PANCE_endocrine 7%

Question 1

(RR)
name two types of hypOthyroidism

Answer 1

Hashimoto thyroiditis

silent thyroiditis

Question 2

(RR)
key features of toxic thyroid adenoma

Answer 2

palpable thyroid nodule
lab values consistent with hyperthyroidism (low TSH, elevated T3, elevated T4)

Question 3

(RR)
“You are treating a patient with type 2 diabetes mellitus. He is currently on metformin, but his hemoglobin-A1c is not at goal. You decide to add insulin. [What] is the best approach when considering this management plan?”

Answer 3

continue oral medications, add long-acting insulin

Question 4

(RR)
severe hyperglycemia with serum glucose usually >600 mg/dL

Answer 4

hyperosmolar hyperglycemic state

Question 5

(RR)
two signs of hyperosmolar hyperglycemic state

Answer 5

AMS
profound dehydration

Question 6

(RR)
lab findings of hyperosmolar hyperglycemic state

Answer 6

glucose > 600 mg/dL
negative ketones

Question 7

(RR)
“A 19 y/o F presents to the ED w/ severe flushing, tremors, and vision changes. V/S: BP 240/110 mm Hg, HR 104 bpm, RR 20 breaths per minute, and T 100.4F. She was recently found to have a mass on her kidney. [What] is the most appropriate course of treatment in this patient?”

Answer 7

“PHENTOLAMINE FOLLOWED BY LABETALOL”

“Must obtain alpha-blockade prior to beta-blockade, classically done by administering phenoxybenzamine, which is an alpha-1 and alpha- 2 blocker, or phentolamine, a nonspecific alpha-blocker….

….followed by a beta blocker, such as labetalol or propranolol”

Question 8

(RR)
Graves is ….

Answer 8

“an autoimmune condition in which autoantibodies to the THYROTROPIN RECEPTOR cause increased thyroid hormone synthesis and secretion and diffuse thyroid growth”

Question 9

classic triad of Graves disease

Answer 9

goiter
orbitopathy
pretibial myxedema (infiltrative dermopathy)

Question 10

(RR)
what are pituitary adenomas?

Answer 10

benign tumors of the anterior pituitary gland

Question 11

(RR)
MC cell type of pituitary adenomas

Answer 11

LACTOTROPH (PROLACTIN-SECRETING ADENOMAS)

(making up 50% of pituitary adenomas)

Question 12

(RR)
clinical manifestations of lactotroph adenomas

Answer 12

hyperprolactinemia (galactorrhea)
hypogonadism (amenorrhea, infertility, vaginal dryness, decreased bone mineral density)

Question 13

(RR)
most important initial intervention for a pt with hyperglycemic hyperosmolar state

Answer 13

aggressive IV NS fluids

Question 14

(RR)
What is the most appropriate therapy for pts with a prolactin-secreting pituitary adenoma

Answer 14

CABERGOLINE
(a dopamine agonist)

(“bromocriptine has historically been used, but cabergoline has been shown to be more effective and have fewer side effects”

Question 15

(RR)
“What is the most likely neurological symptom from a pituitary adenoma?”

Answer 15

“loss of peripheral vision, as the mass intrudes on the optical chiasm”

Question 16

(RR)
lab findings for acromegaly

Answer 16

increased IGF-1

Question 17

(RR)
a pt is in DKA 2/2 a UTI….what is first step in management? and after that? and once the glucose is about 200 mg/dL?

Answer 17

first - NS bolus
next - insulin drip at 5U/hr

after glucose is ~200mg/dL, change fluids to a 5% dextrose in a 0.45% NaCl and decrease insulin drip dose (“to avoid iatrogenic hypoglycemia and cerebral edema”)

Question 18

(RR)
in treatment of DKA, what considerations should be made for K+?

Answer 18

replete K+ deficit (usually falsely elevated)
do not start insulin if K+ is <3.3 mEq/L

Question 19

(CME)
“Which of the following thyroid carcinomas is most common?
a) medullary carcinoma
b) follicular carcinoma
c) papillary carcinoma
d) anaplastic carcinoma”

Answer 19

C) PAPILLARY CARCINOMA

Question 20

(CME)
“Which of the following best explains the Somogyi effect?
f) The Somogyi effect is due to relative insulin excess in the morning
g) The Somogyi effect is due to insulin deficiency at midnight
h) The Somogyi effect is due to rebound nocturnal hypoglycemia
i) None of the above”

Answer 20

H) THE SOMOGYI EFFECT IS DUE TO REBOUND NOCTURNAL HYPOGLYCEMIA

Question 21

(CME)
“Which serologic test should be initially ordered if you suspect primary hypothyroidism?
a) serum T4
b) serum T3
c) free serum T4
d) serum TSH
e) serum TBG”

Answer 21

D) SERUM TSH

Question 22

(CME)
“glucocorticoids are known to do all of the following EXCEPT
f) cause hyperglycemia
g) cause euphoria
h) decrease testosterone and LH
i) promote peptic ulcer disease
j) decrease intraocular pressure”

Answer 22

J) DECREASE INTRAOCULAR PRESSURE

Question 23

(CME)
“Which of the following is most associated with a high aldosterone level?
a) hyperkalemia
b) hypernatremia
c) hypotension
d) Cushing syndrome
e) muscle weakness”

Answer 23

E) MUSCLE WEAKNESS

Question 24

(CME)
“Which lab value is associated with Cushing’s Disease?
f) decreased glucose
g) elevated ACTH
h) decreased cortisol
i) elevated ALT
j) decreased TSH”

Answer 24

G) ELEVATED ACTH

Question 25

(RR) what 3 lab findings are expected in primary adrenal insufficiency

Answer 25

hyponatremia hypoglycemia hyperkalemia (sodium and glucose DOWN, potassium UP)

Question 26

(RR) increased pigmentation at mucus membranes and palmar creases....what is this a sign of?

Answer 26

primary adrenal insufficiency, or Addison disease

Question 27

(RR) how do we manage primary adrenal insufficiency?

Answer 27

hydrocortisone supportive care

Question 28

(RR) if a pt has primary adrenal insufficiency or Addison disease, what is happening to the adrenal gland?

Answer 28

the immune system is destroying the adrenal cortex, causing a reduction of cortisol and aldosterone if a pt has DMI or some other autoimmune condition, think about Addison's

Question 29

(RR) what is acute adrenal insufficiency?

Answer 29

insufficient plasma cortisol, and it's a medical emergency

Question 30

(RR) "Which exam finding is associated with Cushing's syndrome? a) distal atrophy and weakness b) dry skin c) hypotension d) supraclavicular fat pads"

Answer 30

D) SUPRACLAVICULAR FAT PADS (not dry skin - skin findings are usually skin atrophy, purple striae and bruisability)

Question 31

(RR) MC cause of Cushing's Syndrome?

Answer 31

exogenous glucocorticoids

Question 32

(CME) What is Cushing's DISEASE?

Answer 32

"Cushing's syndrome due to excessive pituitary ACTH secretion, due to a pituitary tumor" (RR: "if cause of Cushing Syndrome is a pituitary tumor, then it's called Cushing Disease")

Question 33

(CME) 5 common s/s of Cushing's Syndrome

Answer 33

obesity 90% hyperlipidemia 70% glucose intolerance 79% skin changes 60% hirsutism 75% (women get male-like s/s)

Question 34

(RR) how do we diagnose Cushing Syndrome?

Answer 34

24-hour urine cortisol testing ACTH levels

Question 35

(RR) most noniatrogenic cause of Cushing Syndrome

Answer 35

hypercortisolism from ACTH-secreting pituitary tumor

Question 36

(RR) how do we treat Graves disease in pregnant ladies?

Answer 36

1st trimester - PTU 2nd & 3rd trimesters - methimazole (these are THIONAMIDES) "initiating therapy during the first trimester because the associated fetal anomalies are less severe than with methimazole". Once organogenesis is complete, switch to methimazole, b/c it "is associated with a lower risk of maternal hepatotoxicity"

Question 37

(RR) what hyperthyroidism treatment is recommended for lactating patients?

Answer 37

METHIMAZOLE is recommended for pts who are lactating

Question 38

(RR) most appropriate initial treatment for hyperthyroidism

Answer 38

block sympathetic hyperactivity, control symptoms and heart rate, with a beta blocker (i.e. propanalol) "While thionamide medications can be used, symptom control with a beta-blocker is the most appropriate initial treatment. Once symptoms are controlled, medications to inhibit thyroid hormone synthesis can be initiated."

Question 39

(RR) when do we use radionuclide scans for thyroid nodules?

Answer 39

if a pt has low TSH " Patients with a thyroid nodule and a low TSH level (suggesting subclinical or overt hyperthyroidism) can undergo radionuclide scanning to determine if the nodule is hyperfunctioning."

Question 40

(RR) when do we FNA biopsy a thyrod nodule?

Answer 40

if the pt has a normal TSH

Question 41

(RR) if a pt is on amlodipine, ASA, furosemide, metformin and saxagliptin, and you want to add empagliflozin to get better glycemic control, what med should be adjusted?

Answer 41

furosemide empagliflozin is a Sodium-Glucose Cotransporter 2 (SGLT-2) Inhibitor, which in combination with loop diuretics can cause hypotension (dehydration and volume depletion)

Question 42

(RR) "What class of antihypertensive medications can negate the antidiabetic effects of empagliflozin?"

Answer 42

thiazide diuretics

Question 43

(RR) Which complication is most likely to develop from untreated hyperthyroidism? a) bone loss b) coronary artery disease c) loss of vision d) megacolon e) myxedema coma

Answer 43

A) BONE LOSS "Complications of hyperthyroidism include bone loss, hypercalcemia, cardiac dysrhythmias, and thyroid crisis." NOT myxedema coma, which is a life-threatening complication of hypOthyroidism

Question 44

(RR) what kind of drug is pioglitazone? What is it's black box warning?

Answer 44

a thiazolidinedione antidiabetic agent The single black box warning for pioglitazone is congestive heart failure. (..."can cause or exacerbate heart failure...")

Question 45

(RR) what two drugs are in the thiazolidinedione drug category?

Answer 45

pioglitazone rosiglitazone

Question 46

(RR) "What is the etiology of type 1 diabetes?"

Answer 46

"pancreatic beta cell destruction, which prohibits patients from producing insulin"

Question 47

(RR) what three antidiabetic drugs carry risk of hypoglycemia?

Answer 47

sulfonylureas meglitinides insulin

Question 48

(RR) name two sulfonylureas and give the treatment for recurrent hypoglycemic episodes with sulfonylureas

Answer 48

glyburide & glipizide Tx: octreotide Recurrent hypoglycemic episodes from sulfonylureas should be treated with octreotide, a somatostatin analog. Octreotide inhibits glucose-stimulated insulin release, thus, preventing recurrent hypoglycemia.

Question 49

(NCCPA practice exam) In addition to encouraging a 16 y/o pt in therapeutic lifestyle changes, the most appropriate intervention in terms of initiating therapy for DM II would be _____?

Answer 49

(CME) biguanides, i.e. metformin

Question 50

(NCCPA practice exam) "Which of the following conditions stimulates the physiologic release of vasopressin from the post pit gland? a) hyperkalemia b) hyponatremia c) hypo-osmolality of the blood d) hypovolemia e) metabolic alkalosis"

Answer 50

d) HYPOVOLEMIA vasopressin = ADH

Question 51

(NCCPA practice exam) "A 40 y/o F is admitted to the hospital b/c she has had multiple episodes of anxiety, palpitations, flushing, and HA during the past 6 months. After an extensive workup, pheochromocytomas is diagnosed. FH of which of the following conditions is most likely in this pt? a) Hashimoto thyroiditis b) MEN type 2 c) SLE d) DM II e) ulcerative colitis"

Answer 51

b) multiple endocrine neoplasia type 2 (MEN2) "The approximate frequency of pheochromocytoma in these disorders is 10 to 20 percent in VHL syndrome, 50 percent in MEN2, and 2 to 3 percent with NF1" VHL = von Hippel-Lindau NF1 = neurofibromatosis 1 (UpToDate)