Endocrinology
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57 questions
| 🇬🇧 | 🇬🇧 |
| Levothyroxine 1.6 mcg/kd/d. | How much thyroid replacement do you give for hypothyroid? |
| Mild elevation of TSH ( 4-10) with normal free T4 | How do you diagnose subclinical hypothyroid? |
| Pregnant, memory problem in elderly, hypercholesterolemia. | Who do you treat for subclinical hypothyroid? |
| Low TSH, and high T4. If T4 normal check T3. Positive TPO ( thyroid peroxidase AB in Graves Dz) | How do you dx hyperthyroid? |
| Measure function with RAIU. Gives a picture of thyroid whether it's active (hot) or inactive ( cold) | What is the w/u of hyperthyroid? |
| Graves, toxic multi nodular goiter, Toxic adenoma | What disorder seen with High RAIU? |
| Lymphocitic thyroiditis, thyroxine supplement, amiodarone, and subacute thyroiditis. | What disorder is seen with low RAIU? |
| Low TSH with normal free T3 and T4. Recheck in 2-3 mo | How do you diagnose subclinical hyperthyroid? |
| Over 60 with TSH < 0.1 or TSH 0.1-0.4 with heart disease or osteoporosis. | When do you treat subclinical hyperthyroid? |
| Radioactive iodine ablation. Causes thyroid ablation over 6-18 wk. Most remain euthyroid. Monitor with TSH and T4 in 6 wk and 8 wk, then TSH every 6-12 mo for life. | How do you treat hyperthyroid? |
| Anterior neck pain, dysphagia, sweat, tremor and wt loss. Ass with viral infection. Self limiting 2 mo. | What are the sx of subacute thyroiditis? |
| Low RAIU and high sed rate > 50. Initially hyperthyroid, then euthyroid by 18 mo. | How do you dx subacute thyroiditis? |
| ASA,Steroid, and BB | How do you treat subacute thyroiditis? |
| Prior neck irradiation, solitary nodule, Large size > 4 cm and rapid growth, dysphagia, dysphonia, male, age < 20 and > 70, Hypoechoic on US with micro calcification. | Thyroid nodules: Risk factor for malignancy |
| Hot on RAIU and cystic | What suggest a benign nodule? |
| If symptomatic, treat with unilateral thyroid lobectomy or ablation. If asymptomatic monitor with US 6-12 mo for 2 years. Repeat FNA if change in volume > 20% or new sx. | What is the treatment of benign nodular disease? |
| Hot nodule on RAIU. Rx with Ablative with radioactive iodine or surgery. | How do you treat thyroid adenoma? |
| High calcium, Low PO4 and normal or elevated PTH level. | How do you dx. primary hyperparathyroid? |
| Mostly adenoma, only 3% malignant. | What causes hyperparathyroid? |
| Stones, bones, abdominal groans and psychic moans. Osteoporosis, pancreatitis, depression, kidney stones, | What are the sx of hyperparathyroid? |
| Repeat with free Ca, check albumin to calculate corrected Ca, CMP, Mg, Vit D( can cause secondary hyperparathyroid) and PTH | How do you work up hypercalcemia? |
| Neuroleptics, reglan, doperidone, methyldopa, reserpine, verapamil, cimetidine, estrogen renal failure hypothyroid, and nipple stimulation. | Which drugs cause hyperprolactin? |
| Women : galactorrhea, ameorrhea, hirsutism, infertility Men: Impotence, fatigue, osteoporosis, and gynecomastia. Headache and visual changes. | How does hyperprolactin present ? |
| Functional micro adenoma < 1cm with prolactin levels < 200 Prolactin, LH, FSH, TSH, Free T4, 24 hour urine free cortisol, testosterone, and estradiol, Cr | Prolactinoma definition and work up. |
| Prolactin level > 100 | When do you check MRI with elevated prolactin? |
| Pituitary adenoma with excess Growth Hormone. | What causes Acromegaly? |
| Screen with Insulin like growth factor. If > 3, + Confirm with 100 gm glucose load and check GH in 2 hours. If it does not decrease < 5 then positive test. | How do you diagnose Acromegaly? |
| Transsphenoidal surgery followed by radiation or radiation alone. Can use bromocriptine for shrink tumor before surgery. | How do you treat acromegaly? |
| Neurogenic DI results of decrease ADH from pituitary and Nephrogenic is due to decrease effect of ADH on kidney. | What is the difference between Neurogenic and nephrogenic Diabetes Insipidus? |
| Polyuria, Polydypsia with Hypernatremia | What are the symptoms of DI |
| Idiopathic ( most common) CNS trauma- post surgery, infection or malignancy, autoimmune | What causes Neurogenic DI? |
| Lithium 20%, Elevated Ca and low K, hereditary | Which drugs can cause nephrogenic DI? |
| Water deprivation test with hourly measurment of ADH, plasma and urine osmo. See increase in ADH, but NO increase in urine osmo. | How do you diagnose Nephrogenic DI? |
| Desmopresssin DDAVP oral, nasal or SQ | How do you treat neurogenic DI? |
| Thiazide diuretics. | How do you treat nephrogenic DI? |
| Too much ADH. Cause: CNS trauma, infection, small cell carcinoma, and drugs( chlorpropamide , carbamazepine, and chlorothiazide and clofibrate) | What is SIADH? and what causes it? |
| Low Na. Euvolemic, hyposomolar with inappropriate urine concentration. | What are the manifestation of SIADH. |
| AR with 21 hydroxylase deficiency causing an increase in DHEA. Can also cause elevated 17 hydroxyprogesterone. | Congenital adrenal hyperplasia, cause and lab abnormality. |
| Ambiguous genetalia in children, hirsutism and menstrual irregularity in older girls. | How does congenital adrenal hyperplasia manifest? |
| Increase pituitary ACTH and subsequent increase in DHEA Manifests with hirsutism. | What is Cushing Disease? |
| Adrenal gland is not making enough hormones. Plasma ACTH is high. Cause is autoimmune adrenalitis. | What is primary Addisons Disease? |
| Steroid withdrawal from chronic therapy. ACTH is low. | What causes secondary Addison's Disease? |
| Low Cortisol, low aldosterone and high renin. Wt loss, N/V weakness, orthostatic hypotension, increase skin pigmentation. Lab abnormalities: Low Na and High K. | How does Addison's disease manifest? |
| ACTH stimulation test. Draw baseline cortisol and aldosterone, then check ACTH in 1 hour. If cortisol is low < 20 mcg, then have primary adrenal insufficiency. | How do you diagnose Addison's? |
| Acutely with Dexamethasone, then oral prednisone. Chronic treatment with hydrocortisone and fludrocortisone. | How do you treat Addison's? |