Endocrine

Question 1

primary function of parathyroid hormone

Answer 1

regulate homeostasis of calcium, phosphate and 1,25 dihydroxyvitamin D (calcitriol)

Question 2

what happens when Calcium receptors on Parathyroid gland sense lower calcium levels

Answer 2

PTH is released which causes:
1- within minutes bone resorption begins
2- within minutes calcium reabsorption in the kidney
3- Calcitriol increases the absorption of calcium in the GI tract

Question 3

Will DPP4 inhibitors cause hypoglycemia

Answer 3

No

Question 4

What is unique about SGLT-2 Inhibitors

Answer 4

Reduce CV risk

increase risk of amputations

Question 5

What can microalbuminuria mean

Answer 5

progressive nephropathy

Question 6

What do GLP-1 meds do

Answer 6

enhanced insulin secretion
suppress glucogon secretion
slows gastric emptying
early satiety

Question 7

never mix which insulin with any other type

Answer 7

Insulin Glargine

Question 8

which vitmain will be depleted with long term metformin use

Answer 8

B12

Question 9

Minimum weight loss goal for pre DM to avoid DM dx.

Answer 9

5-10%

Question 10

Fasting BS level to dx pre diabetes

Answer 10

100-125

Question 11

Pros and cons of ACTOS

Answer 11

Pro: 24% reduction of heart attack and stroke, 52% reduction risk of developing DM
Con: Wt gain, Edema, Bone fxr, bladder cancer

Question 12

Tx options for dm neuropathy

Answer 12

Lyrica and Cymbalta FDA approved

TCAs, Tegretol, Venlafaxine

Question 13

What are the levels of Hypoglycemia

Answer 13

Level 1: 54-70
Level 2: <54
Level 3: <54 and requiring assistance

Question 14

Triad of Hemochromotosis

Answer 14

Cirrhosis, DM, Skin Hyperpigmentation

Question 15

what may slow progression of DM retinopathy

Answer 15

Adding fenofibrate to statin tx (Accord trial)

Question 16

When should you be concerned about kidney fxn after starting ACEI?

Answer 16

Rise of Cr to 30% above baseline after two months.

Question 17

Clear indication for ASA 75-162 mg daily

Answer 17

DM with CAD or PVD

Question 18

difference between Adding metformin or 30 min of daily moderate exercise to lose 5-10% wt. on Developing DM

Answer 18

Metformin 31% reduction risk

Wt loss and exercise 58% reduction risk

Question 19

Do statins increase risk of DM

Answer 19

Yes, 9% increased risk
Statins will cause 1 case of new DM for 500 pt treated x one yr
Lack of statins will cause one CV event for 200 pt treated x one yr.

Question 20

Who should have brain MRI in Low T workup

Answer 20

Men <40yrs with T <250, Men >60 yrs with T <150

Question 21

Risk for pts with subclinical hypothyroidism?

Answer 21

Elevated Lipids and progression to hypothyroidism,

Question 22

Next test to check with Subclinical hypothroidism?

Answer 22

anti TPO antibodies

If positive pt WILL become hypothyroid

Question 23

What is thyroid risk in pts taking amiodarone?

Answer 23

3% get hyperthyroidism

Question 24

Test to order if TSH low and T4 high

Answer 24

Radioactive Iodine Uptake scan

Question 25

Starting dose of thyroid med

Answer 25

1.6 mcg / kg recheck in 6 wks.

Question 26

MC thyroid cancer

Answer 26

Papillary (10 yr survival is 90%)

Question 27

Define thyrotoxicosis

Answer 27

Excess thyroid hormone

Question 28

What is the first thing you need to do when you identify thyrotoxicosis?

Answer 28

Determine if it is due to hyperthyroidism or thyroiditis

Question 29

What are some examples of hyper thyroidism?

Answer 29

Graves’ disease, toxic, multinodular, goiter, toxic adenoma

Question 30

What are some examples of thyroiditis?

Answer 30

This is release of preformed, thyroid hormone, such as after a viral infection,

Question 31

Treatment of thyrotoxicosis

Answer 31

It depends on what is causing the thyroid hormone to be elevated. Perhaps just treating symptoms with beta blockers with thyroiditis. Perhaps needs anti-thyroid drugs, such as Graves’ disease

Question 32

who should be screened for DM?

Answer 32

all pts over the age of 45 every 3 yrs. any female with hx of GDM every 3 yrs. Anyone younger with risk factors: obesity, 1st degree relative with DM, pt on BP meds. high risk ethnicity

Question 33

How can hypothyroidism cause Hyperprolactinemia?

Answer 33

Increased TRH causes release of prolactin as well.

Question 34

Why does risperidone cause prolactin secretion?

Answer 34

Dopamine can inhibit the release of prolactin, so dopamine antagonists will contribute to elevated prolactin. Risperidone one of the worse, Abilify resolves this in 80% of trial pts.

Question 35

how to recognize and work up pathologic galactorrhea?

Answer 35

Pathologic nipple discharge, characterized by a spontaneous unilateral, uniductal discharge with bloody features, should also be ruled out. Ultrasonography is the first-line modality in women <30 years of age and mammography is the first-line modality in women ≥30 years of age

Question 36

Who should be screened for type 1 DM?

Answer 36

Patients at risk for T1D, Family history of T1D, A personal or family history of select autoimmune diseases such as celiac, hashimotos or Graves. Consider screening pts with T2D to ensure proper classification.

Question 37

What tests to run to screen for T1D?

Answer 37

assess autoantibodies Glutamic acid decarboxylase 65 AAb (GADA) Insulinoma-associated antigen 2 AAb (IA-2A) Insulin AAb (IAA) Zinc transporter 8 AAb (ZnT8A) Islet cell AAb (ICA)

Question 38

what if you have a positive AAb for T1D

Answer 38