Endo

Question 1

Nutritonal deficiencies associated with gastric bypass

Answer 1

copper deficiency, B12, folate, vtiamin D, iron

Question 2

Myeloneuropathy, normocytic anemia, leukopenai in the setting of history of gastric bypass

Answer 2

Copper deficiency. PResents similar to B12 deficiency as far as symptoms (ataxis, spasticity with weakness, Romberg, dorsal column disease) but then anemia is normocytic

Question 3

Increased intake of what can exacerbate copper deficiecny

Answer 3

Zinc. It competes with copper absorption in the GI tract

Question 4

Failure of anti-diabetic therapy after an initial good response

Answer 4

Progressive insulin deficiency is usually the cause. If gaining weight could be insulin resistance

Question 5

Hungry bone syndrome

Answer 5

Low calcium, low phosphorous, low magnesium, normal to high PTH. Acute withdrawal of PTH post parathyroidectomy leads to a net influx of calcium into the bone (phos and mag resorbed with Ca)

Question 6

Thyrotoxicosis and hypercalcemia

Answer 6

Typically hyperthryoid symptoms. Thyroid hormone acts on osteoclasts to increase bone turnoober. Labs demonstrate hypercalciuria, mild hypercalcemia, suppressed PTH –> renal calcium wasting. Low 1,25 hydroxvitamin D.

Question 7

Antiresoprtive therpay is indivated for postmeonpausal women with:

Answer 7

osteoporosis on DEXA (t score < or = -2.5), low trauma hip or vertebral fracture, osteopenia and a 10 year probability of hip fracture > or = 3% ormajor osteoporotic fracure > or = 20%

Question 8

Osteoporosis medication first line choice.

Answer 8

First line choice oral or IV bisphosphonate. These are not recommended when CrCl < 30-35.

Question 9

Osteoporosis medication choice when renal insufficient

Answer 9

Denosumab, need to monitor for hypocalcemia

Question 10

Failed or can’t tolerate bisphosphonates osteoporosis medications

Answer 10

Teriparatide

Question 11

Next step in thyroid nodule with clinical or subclinical hyperthryoidism

Answer 11

Thyroid scintigraphy to determine “hot” versus “cold” nodule

Question 12

Hot thyroid nodule

Answer 12

Manage as hyperthyroid - does not need an FNA

Question 13

High risk cold thryoid nodule characteristics

Answer 13

microcalcifications, increased vascularity, hypoechoic, elongated, ireregular margins. FNA when >1cm

Question 14

Low risk cold thyroid nodule characteristics

Answer 14

isoechoic, hyperechoic, partially cystic, spongiform. Biopsy if grew >1.5-2cm

Question 15

Hypercalcium with suppressed PTH and high PTHrP

Answer 15

solid tumor or malignancy

Question 16

Hypercalcemia with suppressed PTH and elevated 1,25(OH)D

Answer 16

lymphoma vs sarcoid

Question 17

Hypercalcemia with suppressed PTH and elevated 25(OH)D

Answer 17

vitamin D toxicity

Question 18

Hypercalcemia with suppressed PTH and normal PTHrp, 25(OH)D, and 1,25(OH)D

Answer 18

hyperthyroid, mulitple myeloma, adrenal tumor, acromegaly, vitamin A toxicity, immobilization, milk-alkali syndrome

Question 19

What should be screened for in all patients newly diagnosed with dyslipidemia?

Answer 19

Hypothryoidism. TSH is a common cause of dyslipidemia. And untreated hypothyroidism increases risk of statin-induced myopathy

Question 20

Cushing syndrome diagnosis

Answer 20

Clinical presentation (weight gain, HTN, hirsutism, hypoK, hyperglycemia, proximal weakness, easy bruising) and then 2 different first-line screening tests: low dose overnight dexamethasone suppression test, late night salivary cortisol, 24 hour free cortisol urine

Question 21

Causes of false positives in overnight dexamethasone suppression tests

Answer 21

increased cortisol binding globulin (estrogens aka OCPs), medications that increase dexamethasone metabolism (Anticonvulsants, rifampicin, rifapentine, pioglitazone), depression, alcoholism

Question 22

Things that can increase 24 hour urinary free cortisol

Answer 22

carbamazepine, fenofibrate, synthetic glucocorticoids, licorice

Question 23

False positive salivary cortisol

Answer 23

men > 60 years old, erratic sleep wake cycles

Question 24

Hereditary hemochromatosis presentation

Answer 24

31% have cardiac conduction abnormalities (most commonly sick sinus syndrome), and about 45% have secondary hypogonadism (due to iron accumulation in pituitary gonadotrophs). OFten nonspecific fatigue, arthralgia, loss of libido. Classic presentation of bronze diabetes, cirrhosis LATE presentation and <25% of cases

Question 25

Osteoporosis in men is more likely due to secondary causes. What is the most common secondary cause

Answer 25

Hypogonadism

Question 26

Next step in evaluating hypoglycemia when insulin and c peptide are both normal to high

Answer 26

Demonstrates excess endogenous insulin. Could be due to oral hypoglycemic agents or isulinoma. Do oral hypoglycemic agent screen

Question 27

Orlistat mechanism of action

Answer 27

inhibits pancreatic lipase, thus decreasing fat absorption and increasing fecal fat excretion. If eating a high fat diet can have fat malabsorption symptoms