endocrinology

Question 1

Hyperthyroidism
etiology
primary (dec TSH)

Answer 1

Graves disease (antibody against TSH receptor)
Plummers disease: Multinodular toxic goiter. Hyperfuctioning areas that produce high T3 and T4 –> dec TSH –> atrophy of rest. Have + anti peroxidase and anti thyroglobulin antibodies
subacute thyroiditis

Question 2

Hyperthyroidism
etiology
secondary (inc TSH)

Answer 2

pititary adenoma, hypothalamic disease, germ cell tumor, strauma ovarii, metastatic follicular thyroid carcinoma

Question 3

Clinical of hyperthyroidism

Answer 3

Heat intolerance, tachycardia, sweating, weight loss despite inc appatite. hand tremor, hyperactivity, nervousness, insomia, irritability, diarrhea, palpitation, muscle weakness.
exopthalmos, arrhythmia, increased BP, pretibial myxedema:

Question 4

hyperthyroidism diagnosis

Answer 4

dec if primary, inc if secondary, TSH, T3, T4. Radioactive T3 uptake, scintiography = diffuse uptake in graves and patchy in multinodular toxic (plummer disease)

Question 5

Treatment

Answer 5

Methimazole (contraindicated in pregnancy), and propylthiouracil. (inhibit thyroid hormone synthesis). B-blocker, Radioiodine 131.

Question 6

special symptoms for graves disease

Answer 6

Goiter, bruits, exophtalmos, pertibial myxedema.

Question 7

what is thyroid storm

Answer 7

life-threatening complication of hypert characterized by fever, tachycardia, agitation, psychosis, confusion, NVD. precipitated by infections, DKA, stress: birth, trauma, surgery. Treated with ptu + iodine, b-blocker, dexamethasone (inhibits T3–> T4)

Question 8

Painful tender thyroid gland

Answer 8

Subacute thyroiditis. usually follow a viral ille ness –> hypert –> eu –> hypot. Low radioiodine uptake. t: NSAIDS + aspirin +- corticosteroids.

Question 9

Hypothyroidism

Answer 9

Primary: failure of gland to produce hormone: Hashimoto´s disease (MC, antimicrosomal ab), iatrogenic: prior tx of hyperthyroidism:radioiodine, thyroidectomy, medications.
Secondary: pituitary (low TSH) or hypothalamic (low TRH)

Question 10

Clinical feature of hypothyroidism:

Answer 10

fatigue, weakness, lethargy, weight gain, cold intolerance, CONSTIPATION, depression, muscle weakness. goiter, bradycardia, carpal tunnel syndrome, coarse hair, hoarsness, nonpitting edema.

Question 11

Diagnosis of hypthyroidism

Answer 11

High TSH if primary, or low TSH if secondary or tertiary. Low free T4. Hashimoto: inc antimicrosomal an. inc LDL

Question 12

Tx of hypothyroidism

Answer 12

Levoxine. effect is evident 2-4 w, one daily, monitor TSH levels.

Question 13

Subclinical hypothyroidism

Answer 13

inc TSH and T4 is normal. mild symptoms of hypothyroidism. look for elevated LDL!!!

Question 14

TPO and TG antibody found in which disease

Answer 14

Hashimoto

Question 15

Addisons disease: ethiopathogenesis,

Answer 15

Addisons = primary adrenal insufficency. Causes: autoimmune, infectious (TB), iatrogenic (bilateral adrenalectmy), metastatic (breast, lung)

Question 16

Addisons disease

clinical

Answer 16

GI symp, mental symptoms, hypoglycemia, hyperpigemntation, low aldosterone leading to hyponatremia and hyperkalemia.

Question 17

Addisons disease

Dx

Answer 17

decreased cortisol level, lack of response to infusion wit synthetic ACTH. MRI of brain to rule out hyperparathyroidism.

Question 18

Tx of Addisons disease

Answer 18

daily oral glucocorticoid and mineralocorticoid

Question 19

Thyroid cancer ssx

Answer 19

suggested if nodue is fixed in place and no movement on swallowing. firm consistancy and irregularity, solitary, Hx of radiation to neck, vocal cord paralysis, cervical adenopathy, FH or elevated serum calcitonin

Question 20

Dx and types of thyroid cancer

Answer 20

USG guided FNA Thyroid scan (cold nodule)

Types: papillary (radiation), follicular, medullary (produce calcitonin), anaplastic.

Question 21

Pheochromocytoma: clinical picture, dx ddx tx

Def

Answer 21

Pheochromocytoma: Tumors that produce, store and secrete cathecholamine. Arise from chromaffins cell of the adrenal medulla (90%) and or symp ganglia.

Question 22

Pheochromocytoma clinical

Answer 22

HTN, punding headache, sweating, tachycardia, palpitation, anxiety

Question 23

Pheochromocytoma dx

Answer 23

LAB: hyperglycemia, hyperlipidemia, hypokalemia, Urine: metanephrine, vanillylmadelic acid

Question 24

Type 1 diabetes mellitus: def

Answer 24

is an autoimmune disease, that destroyd B cells of pancreas. This is characterized by severe deficiency of insulin. Onset i typically before 20 yrs, but can occur at an age. Type 1 DM is not related to obesity. Only 5 % of diabetic patients

Question 25

Type 1 diabetes mellitus: diagnosis

Answer 25

Two fasting glucose measurements > 126 mg/dl. Single glucose level of 200 mg/dl with symptoms, Increased glucose levels on oral glucose tolerance testing. HbA1c >6,5 %

Question 26

Ss of DM1

Answer 26

symptoms develop quickly over days to weeks, can occur after an illness. And is often presented as acute DKA

Question 27

SS DM2 (and 1?)

Answer 27

polyuria, polydipsia, fatigue, weight loss, blurred vision, fungal infections. Numbness, tingling of hands and feet.

Question 28

Treatment of DM1

Answer 28

Insulin, adjust dose according to glucose levels. Intensive insulin therapy: long-acting insulin is given once daily in the evening. then regular (fast and short acting) insulin is given 30 min before each meal.

Question 29

Treatment of DM2

Answer 29

Diet, exercise, oral hypoglycemics (usually metformin) start on one drug than add one more from another group if monotherapy fails. Then insulin as last treatment option.

Question 30

DM 2 def:

Answer 30

Ranges from predominantly insulin resistance with relative insulin deficiency to a predominantly insulin secretory defect with insulin resistance secondary to b cell dysfunction. Insulin levels normal to high in the beginning, then diminish over many years of having diabetes.

Question 31

DM2 ethiopatho

Answer 31

obesity is associated with increased plasma level of free fatty acid, which make muscles more insulin resistant, reducing glucose uptake. Therefore, obesity exacerbates insulin resistance.

Question 32

Screening for diabetes type 2

Answer 32

adults over 45 yrs evert 3 years. For those w risk factors: obesity, FHx, Hx of gastational DM. start earlier.

Question 33

Complications of diabetes:

Answer 33

Macrovascular complications: CAD (accelerated rate of atherosclerosis) Peripheral vascular disease. Stroke (cerebrovascular disease) Microvascular: Diabetic nephropathy: = most important cause of ESRD. Proteinuria + HTN Retinopathy, catarac, galucoma. (annulally screening is recommended) Edema of macula is the leading cause of blindness. Distal symmetrical neuropathy.

Question 34

Screening for diabetic nephropathy

Answer 34

MICROALBUMINURIA!!. takes 1-5 yrs before developing proteinuria. Tx: ACEI for BP control.

Question 35

DKA

Answer 35

hyperglycemia, ketosis, and met acidosis.