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Internal Medicine

How do thyroid hormones regular prolactin? 1. TRH increases prolactin release 2. primary hypothyroidism → ↑TSH → ↑prolactin release
Initially treatment for prolactinoma cabergoline or bromocriptine (a dopamine agonist)
1. Best initial test for acromegaly 2. Confirmatory diagnosis 1. IGF-1 levels 2. measure GH after 100 g of oral glucose (normally should suppress GH) 3. MRI
Management for confirmed acromegaly from tumor 1. octreotide 2. dopamine agonists 3. radiotherapy, surgery
Patient with hx of pituitary adenoma presents with severe headache, N/V, and depressed consciousness. pituitary apoplexy
Test to diagnose GH deficiency. arginine infusion then measure GH (should stimulate GH release)
Test to diagnose ACTH deficiency. metyrapone - should block cortisol production and increase ACTH
What drugs can be used in SIADH if fluid restriction is insufficient or difficult to maintain? 1. ADH-antagonist (tolvaptan, conivaptan) 2. Demeclocycline (a tetracycline)
What test can be done to determine if there has been facticious use of thyroid medications? TBG level, which is cosecreted with T4 is low/normal with exogenous T4 usage
↓TSH; ↑T3/T4; ↓RAIU 1. thyroiditis 2. surreptitious use of thyroid meds
↓TSH; ↑T3/T4; diffuse ↑RAIU graves disease
↓TSH; ↑T3/T4; ↑RAIU at single point nodular goiter
1. What is the immediate treatment of hyperthyroidism? 2. Long-term treatment? 1. propanolol; antithyroid drugs: PTU, methimazole 2. radioactive iodine ablative therapy
Patient with Graves disease presents with irritability, delerium, tachycardia/hypotension and restlessness Thyroid storm
Treatment of thyroid storm 1. antithyroid agens 2. iodine - to inhibit hormone release 3. β-blockers 4. dexamethasone
Which antibody is associated with Hashimoto disease antimicrosomal
Treatment for thyroiditis 1. aspirin usually sufficient 2. propanolol for symptoms
How do thyroid cancers usually present? thyroid nodules without symptoms of hyperthyroidism
1. Most common thyroid cancer. 2. Treatment 1. papillary carcinoma 2. surgery if small; radiation therapy w/surgery if large
How does acidosis effect free calcium concentration? 1. increased binding of hydrogen ions to albumin displaces calcium from albumin 2. free calcium is increased
Symptoms associated with hypercalcemia: 1. GI 2. renal 3. cardiovascular 1. constipation, pancreatitis 2. nephrogenic DI 3. short QT
Treatment for severe, life-threatening hypercalcemia. 1. vigorous fluid replacement with normal saline 2. followed by loop diuretics
Patient with multiple blood transfusions now has a seizure. possibly hypocalcemia from citrate in transfusion binding to calcium
Which patients is metformin contraindicated in? those with renal insufficiency for fear of lactic acidosis
Insulins: 1. Ultra-short acting 2. Intermediate 3. Long acting 1. insulin lispro, aspart 2. NPH 3. Glargine
1. Smogyi effect 2. Dawn effect 1. rebound hyperglycemia in the morning b/c of counterregulatory hormone release after an episode of hypoglycemia in the middle of the night 2. early morning rise in plasma glucose
How do you distinguish the Smogyi effect from Dawn effect? 1. cut down on insulin at night 2. wake patient up in the middle of the night and check glucose levels
1. First test to run in suspected Cushing syndrome 2. Gold standard to confirm. 1. overnight dexamethasone suppression test 2. 24-hour free cortisol collection (more expensive so done 2nd)
What does the following response to high dose dexamethasone indicate if Cushing syndrome is suspected: 1. suppression to <50% control 2. No response 1. Pituitary adenoma 2. ACTH-producing tumor, Adrenal neoplasia
1. How do you confirm the diagnosis of primary hyperaldosteronism? 2. What is the usual cause of primary hyperaldosteronism? 1. high urine aldosterone and low plasma renin levels 2. unilateral adrenal adenoma (70%), bilateral hyperplasia (30%)
What acid/base problem is seen in hyperaldosteronism? metabolic alkalosis b/c aldosterone increases hydrogen excretion
What is Bartter Syndrome? defect in Na/K/Cl cotransporter in the loop of Henle leading to excess NaCl loss and secondary hyperaldosteronism
Best test to diagnose pheochromocytoma 1. 24-hour urinary VMA, metanephrines and free catecholamines 2. confirm with CT scan
Medical treatment for pheochromocytoma. alpha-adrenergic blocking agents (phentolamine, phenoxybenzamine)
Patient with low serum sodium, high serum potassium and eosinophilia. Addison's disease



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