Board Vitals Endocrinology Flashcards
What can you use for monitoring response to treatment in type 1 diabetes patients who present to the ER for hyperglycemia and possible DKA?
Beta-hydroxybutyrate
Patient presents with precocious puberty, Cafe-au-lait macules, and polyostotic fibrous dysplasia.
Diagnosis?
McCune-Albright syndrome
Familial progressive myoclonus epilepsy with deafness, lipomas and ataxia.
Diagnosis?
May-White syndrome
What percentage of pheochromocytoma patients have the classic triad of headaches, palpitations and diaphoresis?
~ 50%
Which antibodies are most common in LADA?
GAD-65 antibodies
What enzyme is deficient in alkaptonuria or “dark urine disease”?
Homogentisic acid deoxygenase
What enzyme is deficient in hereditary tyrosinemia type 1?
Fumarylacetoacetate hydrolase (FAH)
What enzyme is deficient in hereditary tyrosinemia type 2?
Tyrosine aminotransferase (TAT)
What is the enzyme deficiency in hereditary tyrosinemia type 3?
4-hydroxyphenylpyruvate dioxygenase (HPD)
Does smoking predispose to vitamin C deficiency?
Yes
Does thyrotoxicosis cause increased vitamin C utilisation?
Yes
Does pregnancy cause increased vitamin C utilisation?
Yes
What percentage of MEN1 patients have parathyroid adenomas by age 40?
90%
What is the most likely mechanism of bone loss in a post-menopausal woman?
Increased osteoclast activity
What causes congenital hypogonadotrophic hypogonadism and when is it diagnosed?
Deficiency of gonadotropin-releasing hormone typically diagnosed in late adolescence.
What treatment restores puberty and fertility in patients with congenital hypogonadotrophic hypogonadism?
Exogenous GnRH in pulses.
What is the definition of septic shock?
Severe sepsis with hypotension that is refractory to IV fluids.
What is the role of hCG in pregnancy?
Acts like LH and maintains corpus luteum and production of progesterone.
What does hCG do to uterine angiogenesis?
Increases it
What does hCG do to thyroid hormone levels?
Increases them (has common alpha-subunit with TSH)
What happens to the urine urea concentration when desmopressin is given to patients with central diabetes insipidus?
Increases
Does desmopressin alter the pH of the urine?
No
Does desmopressin alter urinary reabsorption of calcium?
No
Does desmopressin increase or decrease the water permeability of the inner medullary collecting duct?
Increase
What is the insulin, c-peptide and proinsulin level in patients with exogenous insulin use?
Insulin - high
C-peptide - normal or low
Proinsulin - normal or low
What happens to the triglyceride level in Cushing’s syndrome?
Increases
What happens to the total cholesterol in Cushing’s syndrome?
Increases
What does a detectable level of prolactin and beta subunit of hCG indicate in a male patient with gynecomastia?
Testicular cancer
Statin therapy is associated with a ______ % increased risk of developing type 2 diabetes mellitus and worsening glycemia control in patients with diabetes mellitus.
9%
Should you monitor women who are TPO Ab positive with normal thyroid function for hypothyroidism throughout pregnancy?
Yes
How often should you monitor TPO Ab positive women with normal thyroid function through pregnancy?
Every 4 weeks in the first half of pregnancy and at least once between 26 and 32 weeks of gestation.
Which medication is given to patients with insulinoma on diazoxide when they develop edema?
Hydrochlorothiazide
Do statins’ cardioprotective effects persist despite tendency to hyperglycemia?
Yes
What is pseudohyperaldosteronism also known as?
Liddle syndrome
How is Liddle syndrome inherited?
Autosomal dominant
Young patient with family history of hypertension presents with hypertension, hypokalemia and metabolic acidosis.
Diagnosis?
Liddle syndrome
Patient presents with hypokalemia, hypomagnesemia, metabolic alkalosis, and increased serum aldosterone and renin. Blood pressure is low to normal and urinary calcium excretion is low.
Diagnosis?
Gitelman’s syndrome
Patient presents with hypokalemia, hypomagnesemia, metabolic alkalosis, and increased serum aldosterone and renin. Blood pressure is low to normal and urinary calcium excretion is high.
Diagnosis?
Bartter’s syndrome
What test can assess glucose control over 1 - 2 weeks?
1,5 AG (1,5 anhydroglucitol)
Are levels of fructosamine reliable in settings of low albumin?
No
Is glycated albumin a reliable measure of glucose control in settings of low albumin?
No
What is the mechanism of action of metformin?
Decreases gluconeogenesis in the liver
Does severe hypokalemia predispose to respiratory failure or asystole?
Asystole
What percentage of pheochromocytomas are bilateral or metastatic?
10%
What imaging scan needs to be ordered to look for metastatic lesions from a pheochromocytoma?
1-123 MIBG
gallium 68 DOTATATE
What imaging should you do prior to treating hyperprolactinemia with a dopamine agonist?
MRI pituitary
Does hypocalcemia cause hyporeflexia?
Yes
What is the body’s ability to counter-act nocturnal hypoglycemia called?
When serum glucose levels fall in the late evening, counter-regulatory hormones are activated, causing high glucose levels in the early morning.
Somogyi effect
What is the occurrence hyperglycemic episodes a few hours before or after breakfast because of low levels of endogenous insulin secreted at night (no nocturnal hypoglycemia)?
Dawn phenomenon
What are patients who are severely ill with DKA at risk for developing if they are unable to compensate for metabolic acidosis?
Respiratory failure
What is the urine sodium typically in hyponatremia caused by hypothyroidism?
More than or equal to 20 meq/L
What is the urine sodium expected to be in nephrotic syndrome?
< 10 meq/L
Want kind of hyponatremia does hypothyroidism cause?
Euvolemic hyponatremia
What is the first line medication for ovulation induction in patients with PCOS?
Letrozole
Does radioactive iodine typically cause agranulocytosis?
No
In which part of the cell does steroid synthesis take place?
Smooth endoplasmic reticulum
Does the Golgi apparatus produce hormones?
No
Which part of the cell produces ribosomal subunits?
Nucleolus
In which part of the cell does protein synthesis take place?
Rough endoplasmic reticulum
What effect do anovulatory cycles have on the endometrium?
Endometrial hyperplasia
Hypertension associated with ingestion of black licorice.
Diagnosis?
Apparent mineralocorticoid excess
Pseudohyperaldosteronism
Are the aldosterone levels high or low in apparent mineralocorticoid excess that develops after ingestion of black licorice?
High
What happens when a patient has impaired methionine synthase ?
Lack of methionine leads to abnormal myelin which leads to neurologic symptoms.
What leads to impaired methionine synthase?
Vitamin B12 deficiency
How long can the amount of vitamin B12 stored in the liver last?
> 3 years
What is the treatment of Nelson syndrome?
Early neurosurgical intervention to prevent invasion
What should you do prior to bilateral adrenalectomy in patients with known pituitary adenoma?
Localized brain radiation
Is the urine acidic or alkaline in DKA?
Acidic
Is the urine ammonia level high or low in DKA?
High
Is the urine phosphate level high or low in DKA?
High
Patient taking high doses of multivitamins presents with headaches, blurry vision, dry skin and lips.
Diagnosis?
Hypervitaminosis A
What other conditions should you screen for in patients with type 1 diabetes mellitus?
Hypothyroidism
Celiac disease
Which drugs can mask signs of hypoglycemia?
Beta-blockers
Which glucose transporter is insulin controlled?
GLUT4 (glucose transporter type 4)
Where is GLUT4 expressed?
- Myocytes
- Adipocytes
- Cardiomyocytes
Where is GLUT2 expressed?
- Enterocytes
- Pancreatic beta cells
- Hepatocytes
- Renal tubular cells
Is GLUT2 insulin controlled?
No
Which glucose transporters do neurons express?
- GLUT1
- GLUT3
Irregularly branching, broad hyphae, with rare septations.
Diagnosis?
Mucormyocosis
Regularly branching, narrow hyphae, with many septations.
Diagnosis?
Aspergillus
Which patients are considered high risk for a pheochromocytoma?
- Family history of pheochromocytoma
- Previously resected pheochromocytoma
- MEN2
- Possible pheochromocytoma on imaging
Do you do plasma metanephrines in patients at high or low risk of pheochromocytoma?
High risk
Do you do 24-hr urine fractionated metanephrines and catecholamines in patients at high or low risk of pheochromocytoma?
Low risk
At what age can gender affirming hormones be started?
16 years
Do patients have to live full time as their identified gender for 12 months before starting on gender affirming hormones?
No
Do patients have to have long term documented gender dysphoria before starting on gender affirming hormones?
Yes
Can patients start gender affirming therapy if they have comorbid psychiatric illnesses?
Yes - if the illness is controlled/well-managed.
What is the urine sodium in patients with pre-renal azotemia?
< 20 mEq/L
Should you start insulin infusion in patient with DKA when the serum potassium is below 3.3 mEq/L?
No
Patient with marfanoid body habitus, downward lens dislocation, intellectual disability, and thromboembolic disease.
Diagnosis?
Homocystinuria
What is the treatment of homocystinuria?
- High dose pyridoxine
- Low sulphur diet
- Trimethylglycine
Does pyridoxine decrease risk of thromboembolism in patients with homocystinuria?
Yes
Is the potassium most likely to be high, normal or low in DKA on presentation?
Usually normal or high, rarely low.
Do patients with hyperglycemic emergencies usually have normal WBC counts?
No - mild leukocytosis
Which renal tubular acidosis is frequently seen in patient with diabetes mellitus and chronic kidney disease?
Renal tubular acidosis type 4
What can cause hyperandrogenism during pregnancy?
Ovarian luteoma
What happens to ovarian luteomas after childbirth?
They resolve spontaneously.
Is chromosomal analysis useful in evaluating secondary hypogonadism?
No
How can you differentiate Kallman’s syndrome from idiopathic hypogonadotrophic hypogonadism?
Olfactory loss in Kallman syndrome.
No olfactory loss in normosmic idiopathic hypogonadotrophic hypogonadism.
What is the mechanism of action of tamoxifen in treating gynecomastia?
Blockage of estrogen effects on breast tissue
What is the mechanism of action of danazol in treating gynecomastia?
Inhibits gonadotrophic production from anterior pituitary
What is Waterhouse-Friderichson syndrome?
Primary adrenal insufficiency due to bilateral bleeding into the adrenal glands
What does a mutation in the gene encoding fibrillin cause?
Marfan syndrome
Are growth hormone receptor mutations associated with gigantism?
No
On a 75 gram OGTT, what should the fasting glucose be to diagnose gestational diabetes?
> 92 mg/dL
On a 75 gram OGTT, what should the 1-hour glucose be to diagnose gestational diabetes?
> 180 mg/dL
On a 75 gram OGTT, what should the 2-hour glucose be to diagnose gestational diabetes?
> 153 mg/dL
Is vitamin A only found in animal products?
No
Should the hypertriglyceridemia associated with pancreatitis be treated with lifestyle changes?
No
How high to the triglycerides need to be to qualify as severe hypertriglyceridemia?
> 886 mg/dL
Elevated chylomicrons, elevated triglycerides and elevated total cholesterol…
What type of hyperlipidemia is this?
Familial type I hyperchylomicronemia
(hereditary lipoprotein lipase deficiency)
Elevated LDL and elevated cholesterol…
What type of hyperlipidemia is this?
Autosomal dominant type II familial hypercholesterolemia
Elevated chylomicrons and elevated VLDL…
What type of hyperlipidemia is this?
Autosomal recessive type III dysbetalipoproteinemia
Elevated VLDL and elevated triglycerides…
What type of hyperlipidemia is this?
Type IV hyperlipoproteinemia
What endocrine condition leads to this lipid profile?
Low triglycerides, low VLDL, low LDL and low HDL.
Hyperthyroidism
What amount of weight loss should people typically aim for?
7 - 10%
Renovascular hypertension causes secondary hyperaldosteronism.
True or false?
True
What happens to the urinary potassium in secondary hyperaldosteronism?
Increases
What happens to the urinary sodium in secondary hyperaldosteronism?
Decreases
Is hydroxychloroquine associated with reduced bone mineral density?
No
