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ABIM IM Recert > Board Vitals Endocrinology > Flashcards

Board Vitals Endocrinology Flashcards

1
Q

What can you use for monitoring response to treatment in type 1 diabetes patients who present to the ER for hyperglycemia and possible DKA?

A

Beta-hydroxybutyrate

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2
Q

Patient presents with precocious puberty, Cafe-au-lait macules, and polyostotic fibrous dysplasia.

Diagnosis?

A

McCune-Albright syndrome

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3
Q

Familial progressive myoclonus epilepsy with deafness, lipomas and ataxia.

Diagnosis?

A

May-White syndrome

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4
Q

What percentage of pheochromocytoma patients have the classic triad of headaches, palpitations and diaphoresis?

A

~ 50%

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5
Q

Which antibodies are most common in LADA?

A

GAD-65 antibodies

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6
Q

What enzyme is deficient in alkaptonuria or “dark urine disease”?

A

Homogentisic acid deoxygenase

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7
Q

What enzyme is deficient in hereditary tyrosinemia type 1?

A

Fumarylacetoacetate hydrolase (FAH)

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8
Q

What enzyme is deficient in hereditary tyrosinemia type 2?

A

Tyrosine aminotransferase (TAT)

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9
Q

What is the enzyme deficiency in hereditary tyrosinemia type 3?

A

4-hydroxyphenylpyruvate dioxygenase (HPD)

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10
Q

Does smoking predispose to vitamin C deficiency?

A

Yes

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11
Q

Does thyrotoxicosis cause increased vitamin C utilisation?

A

Yes

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12
Q

Does pregnancy cause increased vitamin C utilisation?

A

Yes

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13
Q

What percentage of MEN1 patients have parathyroid adenomas by age 40?

A

90%

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14
Q

What is the most likely mechanism of bone loss in a post-menopausal woman?

A

Increased osteoclast activity

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15
Q

What causes congenital hypogonadotrophic hypogonadism and when is it diagnosed?

A

Deficiency of gonadotropin-releasing hormone typically diagnosed in late adolescence.

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16
Q

What treatment restores puberty and fertility in patients with congenital hypogonadotrophic hypogonadism?

A

Exogenous GnRH in pulses.

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17
Q

What is the definition of septic shock?

A

Severe sepsis with hypotension that is refractory to IV fluids.

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18
Q

What is the role of hCG in pregnancy?

A

Acts like LH and maintains corpus luteum and production of progesterone.

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19
Q

What does hCG do to uterine angiogenesis?

A

Increases it

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20
Q

What does hCG do to thyroid hormone levels?

A

Increases them (has common alpha-subunit with TSH)

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21
Q

What happens to the urine urea concentration when desmopressin is given to patients with central diabetes insipidus?

A

Increases

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22
Q

Does desmopressin alter the pH of the urine?

A

No

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23
Q

Does desmopressin alter urinary reabsorption of calcium?

A

No

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24
Q

Does desmopressin increase or decrease the water permeability of the inner medullary collecting duct?

A

Increase

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25
Q

What is the insulin, c-peptide and proinsulin level in patients with exogenous insulin use?

A

Insulin - high
C-peptide - normal or low
Proinsulin - normal or low

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26
Q

What happens to the triglyceride level in Cushing’s syndrome?

A

Increases

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27
Q

What happens to the total cholesterol in Cushing’s syndrome?

A

Increases

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28
Q

What does a detectable level of prolactin and beta subunit of hCG indicate in a male patient with gynecomastia?

A

Testicular cancer

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29
Q

Statin therapy is associated with a ______ % increased risk of developing type 2 diabetes mellitus and worsening glycemia control in patients with diabetes mellitus.

A

9%

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30
Q

Should you monitor women who are TPO Ab positive with normal thyroid function for hypothyroidism throughout pregnancy?

A

Yes

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31
Q

How often should you monitor TPO Ab positive women with normal thyroid function through pregnancy?

A

Every 4 weeks in the first half of pregnancy and at least once between 26 and 32 weeks of gestation.

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32
Q

Which medication is given to patients with insulinoma on diazoxide when they develop edema?

A

Hydrochlorothiazide

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33
Q

Do statins’ cardioprotective effects persist despite tendency to hyperglycemia?

A

Yes

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34
Q

What is pseudohyperaldosteronism also known as?

A

Liddle syndrome

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35
Q

How is Liddle syndrome inherited?

A

Autosomal dominant

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36
Q

Young patient with family history of hypertension presents with hypertension, hypokalemia and metabolic acidosis.

Diagnosis?

A

Liddle syndrome

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37
Q

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?

A

Gitelman’s syndrome

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38
Q

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?

A

Bartter’s syndrome

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39
Q

What test can assess glucose control over 1 - 2 weeks?

A

1,5 AG (1,5 anhydroglucitol)

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40
Q

Are levels of fructosamine reliable in settings of low albumin?

A

No

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41
Q

Is glycated albumin a reliable measure of glucose control in settings of low albumin?

A

No

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42
Q

What is the mechanism of action of metformin?

A

Decreases gluconeogenesis in the liver

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43
Q

Does severe hypokalemia predispose to respiratory failure or asystole?

A

Asystole

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44
Q

What percentage of pheochromocytomas are bilateral or metastatic?

A

10%

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45
Q

What imaging scan needs to be ordered to look for metastatic lesions from a pheochromocytoma?

A

1-123 MIBG
gallium 68 DOTATATE

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46
Q

What imaging should you do prior to treating hyperprolactinemia with a dopamine agonist?

A

MRI pituitary

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47
Q

Does hypocalcemia cause hyporeflexia?

A

Yes

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48
Q

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.

A

Somogyi effect

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49
Q

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)?

A

Dawn phenomenon

50
Q

What are patients who are severely ill with DKA at risk for developing if they are unable to compensate for metabolic acidosis?

A

Respiratory failure

51
Q

What is the urine sodium typically in hyponatremia caused by hypothyroidism?

A

More than or equal to 20 meq/L

52
Q

What is the urine sodium expected to be in nephrotic syndrome?

A

< 10 meq/L

53
Q

Want kind of hyponatremia does hypothyroidism cause?

A

Euvolemic hyponatremia

54
Q

What is the first line medication for ovulation induction in patients with PCOS?

A

Letrozole

55
Q

Does radioactive iodine typically cause agranulocytosis?

A

No

56
Q

In which part of the cell does steroid synthesis take place?

A

Smooth endoplasmic reticulum

57
Q

Does the Golgi apparatus produce hormones?

A

No

58
Q

Which part of the cell produces ribosomal subunits?

A

Nucleolus

59
Q

In which part of the cell does protein synthesis take place?

A

Rough endoplasmic reticulum

60
Q

What effect do anovulatory cycles have on the endometrium?

A

Endometrial hyperplasia

61
Q

Hypertension associated with ingestion of black licorice.

Diagnosis?

A

Apparent mineralocorticoid excess
Pseudohyperaldosteronism

62
Q

Are the aldosterone levels high or low in apparent mineralocorticoid excess that develops after ingestion of black licorice?

A

High

63
Q

What happens when a patient has impaired methionine synthase ?

A

Lack of methionine leads to abnormal myelin which leads to neurologic symptoms.

64
Q

What leads to impaired methionine synthase?

A

Vitamin B12 deficiency

65
Q

How long can the amount of vitamin B12 stored in the liver last?

A

> 3 years

66
Q

What is the treatment of Nelson syndrome?

A

Early neurosurgical intervention to prevent invasion

67
Q

What should you do prior to bilateral adrenalectomy in patients with known pituitary adenoma?

A

Localized brain radiation

68
Q

Is the urine acidic or alkaline in DKA?

A

Acidic

69
Q

Is the urine ammonia level high or low in DKA?

A

High

70
Q

Is the urine phosphate level high or low in DKA?

A

High

71
Q

Patient taking high doses of multivitamins presents with headaches, blurry vision, dry skin and lips.

Diagnosis?

A

Hypervitaminosis A

72
Q

What other conditions should you screen for in patients with type 1 diabetes mellitus?

A

Hypothyroidism
Celiac disease

73
Q

Which drugs can mask signs of hypoglycemia?

A

Beta-blockers

74
Q

Which glucose transporter is insulin controlled?

A

GLUT4 (glucose transporter type 4)

75
Q

Where is GLUT4 expressed?

A
  • Myocytes
  • Adipocytes
  • Cardiomyocytes
76
Q

Where is GLUT2 expressed?

A
  • Enterocytes
  • Pancreatic beta cells
  • Hepatocytes
  • Renal tubular cells
77
Q

Is GLUT2 insulin controlled?

A

No

78
Q

Which glucose transporters do neurons express?

A
  • GLUT1
  • GLUT3
79
Q

Irregularly branching, broad hyphae, with rare septations.

Diagnosis?

A

Mucormyocosis

80
Q

Regularly branching, narrow hyphae, with many septations.

Diagnosis?

A

Aspergillus

81
Q

Which patients are considered high risk for a pheochromocytoma?

A
  • Family history of pheochromocytoma
  • Previously resected pheochromocytoma
  • MEN2
  • Possible pheochromocytoma on imaging
82
Q

Do you do plasma metanephrines in patients at high or low risk of pheochromocytoma?

A

High risk

83
Q

Do you do 24-hr urine fractionated metanephrines and catecholamines in patients at high or low risk of pheochromocytoma?

A

Low risk

84
Q

At what age can gender affirming hormones be started?

A

16 years

85
Q

Do patients have to live full time as their identified gender for 12 months before starting on gender affirming hormones?

A

No

86
Q

Do patients have to have long term documented gender dysphoria before starting on gender affirming hormones?

A

Yes

87
Q

Can patients start gender affirming therapy if they have comorbid psychiatric illnesses?

A

Yes - if the illness is controlled/well-managed.

88
Q

What is the urine sodium in patients with pre-renal azotemia?

A

< 20 mEq/L

89
Q

Should you start insulin infusion in patient with DKA when the serum potassium is below 3.3 mEq/L?

A

No

90
Q

Patient with marfanoid body habitus, downward lens dislocation, intellectual disability, and thromboembolic disease.

Diagnosis?

A

Homocystinuria

91
Q

What is the treatment of homocystinuria?

A
  • High dose pyridoxine
  • Low sulphur diet
  • Trimethylglycine
92
Q

Does pyridoxine decrease risk of thromboembolism in patients with homocystinuria?

A

Yes

93
Q

Is the potassium most likely to be high, normal or low in DKA on presentation?

A

Usually normal or high, rarely low.

94
Q

Do patients with hyperglycemic emergencies usually have normal WBC counts?

A

No - mild leukocytosis

95
Q

Which renal tubular acidosis is frequently seen in patient with diabetes mellitus and chronic kidney disease?

A

Renal tubular acidosis type 4

96
Q

What can cause hyperandrogenism during pregnancy?

A

Ovarian luteoma

97
Q

What happens to ovarian luteomas after childbirth?

A

They resolve spontaneously.

98
Q

Is chromosomal analysis useful in evaluating secondary hypogonadism?

A

No

99
Q

How can you differentiate Kallman’s syndrome from idiopathic hypogonadotrophic hypogonadism?

A

Olfactory loss in Kallman syndrome.
No olfactory loss in normosmic idiopathic hypogonadotrophic hypogonadism.

100
Q

What is the mechanism of action of tamoxifen in treating gynecomastia?

A

Blockage of estrogen effects on breast tissue

101
Q

What is the mechanism of action of danazol in treating gynecomastia?

A

Inhibits gonadotrophic production from anterior pituitary

102
Q

What is Waterhouse-Friderichson syndrome?

A

Primary adrenal insufficiency due to bilateral bleeding into the adrenal glands

103
Q

What does a mutation in the gene encoding fibrillin cause?

A

Marfan syndrome

104
Q

Are growth hormone receptor mutations associated with gigantism?

A

No

105
Q

On a 75 gram OGTT, what should the fasting glucose be to diagnose gestational diabetes?

A

> 92 mg/dL

106
Q

On a 75 gram OGTT, what should the 1-hour glucose be to diagnose gestational diabetes?

A

> 180 mg/dL

107
Q

On a 75 gram OGTT, what should the 2-hour glucose be to diagnose gestational diabetes?

A

> 153 mg/dL

108
Q

Is vitamin A only found in animal products?

A

No

109
Q

Should the hypertriglyceridemia associated with pancreatitis be treated with lifestyle changes?

A

No

110
Q

How high to the triglycerides need to be to qualify as severe hypertriglyceridemia?

A

> 886 mg/dL

111
Q

Elevated chylomicrons, elevated triglycerides and elevated total cholesterol…

What type of hyperlipidemia is this?

A

Familial type I hyperchylomicronemia
(hereditary lipoprotein lipase deficiency)

112
Q

Elevated LDL and elevated cholesterol…

What type of hyperlipidemia is this?

A

Autosomal dominant type II familial hypercholesterolemia

113
Q

Elevated chylomicrons and elevated VLDL…

What type of hyperlipidemia is this?

A

Autosomal recessive type III dysbetalipoproteinemia

114
Q

Elevated VLDL and elevated triglycerides…

What type of hyperlipidemia is this?

A

Type IV hyperlipoproteinemia

115
Q

What endocrine condition leads to this lipid profile?

Low triglycerides, low VLDL, low LDL and low HDL.

A

Hyperthyroidism

116
Q

What amount of weight loss should people typically aim for?

A

7 - 10%

117
Q

Renovascular hypertension causes secondary hyperaldosteronism.

True or false?

A

True

118
Q

What happens to the urinary potassium in secondary hyperaldosteronism?

A

Increases

119
Q

What happens to the urinary sodium in secondary hyperaldosteronism?

A

Decreases

120
Q

Is hydroxychloroquine associated with reduced bone mineral density?

A

No

ABIM IM Recert (42 decks)

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