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Endocrinology Flashcards

1
Q

What primarily causes eruptive xanthomatosis?

A

Severe hypertriglyceridemia.

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2
Q

What random plasma glucose level is diagnostic for diabetes?

A

A random plasma glucose greater than 200 mg/dL (11.1 mmol/L).

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3
Q

What are common adverse effects of thiazolidinediones (glitazones)?

A

Weight gain, heart failure, macular edema, osteoporosis, bladder cancer.

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4
Q

What glucose range indicates prediabetes after a 2 hr 75 g OGTT?

A

140 to 199 mg/dL.

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5
Q

When should diabetes screening occur during pregnancy?

A

Between 24 and 28 weeks gestation unless overt symptoms are present before this.

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6
Q

What does monitoring blood glucose levels 1-2 hrs after food consumption assess?

A

Prandial insulin coverage in patients with good preprandial readings but with poor HbA1c.

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7
Q

Do osteoporotic fractures commonly happen when patients are only in the osteopenic range?

A

True.

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8
Q

What characterizes eruptive xanthomatosis?

A

The appearance of reddish-yellow papular skin lesions on an erythematous base concentrated mainly on extensor surfaces of the extremities.

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9
Q

What glucose values indicate gestational diabetes mellitus?

A

Fasting glucose >92 mg/dL, 1 hour glucose >180 mg/dL, 2 hours glucose >153 mg/dL.

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10
Q

What is the relationship between OSA and testosterone in males?

A

OSA can be associated with low testosterone in males due to increased fat tissue, potentially leading to signs such as low libido, poor erection, and smaller testicles.

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11
Q

What are common adverse effects of biguanides such as metformin?

A

Diarrhea, abdominal pain, lactic acidosis.

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12
Q

What fasting plasma glucose level is diagnostic for diabetes?

A

Greater than 126 mg/dL.

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13
Q

What is the onset of action for regular/short acting insulin?

A

Roughly 30 minutes with a peak effect of 2-3 hours and post-injection duration of 3-6 hours.

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14
Q

When are fingerstick glucose measurements performed in diabetes management?

A

Premeal, bedtime, pre and post exercise, symptoms of hypo or hyperglycemia, and before important activities such as flying.

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15
Q

What is the appropriate response for the honeymoon phase of diabetes?

A

Reduction of basal and prandial insulin.

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16
Q

What does insulin cause to shift intracellularly?

A

Magnesium (Mg).

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17
Q

What are SGLT-2 inhibitors recommended for?

A

Many patients with chronic kidney disease (CKD), particularly those with CKD caused by diabetes and those with proteinuria.

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18
Q

What is the first-line noninsulin pharmacologic treatment for diabetes in patients with kidney disease and an eGFR <20 mL/min/1.73 m2?

A

A glucagon-like peptide-1 receptor agonist other than exenatide.

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19
Q

What is the onset of action for intermediate acting insulin such as NPH?

A

2-4 hours with a post-injection duration of 12-18 hours.

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20
Q

What is the classic triad of hyperglycemia symptoms?

A

Polyuria, polyphagia, and polydipsia.

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21
Q

What is the normal HbA1c range?

A

4 to 5.6.

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22
Q

What autoantibodies are diagnostic for type 1 diabetes?

A

Autoantibodies to GAD56 and IA-2.

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23
Q

What are the main classes of diabetes medications that do not cause hypoglycemia?

A

Biguanides (metformin), sodium-glucose cotransporter-2 inhibitors (canagliflozin), GLP-1 receptor agonists (exenatide), thiazolidinediones (pioglitazone), and DPP4 inhibitors (sitagliptin).

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24
Q

What is the most common adverse effect of alpha-glucosidase inhibitors such as acarbose?

A

Abdominal discomfort.

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25
What does the American Diabetes Association recommend metformin for?
Patients with impaired glucose tolerance, impaired fasting glucose values, and HbA1c: 5.7% - 6.4%.
26
What occurs in DKA due to lack of insulin?
No insulin is available to suppress lipolysis, resulting in ketone formation and acidosis.
27
What is the risk associated with sulfonylureas?
Hypoglycemia, particularly problematic in patients with advanced CKD.
28
What is the treatment for pathologic fracture with normal vitamin D?
IV Bisphosphonates.
29
What is the onset of action for long-acting insulin such as determir or glargine?
Lasts for 24 hours and its onset takes several hours.
30
What is the onset of hyperosmolar hyperglycemic state?
Typically has a prolonged onset.
31
What should be avoided in kidney disease?
Alpha-glucosidase inhibitors such as acarbose.
32
What may be particularly problematic in patients with advanced CKD?
Diabetes management may be particularly problematic in patients with advanced CKD.
33
When are fingerstick glucose measurements performed frequently in diabetes management?
Fingerstick glucose measurements are performed frequently in diabetes management for: - Premeal - Bedtime - Pre and post exercise - Symptoms of hypo or hyperglycemia - Before important activities such as flying
34
What is the onset time for rapid acting insulin?
The onset of rapid acting insulin is roughly 10 to 15 minutes.
35
What is the post-injection duration for insulin glulisine?
The post-injection duration for insulin glulisine is roughly 2-4 hours.
36
What are the main side effects of sulfonylureas?
The main side effects of sulfonylureas are hypoglycemia, weight gain, and rash.
37
What are the main classes of diabetes medications that do not cause hypoglycemia?
The main classes of diabetes medications that do not cause hypoglycemia are: - Biguanides (metformin) - Sodium-glucose cotransporter-2 inhibitors (canagliflozin) - GLP-1 receptor agonists (exenatide) - Thiazolidinediones (pioglitazone) - DPP4 inhibitors (sitagliptin)
38
What should a nonelderly woman with multiple vertebral compression fractures be evaluated for?
A nonelderly woman with multiple vertebral compression fractures, weight gain, and fatigue should be evaluated for secondary causes of osteoporosis, including Cushing syndrome.
39
What is the diagnostic range for fasting plasma glucose for prediabetes?
A fasting plasma glucose ranging from 100-125 mg/dL is diagnostic for prediabetes.
40
What is the most appropriate test to diagnose gestational diabetes?
The most appropriate test to diagnose gestational diabetes is the oral glucose tolerance test.
41
What is the onset of action for intermediate acting insulin such as NPH?
The onset of action for intermediate acting insulin such as NPH is 2-4 hours.
42
What are common adverse effects of biguanides such as metformin?
Common adverse effects of biguanides such as metformin include diarrhea, abdominal pain, and lactic acidosis.
43
What is the first-line noninsulin pharmacologic treatment for diabetes in a patient with kidney disease and eGFR <20 mL/min/1.73 m²?
The first-line noninsulin pharmacologic treatment for diabetes in such a patient is a glucagon-like peptide-1 receptor agonist other than exenatide.
44
What is the prediabetic HbA1c range?
The prediabetic HbA1c range is 5.7 to 6.4.
45
What is the best timing for evaluation of Cushing syndrome in a hospitalized patient?
The best timing for evaluation of Cushing syndrome in a hospitalized patient is after discharge and recovery from the stress of hospitalization.
46
What are common adverse effects of thiazolidinediones (glitazones)?
Common adverse effects of thiazolidinediones (glitazones) include weight gain, heart failure, macular edema, osteoporosis, and bladder cancer.
47
What is the onset of action for regular/short acting insulin?
The onset of action for regular/short acting insulin is roughly 30 minutes.
48
What are classic hyperglycemic symptoms plus a random plasma glucose diagnostic for?
Classic hyperglycemic symptoms plus a random plasma glucose greater than 200 mg/dL (11.1 mmol/L) are diagnostic for diabetes.
49
What describes the 'honeymoon phase' in diabetes treatment?
The honeymoon phase describes a diabetic patient that just began treatment with insulin whose body is responding to hypoglycemia with increased insulin production resulting in further hypoglycemia.
50
What is the effect of insulin on phosphate levels?
Insulin causes phosphate to shift intracellularly.
51
What is associated with prolonged bisphosphonate use (>5–10 years)?
Development of atypical fractures
52
Where do atypical fractures usually occur in patients using bisphosphonates?
Below the trochanter or within the femoral shaft
53
What type of trauma is typically associated with atypical fractures from bisphosphonate use ?
Minimal or no trauma
54
What symptoms may patients present with before an atypical fracture from bisphosphonate use occurs?
Prodromal pain, such as groin or thigh pain
55
How are atypical fractures due to prolonged bisphosphonate use characterized radiologically?
Transverse, noncomminuted fracture with cortical hypertrophy and a medial spike
56
What are the typical fractures that are caused by prolonged bisphosphonate use?
Chalkstick fractures
57
A patient’s bone mineral density (BMD) may have been overestimated because of the presence of osteoarthritis (T/F)
A patient’s bone mineral density (BMD) may have been overestimated because of the presence of osteoarthritis (T)
58
What T score indicates a diagnosis of osteoporosis in the absence of vertebral fracture?
−2.5 or lower
59
What is the purpose of obtaining spine radiographs in osteoporosis diagnosis?
To select patients for bisphosphonate therapy by searching for atraumatic fractures
60
True or False: Vertebral fractures can be treated with bisphosphonate therapy regardless of whether they are symptomatic.
False
61
Fill in the blank: A diagnosis of osteoporosis can be made if the T score is _______.
−2.5 or lower
62
What is the treatment focus when diagnosing asymptomatic vertebral fractures?
Selecting patients for bisphosphonate therapy
63
What is the goal level for 25-hydroxyvitamin D in fragility fracture workup?
At least 30 ng/dL
64
What laboratory findings in a cmp can support a diagnosis of vitamin D deficiency?
High alkaline phosphatase level and slightly low calcium and phosphorus levels
65
What is the initial treatment for vitamin D deficiency in osteoporosis patients?
Repletion of vitamin D (either by loading or daily dose depending on the degree of deficiency
66
To what level should vitamin D be repleted in treatment?
30 ng/dL or higher
67
What is the initial treatment for a patient with vitamin D deficiency and osteoporosis?
The repletion of vitamin D, followed by a bisphosphonate.
68
When might patients with chronic adrenal insufficiency need to increase their glucocorticoid dose?
During infection, fever, surgery, or trauma.
69
By how much should patients increase their glucocorticoid dose when ill?
Usually to two or three times the usual dose for 2 or 3 days.
70
What should patients with chronic adrenal insufficiency carry for emergencies?
An emergency kit of injectable hydrocortisone.
71
What is the most appropriate emergency treatment for adrenal crisis?
A 100-mg bolus of intravenous hydrocortisone.
72
What is an alternative treatment to hydrocortisone for adrenal crisis?
Intravenous dexamethasone at a dose equivalent to 100 mg of hydrocortisone (about 4 mg).
73
What action does dexamethasone lack compared to hydrocortisone?
Mineralocorticoid action.
74
Fill in the blank: Patients experiencing an adrenal crisis may develop _______.
hypotension, hyperpyrexia, and shock.
75
What are some symptoms of antiretroviral-associated lipodystrophy?
* Weight gain * Truncal obesity * Peripheral wasting * Dorsocervical fat deposition ## Footnote These symptoms can mimic Cushing syndrome.
76
Which class of medications is most commonly associated with antiretroviral-associated lipodystrophy?
Protease inhibitors ## Footnote An example is saquinavir.
77
Which nucleoside reverse-transcriptase inhibitor may contribute to lipodystrophy?
Zidovudine ## Footnote It is particularly associated with lipoatrophy of the face and limbs.
78
What physical condition is often complained from male patients with lipodystrophy?
Gynecomastia ## Footnote This condition is characterized by enlarged breast tissue in males.
79
What are the increased risks associated with antiretroviral-associated lipodystrophy?
* Heart disease * Insulin resistance * Hyperlipidemia ## Footnote These risks highlight the metabolic complications of the syndrome.
80
True or False: Antiretroviral-associated lipodystrophy can mimic Cushing syndrome.
True ## Footnote Symptoms overlap with those seen in Cushing syndrome.
81
What is frequently used as a screening test for pheochromocytoma and paraganglioma?
Measurement of plasma metanephrine levels ## Footnote Pheochromocytoma is a tumor of the adrenal gland, while paraganglioma refers to tumors that arise from extra-adrenal sites.
82
What is the specificity range for plasma metanephrine levels?
85% to 89% ## Footnote Specificity indicates the test's ability to correctly identify those without the disease.
83
What is the specificity range for 24-hour urine metanephrine levels?
91% to 98% ## Footnote This indicates a higher reliability compared to plasma metanephrine levels.
84
What are common causes of false-positive results in plasma metanephrine testing?
* Use of psychoactive substances * Use of adrenergic-receptor agonists ## Footnote Psychoactive substances include medications like venlafaxine and tricyclic antidepressants.
85
What effect do decongestants and amphetamines have on metanephrine levels?
They increase both metanephrine and normetanephrine levels ## Footnote These substances can lead to misleading test results.
86
What specific medication is mentioned as causing an asymptomatic increase in normetanephrine?
Venlafaxine ## Footnote This increase can lead to false-positive results in testing.
87
What should be done if the suspicion for pheochromocytoma is sufficiently high while on venlafaxine and metanephrines are increased?
Repeat the measurement after switching to an alternative antidepressant ## Footnote This can help to clarify the diagnosis by eliminating the influence of medications causing false positives.
88
What is a hallmark of Cushing syndrome in adrenocortical carcinoma ?
Rapid worsening or new onset of hypertension, hyperglycemia, and weight gain ## Footnote These symptoms are indicative of hypercortisolism.
89
How does symptom onset differ between adrenocortical carcinoma and other presentations of Cushing syndrome?
Symptom onset is often more rapid in patients with adrenocortical carcinoma ## Footnote This contrasts with other presentations of Cushing syndrome.
90
What can cause symptoms in Cushing syndrome in adrenocortical carcinoma apart from hypercortisolism?
Local effects of the primary tumor or by metastatic spread ## Footnote Symptoms may not solely be due to hypercortisolism.
91
What are the characteristics of adrenal lesions in adrenocortical carcinoma?
Large in size (> 4 cm), heterogeneous, with irregular borders and calcifications ## Footnote These characteristics can be visualized on CT.
92
How can very high levels of cortisol in Cushing syndrome, especially caused by adrenocortical carcinoma, affect potassium levels?
They can cause hypokalemia ## Footnote This occurs through activation of the mineralocorticoid receptor.

Internal Medicine (30 decks)

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