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Flashcards in UWorld Endo And Electrolytes Deck (63):
0

Other causes of Addison disease?

1. Chronic granulomatous infections (histoplasmosis, Coccidioides mycosis)
2. DIC
3. Adrenal metastasis
4. Adrenoleukodystrophy

1

Most common neuropathy in diabetics?

Symmetrical distal polyneuropathy

3

Sx of acromegaly? Test?

Arthalgias, HTN, finger swelling, skin tags, carpal tunnel, jaw enlargement

IGF-1

4

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

5

Causes of alkalosis with hypoK and normotension? HypoCl seen in?

1. Vomiting - hypoCl
2. Diuretic use
3. Bartter syndrome
4. Gitelman syndrome

6

Indications for thyroid functioning tests?

1. Hyperlipidemia
2. hypoNa
3. Elevated serum muscle enzymes

7

Use of beta blockers in thyroid disease?

Sx relief in thyrotoxicosis

8

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

9

Elevated testosterone hormone with normal DHEAS versus elevated DHEAS with normal testosterone?

Ovarian versus adrenal source of excess androgen production

10

Screening test for congenital adrenal hyperplasia?

17-hydroxyprogesterone

11

Suspected pagent's disease: two tests to order?

1. Serum alk phos
2. Urinary analysis for telopeptides, hydroxyproline, and deoxypyridinoline (Marker of bone resorption)

12

Most likely cause of death in acromegaly?

Congestive heart failure

13

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

14

Adverse effect of PTU and methimazole?

Adverse effect of radioiodine ablation?

Adverse effect of thyroidectomy?

Agranulocytosis

Worsening of Ophthalmopathy

Recurrent laryngeal nerve damage

15

Contraindications of radioactive iodine tx?

Pregnancy and severe ophthalmopathy

16

Type of lung cancer associated with hypercalcemia?

Squamous (sCa++mous) cell carcinoma

17

Differential diagnosis for anterior mediastinal mass?

4 T's
Thymoma
Teratoma
Thyroid neoplasm
"Terrible" Lymphoma

18

Pt with hashimoto's thyroiditis is at a higher risk for developing?

thyroid lymphoma

19

Bartter's syndrome - labs?

1. hypoK
2. metabolic alkylosis
3. Elevated urine Cl
4. Normal BP

20

Pt with suspected adrenal insufficiency. Must do this test?

Cosyntropin stimulation test.

21

Purpose: Cosyntropin test vs 24 urine cortisol

adrenal insufficiency vs cushings

22

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

23

Causes of primary hypoPTH?

1. post-surgical
2. congenital absence of parathyroids
3. autoimmune
4. defect in Ca sensing receptor

24

Diuretic abuse: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

high>20, up, up, down, up, low/normal

25

Vomiting: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

low<10, up, up, down, up, low/normal

26

Bartter/Gitelmann: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

very high>40, up, up, down, up, normal

27

Primary hyperALDO: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

very high>40, down, up, down, up, up

28

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

29

factitious diarrhea: urine Cl (be specific)? Renin level? ALDO level? Serum K? Serum bicarb? Serum Na?

low<10, up, up, down, up, low/normal

30

HypoNa Ddx if normal serum osmolarity?

hyperproteinemia, hyperlipidemia

31

HypoNa Ddx if serum osm>295?

hyperglycemia, radiocontrast, mannitol

32

HypoNa Ddx if hypovolemic, with Urine Na <10?

Nonrenal salt loss (vomiting, diarrhea, dehydration)

33

HypoNa Ddx if hypovolemic with urine Na >20?

Renal salt loss (diuretics, ACE-Is, Mineralocorticoid deficiency)

34

HypoNa Ddx if euvolemic with osm<280 Urine Na 20+ and Uosm less than 300

psychogenic polydipsia, beer potomania

35

HypoNa Ddx if euvolemic with urine Na >20 and Uosm >300

SIADH

36

HypoNa Ddx if osm<280, and hypervolemic?

CHF, cirrhosis, nephrotic syndrome

37

Non-tumor differentiation between MEN2a and 2b?

elevated PTH (from parathyroid adenoma) vs Marfanoid habitus

38

Causes of myopathy?

1. Connective tissue disease (polymyositis and dermatomyositis)
2. Endocrine (thyroid and cushings)
3. Neuromuscular (LE, MG)
4. Drugs (steroids)

39

VIt D toxicity?

constipation, abdominal pain, polyuria, polydipsia

40

Pt with ED - question to ask?

If organic, possible hormonal causes?

nocturnal erections (to differentiate between psych vs neurological problem)

thyoid, prolactin, testosterone, cushings,

41

Hashimotos - antibodies?

anti-thyroid peroxidase (anti-TPO)
anti-thyroglobubin

42

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)

43

Metabolic syndrome?

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

44

Serious side effect of PTU and methinazole? Appropriate management?

Agranulocytosis. Stop drug at any sign of infection and measure white count.

45

Effect of alkalosis on calcium levels? Mechanisms?

Decreased serum calcium due to increased binding affinity to albumin.

46

Patient with renal insufficiency. CT shows adrenal calcification – cause?

TB

47

Treatment for diabetic neuropathy?

TCAs (amitriptyline, desipramine, nortriptyline) > gabapentin > NSAIDs

48

Endocrine problem that causes eosinophilia?

Glucocorticoid deficiency

49

Signs of panhypopituitary?

ACTH deficiency (hypotension, weight-loss, hypoglycemia, eosinophilia)

Hypothyroid (cold intolerance, dry skin, weak deep tendon reflexes, anemia)

HypoGonadotropin (decreased libido, amenorrhea)

50

Give diabetics metoclopramide if?

Diabetic neuropathy of the gastrointestinal tract (gastroparesis)

51

Most sensitive test for nephropathy in diabetes?

microalbumin/creatinine ratio

52

Normal TSH, Normal T3, low T4?

Central hypothyroidism

53

High TSH, low T3, low T4?

Primary clinical hypothyroidism

54

High TSH, Normal T3, normal T4?

Subclinical primary hypothyroid

55

Low TSH, low T3, low/normal T4?

Euthyroid sick syndrome

56

Normal TSH, low T3, normal T4?

Low T3 syndrome (version of sick euthyroid syndrome)

57

MEN 1

MEN 2A

MEN 2B

Parathyroid, pituitary, pancreatic

Medullary thyroid, parathyroid, pheochromocytoma

Mucosal ulcers, Medullary thyroid, pheochromocytoma

58

Sx and EKG: HyperK vs HypoK?

Both: Muscle weakness and flaccid paralysis

Asystole vs EKG U waves

59

Treatment of hyperkalemia - ways to drive K into cells?

Insulin and glucose, Sodium bicarb, B-2 agonist

60

Effect of magnesium on calcium level?

HypoMg inhibits PTH (decreased secretion and increased resistance), leading to low Ca

61

Signs of fibromuscular dysplasia?

#Vision loss (Amarosis fugax)
#Stroke (family history)
#Bruits
#High renin/Aldo

62

Do not treat a pheochromocytoma with? (Why?)

B-blocker; will increase BP

63

Treatment of pageants disease? If fails?

Bisphosphonates to suppress bone turnover (Pagents is a disease of Osteoclasts)

If fails, calcitonin

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