Flashcards in Endocrinology Deck (96):
Hyperprolactinemia: Best initial test in Women
In Endocrinology ----
Never start with a scan
Hyperprolactinemia: Best initial therapy
Cabergoline OR Bromocriptine
Best Initial Test
IGF-1 level (increased)
Most Accurate Test
Failure of GH to decrease in response to Glucose infusion.
Most common cause of death
Best Initial Treatment
Transsphenoidal resection of the pituitary
Loss of FSH+LH, Anosmia, Renal agenesis
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).
Diabetes Insipidus (DI):
Best initial test
DI: Most accurate test
Water deprivation test
Drug of choice for Lithium-induced NDI not resolving after the Lithium is stopped
SIADH: Mild hyponatremia - Tx
SIADH: Moderate hyponatremia - Tx
Saline + loop diuretic
SIADH: Severe hyponatremia - Tx
For SIADH not responding to other treatments
ADH antagonists: Conivaptan or Tolvaptan
Chronic SIADH - Tx
Hyponatremia d/t decreased free water clearance
Reidel thyroiditis - Tx
Prednisone or Tamoxifen
Very painful thyroid gland - diagnosis
Best initial test to detect hyperthyroidism
Elevated free T4 level
Best initial test to confirm the etiology of hyperthyroidism
TSH level (TSH decreased in ALL except for a pituitary adenoma)
Low TSH, increased radioactive iodine uptake d/t thyroid receptor-stimulating antibodies.
Pregnant woman with hyperthyroidism - Drug Tx
Propylthiouracil (NOT Methimazole)
Major Side effect of Both PTU and Methimazole is -
Neutropenia / agranulocytosis
Best initial step in the management of a Thyroid Nodule is -
TFTs (TSH, T4)
For thyroid nodule - when is radioactive iodine scan as a diagnostic test the answer?
For thyroid nodule - when is biopsy the answer?
ALWAYS - for a nodule that is not hyperfunctioning!
For thyroid nodule - when is thyroid US the answer?
To guide the placement of the biopsy needle.
What is the answer when the words "follicular neoplasm" are in the question?
Surgery for removal of the entire nodule!
The most common type of thyroid cancer
The most common thyroid cancer associated with history of radiation is -
Thyroid cancer with the worst prognosis -
Anaplastic carcinoma (Older people)
Medullary carcinoma associated with
MEN II syndrome
The type of thyroid cancer associated with Calcitonin -
A high calcium level in an otherwise healthy person -
Hypercalcemia: EKG finding
Short QT interval
Hypocalcemia: EKG finding
Prolonged QT interval
Best initial therapy for severe hypercalcemia is -
Normal saline at very high volume
Calcium still high after saline infusion. Most appropriate next step in management -
Hypercalcemia: Line of Tx-
Saline ---> Calcitonin ----> Bisphosphonates (Pamidronate or Zolendronate)
Increased PTH and Ca levels BUT decreased Phosphate level
Both increased Ca and PO4 levels
Unusual causes of hypocalcemia -
1. Hypomagnesemia (prevents PTH release)
2. Hypophosphetemia (increased binding of calcium)
3. Rhabdomyolysis (damaged muscle binds free calcium)
Hypocalcemia associated with Blood transfusion reason?
Citrate (anticoagulant) in stored blood for transfusion chelates calcium (thus prevents blood from clotting during storage).
Chvostek sign (hypocalcemia)
facial spasm on tapping the facial N.
Trousseau sign (hypocalcemia)
carpal spasm with occlusion of brachial artery with a BP cuff.
Autoimmune hypoparathyroidism is associated with -
Vitiligo, Addison disease, Hashimoto thyroiditis, Type 1 DM
Abnormal G-protein attached to the PTH receptor. The PTH will bind but there will be no effect.
Hypocalcemia, hyperphosphetemia with high PTH level
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!
Type 1 DM: Best initial therapy -
A combination of long-acting insulin (glargine) and rapid acting insuline (apsart, lispro, glulisine).
Type 2 DM: Best initial management -
Diet, exercise and weight loss
Type 2 DM: Best initial drug therapy -
Type 2 DM: Not controlled with and/or contraindication to metformin: most appropriate next step in management -
does not increase insulin levels ---> no hypoglycemia and no weight gain
increase insulin release ---> cause hypoglycemia and weight gain
Rosiglitazone and Pioglitazone contraindication (CI) -
cause Fluid Overload therefore beware in CHF. They increase edema and risk of CHF exacerbation.
Metoformin CI ---?
Renal insufficiency. There is a risk of metabolic acidosis.
Sulfonylureas side effect --?
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).
Metformin side effect --?
Alpha-glucosidase inhibitors (acarbose, miglitol) side effects --?
Flatulence, diarrhea and abdominal pain
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!
For the treatment of microalbuminurea (diabetic nephropathy), if both choices (ACE-I and ARB) are in the anwer, then choose ---?
The goal of LDL in diabetic patients is --?
100 mg/dL or lower
The goal of LDL in DM + CAD ---?
70 mg/dL or lower
The goal of BP in DM patients is ---?
Below 130/80 mmHg
Proliferative retinopathy associated with DM --Tx?
Proliferative retinopathy associated with DM -- Drug therapy?
VEGF inhibitors - ranibizumab, bevacizumab
If cranial nerves are involved, the most common CN involvement in DM?
III - Oculomotor N.
DM gastroparesis: Most accurate test
A barium/nuclear gastric emptying study
DM gastroparesis: Best initial therapy
Metoclopramide OR Erythromycin
The most accurate way to assess the severity of DKA is --?
Sr. HCO3, pH, and anion gap
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.
Hypercortisolism: Best initial test
24 h urine cortisol
Confirm the etiology of hypercortisolism?
Confirm the etiology of hypercortisolism in a person with an elevated ACTH?
High dose dexamethasone suppression test
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
In the question stem on Addison disease look for ---
a mention of "salt craving" in the case, such as "drinking pickle juice".
Adrenal insufficiency (Addison disease): Most accurate test?
Cosyntropin (artificial ACTH) stimulation test
Cushing syndrome (hypercortisolism) ---
Low potassium, high BP, high glucose, relative neutrophilia, metabolic alkalosis
Addison disease (hypoadrenalism) ---
high potassium, low BP, low glucose, eosinophilia, metabolic acidosis
Pheochromocytoma: best initial test?
24 h urine for metanephrines and catecholamines
Pheochromocytoma diagnostic work-up flow ----
24 h urine for metanephrines and catecholamines ---> CT abdomen ---> if no lesion found ---> MIBG scan
Pheochromocytoma Tx work-up flow ---
Phenoxybenzamine (alpha-blockade) ---> Propranolol (beta-blockade) ---> surgery
HTN + hypokalemia
Hypokalemia associated common symptoms--
muscle weakness and fatigue (K+ is necessary for normal muscular contraction)
Primary hyperaldosteronism: most accurate test
failure of suppression of aldosterone levels in response to salt loading
The most common cause of primary hypogonadism?
Antiandrogenic drugs or therapy?
MOPP/ABVD therapy for lymphoma, Ketoconazole, Spironolactone (high dose), Heroin addiction
Prolactinoma diagnosis work up --
Check for medications (e.g. DA antagonists) ---> TSH level ---> Prolactin level ---> MRI
Acromegaly diagnosis work-up ---
IGF-1 level ---> Glucose suppression test ---> MRI
Acute Panhypopituitarism diagnosis --
Cortisol and T4 levels