Endocrinology Flashcards
1
Q
Initial oral glucose lowering agent of choice for type 2 DM?
A
Metformin
2
Q
Major toxicity of Metformin?
A
Lactic acidosis
3
Q
Antidiabetic agents that are insulin secretagogues? (4)
A
- Sulfonylurea ( gliclazide)
- Meglitinides ( repaglinide)
- GLP-1 agonist (liraglutide)
- DPP4- Inh ( Sitagliptin)
4
Q
Diabetes drugs that can cause weight loss? (4)
A
- A- glucosidase Inh ( Acarbose)
- Metformin
- SGLT2 Inh ( -gliflozin)
- GLP-1 agonist (-glutide)
5
Q
Diabetes drugs that are weight neutral?
A
DPP4 Inh ( -liptin)
6
Q
Diabetes drugs that causes wt gain?
A
- Sulfonylurea ( gli-; gliclazide)
- Insulin
- Thiazolidinediones ( -glitazones)
Nakakataba abg mag SIT
7
Q
GLP1 receptor agonist used for wt loss? (2)
A
Liraglutide
Semaglutide
8
Q
Contraindications to Metformin use?
A
- EGFR <30
- Lactic acidosis
- Severe hepatic failure
9
Q
Diabetic drugs that can cause hypoglycemia?
A
- Insulin
- Sulfonylurea ( Gli-)
10
Q
Maximum dose of Metformin in patients with normal renal function?
A
2550 mg / day
11
Q
Vitamin deficiency associated with Metformin use?
A
Vitamin B 12
12
Q
FDA approved drugs for the treatment of painful diabetic neuropathy?
A
- Pregabalin
- Duloxetine
- Tapentadol
13
Q
Rapid acting insulin?
A
No LAG or has AA in their names
Lispro
Aspart
Glulisine
14
Q
Insulin with the longest duration of action ?
A
Insulin degludec
( degLONGdec)
15
Q
Long-acting insulin with fatty acid side chain?
A
Insulin detemir
16
Q
HbA1c goal for patients with Type 2 DM?
A
< 7.0%
17
Q
Metabolic Syndrome Criteria? (5)
A
- Central obesity: waist circumference
- Male >102 cm
- Female >88cm - TG >/= 150 mg/ dL or use of specific medications
- HDL
Male: <40 mg/ dL
Female: <50 mg/ dL
Or use of specific medications - BP >/= 130 systolic or >/= 85 diastolic or use of specific medications
- Fasting blood glucose of >/= 100mg/dL or use of specific medications or previously diagnosed with Type 2 DM
18
Q
Microvascular complications of diabetes?
A
- Retinopathy
- Nephropathy
- Neuropathy
19
Q
Most common form of diabetic neuropathy?
A
Distal symmetric polyneuropathy
( stocking glove pattern)
20
Q
Diabetes drug associated with C- cell hyperplasia in rats?
A
GLP1 receptor agonist ( -glutide)
21
Q
SGLT2 Inhibitor associated with risk of lower limb amputation?
A
Canagliflozin
22
Q
DPP4 inhibitor associated with heart failure?
A
Saxagliptin
23
Q
Leading cause of non traumatic lower extremity amputation?
A
Diabetes Mellitus
24
Q
Most serious complication of therapy for diabetes mellitus?
A
Hypoglycemia
25
Symptoms usually present in DKA but are notably absent in HHS ? (3)
Nausea , Vomiting, Abdominal Pain
26
Most common cause of Cushing’s syndrome?
Iatrogenic
Medical use of glucocorticoids for immunosuppression
27
After exclusion of exogenous glucocorticoid use, the overwhelming majority of Cushings syndrome is due to ?
Cushings disease
( ACTH producing pituitary adenoma)
28
Most common cause of Cushings disease?
ACTH secreting Pituitary Adenoma
29
Treatment of choice for Cushings disease?
Transsphenoidal surgical resection
30
Laboratory test to distinguish between the differentials after diagnosing Cushings syndrome?
Plasma ACTH ( ACTH dependent vs independent)
31
Expected ACTH level in Cushings disease?
Normal to elevated
32
Expected ACTH level in Cushings syndrome due to adrenal adenoma?
Low
33
Hormone checked in blood to confirm the diagnosis of Cushing Syndrome?
Adrenocorticotropic hormone
34
Ectopic ACTH Syndrome ACTH level?
Elevated
35
ACTH level suggestive for Cushing’s syndrome?
Normal to mildly elevated
36
ACTH level Suggestive of primary hypercortisolism?
Undetectable or low
37
Cushings syndrome from ectopic ACTH production is predominantly caused by?
Carcinoid tumor( frequently in the lung)
38
Symptom more likely seen in Cushing’s syndrome due to ectopic ACTH production , in contrast to other causes?
Hyperpigmentation of the knuckles or skin areas exposed to friction
( stimulation of melanin production from the POMC Cleavage products)
39
Medical treatment of Cushing’s syndrome in pregnancy?
Metyrapone
40
Order of trophic hormone deficiency in pituitary tumor syndromes?
GH > FSH > LH > TSH > ACTH
41
Receptor for dopamine agonist
D2
42
Receptors for somatostatin receptor analogues?
SST2 and SST5
43
Only anabolic agent used for the treatment of osteoporosis?
Teriparatide
44
Monoclonal antibody of RANKL?
Denosumab
45
Rare adverse effects of biphosphonates ?
Atypical femoral fracture
Osteonecrosis of the jaw
46
DOC for Hypercalcemia in malignancy?
Zoledronic acid
47
Biphosphonates that can be used in GERD?
Zolendronic Acid (IV)
Pamidronate (IV)
48
Anti- hypercalcemic agent that provides analgesic effect in vertebral fractures?
Calcitonin
49
Anti-hypercalcemic agent associated with tachyphylaxis?
Calcitonin
50
Anti-hypercalcemic of choice in ESRD?
Denosumab
51
PTU associated vasculitis?
p-ANCA positive vasculitis
52
Drugs used to inhibit peripheral conversion of T4 to T3 ? (3)
1. PTU
2. Propranolol
3. Glucocorticoids
53
Drugs that decrease absorption of levothyroxine?
1. Aluminum containing antacids
2. Ferrous sulfate
3. Calcium carbonate
4. Sucralfate
54
Doubling the statin dose can decrease LDL-C by how much?
0.06
55
High intensity statins ?
Rosuvastatin 20-40mg
Atorvastatin 40-80mg ?
56
Channel blocked by ezetimibe?
NPC1L1
57
Only known drug that can increase HDL-C levels ?
Niacin
58
Major adverse effects of orlistat?
Steatorrhea , oily stools
59
Anti obesity drug with greatest amount of wt loss?
Phentermine / Topiramate
60
Most commonly performed bariatric surgery procedure?
Sleeve gastrectomy
61
Confirm the presence of nodule and assess the status of thyroid gland?
Thyroid ultrasound
62
Evaluate the physiologic function of thyroid nodules?
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
Detection of metastasis of thyroid cancer ?
Scintigraphy
64
51/F lost to follow up with her endocrinologist. Erratically taking Methimazole. Presents with acute onset of restlessness and agitation , confussion, vomiting and diarrhea.
Thyroid storm
65
Expected findings in thyroid storms?
1. Pyrexia
2. CNS alterations ( agitation, delirium, psychosis, seizure, coma)
3. GI dysfunction ( diarrhea, jaundice)
4. Tachycardia
5. CHF
66
Management of thyroid storm?
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
Local first test to determine in assessing thyroid function?
TSH
68
Test monitored to titrate antithyroid drug regimen after initiating treatment for thyrotoxicosis?
Unbound T4 ( TSH remain suppressed for months)
69
Laboratory test used to follow-up thyroid cancer patients to detect recurrence?
Serum thyroglobulin
70
Sign wherein venous distention over the neck , difficulty in breathing occur when raising the arms, due to large retrosternal goiter?
Pemberton’s Sign
71
Most common cause of thyrotoxicosis ?
Graves disease
72
Limited indications of PTU over Methimazole for the tx of thyrotoxicosis?
1. First trimester of pregnancy
2. Thyroid storm
3. Adverse reactions to Methimazole
73
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?
Agranulocytosis
74
Stable iodide can be given to block thyroid hormone synthesis due to this effect?
Wolff- Chaikoff Effect
