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Endocrine - ABIM

Wrong on test

QuestionAnswer
Patient with incidentally noted adrenal mass. What is the work up? Evaluate for pheochromocytoma with plasma free metanephrines and Cushing syndrome with low-dose dexamethasone suppression test. If patient has hypertension, they should also be tested for hyper aldosteronism (serum aldosterone to renin ratio).
Adrenal mass with imaging showing 30 Hounsfield units This shows high attenuation on noncontrast CT, which is suggestive of a pheochromocytoma
Adrenal mass with noncontrast CT showing five Hounsfield units Low attenuation, which suggests adrenocortical adenoma
Which adrenal incidentalomas should be considered for surgical removal? Size greater than 6 cm, high attenuation greater than 10 Hounsfield units on noncontrast CT. Must rule out a pheochromocytoma prior to any surgical treatment.
When a patient with diagnosed with an asymptomatic prolactinoma, what should be done? If asymptomatic, repeat pituitary MRI in 6 to 12 months.
Patient with a symptomatic prolactinoma. What to do? Treat with cabergoline, a dopamine agonist.
What are the symptoms of a prolactinoma? Erectile dysfunction, headache, visual changes, decreased body and facial hair
What is the difference between a macroprolactinoma and a micro prolactinoma? How to treat? A macro prolactinoma is 10 mm or greater, treat with cabergoline, as long as patient has only mild visual field defects and no rapid progression of the tumor or tumor hemorrhage . A micro prolactinoma is <10 mm, monitor only if it is asymptomatic.
How to treat prolactinoma during pregnancy? High estrogen in the pregnant state can lead to growth of the prolactinoma. Patients should get visual field testing every trimester. Get MRI if pregnant patient has a macro prolactinoma 10 mm or greater plus symptoms.
Can bromocriptine be used to treat prolactinoma in pregnancy? Try to avoid, but usage of bromocriptine in asymptomatic patient might be worth the risk for the patient
In diabetic ketoacidosis, what is the order in which you should give the treatments? Normal saline, then correct potassium, then insulin drip once the potassium is greater than 3.3
When is the only time you give a sodium bicarbonate infusion in treating acidosis? When pH is less than 6.9
What to do with a patient who has hyperprolactinemia and hypothyroidism? Treat the hypothyroidism first, because hypothyroidism could cause hyperprolactinemia. After the patient is euthyroid, recheck prolactin levels.
34-year-old woman w HA, fatigue, 2.5 years of irregular menses followed by 6 mo of amenorrhea, galactorrhea and blurry peripheral vision. She has a 2.4 cm pituitary tumor that elevates the optic chiasm and surrounds her L carotid artery. How to treat? Cabergoline
How to treat graves ophthalmopathy? Methimazole, ocular lubricant, and taping eyes shut at night if they don't close appropriately. Smoking cessation.
What should you not treat with if a patient has moderate to severe graves ophthalmopathy? Don't use radio active iodine because it can worsen the eye disease due to an initial increase in circulating anti-body levels. If it is used, patient should be pretreated with a glucocorticoid.
If medical therapy does not fix Graves eye disease, what to do? Total thyroidectomy or surgical decompression of the optic nerve
Indication to treat hyperparathyroidism with surgery Kidney injury, with GFR < 60, Nephrolithiasis or nephrocalcinosis; age younger than 50, high calcium, osteoporosis, or inpatients you can't medically monitor
When should Patient get a bisphosphonate? When risk of major osteoporotic fracture is 20% or greater, or risk of hip fracture is 3% or greater. Bisphosphonate's should not be used in patients with kidney injury
When would you treat a patient with cinacalcet? What is the mechanism? Use it if a patient with symptomatic hyperparathyroidism declines surgery. Use it in people who cannot undergo parathyroidectomy. It lowers calcium levels by inhibiting PTH secretion.
Female patient with high FSH and LH, normal secondary sex characteristics, low estrogen and amenorrhea. How to treat? She has primary amenorrhea, so she should get estrogen to prevent endometrial hyperplasia and osteoporosis; she should get cyclic progestin to prevent endometrial hyperplasia.
What is the most common cause of primary amenorrhea in a young female patient? Turner syndrome or fragile X (no cognitive impairment in this population)
Why is it particularly important to diagnose turner syndrome? Patients have a higher incidence of cardiovascular disease, metabolic syndrome, thyroid dysfunction.
What should you tell a patient to do if they are status post parathyroidectomy? Decrease calcium intake with a 24 hour urine calcium goal of less than 300 mg excreted and a serum calcium goal of 8 to 8.5.
How to measure adequate vitamin D in a patient with normal parathyroid glands versus a patient status post parathyroidectomy In a normal patient, measure 25 hydroxy vitamin D. In a patient without parathyroid glands, monitor vitamin D with 1, 25 – dihydroxy vitamin D.
What to do for a patient with hypercalcemia greater than 18 and neurologic symptoms or acute kidney injury? Hemodialysis
What is the long-term treatment for a patient with malignancy induced hypercalcemia? I V zoledronic acid or IV pamidronate
What to do first for a patient who has symptoms of mild hyper thyroidism and evidence of multiple nodules on physical exam? Perform a radioactive iodine uptake scan because likely, there is a toxic nodule causing the hyperthyroidism, and toxic nodules do not need to be biopsied, because the likelihood of malignancy in these lesions is low.
What thyroid nodules require find needle aspiration? Cold or warm nodules. Hot nodules, which are autonomously functioning and producing thyroid hormone, do not require FNA.
If a patient is on methimazole and is scheduled for a radioactive iodine thyroid scan, what should you instruct them to do? Hold the methimazole for five days
When to treat a patient with Paget disease of bone? Treat with bisphosphonates if a patient is symptomatic: bone pain caused by increased metabolic activity, elevated calcium level, involvement of skeletal areas at high risk of complications, fractures.
What is Paget disease of bone? Focal areas of accelerated bone remodeling that ultimately causes overgrowth and compromised integrity of bone (Skull, spine, pelvis, long bones of the lower extremities).
What are the bone changes seen in Paget disease of bone? Thickened cortical bone and coarsening of the trabecular bone; Diagnosed on imaging when there are concurrent osteolytic and osteoblastic changes. Also, patient will have elevated alkaline phosphatase.
Should we treat a patient with Paget disease of bone if they are asymptomatic? No
What is the target blood pressure for patients being treated for pheochromocytoma with phenoxybenzamine? Less then 130/80 seated and greater than 90 systolic standing
A patient with pheochromocytoma is about to get surgery. Blood pressure is 120/80. Should they be treated with an alpha blocker? Yes because they can become hypertensive in surgery
If a patient is diagnosed with pheochromocytoma, what is the next step – contrast enhanced adrenal CT for tumor localization? Or treatment with phenoxybenzamine? Treat with phenoxybenzamine first because the iodine contrast media can incite a hypertensive crisis if the patient is not alpha blockaded
Men who are seeking testosterone therapy for a hypogonadism should be advised what? That testosterone therapy may result in a oligospermia and infertility
What to do for a patient with hypogonadism who desires fertility? Can give him human chorionic gonadotropin in, which stimulates production of intratesticular testosterone, which can maintain spermatogenesis
What is the next step in management for a patient who was just diagnosed with medullary thyroid cancer? Check for RET mutation. If there, send fractionated plasma metanephrines to check for pheochromocytoma and MEN2
When should you check and ionized calcium? When you suspect pseudo hypercalcemia. This can happen when the patient has increased protein binding of calcium, such as in hyper albumin (dehydration) or paraproteinemia (multiple myeloma).
What do the thyroid hormones look like in euthyroid sick syndrome? TSH, T4, T3 are all low
Patients with hypercortisolism should be screened for what? Osteoporosis with DEXA scan
How does sarcoidosis cause hypercalcemia? Through increased 1-alpha- hydroxylation that increases the 1,25 – dihydroxy vitamin D levels, which in turn, increases calcium reabsorption in the intestines, dec kidney Ca excretion, incr bone resorption.
What is considered a statistically significant change in DEXA scan results? A change in bone mineral density he that is more than 4%.
When can you give patients a drug holiday from bisphosphonates? If they have been on bisphosphonate therapy for 3 to 5 years, have had no progression of the disease, and have minimal risk for additional fractures. If they still have risk for fracture, they should still be on the medication for greater than five years.
Created by: christinapham