calcitonin, C-cells

Medullary

8

Invasion of tumor capsule & blood vessels

Follicular carcinoma - adenoma does not invade capsule

9

Dense fibrous capsule

Follicular adenoma

10

RAS gene

Follicular

11

Hematogenous spread, no needle bx thyroid Ca type?

Follicular

12

NON-tender thyroiditis, very low RAIU

Subacute LYMPHOCYTIC

13

Tender thyroid, very low RAIU

Subacute/De Quervains Granulomatous

14

Firm thyroid

Riedel's fibrosing

15

Chvostek & Trousseau sign

HypOCa d/t PT resection/hypothyroidism, CKD --> dec 1,25OH

16

Diffuse inc RAIU uptake --> most likely to develop hypOthyroidism

Grave's (vs. subacute or exogenous=dec/low, tumor = patchy)

17

Scalloping of colloid

Grave's - Ab to TSH-Receptor

18

SE of RAI tx for Graves' (#1 choice)

Worse proptosis (10%) (pre-tx w/ steroids), perm hypOthyroidism (80%)

19

Use of anti-thyroid drugs for Grave's

PTU in preg, PTU --> vaculitis, Both PTU & MMI --> agranulocytosis

20

Risks/SE of thyroid surgery

Laryngeal nerve damage, hypoCa

21

Low TSH, Inc T4, hot RAIU uptake

Functioning nodule --> I2 ablation or ?lobectomy

22

Low TSH, inc T4, cold RAIU next step?

U/S FNA --> usually tx w/ RAI?

23

Unsure US FNA, non-functioning RAIU scan

Cancer --> surgery

24

Low TSH, high T4,3, low RAIU, next step?

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?