1. What should you always check in a patient that presents with new-onset A fib?
  2. Which antiarrhythmic is thyrotoxic?
  3. Which endocrine disorder is classically associated with menorrhagia?
  4. Euthyroid sick syndrome
    • Temporary decline in thyroid function that can be seen in any illness
    • Does not require tx
  5. Diagnosis of Cushing syndrome
    • Free urinary cortisol
    • Dexamethasone suppression test
    • ACTH (elevated in Cushing disease, decreased with adrenal adenomas)
    • MRI,if ACTH is increased
    • Abdo CT or MRI, if ACTH is not increased and px is not on steroids
    • CXR, if there are clinical indications of small cell lung cancer
  6. Signs and symptoms of Addison disease
    • Anorexia, weight loss, weakness
    • Hypotension
    • Hyponatremia, hyperkalemia
    • Hyperpigmentation
    • Acidosis
  7. Patient on chronic steroid tx crashes after surgery (hypotension, shock, hyperkalemia)
    Think adrenal insufficiency from long-term suppression
  8. Causes of adrenal insufficiency
    • Iatrogenic--steroid use
    • AI--Addison disease
    • Neoplastic--mets to adrenals, esp from lungs
    • Infectious--TB, fungal
    • Drugs--ketoconazole
  9. Female infant with ambiguous genitalia
    • Think CAH
    • 90% are 21 hydroxylase deficient
    • Hypo or normo tensive, with hyponatremia and hyperkalemia
    • Acidosis, nausea, vomiting
    • High serum 17-hydroxyprogesterone and DHEA
  10. Etiologies of hyperparathyroidism
    • Primary
    • Usually a parathyroid adenoma
    • Secondary
    • Low Ca (e.g renal failure)
    • Tertiary
    • PTH rises in response to longstanding low Ca, and fails to normalize when Ca is corrected (e.g. CRF)
  11. A child presents with tetany in the first 48 hours of life and absent thymic shadow
    • Di George
    • (also associated with immunodeficiency, abnormal cardiac development, and midline facial defects)
  12. Signs and symptoms of hypercalcemia
    • Stones, bones, abdominal groans, psychiatric moans
    • Short QT
    • Muscle weakness
  13. Cancers associated with hypercalcemia
    • MM
    • Squamous cell carcinoma--secretes PTHrP
    • Bone cancer
  14. Pseudohypoparathyroidism
    • Genetic defect resulting in inability to respond to PTH
    • Patients are hypocalcemic (tetany, prolonged QT, altered MS)
    • Short stature, shortened metacarpal bones, and mental retardation
  15. A patient has low measured serum Ca.  What's the next thing to check?
    Either ionized Ca or serum albumin (since albumin binds to Ca, so low albumin can give a lab result of hypocalcemia, even if ionized Ca is normal)
  16. How can true precocious puberty be distinguished from pseudoprecocious puberty?
    • True (idiopathic, or secondary to a CNS lesion) causes testicular or ovarian enlargement, pseudo does not
    • Test with a GnRH stimulation test: if GnRH triggers an increase in LH/FSH, the precocious puberty is true
    • Next step: brain MRI
  17. Causes of pseudoprecocious puberty
    • Exogenous hormone administration
    • Adrenal tumor
    • CAH
    • Hormone-secreting tumor
    • McCune-Albright syndrome (ovarian cysts, fibrous bone dysplasia,and cafe-au-lait spots)
  18. Should precocious puberty be treated?
    • Yes--it causes premature fusion of the growth plates
    • Tx with GnRH antagonists
  19. Conn syndrome
    • Aldosterone-secreting adrenal tumor
    • Presents with hypernatremia, hypokalemia, and HTN
    • Renin is low
    • After lab dx, order an abdo CT to find tumor
  20. Hypernatremia with dilute urine
  21. Patient cannot concentrate urine after administration of vasopressin
    Nephrogenic DI
  22. Treatment of nephrogenic DI
    • Stop offending drug (e.g. lithium)
    • Thiazides (are diuretics, but work for DI because they also help concentrate the urine)
  23. Endocrine disorder that leads to euvolemic hyponatremia
  24. Serum and urine osmolalities in SIADH
    • Low serum osmolality
    • High urine osmolality
  25. Causes of SIADH
    • CNS--stroke, hemorrhage, infection, trauma
    • Meds--narcotics, oxytocin, antiepileptics
    • Trauma--pain normally stimulates ADH secretion.  The post-op combo of pain + narcotics makes pxs especially prone to SIADH
    • Lung disease--pneumonia, small cell cancer
Card Set
step II