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Step 2 CK > First Aid Endo > Flashcards

First Aid Endo Flashcards

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1
Q

dx? a young pt with family hx of medullary thyroid cancer?

A

MEN2A or 2B

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2
Q

two contraindications for metformin?

A
  1. in the elderly more than 80

2. renal insufficiency

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3
Q

what is 3’ hyperparathyroidism?

A

long standing 2’ hyperparathyrodism that leads to hyperplasia of the PTH glands and when one ore more gland becomes autonomous.

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4
Q

who often get 3’ hyperparathyroidism?

A

dialysis pts

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5
Q

what is the cause for 2’ hyperparathyroidism?

A

inc PTH due to renal insufficiency leading to dec production of 1-25 dihydroxyvitamin D

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6
Q

what is Addison’s dz?

A

loss of Sodium retaining/K+ and H+ secreting aldosterone

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7
Q

electrolytes abnormalities in Addison?

A
  1. hyponatremia
  2. hyperkalemia
  3. nonanion gap acidosis
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8
Q

the diff btw 1’ and 2’ adrenal insufficiency?

A

1’ AI is associated with inc skin pigmentation, low glucocorticoids, and low mineralocorticoids, whereas 2’ AI is only associated with low glucocorticoids and does not have skin pigmentation or hyperkalemia

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9
Q

What are the 4S of adrenal crisis management?

A

Salt (0.9% saline), Steroids (IV hydrocortisone 100 mg every 8 hrs), Support, Search for underlying illness

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10
Q

2 ways to diagnose Adrenal Insufficiency?

A
  1. 8 am plasma cortisol levels and ACTH levels –> less than 3 ug/dl is diagnostic
  2. synthetic ACTH stimulation (cosyntropin) test –> failure of cortisol to rise > 20 ug/dl following ACTH administration confirms the diagnosis
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11
Q

side effects of abrupt withdrawal from steroids?

A

2’ hypoadrenalism –> unable to amount appropriate response to ACTH –> result in renal failure, hypotension, and hyponatremia

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12
Q

what is Somogyi effect?

A

reactive hyperglycemia following hypoglycemia

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13
Q

what is the value of A1c for DM?

A

more than 6.5%

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14
Q

what drug can cause Somogyi effect?

A

too much NPH insulin given at night –> hypoglycemia –> leads to reflex hyperglycemia (need to dec insulin at night to prevent this)

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15
Q

dx? a boy with normal TSH, but with significant intellectual disability, motor spasticity, and abnormal gait. Also the child is deaf and mute

A

maternal iodine def during early pregnancy

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16
Q

how do you diagnose diabetes insipidus?

A

by water deprivation test

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17
Q

what type of malignancy can lead to diabetes insipidus?

A

breast cancer

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18
Q

what is the work-up for diabetes insipidus?

A
  1. water deprivation test
  2. if urine is still dilute –> desmopressin is given
  3. If desmopressin leads to diluted urine –> nephrogenic urine (if not, central DI)
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19
Q

zollinger ellison syndrome is associated with what kind of MEN?

A

MEN1

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20
Q

clinical hallmarks of MEN1?

A
  1. pituitary adenoma
  2. hyperparathyroidism
  3. pancreatic tumors
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21
Q

features of Sarcoidosis?

A 
GRUELING
Granulomas
aRthritis
Uveitis
Erhythema nodosum
Lymphadenopathy in hilar
Interstitial fibrosis
Neg TB test
Gammaglobulinemia
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22
Q

what is the definitive test for sarcoidosis?

A

biopsy –> noncaseating granulomas

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23
Q

imaging features for asbestosis?

A

linear opacities at lung base and interstitial fibrosis, calcified pleural plaques

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24
Q

imaging features for silicosis?

A

eggshell calcification

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25
mech of hypercalcemia in sarcoidosis?
hypercalcemia 2' to inc production 1, 25 (OH)2 vitamin D by macrophages within granulomas
26
during pregnancy what is the level of TBG, T4, total thyroxine, and T3 resin uptake?
high TBG b/c of high estrogen inc total thyroxine normal free T4 dec T3-resin uptake
27
diagnostic for central DI?
response to exogenous ADH --> resultant increases in urine osmolarity (50% over baseline)
28
causes for central DI?
head trauma, malignancies that compresses pituitary, granulomatous/inflammatory process
29
what are the infectious agents that can cause primary adrenal insufficiency?
CMV, TB especially in immunecompromised pts
30
treatment for primary AI?
hydrocortisone + fludrocortisone
31
Name some clinical symptoms of hypothyroidism?
carpel tunnel syndrome cardiovascular manifestations: angina, signs of bradycardia, hypotension, rarely cardiomegaly with associated effusion or "myxedema heart."
32
clinical signs for primary hyperparathyroidism?
1. pathologic fracture 2. subperiosteal erosions 3. elevated levels of both calcium and parathyroid hormone
33
most common cause of primary hyperparathyroidism?
solitary parathyroid adenoma
34
what are the criteria for parathroidectomy for hyperparathyroidism?
1. > 1mg/dL above upper limit 2. inc creatinine 3. dec Bone Mineral Density
35
name the 4 antibodies associated with type 1 DM?
1. anti-islet cell 2. anti-glutamic acid decarboxylase (GAD) 3. anti-insulin 4. anti-Zn transporter
36
dx? postprandial hypoglycemia, abdominal bloating in pts with long standing DM?
gastroparesis = autonomic neuropathy
37
treatment for bilateral adrenal hyperplasia?
medical management with spironolactone
38
treatment for unilateral adrenal hyperplasia?
surgical resection (adrenalectomy)
39
clinical symptoms of aldosterone-secreting tumor?
1. elevated urine aldosterone level 2. hypernatremia 3. hypokalemia
40
dx? a pt with DM and hyperthyroidism comes in with comatose with high fever, flushing, sweating, marked tachycardia, a fib.
thyroid storm
41
treatment for thyroid storm?
1. aggressive cooling: cooling blankets, acetaminophen 2. IV esmolol 3. corticosteroid 4. anti-thyroid drugs (PTU, methimazole) 5. high dose potassium iodide
42
treatments for solitary toxic adenoma (hot nodule)?
radioactive iodine
43
treatments for toxic adenoma that is cold nodule?
thyroidectomy
44
clinical symptoms of addison dz?
weight loss, dizziness, dehydration, anorexia, weakness, and increased skin pigmentation
45
when is high dose dexamethasone suppression test useful?
to confirm Cushing syndrome from ectopic ACTH production (small cell lung cancer)
46
when is low does dexamethasone suppresstion test useful?
to rule out Cushing. If low dose dexa suppresses cortisol, then it is NOT Cushing.
47
what are clinical signs of hypocalcemia?
weakness, dry skin, alopecia, circumoral numbness, paresthesia
48
for diabetes, what is an indication that the pt needs to be started on another 1st line agent?
pts with HbA1c > 7.5 at time of diagnosis after 3 months of metformin monotherapy
49
other than small cell lung cancer, what other cancer can cause Cushing?
hypercortisolism can be due to ectopic ACTH secretion by a bronchial tumor.
50
1st and 2nd line treatment for ACTH producing tumor?
1. surgical resection | 2. adrenal enzyme inhibitors such as ketoconazole, metyrapone, aminoglutethimide
51
lab features of Pseudohypoparathyroidism?
hypocalcemia, hyperphosphatemia, elevated intact PTH level
52
explain the reason of subclinical hyperthyroidism in early pregnancy
b/c human chorionic gonadotropin is a weak stimulator of the TSH receptor, causing excess production of thyroid hormone and subsequent decline in TSH due to neg feedback on the pituitary
53
lab findings of familial hypocalciuric hypercalcemia (FHH)?
hypercalcemia, hypocalciuria, mild hypermagnesemia
54
how can Familial hypocalciuric hypercalcemia (FHH) be differentiated from primary hyperparathyroidism?
1. PTH may be elevated or normal, but not to the same degree as in pts with primary hyperparathyroidism 2. presence of hypercalcemia in multiple family members, especially young children.
55
clinical signs for adrenal insufficiency?
1. hypovolemic shock --> hypotension, tachcardia, changes in mental status, dry mucous membrane 2. nausea, vomiting, flank pain, fever
56
dx? pts with elevated thyroid hormone levels in the presence of normal thyroid gland
Struma ovarii (ovarian tumor)
57
what vitamin supplement should an infant being breast fed be given?
Vitamin D
58
5 indications for urgent hemodialysis?
AEIOU ``` Acidosis life threatening Electrolyte abnormalities toxic Ingestion fluid Overload symptoms of Uremia ```
59
dx? hypothermia, bradycardia, hypotension, hypoglycemia, hyponatremia (can be precipitated by illness, ischemic insult)
myxedema coma
60
treatment for myxedema coma?
levothyroxine, triiodothyronine

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