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CB Internal Medicine > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

What is the most common cause of hypothyroidism?

A

Hashimoto thyroiditis

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2
Q

What are the lab findings in Hashimoto thyroiditis?

A

High TSH, low T4, antibodies to thyroid peroxidase (TPO)

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3
Q

Exophthalmos, pretibial myxoedema, and low TSH describes what disease?

A

Graves disease

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4
Q

What is the most common cause of Cushing syndrome?

A

Iatrogenic corticosteroid administration (Cushing Disease is the second most common)

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5
Q

A patient post-thyroidectomy presents with signs of hypocalcemia, increased phosphorus. Why?

A

Hypoparathyroidism (iatrogenic)

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6
Q

“Stones, bones, groans, psychiatric overtones” are signs and symptoms of what?

A

Hypercalcemia

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7
Q

Hypertension, hypokalemia, and metabolic alkalosis are signs of what?

A

Primary hyperaldosteronism (due to Conn syndrome or bilateral adrenal hyperplasia)

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8
Q

A patient presents with: tachycardia, wild swings in BP, headache, diaphoresis, altered mental status, and a sense of panic.

A

Pheochromocytoma

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9
Q

What is first line for treating pheochromocytoma, alpha- or beta-antagonists?

A

ALPHA-antagonist (phenoxybenzamine)

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10
Q

A patient with a history of lithium use presents with copious amounts of dilute urine.

A

Nephrogenic diabetes insipidus (DI)

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11
Q

What is the treatment for central DI?

A

Administration of DDAVP and free-water restriction

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12
Q

A postop patient with significant pain presents with: hyponatremia and normal volume status.

A

SIADH due to stress

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13
Q

What anti diabetic agent is associated with lactic acidosis?

A

Metformin

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14
Q

A patient presents with: weakness, nausea, vomiting, weight loss, and new skin pigmentation. Labs show: hyponatremia and hyperkalemia. What is the diagnosis, and what is the treatment?

A

Primary adrenal insufficiency (Addison Disease)

Treatment: glucocorticoids, mineralocorticoids, and IV fluids

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15
Q

What is the HBA1C goal for patients with DM?

A

<7.0 %

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16
Q

What is the treatment for DKA?

How do you monitor response to treatment?

A

Fluids, insulin, electrolyte replacement (potassium, phosphorus)
Bicarb rarely used unless pH < 6.9
Treat initiating event

Monitor response to treatment by closure of anion gap

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17
Q

What condition presents with: bone pain, hearing loss, and increased alkaline phosphatase?

A

Paget disease

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18
Q

Increased IGF-1

A

Acromegaly

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19
Q

What lesion creates: galactorrhea, amenorrhea, biltemporal hemianopsia?

A

Prolactinoma

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20
Q

What presents with: increased serum 17-hydroxyprogesterone?

A

Congenital adrenal hyperplasia (21-hydroxylase deficiency)

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21
Q

Triad of: pancreas, pituitary, parathyroid tumors

A

MEN1 syndrome

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22
Q

What are the typical lab findings in DKA?

A 
High serum glucose
Metabolic acidosis
Increased urine and serum ketones
High anion gap
Normal serum osmolality
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23
Q

What are the typical lab findings in HHS?

Study These Flashcards
A 
Very high serum glucose 
No acidosis 
No ketons
Normal anion gap
High serum osmolality
24
Q

What is the treatment for HHS?

Study These Flashcards
A

Aggressive fluids, electrolyte replacement, insulin

Treat initiating event

25
What is the criteria for metabolic syndrome?
``` "WEIGHHT" (3/5 = Dx) Waist Expanded Impaired Glucose HTN HDL (low) Triglycerides (high) ```
26
What is the difference between hyperthyroidism and thyrotoxicosis?
Hyperthyroidism: a state of increased synthesis of T3/T4 Thyrotoxicosis: a site of increased levels of T3/4 Note: Graves Disease is the autoimmune form of hyperthyroidism, caused by thyroid stimulating antibodies increasing synthesis of T3/T4
27
What is the acute, life-threatening form of thyrotoxicosis, that may present with: AFib, fever, delirium? What is the treatment?
Thyroid Storm Treatment: antithyroid drugs (methimazole, propylthiouracil), then iodine, IV esmolol, steroids, admit to ICU
28
What condition causes: severe hypothyroidism, decreased mental status, hypothermia, hypotension, bradycardia, hypoventilation? What is the treatment?
Myxoedema coma Treatment: admit to ICU, treat urgently with IV levothyroxine, IV hydrocortisone (if adrenal insufficiency has not been excluded)
29
Is sub-acute thyroiditis painful?
Yes! Presents with a tender thyroid (all other forms associated with painless goiter)
30
Are HYPERfunctioning ("hot") thyroid nodules malignant?
No
31
What is the most common form of thyroid carcinoma?
Papillary 75-80%
32
What are the features of papillary thyroid carcinoma?
"Most Popular is Papillary" ``` Papillae (branching) Palpable lymph nodes "Pupil" nuclei (Orphan Annie nuclei) Psammoma bodies within lesion Postive Prognosis ```
33
What blood level should you check if you suspect Medullary thyroid carcinoma?
Calcitonin Levels
34
What are the four main types of thyroid carcinoma?
1. Papillary (lymphatic spread) 2. Follicular (hematologic spread) 3. Medullary (consider MEN2A, 2B) 4. Anaplastic (BAD)
35
What is the most common cause of fractures in thin, elderly women?
Osteoporosis
36
What is caused by a mineralization defect often due to severe Vit D deficiency? It presents with bone pain, decreased calcium/phosporus, and secondary hyperparathyroidism.
OsteoMALACIA (not osteoporosis) Osteoporosis will have normal calcium, phosphate, parathyroid hormone levels
37
What condition causes a "mosaic" lamellar bone pattern on x-ray?
Paget Disease
38
What bone disease causes increased serum Alk Phos with normal calcium and phosphate levels?
Paget's Disease Note: if increased alk phase, but normal GGT, think BONE etiology, not liver etiology
39
Hyperparathyroidism due to: | a single hyper functioning adenoma (80%), parathyroid hyperplasia (15%), parathyroid carcinoma (5%)
Primary hyperparathyroidism | high PTH, high calcium, low PO4
40
``` Hyperparathyroidism due to: renal insufficiency (due to decreased production of 1-25 dihydroxyvitamin D), calcium deficiency, or Vit D deficiency ```
Secondary hyperparathyroidism | high PTH, low calcium, high PO4 if renal failure
41
Hyperparathyroidism due to: dialysis (seen in patients with long-standing secondary hyperparathyroidism that leads to hyperplasia of parathyroid glands)
Tertiary hyperparathyroidism | high PTH, high calcium, high PO4
42
What is the treatment for acute hypercalcemia?
IV fluids ++++ Loop diuretics (lasix) IV Bisphosphonates
43
How does cortisol secretion respond to the dexamethasone test in patients with Cushing Disease?
Cortisol section remains elected with the low-dose (1mg) dexamethasone test, but is suppressed with the high-dose (8 mg) dexamethasone test.
44
What hormone disturbance causes the inability to concentrate urine in Diabetes Insipidus?
ADH ``` Central DI (ADH deficiency) Nephrogenic DI (ADH resistance) ```
45
What causes euvolemic hyponatremia ia SIADH?
Persistent ADH release independent of serum osmolality
46
What is the cornerstone of SIADH treatment?
Fluid restriction
47
What is the difference between primary Adrenal Insufficiency and secondary/tertiary Adrenal Insufficiency?
Primary (Addison Disease) Increased skin pigmentation (due to increased ACTH), decreased glucocorticoids, decreased mineralcoritocids - Need both glucocorticoid and mineralocorticoid replacement Secondary/Tertiary Decreased glucocorticoids (low ACTH, no skin hyper pigmentation) - Only need glucocorticoid replacement
48
What is the Pheochromocytoma rule of 10s?
``` 10% extra-adrenal 10% bilateral 10% malignant 10% occur in kids 10% familial ```
49
What are the 5 Ps of Pheochromocytoma?
``` Pressure (BP) Pain (headache) Perspiration Palpitations Pallor ```
50
What is Conn Syndrome?
Hyperaldosteronism, excessive secretion of aldosterone from zona glomerulosa of adrenal cortex, due to unilateral adrenal adenoma
51
What is the most common cause of congenital adrenal hyperplasia?
21-hydroxylase deficiency | inherited enzyme defect that impairs cortisol synthesis and results in accumulation of cortisol precursors
52
What lab test is diagnostic of 21-hydrozylase deficiency causing congenital adrenal hyperplasia?
Elevated serum 17-hydroxyprogesterone level
53
MEN 1 (3Ps) MEN 2A (2Ps) MEN 2B (1P)
MEN 1: Pituitary, parathyroid, pancreas MEN2A: Parathyroids, pheochromocytoma MEN2B: Pheochromocytoma
54
What MEN syndromes are associated with medullary thyroid carcinoma?
MEN 2A, 2B
55
What mutation causes MEN2A,B?
RET proto-oncogene

CB Internal Medicine (12 decks)

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