Endocrinology

Question 1

Autoimmune destruction of the pancreatic beta cells, which will result in insulin dependence. Pts usually diagnosed in adolescence

Answer 1

Type I diabetes

Question 2

Classically, DKA is seen with Type ____ diabetes more often

Answer 2

Type 1

Question 3

Characterized by insulin resistance related to obesity. May occur at any age

Answer 3

Type 2

Question 4

Main distinction between type 1 and type 2 diabetes is that type 2 will not have

Answer 4

Antibodies

Question 5

Risk factors for type 2 diabetes

Answer 5

1. > 45 y/o
2. BMI 25
3. DM in 1st degree relative
4. Sedentary lifestyle
5. Gestational DM
6. Hx of delivery of child > 9 lbs
7. Dyslipidemia
8. HTN
9. PCOS

Question 6

Signs/symptoms of dibetes

Answer 6

Polyuria, polydipsia, fatigue

Question 7

More likely to present with a thin pt who is losing weight

Answer 7

Type 1 diabetes

Question 8

More likely to present with obesity and acanthosis nigricans

Answer 8

Type 2 diabetes

Question 9

Screening for diabetes

Answer 9

Screening should be done as part of cardiovascular risk assessment in pts aged 40-70 y/o with BMI > 25 years every 3 years

Question 10

Screening options for diabetes

Answer 10

1. Two fasting glucose levels > 126
2. One glucose level > 200 with symptoms
3. HgA1c > 6.5%
4. Positive 2 hour oral glucose tolerance test

Question 11

Diagnosis for type 1 diabetes specifically

Answer 11

Positive antibodies

Low c-peptide, low insulin, elevated glucose

Question 12

Diagnosis for type 2 diabetes specifically

Answer 12

No antibodies

Normal to increased c-peptide, normal to increased insulin, elevated glucose

Question 13

Management of diabetes

Answer 13

HgA1c is drawn every 3-6 mo to evaluate management.
Goal HgA1c <7%
May be drawn every 3 mo if not controlled, every 6 mo if well controlled

Question 14

Treatment for type 1 diabetes

Answer 14

Insulin is mainstay. Should receive basal insulin (glargine or detemir) followed by pre-meal insulin

Question 15

Treatment for type 2 diabetes

Answer 15

Counseling on weight loss, exercise, and proper nutrition
First line - metformin
Second line - sulfonylureas (glipizide, glimepiride)

Question 16

If pt has a starting HgA1c >9%

Answer 16

Want to start with insulin

Question 17

Diabetes medications that cause weight gain and hypoglycemia

Answer 17

Insulin and sulfonylureas

Question 18

Other second line options for diabetes (type 2)

Answer 18

1. Pioglitazone
2. DPP-4 inhibitors
3. Meglitinides
4. GLP-1 agonists
5. Alpha-glucosidase inhibitors
6. SGLT2 inhibitors

Question 19

Diabetic follow up care:

Answer 19

1. Yearly eye exam to screen for retinopathy
2. Yearly microalbumin screening
3. Yearly comprehensive foot exam

Question 20

Most common etiology of hypothyroidism

Answer 20

Hashimoto’s thyroiditis (autoimmune disease)

Question 21

Most common etiology worldwide of hypothyroidism

Answer 21

Iodine deficiency

Question 22

Signs/symptoms of hypothyroidism

Answer 22

Constipation
Weight gain
Fatigue
Decreased reflexes (on the relaxation phase)
Cold intolerance
Menstrual irregularities
Hair loss

Question 23

Diagnosis of hypothyroidism

Answer 23

High TSH and low T4

Question 24

Diagnosis of hypothyroidism specifically hashimoto’s

Answer 24

Thyroid peroxidase antibodies

Question 25

Primary hyperparathyroidism

Answer 25

Excess (Inappropriate) PTH production

Most common type

Question 26

Primary hyperparathyroidism occurs in 20% of pts taking _________

Answer 26

Lithium

Question 27

Signs/symptoms of hypercalcemia

Answer 27

Stone bones abdominal groans psychic moans

Decreased DTRs

Question 28

Diagnosis of hyperparathyroidism

Answer 28

Hypercalcemia
Elevated PTH
Decreased phosphate 
Increased 24 hour calcium excretion
Increased vitamin D
Imaging studies for parathyroid adenoma
Osteopenia on DEXA

Question 29

Management of hyperparathyroidism

Answer 29

Acute - saline, calcitonin, bisphosphonates

Definitive - parathyroidectomy (remove overactive - if all 4, remove 3.5 glands)