Endo

Question 1

Hormone used to titrate antithyroid meds for Grave’s

Answer 1

Free T4

Question 2

Grave’s disease antibody

Answer 2

Anti TSH receptor

Acts on TSHr in pituitary gland –> over-activation of thyroid to produce T3 and T4

Question 3

Most common benign thyroid nodule

Answer 3

Follicular adenoma

Question 4

Most common neoplasm of thyroid (benign and malignant combined)

Answer 4

Follicular adenoma

Question 5

Most common malignant cancer of the thyroid

Answer 5

Papillary carcinoma

Question 6

DeQuervain thyroiditis

Answer 6

AKA subacute granulomatous thyroiditis
Benign
Follows infection
Presents as painful nodule

Question 7

Doppler ultrasound finding of benign nodular hyperplasia

Answer 7

Ring of fire

Question 8

Follicular adenoma of thyroid characteristics

Answer 8

Red light on colour dopplery U/S
Confined in capusle
Different growth pattern from surrounding parenchyma

Question 9

Most sensitive means of differentiating primary from secondary causes of hyperaldosteronism

Answer 9

Aldosterone-to-renin-ratio (ARR) = ratio of plasma aldo to plasma renin activity
-Measures the rate of production of angiotensin I from endogenous angiotensinogen via renin
-As aldo secretion rises, ARR should fall b/c of Na retention
(RAS decreases when BP high)

Question 10

Renin function

Answer 10

Angiotensinogen to Angiotensin I

Question 11

ACE function

Answer 11

Angiotensin I to Angiotensin II

Question 12

Aldosterone is produced from

Answer 12

Adrenal cortex

Signalled by Ang II

Question 13

Primary aldosteronism

Answer 13

Conn’s Syndrome
Increased production of aldosterone from adrenal gland –> decreased renin
Renin levels may fall well before plasma aldo is increased
Triad of:
HTN
Hypokalemia
Metabolic alkalosis

Question 14

Secondary hyperaldosteronism

Answer 14

Decreased renal blood flow (ie. due to obstruction, edematous d/o such as CHF/nephrotic syndrome/cirrhosis, renal vasoconstriction)
RAS stimulated –> aldo hypersecreted
Aldo and renin HIGH

Question 15

Hashimoto’s antibody

Answer 15

Anti-TPO

Question 16

Timeframe to recheck TSH

Answer 16

Wait >6wks to recheck TSH after dose change

Regular monitoring is 2-3mo then annually once stable

Question 17

Hyperthyroid tx

Answer 17

Methimazole (high rate of relapse)

I-131

Question 18

Starting insulin dose

Answer 18

0.3-0.5 U/kg

Question 19

Rapid acting insulins (bolus dosing)

Answer 19

Insulin aspart (NovoRapid)
Insulin lispro (Humalog)

Question 20

Short-acting insulins (bolus dosing)

Answer 20

Humulin-R

Novolin-ge Toronto

Question 21

Intermediate acting insulin (basal dosing)

Answer 21

Humulin-N

Novolin-ge NPH

Question 22

Long-acting insulin (basal dosing)

Answer 22

Insulin detemir (Levemir)
Insulin glargine (Lantus)

Question 23

Carcinoid syndrome

Answer 23

Flushing (histamine, bradykinin), secretory diarrhea (serotonin), abdo pain, tricuspid regurg, skin color changes, wheezing
Result from carcinoid tumour (slow growing neuroendocrine tumours)
Usually asymptomatic
Once carcinoid symptoms occur then metastasis to LIVER likely has already occurred

Question 24

Biochemical test to confirm carcinoid syndrome

Answer 24

5-hydroxyindoleacetic acid (5-HIAA) measured in 24h urine sample
Serotonin released by carcinoid tumours –> metabolized by monoamine oxidases in liver, lungs and brain –> 5-HIAA
+ imaging
+ hepatic panel if liver met

Question 25

Carcinoid tumour mgmt

Answer 25

``` Cytoreductive surgery (debulking) on primary or met Somatostatin analogues (ie. octreotide) have hormone blocking properties --> help with symptoms +/- chemoembolization of mets (esp in liver) ```

Question 26

Most common location of carcinoid tumour

Answer 26

Ileum | sometimes appendix

Question 27

Thyroid nodule with high TSH next step

Answer 27

FNA biopsy with cytology

Question 28

Thyroid nodule with low TSH next step

Answer 28

Radioiodine 123 scan or Technetium-99 scan to test for nodule functionality + fT4 and T3

Question 29

Cold thyroid nodule

Answer 29

FNA biopsy, U/S | R/O malignancy

Question 30

Homogeneously diffusely hot thyroid nodule

Answer 30

Graves

Question 31

Hetereogeneously diffusely hot thyroid nodule

Answer 31

Toxic multinodular goiter

Question 32

Focal diffuse hot thyroid nodule

Answer 32

Functioning adenoma

Question 33

No pick up on I123 thyroid scan

Answer 33

Thyroglobulin levels If high --> ?thyroiditis If low --> ?thyrotoxicosis

Question 34

Most common thyroid cancer

Answer 34

Papillary carcinoma

Question 35

Syndrome a/w medullary thyroid cancer

Answer 35

MEN-2A/B

Question 36

Tx for thyroid CA

Answer 36

Thyroidectomy +/- I131 radiation

Question 37

Parathyroid hormone action

Answer 37

hypercalcemia + hypophosphatemia

Question 38

Vitamin D association with Ca and P

Answer 38

Increases GI absorption of both

Question 39

MEN-1

Answer 39

Often a/w zollinger-ellison syndrome Auto dominant d/o Tumours in parathyroid gland (causes hyperca), pancrea, pituitary gland

Question 40

If TSH < ___ in pregnancy with negative anti-TPO, no need to treat

Answer 40

4

Question 41

Treatment for Graves in pregnancy

Answer 41

Propylthiouracil during preconception and 1st trimester Switch to methimazole after first triemster to reduce maternal hepatotoxicity Follow b/w q4-6wks

Question 42

Propylthiouracil excreted in breastmilk T/F

Answer 42

True

Question 43

Sick euthyroid syndrome

Answer 43

Abnormal thyroid function a/w acute severe non-thyroidal illness Low T3 + normal T4 and TSH If severe, serum T4 may also drop and TSH may be high or low

Question 44

Creutzfelt-Jakob disease

Answer 44

Neurodegenerative prion based brain disorder that has long incubation period with rapid progressive mental deterioration and myoclonus Incurable and fatal Spong-like appearance of brain Brain bx is gold standard for dx

Question 45

Adrenal cytoplasmic antibodies positive in what disease?

Answer 45

Addison's disease

Question 46

Addison's disease

Answer 46

Primary adrenal insufficiency | Hypocortosolism

Question 47

Conn's syndrome

Answer 47

Primary hyperaldosteronism

Question 48

Paget disease lab findings

Answer 48

Increased ALP, normal Ca, phosphate and PTH | Urinary pyridine and deoxypyridine levels increased

Question 49

Hypercalcemia treatment

Answer 49

IVF (+/- furosemide to prevent HF) | Adjunctive tx: Alendronate, calcitonin

Question 50

Hypercalcemia tx secondary to hormonal treatment

Answer 50

Prednisone

Question 51

TSH screening in pregnancy

Answer 51

q4wks during first half of pregnancy | At least once each trimester in latter half of pregnancy

Question 52

Insulinoma

Answer 52

Raised insulin --> fasting hypoglycemia | Plasma C-peptide