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What lab tests would you monitor in a patient with medullary thyroid cancer after treatment? - Calcitonin. Patients with medullary thyroid cancer secrets calcitonin and CEA. After complete treatment, the labs should show low levels of calcitoin or CEA Testing for calcitonin and CEA can be use to diagnose and monitor medullary cancer What antibodies will be seen in patients with hoshimoto's autoimmune disease? - Anti-thyroglobulin antibodies What is the radionuclide imaging pattern noted during a thyroid scan in patients with subacute thyroiditis? - Low uptake of radioactive iodine Acute inflammation is occurring during subacute thyroiditis, causing leakage of stored thyroid hormone into the circulation. The thyroid is not metabolically active, and therefore there is low radioactive iodine uptake on scan. In patients with Pagets disease, what will happens to serum calcium, phosphorus, and alkaline phosphate? - Serum calcium and phosphorus are in normal range Alkaline phosphate levels are elevated
What is the treatment of choice for pagets disease? - Bisphophates** New drug, that seems to be effective in the treatmen of paget is Tiludronate orally for 3months Name the three cancers that are known to cause diabetes insipidus - Metastatic lung and breast cancer cranipharyngiomas Nephrogenic diabetes insipidus and central diabetes insipidus typically present in what type of patients? - young patients The leision for pheochromocytoma is typically seen where? - Adrenal medulla What you on the lab of a patient with pheochromocytoma? - Elevated catecholamine What is the best medication to use to treat hyperlipidemial during pregnancy? - Colesevelam (WelChol) Its pregnancy category B
This test helps the practitioner determine if the patient can concentrate his/her urine with or without becoming hyperosmolar. The patient is restricted from liquids and food during the test, which must be done in a controlled environment. What is the difference between the result of Water Deprivation Test in differentiating between primary polydipsia or diabetes insipidus? - A patient with PRIMARY POLYDIPSIA will be able to concentrate his/her urine without becoming hyperosmolar WHILE A patient with DIABETICS INSIPIDUS will become hyperosmolar without concentrating the urine. What genetic testing is done in family member to determine medullary thyroid carcinoma, multiple endocrine neoplasias type 2A and 2B, phaeochromocytoma and parathyroid hyperplasia - ret proto-oncogene this genetic test can also be done in patients with pheochromocytoma Ret proto-oncogene genetic testing can be done in the family members of patients with what diseases? - Medullary thyroid cancer and/or Pheochromocytoma
Most patients require approximately ------- of glargine to reach therapeutic goals. - 45 units What is somogyi effect? - It is when too much intermediate insulin is given at dinnertime. Nocturnal hypoglycemia results in counter-regulatory hormones producing hyperglycemia. Amiodarone is use to tx what? - Atril fibrillation What are the common unpleasant side effect of amiodarone? - Hypo/ hyperthyroidism What causes acromegaly? - Pituitary adenoma secreting growth hormone What are the symptoms of acromegaly? - Coarse facial features, prognathism, widely spaced teeth, and sleep apnea. What are the lab finding of patient with hypothyroidism (Hoshimoto)? - High serum TSH, low serum total T4, low serum total T3, high thyroidal peroxidase antibodies, thyroglobulin, and TSH receptor blocking autoantibodies
Hyperglycemia (normal range 74-106) Hyperosmolar (normal range is 275-295) no ketosis Very high triglyceride level (greater than 1000) put patient at risk for what disease
- Acute Pancretitis Which of the oral anti diabetic agents are known to have the highest risk? - Sulfonylureas Which of the anti diabetic medications are known to preserve beta cell function? - Thiazolidinediones (TZDs) --(Pioglitazone (Actos) Rosiglitazone (Avandia)) What type of breathing is associated with diabetic ketoacidosis? - Kussmaul Breathing Can also be seen during metabolic acidosis or hypoxia
Cheyne stokes respiration is associated with what chronic disease? - Left sided Heart failure*, high altitude, neurologic disease is a waxing and waning pattern of rate and volume that includes periods of apnea. Biot breathing can be seen in what kind of patients? - Patients with Mennigitis What is the definitive treatment of choice for elderly patients diagnosed with Graves' disease? - Radioactive iodine What is the most common and likely presenting type of thyroid cancer? - Pappillary thyroid carcinoma It is also the least aggressive type of thyroid cancer What is the most aggressive typer of thyroid cancer? - Anaplastic thyroid cancer It is the least likely to occur
What group of anti diabetic medications are known to reduce post prandial glucose level - dipeptidyl peptidase 4 (DPP-4) inhibitor --- (eg,sitagliptin and vildagliptin). The class is particularly appropriate to utilize in patients who have near-normal HbA1C and elevated postprandial serum glucose because they work only when food enters the gut and have little to any chance of hypoglycemia. What is the primary cause of Primary hyperparathyroidism? - Solitary parathyroid adenoma What is the most common complication of insulin therapy - hypoglycemia reaction It can occur if a patient skips a meal or if he/she performs excessive amounts of exercise without additional calories or a decrease in insulin dose. What is the first sign of puberty in males - Scrotal and testicular enlargement
What is the acute treatment of hypocalcemic tetany due to hypoparathyroidism? - Calcium gluconate IV Once the patient is stable, calcium carbonate and p.o. vitamin D is added What type of cells does follicular and pappilary thyroid cancers result from? - Epithelial cells What type of cells does medullary thyroid cancer result from? - Parafollicular cells What type of cells does Anaplastic thyroid cancer result from - undifferentiated cells Can a DM1 patient present for the first time with symptoms of diabetic ketoacidosis? - YES What are the signs and symptoms of patients with diabetic ketoacidosis (typically occurs in DM 1 patients)? - polyuria, polydipsia, marked fatigue,
salicylates, sulfonamides, pentamidine, quinine (use for malaria), quinolone antibiotics, beta1-adrenergic antagonists. What are the disorders commonly found in multiple endocrine neoplasia (MEN) 2A? - Medullary thyroid carcinoma, pheochromocytoma, parathyroid hyperplasia What is the one physical exam finding that clearly suggest hyperthyroidism? - Exophthalmos Usually its found in hyperthyroidism due to graves disease. Other potential findings are tremor, moist skin, and tachycardia What are the side effect of amiodarone - Constipation and bradycardia so before you make the conclusion that a pateint on amiodarone who present with these symptoms are medication side effect, check TSH levels since amiodarone is also known to cuase hypothyroidism
What is the treatment for central diabetics insipidus? - Dessmopression Patients with hypothalamic diabetes insipidus can't secrete vasopression (or antidiuretic hormone), since the vasopressin producing neurons are dead. Vasopressin analog desmopressin is available in tablets, nasal solution, and parenteral solution for patients with this disorder. What is the pathophisiologhy action of metformin? - Suppress hepatic glucose production What are the common symptoms of hypothyroidism? - Depression Weight Gain Bradycardia Weakness Fatigue Menorrhagia Hoarseness Slow relaxation of reflex
they are also at risk for colon cancer What finding is seen in 90% of patients with acromegaly? - Enlarged sella tursica Other findings on skull radiographs include thickened calvarium (upper portion of the skull), enlarged mandible, and sinuses. Bony growth* is a hallmark of the disease. What X-ray finding is commonly noted in patients with paget disease? - Punched out lesions What is the definitive test used to differentiate pituitary from non-pituitary ACTH dependent Cushing's syndrome? - Inferior petrosal sinus ACTH What are the two common and serious side effect of statins - Myositis (complain of muscle pain) Elevated liver enzyme
What is the criteria for diagnosing metabolic symdrome? - It is defined as three or more of the following findings: ------Waist circumference of >102 cm in men or > cm in women; ----Serum triglyceride level of at least 150 mg/dL, ----HDL level of <40 mg/dL in men or <50 mg/dL in women; ----Blood pressure of at least 130/85 mm Hg; -----Serum glucose level of at least 110 mg/dL. Patients using highly active antiretroviral therapy (HAART) can develop symptoms of what disease? - Cushings Disease dorsocervical fat pad, thin extremities, and central obesity Any woman who presents with a chronic vaginal discharge or chronic vaginal pruritis should be screened what disease? - Type 2 DM Glargine is a a ----------- acting insulin - Long Acting Lispro and Aspart are --------- acting insulin - Rapid Acting
Medullary thyroid cancer cells secrets what? - Calcitonin and CEA Test for this can be helpful in diagnosing and monitoring of patients after treatment. Acarbose, and Miglitol, are alpha-glucosidase inhibitors, what actions do they play in DM 2 patients? - They delay the absorption of carbohydrates and reduced postprandial glucose excursion. What is the treatment of choice for a patient who has developed Cushing's syndrome secondary to an ACTH secreting pituitary adenoma (Cushing's disease).
- Transsphenoidal resection of the pituitary microadenoma What is the blood pressure goal for a patient with diabetes mellitus (DM) or chronic kidney disease (CKD) - <130/ What is the most common cause of primary adrenal insufficiency in the United States? - Autoimmune destruction
What autoantibodies are common in patients with type 1 diabetes mellitus? - Islet beta cell autoantibodies What is the effect of growth hormone deficiency on glucose? - Causes hypoglycemia (which can lead to seizure if it is severe) What is the action of growth hormone on insulin - Growth hormone antagonize the action of insulin leading to hyperglycemia in acromegaly where there is high growth hormone level. What is the pathophysiology behind the presentation of hyperpigmentation in addisons disease (adrenal insufficiency)? - the excess ACTH, act like melanocyte stimulating factor on the skin and cause hyperpigmentation. What are the signs and symptoms of patients with adrenal insufficiency - High ACTH Low Cortisol Hyperkalemia Hyponatremia (low aldosterone) Weight loss
