Endocrine Board Review 3rd Edition Flashcards
1
Q
What can you see if you image the pituitary in a patient with primary hypothyroidism?
A
Pituitary enlargement
2
Q
What happens to the alpha subunit during pregnancy?
A
It is increased
3
Q
Do patients with non-classical CAH typically achieve mid-parental height?
A
No
4
Q
Which type of progestin has been shown to improve PMS symptoms when in oral contraceptive pills?
A
Drospirenone (anti-mineralocorticoid activity)
5
Q
Which is the superior fertility treatment for women with PCOS…
Metformin or clomiphene?
A
Clomiphene
6
Q
What is the difference between Kallman syndrome due to KAL1 gene mutations and Kallman syndrome due to FGFR1 gene mutations?
A
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)
7
Q
What should you think of when the vas deferens is not palpable?
A
Cystic fibrosis (congenital absence is common)
8
Q
If a patient has gynecomastia, azoospermia, very small testes in association with elevated gonadotrophins - what should you think of?
A
Klinefelter syndrome
9
Q
What can you see if you image the pituitary during pregnancy?
A
Pituitary enlargement
10
Q
If a male patient has:
- Tender gynecomastia
- Low libido
- Low testosterone
- High estrogen
- Suppressed gonadotropin levels
Diagnosis?
A
Sertoli cell tumor or Leydig cell tumor that makes estradiol.
11
Q
Is regular menstrual bleeding a reliable predictor of normal ovulatory function in women with hirsutism?
A
No
12
Q
What is the best test to check for anovulation?
A
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.
13
Q
Are testosterone levels high or low with an hCG-producing tumor?
A
High
14
Q
Are gonadotropin levels high or low with an hCG-producing tumor?
A
Low
15
Q
In hyperthyroidism are total testosterone levels high or low?
A
High
16
Q
In hyperthyroidism are free testosterone levels high or low?
A
Low
17
Q
In hyperthyroidism are free testosterone to free estradiol ratios high or low?
A
Low
18
Q
In hyperthyroidism are estradiol levels high or low?
A
High
19
Q
In hyperthyroidism are total SHBG levels high or low?
A
High
20
Q
Does hyperthyroidism cause tender gynecomastia?
A
It can
21
Q
A history of venous thrombosis is generally considered to be an absolute contraindication to all oral estrogen-progestogen contraceptive use.
True or false?
A
True
22
Q
Do non-oral progestogen-only contraceptives increase the risk of thromboembolism?
A
No
23
Q
Amenorrhea occurs in ____% of menstrual cycles in patients taking OCPs.
A
5 - 10%
24
Q
Macroprolactinemia accounts for ~ ____% of biochemical hyperprolactinemia.
A
20
25
How should you treat a prolactinoma in a woman if she is not planning to get pregnant?
Oral contraceptive pills
26
What is the next step in treatment of erectile dysfunction if the response to a PDE-5 inhibitor is not satisfactory?
Alprostadil
27
What hormone can you check to screen for Turner syndrome in an amenorrheic female?
FSH (serum)
28
What should you suspect in a patient with symptoms of primary adrenal insufficiency and hypogonadotrophic hypogonadism?
Adrenal hypoplasia congenita
29
What is the best initial test with adrenal hypoplasia congenita is suspected?
A cosyntropin stimulation test
30
Colles fractures from trauma are not associated with a greater risk of future vertebral fractures.
True or false?
False
31
Increased age and previous fracture increase the risk of future fracture.
True or false?
True
32
What treatment results in the largest increase in lumbar spine BMD?
Teriparatide (PTH 1-34)
33
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
34
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
35
Is the vitamin 1,25 (OH) D level high or low in tumor-induced osteomalacia?
Low
36
What do tumors that cause tumor-induced osteomalacia secrete high levels of?
FGF-23
37
What does increased vitamin 1, 25 (OH) D do?
Increases intestinal absorption of calcium
38
McCune Albright syndrome is caused by somatic mutations in the ____ gene leading to reduction in expression of Gsalpha by about 50%.
GNAS
39
McCune Albright syndrome is caused by somatic mutations in the GNAS gene leading to reduction in expression of ____ by about 50%.
Gsalpha
40
McCune Albright syndrome is caused by somatic mutations in the GNAS gene leading to reduction in expression of Gsalpha by about __%.
50%
41
What do activating mutations in the LRP5 gene do to bone mass?
Increase it
42
Long term glucocorticoid therapy causes direct suppression of osteoblast function leading to decreased bone formation.
True or false?
True
43
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
44
Long term glucocorticoid therapy causes decreased intestinal calcium absorption.
True or false?
True
45
Long term glucocorticoid therapy causes increased urinary calcium loss.
True or false?
True
46
Germline mutation in the _____ gene causes hyperparathyroidism-jaw tumor syndrome.
HRPT2
47
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
48
Patients with humoral hypercalcemia of malignancy have decreased intestinal calcium absorption due to decreased 1,25-dihydroxyvitamin D levels.
True or false?
True
49
Ectopic PTH production has not been reported with humoral hypercalcemia of malignancy?
True or false?
False
50
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
51
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
52
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.
53
What happens to the urinary cyclic AMP levels in pseudohypoparathyroidism?
They are decreased.
54
X-linked hypophosphatemic rickets is caused by genetic mutations in the ___ gene.
PHEX
55
What is the treatment of Prader-Willi Syndrome?
Growth hormone replacement
56
Is sitosterolemia associated with tendon xanthomas?
Yes
57
Is there evidence that cholestyramine reduces cardiovascular risk?
Yes
58
Are omega-3 fatty acids effective in treating hypertriglyceridemia during pregnancy?
Not particularly
59
Can fibrates be used in pregnancy?
Yes
60
Does elevated C-reactive protein indicate increased risk of cardiovascular disease?
Yes
61
Which are the only drugs that causes paradoxical increase in cholesterol (because of increased VLDL synthesis)?
Bile acid binding resins
62
Which is more important - LDL particle size or number?
LDL particular number
63
Gastric bypass operations typically produce weight loss of about ____ % of excess weight.
65%
64
What do anabolic steroids do to HDL levels?
Reduce them
65
What needs to be tested to diagnose anabolic steroid use?
Testosterone and LH
66
What endocrine abnormality caused by hereditary Hemochromatosis tends to improve with treatment of this underlying disorder?
Diabetes improves
67
What is the likely diagnosis if a woman has signs and symptoms of diabetes insipidus during pregnancy?
Excessive placental vasopressin made
68
Somatostatin inhibits pituitary hormones including ACTH, GH, TSH and prolactin.
True or false?
True
69
Somatostatin inhibits insulin secretion and stimulates glucagon secretion.
True or false?
False
70
Hypercalcemia is usually the first sign, followed by lesions of the pancreatic islet and pituitary.
Which syndrome is this?
MEN 1
71
How is MEN 1 genetically transmitted?
Affected patients inherit one normal and one mutant allele. A second hit knocking out the normal allele results in attenuation of the constraint on cell growth by menin.
72
The concordance of type 1 diabetes mellitus in genetically identical twins is _____ %.
30 - 60%
73
The concordance of type 2 diabetes mellitus in genetically identical twins is _____ %.
> 90%
74
About _____ % of first degree relatives of individuals with type 1 diabetes will have islet-cell antibodies or GAD antibodies.
3 - 4%
75
Does insulin administration prevent type 1 diabetes in first-degree relatives who are islet-cell antibody positive?
No (Diabetes Prevention Trial)
76
Should the diagnosis of diabetes be made on the basis of home glucose values?
No - blood glucose values should be confirmed by a laboratory.
77
Lifestyle modification, merformin, rosiglitazone, pioglitazone, and acarbose have been shown to delay the progression to diabetes.
True or false?
True
78
Which is more effective at delaying progression of impaired glucose tolerance to diabetes...
Intensive lifestyle modification or metformin?
Intensive lifestyle modification
79
The ADA recommends metformin (rather than thiazolidinediones or acarbose) as the initial therapy for individuals with impaired glucose tolerance.
True or false?
False
80
Lifestyle modification is preferred to medications, as it has been demonstrated not only to delay the progression to diabetes but also to reduce microvascular and cardiovascular complications of diabetes.
True or false?
False
81
Which drug class has been shown to delay the progression of nephropathy for a hypertensive individual with type 1 diabetes mellitus and microalbuminuria or macroalbuminuria...
ACEIs or ARBs?
ACEIs
82
Which drug class reduces progression to macroalbuminemia in type 2 diabetes mellitus patients with hypertension and microalbuminuria...
ACEIs or ARBs?
Both ACEIs and ARBs
83
Which drug class is usually sufficient as monotherapy to control hypertension in patients with type 2 diabetes mellitus...
ACEIs or ARBs?
Neither
84
Which drug class is accompanied by improvements in renal outcomes greater than what would be predicted by BP lowering alone...
ACEIs or ARBs?
Both ACEIs and ARBs
85
What pregnancy class are sulfonylureas?
Category C
86
Which sulfonylurea is preferred in the second and third trimester because it does not cross the placenta?
Glyburide
87
What pregnancy category are ACEIs and ARBs?
Category C in the first trimester and Category D in the second and third trimester.
88
Is there greater evidence for fetal anomalies in the first trimester with ACEIs or ARBs?
ACEIs
89
Is the HbA1c accurate in a patient with anemia secondary to renal disease?
No
90
Fluid retention, but not left ventricular dysfunction, is a side effect of both rosiglitazone and pioglitazone.
True or false?
True
91
Rosiglitazone is likely less safe than pioglitazone and currently is restricted to a company-regulated Access Program.
True or false?
True
92
Newer liquid chromatography-tandem mass spectrometry assays do detect all sulfonylureas available in the US and repaglinide.
True or false?
True
93
In fasting hypoglycemia caused by a nonpancreatic tumor, the insulin and c-peptide levels are suppressed during hypoglycemia.
True or false?
True
94
Intensive glycemic control in non-pregnant patients may worsen retinopathy initially (over months) but reduces the progression of retinopathy with longer-term follow-up (years).
True or false?
True (DCCT)
95
What race/ethnicity typically has ketosis-prone type 2 diabetes?
African-American or Hispanic
96
Can insulin glargine be mixed with other insulin formulations?
No (formulated at acidic pH)
97
What is the accelerated pharmacokinetic action of insulins Aspart, Lispro, and Glulisine related to?
Their molecular structure
98
Bedtime insulin glargine and NPH insulin are similar in HbA1c reduction and risk of severe hypoglycemia when added to oral agents for the treatment of type 2 diabetes mellitus.
True or false?
True
99
Which lipid disorder causes markedly elevated HDL levels?
CETP deficiency
100
MODY is inherited in an autosomal dominant fashion with a 30% penetrance rate.
True or false?
False
101
MODY is most often caused by mutations in the glucokinase or a hepatocyte nuclear factor (HNF) gene.
True or false?
True
102
When are GLP-1 agonists prone to cause hypoglycemia?
When they are used with other drugs that cause hypoglycemia like sulfonylureas.
103
Whole pancreas transplantation is superior to islet-cell transplantation at nearly normalizing glucose homeostasis 2 - 5 years after transplantation (without the need for supplemental insulin).
True or false?
True
104
Post-transplant diabetes is associated with reduced graft survival and patient survival after transplantation.
True or false?
True
105
What is the HbA1c goal for children younger than 6 years old?
8.5%
106
What is the HbA1c goal for children 6 - 12 years old?
8%
107
What is the HbA1c goal for children 13 - 19 years old?
7.5%
108
Does diabetic retinopathy always get worse during pregnancy?
No
109
What does diffuse uptake in the thyroid on a PET scan most likely indicate?
General thyroid abnormalities like Hashimoto's thyroiditis,
110
Does transdermal estrogen affect levothyroxine dose?
No
111
What should you check when C-cell hyperplasia is discovered on pathology?
TPO antibodies
112
What is the adult dose of potassium iodide required after a nuclear accident?
130 mg daily for as long as the exposure is on-going.
113
What should you do if a patient is still hypothyroid after large doses of levothyroxine because of malabsorption?
Increase the dose - even if it's crazy high.
114
How is resistance to thyroid hormone inherited?
Autosomal dominant inheritance
115
A fetus with a TR beta is more likely to survive pregnancy.
True or false?
True
116
What happens to the free T4 level in familial dysalbuminemic hyperthyroxinemia?
Usually normal
| total T4 and free thyroxine index is elevated
117
What is the 'donut' sign (thyroid gland encircling the trachea) indicative of?
Thyroid lymphoma
118
What medication is helpful in Riedel thyroiditis?
Tamoxifen
119
What is the most likely adverse effect of exposure to radioactive iodine during pregnancy?
Miscarriage
120
If a patient has a goiter that appears to be because of Hashimoto's disease but they have negative TPO antibodies... what is the likely cause of the goiter?
Thyroid peroxidase gene mutation (disorder of organification)
121
What is the classic cause of 'black thyroid'?
Minocycline
122
If a patient has a lobectomy with medullary thyroid cancer, but then has a negative RET mutation, no family history of MTC, normal level of calcitonin... does the patient need a completion thyroidectomy?
No
123
Do patients with follicular thyroid cancer and capsular invasion alone have increased mortality due to disease?
No
124
Treatment of toxic multinodular goiter with radioactive iodine may lead to Graves disease.
True or false?
True
125
Can acute symptomatic hyponatremia (hypervolemic or euvolemic) be treated with conivaptan?
Yes
126
Which axis is most important to be assessed after head trauma?
Hypothalmic-pituitary-adrenal axis
127
Which treatment of acromegaly has a good chance of efficacy (both IGF-1 levels and tumor size) within a year?
Somatostatin anologs i.e. octreotide
128
When should follow-up imaging be done for a macroadenoma of the pituitary?
6 months
129
When should formal visual testing be done for a pituitary adenoma?
When the tumor abuts the optic chiasm
130
Does transspenoidal surgery treat the supra-sellar component of a pituitary adenoma?
No
131
Does transcranial surgery treat the sellar component of a pituitary adenoma?
No
132
In panhypopituitarism secondary to a macroadenoma causing visual symptoms how should the hormone replacement be handled?
Treatment with hydrocortisone should be initiated immediately, and then evaluate adrenal, thyroid and testicular function in 4 - 6 weeks.
133
What should be done when dopamine agonists are suppressing the prolactin but not decreasing the size of the pituitary macroadenoma?
Transsphenoidal surgery to remove the 'non-secretory' part of the pituitary macroadenoma.
134
Do somatostatin anologs cause gallstones?
Yes
135
If a patient gets gallstones with cholecystitis on somatostatin anologs then what is the next step?
Cholecystectomy.
| No point stopping the therapy if it is effective.
136
Is high dose bromocriptine effective for Cushing's disease?
No
137
Does phenoxybenzamine give false positive results when testing for pheochromocytomas?
No
138
Does amitriptyline give false positive results when testing for pheochromocytomas?
Yes
139
What should you suspect in a young patient with hypertension, spontaneous hypokalemia and a renin level that is not suppressed?
Renovascular disease caused by fibromuscular dysplasia
140
"Eversion of the upper and lower eyelids"
Diagnosis?
MEN 2B
141
Is MEN 2B associated with primary hyperparathyrodism?
No
142
Is MEN 2B associated with medullary thyroid cancer?
Yes
143
Is MEN 2A associated with medullary thyroid cancer?
Yes
144
Adrenocortical adenomas are associated with pure glucocorticoid excess and low adrenal androgens.
True or false?
True
145
Are the aldosterone levels high or low in Liddle syndrome?
Low
146
Is the renin plasma activity high or low in Liddle syndrome?
Low
147
Is hypertension a feature of Liddle syndrome?
Yes
148
What is the inheritance pattern of congenital adrenal hyperplasia?
Autosomal recessive
149
What is multi-nodular bilateral adrenal enlargement in the setting of mild Cushing syndrome diagnostic of?
ACTH-independent macronodular adrenal hyperplasia (AIMAH)
150
When there is maternal imprinting then there is higher penetrance when the mutation is inherited from...?
the father
151
Is SDHC inherited via maternal imprinting?
No
152
Is SDHD inherited via maternal imprinting?
Yes
153
Can you continue phenoxybenzamine for a 123 I-MIBG scan?
Yes
154
Can you continue labetalol for a 123 I-MIBG scan?
No
155
Can you continue nifedipine for a 123 I-MIBG scan?
No
156
Can you continue amitriptyline for a 123 I-MIBG scan?
No
157
Can you continue prochlorperazine for a 123 I-MIBG scan?
No
158
IPSS data are not valid if the patient does not have active hypercortisolism on the day of sampling.
True or false?
True
159
What is the best test to detect subclinical Cushing's syndrome?
Over night dexamethasone test
