Endocrinology

Question 1

Bone mineral density < 2.5 SDs from normal peak bone mass or T score < - 2.5

Answer 1

Osteoporosis

Question 2

Drug used in prevention and treatment of osteoporosis and reduction of invasive breast cancer occurence

Answer 2

Raloxifene (selective-estrogen modulator)

Question 3

Novel agent, monoclonal antibody to RANKL, inhibiting formation of osteoclast

Answer 3

Denosumab

Question 4

High calcium, low phosphate, high alkaline phosphatase

Answer 4

Hyperparathyroidism

Question 5

Normal to low calcium, high ALP

Answer 5

Osteomalacia

Question 6

Very high ALP

Answer 6

Paget’s disease

Question 7

Normal calcium, phosphorus, alkaline phosphatase

Answer 7

Osteoporosis

Question 8

Best initial diagnostic test for Cushing’s Syndrome

Answer 8

1mg overnight dexamethasone supression test and 24-hr urine cortisol

Question 9

Most accurate diagnostic test for Cushing’s Syndrome

Answer 9

24-hour urine cortisol

Question 10

Next diagnostic test if patient has hypercortisolism

Answer 10

Plasma ACTH measurement

Question 11

Clinical features of Cushing’s Syndrome

Answer 11

Weight gain, central obesity, rounded face “moon face”, fat pad on the back and neck “buffalo hump”, hirsutism, broad and purple stretch marks or striae, muscle weakness amd atrophy

Question 12

Only adrenal-inhibiting medication that can be administered to pregnant women with Cushing’s syndrome

Answer 12

Metyrapone

Question 13

Most common cause of Cushing’s syndrome in general

Answer 13

Medical use of glucocorticoids

Question 14

Major endogenous cause of Cushing’s syndrome (around 70% of cases)

Answer 14

Pituitary corticotrope adenoma

Question 15

ACTH-independent cortisol excess

Answer 15

Cortisol-producing adrenal adenoma

Question 16

Investigation of choice in ACTH-dependent Cortisol excrss

Answer 16

MRI of the pituitary

Question 17

Most common cause of mineralocorticoid excess

Answer 17

Primary hyperaldosteronism

Question 18

Clinical hallmark of mineralocorticoid excess

Answer 18

Hypokalemic hypertension

Question 19

Medical treatment for hyperaldosteronism

Answer 19

Spironolactone

Question 20

ADA recommendations for T2DM Screening

Answer 20

All individuals >45 years old every 3 years

Earlier if BMI > 25 plus additional risk factor for DM

Question 21

Physiologic responses to Hypoglycemia

Answer 21

First line: decrease in insulin
Second line: increase in glucagon
Third line: increase in epinephrine

In prolonged hypoglycemia (not critical) : increase in cortisol and growth hormone

Question 22

ADA 2012 Criteria for diagnosis of Diabetes

Answer 22

HbA1c >= 6.5% (standardized) OR
FBS >= 126mg/dl (7.0mmol/L) OR
2hr OGTT >= 200mg/dl (11.1mmol/L) OR
Classic symptoms of hyperglycemia or hypoglycemic crisis + Random plasma glucose >= 200mg/dl

Question 23

Risk factors for DM

Answer 23

Family history of DM
Obesity (BMI >= 25)
Physical inactivity
Race (Asian, African American)
Previously identified prediabetic care
History of GDM or delivery of baby > 4kg
Hypertension  (BP >= 140/190)
HDL < 35 and/or Triglycerides > 250
PCOS or acanthosis nigricans
History of CVD

Question 24

Preferred initial pharmacologic agent for T2DM

Answer 24

Metformin monotherapy

Question 25

Consider dual combination therapy when A1c is

Answer 25

>= 9%

Question 26

Consider combination injectable therapy when A1c is

Answer 26

>= 10%

Question 27

Triad of DKA

Answer 27

Hyperglycemia Metabolic acidosis (HAGMA) Ketosis

Question 28

HAGMA

Answer 28

Lactic acidosis Ketoacidosis Toxins Renal failure

Question 29

Normal AG

Answer 29

8-10 mEq/L

Question 30

Predominant ketone in ketosis

Answer 30

3-hydroxybutsrate

Question 31

Treatment for DKA

Answer 31

IV fluid replacement : Plain NSS Insulin therapy Potassium replacement Bicarbonate replacement (not necessary unless sever acidosis pH < 7)

Question 32

Hyperglycemia (> 900mg/dl), hyperosmolarity (>320 mOsm/L), serum pH > 7.3 (no acidosis)

Answer 32

Hyperglycemic hyperosmolar state (HHS)

Question 33

Rule of tens in pheochromocytoma

Answer 33

10% bilateral 10% extraadrenal 10% malignant

Question 34

Most sensitive test for Pheochromocytoma

Answer 34

Measurements of plasma metanephrine

Question 35

Classic triad of pheochromocytoma

Answer 35

Palpitations, headache, sweating

Question 36

Dominant sign of pheochromocytoma

Answer 36

Hypertension