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Medicine > Endocrine I > Flashcards

Endocrine I Flashcards

1
Q

A major pathogenic factor underlying metabolic syndrome is […] resistance.

A

A major pathogenic factor underlying metabolic syndrome is insulin resistance.

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2
Q

A patient with diabetic sensorimotor polyneuropathy with symptoms of loss of proprioception/vibration sense and foot deformities likely has injury to the […] nerve fibers (size).

A

A patient with diabetic sensorimotor polyneuropathy with symptoms of loss of proprioception/vibration sense and foot deformities likely has injury to the large nerve fibers (size).

“negative” symptoms predominate (vs. “positive” symptoms - pain, paresthesias with small nerve fiber injury)

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3
Q

A patient with diabetic sensorimotor polyneuropathy with symptoms of pain, paresthesias, and allodynia likely has injury to the […] nerve fibers (size).

A

A patient with diabetic sensorimotor polyneuropathy with symptoms of pain, paresthesias, and allodynia likely has injury to the small nerve fibers (size).

“positive” symptoms predominate (vs. “negative” symptoms - numbness, loss of proprioception and vibration with large nerve fiber injury)

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4
Q

A patient’s diabetes is considered well controlled if the HbA1c is

A

A patient’s diabetes is considered well controlled if the HbA1c is 7.0%.

i.e. no new additional medication is needed

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5
Q

A prolactin level > […] ng/mL is virtually diagnostic of prolactinoma.

A

A prolactin level > 200 ng/mL is virtually diagnostic of prolactinoma.

prolactin elevation correlates with the size of the prolactinoma

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6
Q

Alanine is converted to […] by alanine aminotransferase during the process of gluconeogenesis.

A

Alanine is converted to pyruvate by alanine aminotransferase during the process of gluconeogenesis.

so sorry for bringing back haunting memories of biochemistry…

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7
Q

Anti-thyroid drug therapy alone may be used to treat Grave’s disease in those with mild disease, […], or older patients with limited life expectancy.

A

Anti-thyroid drug therapy alone may be used to treat Grave’s disease in those with mild disease, pregnant women, or older patients with limited life expectancy.

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8
Q

Anti-thyroid drug therapy alone may be used to treat Grave’s disease in those with mild disease, pregnant women, or […].

A

Anti-thyroid drug therapy alone may be used to treat Grave’s disease in those with mild disease, pregnant women, or older patients with limited life expectancy.

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9
Q

Diabetic gastroparesis may be managed with small, frequent meals and prokinetic agents such as […], erythromycin, and cisapride.

A

Diabetic gastroparesis may be managed with small, frequent meals and prokinetic agents such as metoclopramide, erythromycin, and cisapride.

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10
Q

Familial hypocalciuric hypercalcemia (FHH) is caused by inactivating mutations of the […] that regulate PTH secretion.

A

Familial hypocalciuric hypercalcemia (FHH) is caused by inactivating mutations of the Ca2+-sensing receptors that regulate PTH secretion.

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11
Q

Graves ophthalmopathy is caused by T-cell activation and stimulation of […] by TSH receptor antibodies, leading to expansion of orbital tissues.

A

Graves ophthalmopathy is caused by T-cell activation and stimulation of orbital fibroblasts by TSH receptor antibodies, leading to expansion of orbital tissues.

e.g. lid lag, diplopia, proptosis, ocular irritation, impaired/painful EOM

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12
Q

How do ionized Ca2+ levels change in a patient with respiratory or metabolic alkalosis?

A

How do ionized Ca2+ levels change in a patient with respiratory or metabolic alkalosis?

Decreased ionized Ca2+

due to dissociation of hydrogen ions from albumin, allowing more Ca2+ to bind (the opposite occurs with acidosis)

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13
Q

How do serum levels of K+ typically change in patients with diabetic ketoacidosis?

A

How do serum levels of K+ typically change in patients with diabetic ketoacidosis?

normal or increased

due to an extracellular shift of K+ driven by increased plasma tonicity and loss of insulin-dependent K+ uptake;

note: total K+ levels are typically decreased due to osmotic diuresis and renal elimination of potassium ketoacid salts

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14
Q

How do the following laboratory values change in central adrenal insufficiency?

Cortisol: […]

ACTH: […]

Aldosterone: […]

A

How do the following laboratory values change in central adrenal insufficiency?

Cortisol: decreased

ACTH: decreased

Aldosterone: normal (no change)

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15
Q

How do the following laboratory values change in milk-alkali syndrome?

PTH: […]

Ca2+: […]

A

How do the following laboratory values change in milk-alkali syndrome?

PTH: Decreased

Ca2+: Increased

PTH is suppressed from exogenous calcium intake; other laboratory features include acute kidney injury and metabolic alkalosis

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16
Q

How do the following laboratory values change in patients with an exogenous insulin use?

Serum insulin: […]

C-peptide level: […]

A

How do the following laboratory values change in patients with an exogenous insulin use?

Serum insulin: Increased

C-peptide level: Decreased

C-peptide level helps distinguish exogenous insulin use from insulinoma (high C-peptide)

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17
Q

How do the following laboratory values change in patients with an insulinoma?

Serum insulin: […]

C-peptide level: […]

A

How do the following laboratory values change in patients with an insulinoma?

Serum insulin: Increased

C-peptide level: Increased

C-peptide level helps distinguish insulinoma from exogenous insulin use (low C-peptide)

18
Q

How do the following laboratory values change in patients with hypopituitarism?

Free T4: […]

Serum cortisol: […]

Aldosterone: […]

A

How do the following laboratory values change in patients with hypopituitarism?

Free T4: Decrease

Serum cortisol: Decrease

Aldosterone: No change

aldosterone is primarily regulated by the renin-angiotensin system, not the pituitary

19
Q

How do the following laboratory values change in primary adrenal insufficiency?

Cortisol: […]

ACTH: […]

Aldosterone: […]

A

How do the following laboratory values change in primary adrenal insufficiency?

Cortisol: decreased

ACTH: increased

Aldosterone: decreased

20
Q

How do the following laboratory values change in primary hyperparathyroidism?

PTH: Increased

Ca2+: […]

Phosphorus: […]

A

How do the following laboratory values change in primary hyperparathyroidism?

PTH: Increased

Ca2+: Increased

Phosphorus: Decreased

21
Q

How do the following laboratory values change in secondary hyperparathyroidism (e.g. CKD)?

PTH: Increased

Ca2+: […]

Phosphorus: […]

A

How do the following laboratory values change in secondary hyperparathyroidism (e.g. CKD)?

PTH: Increased

Ca2+: Decreased

Phosphorus: Increased

22
Q

How do the following laboratory values typically change in patients with osteomalacia?

Calcium: […]

Phosphate: […]

Alkaline phosphatase: […]

A

How do the following laboratory values typically change in patients with osteomalacia?

Calcium: decreased or normal

Phosphate: decreased

Alkaline phosphatase: increased

Ca2+ levels may normalize due to secondary hyperparathyroidism

23
Q

How do the following laboratory values typically change in patients with osteoporosis?

Calcium: […]

Phosphate: […]

Alkaline phosphatase: […]

A

How do the following laboratory values typically change in patients with osteoporosis?

Calcium: normal

Phosphate: normal

Alkaline phosphatase: normal

important distinguishing feature from osteomalacia

24
Q

How do the serum levels of the following change with vitamin D deficiency?

Ca2+: […]

Phosphate: […]

PTH: […]

A

How do the serum levels of the following change with vitamin D deficiency?

Ca2+: Decrease

Phosphate: Decrease

PTH: Increase

vitamin D is responsible for intestinal absorption of Ca2+ and phosphate; low Ca2+ stimulates PTH production

25
Q

How do total Ca2+ levels change in patients with hypoalbuminemia?

A

How do total Ca2+ levels change in patients with hypoalbuminemia?

Decreased

however, ionized Ca2+ remains stable and thus patients remain asymptomatic

Corrected Ca = (measured total Ca) + 0.8(4.0g/dL - serum albumin in g/dL)

26
Q

How do total K+ levels typically change in patients with diabetic ketoacidosis or hyperosmolar hyperglycemic state?

A

How do total K+ levels typically change in patients with diabetic ketoacidosis or hyperosmolar hyperglycemic state?

Decreased

patients may have normal or elevated K+ on labs due to movement of potassium out of cells from insulin insufficiency

27
Q

How does oral estrogen change the required therapeutic dose of levothyroxine in patients with hypothyroidism?

A

Increased dose required

oral estrogen increases TBG concentration, thus resulting in decreased free T4 and increased TSH

28
Q

How does secretion of the following hormones change in secondary adrenal insufficiency?

Glucocorticoids: […]

Androgens: […]

Mineralocorticoids: […]

A

How does secretion of the following hormones change in secondary adrenal insufficiency?

Glucocorticoids: decreased

Androgens: decreased

Mineralocorticoids: normal (no change)

e.g. due to pituitary disease; normal mineralocorticoid levels (and thus no hyperkalemia, hyperpigmentation, etc.) helps differentiate from primary adrenal insufficiency

29
Q

Inability to lift the skin on the dorsum of the second toe is highly specific for […].

A

Inability to lift the skin on the dorsum of the second toe is highly specific for lymphedema.

i.e. positive Stemmer sign; typically occurs with advanced lymphedema, which causes firm, thickened, non-pitting edema secondary to deposition of collagen and adipose tissue

30
Q

Indications for BRCA mutation testing include a 1st or 2nd degree relative with […] cancer (any age) or two 1st degree relatives with breast cancer, including 1 at age [].

A

Indications for BRCA mutation testing include a 1st or 2nd degree relative with breast & ovarian cancer (any age) or two 1st degree relatives with breast cancer, including 1 at age <50.

USPSTF does not have established guidelines for BRCA mutation testing, thus the exact details are unlikely to appear on an exam (hopefully)

31
Q

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. […]
  2. Fasting glucose (> 100-110 mg/dL)
  3. Blood pressure (> 130/80 mmHg)
  4. Triglycerides (> 150 mg/dL)
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
A

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. Fasting glucose (> 100-110 mg/dL)
  3. Blood pressure (> 130/80 mmHg)
  4. Triglycerides (> 150 mg/dL)
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
32
Q

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. […]
  3. Blood pressure (> 130/80 mmHg)
  4. Triglycerides (> 150 mg/dL)
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
A

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. Fasting glucose (> 100-110 mg/dL)
  3. Blood pressure (> 130/80 mmHg)
  4. Triglycerides (> 150 mg/dL)
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
33
Q

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. Fasting glucose (> 100-110 mg/dL)
  3. […]
  4. Triglycerides (> 150 mg/dL)
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
A

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. Fasting glucose (> 100-110 mg/dL)
  3. Blood pressure (> 130/80 mmHg)
  4. Triglycerides (> 150 mg/dL)
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
34
Q

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. Fasting glucose (> 100-110 mg/dL)
  3. Blood pressure (> 130/80 mmHg)
  4. […]
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
A

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. Fasting glucose (> 100-110 mg/dL)
  3. Blood pressure (> 130/80 mmHg)
  4. Triglycerides (> 150 mg/dL)
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
35
Q

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. Fasting glucose (> 100-110 mg/dL)
  3. Blood pressure (> 130/80 mmHg)
  4. Triglycerides (> 150 mg/dL)
  5. […]
A

Metabolic syndrome is diagnosed when at least 3 of the 5 following criteria are met:

  1. Abdominal obesity (waist circumference > 40 inches in males, > 35 inches in females)
  2. Fasting glucose (> 100-110 mg/dL)
  3. Blood pressure (> 130/80 mmHg)
  4. Triglycerides (> 150 mg/dL)
  5. HDL cholesterol (< 40 mg/dL in men, < 50 mg/dL in women)
36
Q

Monofilament testing is useful for determing the presence of […].

A

Monofilament testing is useful for determing the presence of peripheral neuropathy.

useful in determining a patient’s risk for diabetic foot ulcers

37
Q

Post-operative adjuvant therapies for papillary thyroid carcinoma may include radioiodine ablation and/or suppressive doses of […].

A

Post-operative adjuvant therapies for papillary thyroid carcinoma may include radioiodine ablation and/or suppressive doses of thyroid hormone.

thyroid hormone suppresses TSH, which can stimulate growth of occult residual or metastatic disease; adjuvant therapy is usually for patients with increased risk of recurrence

38
Q

Potassium should be added to the IV fluids of a patient with diabetic ketoacidosis once serum K+ is […].

A

Potassium should be added to the IV fluids of a patient with diabetic ketoacidosis once serum K+ is 5.2 mEq/L.

39
Q

Primary adrenal insufficiency is associated with […]-natremia and […]-kalemia.

A

Primary adrenal insufficiency is associated with hypo-natremia and hyper-kalemia.

due to loss of mineralocorticoid secretion and increased ADH

40
Q

Primary adrenal insufficiency is associated with […] levels of ADH.

A

Primary adrenal insufficiency is associated with increased levels of ADH.

in response to volume depletion and increased corticotropin-releasing hormone; leads to dilutional hyponatremia

Medicine (33 decks)

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