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Flashcards in Endocrinologie Deck (412):
1

Clue for surreptitious vomiting(2)

Dental erosions
scars dorsal of hands

2

Normotension and metabolic alkalosis and hypokalemia(4)

Surreptitious vomiting
diuretic abuse
barter syndrome
Gitelman syndrome

3

Urine chloride in surreptitious vomiting

Low

4

urine chloride in Barter gitelman syndrome

High

5

How to differentiate barter from surreptitous vomiting

urine chloride concentration

6

How's urine chloride in diuretic abuse

High

7

Treatment of prolactinoma(2) regardless the size

bromocriptine or
cabergoline

8

quid of microadenoma

Size less than 10 mm

9

first thing to in front of hypercalcemia

doser PTH

10

Cause of hypercalcemia with high PTH

primary hyperparathyroidism

11

What to do in front of hypercalcemia with low PTH(3)

doser 1,25 OH vit D
25 OH vit D
PTHrelated peptide

12

Cause of hypercalcemia with high 1 ,25 OH Vit D(2)

Lymphoma
Sarcoidosis

13

Cause of hypercalcemia with high 25 OH vit D

vit D toxicity

14

Hypercalcemia with normal vit D and low PTH(7)

drug induced
Malignancy
Immobilization
Multiple Myeloma
Hyperthyroidism
Vit A toxicity
Milk alkali syndrome

15

Hypercalcemia with PTHrelated peptide

cancer

16

drug causing hypercalcemia(2)

HCTZ
Lithium

17

rx of hypercalcemia caused by immobilization(2)

hydration
biphosphonate

18

Rx of SIADH what to consider

the level of hyponatremia

19

SIADH with mild hyponatremia(2)

Fluid restriction

20

Most common type of neuropathy in diabetics

symmetric distal polyneuropathy

21

what cause hypercalcemia in immobilization

osteoclastic bone resorption
increase osteoclaste activity

22

The onset of hypercalcemia depends on what factors?(2)

the magnitude of bone turnover
kidney capacity of excreting calcium

23

control of heart rate in hyperthyroidism

propranolol

24

first test to ask in Hyperthyroidism

TSH

25

If TSH is low what 's the second test to ask

T4

26

If low TSH and high T4 next step

radioiodine uptake
scan

27

importance of radioiodine uptake and scan

to Differentiate graves from other forms of hyperthyroidism

28

Physiopatho of Paget

Bone remodeling

29

Clue for Paget

Hearing loss
High ALP

30

Tumor in Paget(2)

Osteosarcoma
giant cell tumor

31

In what cases Paget will cause hypercalcemia(2)

Pathologic fracture
immobilzation

32

More sensitive image test for Paget

Bone scan

33

Plain xray of Paget(2)

Lytic lesion
Mixed Lesion (sclerotic and Lytic)

34

Rx of Paget

Biphosphonate

35

Cancer producing PTH related peptide

SCC of lung
Renal and bladder cancer
ovarian and endometrial
breast
esophageal cancer
Head and neck SCC

36

How cancer cause hypercalcemia

PTH related peptide production
ectopic PTH
bone Metastasis
Production of 1,25 OH vit D

37

Cancer producing high 1,25 OH vit D

Lymphoma

38

Action of 1,25 OH vit D

excessive gut absorption of calcium

39

how metastasis cause bone resoprtion

tumor secrete Cytokines causing increase activity of osteoclaste

40

what cytokines are involved in bone resorption in case of metastasis(4)

IL-3
IL-6
TNF Alpha
Macrophage inflammatory factor 1

41

Hyperandrogenism work up in woman(2)

Testosterone
DHEAS

42

what is the principal source of production of DHEAS

surrenale

43

hyperandrogenism ,high testo and normal DHEAS

ovary problem

44

Hyperandrogenism ,high DHEAS and normal testo

surrenal problem

45

Lieu of formation of DHEA(2)

ovary
surrenal

46

When to ask for RAIU in case of primary hyperthyroidism

when there is no sign of graves disease

47

If RAIU is high ,what pattern will be suggestive for grave's

diffuse pattern

48

If RAIU is high with nodular uptake dx?(2)

Multinodular goiter
toxic adenoma

49

What to if RAIU is low

doser thyroglobuline(TG)

50

Dx of low RAIU and low TG

intake of exogenous hormone

51

Dx of low RAIU and high TG(3)

Thyroiditis
iodide exposure
extra glandular production

52

When to measure T3

when TSH is low and T4 normal

53

Normal T3 T4 with low TSH(3)

pregnancy
subclinical hyperthyridism
non thyroid illness

54

High TSH and high T3

Pituitary adenoma secreting TSH

55

quid of maladie d'addisson

primary adrenal insufficiency

56

first cause of adrenal insufficiency in Addisson in developped country

autoimmune

57

clue for adrenal insufficiency(5)

Hypotension
hyperkalemia
hyponatremia
acidosis metabolic
hypereosinophilia

58

why hyperkaliemia maladie d'addison

no aldosterone produced

59

Why hyponatremia

No aldosterone produced

60

Why patient with autoimmune adrenal insufficiency can also has hypothyroidism

because you can have autoimmune destruction of this gland (hashimoto)

61

What other gland can be involved in autoimmune adenal insufficiency(3)

thyroid
parathyroid
ovaries

62

Hallmark of insipidus diabetes

Hyponatremia

63

What is the clue of the management of diabetes insipidus

volemia

64

treatment of insipidus diabetes in hypovemic syptomatic patient

nacl 0,9%

65

Rx of diabtes insipidus in euvolemic patient

free water

66

Rx of diabetes insipidus in hypovolemic asymptomatic patient

DW 5%

67

Rx of insipidus diabetes after becoming euvolemia in a previous symptomatic hypovolemic patient

DW 5%

68

How to correct the hypernatremia in Diabetes insipidus

0,5 meq/dl/hr
dont exceed 12 meq/dl/24h

69

why hypernatremia should be corrected slowly in insipidus diabetes

to prevent cerebral edema

70

what's the basic level of glucose to have DKA

250 mg/dl

71

what's the basic level to have hyperosmolar hyperglycemic state

>600 mg/dl

72

why you will never have ketosis in type 2 diabetes

because there is sufficient insulin in the body to prevent ketosis

73

thyrotoxycosis with low RAIU uptake(4)

Thyroiditis
levothyroxine overdose
iodine induce thyrotoxicosis
stroma ovarii

74

The 2 types of thyroiditis capable of induce thyrotoxycosis

subacute lymphocytic thyroiditis
subacute granulomatous thyroiditis(de quervain)

75

in case of hyponatremia what's the 3 first dx to have in mind?

-Hypothyroidism
-adrenal insufficiency
-SIADH

76

Dx test for SIADH

osmolarity plasma
osmolarity urine

77

Osmolarity urine in SIADH

>100-150

78

Osmolarity plasma in SIAD

79

one cause of SIADH

NSAIDS use

80

Why NSAIDS causes SIADH

because it potentiates action of ADH

81

Differnce between Dequervain and lymphocytic thyroiditis

Pain in Dequervain

82

first step in front of a patient with hypercalcemia and HTA and elevated PTH

plasma metanephrines

83

quid of MEN type 1(3)

Parathyroid adenoma
pituitary adenoma
Pancreatic tumor

84

MEN 2A(3)

Parathyroid Hyperplasia
Pheo
Medularry thyroid cancer

85

MEN 2B(4)

Pheo
medullary thyroid cancer
Mucosal and intestinal neuroma
Marfanoid habitus

86

Screening test for MEN 2

Ret proto-oncogen

87

Erectile dysfunction causes(2)

psychologic
organic

88

first thing to assess in case of erectile dysfunction

Nocturnal or morning penile tumescence

89

What are the 2 mechanism for liver to create sugar

glycogenolysis
gluconeogenesis

90

what's the main substrat for gluconeogenesis?(2)

Amino acid
Alanin

91

Quel est le produit intermediaire entre alanin et glucose

pyruvate

92

how long can last the glycogen storage in case of fasting

12hrs

93

How hypothyroidism causes hypercholesterolemia(2)

decrease number of LDL surface receptor
decrease activity of LDL receptor

94

how hypothyroidism cause hypertriglycedemia

Decrease of lipoproteine lipase activity

95

What are the five criteria to consider for Metabolic syndrome

Waist circumference
HDL
triglyceride
BP
fasting glucose

96

how many criteria needed to Dx metabolic syndrome?

at least 3

97

waist circumference in men for MS

>40

98

waist circumference in women for MS

>35

99

HDL in men for MS

100

HDL in women for MS

101

triglycerides in MS

>150

102

fasting glucose

>100 -110

103

what's the most pathogenic factor in MS(2)

insulin resistance or
Central type obesity

104

what are the 3 forms of existence of calcium in the body

ionised
bound to albumin
bound to anions

105

What's the active form of calcium

ionised form only

106

Why respiratory alkalosis causes hypocalcemia

because of increase extracellular PH level

107

what happen to calcium when extracellualr PH is high

calcium becomes highly bound to albumin

108

cause of respiratory alkalosis

hyperventilation

109

cause of hyperventilation without any disease

high altitude

110

clue for hyporcalcemia(3)

cramps
paresthesia
carpopedal spasm

111

Patient on diet develops constipation ,thirst and polutria and polydypsia

hypercalcemia cause by excess of vit D intake

112

why vit supplement can cause hypercalcemia

because fat soluble(vit D eg.) vit are stored in body for long periods of time

113

what are the 3 hormones most commonly involved in hypopituitarism

ACTH
TSH
Gonadotrophin releasing hormone

114

causes of hypopituitarism(7)

Infection
infarction
infiltrative
immunologic
iatrogenic
empty sella syndrome
apoplexy

115

Infarction of pituitary gland

sheehan syndrome

116

the first disease to infiltrate the pituitary gland

hemochromatosis

117

iatrogenic cause(2)

surgery
radiation

118

hypothalmic problem causing hypopituitarism(6)

infection
infiltrative
iatrogenic
tumeur
injury
metastasis

119

first tumor causing hypothalamic hypopituitarism

cranipharyngioma

120

Infection causing hypothalamic hypopituitarism

TB

121

first cause of secondary adrenal insufficiency

pituitary adenoma

122

difference between primary and secondary adrenal insufficiency(3)

IN SECONDARY ADRENAL INSUFFICIENCY
no hyperkaliemie
no salt wasting
no hyperpigmentation

123

trauma causing hypothalamic hypopituitarism

skull base

124

in secondary adrenal insufficiency how's aldosterone

normal

125

clue for DKA(4)

blood glucose >250
PH

126

4 things to in DKA

Nacl 0,9%
Insulin
antibio
rx hyperkalemia

127

Hypercalcemie with high or normal PTH Dx?(3)

Primary hyperparathyroidism
familial hypocalciuric hypercalcemia
tertiary hyperparathyroidism

128

How to differentiate primary hyperparathyroidism and FHH

urinary excretion of calcium

129

quid urinary excretion of ca++ in FHH

130

quid urinary excretion of calcium in primary hyperparathyroidism?

> 250/24 h

131

first test to in front of hypercalcemia

PTH dosage

132

hallmark of SIADH

hypernatremia

133

rx of SIADH rules

depend on severity of symptom

134

symptom for mild SIADH

forgetfulness

135

rx for asymptomatic patient or mild symptoms

fluid restricton

136

Syptoms for moderate SIADH(2)

Confusion
lethargy

137

Rx for moderate SIADH

Hypertonic saline jusqu'a augmenter Nacl 120 meq/l

138

symptoms for severe SIADH(2)

convulsions
coma

139

Rx of severe SIADH

Bolus of Hypertonic saline jusqu'a resoultion des symptomes
Conivaptan

140

quid of conivaptan

vasopressin receptor antagonist

141

physiopatho of exophtalmos in Grave's desease(2)

periorbital lymphocytic infiltration
retro orbital tissue expansion

142

why renin is high in fibromxar dysplasia

decrease renal perfusion

143

work up for fibro muscular dysplasia(2)

ct angiography of abdomen or
duplex U/S

144

in addition of renal arteries what other arteries can be involved in fibromuscular dysplasia

Cerebral arteries

145

mechanism of stroke in fibro muscular dysplasia

cerebral arteries involvement

146

what's the most common testicular cancer

Leydig cell tumor

147

clue for leydig cell tumor(3)

gynecomastia
High testo
high estrogen

148

role of leydig cells(2)

testo
oestrogen formation

149

role of aldosterone(3)

regule pompe Na+K+
sortie de K+ couple avec H+
entree de Na+ couple avec HCO3_

150

best way to slow progression of diabetic nephropathy

ACE inhibitor

151

clue for primary hyperaldosteronism(4)

HTA
NA high
K+ low
metabolic alkalosis

152

work up of primary hyperaldosteronism?(3)

low plasma renin
high plasma aldosterone
rapport plasma aldosterone /plasma renin >20

153

Confirmatory dx of primary hyperaldosteronism?

oral saline load suppression test

154

interpretation of oral saline load test

adrenal supression=primary hyper aldosteronism

155

Why CT and adrenal venous sampling are important

to help differentiate adrenal adenoma from bilateral adrenal hyperplasia

156

two causes of primary aldosteronism

Bilalateral adrenal hyperpalsia
adrenal adenoma

157

rx for adrenal adenoma

surgery (prefered)
aldosterone antagonist

158

Rx of bilateral adrenal hyperplasia

aldosterone antagonist

159

what's the most drug used in primary hyperaldosteronism

epleronone
spironolactone

160

quid of urinary dribbling

incontinence

161

cause of incontinence in diabetic patient

neurogenic bladder

162

organ targeted by autonomic diabetic neuropathy(4)

cardio vascular
peripheral nerves
gastro intestinal
genito urinary

163

Manif of cardio vascular autonomic diabetic neuropathy(2)

tachycardia
postural hypotension

164

Manif of gastrointestinal autonomic diabetic neuropathy(3)

esophageal dysmotility and dyspepsia
gastroparesis
intestinal involvement

165

Manif of peripheral nerves autonomic diabetic neuropathy(3)

foot ulcer
poor wound healing
charcot arthropathy

166

Manif of genitourinary autonmic diabeticneuropathy(3)

reccurent infection
overflow incontinence
erectile dysfonction

167

why you can't give blocker initially in Pheochromocytoma

BP will rise dramatically

168

First anti hypertensor to give in case of pheo

alpha blocker

169

why beta blocker is dangerous in first intention(2)

you block the bete receptor vascular
unopposed stimulation of alpha receptor by catecholamines

170

what's the only beta that can be used in Pheo

Labetalol

171

Why labetalol can be used in Pheo

it blocks both alpha and beta blocker

172

primary adrenal insufficiency cause in developping country Dx(3)

TB
fungus infection
cytomegalovirus

173

calcification on CT for primary adrenal insufficiency Dx?

TB

174

Primary adrenal insufficiency in developed country

autoimmune

175

most common of death in patient with acromegaly?

CHF

176

how much fluid patient with hyperosmolar hyperglycemic state needs

8-10 liters

177

first cause of acromegaly

somatotroph adenoma

178

in the rehydration of patient of hyperglycemia why add glucose whe glycemia 250 mg/dl

to prevent cerebral edema

179

first agent used in diabetes type 2

biguanide (metformin)

180

second line if metformin fails in case of diabetes type 2

sulfonyluree(glyburide)

181

when you can use insulin in diabetes type 2

when metformin fails can be used as a second agent if A1C> 8,5

182

only oral hypoglycemiant associated with weight loss

GLP-1 agonist receptor

183

Example of GLP-1 agonist receptor

exenatide

184

oral hypoglycemiant with neutral action on weight

Metformin
DPP_iv inhibitor

185

example of DPPIV inhibitor

sitagliptin

186

oral hypoglycemiant associated with weight gain

insulin
pioglytazone
glyburide

187

family of pyoglitazone

thiazolidonedione(TZD)

188

oral hypoglycemiant can be used in renal insufficiency

dpp-iv inhibitor
Pyoglitazone

189

oral hypoglycemiant associated with bladder cancer

pyoglitazone

190

med with the greater efficacy to decrease A1C

insulin

191

effect of acidosis on respiration in case of DKA

kusmall

192

quid of kusmaull

deep and rapid respiration

193

how to differentiate primary hyperthyroidism and FHH in a context of hypercalcemia

Urinary calcium creatinin clearance ratio(UCCCR)

194

How 's UCCCR in FHH

195

HoCR in primary hyperparathyroidism

>0,02

196

Physiopatho of FHH(2)

defect in calcium sensing receptor in kidney
excess reabsorption of calcium

197

specificity of HCTZ induce hypercalcemia

it's less than 11

198

rx which can worsen exophtalmy in grave's

RAI

199

the only medication given in first trimester of pregnancy in graves

PTU

200

drugs used in hyperthyroidism causing agranulocytosis(2)

PTU
MM

201

permanent rx of hyperthyroidism(2)

surgery
RAI

202

drugs used in hyperthyroidism causing vasculitis

PTU

203

procedures used in hyperthyroidism causing hypothyroidism(2)

surgery
RAI

204

when to use statin in diabetics patient

any diabetics aged 40-45 ans regardless lipid profile

205

quid of high intensity statin(2)

atorvastatin 80 mg
rosuvastatin 20-40 mg

206

quid of moderate intensity statin

simvastatin 20-40 mg

207

indication blocker in pheochromocytoma

tremor

208

physio patho of hta in thyrotoxicosis

hyperdynamic circulation

209

How's HTA in thyrotoxycosis

Systolic

210

HTA and low renin activity with high plasma aldosterone

conn tumor

211

Quid of conn tumor

tumor or corticosurrenale

212

Clue for conn syndrome(4)

HTA
Hypokaliemie
Low renin activity
high plasma aldosterone

213

cause of secondary hyperaldosteronism

everything which can decrease flux sanguin renal
high renin secretion

214

cause of secondary hyperaldosteronism(7)

Diuretic use
cirrhosis
CHF
renin producing tumor
reno VX HTA
Malignant HTA
aorta coarctation

215

best test to confirm primary hyperaldosteronism

adrenal ct scan

216

screening test for primary hyperaldosteronism

ratio plasma aldosterorone concentration sur plasma renin activity

217

value for PAC/PRA in primary hyperaldosteronism

>20
aldosterone > 15 ng/dl

218

Hta plus hypokaliemie and low PAC and PRA(5)

congenital adrenal hyperplasia
glucocorticoid resistance
exogenous mineralocorticoid
cushing's syndrome
altered aldosterone metabolism

219

Mechanism of Hypocalcemia in renal failure(2)

hyperphospahtemia

220

cause hyperphosphatemia in renal failure

retention of phosphate

221

how hyperphosphatemia causes hypocalcemia

by binding to calcium in blood
by interfering with 1.25 oH vit D in kidney

222

why secondary hyperparathyroidism in renal failure

hyperphosphatemia stimulates parathyroid to produce more PTH

223

clue for hyperosmolar hyperglycemic state(2)

non anion gap acidosis
Bicarb> 18

224

why you dont have ketosis in diabete type 2

sufficient insulin to prevent ketosis

225

why coma in hyperosmolar state

because of hyperosmolarity

226

how's bicarb in DKA

227

Marker for paget(2)

ALP
N-telopeptide

228

signification of Ntelopeptide

bone resorption

229

signification of ALP

bone formation

230

Mechanism of Paget disease

abnormal bone remodeling

231

initial work up for primary adrenal insufficiency(3)

doser
cortisol
ACTH
cosyntropin stimulation test

232

What's the normal reaction of the body during cosyntropin stimulation test to rule out addison disease

increase of cortisol> 20 mcg when giving 250 mcg of cosyntropin

233

clue for secondary or tertiary adrenal insufficiency(2)

Low ACTH
low cortisol

234

screening test for diabetic nephropathy

ramdom urine microalbumine sur creatinine ratio

235

normal protein excretion in 24 hr

236

quid of microalbuminuria

30-300 mg of protein excretion par 24 h

237

effect of T3 T4 on bone

increase osteoclastic activity

238

risk in hyperthyroidism regarding bone(2)

bone loss---------->hypercalcemia

239

most common risk factor for diabetic foot ulcer

neuropathy

240

method of screening diabetic peripheral neuropathy

pressure sensation by 10 g monofilament

241

interperetation of 10 g monofilament test

loss of monofilament sensation is associated with the risk of foot ulceration

242

risk factor for foot ulceration(6)

diabetic neuropathy
smoking
PAD
Bony abnormalities in foot
diabetes > 10 ans
sexe male

243

when beginning diabetic screening

45 years old

244

Test to screen for diabetes(4)

A1C
fasting glucose
OGTT
random glucose

245

Abnormal A1C=diabetes

> 6,5

246

Abnormal OGTT

> 200 mg/dl

247

abnormal random glucose

> 200 mg /dl

248

best test to sreen diabetes

A1C

249

FBG tellig diabetes =is Dx

> 126 mg/dl

250

quid of impaired fasting glucose

100-125 mg/dl

251

Normal FBG

70-99mg/dl

252

Normal A1C

Less 5.7%

253

A1C telling you are at high risk of diabetes

5,7-6,4%

254

Rx of diabetic peripheral neuropathy(3)

TCA
or Gabapentin
or NSAIDS

255

Danger of TCA in the rx of diabetic peripheral neuropathy(2)

can worsen hypotension in diabetes
urinary symptom

256

what causes Hypotension in diabetics

autonomic dysfunction

257

marker of androgen producing tumor in woman

DHEAS

258

symptom of hyperandrogenism in woman

Masculinisation

259

lieu of production of DHEAS

adrenal gland

260

Lung malignancy causing hyper calcemia

SCC

261

causes of hypercalcemia in malignancy(4)

oeteolytic malignancy
PTH related peptide
increase production of 1,25 OHvit D
increase interleukin 6

262

difference of hypercalcemia causing by ca and primary hyperparathyroidism

calcemia >13 mg in Cancer

263

best long term rx of grave's

radio active iodine

264

contrindication of RAI(2)

pregnancy
severe ophtalmopathy

265

Most common cause of Vit D deficiency?

gastrointestinal malabsorption

266

electrolytic abnormality of vit D decficiency(3)

low calcemie
low phosphatemie
High PTH

267

cause of hypocalcemia(5)

respiratory alkalosis
vit d deficiency
hypoparathyroidism
renal failure
low albumin

268

cause of hypoparathyroidism(4)

post surgery
congenital of absence of parathyroid gland
autoimmune destruction
defective calcium sensing receptor on parathyroid receptor

269

congenital cause of hypoparathyroidism

di george syndrome

270

what syndrome cause autoimmune destruction of parathyroid gland

APECED syndrome

271

quid of APECED syndrome(6)

autoimmune
polyglandular
endocrinopathy
candidiasis
ectodermal
dysplasia

272

target of neuropathy(3)

nerve
GI
hypotension

273

patient diabetic with early satiety

gastroparesis

274

rx of gastroparesis(2)

metochlopramide or
erythromycine

275

why they don't use cisapride anymore in gastroparesis

cardiac aryhtmia

276

consequence of gastroparesis in diabetic patient(3)

delayed gastric emptying
decrease Gut absorption
risk of hypoglycemia

277

how's potassium ion DKA

high

278

why hyperkaliemie in DKA is called paradoxal

because total body K is depleted

279

why blood potassium level is high in DKA

extra cellular shift

280

cause of paradoxical hyperkaliemie in DKA(2)

extra cellular shift with ion H+
insulin dependent impaired entry of ion k+inside of cells

281

best way to lower the risk of of nephropathy caused by diabetes

tight blood pressure control

282

causes of erectil dysfunction in diabetes(3)

neuropathy
impaired penile circulation
gonadotrophic hypogonadism

283

quid of FS/LH in secondary hypogonadism

normal or
low

284

first step in secondary hypogonadism

ask for serum prolactine level

285

indication of MRI of head in the context of secondary hypogonadism(4)

high prolactine
testosterone

286

indication of surgery in asymptomatic hyperparathyroidism(4)

young age1mg above the upper normal limit

287

anapath characteristics of medullary thyroid cancer

Invasion of capsule and blood vessel

288

characteristic of medullary thyroid cancer

produces calcitonin

289

what's the most common type of thyroid cancer

papillary

290

clue for papillary thyroid cancer

psammoma body

291

thyroid cancer whoth the best prognosis

papillary carcinoma

292

complication of invading blood vessel by medullary thyroid cancer

rapidly metastasizes

293

initial aproach to patient with hypoglycemia

doser insulin

294

cause of hypoglycemia with high insulinemia(2)

insulinoma
surreptitious hypoglycemia

295

cause of surreptitious hypoglycemia(2)

voluntary intake of insuline or
sulfonylurea

296

clue for b cell tumor(2)

c peptide
proinsuline more than 5 pg

297

Screening of MEN 2A 2b

Dna testing
ret proto-oncogen positif

298

If Ret protooncogen positif CAT

thyroidectomie

299

Causes of osteomalacia(3)

digestive malabsorption
liver disease
kidney disease

300

digestive cause of malabsorption giving osteomalacia(2)

celiac sprue
crhron

301

complication of osteomalacia?

pseudo fracture

302

erectile dysfunction treatment(2)

sildenafil and
doxazocin

303

how to give sildenafil and doxazocin

we have to give them 4 hours interval each

304

sildenafil and nitrate risk?

Hypotension

305

risk if sildenafil is given with erytromycin or cimetidine(2)

increase half life of sildenafil
priapism

306

patient on PTU or Methimazole develops sore throat next step?

wbc count

307

patient on PTU or methimazole develops wbc

stop meds

308

patient on PTU or MM develops fever with blood cell >1500 ?

continue the drug

309

side effect of PTU or MM

agranulocytosis

310

first thing to do in thyroid nodule

sono to search sign of malignancy

311

in case of thyroid noduleif sono doen't show sign of malignancy what to

TSH

312

Thyroid nodule with low TSH

iode 123 scyntigraphy

313

quid of cold nodule

hypofunctionning nodule with iode 123

314

Management of cold nodule

FNA

315

quid of hot nodule

hyperfunctioning nodule on iode 123

316

Management of hot nodule

rx hyperthyroidism

317

if sono shows sign of malignancy next step

FNA

318

thyroid nodule with no sign of malignancy on sono but normal or high TSH

FNA

319

patient on prednisone develops hyponatremia Why

central adrenal insufficiency

320

why hyponatremia during prednisone

because of low cortisol

321

action of cortisol on ADH(2)

cortisol inhibits release of ADH by post hypophise
low cortisol ,more ADH

322

why cortisol is low whe taking prednisone(2)

prednisone blocks hypothalamo pituitary axis
low ACTH--->low cortisol

323

work up of acromegaly

Measure insulin grothw like factor -1

324

In acromegaly in IGLF-1 positive next step

oral glucose suppression test

325

interpretation of oral glucose suppression test in acromegaly

GH suppression

326

if you have an inadequate GH suppression during oral glucose suppression test next step?

brain MRI

327

adequate glucose suppression

no acromegaly

328

what cause of hyperthyroidism can cause hypothyroidism after RAI

grave's

329

what can cause false decrease of calcium

low albumin

330

how to measure the right calcium level in case of low albumin

coreected calcium=measeured calcium+0,8(4-measured albumin)

331

what to do in front of all hypocalcemia

look albumin level

332

clue for MEN 2B(4)

Medullary thyroid ca
Pheo
marfanoid habitus
neuroma

333

hyperplasia parathyroid MEN?

2A

334

Parathyroid adenoma MEN?

1

335

what's the most common pituitary tumor?

lactotroph adenoma

336

cause of high cortisol

cushing syndrome
cushing disease

337

cause of florid cushing disease

hypophyse tumor

338

screening test for cushing?(2)

24 hour urine free cortisol
low dose dexamethasone suppression test

339

florid cushing syndrome

adenoma surrenal

340

cause of ectopic ACT production(4)

SCC
pancreatic ca
bronchial carcinoma
neuroendocrine tumors

341

link between cushing disease and ectopic ACTH production

high ACTH

342

indication of high dose dexamethasone suppression test?

to differentiate ectopic ACTH syndrome from cushing disease

343

high dose dexamethasone suppression test in favor of ectopic production of ACTH(2)

Failure to suppress 24 Hr urine free cortisol
failure to decrease serum cortisollevel from 50%of its baseline

344

abnormal 24 h urine free cortisol

> 90 mcg/24 h

345

Normal ACTH

9-52 pg/ml

346

Marker of hashimoto

TPO antibodies

347

risk for hashimoto

thyroid lymphoma

348

first test to in hyperthyroidism suspected

TSH
T4

349

most common cause of thyroid nodule

colloid nodule

350

low TSH and high T4

hyperthyroidism

351

in case of hyperthyroidismnext step

RAIU

352

RAUI with diffuse uptake in a context of hyperthyroidism

grave's

353

RAIU with nodular pattern in a context of hyperthyroidism(2)

Nodular goiter
Multinodular goiter

354

high t4 with normal or high TSH

secondary hyperthyroidism

355

next step in secondary hyperthyroidism

Brain MRI

356

T4 normal and low TSH in a context of hyperthyroidism?

doser T3

357

High T3 low TSH normal T4

Hyperthyroidism

358

Low TSh with normal T3 T4(3)

pregnancy
subclinical hyperthyroidism
non thyroid illness

359

indication of dosage of thyroglobulin

low raiu

360

Low RAIU and high thyroglobulin in a context af hyperthyroidism(3)

thyroiditis
iodide exposure
extra glandular production

361

Low RAIU,high T4,low thyroglobulin

exogenous hormone

362

best way to monitor response of rx in case diabetes DKA(2)

serum anion gap
arterial PH

363

what can explain biochemically low raiu in a context of hyperthyroidism(2)

Low TG
high TG

364

Marker for graves

TSI

365

quid of isolated low T3 syndrome

sick euthyroid syndrome

366

what causes sick euthyroid syndrome(2)

increase level of
IL-1
IL-6

367

cardiogenick shock patient or any hosptilaisede patient with serious illness with isloated low t3

sick euthyroid syndrome

368

how's the RAIU in Multinodular toxic goiter

patchy pattern

369

Raiu in toxic adenoma

one lobe pattern

370

what's the first test to do in low calcium(3)

doser MG++
ask for blood transfusion
check drug

371

drugs causing low calcium(3)

phenytoin
biphosphonate
ca++ chelator

372

cause of low calcium with high PTH(4)

vit d deficiency
renal failure
inflammatory cause(sepsis,pancreatitis)
tumor lysis syndrome

373

causes of low calcium and low PTH(4)

surgery
radiation of neck
APCED
infiltrative disease

374

infiltrative disease causing low calcium and low PTH(3)(primary hypothyroidism)

wilson
hemochromatosis
ca metastatic

375

what'sthe next step in patient presenting low calcium and elevated PTH

doser 25 OH vit D

376

causes of polyurie(3)

diabetes melitus
diabete insipide
primary polydipsia

377

first thing to in a context of polyuria with low osmolarity of urine


water deprivation test

378

if urine osmolarity increases during water deprivation test

primary polydypsie

379

if there 's no changes in water deprivation test in a context of low urine osmolarity next step

desmopressin

380

when given desmopressin if osmolarity of urine increases of 50% a 100%

central diabetes insipidus

381

when given desmopressin if osmolarity of urineshows small change

nephrogenic diabetes

382

urine osmolarity

50-1400 mosm/kg

383

serum osmolarity

275-295 mosm/kg

384

rx of central diabetes insipidus

desmopressin intranasal(vasopressin)

385

drug of choice of SIADH

demeclocyclin

386

illaic bone fracture and impotence why?(2)

neurogenic cause
parasympathic fibers are cut

387

hypothyroidism symptom in a context of Normal thyroid bilan

receptor problem in peripheral tissues

388

Rx of Paget

biphosphonates

389

quid of non funvtionning adenoma

pituitary adenoma producing alpha unit of LH and FSH

390

biochemistry of FSH LH(3)

dimeric
alpha et B unit
Beta units are more active

391

why non functionning pituitary adenoma causes hypogonadism?

because only alpha unit is produced for LH/FSH

392

why prolactine is elevated in non functionning pituitary adenoma

mass destroys the dopaminergic neurone inhibiting normally secretion of prolactine

393

what should be the level of prolactinemia to think of prolactinome

more than 200

394

how's t3 t4 in non functionning adenoma in hypophyse

low

395

central hypogonadism ,low t3 t4 ,increase prolactin level mildly?

non functionning pituitary adenoma

396

cause of bone pain in osteomalacia

impaired osteoid matrix mineralization

397

role of vit D(2)

absorption of calcium
and phosphate

398

foot ulcer grade 1 and management(2)

superficial ulcer
debridement and wound dressing

399

foot ulcer grade 2 and management(3)

deep ulcer
Mx and ligament are seen
debridement and wound dressing

400

foot ulcer grade 3 and management(5)

bone involvement
osteomyelitis/abcess
hospitalisation
antibio
debridement

401

foot ulcer grade 4

local gangrene

402

foot ulcer grade 5

whole foot gangrene

403

management of grade 4 et 5 foot ulcer

amputation

404

first test to do in primary hyperaldosteronism

plasma renin activity and aldosterone concentration

405

high plasma aldosterone concentration ,next step in a context of primary hyperaldosteronism

adrenal suppresion test

406

si adrenal suppression test is positive next step in a context of primary hyperaldosteronism

CT adrenal

407

positive CT in a context of primary hyperaldosteronism in 40 rx?

surgery

408

if CT is negative next step in a context of primary hyper aldosteronism

venous sampling

409

quid of venous sampling(3)

to differentiate adrenal adenoma from bilateral adrenal hyperplasia in a context of negative CT
patient > 40 ans
venous sampling can also reveal adenoma CT

410

cause of proximal MX weakness(7)

Polymyositis
dermatomyositis
hypo or hyperthyroidism
cushing
Myasthenie gravis
Lambert eaton syndrome
steroids

411

Patient taking prednisone develops mx weakness

steroid myopathyy

412

patient 45 yo with no protinuria normal blood pressure diabetes on metformin ,what meds should be added in medication choix Rosuvastatin,lisinopril

rosuvastatin