Endocrinology Flashcards
1
Q
Most common 2nd messenger system
A
cAMP (e.g. glucagon)
2
Q
2nd messenger system of insulin
A
tyrosine kinase (also used by IGF-1, EPO)
3
Q
2nd messenger system of thyroid hormone
A
none (acts like steroids)
4
Q
Hormones derived from proopiomelanocortin (POMC)
A
MSH, ACTH, B-lipoprotein, B-endorphin
5
Q
Other name for growth hormone
A
somatotropin
6
Q
Other name for insulin-like growth factor 1 (IGF-1)
A
somatomedin
7
Q
Antagonizes prolactin
A
dopamine (and analogs like bromocriptine)
8
Q
Main site of ADH/vasopressin synthesis
A
supraoptic nuclei of the anterior hypothalamus
9
Q
Main site of oxytocin synthesis
A
paraventricular nuclei of the anterior hypothalamus
10
Q
Site of ADH and oxytocin storage and secretion
A
posterior pituitary
11
Q
Predominant form of thyroid hormone in the blood
A
T4
12
Q
Active form of thyroid hormone
A
T3
13
Q
3 parts of the adrenal cortex from outer to inner
A
Glomerulosa –> Fasciculata –> Reticularis (salty, sweet, sex)
14
Q
2 products of the adrenal medulla
A
epinephrine (80%), norepinephrine (20%)
15
Q
Increased adrenal androgens, decreased aldosterone, decreased cortisol
A
21-beta hydroxylase deficiency (virilizing)
16
Q
Increased aldosterone, decreased adrenal androgens, decreased cortisol
A
17-alpha hydroxylase deficiency (non-virilizing)
17
Q
Effect of insulin on potassium
A
increased uptake in muscles and adipose (decreased plasma K)
18
Q
Marker for endogenously produced insulin
A
c-peptide
19
Q
Responsible for tensile strength of the bone
A
collagen fibers (95% of organic amtrix)
20
Q
Responsible for compressional strength of the bone
A
bone salts
21
Q
Decreases calcium and phosphate excretion but increases urinary calcium, increases intestinal calcium absorption
A
vitamin D
22
Q
Decreases calcium excretion, increases phosphate excretion, increases 1-alpha hydroxylase, increases bone resorption
A
PTH
23
Q
Stimulated by LH, releases the “libido” hormone testosterone
A
Leydig cells (LLL: LH, Leydig, Libido)
24
Q
Stimulated by FSH, nurse cell for sperm
A
Sertoli Cells
25
Sperm formation
seminiferous tubules
26
Sperm motility
epididymis
27
Sperm storage
vas deferens
28
Production of fructose and prostaglandins for sperm
seminal vesicle
29
Semen alkalinity
prostate
30
Supplies mucus to semen for lubrication
Cowper's glands/bulbourethral glands
31
Main hormone for the follicular phase
estrogen
32
Main hormone for the luteal phase
progesterone
33
Causes ovulation
LH surge
34
Cells of the blastocyst that digests and liquefies the endometrium for invasion
trophoblast
35
Nutrient-rich endometrium invaded by trophoblast
decidua
36
B-HCG source
syncytiotrophoblast
37
Promotes growth fo the fetus, insulin resistance in the mon, lipolysis in the mother, index fo fetal well-being
human chorionic somatomammotropin (HCS), formerly known as human placental lactogen (HPL)
38
Prevents pregnancy during breastfeeding
prolactin inhibition of GnRH
39
Peak GH response to hypoglycemia of
adult growth hormone deficiency
40
Failure of GH suppression to
acromegaly
41
GH receptor antagonist via blocking peripheral GH binding to its receptor
pegvisomant
42
Pituitary corticotrope adenoma causes?
Cushing's disease (Cushing's syndrome is nonspecific to just increased cortisol)
43
Syndrome of abnormally large volumes of dilute urine (> 50 mL/kg 24-hr urine volume, urine osmolality
Diabetes Insipidus
44
Venous distention over the neck and difficulty breathing especially when the arms are raised
Pemberton's sign (large retrosternal goiter)
45
Rule of 10s in pheochromocytoma
10% bilateral, extra-adrenal, malignant, calcify, in children, familial
46
Rule of 1/3 in carcinoid syndrome
1/3 metastasize, present with 2nd malignancy, multiple
47
Screening for DM
age > 45 q3 years (screen earlier if BMI > 25 and with 1 risk factor for DM)
48
Corrected serum sodium regards to glucose administration
Add 1.6 meq for each 100 mg/dL rise in serum glucose
49
Microvascular manifestations of DM
retinopathy, neurophaty, nephropathy
50
Macrovascular manifestations of DM
coronary heart disease, peripheral arterial disease, cerebrovascular disease
51
Treatment for proliferative retinopathy
panretinal laser photocoagulation
52
Treatment for macular edema
focal laser photocoagulation
53
Microalbuminuria
30-299 mg/day in a 24-hr collection OR 30-299 ug/mg creatinine in a spot collection
54
Diabetic dermatopathy
pigmented pretibial papules aka diabetic skin spots
55
Normal ejaculate values
2-6 mL, sperm count > 20M/mL, motility > 50%, > 15% normal morphology
56
True gynecomastia value
glandular breast tissue > 4cm diameter
57
Infertility definition
inability to conceive after 12 months of unprotected sexual intercourse
58
Precocious puberty in boys age cutoff
development of secondary sexual characteristics before age 9
59
Delayed puberty in boys age cutoff
development of secondary sexual characteristics after age 14
60
Precocious puberty in girls age cutoff
development of secondary sexual characteristics before age 8
61
Delayed puberty in girls age cutoff
absence of secondary sexual characteristics by age 13
62
Cause of humoral hypercalcemia of malginancy
overproduction of PTH-related peptide (PTHrP) by cancer cells
63
Potent inhibitor of renal 1A-hydroxylase
fibroblast growth factor 23 (FGF-23), suppresses ability of kidneys to activate vitamin D and impairs calcium absorption
64
WHO definition of osteoporosis
Bone density with 2.5 standard eviations below the mean for young healthy adults of same sex
65
Diagnosis of osteoporosis
T score below -2.5 in lumbar spine, femoral neck or total hip
66
Monoclonal antibody to RANKL, used for osteoporosis
denosumab
67
Exogenous PTH analogue
teriparatide
68
Excessive urination due to insensitivity of renal tubules to ADH
nephrogenic Diabetes Insipidus
69
Excessive urination secondary to lack of ADH
central Diabetes Insipidus
70
Excess ADH causing excessive resorption of water in hyponatremia
SIADH
71
Most common cause of hypopituitarism in children associated with WNT signalling pathway
craniopharyngioma
72
Hypothyroidism in infancy or early childhood leads to?
cretinism
73
Tapping facial nerve induces contractions of the muscles of eye, mouth, or nose
Chvostek's sign (hypocalcemia)
74
Carpal spams produced by occlusion of the circulation to the forearm
Trosseau sign (hypocalcemia)
75
Most common functioning pituitary adenoma
prolactinoma
76
Second most common pituitary adenoma
somatotroph adenoma
77
Postpartum necrosis of anterior pituitary gland
Sheehan syndrome (presents with sudden cessation of lactation)
78
Sudden headache, diplopia, and hypopituitarism
Pituitary apoplexy
79
Papillary thyroid CA patho
Orphan Annie eye nuclei
80
Follicular thyroid CA patho
Hurthle cells, invades blood vessels
81
Medullary thyroid CA patho
C cells, MEN-associated
82
Apalstic thyroid CA patho
giant cells, spindle cells
83
Most common cause of hypothyroidism in iodine sufficient areas
Hashimoto's thyroiditis
84
Most common casue of hypothyroidism worldwide
iodine deficiency
85
Most common casue of painful thryroid gland; associated with viral infection
De Quervain
86
Condition where thyroid tissues are replaced by fibrous tissue
Reidel thyroiditis
87
Hyperthyroidism + ophthalmopathy + dermopathy = ?
Graves disease
88
Histologic finding of Grave's disease
diffuse thyroid hypertrophy and hyperplasia
89
Most common primary thyroid cancer
papillary thyroid CA
90
Diseases with Psammoma bodies
papillary thyroid CA, serous cystadenoma of ovaries, mesothelioma, meningioma
91
Most common cause of primary hyperparathyroidism
parathyroid adenoma
92
Osteoporosis
decreased bone mass
93
Osteopetrosis
thickened, dense bone
94
Osteomalacia/rickets
soft bones
95
Osteitis fibrosa cystica
"Brown tumors"
96
Paget's disease in bone
abnormal bone architecture
97
Hypertension with hypokalemia not controlled by monotherapy
hyperaldosteronism
98
Most common cause of primary hyperaldosteronism
idiopathic hyperaldosteronism
99
Adrenals are converted to sacs of clotted blood, obscuring all details
Waterhouse-Friderichsen syndrome (causes acute adrenal insufficiency)
100
Neoplams composed of chromaffin cells, which release catecholamines
pheochromocytoma
101
Trophic hormone failure associated with pituitary compression or destruction, occurs in what sequence of hormones?
GH > FSH > LH > TSH > ACTH (1st sign in childhood = growth retardation; in adults = hypogonadism)
102
ACTH reserve most reliably assessed by
ACTH and cortisol levels during insulin-induced hypoglycemia
103
Most common cause of pituitary hormone syndromes in adults
pituitary adenoma
104
Size of microadenoma
105
Mechanism which suprasellar extension can lead to bitemporal hemianopsia
compression of optic chiasm
106
Early sign of optic tract pressure
loss of red perception
107
Desired surgical approach for pituitary tumors
transsphenoidal surgery
108
Most common pituitary hormone hypersecretion syndrome
hyperprolactinemia
109
Hallmarks of hyperprolactinemia
amenorrhea, glactorrhea, infertility
110
Mainstay therapy for micro/macroprolactinemia
dopamine agonist (cabergoline and bromocriptine)
111
Most abundant anterior pituitary hormone
GH
112
Major source of circulating IGF-1
liver
113
Major determinant of hepatic IGF-1 synthesis
GH
114
GH excess causes most significant clinical impact on which system?
cardiovascular system
115
Screening measure when raising possibility of acromegaly
IGF-1 levels
116
Initial treatment for most patients with acromegaly
Surgical resection of GH secreting adenoma
117
Side effect of somatostatin analogues (used in acromegaly)
drug-induced suppression of GI motility and secretion
118
Accounts for 70% of patients with endogenous casues of Cushing's syndrome
pituitatry adenoma
119
Most common cause of Cushingoid features
iatrogenic hypercortisolism
120
Primary cause of death in Cushing's
cardiovascular disease
121
Precise screening test for Cushing's syndrome
24-hr urine free cortisol
122
Most common presenting feature of adult hypopituitarism
hypogonadism
123
What test differentiates central vs peripheral Diabetes Insipidus
Fluid deprivation test
124
Thyroid hormone synthesis normally begins at?
11 weeks AOG
125
Subunit unique to TSH
beta subunit (alpha subunit is common to FSH, LH, and hCG)
126
First step in thyroid hormone synthesis
iodide uptake
127
Most common cause of preventable mental deficiency
iodine deficiency
128
Method of choice in determining thyroid size accurately
ultrasound
129
1st test in thyroid testing, using a logical approach
TSH levels
130
Most common symptom of hypothyroidism
tiredness, weakness
131
Most common sign of hypothyroidism
dry coarse skin, cool extremities
132
Autoimmune hypothyroidism is primarily mediated by
CD8+ cytotoxic T cells
133
Major role in pathogenesis of myxedema coma, leading to hypoxia and hypercapnia
hypoventilation
134
Thyrotoxicosis via hyperthyroidism have what major etiologies?
Graves' disease, toxic multinodular goiter, toxic adenoma
135
Most common symptom of hyperthyroidism
hyperactivity, irritability, dysphoria
136
Most common sign of hyperthyrdoidism
tachycardia, atrial fibrillation in the elderly
137
Minor risk factor for Graves' disease
smoking
138
Major risk factor for Graves' ophthalmopathy
smoking
139
Most common cardiovascular manifestation of hyperthyroidism
sinus tachycardia
140
Earliest manifestations of Graves' ophthalmopathy
eye discomfort, grittiness and excess tearing
141
Most serious manfiestation of Graves' ophthalmopathy
compression of optic nerve at apex of the orbit
142
Most frequent site of thyroid dermopathy
pretibial myxedema
143
Time of major risk of relapse in Graves' disease in pregnancy
postpartum period
144
Prior to radioiodine therapy, carbimazole or methimazole should be stopped when?
2 days before
145
Prior to radioiodine therapy, PTU should be stopped when?
several weeks before (sorry several talaga nakasulat)
146
Absolute contraindications to radioiodine
pregnancy and breastfeeding
147
Most common clinically apparent cause of chronic thyroiditis
Hashimoto's thyroiditis
148
Major cause of sick euthyroid syndrome
relase of cytokines
149
Clinical manifestations of most goiters
asymptomatic
150
Most common malignancy of the endocrine system
thyroid CA
151
More common thyroid CA in iodine-deficient regions
follicular thyroid CA
152
Preferable treatment in almost all patients with well-differentiated cancer
near-total thyroidectomy
153
Mainstay of thyroid cancer treatment
levothyroxine suppression of TSH
154
Most common type of thyroid lymphoma
diffuse large-cell lymphoma
155
Provides a marker of residual or recurrent medullary thyroid CA
elevated serum calcitonin
156
Primary management of medullary thyroid CA
surgical
157
Size of most palpable thyroid nodules
> 1 cm
158
Most common cause of Cushing's syndrome overall
medical use of glucocorticoids
159
Ectopic ACTH production is predominantly caused by
occult carcinoid tumors, most frequently lung
160
Source of ACTH-independent cortisol excess in majority
cortisol-producing adrenal adenoma
161
Most prominent features in Cushing's are caused by
upregulation of gluconeogenesis, lipolysis and protein catabolism
162
Most important first step in management of suspected Cushing's syndrome
extablish the correct diagnosis
163
Investigation of choice in ACTH-dependent cortisol excess
MRI fo the pituitary
164
Oral agents with established efficacy in Cushing's syndrome
metyrapone and ketoconazole
165
Most common cause of mineralocorticoid excess
primary hyperaldosteronism (Conn's syndrome)
166
Clinical hallmark of mineralocorticoid excess
hypokalemic hypertension
167
accepted screening test for primary hyperaldosteronism
concurrent measurement of plasma renin and aldosterone with calculation of aldosterone-renin ratio
168
Most straightforward test for primary hyperaldosterism
saline infusion test
169
Method of choice for adrenal imaging in hyperaldosteronism
fine-cut CT scan of adrenal region
170
Preferred appraoch for unilateral lesions in hyperaldosteronism
laparoscopic adrenalectomy
171
Medical management for hyperaldosteronism consists primarily of
spirinolactone
172
Most common cause of a malignant adrenal mass
metastatsis (from breast and lung)
173
Highly sensitive for detection of malignancy that may not be obvious on CT scan
18-FDG PET scan
174
Metastasis in adrenocortical carcinoma most frequently occurs to
liver and lungs
175
Most frequent origin of adrenal insufficiency
hypothalamic-pituitary
176
Most common cause of primary adrenal insufficiency
autoimmune adrenalitis
177
Distinguishing feature of primary adrenal insufficiency
hyperpigmentation
178
Characteristic feature of primary adrenal insufficiency (80%)
hyponatremia
179
Most prevalent cause of CAH (90-95% of causes)
CYP21A2 mutation (21-hydroxylase deficiency)
180
Marker for overtreatment of CAH
17-hydroxyprogesterone (17OHP)
181
Classic triad of pheochromocytoma
palpitations, headaches, profuse sweating
182
Dominant sign of pheochromocytoma
hypertension
183
Traditionally the 1st step in diagnosing pheochromocytoma
measure catecholamines
184
Cornerstone for diagnosing pheochromocytoma
elevated plasma and urinary catecholamines
185
Initial testing for pheochromocytoma
urinary test for VMA, metanephrine, catecholamines
186
Ultimate goal for pheochromocytoma
complete tumor removal
187
Before surgery for pheochromocytoma, BP should be
consistently below 160/90
188
Surgery of choice for pheochromocytoma
atraumatic endoscopic surgery
189
FIRST described pheochromocytoma-associated syndrome
neurofibromatosis type 1 (NF 1)
190
BEST KNOWN pheochromocytoma-associated syndrome
MEN 2A, MEN 2B
191
Leading causes of ESRD, nontraumatic lower extremity amputations and adult blindness
DM
192
Differentiate type 1a and 1b DM
1a is autoimmune, b is non-autoimmune destruction of Beta cells
193
Most reliable and convenient test for identifying DM in asymptomatics
HbA1C or FBS
194
Key regulator of insuling secretion
glucose
195
Glucose levels that stimulate insulin synthesis
glucose > 70 mg/dL (3.9 mmol/L)
196
Rate-limiting step that controls glucose-regulated insulin secretion
glucokinase (liver; higher Km; lower afinity, higher Vmax) and hexokinase (everywhere else; lower Km; higher affinity, lower Vmax)
197
Most potent incretin
glucagon-like peptide 1 (GLP-1)
198
Major portion of postprandial glucose is utilized by
skeletal muscle
199
Features of DM become evident when this % of Beta cells are destroyed
~80% destroyed
200
Major susceptibility gene in T1DM
HLA region on chromosome 6
201
Central to the development of T2DM
insulin resistance and abnormal insulin secretion
202
Predominantly accounts for increased FBS levels
increased hepatic glucose output
203
Results in postprandial hyperglycemia
decreased peripheral glucose usage
204
Classic signs of DKA
Kussmaul respirations and fruity odor (increased acetone and metabolic acidosis)
205
3 ketone bodies
acetone, acetoacetate, beta-hydroxybutyrate
206
Extremely serious complication of DKA, seen most frequently in children
cerebral edema
207
Conditions necessary for DKA to develop
both insulin deficiency and glucagon excess
208
Consistent finding in DKA (distinguishes from simple hyperglycemia)
ketonemia
209
Drug that causes false-positive reaction on nitroprusside tablet test for DKA
captopril or penicillamine
210
Central to successful treatment of DKA
monitoring and frequent reassessment for improvement
211
Potassium level in which you may start insulin in DKA
serum K
212
Underlying cause of hyperglycemic hyperosmotic state
relative insulin inefficiency and inadequate fluid intake
213
Leading casue of blindness between ages 20 and 74
DM
214
Hallmark of proliferative diabetic retinopathy
neovascularization in response to retinal hypoxia
215
Non-proliferative diabetic retinopathy is marked by
retinal vascular microaneurysms, blot hemorrhages and cotton wool spots
216
Best predictor of development of retinopathy
duration of DM and degree of glycemic control
217
Non-proliferative diabetic retinopathy is found in almost all with x years of DM?
DM > 20 years
218
Most effective therapy for DM retinopathy
prevention
219
Fibrin caps, capsular drops, Kimmelsteil-Wilson nodules
DM nephropathy (nodular glomerulosclerosis)
220
Optimal therapy for DM nephropathy
prevention via control of glycemia
221
Preferred therapy for DM nephropathy
renal transpalnt
222
Most common form of DM neuropathy
distal symmetric polyneuropathy
223
Most commonly involved nerve in DM mononeuropathy
CN III- heralded by diplopia
224
Most prominent GI symptoms in DM
delayed gastric emptying, altered small- and large-bowel motility
225
Primary goal in GI and GU dysfunction in DM
improved glycemic control
226
Most common pattern of dyslipidemia in Dm
hypertriglyceridemia and reduced HDL
227
Drug that effectively raises HDL, but high doses (> 2 g/d) may worsen glycemic control
niacin/nicotinic acid
228
Most common site of foot ulcers
great toe or metatarsophalangeal areas
229
Optimal therapy for foot ulcers and amputation
prevention
230
Most common site of ulceration in DM
plantar surface of foot
231
Most helpful diagnostic for infected foot ulcer
culture of debrided ulcer base/purulent drainage/wound aspirate
232
Most specific modality for osteomyelities in DM
MRI of foot
233
Common denominator in DM infections
poor glycemic control
234
Most common skin manifestation in DM
protracted wound healing and skin ulcerations
235
Considered hypertension in DM
BP > 130/80
236
Confirms a patient's need for insulin
low c-peptide levels
237
Symptoms of DM usually resolve in what glucose level?
238
Primary goal of treatment in DM is what HbA1c level?
HbA1c
239
Recommendations on exercise in Dm
150 min/week distributed over at elast 3 days of moderate aerobic physical activity
240
Standard of care in DM management
self-monitoring blood glucose
241
Standard method for long-term glycemic control
HbA1c
242
Primary predictor of long-term compliance in DM
HbA1c
243
Can be used as an alternative indicator of glycemic control when HbA1c is inaccurate (hemolytic anemia, hemoglobinopathies)
albumin
244
Major toxicity of metformin
lactic acidosis
245
Major side effects of GLP-1 agonist
nausea, vomiting, diarrhea
246
Major side effects of alpha-glucosidase inhibitors
diarrhea, flatulence, abdominal distention
247
Most serious complication of therapy for Dm
hypoglycemia
248
Preferred in ICU/unstable settings for DM
IV insulin infusion (SC insulin absorption is variable)
249
Preferred over insulin analogue for IV insulin infusion
regular insulin (less expensive and equally effective)
250
Pregnancy issues- most crucial period of glycemic control in pregnancy
soon after fertilization
251
Whipple's triad
symptoms of hypoglycemia, low plasma glucose via precise method (not a glucose monitor) and relief of symptoms after glucose is raised
252
Lower limit of the fasting plasma glucose concentration
70 mg/dL (3.9 mmol/L)
253
Obligate metabolic fuel for the brain under physiologic conditions
glucose (ketones in prolonged fasting > 2 weeks)
254
Hepatic glycogen stores are usually sufficient to maintain glucose levels for how long?
8-12 hrs
255
Primary glucose regulatory factor (1st defense against hypoglycemia)
decrease insulin
256
Primary glucose counterregulatory factor (2nd defense against hypoglycemia)
increase glucagon
257
3rd defense against hypoglycemia
increase epinephrine
258
Limiting factor in the glycemic management of DM
hypoglycemia
259
In hospitalized patients, glycemic maintenance goals have been modified to fall between
140-180 mg/dL
260
Second only to drugs as causes of hypoglycemia
serious illnesses (renal, hepatic, cardiac failure, sepsis, inanition)
261
Major site of endogenous glucose production
liver
262
Hypoglycemia in non-beta cell tumors
Overproduction of insulin-like growth factor II ("big IGF-II")
263
Prototypical cause of endogenous hyperinsulinism
insulinoma
264
Ingestion of an insulin secretagogue in relation to c-peptide levels
causes hypoglycemia with increased c-peptide levels
265
Exogenous insulin in relation to c-peptide levels
causes hypoglycemia with low c-peptide levels
266
Emerging as method of choice for testosterone measurement
liquid chromatography tandem mass spectrometry (LC-MS/MS)
267
Most important step in the evaluation of male infertility
semen analysis
268
Most common cause of androgen deficiency in acute illness
hypogonadotropic hypogonadism
269
Most common chromosomal disorder associated with testicular dysfunction and male infertility
Klinefelter syndrome (47 XXY)
270
Most effective therapy if gynecomastia is of long duration
surgery
271
Most common cause of female infertility
abnormalities in menstruation
272
Most widely used form of hormonal contraception
oral contraceptives
273
Primary regulator of calcium physiology
PTH, from chief cells of parathyroid
274
Primary function of PTH
maintain ECF calcium concentration
275
90% of all cases of hypercalcemia
hyperparathyroidism and cancer
276
Second most common cause of hypercalcemia in the adult
malignancy
277
Serum Ca levels for hypercalcemia symptoms (bones, groans, overtones, moans)
calcium > 11.5-12 mg/dL (> 2.9-3.0 mmol/L)
278
Serum Ca levels for severe hypercalcemia and medical emergency
Ca 15-18 mg/dL (3.7-4.5 mmol/L)
279
Parathyroid tumors are most often encountered in
isolated adenomas
280
Parathyroid adenomas are most often located in which parathyroid glands
inferior parathyroid glands
281
Predominant in both hyperplasia and adenoma of the parathyroid gland
chief cells
282
Hyperparathyroidism manifestations primarily involve which systems?
kidneys and skeletal system
283
Most prevalent form of hyperparathyroidism
asymptomatic hyperparathyroidism
284
Definitive therapy for hyperparathyroidism
surgical excision of the abnormal parathyroid tissue
285
Responsible agent in most solid tumors that cause hypercalcemia
PTHrP (in squamous cell lung CA, renal cell CA)
286
Striking feature of malignancy-associated hypercalcemia
rapidity in course
287
First principle of treatment of hypercalcemia
restore normal hydration
288
Treatment of choice for severe hypercalcemia complicated by renal failure
dialysis
289
Most frequent cause of acquired hypoparathyroidism in the past
surgery for hyperthyroidism
290
Currently the most frequent cause of acquired hypoparathyroidism
surgery for hyperparathyroidism
291
Chief clinical manifestations of osteoporosis
vertebral and hip fractures
292
Final common path in osteoclast development and activation
activation of RANK by RANKL
293
Age range after which resorption exceeds formation of calcium
after age 30-45
294
Most common estrogen-deficient state
menopause
295
Most common early consequence of estrogen deficiency
vertebral fractures
296
Most common cause of medication-induced osteoporosis
glucocorticoids
297
Standard for measuring bone density
Dual Energy X-Ray Absorptiometry (DEXA or DXA)
298
Preferred DXA sites of measurements
lumbar spine and hip
299
Can falsely increase bone density of the spine esp in the elderly
bone spurs
300
Guidelines further recommend that bone mass measurement be considered in
ALL women by age 65 (exact phrase of Q&A)
301
Preferred source of calcium
dairy products and other foods
302
Calcium carbonate requirements
best taken with food (require acid for solubility)
303
Primary therapeutic agent for prevention or treatment of osteoporosis
estrogen treatment
304
Approved for the prevention and treatment of breast cancer
tamoxifen (increased risk of uterine cancer in postmenopausal)
305
Osteonecrosis of the jaw in patients with cancer comes from being given high doses of
zoledronic acid or pmidronate
306
More severely affected bone in glucocorticoid-induced osteoporosis
trabecular bone (more than cortical bone)
307
Duration of steroids to have bone mass measurement via DEXA
> 3 months glucocorticoid therapy
308
If only one skeletal site can be measured for DEXA, where is it best taken?
spine in 60 years
309
Demonstrated to reduce the risk of fractures in patients being treated with glucocorticoids
only bisphosphonates
