Endocrine

Question 1

MC thyroid cancer (70-75%)

Answer 1

Papillary Carcinoma

Question 2

2nd MC thyroid cancer (10%)

Answer 2

Follicular Carcinoma

Question 3

Activation of receptor tyrosine kinases

Answer 3

Papillary and Medullary carcinoma

Question 4

Hashimoto thyroiditis is a risk factor

Answer 4

B-cell lymphoma

Question 5

Cancer arising from Parafollicular C cells

Answer 5

Medullary Carcinoma

Question 6

Commonly associated with RAS mutation or PAX8-PPAR gamma 1 rearragement

Answer 6

Follicular carcinoma

Question 7

Commonly associated with rearrangements in RET oncogene or NTRK1

Answer 7

Papillary carcinoma

Question 8

MC mutation in the BRAF gene (serine/threonine kinase)

Answer 8

Papillary carcinoma

Question 9

What should you measure in a thyroidectomy patient with post-op perioral tingling?

Answer 9

Calcium level. If parathyroids are removed during thyroidectomy then the pt will be hypocalcemic

Question 10

How is Hb glycosylated in diabetes (HbA1c)?

Answer 10

Non-Enzymatic glycosylation

Question 11

What cells have GLUT-2 receptor?

Answer 11

Beta cells of the pancreas (important bc glut2 receptors allow beta cells to monitor glucose levels)
Small intestine
Liver
Kidney

Question 12

Which tissues require insulin for glucose uptake?

Answer 12

Skeletal muscle, Adipose tissue (GLUT-4)

Question 13

What enzyme converts glucose to sorbitol?

Answer 13

Aldose reductase

Question 14

Which tissues lack sorbitol DH, the enzyme that converts sorbitol to fructose?

Answer 14

Schwann cells, Retina and lens, Kidney

Question 15

Lactic acidosis is a rare, but worrisome AE

Answer 15

Metformin

Question 16

MC AE is hypoglycemia

Answer 16

Sulfonylureas:

• Glyburide
• Glimepiride
• Glipizide

Question 17

Recommended first-line tx for most pts

Answer 17

Metformin

Question 18

Not safe in settings of hepatic dysfunction or CHF

Answer 18

TZDs

• Pioglitazone
• Rosiglitazone

Question 19

Should not be used in pts with elevated serum creatinine

Answer 19

Metformin

Question 20

Shouldn’t be used in pts with cirrhosis or IBD

Answer 20

Alpha-glucosidase inhibitors

• Miglitol
• Acarbose

Question 21

Not associated with weight gain

Answer 21

Metformin, DPP-4 inhibitors, GLP-1 analogs

Question 22

Metabolized by liver, excellent choice in pts with renal dz

Answer 22

TZDs

Question 23

MOA: Closes K channel on beta cells, leading to depolarization=>Calcium influx=>insulin release

Answer 23

Sulfonylureas

• Glyburide
• Glimepiride
• Glipizide

Question 24

MOA: inhibits alpha-glucosidase at intestinal brush border

Answer 24

Alpha-glucosidase inhibitors

• Acarbose
• Miglitol

Question 25

MOA: agonist at PPAR-gamma receptors=> improved target cell response to insulin

Answer 25

TZD: Pioglitazone Risoglitazone

Question 26

MOA: decreases hepatic gluconeogenesis

Answer 26

Metformin

Question 27

Good for weight loss

Answer 27

GLP-1 Agonist

Question 28

Avoid in hypoglycemia

Answer 28

Sulfonylureas

Question 29

Best treatment for anyone with organ failures (renal, liver, heart)

Answer 29

Insulin

Question 30

What are the five categories for the diagnosis of metabolic syndrome

Answer 30

``` Abdominal obesity Elevated triglycerides Low HDL Elevated BP Elevated glucose ```

Question 31

At what BMI is a pt considered obese?

Answer 31

>30

Question 32

What are the three functions of vitamin D?

Answer 32

Calcium absorption from gut Phosphate absorption from gut Bone resorption of Ca and PO4

Question 33

How does PTH increase Ca levels

Answer 33

Increasing bone resorption | Increasing renal reabsorption in the DCT

Question 34

Where does PTH "trash" phosphate?

Answer 34

PCT

Question 35

What cells make PTH?

Answer 35

Chief cells of the parathyroid

Question 36

What cells make Calcitonin?

Answer 36

Parafollicular C cells of the thyroid

Question 37

what are the two signs of hypocalcemia

Answer 37

Chvostek's sign -tap the cheek=>facial muscle contraction Trousseau's sign -Tighten a BP cuff on the arm=>Carpopedal spasm

Question 38

What are the two MCC of primary hyperparathyroidism?

Answer 38

Solitary parathyroid adenoma | Parathyroid hyperplasia