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Flashcards in Endocrinology Deck (351):
1

Hypothalamus

Dopamine-> inhib prolactin
GNRH->Growth hormone
TRH->TSH
CRH->ACTH
GnRH->FSH/LH
Post pit directly releases oxytocin/ADH

2

Screening for Axis fxn

Hypoth-Pit-Gonadal-check serum LH/FSH
Hypothal-Pit-Thyroid -> TSH/T4
Hypothal-Pit-Adrenal Axis->ACTH (serum)

3

Most sensitive determinant of pitutiary fxn?

FSH/LH level

4

Screening for hormone excess

Prolactinoma->prolactin level
Hyperthyroid-<>FTI/T4, TSH
Acromegaly-> IGF-1 (not GH - is pulsatile)
Cushings -> 1mg DMS

5

Pt with MVA - CT head with no bleed but 0.8cm solid mass in pituitary - pt nulliparus, menstation regular wtd?

check prolactin, T4/TSH/IGF-1 and 1mg DMS test (all axises)

6

Things that increase prolactin

Nipple manipulation
Phenothiazines
reserpine
Mehydopa
estrogens
marijuana
prgenancy
hypothyroid

7

Prolactinoma

Prolactin >200 - macroadenoma
failure then surgery

8

Middle aged woman wit dec libiddo adn fatigue test low, FSH low

check prolactin adn TSH

9

Pt wit galactorreha wtd?

check TSH and prolactin

10

Young woman with galactorreha on manipulation of nipple, TSH/prolactin normal

avoid manipulation of nipple

11

35yo F with galactorreha and amenorrhea x 6 months - preg neg prolactin 184 TFT normal wtd?

MRI r/o stalk tumor

12

Pt post partum continues to have galactorrhea fter finishing nursing baby - TSH 2.8, prolactin 281 takes no meds - dx?

prolactinoma - check MRI

13

45yo M c/o fatigue and dec libido - testosterone 18, prolactin 2500 FSH 2.2 cause?

prolactinoma

14

Pt with prolactinoma micro or macro - wants to concive

start dopamin agonist (bromocryptine - reduce prolactin level and induce ovulation

15

Pt tx'd with bromocryptine for macroadenoma and gets pregnant wtd?

d/c bromocryptine
monitor visual fields - only restart if changes

16

Acromegaly

inc'ing shoe size, hat size, ring size, hyperglycemia, prominent jaw, wide space between teeth, big tongue, flshey palms soles, osteoarthritis changes on Xray

17

Screening test for acromegaly

IGF-1 (somatosatin C) - also to follow dz activity

18

Confirm acromegaly (after IGF-1 screening) with...

oral glucose suppression test
failure to suppress GH to <2ng after 100g glucose

19

Tx for Acromegaly

Transphenoid surgery

20

Complciations of acromegaly

HTN, LVH, CHF, OSA, colonic polyps, carpel Tunnel

21

DM

dx FBS>126 - repeat x 1 to confirm
HgA1c>=6.5
Random blood sugar >200 with sx
75g gluc load GTT >200

22

Pt with BP 135/80 or BMI 25 or sedentery lifestyle or >40 wtd?

screen for DM (FSG, HgA1c)

23

Pt with DM (FSG >126) at risk for

DM and retinopathy, nephropathy

24

DM I vs II

check for Ab vs glutamic acid carboxylase, ab to islet cells

25

DM tx

Diet/excercise - 0.4% red A1c
Type I-> insulin
Type II sulfonyureas (hypogly), biguanide (metformin), repaglinide, glitazone, insulin, exenatid(no hypo, incretin (no hypo)

26

Insulin

All Type I DM
Type II not responding to oral hypoglycemics
Type II on oral mes but hospitalized, major surgery, infxn
pregnancy

27

Hospitalized pateint with DM

tx with basal insulin and rapid acting agent

28

Sulfonyureas (glipizide), glyburide, glimeperide

inc'd release insulin form B cells
avoid in obese pts

29

Meglitnide - repaglinid

inc rel insulin from B cells - excreted in bile ok in renal insufficiency - rapid

30

Biguanides - metformin

dec hepatic gluconeogenesis, dec insulin resistantce, dec weight, TG, chol
bestin obese pts with inc TGA
lactic acidosis
avoid in renal failure

31

A glucosidase inhibitors - acarbose

inhbits breakdown of cardbs, dec absorption of glucose - use for post prandial hyperglycemia

32

Thiazolidinediones (glitazones) - pioglitazone - actos

PPAR rct - inc glucose transport dec insluin resistance dec TGA, inc LDL - avoid in NYHA II HF

33

Incretin mimetics - exenatide GLP1 agonist

dec hep gluconeogenesis, dec gastric emphtying wt loss, early satiety inc'd cell growth
good for obese pt failing metformin +- glit/sulf
watch out for pancreatitis

34

Inretin memetic - DDP4

Sitagliptin (januvia
s/e nausea

35

Amylin analogue pramlintide

slows gastric emptying dec glucagon secretion, wt loss and early satiety
complementary to insulin, no hypoglycemia
good for obese pt failing insulin therapy with high post prandial BS

36

Which DM meds DO NOT CAUSE WT GAIN?

Metformin, incretin drugs (exenatide and amylin alaog pramlintide

37

Blood sugar goals in DM

A1c<120

38

Pt with BMI 32, FBS 115 fhx DM - best way to prevent DM?

Diet/excercise (aerobics and resistance training

39

Drugs that cause hyperglycemia

Statins, BB, HCTZ, niacin, olanzapine, PI, steroids

40

45yo F dx with Type II DM 4 montsh ago with FBS 170 A1c 8.9 wt 205 started on exc/diet - repeat FBS 165 wtd?

Metformin

41

Pt with DM II and obese not well controlled on sulfonyurea (glipiz,glyburide, glimeperide)

Add metformin

42

What' increases insulin sensitivity

Glitazone

43

Which drug improves mortality and dec early HF in DM pts

Metformin

44

Pt with DM2 responsds well to metformin adn sulfonyrea for years bu tnow with inc BS, no infxn, HgA1c 9 - wtd

add insulin basal - keep only metformin

45

If FBS with just insulin and metformin still 115- 130

start lispro insulin

46

Pt refuses insulin injections wtd

continue metformin add sulfonyurea or glitazone

47

S/E metformin

lactic acidosis

48

When is metformin contraindicated?

Cr >1.4 F>1.5 M and advanced HF (>NYHA II)

49

Pt on multiple meds Cr >1.5, CHF EF 35% wtd?

d/c metformine and glitazone, start glargine for detemir and lispro or aspart

50

Pt going for cardiac cath or radiocontrast study - what drug to stop?

Metformin

51

60yo Pt dx with DMII - Cr 3.7 - what meds to start?

repaglinide (excreted in bile)

52

40yo Pt with DM2 tx'd with metformin - 1 year later gaining wt as he stopped excerciseing BS also up

start exenatide (GLP-1) good for obese pt failing metformin

53

Dawn's Phenomenon - pt wakes up with fatigue, sweating h/a, vivid dreams

inc'd 4-7am gluc 2/2 insulin resistance/hormonal factors
Tx - inc PM NPM

54

DM pt on NPH/R in AM, supper or glardgine HS
Palpitations, sweating, nocturnal awakening AM h/a wtd?

check 3am FSG

55

Blood sugar 3am 40

change NPH to HS or swtichto long acting insulin analog (glargine)

56

Persistently ele FBS 3am 200

inc supper NPH or glargine

57

Blood sugar 30 pt passes out at 12noon on 20 U NPH and 5 U R in AM wtd?

D/C "R insulin" in AM

58

FSG 180 5pm

in NPM in AM

59

FSG 4pm 25 and 10pm 210 pt in 36U NPH in AM

Change to 24 U NPH AM and 12U NPH PM

60

All post prandials high, premeals ok on basal bolus regimen

inc dose of pre-meal insulin

61

All pre and post prandials high

inc long acting insulin dose

62

FBG 115 but A1c 7.5 takes NPH/metformin wtd?

check POST prandial blood sugar

63

65yo M DM started on glargine insulin 30U qam with metformin with FSG going steadily up throughout day

change to glargine twice daily

64

Insulin dosing

Mass kg * 0.5u/kg = total daily insulin
1/2 total daily as basal (15 daily)
1/2 total insulin as lispro TID (5 tid) premeal

65

AA M DM f/u FBS 115-130 A1c 11 etiolgoy?

hemoglobinopathy

66

Falsely elevated HgA1c

decreased RBC turnover (dec retic)
IDA
Folate/B12 def
Hemoglobinopathies
Sickle cell, thalassemia

67

Falsely LOWER HgaA1c

inc'd RC turnover (inc retic)
Hemolytic anemia, HIV
treating IDA, folate
B12 def or blood tx

68

Pt Hg 6.6 - BS ranges between 90-150 except 5pm which is 280 has fresh fuit snake at 4pm etio?

Not washing hands after fruit snack - false elevation of A1c

69

Pt with DM, BS 340, TG 2400 hospitalized with pancreatitis - fastest way to control TG would be to give...

Insulin

70

Pt IDDM with abd pain has DKA, started on insulin gtt 10u?hr, IF BS dec to 250 and IVF changed to D51/2NS and insulin gtt dec'd to 5U/hr - BS now inc'd to 375, AG 19

wtd? - inc insulin gtt

71

How to prevent DKA pt from going back into DKA when turning off insulin gtt -

give SQ insulin 30 min prior to stopping insulin gtt

72

Pt with diabetic ketoacidosis BS 725, ketones +++ started on insulin gtt, ivf 10am - BS 250 at 7pm - wtd?

start IVF D51/2NS, c/w insulin gtt
Follow with AG if closed then overlap SQ insulin

73

Pt with DM admitted for surgery in AM - on glargine and lispro wtd morning of surgery if pt receives glargine in AM, in PM

Glargine AM schedule: 1/2 dose glargine and NO lispro
Glargine PM schedule: d/c lispro

74

24yo Preg F 24th wk FBS 115, repeat 114 - wtd?

Metformin (ok in preg)

75

25yo DM pt 24th wk FBS 120, post prandial 180 on glucotrol and metformin wtf?

add insulin

76

Elerly pt DMII brought in with seizure - BS 1050, BUN /cr 50/1.8, ketones + dx?

Hyperosmolar non-ketotic coma -
IVF, insulin
inc 100 gluc, Na dec 1.6 up to 300
>300 inc 100 Gluc dec Na 2.5

77

Type I DM with DKA BS 725, ketones +++ on insulin gtt 10am - 10pm BS 200, ketones neg - bicarb up to 18 from 4, K dropped to 4.5 - pt with difficuulty breathing/muscle wk - +CPK, most likely cuase

hypophosphatemia - insluin drip forces lyesinto cells - no Phos to make ATP

78

Nurse calls you to let you know FBS 62

Asymptomatic - adjust regimen
Symptomatic with tachycardia - 15gm carbs, if on acarbose then pur glucose (dextrose) and adjust tx regimen

79

Newly Dx DM BG 350 on insulin drops to 130 - becomes tachy adn diaphoretic wtd

keep <200 at first

80

DM complications

Macrovasc - CAD/PAD - aggressive LDL control autonomic
peripher sensory motor polyneuropathy
stock/glove distribution - amitryptyline, desipramine, gabapentin

81

DM Autonic neuroapthy

Impotence - tx with phospodiesterase inhibitor (viagra)
Neurogenic bladder - urinary hesitancy, dribbling, incomplete evacuation - bladder training, bethancol
orthostatic hypotension - fludrocortisone & high salt diet
Gastropareisis - wide fluctuation of BS 50-400mg
Writst/foot drop
DM foot ulcers - common bug S aur, b hem strep

82

Cause of DM foot ulcer

peripheral neuropathy

83

Best way to prevent DM foot ulcer

mon-filament testing - protective footwear

84

Pt with DM 15yr on metformin sulfonyrea/insulin with hypoglycemic attacks post prandial, early satiety, oitting BS 50 to 400 range widely dx?

Gastropareisis (autonomic neuropathy)
Best test - SCscintography of gastric contents
Tx - small frequent meals of liquid/pureed low fat, low in no-digestible fiber - metoclopramide/domeperidone

85

T/F type I DM should have annual eye exam after 5 yers after onset of DM or age 30 whichever first

T

86

T/F Type 2 DM pt shoudl have annual eye exam from onset of dz

T

87

T/F DM pt with difficulty driving at night will prob have ED

T

88

T/F ACCORD trial HgA1cd hypoglycemic events

T

89

T/F ACCORD trial BP <140./80 had more s/e

T

90

Current recommendations for f/u DM pt

HgA1c quarterly, microalb semi ann, lipid panel annual, opthal exam annually

91

Pt with BS 35 taking glipizide, metformin acarbose

admit start IV dextrose

92

22yo F recurrent dizzy attacks in ER, mother DM, blood gluc 35 - next dx test

make sure no surepticous insulin/sulfonyurea use - check urine serum sulfonyurea screen

93

Above pt still hypoglycemic - ampule D50 give, IV dextrose started next step?

glucagon then octreodtide

94

TRH

downreguated by T4, lithium, iodine

95

SICU thyroid

dec T3, normal T4 and TSH

96

best test to screen for thyroid dz

TSH
confirm with T4, FTI

97

Best test to follow hypothyroid tx

TSH

98

Best test to follow Hyperthyroid tx

FT4 or T3
Total T4 + T3=T3RIA

99

Thyrotoxicosis

T3 inc->inc T3 RIA

100

Radioiodine uptake

inc'd Hyperthyroid states (graves, hot nodules)
dec'd thyroiditis (exogenous, amiodarone)

101

Radionuclide scan

differentiate between hot vs cold nodules

102

FNA/bx

cold nodules

103

Ultrasound

diff solid vs cystic

104

Graves dz

inc FT4, inc T3, dec TSH, inc RAI

105

Multinodular goiter

hot nodules - inc FT4, inc T3, dec TSH, inc RAI

106

Toxic nodule

inc FT4, inc T3 ria, dec TSH, inc RAI

107

T3 thyrotoxicosis

n/dec FT4, inc T3 ria, dec TSH, inc RAI

108

TSH adenoma

inc FT4, inc T3RIA, inc TSH, inc RAI

109

Thyroiditis

inc thyroglobulins, inc FT4, inc T3 RIA, dec TSH, inc RAI

110

exogenous T3 (factitious)

dec FT4, inc T3RIA, dec TSH, Dec RAI

111

Exog T4 (factitious)

inc FT4, inc T3 RIA, dec TSH, dec RAI

112

Primary hypothyroid

dec FT4, Dec T3 RIA, inc TSH - RAI n/a

113

Hypopit hypothyroid

dec FT4, dec T3 RIA, dec TSH

114

Pt with wt loss, feels warm in windter, tremors, inc appetite, diarrhea, palpiatins, afib, enlarged thyroid FTI inc, TSH dec wtd?

Radioactive uptake study
diffuse - graves
Focal - toxic nodule
uptake - thyroiditis
areas of inc and dec uptake - multinodular goiter

115

Pt with hyperthyroid and dec'd radioiodine uptake - how to differentiate thyroititis vs factitous thyrotoxicosis

inc'd thyroglobulin - thyroiditis (and follicular/papillary CA)
dec'd thyroglobulin - factitious thyrotoxicosis
inc'd TBG - estrogen/pegnancy

116

Elderly pt with wk, EKG afbi, TSH dec'd - etiology of afib?

hyperthyroid

117

Elderly pt with apathy, wt loss, arrythmia, CHF, diarrhea, depression, sleepiness, TSH dec, T4 nlow normal T3RU >30%

apathetic thyrotoxicosis

118

Pt with T4 elv, TSH 4.5

MRI brain (no feedback - with high T4 should be low TSH unless there is pituitary tumor secreteing TSH)

119

26yo F si/sx hyperthyroid - started on a new "diet pill recently and has been excercisign - T3 elev, TSH low and RAI uptake low

taking thyroxine in "diet pill"

120

40yo Pt with asympt low tsh

subclinical hyperthyroid - onitor, repeat TSH in 3months - tx only if osteoprosis or CV dz present

121

Tx of thyrotoxicosis (TSHr AB_, anti TPO +

Pregnancy -> 1st trim PTU (SE agranulocytosis, ANCA + ab, MPO+ (1st trimester ONLY)
Others-> radioactive Iodine-> >50% become hypothyroid in 2months
Thyroid ophthalmopathy - subtotal thyroidectomy

122

52yo F a/w PNA - exam pt confused hitting med staff and inattentive - diarrhea and family says lost 15lbs in 6 months - tmep 104, HR 140 rales at bases CXR RLL consodiation - on abx 2 days later hypotensive adn comatosed - dx?

Thyroid storm
Tx: PTU/steroids + BB, digoxin for afib
etio - infxn, surgery, trauma

123

Can you cardiovert afib to NSR in thyroid storm?

No, not till 3 months after euthyroid - spontaneous conversion common

124

Pt with graves d has radioiodine ablation - 8 wks later gained wt, TSH 0.2, free T4 0.2 wtd?

start T4 (hypothyroid)

125

hypothyroid pt started on T4 - 2 months later watery eyes, slceral injection, perioorbital edema, afferent pupillary defiect, painful eye movement - dx?

Thyroid ophthalmopathy with opti cnerve impingenment
Tx: steroids

126

Pt with thyrotoxicosis and ophthalmopathy - management?

Surgery

127

Thyroiditis

all with dec'd RAI uptake - may present hyper,hypo or euthyroid
Release of preformed hormones - thyrotoxicosis - returns to nromal
Thyroglobulin inc'd....

128

Pt with URI, soreless in neck enlarged tender thyroid, inc'd ESR, inc T3RU, T4 normal - how to get dx?

RAI uptake - decreased
subacute thyroiditis - sub acute granulomatous, de Quervain's thyroitis
Tx
Palpitations with tachycardia - BB
Pain - ASA + NSAIDs
DO NOT USE antithyroid drugs
don't need to check for antibodies....

129

Young pt with nervousness, insomnia, irritability after uncompicated delvery - is breast feeding, thyroid endalrged, non-tender, TSH low, T4 mildly elevated - dx lyphocytis thyroitis - wtd?

BB only - avoid RAIU during lactation
Usually transient hyperhtyroid then hypotheyroid then euthyroid after several months

130

Ab most likley to differential graves vs thyroiditis

TSH rct autoab in graves
Anti TPO + in both, TBG elev in both

131

Young woman 4 months post partum wit huncomplicated couse with wt gain, low enverygy, delayed DTR, amenorrhea - preg neg wtd?

Check TSH, r/o hypothyroid stage or chronic lyphocytic thyroiditis

132

30yo post partum with tremor and depression - T4 high, - reassure her but coems back 1 month later with dpression now fatigue - T4 low, TSH high wtd?

start synthroid, reassure and reepeat TFT in 3 months or less

133

Pt p/w tremor/tachycardia on asa, dig, amiodarone, IFN - T3, T4 high, TSH low, RAI < 5% - etiology?

Amiodarone or alpha interfereron

134

Pt with acute illness intubated and in ICU - episode of hypotension on vasopressors - T4 nl/dec, T3 low, TSH nl/low

SICK euthyroid syndrome
Tx: tx underlying cause - repeat TSH 2-3 wks after recovery

135

Hypothyroid

cold intolerance constipation, coarsening of feathers, delayed DTR, amenorrhea, elevated prolactin

136

TSH elev, T4 dec

primary hypothyroid

137

TSH dec, T4 dec, rT3 dec

hypopit hypothyroid

138

TSH inc, T4 nl

subclincial hypothyroid

139

Pt p/w fatigue, cold intolerance and delayed DTR - TSH 6, T4 1.2 (normal)

hasimotos thyroiditis - leading cuase of hypothyroid - anti-TPO+

140

28yo F fatigue, wk, difficulty getting up from sitting, pain in hands CPK 200, DTR slow wtd?

check TSH (joint pain, inc CPK, dec DTR)

141

In pt with CAD or elderly start...

low dose synthoid
Start 25mcg and inc 24 q4-6 wks
check TSH if inc/d same inc T4,
If TSH dec - dec T4 dose

142

Pt taking synthroid for hypothyroid T4 nl, T3 nl, TSH high wtd?

inc T4 dose

143

Hypothyroid pt on thyroixin goes on <1wk vac forget meds wtd?

restart T4 upon arrival (t1/2 T4 is 7 days)

144

Hypothyroid pt started on levothyroxine 200mcg - 3 montsh later TSH 2 T4 1.6, Te 6 - pt c/o not losing wt despite diet/exc - BMI elev

continue same dose of T4

145

Pt with refractive arrhythia - resonding to amiodarone - 4 months later with sx of hypothyroid TSH elev, T4 dec wtd?

start synthoid

146

Hashimotos thyroiditis

leading cuase of hypothyroid
CPK elevated before sx of hypothyroid
Indications for tx subclinical hypothyroid
inc LDL
anti-thyroid perioxidase Ab (anti TPO)+

147

Pt with bipolar dz responsds to leithium fo r>8yrs - past sever montsh wt gain, delayed DTR T4 borderline, TSH inc'd wtd?

start levothyroxine

148

Pt with slightly elev TSH - repeat TFT cofirm elev of TSH 12 - T3/T3 normal - asympt0omatic, BMI 30, LDL 160

Subclinical hypothyroid
Tx - with levothyroxine - results in lowered LDL

149

Pt with 3 v CAD going for CABG TSH 11 wtd?

Clear for surgery

150

Pt with angina has cardiac cath - develops thyroid swelling T4 1.6, TSH 5

repeat T4 in 4 weeks

151

Pt with 15lb wt gain over few months unable to lose - delsyed tendon reflexes, TSH inc'd wtd?

start levothyroxine

152

Pt brought to ED on cold day, stuperous, hypothermic, bradycardic to 40/min periorbital edema, pugblic hair loss, amxillary hair loss

Myxedema coma
Tx - Iv hydrocortisone plus T4/T3 + abx

153

Pt with hypothyroid controlled on synthroid get pregnant - what is increased requirement of synthroid

Elevated during 1st trim - till end of preg 30-50%

154

Preg pt with anti-TPO ab and started on levothyroxine - check TSH in 6 weeks - what is target TSH?

TSH<2.5

155

Thyroid nodules

Hot and cystic - benign
COld and solid - r/o malingnancy
Asyx nodule on physical exam - wtd?
check TSH

156

Pt with cold and solid nodule - TSH 1.5, US with hypoechoic nodule wtd?

FN bx (FNA)
If TSH dec and T4 inc wtd? - confirm dx with RAIU
if uptake inc'd - graves dz ->
tx: anti-thyroid meds -> radioactive iodine-> surgery

157

RAIU - Radioactive Iodine uptake test

used in dx of thyroid problems esp hyperthyroid
also used after radioactive iodide ablation to make sure no thyroid cells survived (could still be cancerous)
Low uptake suggests thyroiditis
High uptake suggests Graves dz
Uneven uptake suggest thyroid nodule

158

Pt with multinodular goiter on synthroid >1 yr p/w palpitations and wt loss - FTI inc, TSH dec, synthroid dose dec'd - 8 weeks later T4 still high, TSH still dec, T4 dose is again lowered and repeat TSH is still low wtd?

RAIU
If uptake dec then lower T4 dose and repeat TSH
If uptake high pt now euthyroid or has thyrotxicosis
stop synthoid and repeat TSH in 6 wks

159

FTI=free thyroid index

assessment of free unsaturated thryoid binding proteins - estimate of amount of circulating free thyroxine

160

Pt develops panhypopit including hypothyroid after radiotherapy to brain - TSH 0.1, replacement with levothyroxine began - how to follow this pt?

Free T4 (NOT TSH - will never go up because of hypopanpit)

161

Pt with longstanding h/o goiterous hashimotos thyroiditis p/w enlarging goiter, sob, harosenss and dysfphagia - exam with goiter tha tis hard and dosen't move on swallowing - dx?

Thyroid lymphcytic B cell type (60x more common with hashimotos)

162

Nuclear power plant disaster - what to give surrounding community?

Potassium iodide (ideally before to prevent radioactive iodine uptake from nuclear plant....)

163

Vitamin D deficiency

<20ng/ml
Tx 50KIU/wk po then 1-2Kiu/day

164

Vit D insufficiency

<30ng/day (dec muscle strength)
Tx 1-2K IU/day

165

Vit D sufficiency

>30ng/mL -
Maintenance
70yo 800 IU/day

166

At what vit D dose are fractures preventable

800 IU/day

167

Pt with serium Ca 11.5, repeat 11.5 - wtd next to ID etio?

check serum PTH

168

Sarcoid

inc 1,25OHD3 - inc Ca+/PO4 absorp from Gut
in macrophages - 25OHD3--> 1,25OHD3

169

hyperPTH

inc Ca absorbp from gut, dec PO4

170

MM

inc Ca

171

ESRD

dec'd 1,25OHD3 (25OHD3-> 1,25OHD3 in kidney)

172

PTH >1000

PTHectomy

173

what does 1,25OH2D3 do?

mobilizes Ca+/PO4 from gut

174

HyperCa (bone breakdown)

fastest agent is calcitonin (2-3 days)
then change to bisphosphonate

175

Ca inc PTH inc

primary hyperPTH (PO4 dec)
or Lithium tx

176

If Pa inc, PTH N

Familial benign hypocalciuric hypercaclcemia (FBHH)
abnormal Ca sensor in kidney - mild high serium Ca
Urine Ca to Cr ratio <0.01
NO TX NEEDED

177

If Ca inc PTH ver low

Malignance - MM - MCC hyper Ca+
PTH like sustance not measured by regular PTH assay
Skeletal survey needed
Vit D intox
measure 25OHD3
Sarcoid
check 1,25OH2D3 (inc'd bowel Ca+ absorbtion)

178

Other causes of hyper Ca+

Thiazide diruetics - dec'd Ca+ excretion
Lithium induced hyper Ca+ inc'd threshold of Ca need to dec PTH production
wtd? d/c lithium

179

Lithium induced hypothroid wtd?

treat with levothyroxine

180

Hyper PTH

inc'd PTH, inc'd Ca+, dec PO4
Bankd keratopathy, subperiodsteal bone resorption (moth eaten phalangeoal cortex on xray hand
Skull xray with punched out lesion
renal stones and muscle wkness
50% also with Vit D def - with PTH always check 25OHD3
May be in MENs syndrome

181

Leading cause of secondary HyperPTH?

Vit D dif

182

Pt with PTH elevation what to measure?

25 OH D3

183

Vit D inc'd

PTH dec (feedback), Ca inc, PO4 inc

184

Sarcoid

PTH dec, Ca inc, PO4 inc

185

hyperPTH

inc PTH, inc Ca+, dec PTH

186

Malignancy

PTH dec, Ca inc, PO4 dec

187

Milk alkali syndrome (antacids)

dec PTH, inc Ca+, dec PO4

188

MEN type I

Parathyroid - inc'd Ca+
Pituitary - MRI r/o it tumor
Pancrease - hypoglycemia

189

MEN II

Pheochromocytoma - HTN, palptiations 24 hr metaneph urine
Ca Medullary thryoid- calcitonin inc'd
Parathyroid - inc'd Ca+

190

MEN III

Ca Med thyroid
Pheochromocytoma
Mucosal neuromas

191

Pt with thyroid Mass, Ca inc'd calcitonin inc'd dnese calficiation in mass mdulalary Ca dx - screen family members?

yes - serium calcitonin RET proto oncogene

192

45yo F thyroid nodule 2.5cm, asx, TFT normal FNAB - medulalary cardinoma - serum calcitonin 1200 - scheduled for thryoidectomy - wtd prior to surgery

24hr urine metanephrine and catechol r/o pheo

193

34yo with recurren tnephorlitiasis Ca 11.5, PO4 2.3, perum PTH 225 - managment?

surgical exploration of neck for PTHoma

194

Indications for PTH surgery

Age>50
Serum Ca >2mg abv normal (11.5)
30% red in Cr clearance
Sx (osteoporosis T >-2.5, dehydration, stones)

195

40yo asx woman with minimal hyperCa, PTH 125 wtd?

refer for surgery

196

Pt with hyperPTH refused PTH ectomy wtd?

Cinacalcet (calcitonin)

197

Asx pt with Ca 10.5 - serum PTH 45 no h/o stones

check urine exretion of Ca - familal benign hypocalciuric hypercalcemia

198

35yo health concious excercise takes lot of vitamins p/w fague, constipation MM dry Ca 11.2, PTH 10 - most likely has?

Vit D intoxiation (25 OH D3)

199

45yo F c/o getting up at night ot urinate - constipated MM dry nauseous only other hx dyspepsia (takes lots of antiacids) Ca 11, Phos 2.5, PTH 15 dx?

Mild akali syndrome
tx - change ca+ containing antacids

200

Pt with lung Ca to ER with mental obtundation Ca 17 - mamagement?

Aggressive IVF?
long term management - zolendronate>pamidronate

201

Fastest acting hypocalcemic agent

Calcitonin - 2-3 days then resistance...

202

Least likely cuase of hyper Ca+

Prostate CA

203

32yo F with Ca 11.5, PO4 4, CXR b/l hilar LAD - whic elevated?

sarcoid - 1,25OHD3 (macrophages

204

28yo F kidney stone, Ca 11.2, PO4 4.1, serum PTH 7 dx?

sarcoid
tx with prednisone after controlling hyper Ca+

205

HypoPTH

dec PTH, dec Ca inc PO4

206

Hypomagnesemia

Dec PTH, dec Ca, inc PO4, dec K+

207

Vit D def

inc PTH, dec Ca, dec PO4, inc alk phos

208

PTH resistance
PseudohypoPTH
CRF

inc PTH, dec Ca, inc PO4

209

Young pt with h/o irritability depression muscle wk Chvstek/trousseau's sign, dec Ca, dec PTH, inc PO4

hypo PTH

210

65yo M bone pain, osteopenia on xray, serum Ca 7, P4 1.9, alk phos 145, alb 2.2 serum protein 4.5, xray bands of radiolucense cause?

osteomalaicia 2/2 vit D def

211

Pt with fx on alendronate tx Ca 7.4, PO4 2.2, alk phos 135 dx?

Vit D def

212

Xray with SHORT 4th and 5th METACARPELS dx?

PseudohypoPTH (appropriate high PTH - tissues don't respond to PTH so Ca is still low)
etio? dec'd tissue response to PTH

213

Inc'd Ca+ in Tb/Sarcoid/leprocy

inc'd 1.25OHD3 from macrophages in granulomatous tissue

214

How to dx Osteoporosis

FRAX - clinical risk factors + femoral neck BMD with DXA (more than -2.5)

215

Clinical risk factors for osteoporosis

inc age
Prev fx
steroids
parental h/o hip fx
Low BMI
sedentary lifestyle
smoking
etoh
Rheum Arthritis

216

Secondary osteoporosis

Hyperthryoid
HyperPTH
MM
low Vit D
Hypogonaldism
Premature menopause
malabsorbption
Chronic liver dz
Inflamm bowel dz
Drugs - steroids 5mg/day x 3 months at least
Dilantin, long term heparin, aromatase inhibitors
LHRH agonists

217

Which is bigger risk factor for osteoporosis

Sedentary lifestyle
Obestity bigger risk for osteoarthritis

218

Pt on prednisone 5mg/day > 3months

get DEXA baseline then yearly if stil on steroids

219

DEXA socre -1.5, pt on Ca/vit D wtd?

start alendronate
If normal pt (not on steroids) T score < -2.5 then start bisphosphonate

220

52yo M pw pain in R groin and thigh for couple weeks denies trauma and walks a mile /day, alk phos normal Ca 9.2 ESR 23, Xray mild osteopenia MRI T1 def enhancement fem head T2 inc enhancement of fem head dx?

Transient osteoporosis

221

R groin pain with rheum arthritis and osteophytes on xray

secondary osteoARTHRITIS

222

R groin pain, with Rheum arthritsi xray neg, MRI double line sign on T2 dx?

avascular necrosis
tx: quit smoking, start bisphosphonate
calcitoin for pain
Ca 1500mg./day
Vit D 70 800 IU/day
Raloxifene
Teriparatide - dec osteoclast, inc osteoblast

223

65yo post menopausal F wnats to know risk for osteoporosis - past hx with renal stone 5ya - T score -.25, Z score -1.5 wtd?

Alendronate + Ca + vit D
(nephrolithiasis NOT contradindication for inc Ca in diet)

224

Elderly F with hip fx DEXA -1.4 most imporant indiactor for starting alendronate ?

Hip Fx

225

Most important risk factor for fracture?

hx of hip fx with normal T score (< -2.5)

226

70yo pt with serum Ca 11.5, PTH 115 DEXA T score -2.5 hip -1.5 spine etiology of osteoporosis?

hyperPTH

227

70yo F comes to renew estrogen for osteoporosis wtd?

d/c estrogen start alendronate, Ca, Vit D

228

What medication shown to dec mortality in Pt with osteoprosis and fx

Zolendronate (S/e fever, myalgia)

229

65yo F with osteoprosis and renal insufficiency

Denosumab (RANKL inhibitor - prevents preosteoclasts from maturing into functional osteoclasts)

230

Pt taking Vit D and Ca - 48yo develops hot flashes what med for both bone health and hot flashes?

estrogen and progestin

231

T/F Local estrogen therapy helpful for vulvo vaginal atrophy

T

232

T/F Local estrogen therapy didn't releive dysparenunia

T

233

T/F Local estrogen therapy can reduce risk of recurrent UTIs

T

234

T/F hormone therapy does not reduce post menopaual osteoporotic fx's

F

235

T/F Hormonal tx within 10 years of menopaus in age less tthan 60 and use of hormonal therapy more than 5 years a/w reduction in 30% total morrtality and indicence of heart dz - not recommended assole reason for therapy

T

236

T/F Risk of heart dz increased if hormonal therapy started after menopause

T

237

T/F estrogen progestin therapy in's risk fo ischemic stroke in F > 60

T

238

T/F inc'd risk of DVT, however risk lower if started below 60

T

239

T/F unopposed estrogen tx at increased risk of endometrial Ca - so use concominant progestogens

T

240

T/F Breast Ca risk inc's with estrogen progest therapy for more than 5 years

T

241

T/F Hormonal therapy less than 5 years has signifcant impact on breast CA

F

242

T/F Hormone therapy if starte dafter age 65 can inc risk of dementia

T

243

T/F Hormonal tx started soon after menoapuse decreases risk of dementia later in life

T

244

T/F Hormonal replacement therapy in premature menopause that is in premature ovarial failure has protective effec ton CHF but don't extrapolate data to women experiencing menopause at a typical age

T

245

T/F Transdermal estrogen tx can be reconsidered if pthas concerns for DVT

T

246

T/F Estrogen therapy reduces risk of colon CA

T

247

58yo F long h/o hypothyroid on synthroid - what dx test to do (that is appropriate)

DEXA scan

248

58yo F long h/o hypothyroid on synthroid with DEXA + for osteoporosis wtd?

check TSH if low dec T4 dose (better than starting bisphosphonate

249

62yo F with DEXA scan reveals T score at spine -1.1, hip -2.5 - reason for discrepancy?

osteoarthritis of spine

250

Pt with osteoporosis T score -2.5 on alendroneate - 2 yrs later fall with fx T score -2.5 wtd?

D/c alendronate start Teriparatide
Can use for 2 years

251

70yo M with hip fx, xray with osteopenia - Ca+, PO4 normal - skeletal survey no lytic lesions but osteopenia+ total proteins wnL protein electrophoresis slighly inc'd IgG no M spike wtd?

DEXA scan
if shows osteoporosis ->
tx with alendronate

252

79yo prostate Ca on antiadndrogen sustains hip fx - is alcoholic - DXA shows osteoporosis - reason?

decreased androgens

253

S/E bisphosphonate

osteonecrosis of jaw (mandible)

254

70yo F comes ot you reading on internet bisphophonates can cause osteonecrosis - taking alendronate for 7 years wtd?

D/C alendronate
If > 5 years can stop - effect lasts for years

255

Paget's dz

alk phos inc'd, bone scan +
excessive breakdown and formation of bone (osteoblast, osteoclast phases)
Tx
asx - no tx
Sx - tx with alendronate/calcitonin
Sx's bone pain, spinal cord compression fx, high output heart failure

256

Paget's dz

Ca nl, Phos nl, alk phos INC, PTH nl

257

Perimenopause

50's irregular mentstual cycle, hot flashes, mood changes, insomnia, fatigue during day
Vaginal dryness, stress incontinence, dec memory
Tx - estrogen +- low dose preogestine
Complications - thromboembolic events
Dx? clinical

258

49yo F irreg menstual cycles, insomnia fatigue wtd?

estrogen challenge see if sx imoprove - FSH unreliable

259

35yo F hot flashes and early menopause wtd?

FSH level - if elevated - estrogen tx

260

52yo irreg mentstual cycle hot flash fatigue, h/o DVT in past - refuses to go on estrogen 2/2 risk of thormbus or post breast Ca tx, cancer risk wtd?

SSRI (venlafaxine, paroxetine sertraline)

261

Pt with severe mood swings prior to period so bad needs to miss work - dx?

Premenstrual dysphoric d/o
Tx: Paroxetine (paxil)

262

Adrenal cortex

Zona Glomerulosa -> aldosterone
Zona Fasciculata -> corticosteroids
Zona Reiticularis -> Sex steroids
Adrenal Medulla -> Epi/norepi

263

Dec'd ACTH

no change aldo, dec corticosteroids, dec sex steroids, no change epi/norepi

264

Inc'd ACTH

inc'd aldo, inc'd corticosteroids, inc'd sex steroids, no change epi/norepi

265

inc'd corticosteroids

dec ACTH, dec sex steroids

266

Congential adrenal hyperplasia

21OH def - dec'd aloserone and cortisol, inc'd sex steroids
17 OH def less common - dec'd cortisol and sex steroids, inc'd aldosterone (mineralocorticoid)

267

Pt with hypopituitarism - started on T4 and prednisone - best way to find out adequacey of adrenal gland

DMS suppression test - stim test

268

Young woman with hirsuitism irreg peridos normal BP - 17OH progesterone level increased - pt has...

17 B hydroxlase def (CAH late onset)

269

Primary Hyperaldo

inc'd BP, dec K, inc aldosterone, dec renin (20:1 aldo:renin)

270

Reninoma

inc'd BP, dec K, inc'd aldo, inc'd renin

271

Hyporeninemic hypoaldo

dec BP inc'd K, dec aldo, dec Renin

272

45yo F routine physical BP 140/110, K 3.3, Cr 0.8, HCO3 27 on ACE, sprionolactone and BB wtd?

hold ace and sprionolactone
screening - paired serum aldo.renin if 20:1 primary hyper aldo
Best dx study
replete K, 2lts n/s over 4 hrs recheck serum aldo

273

42yo checking BP x 6 months - gradual inc - b/s also with HTN, BP 158/101, Na 134, K 2.9 wtd?

Check aldo:renin ratio or 24hr urine aldo

274

Pt dx with primary hyperaldo aldo:renin 20:1 - confirm with suppression test - CT abd wtd?

b/l adrenal vein sampling r/o adenoma vs hyperplasia
Tx Adenoma - surgery
Hyperplasia - spironolactone

275

55yo DM on insulin - BP 95/65, K 5.3, bicarb 20, Cr 2.1 BS 165 etio?

hyporeninemic hypoaldosteronism

276

When is renin low?

Primary hyperaldosteronism
Confirm with ACTH stim test (quick inc in cortisol)
Tx - flucortidsone, low K diet, lasix
(renin high in CHF and with ACEi)

277

Cushing's

pt with prox muscle wk, abd striae, fullness face, swelling back of neck, acne, facial hair irreg menstrual cycles, hyperglycemia wtd?
Med reconcililation

278

Cushing's syndrome w/u

24hr free cortisol in urine >100mcg.day confirms cushings
figure out where excess cortisol coming from
(leading cause pituitary adenoma)

279

Cushings Dz - Pituitary/ectopic

inc'd cortisol/Ucortisol, inc'd DHEA/17 ketosteroid, inc'd ACTH
Tx: Surgery

280

Adrenal adenoma

inc'd cortisol/Ucortisol, dec'd DHEA/17 keto steroid, dec'd ACTH
Tx: Surgery

281

Adrenal Carcinoma

inc'd Cortisol/Ucortisol, very inc DHEA/17 ketosteroid, dec ACTH
Tx: Surgery

282

Exogenous steroids

Dec Cortisol/UCortisol, dec DHEA/17 ketosteroid, dec ACTH
Tx: D/C (taper) steroids

283

25yo 10lb wt gain, amenorrhea, acne, hirsuitism and is irriatable - posterior cervical fullness

check urine free cortisol

284

Pt with elev 24hr urine cortisol - dx with cushings syndrome - ACTH 50 after 8mg dexamethasone suppp ACTH and cortisol suppressed wtd?

MRI brain

285

If MRI neg in cushing's w/u or ACTH can't be suppressed then wtd?

b/l inf petrosal sinus sampling

286

Pt p/w h/o hyperpigmentation, high BP, muscle wk no h/o wt loss - K dec, BS high CT scan - nodule in lung dx?

ACTH producing tumor
Tx Correct K, check cortisol, surgery

287

Pt with ACTH mediated cushing dz - source not localized wtd?

B/L adrenalectomy

288

Pt s/p adrenalectomy for cushings with h/a, hyperpigmentation dx?

Nelson's syndrome - rapid enlargement of pituitary adenoma after removal of b/l adrenal glands
Tx: pituitary irradiation (replace hydrocortisone first)

289

Addison's Dz

Hyperpigmentation esp palmar creases, oral mucosa, wt loss, salt craving n/v/wk, postural hypotension

290

How to confirm addison's dz?

Check cortisol level
18 - pituitary problem - not making ACTH

291

Pt w/ hypotension and shock - dec Na, inc K r/o addisonian crisi

Tx: NS/IV hydrocortisone

292

H/o addison's on hydrocrtisone and fludorcortisone p//w viral URI - no abx presecribed wtd?

Inc hydrocortisone dose

293

Pt dx with hypothyroid and addison's which to treat first?

Give steroids first then thyroxine - otherwise adrenal crisis will occur

294

Pt dx with PNA started on ceft and azithro - h/o asthma with exacerbation 1 month ago tx'd with nebs and taping steroids - BP 90/70, orthostatic - IVF began - wtd?

hydrocortisone

295

Pheochromocytoma

Palpitations, sweating, h/a, episodic in nature labile BP
inc'd urinary exc of catecholamines and metabolites - part of MEN II/III

296

Screen/dx Pheo?

24 hr urine metanephrine/catecholamines

297

If pheo >10cm - wtd?

Check Meta Iodine Benzyl Guianine to r/o mets
Tx: surgery

298

Presurgical managment of Pheo

Alpha blockade FIRST with prazosin
then Betablockade with propranolol

299

Adrenal incidentaloma

>4-6cm - inc'd risk of malignancy
<4-6cm - benign

300

W/U of adrenal incidentaloma

Check fxn -
1mg overnight DMS suppression - r/o cushings
Urine catecholam/metabolites - r/o Pheo
Paired renin/Aldo, K levels -> r/o hyperaldosteronism
17 OH ketosteroids - r/o Adrenal CA

301

Therapy for Adrenal incidentaloma

>6cm - surgical removal whether fxn or not
surgical removal
No Sx if <4-6 cm non-fxn and not getting bigger on serial CT

302

Pt with CT scan - 2cm mass on adrenal - BP 148/86, 1mg DMS and 17 OH ket steoid normal wtd?

Check Renin:Aldo level r/o hyperaldosteronism
If BP normal check urine for catecholamines

303

Pt with 3cm mass on adrenal - all hormones within normal limits wtd?

Repeat CT in 4-6 months

304

45yo severe h/a not relieved with pain meds - next day stiff neck, fever, double vision - no rash - b/l temporal or homonymou hemianopsia BP 80/60, spinal tap few WBC /RBC - CTH lesion in pituitary/dense lesion in sella dx?

Pituitary apoplexy - bleeding into or compromised blood supply to pituitary usually a/w pitutary tumor
r/o meningits/SAH
Tx: NSx c/s for urgen decompression
Check random cortisol
give IV glucocorticoids

305

25yo post partum with difficult labor and delivery, lost lot of blood, unable to breast feed and no restoration of menses - fatigued, cold intolerance and delayed refelxes - TSH/FSH low dx?

Sheehan's syndrome with hypopituitarism
tx: Replace hydrocortisone first then others....

306

32yo F with new onset severe h/a a/w vsiion changes - BP 90/70 supine and 80 si=ystolic sitting up, HR inc's on sitting up dx?

Lymphocytic hypophysitis
Inflammation of pituitary gland from autoimmunity

307

18yo with h/a, visual distrbance, poor sexual devlopent - urine osmolarity decreased, prolactin inc'd xray dense suprasellar calcification dx?

Craniopharyngioma

308

Male Hypogonadism

Klinefelter's - 47XXY
primary testicular failure small testes, gynecomastia - tall stature, low normal testosterone FSH elev
Kallman's - low FSH
GnRH deficiency and can't smell
Analbolic steroids
muscular with small testes

309

114yo pw small penis and testes - exam with lack of pubertal and axillary hair - testosterone, LH, FSH normal wtd?

reassure - your time will come
Testosterone >350 = normal
200-350 - equivocal
<200 abnormal

310

Man with testosterone <350 wtd?

repeat early AM testosterone

311

Man with testosterone <350, BMI 35 or elderly wtd?

check sex binding globulin - dec'd with obesity and old age
Check FREE testosterone level

312

Man with testosterone <200 wtd?

Check if takes opiod, steroid, hormone tx

313

70yo M with fague - steroids fo rCOPD testosteron 140 etio?

taper steroids - d/c steroids
If can't d/c steroids then testosterone replacement tx

314

Pt asks if testosterone will cause prostate CA

will not change composition of prostate tissue
Can exacerbate prostate CA if present - f/u with PSA

315

Baseline PSA 0.5, after testosterone now PSA 2 wtd?

d/c testosterone and refer for prostate Bx
PSA SHOULD NOT more than DOUBLE with testosterone replacement tx!!

316

Erectile Dysfxn

Hypothal-Pit-Gonadal axis
Prolactinoma
Hypothyroid
Radiatio inducted hypopit
Klinefelters (XXY inc FSH)
Kallman (dec FSH)

Vasc supply - penile brachial index <6

Nerves DM neuropathy - if difficulty accomodating to pupillary reflex they have it

Psychogenic

Drugs - thiazide, SSR TCA, finasteride, BB

317

MC sexual dysfxn

premature ejaculation
Tx SSR, sildenafil

318

Can SSRI cause retrograde ejaculation?

Yes

319

Pt with dec'd libido - testosterond 150 wtd?

check FSH

320

Pt with impotence with normal testosterone

check nocturnal penile tumescence - differentiate psychogenic vs organic
If normal r/o psychogenic or drug causes

321

nocturnal penile tumescence decreased in...

DM neuropathy
Vasc Insuff
HP gonadal axis problem
Prolactinoma
Hypothyroid
Marijuana

322

Mechanism of sildenafil

PDI5 inhib - inc nitric oxide - inc cGMP

323

Married couple comes to you cuz not having kids

Sperm count after 3 days abstinence

324

How to manage ED with pt on nitrates

Penile tumescent devices

325

How soon after using sildenafil or tadalafil can nitrates be used

24 hrs after sildenafil
48 hrs after tadalafil

326

Pt with CP given nitrates and sudden hypotension - had tadafanil 6hrs ago - wtd?

Put in trendelenbureg postion, IVF, phenyephrine (NOT NOREPI)

327

Gynecomastia

Puberty, elderly, obesity, cirrhosis, germ cell tumor Klinfelter's

328

15yo wiht enlargement of breast

uni or b/l - reassurance - related to puberty
Men - unilater breast inc -> bx

329

Pt with c/o decreased libido - decreased nocturnal penil tumescence - received rad to head - FSH 5, LH 4, testosterone 160 prolactin i22 dx?

Gonadotropin deficiency

330

38yo F doing well on fluoxetine for depression unable to achieve orgasm for 2 months wtd?

add or switch to bupropion

331

Primary amenorrhea - Never had menses - web neck, short stature, low setears, intact smell, rudimentary ovaries

Turner syndrome XO

332

Primary amenorrhea no vagina, no uterus, ovaries OK breasts normal

Rokitanksy, kuster huser syndrome 46X

333

Primary amenorrhea with acne, clitoromegaly, hirsuitism no ovaries no breasts

46XY gonadal dysgenesis

334

Primary Amenorrhea wit hatrophic vagina no cervic +breasts, no pubic/axillary hair

Androgen insensitivity syndrome
testes formation in fetus - produces testosterone
No androgen rct so end organ resistance - so get vaginad and uterus as default
since excess testoerone cant work - converted to estrone -> breast formation
Testes undescended - androgen rct coded by X chromasome

335

Primary amenorrhea with anosmia (can't smell) dec LH/FSH

Kallman's syndrome

336

St. John's Wart

OCP failure

337

Bariatric surgery

Now fertile

338

Polycystic Ovarian Dz

Irreg mentstual cycle from puberty, obesity, acne, hirsuitism
inc'd testosterone, inc DHEA, inc LH/FSH ratio>3, hyperglyemia, hyperTGA
Acanthosis nigricans - muddy brown skin in acilla - w/w gastric CA, insulin resistance, obseity, PCO
Tx: anti androgen OCP
Metformin
Spironolactone

339

Premature ovarian failure

Ovary fails - dec'd estradiol, inc FSH first, then in LH
Tx: estrogen replacement

340

Etiology of skin lesions in Vitiligo

Ab vs melanocytes

341

Amenorrhea with galactorreha Prolactin level >200 wtd?

CT /MRI head r/o prolactinoma

342

17 yo amenorrhea BM normal, preg test neg - rx for prg and gets periods - wtd?

reassurance?

343

47yo otherwise regular period with amenorrhea for 2 months wtd?

preg test

344

Young woman on OCP with no breakthru bleed wtd?

preg test

345

Pt stopped taking OCP sever months ago with no menses - preg test neg, LH/FSH normal estrogen challenge no bleed - etiology?

Asherman's syndrome (endometrial adhesions post D&C) or
Uterine synechiae

346

Young marathon runner c/o only couple periods in last year wtd?

no further testing
Tx to get back periods - cut down on excercise
Mechanism - excess exc, inhibits LHRH -> hypogonadotropic hypogonadism

347

Pt asks how to to cut down on bone loss in addition to Ca and Vit D

OCP

348

Hirsuitism

Inc'd DHEA (adrenal) - inc ACTH, inc cortisol, inc'd 17 keto steroids=cushings

349

Pt with hirsuitsim - labs to order?

Testosterone, DHEA (17 OH ketosteroid), urine free cortisol

350

Pt with hirusitism testosterone high, corsol normal wtd?

TVUS for ovaries

351

18yo F with inc'd hair on arms/legs - family with similar hair

no further testing