Endocrinology

Question 1

what is addisons disease

Answer 1

autoimmune or infectious disease of the adrenal gland - decrease in cortisol secretion

Question 2

what is secondary adrenal insuffiency

Answer 2

pituitary adenoma or discontinuation of steroid - pituitary failure

Question 3

what is the treatment of addisons

Answer 3

cortisol replacement therapy + androgen replacement

Question 4

a 34-year-old female complaining of irritability and nervousness, heat intolerance with increased sweating, and weight loss despite an increase in appetite.
Whats her diagnosis

Answer 4

hyperthyroidism

Question 5

what is graves disease

Answer 5

hyperthryoidism
diffuse goiter with a bruit, exopthalmos, pretibial myxedema

Question 6

what is the presentation of thyroid storm

Answer 6

fever, tachycardia and delirium

Question 7

how is hyperthryoidism diagnosed

Answer 7

Decreased TSH
Elevated T4
RAIU studys shows increased uptake in graves and toxic multinodular goiter

Question 8

what antibody is present with graves

Answer 8

anti-thyrotropin antibodies

Question 9

what antithyroid drug is prefered during pregnancy

Answer 9

PTU

Question 10

a 32-year-old woman comes to the clinic because of new skin markings on her abdomen. Physical exam shows a round face, large purple striae over the abdomen, and several ecchymoses over her trunk, arms, and legs. She describes easy bruising, as well as a significant weakness when she tries to stand up from sitting on the ground. Her 24-hour urine free cortisol is 3 x the upper limit, her late-night serum cortisol is elevated and her plasma ACTH level is < 5 pg/mL.
what is her diagnosis

Answer 10

cushings disease

Question 11

how is cushings diagnosed

Answer 11

24hr urine free cortisol
late-night serum cortisol
and/or
low-dose dexamethasone suppression test

Question 12

what is the treatment of cushings disease

Answer 12

transphenoidal selective resection of pituitary tumor

Question 13

a 28-year-old woman with increased fatigue and a 10-lb weight gain over the last 2 months. She states that she “feels cold” all the time, has decreased energy, and is experiencing worsening constipation. Patient has a tender thyroid, increased TSH, elevated antimicrosomal antibodies, and increased antithyroglobulin antibodies.
What is the patients diagnosis

Answer 13

hypothyroidism

Question 14

what is hashimotos

Answer 14

hypothyroidism

Question 15

what is the lab presentation of hypothyroidism

Answer 15

Low T4 and elevated TSH

Question 16

what is diabetes insipidus

Answer 16

caused by a deficiency of or resistance to vasopressin (ADH), which decreases the kidneys’ ability to reabsorb water, resulting in massive polyuria

Question 17

what is central diabetes insipidus

Answer 17

Deficiency of ADH from posterior pituitary/hypothalamus
* No ADH production. The most common type is idiopathic, autoimmune destruction of the posterior pituitary from head trauma, brain tumor, infection, or sarcoidosis

Question 18

what is nephrogenic diabetes insipitud

Answer 18

Lack of reaction to ADH
* Partial or complete insensitivity to ADH: caused by drugs (Lithium, Amphoterrible), hypercalcemia, and hypokalemia affect the kidney’s ability to concentrate urine, acute tubular necrosis

Question 19

how is diabetes insipidus diagnosed

Answer 19

Serum osmolality is high and urine osmolality is low
- water deprivation test
- desmopressin stimulation test

Question 20

what is the treatment of central diabetes insipidus

Answer 20

Desmopressin/DDVAP

Question 21

what is the treatment of nephrogenic diabetes insipidus

Answer 21

sodium and protein restriction
HCTZ
indomethacin

Question 22

how is T1DM diagnosed

Answer 22

random plasma glucose >200 with classic symptoms, or fasting >126 or > on more than one occasion

Question 23

what are side effects of metformin

Answer 23

lactic acidosis
GI side effects

Question 24

what are sulfonylurea medications

Answer 24

glyburide (diabeta)
glipizide (glucotrol)
glimepiride (amaryl)

Question 25

what are thiazolidinedione medications

Answer 25

pioglitazone (actos) rosiglitazone (avandia)

Question 26

what are DDP-4 inhibitors

Answer 26

sitaglipitin (januvia) saxaglipitin (onglyza)

Question 27

what are SGLT2 Inhibitors

Answer 27

canagliflozin

Question 28

what is the MOA of SGLT2 inhibitors

Answer 28

lowers renal glucose threshold which results in increased urinary glucose excretion

Question 29

what are side effects of SGLT2 inhibitors

Answer 29

vulvovaginal candidiasis UTI bone fractures lower limb amputations AKI DKA

Question 30

what is the treament of DKA

Answer 30

IV fluids = critical first step regular insulin potassium bicarab in severe acidosis

Question 31

a 37-year-old female with a 2-week history of a painful mass in her neck after having a sore throat and fever for 3 days. The patient reports the mass has slowly been enlarging over that time span and has become more painful to the touch. She also reports feeling hot, even when her coworkers feel cold, and reports loose stools over the past week. The patient’s vital signs are T 98.6F, BP 140/90, Pulse 110 bpm, and SpO2 100%. On exam, you note a diffusely enlarged thyroid that is painful to the touch. Thyroid-stimulating hormone (TSH) is decreased, T4/T3 is elevated, and radioactive iodine uptake and scan at 24 hours reveals an uptake of 3% (normal 8-25%). What is her diagnosis

Answer 31

thyroididits

Question 32

what medications can cause thyroiditis

Answer 32

antithryoid medicatons lithium amiodarone

Question 33

what is a essential tremor

Answer 33

usually presents with a postural tremor of the hands or head that is often worsened by psychic stress; can occur at any age

Question 34

what is the treatment of essentail tremor

Answer 34

BB (propranolol)

Question 35

a 33-year-old woman presents to the emergency department due to diffuse pain and fatigue. The woman states that she feels like her bones and muscles diffusely hurt. She also has experienced some abdominal pain as well and states that she has trouble focusing. what is her diagnosis

Answer 35

hyperparathyroidism

Question 36

what is the presentation of hyperparathyroidism

Answer 36

Stones, bones, abdominal groans, psych moans, and fatigue overtones

Question 37

what is the treatment of hyperparathyroidism

Answer 37

primary - surgical correction secondary - replace cause