Endocrinology & Metabolism

Question 1

What are the 4 most common cause of unintentional weight loss (general)?

Answer 1

1. Malignancy
2. chronic infections
3. GI disorders
4. psychiatric conditions

Question 2

How is unintentional weight loss evaluated?

(Labs & Imaging orders)

Answer 2

1. Labs: CBC, CMP, thyroid panel
2. Imaging: CXR, abdominal CT (if malignancy suspected)

Question 3

What are complications of unintentional weight loss?

Answer 3

Malnutrition, functional decline.

Question 4

DM is diagnosed when HbA1c is greater than… OR Fasting Glucose is greater than…

Answer 4

• 6.5%
• 126 mg/dL

(prenatal uses OGTT and is dx with glucose > 200 mg/dL)

Question 5

First Line Tx for DM

Answer 5

lifestyle always! then Metformin

Question 6

What are the complications of DM?

Answer 6

• Microvascular → Retinopathy, Nephropathy, Neuropathy
• Macrovascular → Coronary Artery Disease (CAD), Stroke

Question 7

When does screening for DM begin?

Answer 7

45 y/o

(sooner if obese, family hx, HTN or PCOS)

Question 8

Diabetic Retinopathy → Fundoscopic exam shows …

Answer 8

cotton-wool spots, hemorrhages

(microvascular vessel damage)

Question 9

Diabetic Neuropathy →… (3)

Answer 9

1. Stocking-glove pattern
2. gastroparesis
3. foot ulcers

Question 10

What are the macrovascular (Large vessel damage) changes/complications of DM?

Answer 10

• Heart → CAD, MI (DM = equivalent to CAD risk!)
• Brain → Stroke (2-4x increased risk in diabetics)
• Peripheral Vascular Disease → Claudication, gangrene, amputation risk

Question 11

Metformin (Biguanide) → Decreases hepatic glucose production, NO hypoglycemia. What is the life-threatening side effect to look out for?

Answer 11

auses lactic acidosis (avoid in CKD)

(weight neutral, contraindicated in CDK)

Question 12

What are the two classes of diabetes meds that promote weight loss?

Answer 12

SGLT2 inhibitors (Empagliflozin) & GLP-1 agonists (Liraglutide)→ SGLT2 causes glucose loss in urine, GLP-1 slows gastric emptying & suppresses appetite

Question 13

What diabetes drug class increases insulin secretion and causes hypoglycemia?

Answer 13

Sulfonylureas (Glipizide, Glyburide) → Stimulates pancreas, but causes hypoglycemia & weight gain

Question 14

Which diabetes medication should be avoided in CHF due to fluid retention?

Answer 14

Thiazolidinediones (Pioglitazone) → Increases insulin sensitivity, but causes edema & CHF exacerbation.

(remember PPAR-g in the “glitter-zone”)

Question 15

What is the best oral diabetes medication for patients with CKD?

Answer 15

DPP-4 inhibitors (Sitagliptin) → Less potent, but safe in kidney disease.

Question 16

What is the main difference between DKA & HHS?

Answer 16

• DKA a/w Type 1, ketones & acidosis
• HHS a/w Type 2, very high glucose, no ketones, no acidosis

(tx both w/fluids. DKA: give insulin and K+)

Question 17

How do you treat DKA?

Answer 17

IV Fluids → Insulin → Potassium replacement (watch for hypokalemia!)

(HHS is just treated w/fluids)

Question 18

Why is potassium replacement critical in DKA treatment?

Answer 18

Insulin drives K+ into cells, causing life-threatening hypokalemia if not replaced.

(DKA tx = IV Fluids → Insulin → Potassium replacement)

Question 19

When do you start insulin in Type 2 Diabetes (4)?

Answer 19

1. A1c >10%
2. maxed-out orals
3. symptomatic weight loss
4. hospitalization

(remember how mad dad’s doctor was when his A1c was 12%?!)

Question 20

What are the 4 types of insulin and their use?

Answer 20

1. Rapid-acting (Lispro, Aspart) → Mealtime insulin
2. Short-acting (Regular) → DKA (IV), inpatient use
3. Intermediate-acting (NPH) → Twice-daily basal insulin
4. Long-acting (Glargine, Detemir) → Once-daily basal insulin

Question 21

What is the insulin protocol for DKA treatment (4)?

Answer 21

1. IV Regular Insulin (First-line)
2. Switch to subQ Basal Insulin once anion gap closes
3. Always check & replace K+ before giving insulin
4. If glucose <200 but still acidotic → Add dextrose & continue insulin

Question 22

How do you differentiate causes of hyperthyroidism using the radioactive iodine uptake (RAIU) test?

Answer 22

• ↑ Utake (Diffuse) → Graves’ Disease
• ↑ Uptake (Nodular) → Toxic Adenoma or Multinodular Goiter
• ↓ Uptake → Thyroiditis, Exogenous Thyroid Hormone Use

Question 23

HypERthyroidism/GravEs Diz is caused by… Abs..
HypOthyroidism/HashimOtOs diz is caused by… Abs.

Answer 23

HypERthyroidism/GravEs = TSH receptor Abs
HypOthyroidism/HashimOtOs = Anti-TPO Abs

(TSH ticklers, TPO destrOyers)

Question 24

When is Methimazole used for hyperthyroidism

Answer 24

1st-line, except in 1st trimester pregnancy (use PTU instead, PTU also used for thyroid storm)

(definitive tx: radioactive iodine ablation OR thyroidectomy)

Question 25

When is PTU used in hyperthyroidism?

Answer 25

1st trimester pregnancy & thyroid storm

Question 26

Thyroid Storm sx (Myxedema Crisis is the opposite = Severe hypOthyroidism)

Answer 26

1. Fever 1. Tachycardia 1. AMS 1. HTN Crisis (Tx= PTU, Beta-blockers, IV Steroids)

Question 27

Tx for thyroid storm (3)

Answer 27

1. PTU (also used in 1st trimester of pregnancy) 1. Beta-blockers 1. IV Steroids (Thyroid Storm sx = Fever, Tachycardia, AMS, HTN Crisis)

Question 28

3 complications of hyperthyroidism

Answer 28

1. thyroid storm 1. A-Fib (high-output HF risk!) 1. osteoporosis (chronic hyperthyroidism = increased bone turnover)

Question 29

Myxedema Crisis (Severe Hypothyroidism) sx (3) (don't confuse w/pretibial myxedema which is a hypErthyroid sx)

Answer 29

1. Hypothermia 1. Hypotension 1. Bradycardia (ICU Treatment)

Question 30

When do you do screening for Hashimotos (2 groups)?

Answer 30

1. All Women >60 1. Younger if risk factors (Family history, autoimmune disease, previous radiation, pregnancy, lithium use, amiodarone use)

Question 31

difference between myopathy in hypOthyroidism/HashimOto and hypErthyroidism/GravEs?

Answer 31

HypOthyroid/HashimOto = mucle edema/myoedema and **increased CK** (both have muscle weakness)

Question 32

DEXA scan T-score less than ... = Osteoporosis (and/or fragility fx)

Answer 32

≤ -2.5 (bone mineral density is used for screening in asymptomatic patients)

Question 33

Labs to rule out secondary causes of osteoporosis (4)

Answer 33

1. Vitamin D deficiency (25-hydroxyvitamin D level) 1. Hyperparathyroidism (PTH level) 1. Hyperthyroidism (TSH) 1. Multiple myeloma (serum protein electrophoresis if suspicious)

Question 34

1st-line agents that tx osteoporosis (T score < 2.5)

Answer 34

1. Zoledronic acid 1. Risedronate 1. Alendronate

Question 35

3 Rx AE of bisphosphonates?

Answer 35

1. Esophagitis (must take and stay upright for 30 min to avoid) 1. Atypical fractures 1. Osteonecrosis of the jaw

Question 36

Rx for Osteoporosis in pateints w/established CKD

Answer 36

Denosumab (RANKL inhibitor)

Question 37

Indication for Teriparatide (PTH analog)

Answer 37

T-score < -3.5 or multiple fractures (severe osteoporosis)

Question 38

When is Raloxifene (Selective Estrogen Receptor Modulator - SERM) indicated?

Answer 38

for postmenopausal women **who can’t take bisphosphonates** (can't take them if GI issues, CKD. Used b/c this group of patients is at risk for breast cancer)