Endocrine Board Review 2015 Flashcards
Sunitinib therapy can cause thyroid dysfunction (hypothyroidism)…
True or false?
True
In a lactating mother, how soon before radioactive iodine ablation therapy for thyroid cancer should breast-feeding be stopped?
3 months
How can you tell if someone is taking/abusing exogenous thyroid hormone (in the form of supplements etc)?
Measure thyroglobulin levels - they are suppressed when taking exogenous thyroid hormone.
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?
Iodine
Should liothyronine (T3) be used in pregnnacy?
No
Name a characteristic that predicts a Graves disease patient will go into remission?
Thyroid-stimulating immunoglobulin level (that should be low)
How long does thyroiditis typically take to resolve?
3 months
Should profoundly hypothyroid people get pregnant?
No - they need to use reliable contraception until their TSH level comes down to goal.
AJCC-7 Thyroid Cancer Staging for patients less than 45 years old with papillary or follicular thyroid cancer…
What is stage I?
Any T
Any N
M0
AJCC-7 Thyroid Cancer Staging for patients less than 45 years old with papillary or follicular thyroid cancer…
What is stage II?
Any T
Any N
M1
AJCC-7 Thyroid Cancer Staging for patients less than 45 years old with papillary or follicular thyroid cancer…
What is stage III?
There is no stage III
AJCC-7 Thyroid Cancer Staging for patients less than 45 years old with papillary or follicular thyroid cancer…
What is stage IV?
There is no stage IV
AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…
What is stage I?
T1 (less than or equal to 2 cm)
N0
M0
Old ThyCa question
AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…
What is stage III?
- T3 (> 4 cm) + N0 or N1a (to level IV) + M0
- T1 (= 2cm) or T2 (> 2cm = 4 cm) + N1a (to level VI) + M0
AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…
What is stage IVA?
- T4a (tumor beyond thyroid capsule) + any N + M0
- T1 - T3 + N1b (cervical lymph nodes levels I - V) + M0
AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…
What is stage IVB?
T4b (extensive invasion - pretracheal fascia/encases mediastinal vessel)
Any N
M0
AJCC-7 Thyroid Cancer Staging for patients more than 45 years old with papillary or follicular thyroid cancer…
What is stage IVC?
Any T
Any N
M1
AJCC-7 Thyroid Cancer Staging for patients with medullary thyroid cancer…
What is stage I?
T1 (less than or equal to 2 cm)
N0
M0
Old ThyCa Question
AJCC-7 Thyroid Cancer Staging for patients with medullary thyroid cancer…
What is stage III?
- T3 (> 4 cm) + N0 or N1a (to level IV) + M0
- T1 (= 2cm) or T2 (> 2cm = 4 cm) + N1a (to level VI) + M0
AJCC-7 Thyroid Cancer Staging for patients with medullary thyroid cancer…
What is stage IVA?
- T4a (tumor beyond thyroid capsule) + any N + M0
- T1 - T3 + N1b (cervical lymph nodes levels I - V) + M0
AJCC-7 Thyroid Cancer Staging for patients with medullary thyroid cancer…
What is stage IVB?
T4b (extensive invasion - pretracheal fascia/encases mediastinal vessel)
Any N
M0
Delete card
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?
Advise patient to wear an eye patch.
How can you differentiate between thyroid hormone resistance and a TSH-secreting pituitary adenoma?
Measure the alpha-subunit - it will be low in thyroid hormone resistance and high in pituitary adenoma.
TSH in the first trimester is inversely related to serum hCG…
True or false?
True
Can a radioactive iodine uptake scan reliably distinguish between amiodarone-induced thyrotoxicosis 1 and 2?
No - because it can be low even in type 1
What should the goal be for free T4 when treating Graves’ disease in pregnancy?
Upper limit of normal
What should the goal be for total T3 when treating Graves’ disease in pregnancy?
1.5 times the upper limit of normal
What kind of chemotherapy is used in advanced medullary thyroid cancer?
Tyrosine kinase inhibitors
What is the 10 year survival of papillary thyroid cancer patients with strongly FDG avid metastatic lesions?
~ 10%
What can be done to treat a goiter with compression symptoms if the patient is not a candidate for surgery and labs are euthyroid?
Radioactive iodine ablation therapy without recombinant human TSH
What should you think of in a patient with type 1 diabetes and hypothyroidism who starts to feel worse despite levothyroxine initiation?
Adrenal insufficiency
Octreotide can be used to treat TSH-oma after initial resection does not cure patient.
True or false?
True
What medication is the most rapid means to prevent additional episodes of thyrotoxic periodic paralysis?
Propranolol
What is the next step in treatment of hirsutism if a patient is already on oral contraceptive pills?
Spironolactone
What is the most common pregnancy risk in a patient with Turner syndrome?
Pre-eclampsia
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?
FGFR1
Severe hirsutism and virilization in postmenopausal women are more often due to ovarian hyperthecosis than to virilizing ovarian tumors.
True or false?
True
Highest relative risk of ______ with estrogen-only therapy in post-menopausal women other than DVT.
Stroke
In a patient with PCOS and a high BMI, in addition to metformin, which treatment most effectively induces ovulation?
Letrozole
What is the treatment for painful periods with premenstrual mood changes that are disruptive?
Low dose oral contraceptive pill and serotonin reuptake inhibitor.
What is the most likely diagnosis when the AMH is low in a young woman?
Pre-mature ovarian insufficiency
What is the minimum duration of therapy with transdermal gel after which the testosterone level can be meaningfully assessed?
2 weeks
For fertility induction in secondary hypogonadism in males - those with post pubertal hypogonadism respond to ________.
hCG alone
For fertility induction in secondary hypogonadism in males - those with pre pubertal hypogonadism respond to ________.
Combination therapy with hCG and FSH
Prednisone can cause hypogonadotrophic hypogonadism.
True or false?
True
Opioids can cause hypogonadotrophic hypogonadism.
True or false?
True
What is the treatment for otherwise normal male with early ejaculation?
SSRI like paroxetine etc Also clomipramine (non-SSRI) and topical lidocaine/prilocaine
When you have a total testosterone that seems discordant with the clinical picture - what do you do?
Measure free testosterone
What happens to the sperm count in Y-chromosome micro deletion?
Azoospermia
Patient has:
- Delayed puberty
- Hypogonadotrophic hypogonadism
- Primary adrenal insufficiency.
Diagnosis?
Adrenal hypoplasia congenita
What is the next step after diagnosing secondary hypogonadism on labs?
MRI of pituitary sella
If a patient has secondary hypogonadism and pituitary imaging is normal - what other hormone needs to be checked?
Prolactin
What disease can cause hypogonadotrophic hypogonadism and arthralgias with chondrocalcinosis of the small joints of the hands?
Hemochromatosis
Target blood pressure is less than ____ for diabetics.
140/90 mmHg
Which two things can be measured to most accurately determine a patient’s long-term insulin management?
- Beta-cell autoimmunity
- Beta-cell function
What is the treatment of diffuse proliferative diabetic retinopathy and ischemia?
Panretinal laser photocoagulation
What kind of diabetic neuropathy caused exquisite pain in a particular area?
Diabetic radiculopathy
What is the most likely diagnosis if you have no signs, symptoms or blood work consistent with diabetes but have glucosuria?
Familial renal glucosuria
If a patient has a hypoglycaemia syndrome and you suspect it is auto-immune - which antibody would you check?
Insulin autoantibody
For cystic fibrosis related diabetes oral agents are not as effective as insulin in improving nutritional status.
True or false?
True
For cystic fibrosis related diabetes oral agents are not as effective as insulin in reducing mortality.
True or false?
False
What should you think of when you develop a rash with diabetes?
Glucagonoma
What type of diabetic neuropathy can lead to glucose variability and hypoglycemia?
Autonomic neuropathy resulting in gastroparesis
Risk for nephropathy is associated with risk for retinopathy.
True or false?
True
The adjusted mean risk of the development of retinopathy in the DCCT in the intensively treated group was reduced by how much?
76%
Cystic fibrosis related diabetes occurs as a result of non-autoimmune destruction of pancreatic alpha and beta cells.
True or false?
True
What is the gene mutation in Prader-Willi syndrome?
Deletion in 15q11.2-q13 chromosomal region
What is the best way to improve BMI (lose weight) in Prader-Willi syndrome?
Prescribe Growth Hormone
Is the LDL level low or high in LCAT (lecithin-cholesterol acyltransferase) deficiency?
High
Is the HDL level low or high in LCAT (lecithin-cholesterol acyltransferase) deficiency?
Low
Which disease is also called ‘fish eye disease’?
LCAT deficiency
What condition results in very high HDL leading to high total cholesterol?
CETP (cholesteryl ester transfer protein) deficiency
No particular dietary strategy has been proven to be superior for sustained weight loss.
True or false?
True
If a patient has very high cholesterol with xanthomas in the presence of low hematocrit - what is the likely diagnosis?
Sitosterolemia
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?
True
Are statins recommended for diabetic patients younger than 40 years old according to the American Heart Association cholesterol guidelines?
No
Patient has:
- Increased confusion
- Dysarthria
- Nystagmus
- Unsteady gait
- Third nerve palsy
- Decreased sensation on lower extremities
Deficiency of…?
Thiamine
What does alcohol do to HDL?
Raises it
Is fenofibrate contraindicated in pregnancy?
No
What mutation is associated with hypercalcemia (with suppressed PTH and PTHrp), kidney stones and chronic kidney disease?
CYP24A1 mutation
Is the 24,25(OH)2D level low or high when there is a CYP24A1 mutation?
Low
How do you treat primary hyperparathyroidism with hypercalcemia in patients who are poor surgical candidates?
Cinacalcet
50% of hypoparathyroidism is due to inactivating _____ mutations.
CASR
Which test gives the most useful information about the age of a fracture if it occurred more than 6 months ago?
Nuclear medicine bone scan
Does cinacalcet increase or decrease calcium?
Decreases calcium
Is secondary hyperparathyroidism a contraindication for teriparatide?
Yes
History of radiation treatment is a contraindication to the use of teriparatide.
True or false?
True
Which medication causes hypophosphatemia…
Tenofovir or entecavir?
Tenofovir
How does tenofovir cause hypophosphatemia?
By causing drug-induced Fanconi syndrome (renal phosphate wasting).
How does sodium valproate cause hypophosphatemia?
By causing drug-induced Fanconi syndrome (renal phosphate wasting).
How does cisplatin cause hypophosphatemia?
By causing drug-induced Fanconi syndrome (renal phosphate wasting).
How does deferasirox (iron chelator) cause hypophosphatemia?
By causing drug-induced Fanconi syndrome (renal phosphate wasting).
How does ifosfamide cause hypophosphatemia?
By causing drug-induced Fanconi syndrome (renal phosphate wasting).
How do aminoglycoside antibiotics cause hypophosphatemia?
By causing drug-induced Fanconi syndrome (renal phosphate wasting).
What does high FGF-23 cause?
Renal phosphate wasting -> hypophosphatemia -> inhibition of 1 alpha hydroxylase -> inappropriately low 1,25(OH)2D
What is the treatment of tumor induced osteomalacia?
Phosphate supplementation and calcitriol
What kind of cancer do patients with Paget’s disease get?
Osteosarcoma
What kind of fractures occur in osteomalacia?
Stress fractures
The risk of osteonecrosis of the jaw after 5 years of bisphosphonate use is…..
1/500 - 1/4000
The risk of osteonecrosis of the jaw after 10 years of bisphosphonate use is…..
1/250 - 1/2000
Risk of osteonecrosis of the jaw is ________ person years with osteoporosis dosages of bisphosphonates.
1/2500 - 1/20,000
What can you try for persistent acromegaly if octreotide doesn’t work?
Pegvisomant
If Cushing’s disease is diagnosed during pregnancy - should treatment be deferred till after delivery?
No
If a patient has microprolactinoma but has regular periods, no galactorrhea and is not interested in having children - does she need to be treated?
No
What should be the next management step in persistent Cushing’s disease?
Early re-operation
What does testosterone do to prolactin levels?
Increases them
How can you block the prolactin rise caused by testosterone administration?
Giving an aromatase inhibitor (e.g. anastrozole)
Which medical treatment for Cushing’s disease worsens glycemic control?
Pasireotide
Ipilimumab can cause hypophysitis (resulting in panhypopituitarism).
True or false?
True
Which test is best for identifying growth hormone deficiency?
Insulin tolerance test with measurement of GH.
Can benign intracranial hypertension cause empty sella syndrome?
Yes
What endocrine abnormality does a basal skull fracture typically result in?
Hypopituitarism
If a pituitary mass is growing rapidly (and hypopituitarism is present) then what is the likely diagnosis?
Metastasis
How can you prevent further growth of residual gonadotroph pituitary adenomas?
Radiotherapy
How do you treat patients with amenorrhea secondary to hyperprolactinemia secondary to anti-psychotic medications when their psychiatric medications cannot be changed?
Estrogen and progestin replacement
Which symptom of acromegaly is likely to persist despite surgery?
Arthralgiaa
What is the rate of remission of diabetes mellitus after Roux-en-Y bypass?
35%
