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ABIM - Endocrinology > Endocrine Board Review 2015 > Flashcards

Endocrine Board Review 2015 Flashcards

1
Q

Sunitinib therapy can cause thyroid dysfunction (hypothyroidism)…

True or false?

A

True

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2
Q

In a lactating mother, how soon before radioactive iodine ablation therapy for thyroid cancer should breast-feeding be stopped?

A

3 months

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3
Q

How can you tell if someone is taking/abusing exogenous thyroid hormone (in the form of supplements etc)?

A

Measure thyroglobulin levels - they are suppressed when taking exogenous thyroid hormone.

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4
Q

If a previously euthyroid patient develops hyperthyroidism after taking a ‘thyroid supplement pill’ with suppressed TSH and elevated T3 and T4, negative antibodies and normal - high-normal TG then what does the supplement contain?

A

Iodine

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5
Q

Should liothyronine (T3) be used in pregnnacy?

A

No

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6
Q

Name a characteristic that predicts a Graves disease patient will go into remission?

A

Thyroid-stimulating immunoglobulin level (that should be low)

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7
Q

How long does thyroiditis typically take to resolve?

A

3 months

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8
Q

Should profoundly hypothyroid people get pregnant?

A

No - they need to use reliable contraception until their TSH level comes down to goal.

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9
Q

AJCC-7 Thyroid Cancer Staging for patients less than 45 years old with papillary or follicular thyroid cancer…

What is stage I?

A

Any T
Any N
M0

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10
Q

AJCC-7 Thyroid Cancer Staging for patients less than 45 years old with papillary or follicular thyroid cancer…

What is stage II?

A

Any T
Any N
M1

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11
Q

AJCC-7 Thyroid Cancer Staging for patients less than 45 years old with papillary or follicular thyroid cancer…

What is stage III?

A

There is no stage III

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12
Q

AJCC-7 Thyroid Cancer Staging for patients less than 45 years old with papillary or follicular thyroid cancer…

What is stage IV?

A

There is no stage IV

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13
Q

AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…

What is stage I?

A

T1 (less than or equal to 2 cm)
N0
M0

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14
Q

Old ThyCa question

A
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15
Q

AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…

What is stage III?

A
  • T3 (> 4 cm) + N0 or N1a (to level IV) + M0

- T1 (= 2cm) or T2 (> 2cm = 4 cm) + N1a (to level VI) + M0

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16
Q

AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…

What is stage IVA?

A
  • T4a (tumor beyond thyroid capsule) + any N + M0

- T1 - T3 + N1b (cervical lymph nodes levels I - V) + M0

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17
Q

AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…

What is stage IVB?

A

T4b (extensive invasion - pretracheal fascia/encases mediastinal vessel)
Any N
M0

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18
Q

AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…

What is stage IVC?

A

Any T
Any N
M1

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19
Q

AJCC-7 Thyroid Cancer Staging for patients with medullary thyroid cancer…

What is stage I?

A

T1 (less than or equal to 2 cm)
N0
M0

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20
Q

Old ThyCa Question

A
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21
Q

AJCC-7 Thyroid Cancer Staging for patients with medullary thyroid cancer…

What is stage III?

A
  • T3 (> 4 cm) + N0 or N1a (to level IV) + M0

- T1 (= 2cm) or T2 (> 2cm = 4 cm) + N1a (to level VI) + M0

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22
Q

AJCC-7 Thyroid Cancer Staging for patients with medullary thyroid cancer…

What is stage IVA?

A
  • T4a (tumor beyond thyroid capsule) + any N + M0

- T1 - T3 + N1b (cervical lymph nodes levels I - V) + M0

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23
Q

AJCC-7 Thyroid Cancer Staging for patients with medullary thyroid cancer…

What is stage IVB?

A

T4b (extensive invasion - pretracheal fascia/encases mediastinal vessel)
Any N
M0

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24
Q

Delete card

A
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25
Q

What do you do in patients with Graves ophthalmopathy with diplopia before referring them for decompression and strabismus surgery other than starting then on steroids?

A

Advise patient to wear an eye patch.

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26
Q

How can you differentiate between thyroid hormone resistance and a TSH-secreting pituitary adenoma?

A

Measure the alpha-subunit - it will be low in thyroid hormone resistance and high in pituitary adenoma.

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27
Q

TSH in the first trimester is inversely related to serum hCG…

True or false?

A

True

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28
Q

Can a radioactive iodine uptake scan reliably distinguish between amiodarone-induced thyrotoxicosis 1 and 2?

A

No - because it can be low even in type 1

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29
Q

What should the goal be for free T4 when treating Graves’ disease in pregnancy?

A

Upper limit of normal

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30
Q

What should the goal be for total T3 when treating Graves’ disease in pregnancy?

A

1.5 times the upper limit of normal

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31
Q

What kind of chemotherapy is used in advanced medullary thyroid cancer?

A

Tyrosine kinase inhibitors

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32
Q

What is the 10 year survival of papillary thyroid cancer patients with strongly FDG avid metastatic lesions?

A

~ 10%

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33
Q

What can be done to treat a goiter with compression symptoms if the patient is not a candidate for surgery and labs are euthyroid?

A

Radioactive iodine ablation therapy without recombinant human TSH

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34
Q

What should you think of in a patient with type 1 diabetes and hypothyroidism who starts to feel worse despite levothyroxine initiation?

A

Adrenal insufficiency

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35
Q

Octreotide can be used to treat TSH-oma after initial resection does not cure patient.

True or false?

A

True

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36
Q

What medication is the most rapid means to prevent additional episodes of thyrotoxic periodic paralysis?

A

Propranolol

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37
Q

What is the next step in treatment of hirsutism if a patient is already on oral contraceptive pills?

A

Spironolactone

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38
Q

What is the most common pregnancy risk in a patient with Turner syndrome?

A

Pre-eclampsia

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39
Q

A teenage girl has:

  • primary amenorrhea
  • impaired sense of smell
  • axillary and pubic hair present
  • Tanner stage 2 breast development
  • Labs with hypogonadotrophic hypogonadism

Mutation in which gene is the cause?

A

FGFR1

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40
Q

Severe hirsutism and virilization in postmenopausal women are more often due to ovarian hyperthecosis than to virilizing ovarian tumors.

True or false?

A

True

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41
Q

Highest relative risk of ______ with estrogen-only therapy in post-menopausal women other than DVT.

A

Stroke

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42
Q

In a patient with PCOS and a high BMI, in addition to metformin, which treatment most effectively induces ovulation?

A

Letrozole

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43
Q

What is the treatment for painful periods with premenstrual mood changes that are disruptive?

A

Low dose oral contraceptive pill and serotonin reuptake inhibitor.

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44
Q

What is the most likely diagnosis when the AMH is low in a young woman?

A

Pre-mature ovarian insufficiency

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45
Q

What is the minimum duration of therapy with transdermal gel after which the testosterone level can be meaningfully assessed?

A

2 weeks

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46
Q

For fertility induction in secondary hypogonadism in males - those with post pubertal hypogonadism respond to ________.

A

hCG alone

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47
Q

For fertility induction in secondary hypogonadism in males - those with pre pubertal hypogonadism respond to ________.

A

Combination therapy with hCG and FSH

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48
Q

Prednisone can cause hypogonadotrophic hypogonadism.

True or false?

A

True

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49
Q

Opioids can cause hypogonadotrophic hypogonadism.

True or false?

A

True

50
Q

What is the treatment for otherwise normal male with early ejaculation?

A 
SSRI like paroxetine etc
Also clomipramine (non-SSRI) and topical lidocaine/prilocaine
51
Q

When you have a total testosterone that seems discordant with the clinical picture - what do you do?

A

Measure free testosterone

52
Q

What happens to the sperm count in Y-chromosome micro deletion?

A

Azoospermia

53
Q

Patient has:

  • Delayed puberty
  • Hypogonadotrophic hypogonadism
  • Primary adrenal insufficiency.

Diagnosis?

A

Adrenal hypoplasia congenita

54
Q

What is the next step after diagnosing secondary hypogonadism on labs?

A

MRI of pituitary sella

55
Q

If a patient has secondary hypogonadism and pituitary imaging is normal - what other hormone needs to be checked?

A

Prolactin

56
Q

What disease can cause hypogonadotrophic hypogonadism and arthralgias with chondrocalcinosis of the small joints of the hands?

A

Hemochromatosis

57
Q

Target blood pressure is less than ____ for diabetics.

A

140/90 mmHg

58
Q

Which two things can be measured to most accurately determine a patient’s long-term insulin management?

A
  • Beta-cell autoimmunity

- Beta-cell function

59
Q

What is the treatment of diffuse proliferative diabetic retinopathy and ischemia?

A

Panretinal laser photocoagulation

60
Q

What kind of diabetic neuropathy caused exquisite pain in a particular area?

A

Diabetic radiculopathy

61
Q

What is the most likely diagnosis if you have no signs, symptoms or blood work consistent with diabetes but have glucosuria?

A

Familial renal glucosuria

62
Q

If a patient has a hypoglycaemia syndrome and you suspect it is auto-immune - which antibody would you check?

A

Insulin autoantibody

63
Q

For cystic fibrosis related diabetes oral agents are not as effective as insulin in improving nutritional status.

True or false?

A

True

64
Q

For cystic fibrosis related diabetes oral agents are not as effective as insulin in reducing mortality.

True or false?

A

False

65
Q

What should you think of when you develop a rash with diabetes?

A

Glucagonoma

66
Q

What type of diabetic neuropathy can lead to glucose variability and hypoglycemia?

A

Autonomic neuropathy resulting in gastroparesis

67
Q

Risk for nephropathy is associated with risk for retinopathy.

True or false?

A

True

68
Q

The adjusted mean risk of the development of retinopathy in the DCCT in the intensively treated group was reduced by how much?

A

76%

69
Q

Cystic fibrosis related diabetes occurs as a result of non-autoimmune destruction of pancreatic alpha and beta cells.

True or false?

A

True

70
Q

What is the gene mutation in Prader-Willi syndrome?

A

Deletion in 15q11.2-q13 chromosomal region

71
Q

What is the best way to improve BMI (lose weight) in Prader-Willi syndrome?

A

Prescribe Growth Hormone

72
Q

Is the LDL level low or high in LCAT (lecithin-cholesterol acyltransferase) deficiency?

A

High

73
Q

Is the HDL level low or high in LCAT (lecithin-cholesterol acyltransferase) deficiency?

A

Low

74
Q

Which disease is also called ‘fish eye disease’?

A

LCAT deficiency

75
Q

What condition results in very high HDL leading to high total cholesterol?

A

CETP (cholesteryl ester transfer protein) deficiency

76
Q

No particular dietary strategy has been proven to be superior for sustained weight loss.

True or false?

A

True

77
Q

If a patient has very high cholesterol with xanthomas in the presence of low hematocrit - what is the likely diagnosis?

A

Sitosterolemia

78
Q

In persons with type 2 diabetes mellitus weight loss produced by a lifestyle program has not been shown to reduce cardiovascular morbidity or mortality.

True or false?

A

True

79
Q

Are statins recommended for diabetic patients younger than 40 years old according to the American Heart Association cholesterol guidelines?

A

No

80
Q

Patient has:

  • Increased confusion
  • Dysarthria
  • Nystagmus
  • Unsteady gait
  • Third nerve palsy
  • Decreased sensation on lower extremities

Deficiency of…?

A

Thiamine

81
Q

What does alcohol do to HDL?

A

Raises it

82
Q

Is fenofibrate contraindicated in pregnancy?

A

No

83
Q

What mutation is associated with hypercalcemia (with suppressed PTH and PTHrp), kidney stones and chronic kidney disease?

A

CYP24A1 mutation

84
Q

Is the 24,25(OH)2D level low or high when there is a CYP24A1 mutation?

A

Low

85
Q

How do you treat primary hyperparathyroidism with hypercalcemia in patients who are poor surgical candidates?

A

Cinacalcet

86
Q

50% of hypoparathyroidism is due to inactivating _____ mutations.

A

CASR

87
Q

Which test gives the most useful information about the age of a fracture if it occurred more than 6 months ago?

A

Nuclear medicine bone scan

88
Q

Does cinacalcet increase or decrease calcium?

A

Decreases calcium

89
Q

Is secondary hyperparathyroidism a contraindication for teriparatide?

A

Yes

90
Q

History of radiation treatment is a contraindication to the use of teriparatide.

True or false?

A

True

91
Q

Which medication causes hypophosphatemia…

Tenofovir or entecavir?

A

Tenofovir

92
Q

How does tenofovir cause hypophosphatemia?

A

By causing drug-induced Fanconi syndrome (renal phosphate wasting).

93
Q

How does sodium valproate cause hypophosphatemia?

A

By causing drug-induced Fanconi syndrome (renal phosphate wasting).

94
Q

How does cisplatin cause hypophosphatemia?

A

By causing drug-induced Fanconi syndrome (renal phosphate wasting).

95
Q

How does deferasirox (iron chelator) cause hypophosphatemia?

A

By causing drug-induced Fanconi syndrome (renal phosphate wasting).

96
Q

How does ifosfamide cause hypophosphatemia?

A

By causing drug-induced Fanconi syndrome (renal phosphate wasting).

97
Q

How do aminoglycoside antibiotics cause hypophosphatemia?

A

By causing drug-induced Fanconi syndrome (renal phosphate wasting).

98
Q

What does high FGF-23 cause?

A

Renal phosphate wasting -> hypophosphatemia -> inhibition of 1 alpha hydroxylase -> inappropriately low 1,25(OH)2D

99
Q

What is the treatment of tumor induced osteomalacia?

A

Phosphate supplementation and calcitriol

100
Q

What kind of cancer do patients with Paget’s disease get?

A

Osteosarcoma

101
Q

What kind of fractures occur in osteomalacia?

A

Stress fractures

102
Q

The risk of osteonecrosis of the jaw after 5 years of bisphosphonate use is…..

A

1/500 - 1/4000

103
Q

The risk of osteonecrosis of the jaw after 10 years of bisphosphonate use is…..

A

1/250 - 1/2000

104
Q

Risk of osteonecrosis of the jaw is ________ person years with osteoporosis dosages of bisphosphonates.

A

1/2500 - 1/20,000

105
Q

What can you try for persistent acromegaly if octreotide doesn’t work?

A

Pegvisomant

106
Q

If Cushing’s disease is diagnosed during pregnancy - should treatment be deferred till after delivery?

A

No

107
Q

If a patient has microprolactinoma but has regular periods, no galactorrhea and is not interested in having children - does she need to be treated?

A

No

108
Q

What should be the next management step in persistent Cushing’s disease?

A

Early re-operation

109
Q

What does testosterone do to prolactin levels?

A

Increases them

110
Q

How can you block the prolactin rise caused by testosterone administration?

A

Giving an aromatase inhibitor (e.g. anastrozole)

111
Q

Which medical treatment for Cushing’s disease worsens glycemic control?

A

Pasireotide

112
Q

Ipilimumab can cause hypophysitis (resulting in panhypopituitarism).

True or false?

A

True

113
Q

Which test is best for identifying growth hormone deficiency?

A

Insulin tolerance test with measurement of GH.

114
Q

Can benign intracranial hypertension cause empty sella syndrome?

A

Yes

115
Q

What endocrine abnormality does a basal skull fracture typically result in?

A

Hypopituitarism

116
Q

If a pituitary mass is growing rapidly (and hypopituitarism is present) then what is the likely diagnosis?

A

Metastasis

117
Q

How can you prevent further growth of residual gonadotroph pituitary adenomas?

A

Radiotherapy

118
Q

How do you treat patients with amenorrhea secondary to hyperprolactinemia secondary to anti-psychotic medications when their psychiatric medications cannot be changed?

A

Estrogen and progestin replacement

119
Q

Which symptom of acromegaly is likely to persist despite surgery?

A

Arthralgiaa

120
Q

What is the rate of remission of diabetes mellitus after Roux-en-Y bypass?

A

35%

ABIM - Endocrinology (17 decks)

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