endocrine

Question 1

Polymyositis syx + weight loss, tachycardia

Answer 1

Hyperthyroid myopathy

Have proximal muscle weakness + atrophy

Question 2

Muscle hypertonicity after blood transfusions

Answer 2

hypocalcemia

Impaired liver fxn at increased risk d/t decreased citrate clearance by the liver

Question 3

weight loss, fatigue, GI syx

Hyperpigmentation at palmar creases

Answer 3

Chronic adrenal insufficiency

Hyponatremia, hyperkalemia

Question 4

Pt has cental adrenal insufficiency after taking prednisone chronically. Which hormones are affected?

Answer 4

Low ACTH, cortisol
NL aldosterone
d/t suppresion of HPA axis, gluccocrticoids suppress corticotropin-releasing hormone from the hypothalamus and ACTH from the pituitary

Question 5

Post menopausal woman with hypercalcemia despite thiazide

Answer 5

Milk-alkali syndrome

excessive intake of calcium and absorbable alkali. suspect in women taking OTC calcium supplements

Question 6

How does po estrogen in menopause affect a hypothyroidism pt?

Answer 6

po estrogen increases thyroxin-binding globulin. Pt on thyroid replacement may need a higher dose to saturate the increased levels of TBG

Question 7

What is the primary cause of primary adrenal insufficiency in adults in this country

Answer 7

Autoimmune adrenalitis

Tend to have autoimmune acitivity against other endocrine glands (ie thyroid, parathyroid, ovaries)

Question 8

Diabetic has anorexia, n/v, early satiety, postprandial fullness

Answer 8

Diabetic gastroparesis (delayed gastric emptying)
Tx - prokinetic agents (metoclopramide, erythromycin, cisapride)

Question 9

Adult male presents with ED, hypogonadism, low test

Answer 9

Secondary hypogonadism
d/t mass lesion in hypotalamus or pituitary, hyperprolactinemia, long term use of steroids or opiates, severe systemic illness

Question 10

Pts with carcinoid are at risk for which vitamin deficiency

Answer 10

Niacin

Serotonin is made from tryptophan and requires niacin for synthesis -? pellagra (3 D’s derma, diarrhea, dementia)

Question 11

which lab abn is associated with hypothyroidism?

Answer 11

HLD
hyponatremia
asyx increase in Creatinine kinas
LFTS

Question 12

If you suspect acromegaly get a

Answer 12

insulin like growth factor 1

GH fluctuates too much

Question 13

HTN
hypernatremia
hypokalemia
Metabolic alkalosis
Adrenal mass

Answer 13

Primary hyperaldosteronism (Conn's syndrome)
alkalosis d/t poor bicarb reabsorption in the kidney

Question 14

acute severely ill pt has abn low T3

Answer 14

Euthyroid sick syndrome
Fall in total and free T3 w/ NL T4 and TSH
Decreased deiodination of T4 d/t calorie deprevation and inflammatory markers

Question 15

young female has hirtuism and virilization (NL BMI, no cushing syx)

Answer 15

Androgen producing adrenal tumor
High Test, DHEAS
Low LH/FSH

Question 16

Male pattern hair loss in a female
irregular menses
obesity

Answer 16

PCOS

d/t increased risk for T2DM, screen with ogtt

Question 17

Thyroid malignancy + elevated calcitonin

Answer 17

Medullary thyroid cancer
Associated with pheo (Men 2A, 2B)
check fractionated metanephrines even if normotensive

Question 18

postpartum fatigue, orthostatics
skin hyperpigmentation
hyperK, hypoNa

Answer 18

Post partum adrenal insufficiency d/t autoimmune adrenalitis

Pituitary infarction would not include skin or mineralcorticoid changes

Question 19

gluccocorticoid defieciency (hypoglycemia, anorexia)
hypogonadism (low libido)
hypothyroidism (faituge, cold intolerance)

Answer 19

Hypopituitarism
Low Thyroid hormones
Low cortisol, ACTH
NL Aldosterone (regulated by RAAS, not pituitary)

Question 20

Who should be screened for t2DM?

Answer 20

Sustained BP > 135/80
> 45 y/o, or any age if RF’s are present
fasting glucose, 2 hours OGTT, A1C are all acceptable

Question 21

Whats the risk of a contrast CT for a pt with hyperthyroidism syx?

Answer 21

Thyroid storm (fever, tachycardia, delirium)