Endocrine Board Review 3rd Edition Flashcards
What can you see if you image the pituitary in a patient with primary hypothyroidism?
Pituitary enlargement
What happens to the alpha subunit during pregnancy?
It is increased
Do patients with non-classical CAH typically achieve mid-parental height?
No
Which type of progestin has been shown to improve PMS symptoms when in oral contraceptive pills?
Drospirenone (anti-mineralocorticoid activity)
Which is the superior fertility treatment for women with PCOS…
Metformin or clomiphene?
Clomiphene
What is the difference between Kallman syndrome due to KAL1 gene mutations and Kallman syndrome due to FGFR1 gene mutations?
KAL1 mutations: midline abnormalities (colobomas, cleft palate, horseshoe kidney, renal agenesis) and subtle neurological changes (synkinesia).
This is X-linked.
FGFR1 mutations: increased cleft palate but nothing else.
This is autosomal (usually dominant)
What should you think of when the vas deferens is not palpable?
Cystic fibrosis (congenital absence is common)
If a patient has gynecomastia, azoospermia, very small testes in association with elevated gonadotrophins - what should you think of?
Klinefelter syndrome
What can you see if you image the pituitary during pregnancy?
Pituitary enlargement
If a male patient has:
- Tender gynecomastia
- Low libido
- Low testosterone
- High estrogen
- Suppressed gonadotropin levels
Diagnosis?
Sertoli cell tumor or Leydig cell tumor that makes estradiol.
Is regular menstrual bleeding a reliable predictor of normal ovulatory function in women with hirsutism?
No
What is the best test to check for anovulation?
Serum progesterone level at day 20 - 24 of menstrual cycle. If it is less than or equal to 3 ng/mL then that indicates anovulation.
Are testosterone levels high or low with an hCG-producing tumor?
High
Are gonadotropin levels high or low with an hCG-producing tumor?
Low
In hyperthyroidism are total testosterone levels high or low?
High
In hyperthyroidism are free testosterone levels high or low?
Low
In hyperthyroidism are free testosterone to free estradiol ratios high or low?
Low
In hyperthyroidism are estradiol levels high or low?
High
In hyperthyroidism are total SHBG levels high or low?
High
Does hyperthyroidism cause tender gynecomastia?
It can
A history of venous thrombosis is generally considered to be an absolute contraindication to all oral estrogen-progestogen contraceptive use.
True or false?
True
Do non-oral progestogen-only contraceptives increase the risk of thromboembolism?
No
Amenorrhea occurs in ____% of menstrual cycles in patients taking OCPs.
5 - 10%
Macroprolactinemia accounts for ~ ____% of biochemical hyperprolactinemia.
20
How should you treat a prolactinoma in a woman if she is not planning to get pregnant?
Oral contraceptive pills
What is the next step in treatment of erectile dysfunction if the response to a PDE-5 inhibitor is not satisfactory?
Alprostadil
What hormone can you check to screen for Turner syndrome in an amenorrheic female?
FSH (serum)
What should you suspect in a patient with symptoms of primary adrenal insufficiency and hypogonadotrophic hypogonadism?
Adrenal hypoplasia congenita
What is the best initial test with adrenal hypoplasia congenita is suspected?
A cosyntropin stimulation test
Colles fractures from trauma are not associated with a greater risk of future vertebral fractures.
True or false?
False
Increased age and previous fracture increase the risk of future fracture.
True or false?
True
What treatment results in the largest increase in lumbar spine BMD?
Teriparatide (PTH 1-34)
Which has a greater increase in bone mineral density…
Sequential use of…
- PTH (teriparatide) and then alendronate
or
- Alendronate and then PTH (teriparatide)?
Sequential use of PTH (teriparatide) and then alendronate
What is the easiest and least expensive way to check for FHH in a patient whose calcium clearance/creatinine clearance ratio is 1% (0.01)?
Check calcium levels of patient’s parents
Is the vitamin 1,25 (OH) D level high or low in tumor-induced osteomalacia?
Low
What do tumors that cause tumor-induced osteomalacia secrete high levels of?
FGF-23
What does increased vitamin 1, 25 (OH) D do?
Increases intestinal absorption of calcium
McCune Albright syndrome is caused by somatic mutations in the ____ gene leading to reduction in expression of Gsalpha by about 50%.
GNAS
McCune Albright syndrome is caused by somatic mutations in the GNAS gene leading to reduction in expression of ____ by about 50%.
Gsalpha
McCune Albright syndrome is caused by somatic mutations in the GNAS gene leading to reduction in expression of Gsalpha by about __%.
50%
What do activating mutations in the LRP5 gene do to bone mass?
Increase it
Long term glucocorticoid therapy causes direct suppression of osteoblast function leading to decreased bone formation.
True or false?
True
Long term glucocorticoid therapy causes direct suppression of gonadotropin secretion by the pituitary, leading to decreased gonadal sex steroid secretion and subsequent decreased BMD.
True or false?
True
Long term glucocorticoid therapy causes decreased intestinal calcium absorption.
True or false?
True
Long term glucocorticoid therapy causes increased urinary calcium loss.
True or false?
True
Germline mutation in the _____ gene causes hyperparathyroidism-jaw tumor syndrome.
HRPT2
Patients with humoral hypercalcemia of malignancy describes a clinical syndrome that arises most commonly from over-production of PTH-related peptide by tumor cells.
True or false?
True
Patients with humoral hypercalcemia of malignancy have decreased intestinal calcium absorption due to decreased 1,25-dihydroxyvitamin D levels.
True or false?
True
Ectopic PTH production has not been reported with humoral hypercalcemia of malignancy?
True or false?
False
PTH-related peptide (PTH-rP) leads to increased expression of RANKL (receptor activator of nuclear factor-kappa B ligand) and decreased osteoprotegerin (OPG), with resultant increased bone turnover.
True or false?
False
Patients with humoral hypercalcemia of malignancy have an increase in their renal tubular phosphorus reabsorption threshold and an increase in their serum phosphate levels.
True or false?
False
What is the difference between pseudohypoparathyroidism and pseudopseudohypoparathyroidism?
Patients with pseudohypoparathyroidism are resistant to PTH (thus high levels of PTH, with low calcium) and patients with pseudopseudohypoparathyroidism are responsive to PTH.
What happens to the urinary cyclic AMP levels in pseudohypoparathyroidism?
They are decreased.
X-linked hypophosphatemic rickets is caused by genetic mutations in the ___ gene.
PHEX
What is the treatment of Prader-Willi Syndrome?
Growth hormone replacement
Is sitosterolemia associated with tendon xanthomas?
Yes
Is there evidence that cholestyramine reduces cardiovascular risk?
Yes
Are omega-3 fatty acids effective in treating hypertriglyceridemia during pregnancy?
Not particularly
Can fibrates be used in pregnancy?
Yes
Does elevated C-reactive protein indicate increased risk of cardiovascular disease?
Yes
Which are the only drugs that causes paradoxical increase in cholesterol (because of increased VLDL synthesis)?
Bile acid binding resins
Which is more important - LDL particle size or number?
LDL particular number
Gastric bypass operations typically produce weight loss of about ____ % of excess weight.
65%