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DIT Step 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What causes increase of TBG? Decrease?

A

more with preggers and OCP. So more T4 is made to keep T4

Free T3/T4 are normal even in hepatic failure

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2
Q

Toxic adenoma or toxic multinodular goiter shows what on scan? Tx?

A

Increased thyroid uptake. Tx by thionamides again or radioactive iodine or resection

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3
Q

Tx of subacute thyroiditis?

A

Supportive. NSAIDs and bta blocker if needed for symptoms. IT IS TRANSIENT

Beta blockers can help with hyperthyroid symptoms

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4
Q

Amiodorone can do what to thyroid?

A

Hperthryroid. Check TFT, LFT and PFTs with it

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5
Q

Tx of thyroid storm?

A

Beta blockers
Thionamides
IV sodium iodid
Glucocorticoids reduce T4-T3 transition!!!

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6
Q

If you had to chose how to treat Graves, what would you do?

A

radioctive iodine

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7
Q

What is silent thyroiditis?

A

Temporary painless goiter with hyperthroiditis. IT IS SELF LIMITED

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8
Q

Most common cause of hypothyroid?

A

Hashimoto

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9
Q

What do you ee on biopsy of hashiomtos?

Tx of it

A

Lymphocytic infiltrates and fibrosis

Tx with levo forever

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10
Q

Cretinism scan?

A

Decreased uptake. IT is too late to save it, so Tx is TO THYROID REPLACEMENT

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11
Q

Subacute thyroiditis is what

A

De Quarvain from viral stuff

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12
Q

First step to palpable thyroid?

A

TSH, Free T4, US to look for others

If hyperthyroid, do radioactive scan. If hot, treat as hyperthyroid.

IF COLD or anything euthyroid or hyperthyroid, do FNA

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13
Q

Do thyroid cancers make excess thyroid?

A

NOOOOO SO IF SCAN IS HOT, it is not cancer!!

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14
Q

What is a toxic adenoma?

A

Noninvasive! not cancer. Hot ndule is seen

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15
Q

What if FNA is benign thyroid nodule?

A

Repeat workup in a year to make sure not growing, if it did, repeat FNA

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16
Q

Most common cancer?

A

Papillary. Follicular variant can be invasive, but rare

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17
Q

MEdullary thyroid carcinoma release what?

A

PArafolilcular cells. Associated with MEN

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18
Q

Malignant thyroid tx?

A

Surgical resection followed by radioidone ablation!

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19
Q

Hypothyroidism can lead to high ldl and total cholesterol!

A

OH OK Right Brain Bonus

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20
Q

what does PTH tell kidney to do?

A

More calcium reasorption, less phosphate reabsorption

More 25-OH to be made to 1,25 OH vit D

Vit D helps reabsorb phosphate

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21
Q

Rickets X ray shows what?

A

Bowing at the knees, legs bent out sideways

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22
Q

Symptoms with hypercalcemia:

A

Bones Stones Mones and Psych overtones

Groans is constipation, N/V, ulcers (gastrin b/c high calcium), PANCREATITIS

Psych is lethargy, depression psychosis….

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23
Q

Treatment of secondary hyperparathyroidism

A

Limit oral phosphate, Phosphate binders with meals: CaCO3, or calcium acetate

If you limit phosphatemia, then there is less bone resorption!

Calcitriol helps reduce PTH secretion

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24
Q

Tx of hypoparathyroidism? It makes sense dude

A

Calcitriol (1,25 D3) b/c kidney can’t make this!

Calcium

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25
What is Albright's hereditary osteodystrophy? What does it look like?
From pseudohypoparathyroidism Autosomal dominant with maternal imprinting (if from mom, they will have it!!, if from dad only partial) findings: short, short 4th metacarpal, developmental delay, OBESITY Tx: Calcium, Vit D Calcitriol
26
What is cinacalcet?
Mimics calcium so PTH is lowered!
27
Vit D deficiency does what to labs for Ca PTH and phosphate?
Low Ca, High PTH, low Phosphate
28
Cabergoline?
DA agonist used for prolactinoma is the better one
29
Tx of prolactinoma?
Cabergoline then promo, if those don't work, then surgery
30
Dx of acromegaly?
IGF1 is more consistent. Do oral glucose suppression test, then measure GH at 1 and 2 horus, if stays high, it is ACROMEGALY Do pituitary MRI after that!!
31
Major complication of acromegaly?
HTN/DM can lead to cardiac failure. Also can have spinal cord compression INSULIN RESISTANCE WITH IT!
32
Tx for acromegaly?
Surgery, if not successful, use somatostatin analog Octreotide or lanreotide (inhibits GH secretion) Can follow ILGF to see if it works if no working, try cabergoline PEGVISOMANT is if all that fails which is GH antagonist
33
Sheehan syndrome is what?
postpartum hemorhage with blood lose causing infarct of pituitary. Lethargy, no lactation after delivery No menses May have fatigue, anorexia, weight loss
34
Empty sella is what?
It is empty on MRI, screen hormones. Often still functional hormones crunched up on there
35
Tx of hypopituitarism?
Replace deficient hormones ``` GH in children Hypogonadism give test or est maybe Pulstaile GnRH can help for preggers Hypothyrodism give Levo ACTH give cortisol!!! ```
36
Most common presentation in prolactinoma?
Hypogocnadism
37
Cushing complications
CV, dm, HTN, thromboembolic, infection, osteoporosis, avascular necrosis of hip
38
Dx of cushing
24 urinary cortisol. Late night salivary Dex suppression test
39
Dexamethasone suprresion test
1 mg at night, if it lowers cortisol next morning, then pituitary was lowered an not due to intrinsic cause If still high, try high dose and see if that lowers it and if cortisol is suppressed, it is pituitary, if not check ACTH. If high, it is ACTH making tumor (like small cell), if not, it is a adrenal tumor
40
Corticotrophin pituitary tumor tx?
Surgical removal and if not successful, do tradition CONSIDER MIGHT NEED CORTISOL THEREPY LATER ON!
41
Conn syndrome is what?
Hyperaldosteronism. Primary is from adrenal tumor
42
HTN, Hypokalemia and metabolic alkalosis?
Conn syndrome!
43
Secondary hyperaldosteronism is from what?
Secondary from increased activity of RAAS (renin and ACE action making more ang II). Kidneys think low blood pressure, so renal artery stenosis, Left sided CHF, Nephrotic syndrome, Cirrhosis (less intravascular volume in the latter 2)
44
What does aldosterone to renin ratio tell you?
Conn syndrome (primary) is high aldosterone, low renin Secondary is high aldosterone: high renin
45
PAC: PRA high is what?
Primary hyperaldosteronism Plasma aldosterone concentration: Plasma renin activity
46
PAC low and PRA low?
Means stimulation of aldosterone receptor, consider cortisol or something like that! Or lots of licorice (think people eating it from another country)
47
Tx of hyperaldosteronism?
Treat underlying cause, or surgery or spironolactone until definitive tx is done
48
Where is DHEAS made?
Only in adrenals
49
Tertiary adrenal insufficiency is what? From what?
Hypothalumus not making CRH. From chronic corticosteroid use
50
Increased skin pigmentation and hypotensive? Easy to remember
Addisons.. primary. Autoimmune EASY TO REMEMBER b/c POMC released and broken into ACTH and MSH (melanocyte stim hormone). So high ACTH and high MSH SO YHOU GET TAN
51
Eosinophilia sometimes happens with what adrenal issue?
Hypoaldosteronism
52
What is cosyntropin?
ACTH analog to stim aldosterone to determine if primary or not. WAS ON Q BANK
53
Adrenal insufficiency treatment
Glucocorticoids, mineralocotricoids (fludrocortisone) Extra cortisol during stress (illness or MI or surgery or whatever(
54
Addisonian crisis is what?
history of adrenal insufficiency and SEVERE weakness fever, mental status change vascular collapse. Get it b/c not met cortisol need during stress Tx: glucose, hydrocortisone, can use vasopressors if in shock
55
Mnemonic for CAH defficiencies?
If starts with a 1 it causes hypertension If ends in a one, you have virilization
56
17 alpha hydroxylase symptoms Tx?
HTN, no sex hormones (does not end in a 1) Ambiguous genitalia in boys Amenorrhea in girls Tx with cortisone to suppress ACTH
57
21 alph hydroxylase deficiency
No htn (Actually you have hypotension). SALT WASTING Women have virilization (ends in 1) and female infants ambiguous genitalia Boys can have precocious puberty Dehydration and HYPOTENSION possible Low Na and increased K+ with increased androgen
58
11 beta hydroxylase deficiency
Virilization, Hypertension EXCESS deoxycorticosterone (has mineralocorticoid activity)
59
Newborn ambiguous genitalia?
Check serum potassium to treat quickly. Treat with cortisol replacement!!!
60
Palpitations, chest pain, diaphoresis, headache?
PHEO
61
Pheo dx?
24 hour urine catecholamines: metanephrine, normetanephrine, VMA
62
Pheo tx?
Alpha blocker first, then beta blocker PHENOXYBENZAMINE or PHENTOLAMINE first, then can give beta blockers carvedilol or labetalol have weak alpha blocking affects
63
MEN mnemonic. RET proto oncogene THINK MEN 2a and 2B
MEN 1 PPP (diamond) Parathyroid Pituitary Pancreas MEN 2A PPM (square) Parathyroid Pheo Medullary MEN 2B PMM (triangle) Pheo Medulary Mucosal neuroma
64
If you see ret, you think what?
MEN2a and MEN2b

DIT Step 2 (77 decks)

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