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IM Board Correlates > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Most common 2nd messenger system

A

cAMP (e.g. glucagon)

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2
Q

2nd messenger system of insulin

A

tyrosine kinase (also used by IGF-1, EPO)

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3
Q

2nd messenger system of thyroid hormone

A

none (acts like steroids)

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4
Q

Hormones derived from proopiomelanocortin (POMC)

A

MSH, ACTH, B-lipoprotein, B-endorphin

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5
Q

Other name for growth hormone

A

somatotropin

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6
Q

Other name for insulin-like growth factor 1 (IGF-1)

A

somatomedin

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7
Q

Antagonizes prolactin

A

dopamine (and analogs like bromocriptine)

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8
Q

Main site of ADH/vasopressin synthesis

A

supraoptic nuclei of the anterior hypothalamus

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9
Q

Main site of oxytocin synthesis

A

paraventricular nuclei of the anterior hypothalamus

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10
Q

Site of ADH and oxytocin storage and secretion

A

posterior pituitary

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11
Q

Predominant form of thyroid hormone in the blood

A

T4

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12
Q

Active form of thyroid hormone

A

T3

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13
Q

3 parts of the adrenal cortex from outer to inner

A

Glomerulosa –> Fasciculata –> Reticularis (salty, sweet, sex)

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14
Q

2 products of the adrenal medulla

A

epinephrine (80%), norepinephrine (20%)

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15
Q

Increased adrenal androgens, decreased aldosterone, decreased cortisol

A

21-beta hydroxylase deficiency (virilizing)

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16
Q

Increased aldosterone, decreased adrenal androgens, decreased cortisol

A

17-alpha hydroxylase deficiency (non-virilizing)

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17
Q

Effect of insulin on potassium

A

increased uptake in muscles and adipose (decreased plasma K)

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18
Q

Marker for endogenously produced insulin

A

c-peptide

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19
Q

Responsible for tensile strength of the bone

A

collagen fibers (95% of organic amtrix)

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20
Q

Responsible for compressional strength of the bone

A

bone salts

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21
Q

Decreases calcium and phosphate excretion but increases urinary calcium, increases intestinal calcium absorption

A

vitamin D

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22
Q

Decreases calcium excretion, increases phosphate excretion, increases 1-alpha hydroxylase, increases bone resorption

A

PTH

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23
Q

Stimulated by LH, releases the “libido” hormone testosterone

A

Leydig cells (LLL: LH, Leydig, Libido)

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24
Q

Stimulated by FSH, nurse cell for sperm

A

Sertoli Cells

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25
Q

Sperm formation

A

seminiferous tubules

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26
Q

Sperm motility

A

epididymis

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27
Q

Sperm storage

A

vas deferens

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28
Q

Production of fructose and prostaglandins for sperm

A

seminal vesicle

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29
Q

Semen alkalinity

A

prostate

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30
Q

Supplies mucus to semen for lubrication

A

Cowper’s glands/bulbourethral glands

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31
Q

Main hormone for the follicular phase

A

estrogen

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32
Q

Main hormone for the luteal phase

A

progesterone

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33
Q

Causes ovulation

A

LH surge

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34
Q

Cells of the blastocyst that digests and liquefies the endometrium for invasion

A

trophoblast

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35
Q

Nutrient-rich endometrium invaded by trophoblast

A

decidua

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36
Q

B-HCG source

A

syncytiotrophoblast

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37
Q

Promotes growth fo the fetus, insulin resistance in the mon, lipolysis in the mother, index fo fetal well-being

A

human chorionic somatomammotropin (HCS), formerly known as human placental lactogen (HPL)

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38
Q

Prevents pregnancy during breastfeeding

A

prolactin inhibition of GnRH

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39
Q

Peak GH response to hypoglycemia of

A

adult growth hormone deficiency

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40
Q

Failure of GH suppression to

A

acromegaly

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41
Q

GH receptor antagonist via blocking peripheral GH binding to its receptor

A

pegvisomant

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42
Q

Pituitary corticotrope adenoma causes?

A

Cushing’s disease (Cushing’s syndrome is nonspecific to just increased cortisol)

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43
Q

Syndrome of abnormally large volumes of dilute urine (> 50 mL/kg 24-hr urine volume, urine osmolality

A

Diabetes Insipidus

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44
Q

Venous distention over the neck and difficulty breathing especially when the arms are raised

A

Pemberton’s sign (large retrosternal goiter)

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45
Q

Rule of 10s in pheochromocytoma

A

10% bilateral, extra-adrenal, malignant, calcify, in children, familial

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46
Q

Rule of 1/3 in carcinoid syndrome

A

1/3 metastasize, present with 2nd malignancy, multiple

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47
Q

Screening for DM

A

age > 45 q3 years (screen earlier if BMI > 25 and with 1 risk factor for DM)

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48
Q

Corrected serum sodium regards to glucose administration

A

Add 1.6 meq for each 100 mg/dL rise in serum glucose

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49
Q

Microvascular manifestations of DM

A

retinopathy, neurophaty, nephropathy

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50
Q

Macrovascular manifestations of DM

A

coronary heart disease, peripheral arterial disease, cerebrovascular disease

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51
Q

Treatment for proliferative retinopathy

A

panretinal laser photocoagulation

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52
Q

Treatment for macular edema

A

focal laser photocoagulation

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53
Q

Microalbuminuria

A

30-299 mg/day in a 24-hr collection OR 30-299 ug/mg creatinine in a spot collection

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54
Q

Diabetic dermatopathy

A

pigmented pretibial papules aka diabetic skin spots

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55
Q

Normal ejaculate values

A

2-6 mL, sperm count > 20M/mL, motility > 50%, > 15% normal morphology

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56
Q

True gynecomastia value

A

glandular breast tissue > 4cm diameter

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57
Q

Infertility definition

A

inability to conceive after 12 months of unprotected sexual intercourse

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58
Q

Precocious puberty in boys age cutoff

A

development of secondary sexual characteristics before age 9

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59
Q

Delayed puberty in boys age cutoff

A

development of secondary sexual characteristics after age 14

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60
Q

Precocious puberty in girls age cutoff

A

development of secondary sexual characteristics before age 8

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61
Q

Delayed puberty in girls age cutoff

A

absence of secondary sexual characteristics by age 13

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62
Q

Cause of humoral hypercalcemia of malginancy

A

overproduction of PTH-related peptide (PTHrP) by cancer cells

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63
Q

Potent inhibitor of renal 1A-hydroxylase

A

fibroblast growth factor 23 (FGF-23), suppresses ability of kidneys to activate vitamin D and impairs calcium absorption

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64
Q

WHO definition of osteoporosis

A

Bone density with 2.5 standard eviations below the mean for young healthy adults of same sex

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65
Q

Diagnosis of osteoporosis

A

T score below -2.5 in lumbar spine, femoral neck or total hip

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66
Q

Monoclonal antibody to RANKL, used for osteoporosis

A

denosumab

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67
Q

Exogenous PTH analogue

A

teriparatide

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68
Q

Excessive urination due to insensitivity of renal tubules to ADH

A

nephrogenic Diabetes Insipidus

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69
Q

Excessive urination secondary to lack of ADH

A

central Diabetes Insipidus

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70
Q

Excess ADH causing excessive resorption of water in hyponatremia

A

SIADH

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71
Q

Most common cause of hypopituitarism in children associated with WNT signalling pathway

A

craniopharyngioma

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72
Q

Hypothyroidism in infancy or early childhood leads to?

A

cretinism

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73
Q

Tapping facial nerve induces contractions of the muscles of eye, mouth, or nose

A

Chvostek’s sign (hypocalcemia)

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74
Q

Carpal spams produced by occlusion of the circulation to the forearm

A

Trosseau sign (hypocalcemia)

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75
Q

Most common functioning pituitary adenoma

A

prolactinoma

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76
Q

Second most common pituitary adenoma

A

somatotroph adenoma

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77
Q

Postpartum necrosis of anterior pituitary gland

A

Sheehan syndrome (presents with sudden cessation of lactation)

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78
Q

Sudden headache, diplopia, and hypopituitarism

A

Pituitary apoplexy

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79
Q

Papillary thyroid CA patho

A

Orphan Annie eye nuclei

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80
Q

Follicular thyroid CA patho

A

Hurthle cells, invades blood vessels

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81
Q

Medullary thyroid CA patho

A

C cells, MEN-associated

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82
Q

Apalstic thyroid CA patho

A

giant cells, spindle cells

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83
Q

Most common cause of hypothyroidism in iodine sufficient areas

A

Hashimoto’s thyroiditis

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84
Q

Most common casue of hypothyroidism worldwide

A

iodine deficiency

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85
Q

Most common casue of painful thryroid gland; associated with viral infection

A

De Quervain

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86
Q

Condition where thyroid tissues are replaced by fibrous tissue

A

Reidel thyroiditis

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87
Q

Hyperthyroidism + ophthalmopathy + dermopathy = ?

A

Graves disease

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88
Q

Histologic finding of Grave’s disease

A

diffuse thyroid hypertrophy and hyperplasia

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89
Q

Most common primary thyroid cancer

A

papillary thyroid CA

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90
Q

Diseases with Psammoma bodies

A

papillary thyroid CA, serous cystadenoma of ovaries, mesothelioma, meningioma

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91
Q

Most common cause of primary hyperparathyroidism

A

parathyroid adenoma

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92
Q

Osteoporosis

A

decreased bone mass

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93
Q

Osteopetrosis

A

thickened, dense bone

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94
Q

Osteomalacia/rickets

A

soft bones

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95
Q

Osteitis fibrosa cystica

A

“Brown tumors”

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96
Q

Paget’s disease in bone

A

abnormal bone architecture

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97
Q

Hypertension with hypokalemia not controlled by monotherapy

A

hyperaldosteronism

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98
Q

Most common cause of primary hyperaldosteronism

A

idiopathic hyperaldosteronism

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99
Q

Adrenals are converted to sacs of clotted blood, obscuring all details

A

Waterhouse-Friderichsen syndrome (causes acute adrenal insufficiency)

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100
Q

Neoplams composed of chromaffin cells, which release catecholamines

A

pheochromocytoma

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101
Q

Trophic hormone failure associated with pituitary compression or destruction, occurs in what sequence of hormones?

A

GH > FSH > LH > TSH > ACTH (1st sign in childhood = growth retardation; in adults = hypogonadism)

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102
Q

ACTH reserve most reliably assessed by

A

ACTH and cortisol levels during insulin-induced hypoglycemia

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103
Q

Most common cause of pituitary hormone syndromes in adults

A

pituitary adenoma

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104
Q

Size of microadenoma

A
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105
Q

Mechanism which suprasellar extension can lead to bitemporal hemianopsia

A

compression of optic chiasm

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106
Q

Early sign of optic tract pressure

A

loss of red perception

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107
Q

Desired surgical approach for pituitary tumors

A

transsphenoidal surgery

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108
Q

Most common pituitary hormone hypersecretion syndrome

A

hyperprolactinemia

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109
Q

Hallmarks of hyperprolactinemia

A

amenorrhea, glactorrhea, infertility

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110
Q

Mainstay therapy for micro/macroprolactinemia

A

dopamine agonist (cabergoline and bromocriptine)

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111
Q

Most abundant anterior pituitary hormone

A

GH

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112
Q

Major source of circulating IGF-1

A

liver

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113
Q

Major determinant of hepatic IGF-1 synthesis

A

GH

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114
Q

GH excess causes most significant clinical impact on which system?

A

cardiovascular system

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115
Q

Screening measure when raising possibility of acromegaly

A

IGF-1 levels

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116
Q

Initial treatment for most patients with acromegaly

A

Surgical resection of GH secreting adenoma

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117
Q

Side effect of somatostatin analogues (used in acromegaly)

A

drug-induced suppression of GI motility and secretion

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118
Q

Accounts for 70% of patients with endogenous casues of Cushing’s syndrome

A

pituitatry adenoma

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119
Q

Most common cause of Cushingoid features

A

iatrogenic hypercortisolism

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120
Q

Primary cause of death in Cushing’s

A

cardiovascular disease

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121
Q

Precise screening test for Cushing’s syndrome

A

24-hr urine free cortisol

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122
Q

Most common presenting feature of adult hypopituitarism

A

hypogonadism

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123
Q

What test differentiates central vs peripheral Diabetes Insipidus

A

Fluid deprivation test

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124
Q

Thyroid hormone synthesis normally begins at?

A

11 weeks AOG

125
Q

Subunit unique to TSH

A

beta subunit (alpha subunit is common to FSH, LH, and hCG)

126
Q

First step in thyroid hormone synthesis

A

iodide uptake

127
Q

Most common cause of preventable mental deficiency

A

iodine deficiency

128
Q

Method of choice in determining thyroid size accurately

A

ultrasound

129
Q

1st test in thyroid testing, using a logical approach

A

TSH levels

130
Q

Most common symptom of hypothyroidism

A

tiredness, weakness

131
Q

Most common sign of hypothyroidism

A

dry coarse skin, cool extremities

132
Q

Autoimmune hypothyroidism is primarily mediated by

A

CD8+ cytotoxic T cells

133
Q

Major role in pathogenesis of myxedema coma, leading to hypoxia and hypercapnia

A

hypoventilation

134
Q

Thyrotoxicosis via hyperthyroidism have what major etiologies?

A

Graves’ disease, toxic multinodular goiter, toxic adenoma

135
Q

Most common symptom of hyperthyroidism

A

hyperactivity, irritability, dysphoria

136
Q

Most common sign of hyperthyrdoidism

A

tachycardia, atrial fibrillation in the elderly

137
Q

Minor risk factor for Graves’ disease

A

smoking

138
Q

Major risk factor for Graves’ ophthalmopathy

A

smoking

139
Q

Most common cardiovascular manifestation of hyperthyroidism

A

sinus tachycardia

140
Q

Earliest manifestations of Graves’ ophthalmopathy

A

eye discomfort, grittiness and excess tearing

141
Q

Most serious manfiestation of Graves’ ophthalmopathy

A

compression of optic nerve at apex of the orbit

142
Q

Most frequent site of thyroid dermopathy

A

pretibial myxedema

143
Q

Time of major risk of relapse in Graves’ disease in pregnancy

A

postpartum period

144
Q

Prior to radioiodine therapy, carbimazole or methimazole should be stopped when?

A

2 days before

145
Q

Prior to radioiodine therapy, PTU should be stopped when?

A

several weeks before (sorry several talaga nakasulat)

146
Q

Absolute contraindications to radioiodine

A

pregnancy and breastfeeding

147
Q

Most common clinically apparent cause of chronic thyroiditis

A

Hashimoto’s thyroiditis

148
Q

Major cause of sick euthyroid syndrome

A

relase of cytokines

149
Q

Clinical manifestations of most goiters

A

asymptomatic

150
Q

Most common malignancy of the endocrine system

A

thyroid CA

151
Q

More common thyroid CA in iodine-deficient regions

A

follicular thyroid CA

152
Q

Preferable treatment in almost all patients with well-differentiated cancer

A

near-total thyroidectomy

153
Q

Mainstay of thyroid cancer treatment

A

levothyroxine suppression of TSH

154
Q

Most common type of thyroid lymphoma

A

diffuse large-cell lymphoma

155
Q

Provides a marker of residual or recurrent medullary thyroid CA

A

elevated serum calcitonin

156
Q

Primary management of medullary thyroid CA

A

surgical

157
Q

Size of most palpable thyroid nodules

A

> 1 cm

158
Q

Most common cause of Cushing’s syndrome overall

A

medical use of glucocorticoids

159
Q

Ectopic ACTH production is predominantly caused by

A

occult carcinoid tumors, most frequently lung

160
Q

Source of ACTH-independent cortisol excess in majority

A

cortisol-producing adrenal adenoma

161
Q

Most prominent features in Cushing’s are caused by

A

upregulation of gluconeogenesis, lipolysis and protein catabolism

162
Q

Most important first step in management of suspected Cushing’s syndrome

A

extablish the correct diagnosis

163
Q

Investigation of choice in ACTH-dependent cortisol excess

A

MRI fo the pituitary

164
Q

Oral agents with established efficacy in Cushing’s syndrome

A

metyrapone and ketoconazole

165
Q

Most common cause of mineralocorticoid excess

A

primary hyperaldosteronism (Conn’s syndrome)

166
Q

Clinical hallmark of mineralocorticoid excess

A

hypokalemic hypertension

167
Q

accepted screening test for primary hyperaldosteronism

A

concurrent measurement of plasma renin and aldosterone with calculation of aldosterone-renin ratio

168
Q

Most straightforward test for primary hyperaldosterism

A

saline infusion test

169
Q

Method of choice for adrenal imaging in hyperaldosteronism

A

fine-cut CT scan of adrenal region

170
Q

Preferred appraoch for unilateral lesions in hyperaldosteronism

A

laparoscopic adrenalectomy

171
Q

Medical management for hyperaldosteronism consists primarily of

A

spirinolactone

172
Q

Most common cause of a malignant adrenal mass

A

metastatsis (from breast and lung)

173
Q

Highly sensitive for detection of malignancy that may not be obvious on CT scan

A

18-FDG PET scan

174
Q

Metastasis in adrenocortical carcinoma most frequently occurs to

A

liver and lungs

175
Q

Most frequent origin of adrenal insufficiency

A

hypothalamic-pituitary

176
Q

Most common cause of primary adrenal insufficiency

A

autoimmune adrenalitis

177
Q

Distinguishing feature of primary adrenal insufficiency

A

hyperpigmentation

178
Q

Characteristic feature of primary adrenal insufficiency (80%)

A

hyponatremia

179
Q

Most prevalent cause of CAH (90-95% of causes)

A

CYP21A2 mutation (21-hydroxylase deficiency)

180
Q

Marker for overtreatment of CAH

A

17-hydroxyprogesterone (17OHP)

181
Q

Classic triad of pheochromocytoma

A

palpitations, headaches, profuse sweating

182
Q

Dominant sign of pheochromocytoma

A

hypertension

183
Q

Traditionally the 1st step in diagnosing pheochromocytoma

A

measure catecholamines

184
Q

Cornerstone for diagnosing pheochromocytoma

A

elevated plasma and urinary catecholamines

185
Q

Initial testing for pheochromocytoma

A

urinary test for VMA, metanephrine, catecholamines

186
Q

Ultimate goal for pheochromocytoma

A

complete tumor removal

187
Q

Before surgery for pheochromocytoma, BP should be

A

consistently below 160/90

188
Q

Surgery of choice for pheochromocytoma

A

atraumatic endoscopic surgery

189
Q

FIRST described pheochromocytoma-associated syndrome

A

neurofibromatosis type 1 (NF 1)

190
Q

BEST KNOWN pheochromocytoma-associated syndrome

A

MEN 2A, MEN 2B

191
Q

Leading causes of ESRD, nontraumatic lower extremity amputations and adult blindness

A

DM

192
Q

Differentiate type 1a and 1b DM

A

1a is autoimmune, b is non-autoimmune destruction of Beta cells

193
Q

Most reliable and convenient test for identifying DM in asymptomatics

A

HbA1C or FBS

194
Q

Key regulator of insuling secretion

A

glucose

195
Q

Glucose levels that stimulate insulin synthesis

A

glucose > 70 mg/dL (3.9 mmol/L)

196
Q

Rate-limiting step that controls glucose-regulated insulin secretion

A

glucokinase (liver; higher Km; lower afinity, higher Vmax) and hexokinase (everywhere else; lower Km; higher affinity, lower Vmax)

197
Q

Most potent incretin

A

glucagon-like peptide 1 (GLP-1)

198
Q

Major portion of postprandial glucose is utilized by

A

skeletal muscle

199
Q

Features of DM become evident when this % of Beta cells are destroyed

A

~80% destroyed

200
Q

Major susceptibility gene in T1DM

A

HLA region on chromosome 6

201
Q

Central to the development of T2DM

A

insulin resistance and abnormal insulin secretion

202
Q

Predominantly accounts for increased FBS levels

A

increased hepatic glucose output

203
Q

Results in postprandial hyperglycemia

A

decreased peripheral glucose usage

204
Q

Classic signs of DKA

A

Kussmaul respirations and fruity odor (increased acetone and metabolic acidosis)

205
Q

3 ketone bodies

A

acetone, acetoacetate, beta-hydroxybutyrate

206
Q

Extremely serious complication of DKA, seen most frequently in children

A

cerebral edema

207
Q

Conditions necessary for DKA to develop

A

both insulin deficiency and glucagon excess

208
Q

Consistent finding in DKA (distinguishes from simple hyperglycemia)

A

ketonemia

209
Q

Drug that causes false-positive reaction on nitroprusside tablet test for DKA

A

captopril or penicillamine

210
Q

Central to successful treatment of DKA

A

monitoring and frequent reassessment for improvement

211
Q

Potassium level in which you may start insulin in DKA

A

serum K

212
Q

Underlying cause of hyperglycemic hyperosmotic state

A

relative insulin inefficiency and inadequate fluid intake

213
Q

Leading casue of blindness between ages 20 and 74

A

DM

214
Q

Hallmark of proliferative diabetic retinopathy

A

neovascularization in response to retinal hypoxia

215
Q

Non-proliferative diabetic retinopathy is marked by

A

retinal vascular microaneurysms, blot hemorrhages and cotton wool spots

216
Q

Best predictor of development of retinopathy

A

duration of DM and degree of glycemic control

217
Q

Non-proliferative diabetic retinopathy is found in almost all with x years of DM?

A

DM > 20 years

218
Q

Most effective therapy for DM retinopathy

A

prevention

219
Q

Fibrin caps, capsular drops, Kimmelsteil-Wilson nodules

A

DM nephropathy (nodular glomerulosclerosis)

220
Q

Optimal therapy for DM nephropathy

A

prevention via control of glycemia

221
Q

Preferred therapy for DM nephropathy

A

renal transpalnt

222
Q

Most common form of DM neuropathy

A

distal symmetric polyneuropathy

223
Q

Most commonly involved nerve in DM mononeuropathy

A

CN III- heralded by diplopia

224
Q

Most prominent GI symptoms in DM

A

delayed gastric emptying, altered small- and large-bowel motility

225
Q

Primary goal in GI and GU dysfunction in DM

A

improved glycemic control

226
Q

Most common pattern of dyslipidemia in Dm

A

hypertriglyceridemia and reduced HDL

227
Q

Drug that effectively raises HDL, but high doses (> 2 g/d) may worsen glycemic control

A

niacin/nicotinic acid

228
Q

Most common site of foot ulcers

A

great toe or metatarsophalangeal areas

229
Q

Optimal therapy for foot ulcers and amputation

A

prevention

230
Q

Most common site of ulceration in DM

A

plantar surface of foot

231
Q

Most helpful diagnostic for infected foot ulcer

A

culture of debrided ulcer base/purulent drainage/wound aspirate

232
Q

Most specific modality for osteomyelities in DM

A

MRI of foot

233
Q

Common denominator in DM infections

A

poor glycemic control

234
Q

Most common skin manifestation in DM

A

protracted wound healing and skin ulcerations

235
Q

Considered hypertension in DM

A

BP > 130/80

236
Q

Confirms a patient’s need for insulin

A

low c-peptide levels

237
Q

Symptoms of DM usually resolve in what glucose level?

A
238
Q

Primary goal of treatment in DM is what HbA1c level?

A

HbA1c

239
Q

Recommendations on exercise in Dm

A

150 min/week distributed over at elast 3 days of moderate aerobic physical activity

240
Q

Standard of care in DM management

A

self-monitoring blood glucose

241
Q

Standard method for long-term glycemic control

A

HbA1c

242
Q

Primary predictor of long-term compliance in DM

A

HbA1c

243
Q

Can be used as an alternative indicator of glycemic control when HbA1c is inaccurate (hemolytic anemia, hemoglobinopathies)

A

albumin

244
Q

Major toxicity of metformin

A

lactic acidosis

245
Q

Major side effects of GLP-1 agonist

A

nausea, vomiting, diarrhea

246
Q

Major side effects of alpha-glucosidase inhibitors

A

diarrhea, flatulence, abdominal distention

247
Q

Most serious complication of therapy for Dm

A

hypoglycemia

248
Q

Preferred in ICU/unstable settings for DM

A

IV insulin infusion (SC insulin absorption is variable)

249
Q

Preferred over insulin analogue for IV insulin infusion

A

regular insulin (less expensive and equally effective)

250
Q

Pregnancy issues- most crucial period of glycemic control in pregnancy

A

soon after fertilization

251
Q

Whipple’s triad

A

symptoms of hypoglycemia, low plasma glucose via precise method (not a glucose monitor) and relief of symptoms after glucose is raised

252
Q

Lower limit of the fasting plasma glucose concentration

A

70 mg/dL (3.9 mmol/L)

253
Q

Obligate metabolic fuel for the brain under physiologic conditions

A

glucose (ketones in prolonged fasting > 2 weeks)

254
Q

Hepatic glycogen stores are usually sufficient to maintain glucose levels for how long?

A

8-12 hrs

255
Q

Primary glucose regulatory factor (1st defense against hypoglycemia)

A

decrease insulin

256
Q

Primary glucose counterregulatory factor (2nd defense against hypoglycemia)

A

increase glucagon

257
Q

3rd defense against hypoglycemia

A

increase epinephrine

258
Q

Limiting factor in the glycemic management of DM

A

hypoglycemia

259
Q

In hospitalized patients, glycemic maintenance goals have been modified to fall between

A

140-180 mg/dL

260
Q

Second only to drugs as causes of hypoglycemia

A

serious illnesses (renal, hepatic, cardiac failure, sepsis, inanition)

261
Q

Major site of endogenous glucose production

A

liver

262
Q

Hypoglycemia in non-beta cell tumors

A

Overproduction of insulin-like growth factor II (“big IGF-II”)

263
Q

Prototypical cause of endogenous hyperinsulinism

A

insulinoma

264
Q

Ingestion of an insulin secretagogue in relation to c-peptide levels

A

causes hypoglycemia with increased c-peptide levels

265
Q

Exogenous insulin in relation to c-peptide levels

A

causes hypoglycemia with low c-peptide levels

266
Q

Emerging as method of choice for testosterone measurement

A

liquid chromatography tandem mass spectrometry (LC-MS/MS)

267
Q

Most important step in the evaluation of male infertility

A

semen analysis

268
Q

Most common cause of androgen deficiency in acute illness

A

hypogonadotropic hypogonadism

269
Q

Most common chromosomal disorder associated with testicular dysfunction and male infertility

A

Klinefelter syndrome (47 XXY)

270
Q

Most effective therapy if gynecomastia is of long duration

A

surgery

271
Q

Most common cause of female infertility

A

abnormalities in menstruation

272
Q

Most widely used form of hormonal contraception

A

oral contraceptives

273
Q

Primary regulator of calcium physiology

A

PTH, from chief cells of parathyroid

274
Q

Primary function of PTH

A

maintain ECF calcium concentration

275
Q

90% of all cases of hypercalcemia

A

hyperparathyroidism and cancer

276
Q

Second most common cause of hypercalcemia in the adult

A

malignancy

277
Q

Serum Ca levels for hypercalcemia symptoms (bones, groans, overtones, moans)

A

calcium > 11.5-12 mg/dL (> 2.9-3.0 mmol/L)

278
Q

Serum Ca levels for severe hypercalcemia and medical emergency

A

Ca 15-18 mg/dL (3.7-4.5 mmol/L)

279
Q

Parathyroid tumors are most often encountered in

A

isolated adenomas

280
Q

Parathyroid adenomas are most often located in which parathyroid glands

A

inferior parathyroid glands

281
Q

Predominant in both hyperplasia and adenoma of the parathyroid gland

A

chief cells

282
Q

Hyperparathyroidism manifestations primarily involve which systems?

A

kidneys and skeletal system

283
Q

Most prevalent form of hyperparathyroidism

A

asymptomatic hyperparathyroidism

284
Q

Definitive therapy for hyperparathyroidism

A

surgical excision of the abnormal parathyroid tissue

285
Q

Responsible agent in most solid tumors that cause hypercalcemia

A

PTHrP (in squamous cell lung CA, renal cell CA)

286
Q

Striking feature of malignancy-associated hypercalcemia

A

rapidity in course

287
Q

First principle of treatment of hypercalcemia

A

restore normal hydration

288
Q

Treatment of choice for severe hypercalcemia complicated by renal failure

A

dialysis

289
Q

Most frequent cause of acquired hypoparathyroidism in the past

A

surgery for hyperthyroidism

290
Q

Currently the most frequent cause of acquired hypoparathyroidism

A

surgery for hyperparathyroidism

291
Q

Chief clinical manifestations of osteoporosis

A

vertebral and hip fractures

292
Q

Final common path in osteoclast development and activation

A

activation of RANK by RANKL

293
Q

Age range after which resorption exceeds formation of calcium

A

after age 30-45

294
Q

Most common estrogen-deficient state

A

menopause

295
Q

Most common early consequence of estrogen deficiency

A

vertebral fractures

296
Q

Most common cause of medication-induced osteoporosis

A

glucocorticoids

297
Q

Standard for measuring bone density

A

Dual Energy X-Ray Absorptiometry (DEXA or DXA)

298
Q

Preferred DXA sites of measurements

A

lumbar spine and hip

299
Q

Can falsely increase bone density of the spine esp in the elderly

A

bone spurs

300
Q

Guidelines further recommend that bone mass measurement be considered in

A

ALL women by age 65 (exact phrase of Q&A)

301
Q

Preferred source of calcium

A

dairy products and other foods

302
Q

Calcium carbonate requirements

A

best taken with food (require acid for solubility)

303
Q

Primary therapeutic agent for prevention or treatment of osteoporosis

A

estrogen treatment

304
Q

Approved for the prevention and treatment of breast cancer

A

tamoxifen (increased risk of uterine cancer in postmenopausal)

305
Q

Osteonecrosis of the jaw in patients with cancer comes from being given high doses of

A

zoledronic acid or pmidronate

306
Q

More severely affected bone in glucocorticoid-induced osteoporosis

A

trabecular bone (more than cortical bone)

307
Q

Duration of steroids to have bone mass measurement via DEXA

A

> 3 months glucocorticoid therapy

308
Q

If only one skeletal site can be measured for DEXA, where is it best taken?

A

spine in 60 years

309
Q

Demonstrated to reduce the risk of fractures in patients being treated with glucocorticoids

A

only bisphosphonates

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