USMLE Step 2 (Fach) / Endocrinology (Lektion)
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Step 2 CK
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- Metabolic syndrome Three out of five of the following criteria must be met:- Abdominal obesity: ≥ 102 cm in men and ≥ 88 cm in women- Triglycerides ≥ 150 mg/dL- HDL < 40 mg/dL in men and < 50 mg/dL in women- BP ≥ ...
- Comparing DKA and HHS Diabetic ketoacidosis:- Type 1 > Type 2- Precipitants: stress, infections, MI, trauma, alcohol- Abdominal pain, nausea, vomiting, Kussmaul respirations, mental status changes, and a fruity, acetone breath ...
- Testing of thyroid function TSH measurement: The single best test for the screening of thyroid disease and for the assessment of thyroid function Radioactive iodine uptake (RAI) and scan: Determines if a nodule is functioning in ...
- Radioactive iodine findings in hyperthyroidism Graves: ↑%, diffuse uptake Multinodular goiter: ↑%, multiple nodules of increased uptake Toxic adenoma: ↑%, one area of increased uptake Thyroiditis: ↓%, low uptake, ↑ thyroglobulin Exogenous ...
- Hyperthyroidism Etiology:- Hyperfunctioning thyroid gland → Graves disease (∼ 60-80% of cases) → Toxic multinodular goiter (MNG) (∼ 15-20% of cases)→ Toxic adenoma (3-5% of cases)→ TSH-producing pituitary ...
- Hypothyroidism Etiology:- Primary hypothyroidism→ Hashimoto thyroiditis (autoimmune hypothyroidism)→ Thyroiditis (postpartum, postviral, subacute): follows hyperthyroid phase→ Iatrogenic (e.g., surgery, radioiodine ...
- Hyperparathyroidism Etiology:- Primary hyperparathyroidism:→ Adenoma (80% of cases)→ Hyperplasia (15-20% of cases)- Secondary hyperparathyroidism: → Chronic kidney disease (most frequent cause)→ Vitamin D deficiency ...
- Lab values in hyperparathyroidism 1°: PTH↑, Calcium ↑, PO4 ↓ 2°: PTH ↑, Calcium N/↓, PO4 (↑ when etiology is renal failure) Ectopic PTHrPa: PTH ↑, Calcium ↑, PO4 N/↑
- Acromegaly Etiology:- Pituitary GH-secreting adenoma Clinical presentation:- Large skull, coarsened features: enlarged nose, forehead, and jaw (macrognathia), widened hands, fingers, and feet- Painful arthropathy ...
- Hyperprolactinemia Etiology:- Prolactinoma- Pituitary stalk compression- Drugs (dopamin antagonists, metoclopramide, verapamil)- Renal failure- Hypothyroidism Pathophysiology: Elevated prolactin inhibits GnRH secretion ...
- Adrenal insufficiency Etiology:- Primary adrenal insufficiency→ Autoimmune adrenal cortical destruction (Addison disease)→ Congenital enzyme deficiencies→ Adrenal hemorrhage (Waterhouse-Friderichson syndrome from N. ...
- Pheochromocytoma Etiology:- Tumor arise from chromaffin cells, which are derived from the neural crest.→ Locations include:∼ 90% adrenal medulla → ∼ 10% extra-adrenal in the sympathetic ganglia→ ∼ 10% at ...
- Primary hyperaldosteronism Etiology:- Bilateral idiopathic hyperplasia of the adrenal glands (most common)- Aldosterone-producing adrenal adenoma, or aldosteronoma- Familial hyperaldosteronism- Aldosterone-secreting carcinomas ...
- Congenital adrenal hyperplasia Pathophysiology:- Autosomal recessive defects in enzymes that are responsible for the production of cortisol.- 21β-hydroxylase (> 95% of CAH)- 11β-hydroxylase (∼ 5% of CAH)- 17α-hydroxylase (rare)- ...
- Thyroid storm An acute exacerbation of hyperthyroidism, resulting in a life-threatening hypermetabolic state. Precipitating factors:- Thyroid surgery, RAI ablation, discontinuation of antithyroid medication- Acute ...
- Myxedema coma Etiology:- Decompensation of an existing thyroid hormone deficiency - Triggered by infections, surgery, and trauma Clinical presentation:- Cardinal symptoms: impaired mental status, hypothermia, and concurrent ...
- Subacute granulomatous thyroiditis (De Quervain thyroiditis) ... Etiology:- Viral infections: Mumps virus, Coxsackie virus, influenza virus, echovirus, adenovirus- Mycobacterial infections Pathophysiology:1. Thyrotoxic phase (lasts 4-6 weeks)2. Hypothyroid phase (lasts ...
- Subacute lymphocytic thyroiditis Subacute lymphocytic thyroiditis is characterized by damage to follicular cells with lymphocytic infiltration resembling Hashimoto's thyroiditis instead of granuloma formation. Etiology:- Drugs: α-interferon, ...
- Hashimoto's thyroiditis (Chronic lymphocytic thyroiditis) ... Epidemiology:- Most common form of thyroiditis and the most frequent cause of hypothyroidism in the US- Occurs particularly in women aged 30-50 years Pathophysiology:- Associations with HLA-DR3, DR4, ...
- Riedel thyroiditis Rare, special form of autoimmune thyroiditis. Pathophysiology:- Invasive fibrous growth beyond the thyroid tissue into surrounding tissue with destruction of thyroid tissue Clinical presentation:- Goiter- ...
- Thyroid nodules Benign thyroid nodules (∼ 95% of cases):- Thyroid adenomas→ Follicular adenoma (most common)→ Hürthle cell adenoma→ Toxic adenoma→ Papillary adenoma (least common)- Thyroid cysts- Dominant ...
- Euthyroid sick syndrome Occurs in severe illness or under severe physical stress (especially in intensive care patients). Pathophysiology:- Normal thyroid function- Cytokines (e.g., interleukin 6) cause various changes in levels ...
- Thyroid cancer Papillary thyroid carcinoma (∼ 80% of cases):- 30-50 years of age- Associated with RET/PTC rearrangements and BRAF mutations- Associated with childhood radiation- Well-differentiated- Lymphatic metastasis ...
- Hypopituitarism Etiology:- Intrasellar mass: Nonsecretory pituitary macroadenomas (most common)- Pituitary apoplexy→ Most commonly occurs in patients with a pre-existing pituitary adenoma→ Sheehan syndrome: postpartum ...
- Diabetes insipidus Central diabetes insipidus (most common form): - Primary (∼ ⅓ of cases): Most cases are idiopathic. - Secondary (∼ ⅔ of cases)→ Brain tumors (especially craniopharyngioma) and cerebral metastasis ...
- Syndrome of inappropriate antidiuretic hormone secretion ... Etiology:- CNS disturbance (e.g., stroke, hemorrhage, infection, trauma)- Pulmonary disease (pneumonia, COPD)- Drugs (e.g., carbamazepine, cyclophosphamide, SSRIs, NSAIDs)- Neurosurgery (especially: transsphenoidal ...
- Hypoparathyroidism Etiology:- Postoperative (most common cause): secondary to (para-)thyroidectomy, radical neck dissection- Autoimmune: second most common cause- Congenital: Parathyroid aplasia or hypoplasia (DiGeorge ...
- Cushing syndrome Etiology:- Exogenous Cushing's syndrome (most common cause): Hypercortisolism as a result of prolonged glucocorticoid therapy- Primary hypercortisolism (ACTH-independent Cushing's syndrome): Autonomous ...
- Diabetes mellitus Classification according to the WHO and American Diabetes Association (ADA):1. Type 1: Insulin-dependent (IDDM) or juvenile-onset diabetes mellitus- Autoimmune (type 1A)- Idiopathic (type 1B)2. Type 2: ...
- Diabetes mellitus – Complications Acute:- Hyperglycemic crisis: Hyperosmolar hyperglycemic state (HHS) or diabetic ketoacidosis (DKA)- Life-threatening hypoglycemia: secondary to inappropriate insulin therapy Long-term:- Macrovascular ...
- Somogyi effect Early-morning hyperglycemia because of a counterregulatory secretion of hormones that is triggered by nocturnal hypoglycemia secondary to an evening insulin injection. Treatment: reduction of the evening ...
- Dawn phenomenon A common problem (especially in young type 1 diabetic patients). Definition: early-morning hyperglycemia occurs because of the physiological increase of growth hormone levels in the early morning hours, ...
- Hyperglycemic crises Etiology:- Undiagnosed, untreated diabetes mellitus- Treatment failure in known diabetics: insulin pump failure, forgotten insulin injection, noncompliance with insulin therapy- Stress: infections, surgery, ...
- Hypoglycemia The lower limit of normal for fasting plasma glucose is 70 mg/dL (3.9 mmol/L). Etiology:- In diabetics: (relative) overdose of insulin or noninsulin drug for treating diabetes mellitus (sulfonylurea, ...
- Multiple endocrine neoplasia MEN 1:- Genetics: Altered menin protein expression- Diseases:→ Hyperparathyroidism (∼ 90% of cases)→ Endocrine pancreatic tumors (∼ 50-80% of cases) such as gastrinoma (most common) and insulinoma→ Pituitary ...
- Diabetes - Diagnosis 1. Hemoglobin A1C ≥ 6.5%. 2. Fasting plasma glucose level of ≥ 126 mg/dL (7.0 mmol/L). 3. Plasma glucose ≥ 200 mg/dL (11.1 mmol/L) 2 hours after an oral glucose tolerance test. 4. In a patient with ...
- Management of DKA & HHS IV fluids:- High-flow 0.9% normal saline is initially recommended- Add dextrose 5% when serum glucose is ≤ 200 mg/dL Insulin:- Initial continuous IV insulin infusion- Switch to SQ (basal bolus) insulin ...
- Complications of Graves disease treatment Antithyroid drugs (thionamides):- Skin rash (most common)- Agranulocytosis- Methimazole: 1st-trimester teratogen, cholestasis- Propylthiouracil: Hepatic failure, ANCA-associated vasculitis Radioiodine ...
- Effect of intensive glycemic control in type 2 diabetes ... Macrovascular complications (eg, acute myocardial infarction, stroke)- No change Microvascular complications (eg, neuropathy, retinopathy)- ↓
- Thyrotoxicosis and RAIU Thyrotoxicosis with normal or ↑ RAIU (radioactive iodine uptake):- Graves disease- Toxic multinodular goiter- Toxic nodule Thyrotoxicosis with ↓ RAIU:- Painless (silent) thyroiditis- Subacute (de ...
- Recommended glycemic targets for adults with diabetes ... Preprandial/fasting glucose: 80-130 mg/dL Postprandial glucose: < 180 mg/dL Hemoglobin A1c: < 7%- Very high A1c levels (> 10%) suggest severe fasting hyperglycemia- Lesser abnormalities may be due to ...
- Clinical features of androgen abuse Types of androgens:- Exogenous (eg, testosterone replacement therapy)- Synthetic (eg, stanozolol, nandrolone)- Androgen precursors (eg, DHEA) Side effects/clinical presentation:- Reproductive→ Men: ...
- Osteoporosis risk factors Nonmodifiable:- Advanced age- Postmenopausal- Low body weight- White or Asian ethnicity- Malabsorption disorders- Hypercortisolism, hyperthyroidism, hyperparathyroidism- Inflammatory disorders (eg, rheumatoid ...
- Heat stroke Life-threatening condition in which the body temperature exceeds 41.1°C because of an imbalance in heat generation and dissipation. Whereas in fever there is a physiological increase in the temperature ...
- Conditions that alter TBG concentration ↑ TBG: - Estrogens (e.g., pregnancy, OCs, HRT) & estrogenic medications (e.g., tamoxifen)- Acute hepatitis ↓ TBG:- Androgenic hormones- High-dose glucocorticoids/hypercortisolism- Hypoproteinemia ...
- Toxic adenoma Epidemiology:- Accounts for ∼ 5–10% of hyperthyroidism cases- ♀ > ♂- Seen mostly in patients 30–50 years of age Pathophysiology: - Gain-of-function mutations of TSH receptor gene in ...
- Adrenal crisis Acute, severe glucocorticoid deficiency that is usually precipitated by one of the following triggers:- Stress (e.g., infection, trauma, surgery) in a patient with underlying adrenal insufficiency- ...
- Short stature Short stature: height of 2 or more standard deviations below the mean for children of the same age, sex, and, ideally, race and ethnicity; or an adult height of 147 cm or less Diagnostics:- Family history- ...
- VIPoma Neuroendocrine tumor that secretes excess VIP Pathophysiology:- Excess VIP → increases relaxation of gastric and intestinal smooth muscles and adenylate cyclase (cAMP) activity (similar to cholera toxin) ...
- Functional adrenal masses Cortisol-producing adenoma:- Central obesity, moon facies, enlarged dorsocervical fat pad- Hypertension- Proximal muscle weakness- Hyperglycemia, hypokalemia→ Elevated cortisol (urine, salivary)→ ...