ESAP 2014 Flashcards
What does hCG do to thyroid function tests?
Causes hyperthyroidism - suppressed TSH and high free T4
When do you do embryo cryopreservation as opposed to oocyte cryopreservation?
Embryo cryopreservation is preferred when the woman has a partner.
Oocyte cryopreservation is done when the woman does not have a partner and does not want to use a donor sperm.
When detecting androgen abuse (testosterone doping tests) what enzyme deficiency can cause false negative results?
Uridine diphosphoglucuronosyl transferase 2B17 (UGTB217)
What causes episodes of hypoglycemia occurring 30 to 60 minutes after mealtime insulin dosing?
Diabetic gastroparesis
How do you treat diuretic-induced hyponatremia in patients who are mildly symptomatic?
Normal saline infusion
The ADA recommends that all diabetics (adults) with diabetes undergo annual measurement of creatinine.
True or false?
True
Pheochromocytomas in MEN 2 often secrete ________, while those in patients with VHL produce high levels of ________.
- epinephrine
- norepinephrine
What are SDHD mutations associated with…
Pheochromocytomas or paraglangliomas?
Paragangliomas
With intensive glycemic control to lower patient’s blood glucose (HbA1c: 6 - 6.5%) over 5 years compared to normal control (HbA1c: 7 - 8%) the patient has greater weight gain.
True or false?
True (ACCORD study)
Which diabetic complication are Hispanic Americans more likely to develop?
Retinopathy
Which diabetic complication are Black Americans more likely to develop?
End-stage renal disease
Should a patient with a Roux-en-Y bypass have a mixed meal test with a meal that typically provokes symptoms or a standard meal?
A standard meal
(People with Roux-En-Y gastric bypass will always have symptoms with a meal containing calories in liquid or semi-liquid form)
What is the underlying mechanism of lithium-induced nephrogenic diabetes insipidus?
Resistance to action of ADH on distal nephron.
Does ADH concentrate or dilute urine?
Concentrates urine
What is the risk of doing an ethanol ablation of an insulinoma in a patient with portal hypertension?
Risk of complications such as bleeding is increased
What should you think of when hypocalcemia and hyperphosphatemia develop in the setting of treating a hematologic malignancy?
Tumor lysis syndrome
What is a common obstacle to effective management of elderly type 2 diabetics?
Untreated depression
Should family members be tested if a patient has an HRPT2 mutation?
Yes.
It may lead to early detection and prevention of parathyroid malignancy.
What kind of tumors secrete beta hCG?
Choriocarcinomas
Are the testosterone levels increased or decreased when the patient has a choriocarcinoma?
Normal
Are the estradiol levels increased or decreased when the patient has a choriocarcinoma?
Increased
Are the TSH levels increased or decreased when the patient has a choriocarcinoma?
Decreased
Are the LH levels increased or decreased when the patient has a choriocarcinoma?
Decreased
What should you suspect in a patient with very low LDL cholesterol levels?
Hypobetalipoproteinemia
A patient must be able to independently manage the pump if it is initiated in a hospital setting.
True or false?
True
What genetic testing should be done in case of an insulinoma?
MEN 1
What is the only agent approved for management of pre-existent diabetes in the second trimester of pregnancy?
Insulin
Patient has:
- Primary hypogonadism
- Frontal balding
- Insulin resistance
- Premature cataracts
- Cardiac conduction deficits
- Percussion myotonia
Diagnosis?
Myotonic dystrophy type 1 (Steinert disease)
Defect in which gene causes myotonic dystrophy type 1?
DMPK (dystrophia myotonica-protein kinase)
Can long-standing idiopathic hypercalciuria cause parathyroid autonomy?
Yes
Can long-standing idiopathic hypercalciuria cause tertiary hyperparathyroidism?
Yes
What should you suspect if different tests for Cushing’s syndrome are discordant?
Steroids in over-the-counter medications - these need to be reviewed.
Does hypothyroidism cause delayed ejaculation?
Yes
Are alpha-glucosidase inhibitors recommended in patients with renal disease?
No - because they have not been studied in this population.
What is the differential diagnosis of elevated FGF-23?
- Tumor-induced osteomalacia
- X-linked hypophosphatemia
- Autosomal dominant hypophosphatemic rickets (ADHR)
New presentation of diabetes insipidus and pituitary mass suggests…
Pituitary metastasis
Pituitary mass with cystic and solid components on T1 weighted imaging…
Diagnosis?
Craniopharyngioma
If the free T3 or free T4 levels in pregnancy are a little low but the TSH is at goal then should the levothyroxine dose be changed?
No - the levothyroxine dose during pregnancy should be titrated according the TSH.
Mutations in which genes are associated with Osteogenesis imperfecta?
COLIA1 and COLIA2
Do patients with osteogenesis imperfecta develop conductive or sensorineural hearing loss?
They can develop both.
Is basilar skull invagination a complication of osteogenesis imperfecta?
Yes
What happens to the urinary excretion of calcium after gastric bypass surgery?
It is decreased (calcium deficiency)
What happens to the femoral bone mineral density after a Roux-en-Y gastric bypass?
Decreases
What is a common cause for obstruction causing azoospermia and no fructose?
Cystic fructose
If the blockage is present at the level of the ejaculatory duct then is fructose present or absent?
Absent
If the blockage is present at the level of the vas deferens then is fructose present or absent?
Present
How do you treat male infertility caused by cystic fibrosis?
Percutaneous epididymal aspiration
Can prednisone increase cholesterol and triglyceride levels?
Yes
Hypercalcemia associated with elevated 1,25 (OH) vitamin D…
Diagnosis?
Sarcoidosis
How does hypertriglyceridemia affect TPN?
May limit the addition of lipid emulsion
Is FHH caused by an activating mutation or an inactivating mutation in CaSR?
Inactivating mutation
The degree of elevated calcium levels in FHH reflect a gene-dose effect.
True or false?
True
Patient has a triad of anemia, renal insufficiency and proteinuria. What’s the diagnosis?
Multiple myeloma
What is the lowest dose of ethinyl estradiol that should be given to ameliorate hot flash symptoms?
10 - 20 mcg
Which is the most common risk of subclinical hyperthyrodism?
Atrial fibrillation.
How do you treat patients with symptoms of adrenal insufficiency (hypoaldosteronism and hypocortisolism) after an adrenalectomy?
Conservatively manage following a high sodium and low potassium diet.
What is one of the risks of immunotherapy after pancreatic transplant?
Pancreatitis
When is nutritional support considered in critically ill patients?
Weight losses greater than 10% from initial weight.
Are there any studies showing that dextrose containing fluids are better than normal saline?
No
Pancreas plus kidney transplant is associated with better outcomes than kidney transplant alone whether the transplants are performed simultaneously or sequentially.
True or false?
True
Survival after transplant of a transplant of a kidney alone from a living donor is superior to that after simultaneous pancreas-kidney transplant.
True or false?
False
What does a parathyroidectomy in hyperparathyroidism do to bone density?
Increases it
What disease should you suspect if a patient has massive xanthomas and premature cardiovascular disease?
Sitosterolemia
consider evaluation by a cardiologist
What is the mutation in autoimmune polyglandular syndrome type 1 (APS 1)?
Mutation in the autoimmune regulator gene
