nephrology

Question 1

rx used for gastroparesis

Answer 1

prokinetic metoclopromide, erythromycin, cisapride

Question 2

elevate T4 and low TSH + TPO Ab

Answer 2

Hashimotos thyroiditis, sx tx with Propranolol

Question 3

Medullary thyroid cancer with elevated calcitonin. What more to check?

Answer 3

Could be part of MEN type 2a or 2b, associated with pheo so check urine catecholamines

Question 4

Wt loss, tachycardia, tremor, lid retraction

Answer 4

Thyrotoxicosis - jacks up cardiac system with increased HR, HTN, pulse pressure and output

Question 5

3 types of thyroiditis

Answer 5

chronic autoimmune, painless, subacute

Question 6

Diffuse goiter, + TPO antibody, variable radioiodine uptake

Answer 6

Chronic autoimmune thyroiditis/Hashimoto

Question 7

Hyperthyroid, painful/tender goiter, elevated ESR and CRP, low radioiodine uptake

Answer 7

Subacute thyroiditis

Question 8

Cabergoline, Bromocriptine

Answer 8

Tx of prolactinoma

Question 9

Why check serum protein electrophoresis (SPEP) in hypercalcemia

Answer 9

Would be + in MM

Question 10

Hyperaldosteronism leads to hypo_____

Answer 10

HIGH aldosterone = HYPO kalemia

Aldosterone SAVES SODIUM, PASSES POTASSIU

Question 11

chronic fatigue, weakness, weight loss, hypotension, hyperpigmentation/vitiligo, hyponatremia, and hyperkalemia with a low-normal cortisol level

Answer 11

primary adrenal insufficiency/ Addison disease

Question 12

A girl comes in for a near syncopal event and is found to be hypotensive with hyperpigmentation in palmar creases. Labs show low sodium and high potassium. What test should you do to confirm the diagnosis?

Answer 12

Likely primary adrenal insufficiency/addison disease - ACTH test

Question 13

Test for acromegaly

Answer 13

IGF-1

Question 14

Tx for hyperprolactinemia

Answer 14

Dopamine agonist - Cabergoline or Bromocriptine

Question 15

Suspect hypothyroidism, what is the most likely causes

Answer 15

Haushimoto Thyroiditis

Question 16

5 causes of HYPERthyroidism

Answer 16

Graves disease
Subacute thyroiditis
Painless "silent" thyroiditis
Exogenous thyroid hormone use
Pituitary adenoma

Question 17

Hyperthyroidism + proptosis and myxedema + elevated uptake or RAI

Answer 17

GRAVES DISEASE

Question 18

Hyperthyroidism + tender thyroid

Answer 18

Subacute thyroiditis

Question 19

MEN1

Answer 19

Pituitary Adenomas
Primary Hyperparathyroidism
Pancreatic/gastrointestinal neuroendocrine tumors

Question 20

Symptoms of primary hyperparathyroidism

Answer 20

hypercalcemia - polyuria, kidney stones, decreased bone density

Question 21

Types of Pancreatic/GI neuroendocrine tumors in MEN1

Answer 21

Gastrinoma
Insulinoma
VIPoma
Glucagonoma

Question 22

A woman with known chronic hypotension and hyperpigmented skin comes in with abdominal pain, shock, fever, AMS

Answer 22

Acute adrenal crisis in PAI

Question 23

Hyperthyroid sx + tender thyroid + postviral + low radioiodine uptake

Answer 23

Subacute thyroiditis

Question 24

Why increase levo dose in women on estrogen containing BC, HRT, or pregnant?

Answer 24

Estrogen increases TBG decreasing the effective amount of thyroid

Question 25

Irregular menses + hirsutism + weight gain

Answer 25

PCOS - weight loss, birth control, clomid

Question 26

Fatigue, delayed reflexes, myalgias, proximal muscle weakness, elevated serum CK and ESR

Answer 26

hypothyroid myopathy

Question 27

Pt has hypercalcemia - what lab to follow?

Answer 27

PTH to determine if hypercalcemia is PTH dependent or independent

Question 28

Acute or severe illness + fall in total and free T3 levels with normal T4 and TSH

Answer 28

Euthyroid sick syndrome, "low T3 syndrome"

Question 29

Medullary thyroid cancer, pheochromocytoma, marfanoid habitus, mucosal neuromas

Answer 29

MEN 2B

Question 30

Are pts with chronic lymphocytic Hashimoto thyroiditis at increased risk for Thyroid lymphoma?

Answer 30

Yep

Question 31

HTN, mild hypernatremia, metabolic alkalosis, suppressed plasma renin activity, +/- hypokalemia

Answer 31

primary hyperaldosteronism - hypokalemia sometimes doesn't present until diuretic use

Question 32

proximal muscle weakness, muscle atrophy, hyper/hypothyroid symptoms

Answer 32

thyroid myopathy

Question 33

List two rxs that can be used for tx of hyperaldosteronism

Answer 33

eplerenone and spironolactone - block the effects of aldosterone

Question 34

A pt has cushinoid appearance and has been using glucocorticoids chronically for years. Is it likely that this person has HPA disturbance with resultant central adrenal insufficiency?

Answer 34

Yes - measure morning cortisol (low) and ACTH (low)

Question 35

What do you expect ACTH and Aldosterone to be in central vs primary adrenal insufficiency?

Answer 35

``` central = low ACTH and normal Aldosterone primary = high ACTH and low Aldosterone ```

Question 36

Low K, high Na, high HCO3, high Aldo, low renin

Answer 36

primary hyperaldosteronism

Question 37

Does hyperaldosteronism lead to metabolic alkalosis

Answer 37

yes

Question 38

how to differentiate large vs small nerve injury in DM

Answer 38

``` small = positive symptoms like pain, paresthesias, allodynia large = negative symptoms like numbness, loss of proprioception and vibration, diminished ankle reflexes ```

Question 39

test to differentiate central vs peripheral DI

Answer 39

demospressin after water restriction

Question 40

3 different tests to use in initial evalution of Cushing syndrome

Answer 40

confirm hypercortizolism: late-night salvary cortisol assay 24 hr urine free cortisol measurement overnight low-dose dexamethasone test