Endocrinology

Question 1

4 ways to diagnose diabetes?

Answer 1

1. Two fasting glucose >126
2. One random glucose >200 with symptoms
3. 2 hour 75g gtt > 140
4. HgbA1c > 6.4

Question 2

Metformin mechanism of action?

Answer 2

Bigaunide. Inhibits hepatic gluconeogenesis, decreases intestinal glucose absorption, increases insulin sensitivity

Question 3

2nd line agent for DM2 and what is their mechanism of action?

Answer 3

Sulfonylureas (glipizide, glimepiride, glyburide). Act by stimulating pancreatic islet beta-cell insulin release

Question 4

Adverse side effects of sulfonylureas?

Answer 4

Hypoglycemia, SIADH

Question 5

Dipeptidyl peptidas IV inhibitors. examples and MOA?

Answer 5

Sitagliptan and Saxagliptan. Blocks metabolism of incretis (such as glucagon like peptide)

Question 6

Thiazolidinediones. Examples and MOA?

Answer 6

Rosiglitazone, Pioglitazone. Act by increasing peripheral insulin sensitivity

Question 7

Which diabetes medication should be avoided in chf and why?

Answer 7

Thiazolidinediones. Because they can precipitate or worsen CHF.

Question 8

Alpha-glucosidase inhibitors. Examples and MOA?

Answer 8

Acarbose and Miglitol. Block absorption of glucose at intestinal lining.

Question 9

Side-effects of alpha-glucosidase inhibitors (acarbose)?

Answer 9

Since they inhibit glucose uptake at GI lining, will see bloating, distension, flatulance, diarrhea, abdominal pain.

Question 10

Insulin secretagogues. Examples and MOA?

Answer 10

Nateglinide and Repaglinide. act similar to sulfonylureas, stimulate insulin release. Risk of hypoglycemia

Question 11

Glucagon like peptides. Examples and MOA?

Answer 11

Exenatide. Increase insulin and decrease glucagon. They slow gastric emptying and promoted weight loss.

Question 12

Best initial test when suspecting DKA?

Answer 12

Serum bicarbonate

Question 13

Medical therapy for diabetic retinopathy refractory to laser photocoagulation?

Answer 13

VEGF innhibitors: Ranibizumab or Bevacizumab

Question 14

Treatment for diabetic gastroparesis?

Answer 14

Metoclopramide or erythromycin (erythromycin increases the release of “motilin” a promotility GI hormone

Question 15

Graves disease, radioactive iodine uptake increased or decreased? Treatment?

Answer 15

Increased

• Propylthiouracil (PTU) or methimazole acutely
• Then radioactive iodine to ablate the gland
• Propranolol for hyperthyroid symptoms (tremors, palpitations, etc)

Question 16

Silent thyroiditis clinical and lab/imaging findings?

Answer 16

non tender thyroid gland, no other physical exam findings. Normal radioactive iodine uptake, increased T3/T4 with low TSH. Thyroid peroxidase or antithyroglobulin antibodies may be present

Question 17

Subacute thyroiditis clinical and lab/imaging findings? Treatment?

Answer 17

Tender gland. radioactive iodine uptake low. T3/T4 high with low TSH. Can give aspirin for pain.

Question 18

Hyperthyroidism with elevated TSH. Diagnosis, management and treatment?

Answer 18

Pituitary adenoma. Next step get MRI of brain and remove adenoma.

Question 19

Management of thyroid storm?

Answer 19

Iodine - blocks uptake of iodine into thyroid gland
PTU or methimazole - blocks production of thyroxine
Dexamethasone - Blocks peripheral conversio of T3 to T4
Propranolol

Question 20

Most common cause of hypercalcemia?

Answer 20

Primary hyperparathyroidism

Question 21

Symptoms of hypercalcemia?

Answer 21

Kidney stones, osteopenia, ab pain/constipation, confusion

stones, bones, groans, psychiatric overtones

Question 22

Severe hypercalcemia EKG findings?

Answer 22

Short QT syndrome

Question 23

Treatment of acute severe hypercalcemia?

Answer 23

Fluids mainstay. Add furosemide to help with calcium excretion. Can add bisphosphonates or calcitonin

Question 24

Chvostek’s or Trousseau’s sign indicate?

Answer 24

Hypocalcemia

Question 25

3 sources of hypercortisolism causing cushings?

Answer 25

Pituitary tumor, Ectopic ACTH production, adrenal adenoma

Question 26

Cushings syndrome and positive dexamethasone suppression test. Diagnosis?

Answer 26

Pituitary tumor

Question 27

Workup for cushings syndrome?

Answer 27

ACTH level, dexamethasone suppression test and 24 hour urinary cortisol level

Question 28

Diagnostic test to evaluate for adrenal insufficiency (Addison's Disease)?

Answer 28

Cosyntropin (synthetic ACTH) stimulation test | CT of adrenals

Question 29

Example of a glucocorticoid and a mineralocorticoid?

Answer 29

Hydrocortisone - Glucorticoid | Fludrocortisone - Mineralocorticoid

Question 30

Difficult to control BP along with headache, palpitations, tremors, flushing. Suspicious for? What test to evaluate?

Answer 30

Pheochromocytoma Order urinary catecholamines, plasma-free metanephrine and VMA levels Get CT or MRI of adrenals

Question 31

Concern for metastatic pheochromocytoma, what test?

Answer 31

MIGB scan

Question 32

Treatment for pheochromocytoma?

Answer 32

1. Phenoxybenzamine (alpha blocker for BP) 2. Propranolol 3. Surgery

Question 33

Drugs that can cause elevated prolactin levels?

Answer 33

Metoclopramide, phenothiazines, TCAs. | Also always evaluate TSH. hypothyroidism can cause elevated prolactin as well

Question 34

Next diagnostic step after prolactin level found elevated?

Answer 34

MRI of brain

Question 35

Treatment of prolactinoma?

Answer 35

``` Dopamine agonists (Bromocriptine, cabergoline) Surgery if that doesn't work ```

Question 36

Best initial test to confirm diagnosis of acromegaly?

Answer 36

Insulinlike Growth Factor (IGF)

Question 37

Most accurate test for acromegaly?

Answer 37

Glucose induced GH suppression test

Question 38

Treatment for acromegaly?

Answer 38

- Transpheonidal surgical resection cures 70% - Octreotide (somatostatin) can prevent GH release - Dopamine agonists (Cabergoline, Bromocriptine)

Question 39

Girl presents with primary amenorrhea. Breasts present, but no cervix, tubes, or ovaries. Missing top third of vagina. Diagnosis?

Answer 39

Testicular Feminization a.k.a. Androgen insensitivity syndrome

Question 40

Tall man with XXY karyotype, sterile and elevated FSH and LH levels. Diagnosis?

Answer 40

Klinefelter's syndrome

Question 41

55 y/o with recently diagnosed diabetes and ring-shaped red area that blisters, erodes and crusts over, eventually starts clearing from center. Name of rash and underlying diagnosis?

Answer 41

Necrolytic migratory erythema. Evaluate for underlying glucagonoma.

Question 42

Asymptomatic adrenal mass noted incidentally on CT scanning. Labs to evaluate?

Answer 42

Dexamethasone suppression, ACTH, 24 hour urine cortisol, serum electrolytes, vanillylmandelic acid, plasma metanephrines, 17-ketosteroid

Question 43

Criteria for surgical excision of adrenal mass?

Answer 43

- Functional tumors - Malignant appearing on imaging - Size greater than 4 cm