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ABIM > Endo 2 > Flashcards

Endo 2 Flashcards

1
Q

MEN 1
MEN 2A
MEN 2B

A
  1. Pancreatic, Parathyroid, Pituitary
  2. Parathyroid, Pheo, Medullary
  3. Pheo, Medullary, Ganglioneuroma
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2
Q

Name the goal and disadvantage of Each:

  1. Liraglutide Injectables (Victoza) like Trulicity(Dulaglutide)
  2. Empagliflozin (Jardiance) like (Inovokana/Canagliflozin)
  3. Glipizide
  4. Sitagliptin (Januvia)
A
  1. GLP1 agonist Weightloss, pancreatitis
  2. SGLT2 Weightloss and lower BP, Yeast infections, AKI
  3. Sulfolynurea. Weight gain, Hypoglycemia
  4. DPP-4 inhibitor, Pancreatitis like GLP1
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3
Q

77-year-old woman is evaluated in the emergency department for new-onset Generalized Weakness and Myalgia 2 days after receiving Zoledronic Acid for a recent diagnosis of Osteoporosis. Calcium is 7.5. Dx?

A

Hypovitaminosis D.

In patients with initiation of Anti-resportive Therapy block osteoclast which causes EVEN LOWER levels of Ca in pt with Vit D deficiency.

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4
Q
  1. Considered when a Woman Younger than 40 years of age develops Secondary Amenorrhea with Two serum FSH levels in the Menopausal range (>35 mU/mL [35 U/L]). Dx?
  2. Congenital Absence of the Vagina with Variable Uterine Development. Normal Female Karyotype and ovarian function, normal Secondary Sexual Characteristics. Normal External Genitalia with a dimple or Small Pouch Replacing the vagina. Gonadotropins are unremarkable. Dx?
A
  1. Primary Ovarian Insufficiency
  2. Vaginal Agenesis
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5
Q

Acromegaly is associated with increase of what Cancer?

A

Colon Cancer. (IGF-1 stimulating mucosal cell proliferation)

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6
Q

Next step in management with someone presenting with Milky Breast Discharge, Prolactin > 200? What common medications cause elevated prolactin levels?

A

MRI to r/o prolactinoma.
Anti-psychotics and Metochlopramide

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7
Q

Pt presents with Anorexia, Nausea, Polyuria and Constipation and Hypercalcemia. CXR shows b/l Hilar Adenopathy. Next step in management?

A

Prednisone to treat for Sarcoidosis. It will help decrease levels of Caclitrol (1,25 Vit )which leads to increase absorption of calcium

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8
Q

When are these treatments for hypercalcemia indicated?
1. Calcitonin
2. Cinacalcet

A
  1. In Malignancy, along with IV Fluids and Bisphosphenates Ca > 14
  2. Primary or Tertiary hyperparathyroidism.
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9
Q

Next step in management in a patient with Pituitary Apoplexy?

A

Give HIGH Dose Steroids to prevent Acute Secondary Adrenal Deficiency.

Can be life threatening. Steroids recommended in patients without unstable vitals as well.

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10
Q

Pt with new diagnosis of Osteoporosis on Dexa should have what next study?

A

Vitamin D level to check for Secondary Causes of Osteoporosis.

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11
Q

Anti-bodies common in Latent Autoimmune Diabetes? (Age of onset > 35 but < 50)

A

Anti-islet Cell Antibodies and Antibodies to Glutamic Acid Decarboxylase (GAD). Need to be on insulin sooner.

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12
Q

Common medication that can lead to Hypoganoadism?

A

Opioids

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13
Q

Neck step in management in a patient with possible Statin Induced Myopathy.

A

Check TSH because Statins can induce worsening Myopathy and Vice versa.

Important to screen for Hypothyroidism PRIOR to starting Statin.

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14
Q

What electrolyte needs to be corrected in order to improve Hypokalemia and Hypocalcemia?

A

Magnesium (Common in Alcoholics)

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15
Q

Next step in management with a patient with levothyroxine starting Birth Control or Hormonal replacement therapy?

A

Increase Dose due to increase TBG (Thyroid Binding Globulin) (Also Obese Patients Have increase TBG, Pregnancy) from the OCPS- this will lower T4 levels because they become bound to TBG.

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16
Q

Best test to due when evaluation for Cushing Syndrome and patient takes OCPs?

A

The estrogens (OCPs) increase a blood protein called cortisol binding globulin, which acts like a sponge to hold onto cortisol.

When the amount of cortisol binding globulin increases, the TOTAL amount of cortisol that is measured will INCREASE as well.

These patients should get Late night Salivary cortisol or 24 hr Urine Free Cortisol and NOT Late Night Dexamethasone Suppression test.

ACTH is the screening test after these test are done.

17
Q

Next Step in Management in a patient with Hypercalcemia and Elevated PTH?

A

Order Urinary Calcium Excretion. Primary And

Tertiary Hyperparathyroidism present with Elevated Urinary Calcium. Familial Hypocalciuric

Hypercalcemia presents with Low Urinary Calcium.

18
Q

Diagnosis of HYPERcalcemia:
1. Elevated PTH with High Urinary Calcium > 250 ?
2. Elevated PTH with LOW Urinary Calcium <100mg ?
3. Suppressed PTH( < 20) Next step in management?
4. Elevated PTHrP with Suppressed PTH ?
5. Suppressed PTH and Elevated 1,25 (OH)D?
6. Elevated 25 (OH)D?
7. HYPERcalcemia with Normal PTH, PTHrP, Vit 1,25?

A
  1. Primary Or Tertiary Hyperparathyroidism.
  2. Familial Hypocalciuric Hypercalcemia presents with Low Urinary Calcium.
  3. Measure PTHrP and 1, 25 (OH) D (Vit D levels)
  4. Malignancy
  5. CXR for lymphoma or Sarcoid
  6. Vitamin D Toxicity.
  7. Hyperthyroidism, MM, Adrenal Tumor, Acromegaly, Vit A toxicity, Milk Alkai Syndrome (Anti-Acids)
19
Q
  1. Which medication can be used in a patient with CKD (CrCl 30-35) and Osteoporosis?
  2. Which medication is given for patient with Severe Osteoporosis and Presence of Fragility Fracture?
  3. Medication used for Osteoporosis in patients with increased risk of Breast CA?
A
  1. Denosumab (Monitor for Hypocalcemia)
  2. Teriparatide (Also good for those who cant tolerate bisphosphenates
  3. Raloxifene (SERM) (Increased Thrombotic Risk)
20
Q

Name the parameters in Primary and Secondary Hyperparathyroidism.
1. Primary Hyperparathyroidism:
PTH, Calcium, Phosphorous, 25 (OH) D, 1,25 (OH)D,
2. Secondary Hyperparathyroidism due to RENAL FAILURE: PTH, Calcium, Phosphorous, 25 (OH) D, 1,25 (OH)D,

A
  1. PTH (High), Ca (High), Phos (low), 25 (Normal), 1,25 (Normal)
  2. PTH (High) Ca (Normal), Phos (Normal) , 25 (Normal), 1,25 (Normal- LOW) (Active Form that gets CONVERTED in Kidney)
21
Q

Name the parameters in Primary and Secondary Hyperparathyroidism.
3. Vitamin D deficiency with Primary Hyperparathyroidism:

PTH, Calcium, Phosphorous, 25 (OH) D, 1,25 (OH)D,

  1. Vitamin D deficiency:
    PTH, Calcium, Phosphorous, 25 (OH) D, 1,25 (OH)D,
A
  1. PTH (Disproportionately Elevated), Ca (Normal- high), Phos (Normal-low), 25 (Low), 1,25 (Normal)
  2. PTH (Elevated if Vit D < 20), Ca (Normal-LOW), Phos (Normal-LOW), 25 (Low), 1,25 (Normal-LOW,)
22
Q

Man presents with decreased libido, ED, testicular atrophy, gynecomastia, hot flashes. Dx? Initial test?

A

Hypogonadism. Total Testosterone level.

23
Q

Middle-Aged patient presents with new onset fatigue, frequent urination and weight loss. She has hx of discoid lupus. Glucose 250.

What is the confirmatory test for this diagnosis?

A

Latent Autoimmune Diabetes of Adulthood (LADA).

Antibodies to Glutamic Acid Decarboxylase.

24
Q
  1. Very high insulin with Low C-peptide?
  2. Insulin Normal/High with C-peptide Normal/High and +Oral Hypoglycemic Screen?
A
  1. Factitious Insulin Injections.
  2. Factitious Oral Hypoglycemic Agent.
25
Q

What are the differences in Treatment for Central Hypothyrodism Vs Primary Hypothyroidism?

A

Central Hypothyroidism.
- Measure Free T4 because TSH will always remain low when treating with levothyroxine

TSH is used to monitor Primary hypothyroidism

26
Q

What is the Management of Diabetic Ketoacidosis?
1. IV fluids
2. Insulin
3. Potassium
4. Bicarbonate
5. Phosphate

A
  1. Rapid 0.9% NS the add dextrose when glucose < 200
  2. Continuous IV insulin Infusion, Hold if K < 3/3
    Switch to SQ insulin when patient is able to eat, glucose < 200 or Gap <12 and Bicarb > 15
  3. Add IV K if Serum < 5.3, Hold if > 5.3
  4. Consider for patients if PH < 6.9
  5. Consider if phosphate < 1.0, cardiac dysfunction or respiratory depression
27
Q

How does PTH affect Phosphorus.

A

It increases Calcium and Decreases Phosphorus reabsorption in the kidneys.

28
Q

What are the levels of Calcium, Phosphorus and PTH in Hungry Bone Syndrome after Parathyroidectomy?

A

Low Calcium, Low Phosphorous and normal PTH.

ABIM (45 decks)

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