Endocrine

Question 1

Preggo hyperthyroid

Answer 1

PTU, not methimazole

Question 2

MEN 2A
MEN 2B
MEN 1

Answer 2

MTC, hyperpara, pheo
MTC, pheo, ganglioneuromas
MTC, hyperpara, GI tumors

Question 3

preggo prolactinoma

Answer 3

only dangerous with expansion or hypogonadism

so formal visual field testing q trimester

Question 4

bedtime normal glucose with morning hyperglycemia

Answer 4

obtain 3 AM glucose

Question 5

Diagnose Cushing’s

Cushing vs ectopic ACTH

Answer 5

2 of these: 1 mg dexa suppression/ 24 hour urinary cortisol/ salivary cortisol. FYI, get screening DEXA

8mg dexa suppression test

Question 6

switching from insulin to orals in type ii DM

Answer 6

have to ensure beta cell function and no autoimmunity

test for antibodies and fasting c peptide and glucose

Question 7

pituitary apoplexy and vision loss

Answer 7

steroids and urgent transsphenoidal decompression

Question 8

thyroid nodule >1 cm

Answer 8

FNA

Question 9

surveillance post thyroidectomy

Answer 9

TSH

Question 10

Hypercalcemia

Answer 10

severe: AMS or AKI or >18->hemodialysis, then calcitonin or IV bisphosphonate

Question 11

PCOS vs late onset CAH

Answer 11

Elevated LH

Question 12

Bisphosphonate drug holiday

If progressive BMD
stable BMD

Answer 12

only if stable BMD+ therapy for 3-5 years+ minimal risk factors for fractures

teriparatide
Change less than 4%

Question 13

hyperaldosteronism due to bilateral adrenal hyperplasia

Answer 13

spirinolactone/ amiloride

Question 14

hyperprolactinemia in setting of hypothyroidism

Answer 14

hypothyroidism causes hyperprolactinemia

treat hypothyroidism first

Question 15

congenital bilateral absence of vas deferens causes
associated with
klinefelter

Answer 15

obstructive azospermia
cystic fibrosis
primary hypogonadism, 47XXY

Question 16

Early morning cortisol <3

Stim test indicated only when

Answer 16

Adrenal insufficiency. period. treat

AM cortisol is 4-12 (normal is response >20)

Question 17

PCOS infertility

Answer 17

clomiphene, then IVF

Question 18

Microprolactinoma in asymptomatic postmenopausal woman

Answer 18

surveillance: retest in 6-12 months

Question 19

DM neuropathy treatment

Answer 19

No TCA if cardiac disease, duloxetine instead

Question 20

Postprandial hypoglycemia (w/in 5 hours of meal)
symptomatic fasting hypoglycemia

Answer 20

mixed meal testing

72 hour fast, hypoglycemic testing

Question 21

Asherman syndrome

diagnosis

Answer 21

amenorrhea+ cyclic pelvic pain post uterine instrumentation

transvag U/S, hysterosalpingogram

Question 22

progestin withdrawal test

Answer 22

differentiates b/w estrogen sufficient (bleeding) and deficient (no bleeding) states

Question 23

at goal preprandial glucose with hgbA1c not at goal

Answer 23

check postprandial

Question 24

Hyperaldosteronism screening

Answer 24

plasma aldosterone-renin ratio

Question 25

substernal goiter with compressive features

Answer 25

thyroidectomy

Question 26

pheo imaging

Answer 26

alpha blockade before contrast, beta blockade after if needed

Question 27

secondary hypothyroidism treatment dose

Answer 27

based on free T4, not TSH

Question 28

2 discrepant DM screening tests

Answer 28

repeat abnormal test

Question 29

>80 yo, normal TSH

Answer 29

up to 8

Question 30

Primary hyperpara+ vitamin d def | If symptomatic primary hyperpara and kidney involvement

Answer 30

treat def as it can elevate pth | cinacalcet

Question 31

Osteoporosis

Answer 31

Major osteoporotic fracture risk 20% or 3% at hip

Question 32

Osteoporosis

Answer 32

Major osteoporotic fracture risk 20% or 3% at hip

Question 33

Inpatient insulin

Answer 33

weight based basal and preprandial, not SSI

Question 34

incidentaloma

Answer 34

check metanephrines and cortisol | if hypertensive, also check aldosterone

Question 35

Significantly elevated DHEAS

Answer 35

adrenal androgen producing tumor

Question 36

hypoparathyroidism vitamins if urinary calcium is elevated if urinary and serum (>8.5) calcium elevated

Answer 36

25 hydroxy+PTH->1,25 hydroxy->calcium. give calcium and 1,25 hydroxy decrease calcium decrease calcium and vitamin d

Question 37

erratic preprandial only glucose levels

Answer 37

timing of insulin

Question 38

preggo TSH

Answer 38

should be below 2.5

Question 39

Before treating newly diagnosed osteoporosis

Answer 39

look for secondary causes: | CBC, CMP, TSH, Vitamin D, urine calcium

Question 40

hypocalcemia electrolyte cause

Answer 40

hypomagnesemia (impairs PTH activity), replete mag first

Question 41

pseudohypercalcemia

Answer 41

elevated calcium in setting of elevated protein. check ionized calcium

Question 42

pseudohypercalcemia

Answer 42

elevated calcium in setting of elevated protein. check ionized calcium

Question 43

before starting testosterone

Answer 43

assess for desire for fertility-testosterone can cause infertility. Give HCG instead

Question 44

tissue transglutaminase antibody

Answer 44

celiac

Question 45

thyroid stimulating immunoglobulins

Answer 45

graves disease

Question 46

hyperparathyroidism surgery

Answer 46

impaired kidney function/ <50yr/ Ca >1 ULN/ osteoporosis | secondary hyperpara that is refractory to meds

Question 47

Toxic nodule | Cold nodule

Answer 47

scan before treatment | FNA

Question 48

Invasive macroprolactinoma treatment

Answer 48

still cabergoline | only surgery if visual field defects on exam

Question 49

sulfonylurea+ dehydration

Answer 49

hypoglycemia ->AMS

Question 50

thyrotoxicosis labs

Answer 50

t3 in addition

Question 51

high calcium, low PTH (non PTH mediated hypercalcemia)

Answer 51

cancer or granulomas

Question 52

Cushing not just cortisol but also

Answer 52

excessive androgens

Question 53

euthyroid sick syndrome

Answer 53

low everythang