Endocrinology Flashcards Preview

American Board of Internal Medicine > Endocrinology > Flashcards

Flashcards in Endocrinology Deck (67):
1

1. What are the laboratory tests for amenorrhea (4)?
2. What would be a secondary test?

1. a. Pregnancy test
b. FSH - ovarian failure > 20
c. Prolactin - prolactinoma
d. TSH and T4

2. Progestin (x 10d) withdrawal challenge where absence of menses:
a. Estrogen absence
b. anatomic defect - US or MRI

2

What should a non-diabetic's blood sugar be 2-hours after a meal? A diabetic?

1. Non-diabetic < 140
2. Diabetic > 200

3

1. What is the risk for developing diabetes in women with Gestational Diabetes?
2. When should women be retested postpartum?

1. 50% in 10 years of delivery
2. 6 weeks postpartum

4

1. What is the standard insulin unit to carbohydrate ratio?
2. What is the standard premeal correction insulin dose for hyperglycemia?

1. 1 unit insulin : 15 grams carbohydrates
2. 1-2 units for every 40-50 over premeal target

5

What are the classes of DM2 drugs, and how do they work (7)?

1. Sulfonylurea - stimulates insulin release
2. Meglitinides - stimulates postprandial insulin
3. Biguanides - decreases hepatic gluconeogenesis AND increases peripheral insulin sensitivity
4. Alpha-Glucosidase Inhibs - retards gut absorp
5. Thiazolidinediones - increase peripheral insulin sensitivity
6. Glucagon-like Peptide-1 (GLP-1) - stimulates insulin release, decreases hepatic gluconeogenesis, delays gastric emptying
7. DPP-IV Inhibitors - enhance incretin effect on insulin and glucagon secretion

6

1. List examples of Sulfonylureas (3).
2. What are their important side effects (2)?

1. Glyburide, Glipizide, Glimepiride
2. Hypoglycemia (especially in setting of low GFR), weight gain

7

1. List examples of Meglitinides (2).
2. What are their important side effects (2)?

1. Repaglinide, Nateglinide
2. Hypoglycemia, weight gain

8

1. List examples of Biguanides (1).
2. What are their important side effects (3)?

1. Metformin
2. Diarrhea, lactic acidosis, B12 deficiency

9

1. List examples of Alpha-Glucosidase Inhibs (2).
2. What are their important side effects (1)?

1. Acarbose, Miglitol
2. Intestinal gas

10

1. List examples of Thiazolidinediones(2).
2. What are their important side effects (3)?

1. Rosiglitazone, Pioglitazone
2. Liver impairment, EDEMA, weight gain

11

What defines DKA (5)?

1. Glucose > 250
2. Serum or urine ketones
3. Anion Gap > 10
4. Bicarb < 18
5. Arterial pH < 7.3

12

What defines HHS (5)?

1. Glucose > 600
2. No serum or urine ketones
3. Normal bicarbonate
4. Normal pH
5. Plasma osmolarity > 320

13

In what order to you diagnose insulinoma?

1. Prolonged fasting 72 hours for glucose < 45
2. Abdominal CT - pancreas
3. EUS, hep-venous sample or pancrea-arterio
4. Surgery

14

For patients who cannot undergo surgery for insulinoma, what are treatment options?

1. Diazoxide - inhibits pancreatic insulin secretion
2. Octreotide
3. Corticosteroids

15

What are serologic tests for Growth Hormone Deficiency (2)?

1. Glucose Suppression Test
2. Low IGF-1

16

What features distinguish Central Adrenal Insufficiency from Primary Adrenal Insufficiency (4)?

1. No hyperpigmentation
- no excess melanocyte-stimulating hormone
2. Infrequent hyponatremia/hyperkalemia
- aldosterone system functional
3. More hypoglycemia
- combine ACTH and GH deficiency
4. Have other features hypopituitarism

17

What is AVP and what does its deficiency lead to?

Arginine Vasopressin - deficiency leads to DIABETES INSIPIDUS where inability to concentrate urine leads to HYPERNATREMIA

18

What is the "stalk effect"?

When pituitary macroadenomas enlarge and cause elevated prolactin levels (usually less than 100)

19

1. What are medicinal treatments for a Prolactinoma (2)?
2. How does it work?
3. When should it be stopped?

1. Bromocriptine
2. Cabergoline

**Dopamine agonists to inhibit prolactin and prolactinomas, thus stopped when pregnant

20

1. What are medicinal treatments for GH tumors (4)?
2. What is a procedural treatment for GH tumors?

1. Octreotide - somatostatin analogs
2. Pegvisomant - somatostatin analogs
3. Bromocriptine - dopamine agonist
4. Cabergoline - dopamine agonist

**Alternative: Radiation

21

What is the minimum appropriate work-up for a pituitary incidentaloma (less than 1cm)?

Prolactin

22

1. Which drugs increase TBG levels (3)?
2. Which drugs decrease TBG levels (4)?

1. a. Estrogen **Alter Levothyroxine doses
b. 5-FU
c. Methadone

2. a. Andogrens
b. Corticosteroids
c. l-Asparaginase
d. Niacin

23

When is Radioactive Iodine Uptake testing contraindicated?

1. Pregnant
2. Breast-feeding

24

1. What is the pathophysiology of Grave's Disease?
2. What are medicinal treatments (2 classes, 2 drugs)?

1. Antibodies against TSH-receptor which irreversibly bind and activate receptors
2. a. Methimazole or Propylthiouracil
b. Atenolol or Propranolol

25

What are side effects of hyperthyroid medications (4)?

Methimazole or Propylthiouracil:
1. Rash - can substitute drugs
2. Agranulocytosis - must stop all drugs
3. Liver impairment with PTU
4. Aplasia Cutis or Esophageal/Choanal Atresia with Methimazole

26

Who should undergo treatment for Subclinical HYPER-thyroidism (3)?

TSH under 0.1 and:
1. Older than 65
2. Underlying heart disease
3. Osteoporosis

27

What is the goal TSH for treatment with Levothyroxine?

1 to 2.5

28

What is the algorithm for thyroid nodules?

1. TSH depressed --> RAIU
2. TSH normal then FNA:
a. Benign - follow
b. Insufficient - repeat FNA
c. Suspicious - surgery

29

What are the four type of thyroid cancer in order of prevalence, and what are their tumor markers?

1. Papillary - thyroglobulin
2. Follicular - thyroglobulin
3. Medullary - calcitonin
4. Anaplastic - none

30

Which type of thyroid cancer is not treated with radioiodine ablation, and why?

Medullary because calcitonin producing C-cells do not take up radioiodine

31

What serologic tests can be performed on pregnant women to evaluate for Grave's Disease (2)?

1. Thyroid-stimulating immunoglobulins
2. Thyrotropin-binding inhibitory immunoglobulins

32

Which steroids would not interfere with cosyntropin stimulation testing (2)?

1. Dexamethasone
2. Methylprednisolone

33

Which beta-blocker interferes with plasma metanephrine measurement?

Labetolol

34

After obtaining equivocal metanephrines, how can pheochromocytoma be confirmed (2 other serologic tests)?

Clonidine Suppression Test
1. Measure plasma catecholamines (NE, Epi)
2. Give Clonidine (alpha-blocker)
3. Measure catecholamines at 1, 2 and 3h
4. Levels above 500 means pheochromocytoma

Glucacgon Test:
1. Bolus Glucagon
2. Measure catecholamines
3. Levels above 2000 means pheochromocytoma along with BP increase 20/15

35

1. What is the diagnostic serologic test for Primary Aldosteronism?
2. Which drug would impede this result?

1. Aldosterone:Renin greater than 20, Aldo>15
2. Spironolactone

36

What are the four potassium-sparing diurectics and which one has fewer androgen effects?

1. Spironolactone
2. Eplerenone **fewer effects
3. Amiloride
4. Triamterene

37

What are two tests for Cushing Disease (2)?

1. 24-hour urine cortisol > 250 mcirog/d
2. Morning cortisol >5 after 11pm Dexamethasone

38

What are indications to perform FNA on thyroid nodules (4)?

1. Greater than 1-cm
2. Microcalcifications
3. High intranodular blood flow
4. Taller than wide

39

1. What is pharmacodynamics of Cinacalcet?
2. What is its indication?

1. Cinacalcet - sensitizes calcium-receptors in the parathyroid which reduces PTH
2. Secondary hyperparathyroidism, NOT PRIMARY

40

What imaging is used for pheochromocytoma?

Metaiodobenzylguanidine (MIBG)

41

1. What is a T-score?
2. What is a Z-score?
3. How are osteopenia and osteoporosis defined?

1. SD from the mean for young healthy population
2. SD from the mean for age- and sex-matched
3. a. Osteopenia T-score -1 to -2.5
b. Osteoporosis T-score less than 2.5

42

When should bisphosphonates be started in women (4)?

1. T-score less than -2
2. T-score less than -1.5 with risk
3. T-score less than -1 with steroids
4. Women older than 70 with risk facors

43

When should patients taking Prednisone start taking bisphosphonates?

Prednisone 5mg/d for three months

44

1. What medication can be used for GH-tumors after resection?
2. What class are they in?

Octreotide or Lanreotide - somatostatin analogs

45

1. What is Teriparatide?
2. What is its indication and contraindication?

1. Recombinant human parathyroid hormone is an anabolic agent that builds new bone.
2. Osteoporosis and contraindicated with Paget disease

46

1. List examples of Glucagon-like Peptide-1 (GLP-1) (1).

Exenatide

47

What are indications for Parathyroidectomy (6)?

1. Age less than 50
2. Calcium greater than 1 mg/dL above normal AND IF PTH IS EVEN UPPER LIMIT OF NORMAL
3. Osteoporosis or Previous Fracture
4. Renal insufficiency (GFR <60)
5. Nephrolithiasis
6. Hypercalcemic crisis

48

What is the mechanism for hypercalcemia in Sarcoidosis?

Sarcoid granulomas produce enzymes (1a-hydroxylase) taht convert 25-OHD to 1,25-OHD.

49

What is treatment for painful diabetic neuropathy (2)?

1. Duloxetine
2. Pregabalin

50

In treatment for DKA, when should you start:
1. Insulin infusion
2. Potassium infusion
3. Glucose infusion
4. Bicarbonate infusion

1. Immediately unless K less 3.3 (stop after ketones are cleared)

2. K less 5.5
3. Glucose less 250
4. pH less 7.0

51

What are two scenarios for surreptitious hypoglycemia, and which lab confirms it?

1. Oral hypoglycemic agents - Inappropriate HIGH C-peptide thus measure urine sulfonylurea

2. Insulin - Inappropriate LOW C-peptide

52

After 24-hour water-deprivation urine (low osm) confirms Diabetes Insipidus, what is the following test?

Desmopressing Challenge:
1. Urine concentrates --> central DI --> pituitary MRI
2. Urine doesn't --> nephrogenic DI --> renal US

53

How should these forms of DI be treated?
1. Neurosurgery/trauma
2. Chronic central DI
3. Litium nephrogenic DI
4. Non-drug nephrogenic DI

1. Neurosurg/trauma - 1/2NS + DESMOPRESSIN
2. Chronic central DI - intranasal DEMOPRESSIN
3. Litium nephrogenic DI - AMILORIDIE block Na+
4. Non-drug nephrogenic DI - THIAZIDE, NaCl strict

54

What type of vitamin D is given with:
1. Renal disease
2. Hepatic disease
3. All others

1. Renal disease: 1,25-OHD
2. Hepatic disease: 20-OHD
3. All others: D3 or D2

55

How does Amiodarone affect thyroid function?

Decreases peripheral conversion T4-->T3 but euthyroid

56

What does Hyperemesis Gravidarum do to TSH?

Lowers TSH

57

When should Subclinical Hypothyroidism be treated during pregnancy?

ALWAYS

58

What distinguishes Subacute from Silent Thyroiditis?

Neck pain:
1. Subacute: PAINFUL
2. Silent: nonpainful

59

If you see this sign with thyroiditis, consider thyroidectomy.

Pemberton - facial flushing when arms raised

60

When a woman appears virile, what serum test should be ordered?

17-OH progesterone (elevated due to underactive 21-hydroxylase and 11B-hydroxylase)

61

What are drug treatments for infertility in:
1. Congential Adrenal Hyperplasia
2. PCOS

1. Dexamethasone - to reduce hyperplasia
2. Clomiphene - SERM

62

What are extra-skeletal complications of Paget's Disease (2)?

1. Tinnitus
2. Hearing loss

63

When screening tests are done in diabetics, an ophthalmology report about __ should prompt __.

1. Unilateral retinopathy
2. Carotid stenosis

64

What are features of nonproliferative (3) and proliferative (2) retinopathy in diabetics?

Nonproliferative: no visual changes
- hard exudates
- microaneurysms
- minor hemorrhages

Proliferative: visual DECLINE
- cotton-wool spots
- neovascularization

65

How high should PSA rise after testosterone treatment in men for hypogonadism?

PSA doubles, otherwise consider prostate cancer

66

How do you distinguish between onset of Diabetes Mellitus Type 1 and Type 2?

Pancreatic antibodies:
1. Islet cell antibodies
2. Glutamic Acid Decarboxylase antibodies

67

What is treatment for Myxedema Coma (2)?

1. Levothyroxine IV
2. Hydrocortisone IV (while awaiting cortisol and Cosyntropin stimulation testing)