Endocrinology Flashcards
(96 cards)
1
Q
Hyperprolactinemia: Best initial test in Women
A
Pregnancy test
2
Q
In Endocrinology —-
A
Never start with a scan
3
Q
Hyperprolactinemia: Best initial therapy
A
Dopamine agonist:
Cabergoline OR Bromocriptine
4
Q
Acromegaly:
Best Initial Test
A
IGF-1 level (increased)
5
Q
Acromegaly:
Most Accurate Test
A
Failure of GH to decrease in response to Glucose infusion.
6
Q
Acromegaly:
Most common cause of death
A
CHF, cardiomyopathy
7
Q
Acromegaly:
Best Initial Treatment
A
Transsphenoidal resection of the pituitary
8
Q
Kallmann Syndrome
A
Loss of FSH+LH, Anosmia, Renal agenesis
9
Q
Panhypopituitarism: Most accurate tests
A
- Test effect of Insulin and/or arginine on GH levels (increase in normal person).
- Cortisol and ACTH - test with cosyntropin (ACTH) and Metyrapone (11-hydroxylase inhibitor- deceases cortisol –> increase in ACTH in normal person).
10
Q
Diabetes Insipidus (DI): Best initial test
A
Urine Sodium
11
Q
DI: Most accurate test
A
Water deprivation test
12
Q
Drug of choice for Lithium-induced NDI not resolving after the Lithium is stopped
A
Amiloride
13
Q
SIADH: Mild hyponatremia - Tx
A
Fluid restriction
14
Q
SIADH: Moderate hyponatremia - Tx
A
Saline + loop diuretic
15
Q
SIADH: Severe hyponatremia - Tx
A
Hypertonic saline
16
Q
For SIADH not responding to other treatments
A
ADH antagonists: Conivaptan or Tolvaptan
17
Q
Chronic SIADH - Tx
A
Demeclocycline
18
Q
Hypothyroidism
A
Hyponatremia d/t decreased free water clearance
19
Q
Reidel thyroiditis - Tx
A
Prednisone or Tamoxifen
20
Q
Very painful thyroid gland - diagnosis
A
Subacute thyroiditis
21
Q
Best initial test to detect hyperthyroidism
A
Elevated free T4 level
22
Q
Best initial test to confirm the etiology of hyperthyroidism
A
TSH level (TSH decreased in ALL except for a pituitary adenoma)
23
Q
Graves disease
A
Low TSH, increased radioactive iodine uptake d/t thyroid receptor-stimulating antibodies.
24
Q
Anti-thyroperoxidase antibodies
A
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
