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Flashcards in Endocrinology Deck (96):
1

Hyperprolactinemia: Best initial test in Women

Pregnancy test

2

In Endocrinology ----

Never start with a scan

3

Hyperprolactinemia: Best initial therapy

Dopamine agonist:
Cabergoline OR Bromocriptine

4

Acromegaly:
Best Initial Test

IGF-1 level (increased)

5

Acromegaly:
Most Accurate Test

Failure of GH to decrease in response to Glucose infusion.

6

Acromegaly:
Most common cause of death

CHF, cardiomyopathy

7

Acromegaly:
Best Initial Treatment

Transsphenoidal resection of the pituitary

8

Kallmann Syndrome

Loss of FSH+LH, Anosmia, Renal agenesis

9

Panhypopituitarism: Most accurate tests

1. Test effect of Insulin and/or arginine on GH levels (increase in normal person).
2. Cortisol and ACTH - test with cosyntropin (ACTH) and Metyrapone (11-hydroxylase inhibitor- deceases cortisol --> increase in ACTH in normal person).

10

Diabetes Insipidus (DI):
Best initial test

Urine Sodium

11

DI: Most accurate test

Water deprivation test

12

Drug of choice for Lithium-induced NDI not resolving after the Lithium is stopped

Amiloride

13

SIADH: Mild hyponatremia - Tx

Fluid restriction

14

SIADH: Moderate hyponatremia - Tx

Saline + loop diuretic

15

SIADH: Severe hyponatremia - Tx

Hypertonic saline

16

For SIADH not responding to other treatments

ADH antagonists: Conivaptan or Tolvaptan

17

Chronic SIADH - Tx

Demeclocycline

18

Hypothyroidism

Hyponatremia d/t decreased free water clearance

19

Reidel thyroiditis - Tx

Prednisone or Tamoxifen

20

Very painful thyroid gland - diagnosis

Subacute thyroiditis

21

Best initial test to detect hyperthyroidism

Elevated free T4 level

22

Best initial test to confirm the etiology of hyperthyroidism

TSH level (TSH decreased in ALL except for a pituitary adenoma)

23

Graves disease

Low TSH, increased radioactive iodine uptake d/t thyroid receptor-stimulating antibodies.

24

Anti-thyroperoxidase antibodies

Hashimoto thyroidits

25

Antithyroglobulin antibodies

Subacute thyroiditis

26

Pregnant woman with hyperthyroidism - Drug Tx

Propylthiouracil (NOT Methimazole)

27

Major Side effect of Both PTU and Methimazole is -

Neutropenia / agranulocytosis

28

Best initial step in the management of a Thyroid Nodule is -

TFTs (TSH, T4)

29

For thyroid nodule - when is radioactive iodine scan as a diagnostic test the answer?

NEVER!!!!!!

30

For thyroid nodule - when is biopsy the answer?

ALWAYS - for a nodule that is not hyperfunctioning!

31

For thyroid nodule - when is thyroid US the answer?

To guide the placement of the biopsy needle.

32

What is the answer when the words "follicular neoplasm" are in the question?

Surgery for removal of the entire nodule!

33

The most common type of thyroid cancer

Papillary carcinoma

34

The most common thyroid cancer associated with history of radiation is -

Papillary carcinoma

35

Thyroid cancer with the worst prognosis -

Anaplastic carcinoma (Older people)

36

Medullary carcinoma associated with

MEN II syndrome

37

The type of thyroid cancer associated with Calcitonin -

Medullary carcinoma

38

A high calcium level in an otherwise healthy person -

Hyperparathyroidism

39

Hypercalcemia: EKG finding

Short QT interval

40

Hypocalcemia: EKG finding

Prolonged QT interval

41

Best initial therapy for severe hypercalcemia is -

Normal saline at very high volume

42

Calcium still high after saline infusion. Most appropriate next step in management -

Calcitonin

43

Hypercalcemia: Line of Tx-

Saline ---> Calcitonin ----> Bisphosphonates (Pamidronate or Zolendronate)

44

Primary hyperparathyroidism

Increased PTH and Ca levels BUT decreased Phosphate level

45

Vitaminosis D

Both increased Ca and PO4 levels

46

Unusual causes of hypocalcemia -

1. Hypomagnesemia (prevents PTH release)
2. Hypophosphetemia (increased binding of calcium)
3. Rhabdomyolysis (damaged muscle binds free calcium)

47

Hypocalcemia associated with Blood transfusion reason?

Citrate (anticoagulant) in stored blood for transfusion chelates calcium (thus prevents blood from clotting during storage).

48

Chvostek sign (hypocalcemia)

facial spasm on tapping the facial N.

49

Trousseau sign (hypocalcemia)

carpal spasm with occlusion of brachial artery with a BP cuff.

50

Autoimmune hypoparathyroidism is associated with -

Vitiligo, Addison disease, Hashimoto thyroiditis, Type 1 DM

51

Pseudohypoparathyroidism -

Abnormal G-protein attached to the PTH receptor. The PTH will bind but there will be no effect.
Hypocalcemia, hyperphosphetemia with high PTH level

52

Mechanism for low free calcium (normal total calcium) associated with anxiety and panic attack?

Anxiety and panic attack ---> hyperventilation ---> respiratory alkalosis ---> H+ ions removed from albumin ---> and then replaced on the albumin with calcium (another cation) ---> decreased free calcium!

53

Type 1 DM: Best initial therapy -

A combination of long-acting insulin (glargine) and rapid acting insuline (apsart, lispro, glulisine).

54

Type 2 DM: Best initial management -

Diet, exercise and weight loss

55

Type 2 DM: Best initial drug therapy -

Metformin

56

Type 2 DM: Not controlled with and/or contraindication to metformin: most appropriate next step in management -

Sulfonylureas

57

Metformin

does not increase insulin levels ---> no hypoglycemia and no weight gain

58

Sulfonylureas

increase insulin release ---> cause hypoglycemia and weight gain

59

Rosiglitazone and Pioglitazone contraindication (CI) -

cause Fluid Overload therefore beware in CHF. They increase edema and risk of CHF exacerbation.

60

Metoformin CI ---?

Renal insufficiency. There is a risk of metabolic acidosis.

61

Sulfonylureas side effect --?

SIADH

62

Any procedure that requires iodinated contrast in diabetics --

STOP Metformin! contrast agent ---> renal insufficiency ---> precipitation of metabolic acidosis b/c of metformin (causes lactic acidosis).

63

Metformin side effect --?

Lactic acidosis

64

Alpha-glucosidase inhibitors (acarbose, miglitol) side effects --?

Flatulence, diarrhea and abdominal pain

65

What would you expect after the start of an ACE-I or ARB for the treatment of microalbuminuria?

A small increase in creatinine; ACE-I or ARB ---> dilation of efferent arterioles ---> decreased GFR ---> increased creatinine!

66

For the treatment of microalbuminurea (diabetic nephropathy), if both choices (ACE-I and ARB) are in the anwer, then choose ---?

ACE inhibitor.

67

The goal of LDL in diabetic patients is --?

100 mg/dL or lower

68

The goal of LDL in DM + CAD ---?

70 mg/dL or lower

69

The goal of BP in DM patients is ---?

Below 130/80 mmHg

70

Proliferative retinopathy associated with DM --Tx?

Laser photocoagulation

71

Proliferative retinopathy associated with DM -- Drug therapy?

VEGF inhibitors - ranibizumab, bevacizumab

72

If cranial nerves are involved, the most common CN involvement in DM?

III - Oculomotor N.

73

DM gastroparesis: Most accurate test

A barium/nuclear gastric emptying study

74

DM gastroparesis: Best initial therapy

Metoclopramide OR Erythromycin

75

The most accurate way to assess the severity of DKA is --?

Sr. HCO3, pH, and anion gap

76

DKA: Best initial therapy?

High volume fluids (normal saline) and IV insulin. Add potassium to fluids when the K levels comes to a normal value.

77

Hypercortisolism: Best initial test

24 h urine cortisol

78

Confirm the etiology of hypercortisolism?

ACTH level

79

Confirm the etiology of hypercortisolism in a person with an elevated ACTH?

High dose dexamethasone suppression test

80

Elevated ACTH, suppression with high dose dexamethasone but no lesion on pituitary MRI. The most appropriate next step in management ---?

Inferior petrosal sinus sampling after giving CRH

81

In the question stem on Addison disease look for ---

a mention of "salt craving" in the case, such as "drinking pickle juice".

82

Adrenal insufficiency (Addison disease): Most accurate test?

Cosyntropin (artificial ACTH) stimulation test

83

Cushing syndrome (hypercortisolism) ---

Low potassium, high BP, high glucose, relative neutrophilia, metabolic alkalosis

84

Addison disease (hypoadrenalism) ---

high potassium, low BP, low glucose, eosinophilia, metabolic acidosis

85

Pheochromocytoma: best initial test?

24 h urine for metanephrines and catecholamines

86

Pheochromocytoma diagnostic work-up flow ----

24 h urine for metanephrines and catecholamines ---> CT abdomen ---> if no lesion found ---> MIBG scan

87

Pheochromocytoma Tx work-up flow ---

Phenoxybenzamine (alpha-blockade) ---> Propranolol (beta-blockade) ---> surgery

88

HTN + hypokalemia

Hyperaldosteronism

89

Hypokalemia associated common symptoms--

muscle weakness and fatigue (K+ is necessary for normal muscular contraction)

90

Primary hyperaldosteronism: most accurate test

failure of suppression of aldosterone levels in response to salt loading

91

The most common cause of primary hypogonadism?

Klinefelter syndrome

92

Antiandrogenic drugs or therapy?

MOPP/ABVD therapy for lymphoma, Ketoconazole, Spironolactone (high dose), Heroin addiction

93

Prolactinoma diagnosis work up --

Check for medications (e.g. DA antagonists) ---> TSH level ---> Prolactin level ---> MRI

94

Acromegaly diagnosis work-up ---

IGF-1 level ---> Glucose suppression test ---> MRI

95

Acute Panhypopituitarism diagnosis --

Cortisol and T4 levels

96

Chronic Panhypopituitarism --

Insulin stimulation test , vasopressin stimulation test ---> MRI