Endocrinology - PACKRAT-afterReview

Endocrinology - PACKRAT-afterReview History & Physical/Endocrinology A 26-year-old obese female complains of a 3-4 month history of discrete erythematous plaques on the pretibial areas of her legs. The lesions have in ...

Endocrinology - PACKRAT-afterReview History & Physical/Endocrinology A 26-year-old obese female complains of a 3-4 month history of discrete erythematous plaques on the pretibial areas of her legs. The lesions have increased in size, become darker, and are painful. She is concerned because the centers of the lesions have become ulcerated. This patient should be screened for which of the following? Answers A. Hypothyroidism B. Diabetes mellitus C. Melanoma D. Scleroderma - ANS - Explanations (u) A. In hypothyroidism the skin of the pretibial area may thicken leading to edema. This is a diffuse finding, involving the face and eyelids, without discrete lesions. (c) B. The description of the skin lesions is characteristic of necrobiosis lipoidica diabeticorum, one of the dermatologic manifestations of diabetes mellitus. (u) C. The lesions of melanoma are typically not painful and do not ulcerate. (u) D. Scleroderma is marked by thickening of the skin, with swelling of the fingers and hands. The swelling may involve the forearms and face; the lower extremities are relatively spared. Diagnostic Studies/Endocrinology A solitary thyroid nodule is noted on physical examination. The TSH level is normal. The next step in the evaluation is Answers A. measurement of T4 and free T3 levels. B. a radionuclide thyroid scan. C. a fine needle biopsy. D. a surgical excision. - ANS - Explanations (u) A. Measurement of T4 and T3 levels would not be of benefit in the evaluation of a solitary thyroid nodule with a normal TSH level. (u) B. A thyroid scan would be the next step if there were a low TSH level. (c) C. Fine needle aspiration (FNA) is the first step in the evaluation of a solitary nodule with a normal TSH level. FNA has a high level of accuracy in diagnosing benign versus malignant nodules in this setting. (u) D. Surgical excision would be the final step after determination of malignancy or suspicion of malignancy by FNA. Diagnosis/Endocrinology A 38 year-old male presents to your clinic complaining of increasing constant headaches and progressive loss of peripheral vision. His medical and family history is unremarkable. Physical examination reveals bitemporal hemianopsia but is otherwise without any abnormalities. Which of the following is the most likely diagnosis? Answers A. Aneurysm involving the circle of Willis B. Migraine headache C. Multiple sclerosis D. Pituitary tumor - ANS - Explanations (u) A. An aneurysm involving the circle of Willis would result in CN III palsy. This would be a rare finding. (u) B. Although a migraine headache may produce visual field defects, these defects would remit upon resolution of the migraine. It would also be unusual to have the scotomas occur bilaterally. (u) C. Optic neuritis associated with multiple sclerosis presents with decreased visual acuity, dimness, or color desaturation in the central visual field. It would not affect the periphery.? (c) D. A pituitary tumor would account for the headaches and the loss of the peripheral vision in both visual fields. As the tumor grows, the optic chiasm will be compressed by the tumor. Health Maintenance/Endocrinology The most effective method to prevent diabetic retinopathy is Answers A. routine, nondilated eye exams. B. laser photocoagulation. C. intensive glycemic control. D. use of ACE inhibitors. - ANS - Explanations (u) A. Nondilated eye exams are not adequate to properly detect diabetic retinopathy. (u) B. Laser photocoagulation is used in preserving vision once diabetic retinopathy has taken place, but it is not preventative of the disease itself. (c) C. The most effective method to prevent diabetic retinopathy is through intensive glycemic control. (u) D. Although ACE inhibitors help in preventing diabetic nephropathy, they have no effect on retinopathy. Clinical Intervention/Endocrinology A diabetic patient returns for follow-up of non-fasting blood work done at a local health fair. The total cholesterol is 230 mg/dl. Which of the following is the appropriate next step? Answers A. Reassurance B. Give advice on diet and exercise C. Obtain a fasting HDL and LDL lipid measurement. D. Start an HMG Co-A reductase inhibitor (statin) - ANS - Explanations (u) A. See C for explanation. (u) B. See C for explanation. (c) C. A patient with an elevated total cholesterol needs further evaluation through a fasting total lipid profile including LDL and HDL. (u) D. See C for explanation. Clinical Intervention/Endocrinology Radioactive iodine is most successful in treating hyperthyroidism that results from Answers A. Grave's disease. B. subacute thyroiditis. C. Hashimoto's thyroiditis. D. papillary thyroid carcinoma. - ANS - Explanations (c) A. Radioactive iodine is an excellent method to destroy overactive thyroid tissue of Grave's disease. (u) B. Radioactive iodine is ineffective in subacute thyroiditis due to the thyroid's low uptake of iodine. (u) C. Radioiodine uptake is low in Hashimoto's thyroiditis and is often transient. (u) D. Papillary thyroid carcinoma is a common thyroid malignancy and must be treated by a thyroidectomy. ?Clinical The