Flashcards in UWorld Endo And Electrolytes Deck (63):
Other causes of Addison disease?
1. Chronic granulomatous infections (histoplasmosis, Coccidioides mycosis)
3. Adrenal metastasis
Most common neuropathy in diabetics?
Symmetrical distal polyneuropathy
Sx of acromegaly? Test?
Arthalgias, HTN, finger swelling, skin tags, carpal tunnel, jaw enlargement
Pt with suspected acromegaly and elevated IGF-1: next step?
Oral glucose tolerance test. (Glucose should decrease GH in normal patients) If inadequate, MRI brain.
If mass - operate
If no mass - look for GHRH secreting tumor
Causes of alkalosis with hypoK and normotension? HypoCl seen in?
1. Vomiting - hypoCl
2. Diuretic use
3. Bartter syndrome
4. Gitelman syndrome
Indications for thyroid functioning tests?
3. Elevated serum muscle enzymes
Use of beta blockers in thyroid disease?
Sx relief in thyrotoxicosis
Sestamibi scan - follow up?
Purpose: to localize PTH adenoma
Neg with many abnormal glands: bilateral neck exploration
Equivocal scan: bilateral neck exploration
Positive scan with 1 adenoma: parathyroidectomy with radio guidance
Elevated testosterone hormone with normal DHEAS versus elevated DHEAS with normal testosterone?
Ovarian versus adrenal source of excess androgen production
Screening test for congenital adrenal hyperplasia?
Suspected pagent's disease: two tests to order?
1. Serum alk phos
2. Urinary analysis for telopeptides, hydroxyproline, and deoxypyridinoline (Marker of bone resorption)
Most likely cause of death in acromegaly?
Congestive heart failure
Teaticular tumors with increased bata-hCG? Increase in only AFP? increase in AFP and beta-hCG?
ChorioCA, yolk-sac tumor, teratomas/non-seminatous germ cell tumor
Adverse effect of PTU and methimazole?
Adverse effect of radioiodine ablation?
Adverse effect of thyroidectomy?
Worsening of Ophthalmopathy
Recurrent laryngeal nerve damage
Contraindications of radioactive iodine tx?
Pregnancy and severe ophthalmopathy
Type of lung cancer associated with hypercalcemia?
Squamous (sCa++mous) cell carcinoma
Differential diagnosis for anterior mediastinal mass?
Pt with hashimoto's thyroiditis is at a higher risk for developing?
Bartter's syndrome - labs?
2. metabolic alkylosis
3. Elevated urine Cl
4. Normal BP
Pt with suspected adrenal insufficiency. Must do this test?
Cosyntropin stimulation test.
Purpose: Cosyntropin test vs 24 urine cortisol
adrenal insufficiency vs cushings
Distingush between cushing's disease vs ectopic ACTH production?
Dex suppression test.
If cortisol drops, then cushing's disease (pit adenoma)
If cortisol doesn't drop, then ectopic ACTH
Causes of primary hypoPTH?
2. congenital absence of parathyroids
4. defect in Ca sensing receptor
Diuretic abuse: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
high>20, up, up, down, up, low/normal
Vomiting: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
low<10, up, up, down, up, low/normal
Bartter/Gitelmann: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
very high>40, up, up, down, up, normal
Primary hyperALDO: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
very high>40, down, up, down, up, up
Renin-secreting tumor: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
very high>40, up, up, down, up, up
factitious diarrhea: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?
low<10, up, up, down, up, low/normal
HypoNa Ddx if normal serum osmolarity?
HypoNa Ddx if serum osm>295?
hyperglycemia, radiocontrast, mannitol
HypoNa Ddx if hypovolemic, with Urine Na <10?
Nonrenal salt loss (vomiting, diarrhea, dehydration)
HypoNa Ddx if hypovolemic with urine Na >20?
Renal salt loss (diuretics, ACE-Is, Mineralocorticoid deficiency)
HypoNa Ddx if euvolemic with osm<280 Urine Na 20+ and Uosm less than 300
psychogenic polydipsia, beer potomania
HypoNa Ddx if euvolemic with urine Na >20 and Uosm >300
HypoNa Ddx if osm<280, and hypervolemic?
CHF, cirrhosis, nephrotic syndrome
Non-tumor differentiation between MEN2a and 2b?
elevated PTH (from parathyroid adenoma) vs Marfanoid habitus
Causes of myopathy?
1. Connective tissue disease (polymyositis and dermatomyositis)
2. Endocrine (thyroid and cushings)
3. Neuromuscular (LE, MG)
4. Drugs (steroids)
VIt D toxicity?
constipation, abdominal pain, polyuria, polydipsia
Pt with ED - question to ask?
If organic, possible hormonal causes?
nocturnal erections (to differentiate between psych vs neurological problem)
thyoid, prolactin, testosterone, cushings,
Hashimotos - antibodies?
anti-thyroid peroxidase (anti-TPO)
Management of hypercalcemia?
If symptomatic or calcium >14:
1. Short-term: saline and calcitonin (diuretic only if volume overloaded)
2. Long-term: bisphosphonate (zoledronic acid)
Three of the five:
1. Waist circumference >40 in men >35 in women
2. Fasting glucose >100
3. Blood-pressure >130/80
4. Triglycerides >150
5. HDL <50 in women
Serious side effect of PTU and methinazole? Appropriate management?
Agranulocytosis. Stop drug at any sign of infection and measure white count.
Effect of alkalosis on calcium levels? Mechanisms?
Decreased serum calcium due to increased binding affinity to albumin.
Patient with renal insufficiency. CT shows adrenal calcification – cause?
Treatment for diabetic neuropathy?
TCAs (amitriptyline, desipramine, nortriptyline) > gabapentin > NSAIDs
Endocrine problem that causes eosinophilia?
Signs of panhypopituitary?
ACTH deficiency (hypotension, weight-loss, hypoglycemia, eosinophilia)
Hypothyroid (cold intolerance, dry skin, weak deep tendon reflexes, anemia)
HypoGonadotropin (decreased libido, amenorrhea)
Give diabetics metoclopramide if?
Diabetic neuropathy of the gastrointestinal tract (gastroparesis)
Most sensitive test for nephropathy in diabetes?
Normal TSH, Normal T3, low T4?
High TSH, low T3, low T4?
Primary clinical hypothyroidism
High TSH, Normal T3, normal T4?
Subclinical primary hypothyroid
Low TSH, low T3, low/normal T4?
Euthyroid sick syndrome
Normal TSH, low T3, normal T4?
Low T3 syndrome (version of sick euthyroid syndrome)
Parathyroid, pituitary, pancreatic
Medullary thyroid, parathyroid, pheochromocytoma
Mucosal ulcers, Medullary thyroid, pheochromocytoma
Sx and EKG: HyperK vs HypoK?
Both: Muscle weakness and flaccid paralysis
Asystole vs EKG U waves
Treatment of hyperkalemia - ways to drive K into cells?
Insulin and glucose, Sodium bicarb, B-2 agonist
Effect of magnesium on calcium level?
HypoMg inhibits PTH (decreased secretion and increased resistance), leading to low Ca
Signs of fibromuscular dysplasia?
#Vision loss (Amarosis fugax)
#Stroke (family history)
Do not treat a pheochromocytoma with? (Why?)
B-blocker; will increase BP