ENDO 1

Question 1

On abrupt discontinuation of exogenous glucocorticoids, the pituitary gland may be unable to increase ACTH secretion to meet metabolic demands for up to _____, resulting in _________

Answer 1

6-12 months

secondary AI.

Question 2

Any patient who receives chronic glucocorticoids for _________ is at risk for developing secondary AI

Answer 2

≥3 weeks

Question 3

Recommended add-on therapy for patients with established cardiovascular disease (eg, heart failure, myocardial infarction, coronary artery disease) includes

Answer 3

• Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, canagliflozin, empagliflozin)
• Glucagon-like peptide-1 (GLP-1) receptor agonists (eg, semaglutide, liraglutide)

(both induces weight loss)

Question 4

• Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, canagliflozin, empagliflozin)

Adverse effects

Answer 4

Euglycemic ketoacidosis

Increased risk of genitourinary infections

Question 5

• Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, canagliflozin, empagliflozin)

Contraindications

Answer 5

Type 1 DM
History of DKA
Impaired renal function (eGFR <30 mL/min/1.73 m2)

Question 6

• Sodium-glucose cotransporter 2 (SGLT-2) inhibitors (eg, canagliflozin, empagliflozin)

Possible benefits

Answer 6

Reduced progression of nephropathy & albuminuria
Reduced cardiovascular morbidity & mortality
Reduced hospitalizations for heart failure
Weight loss

Question 7

Thyroid hormones undergo significant enterohepatic circulation, with reabsorption in the ______

Answer 7

jejunum and upper ileum.

Question 8

_____ is indicated for the primary prevention of atherosclerotic cardiovascular disease in all patients age ≥40 with diabetes mellitus, regardless of _________.

Answer 8

Statin therapy

LDL level

Question 9

______ are indicated in patients with severe hypertriglyceridemia (ie, >1000 mg/dL) to reduce the risk of_______

Answer 9

Fibrates

acute pancreatitis

Question 10

Nodium levels in plasma, Why?
Central DI
Nephrogenic DI

Answer 10

Central DI usually has significant hypernatremia (>150 mEq/L, due to an impaired thirst mechanism.

Nephrogenic DI usually have an intact thirst mechanism and adequate water intake; they usually compensate for renal water loss and may have a normal sodium level.

Question 11

The 3 major treatment options for Graves’ disease are:

Answer 11

Radioactive iodine ablation (preferred in the United States)
Antithyroid drug (ATD) therapy
Thyroidectomy

Question 12

Out of raloxefine and bisphosphonates, which is more effective

Answer 12

Raloxifene is Less effective than bisphosphonates

Question 13

Effect of hyperthyroidism on bone:

Answer 13

hypercalcemia and hypercalciuria due to increased bone turnover.

Question 14

The magnitude of prolactin elevation correlates with the _________ of the prolactinoma, and a level _____ is virtually diagnostic of prolactinoma.

Answer 14

size

> 200 ng/mL

Question 15

RAI (131I) uptake leads to clinical and biochemical resolution of hyperthyroidism over the subsequent

Answer 15

6-18 weeks (not rapidly)

Question 16

RAI in Graves disease leads to __________.

RAI used to treat toxic nodular goiter and toxic adenoma ______________

Answer 16

permanent hypothyroidism within months in >90% of patients

the radioisotope is taken up only by the autonomous thyroid tissue, and the function of the remaining normal tissue is usually adequate to prevent permanent hypothyroidism.

Question 17

The dose of iodine used in RAI, although sufficient to induce radiation necrosis, is much lower than that required to

Answer 17

biochemically inhibit thyroid hormone synthesis.

Question 18

___________ ratio suggests primary hyperaldosteronism

Answer 18

A PAC/PRA ratio >20 with plasma aldosterone >15 ng/dL .

Question 19

primary lateral sclerosis is caused due to:

Examination findings

Answer 19

Upper motor neuron disease causes slowness, stiffness, and clumsiness of movement rather than proximal muscle weakness and atrophy.

Examination typically shows long tract signs (eg, hyper-reflexia, spasticity).

Question 20

Postpartum endometritis occurs during the ________, most commonly in patients with __________

Answer 20

first 10 days after delivery

prolonged rupture of membranes or cesarian delivery.

Question 21

Hypomagnesemia is an important cause of ________, particularly in alcoholics.
Mechanism:

Answer 21

hypocalcemia

Hypomagnesemia causes decreased release of parathyroid hormone (PTH) and PTH resistance.

Question 22

Hypoparathyroidism induced by low magnesium is not associated with _____________

Answer 22

elevated phosphorus levels

Question 23

Despite PTH deficiency, phosphorus levels are normal or low in magnesium deficiency; this is possibly due to ____________

Answer 23

intracellular phosphorus depletion.

Question 24

treatment with __________ can worsen the ophthalmopathy in graves disease.

Answer 24

RAI

Question 25

The most common drugs associated with myopathy are

Answer 25

corticosteroids, statins, and colchicine.

Alcohol, cocaine, heroin

Question 26

the preferred initial test in suspected acromegaly

Answer 26

Insulin-like growth factor-1

Question 27

the preferred initial test in suspected acromegaly

Answer 27

Insulin-like growth factor-1

Question 28

Milk-alkali syndrome can be seen in patients taking __________ for osteoporosis.

Answer 28

calcium bicarbonate

Question 29

Muscle weakness + hirsutism =

Answer 29

Cushing syndrome

Question 30

Muscle weakness + hypertension, hirsutism, or demineralization of bone. =

Answer 30

Cushing syndrome

Question 31

Changes in TFTs in cirrhosis:

Answer 31

↓serum binding proteins for thyroid hormones
↓total triiodothyronine (T3) and thyroxine (T4) in circulation;
free T3 and T4 levels are unchanged,
TSH will be normal, reflecting a euthyroid status.

Question 32

Elevated testosterone with normal DHEAS suggests an________ , whereas elevated DHEAS suggests an _______ source.

Answer 32

ovarian source

adrenal

Question 33

Management of diabetic ketoacidosis

Start continuous IV insulin infusion; hold if

Answer 33

K <3.3 mEq/L

Question 34

Management of diabetic ketoacidosis

Switch to SQ (basal bolus) insulin for the following:

Answer 34

able to eat,
glucose <200 mg/dL,
anion gap <12 mEq/L
serum HCO3− ≥15 mEq/L

Question 35

Management of diabetic ketoacidosis

Phosphate replacement

Answer 35

Consider for serum phosphate <1.0 mg/dL,
cardiac dysfunction,
or
respiratory depression

Question 36

Management of diabetic ketoacidosis

Frequent clinical and laboratory monitoring is indicated:

Answer 36

♣ the anion gap, electrolytes, and venous pH are measured every 2-4 hours,
♣ serum glucose is measured hourly.