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Internal Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Initial oral glucose lowering agent of choice for type 2 DM?

A

Metformin

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2
Q

Major toxicity of Metformin?

A

Lactic acidosis

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3
Q

Antidiabetic agents that are insulin secretagogues? (4)

A
  1. Sulfonylurea ( gliclazide)
  2. Meglitinides ( repaglinide)
  3. GLP-1 agonist (liraglutide)
  4. DPP4- Inh ( Sitagliptin)
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4
Q

Diabetes drugs that can cause weight loss? (4)

A
  1. A- glucosidase Inh ( Acarbose)
  2. Metformin
  3. SGLT2 Inh ( -gliflozin)
  4. GLP-1 agonist (-glutide)
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5
Q

Diabetes drugs that are weight neutral?

A

DPP4 Inh ( -liptin)

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6
Q

Diabetes drugs that causes wt gain?

A
  1. Sulfonylurea ( gli-; gliclazide)
  2. Insulin
  3. Thiazolidinediones ( -glitazones)

Nakakataba abg mag SIT

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7
Q

GLP1 receptor agonist used for wt loss? (2)

A

Liraglutide
Semaglutide

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8
Q

Contraindications to Metformin use?

A
  1. EGFR <30
  2. Lactic acidosis
  3. Severe hepatic failure
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9
Q

Diabetic drugs that can cause hypoglycemia?

A
  1. Insulin
  2. Sulfonylurea ( Gli-)
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10
Q

Maximum dose of Metformin in patients with normal renal function?

A

2550 mg / day

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11
Q

Vitamin deficiency associated with Metformin use?

A

Vitamin B 12

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12
Q

FDA approved drugs for the treatment of painful diabetic neuropathy?

A
  1. Pregabalin
  2. Duloxetine
  3. Tapentadol
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13
Q

Rapid acting insulin?

A

No LAG or has AA in their names

Lispro
Aspart
Glulisine

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14
Q

Insulin with the longest duration of action ?

A

Insulin degludec

( degLONGdec)

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15
Q

Long-acting insulin with fatty acid side chain?

A

Insulin detemir

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16
Q

HbA1c goal for patients with Type 2 DM?

A

< 7.0%

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17
Q

Metabolic Syndrome Criteria? (5)

A
  1. Central obesity: waist circumference
    - Male >102 cm
    - Female >88cm
  2. TG >/= 150 mg/ dL or use of specific medications
  3. HDL
    Male: <40 mg/ dL
    Female: <50 mg/ dL
    Or use of specific medications
  4. BP >/= 130 systolic or >/= 85 diastolic or use of specific medications
  5. Fasting blood glucose of >/= 100mg/dL or use of specific medications or previously diagnosed with Type 2 DM
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18
Q

Microvascular complications of diabetes?

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy
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19
Q

Most common form of diabetic neuropathy?

A

Distal symmetric polyneuropathy

( stocking glove pattern)

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20
Q

Diabetes drug associated with C- cell hyperplasia in rats?

A

GLP1 receptor agonist ( -glutide)

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21
Q

SGLT2 Inhibitor associated with risk of lower limb amputation?

A

Canagliflozin

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22
Q

DPP4 inhibitor associated with heart failure?

A

Saxagliptin

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23
Q

Leading cause of non traumatic lower extremity amputation?

A

Diabetes Mellitus

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24
Q

Most serious complication of therapy for diabetes mellitus?

A

Hypoglycemia

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25
Q

Symptoms usually present in DKA but are notably absent in HHS ? (3)

A

Nausea , Vomiting, Abdominal Pain

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26
Q

Most common cause of Cushing’s syndrome?

A

Iatrogenic

Medical use of glucocorticoids for immunosuppression

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27
Q

After exclusion of exogenous glucocorticoid use, the overwhelming majority of Cushings syndrome is due to ?

A

Cushings disease

( ACTH producing pituitary adenoma)

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28
Q

Most common cause of Cushings disease?

A

ACTH secreting Pituitary Adenoma

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29
Q

Treatment of choice for Cushings disease?

A

Transsphenoidal surgical resection

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30
Q

Laboratory test to distinguish between the differentials after diagnosing Cushings syndrome?

A

Plasma ACTH ( ACTH dependent vs independent)

31
Q

Expected ACTH level in Cushings disease?

A

Normal to elevated

32
Q

Expected ACTH level in Cushings syndrome due to adrenal adenoma?

A

Low

33
Q

Hormone checked in blood to confirm the diagnosis of Cushing Syndrome?

A

Adrenocorticotropic hormone

34
Q

Ectopic ACTH Syndrome ACTH level?

A

Elevated

35
Q

ACTH level suggestive for Cushing’s syndrome?

A

Normal to mildly elevated

36
Q

ACTH level Suggestive of primary hypercortisolism?

A

Undetectable or low

37
Q

Cushings syndrome from ectopic ACTH production is predominantly caused by?

A

Carcinoid tumor( frequently in the lung)

38
Q

Symptom more likely seen in Cushing’s syndrome due to ectopic ACTH production , in contrast to other causes?

A

Hyperpigmentation of the knuckles or skin areas exposed to friction
( stimulation of melanin production from the POMC Cleavage products)

39
Q

Medical treatment of Cushing’s syndrome in pregnancy?

A

Metyrapone

40
Q

Order of trophic hormone deficiency in pituitary tumor syndromes?

A

GH > FSH > LH > TSH > ACTH

41
Q

Receptor for dopamine agonist

A

D2

42
Q

Receptors for somatostatin receptor analogues?

A

SST2 and SST5

43
Q

Only anabolic agent used for the treatment of osteoporosis?

A

Teriparatide

44
Q

Monoclonal antibody of RANKL?

A

Denosumab

45
Q

Rare adverse effects of biphosphonates ?

A

Atypical femoral fracture
Osteonecrosis of the jaw

46
Q

DOC for Hypercalcemia in malignancy?

A

Zoledronic acid

47
Q

Biphosphonates that can be used in GERD?

A

Zolendronic Acid (IV)
Pamidronate (IV)

48
Q

Anti- hypercalcemic agent that provides analgesic effect in vertebral fractures?

A

Calcitonin

49
Q

Anti-hypercalcemic agent associated with tachyphylaxis?

A

Calcitonin

50
Q

Anti-hypercalcemic of choice in ESRD?

A

Denosumab

51
Q

PTU associated vasculitis?

A

p-ANCA positive vasculitis

52
Q

Drugs used to inhibit peripheral conversion of T4 to T3 ? (3)

A
  1. PTU
  2. Propranolol
  3. Glucocorticoids
53
Q

Drugs that decrease absorption of levothyroxine?

A
  1. Aluminum containing antacids
  2. Ferrous sulfate
  3. Calcium carbonate
  4. Sucralfate
54
Q

Doubling the statin dose can decrease LDL-C by how much?

A

0.06

55
Q

High intensity statins ?

A

Rosuvastatin 20-40mg
Atorvastatin 40-80mg ?

56
Q

Channel blocked by ezetimibe?

A

NPC1L1

57
Q

Only known drug that can increase HDL-C levels ?

A

Niacin

58
Q

Major adverse effects of orlistat?

A

Steatorrhea , oily stools

59
Q

Anti obesity drug with greatest amount of wt loss?

A

Phentermine / Topiramate

60
Q

Most commonly performed bariatric surgery procedure?

A

Sleeve gastrectomy

61
Q

Confirm the presence of nodule and assess the status of thyroid gland?

A

Thyroid ultrasound

62
Q

Evaluate the physiologic function of thyroid nodules?

A
  1. TSH Assays : assessment of thyroid function
  2. Antithyroid antibodies: determine etiology of thyroid dysfunction
  3. Thyroid utz: diagnosis and evaluation of nodular thyroid disease
  4. Calcitonin test: marker of medullary thyroid carcinoma
  5. Fine needle aspiration: most accurate test for determining malignancy
63
Q

Detection of metastasis of thyroid cancer ?

A

Scintigraphy

64
Q

51/F lost to follow up with her endocrinologist. Erratically taking Methimazole. Presents with acute onset of restlessness and agitation , confussion, vomiting and diarrhea.

A

Thyroid storm

65
Q

Expected findings in thyroid storms?

A
  1. Pyrexia
  2. CNS alterations ( agitation, delirium, psychosis, seizure, coma)
  3. GI dysfunction ( diarrhea, jaundice)
  4. Tachycardia
  5. CHF
66
Q

Management of thyroid storm?

A
  1. Stop production of thyroid hormone : PTU , Methimazole, Hydrocortisone
  2. Block peripheral effect of thyroid hormone: Propranolol
  3. Inhibit hormone release: SSKI, Sodium Iodide
67
Q

Local first test to determine in assessing thyroid function?

A

TSH

68
Q

Test monitored to titrate antithyroid drug regimen after initiating treatment for thyrotoxicosis?

A

Unbound T4 ( TSH remain suppressed for months)

69
Q

Laboratory test used to follow-up thyroid cancer patients to detect recurrence?

A

Serum thyroglobulin

70
Q

Sign wherein venous distention over the neck , difficulty in breathing occur when raising the arms, due to large retrosternal goiter?

A

Pemberton’s Sign

71
Q

Most common cause of thyrotoxicosis ?

A

Graves disease

72
Q

Limited indications of PTU over Methimazole for the tx of thyrotoxicosis?

A
  1. First trimester of pregnancy
  2. Thyroid storm
  3. Adverse reactions to Methimazole
73
Q

Most important adverse effect of antithyroid drugs manifesting with fever, sore throat, and mouth ulcers. This is idiosyncratic and abrupt and require immediate discontinuation of drug?

A

Agranulocytosis

74
Q

Stable iodide can be given to block thyroid hormone synthesis due to this effect?

A

Wolff- Chaikoff Effect

Internal Medicine (12 decks)

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