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ABIM - Endocrinology > ESAP 2015 > Flashcards

ESAP 2015 Flashcards

1
Q

Should adrenal venous sampling be done with or without ACTH stimulation?

A

Generally recommended that it be done with ACTH stimulation although there is no compelling evidence that it improves diagnostic accuracy.

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2
Q

What does addition of an ACE inhibitor do to the plasma renin activity in a patient with renal artery stenosis?

A

Increases plasma renin activity

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3
Q

What happens to the total testosterone level after weight loss due to gastric bypass surgery?

A

Significantly increases.

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4
Q

What happens to the free testosterone level after weight loss due to gastric bypass surgery?

A

Significantly increases.

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5
Q

What happens to the total testosterone level after weight loss due to calorie restriction?

A

Increases.

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6
Q

What happens to the free testosterone level after weight loss due to calorie restriction?

A

Increases.

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7
Q

Do serum sex hormone binding globulins increase or decrease with obesity?

A

They decrease.

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8
Q

What happens to the GFR in the early stages of treatment of primary hyperaldosteronism with mineralocorticoid receptor antagonists?

A

It decreases.

Aldosterone-induced hyper-filtration is blocked

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9
Q

Are insulinomas benign or malignant?

A

They can be either.

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10
Q

What are the two possibilities of there is a very marked elevation of beta cell polypeptides (insulin, pro-insulin, c-peptide) in a patient with hypoglycemia (and a pancreatic mass)?

A
  • Insulin antibodies are present

- Insulinoma is malignant

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11
Q

Pancreatic procedures/surgeries in the presence of fatty infiltration may result in…?

A

High risk of complications such as pancreatic fistula or anastomotic breakdown.

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12
Q

If enucleation of an Insulinoma cannot be done because of location then what other non-medical management option is available?

A

Ethanol ablation under the guidance of endoscopic ultrasonography.

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13
Q

Name two drugs used in the medical management of insulinomas?

A
  • Diazoxide

- Somatostatin

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14
Q

What is the ‘legacy effect’ in the DCCT (Diabetes Control and Complications Trial)?

A

The group of type 1 diabetics with intensified glucose control had prolonged reductions in cardiovascular risk.

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15
Q

Can statins reduce lifetime cardiovascular risk in teenagers?

A

Yes - if they have significant dyslipidemia with high LDL.

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16
Q

Is there data to demonstrate reduced risk of cardiovascular disease with low-fat diet alone?

A

No

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17
Q

What three tests should all women diagnosed with primary ovarian insufficiency have?

A
  • Assessment of FMR1 repeat length
  • Measurement of adrenal anti-bodies
  • Karyotype analysis
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18
Q

What does hyperphosphatemia do to PTH levels?

A

Increases them.

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19
Q

In secondary hyperparathyroidism, what happens to the phosphorus levels?

A

Increased or upper-normal.

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20
Q

In secondary hyperparathyroidism, what happens to the calcium levels?

A

Normal or below normal

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21
Q

If calcium is 1 mg/dL above reference range persisting for more than 3 - 12 months after transplant, in a patient with tertiary hyperparathyroidism, then what further management should be done?

A

Either subtotal parathyroidectomy or 4-gland parathyroidectomy with auto-transplant.

In patients with high surgical risk, cinacalcet may be tried.

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22
Q

Do lifestyle changes (goal weight loss > 7% with calorie intake 1200 to 1800 kcal per day; and 175 minutes of moderate-intensity physical activity per week) cause reduction in cardiovascular events or mortality?

A

No

Look AHEAD trial

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23
Q

Do lifestyle changes (goal weight loss > 7% with calorie intake 1200 to 1800 kcal per day; and 175 minutes of moderate-intensity physical activity per week) cause reduction in diabetic complications?

A

This was not studied so data is not available to show this.

Look AHEAD trial

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24
Q

Do lifestyle changes (goal weight loss > 7% with calorie intake 1200 to 1800 kcal per day; and 175 minutes of moderate-intensity physical activity per week) cause decreased need for glucose-lowering therapy?

A

Yes

Look AHEAD trial

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25
Q

What is the mechanism of tumor-mediated hypoglycemia?

A

A circulating factor other than insulin stimulates the insulin receptor (insulin-like factor).

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26
Q

What happens to the endogenous production of beta-cell polypeptides in tumor-mediated hypoglycemia?

A

It ceases (because of the hypoglycemia)

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27
Q

What is the treatment of patients with non classical CAH who desire pregnancy?

A

Glucocorticoids (e.g. dexamethasone 250 mcg qHS)

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28
Q

What does pegvisomant do to HbA1c?

A

Lowers it.

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29
Q

What does pegvisomant do to insulin sensitivity?

A

Increases it.

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30
Q

What is the starting dose of pegvisomant?

A

10 mg daily

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31
Q

What is the risk of pituitary tumor enlargement over a 5-year period of a patient with residual tumor on pegvisomant for acromegaly?

A

3%

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32
Q

After parathyroidectomy, what site does bone density increase at most dramatically?

A

Lumber spine

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33
Q

Does bone density increase at the distal radius after parathyroidectomy?

A

Not significantly.

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34
Q

How can spermatogenesis be induced in men with secondary hypogonadism?

A

GnRH or gonadotropins.

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35
Q

How is GnRH administered?

A

Administered in a pulsatile fashion via an infusion pump that delivers a bolus every 90 to 120 minutes via a subcutaneous needle in the abdomen.

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36
Q

What does GnRH stimulate?

A

Pituitary gonadotropins i.e. LH and FSH.

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37
Q

What does LH stimulate in men?

A

Leydig cells of the testes resulting in synthesis and secretion of testosterone.

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38
Q

What does FSH stimulate in men?

A

Sertoli cells of seminiferous tubules to promote spermatogenesis.

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39
Q

What is the prerequisite for GnRH therapy in men?

A

Intactness of the pituitary gland.

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40
Q

When is hCG sufficient as mono therapy in the treatment of male infertility?

A

In men with testicular size larger than 8 mL.

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41
Q

What should the body fat composition be in men?

A

Less than 23.1%

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42
Q

What should the body fat composition be in women?

A

Less than 33.3%

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43
Q

Despite a normal BMI, increased adiposity confers an increased risk for metabolic complications and increased cardiovascular mortality, particularly for women.

True or false?

A

True

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44
Q

What should you add to abiraterone to resolve the hypermineralocorticoid state caused by the resultant elevated ACTH?

A

A non-mineralocorticoid steroid such as dexamethasone or prednisone.

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45
Q

What is the next step if FNA of the thyroid suggests lymphoma?

A

Core biopsy with repeated flow cytometry.

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46
Q

How many months before presentation do people with insulinomas typically have symptoms?

A

6 - 18 months

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47
Q

Do patients with insulinomas always have weight gain?

A

No

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48
Q

What does a response to glucagon indicate in hypoglycemic patients?

A

The presence of insulin or insulin-like factors.

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49
Q

What is the Rotterdam criteria for diagnosing polycystic ovary syndrome?

A

2 out of 3 of the following criteria:

  • Hyperandrogenism, clinical (hirsutism or acne) or biochemical (elevated testosterone).
  • Irregular menses.
  • Polycystic ovaries on ultrasonography.
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50
Q

Which is higher in functional hypothalamic amenorrhea - LH or FSH?

A

FSH

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51
Q

Which type of amiodarone-induced thyrotoxicosis causes destructive thyroiditis?

A

Type 2 AIT

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52
Q

What is the half life of amiodarone and its metabolites?

A

Up to 100 days.

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53
Q

Where are amiodarone and its metabolites stored in the body?

A

Stored in tissues, notably fat, and released very slowly.

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54
Q

What diagnostic modality other than radio-iodine uptake scan can be used to distinguish between thyrotoxicosis secondary to thyroiditis or underlying auto-immunity?

A

High-resolution thyroid and color-flow Doppler ultrasonography.

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55
Q

What happens to the effectiveness of growth hormone therapy in patients taking oral estrogen replacement?

A

Decreases effectiveness.

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56
Q

What are two strategies to achieve satisfactory IGF-1 levels in patients taking growth hormone replacement as well as oral estrogen replacement?

A
  • Transition to transdermal estrogen and progestin
    OR
  • Increase dosage of GH replacement.
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57
Q

What is the most likely diagnosis in patients who present with primary adrenal insufficiency and pubertal delay?

A

Congenital adrenal hypoplasia

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58
Q

When does classic congenital adrenal hyperplasia due to 21 alpha-hydroxylase deficiency present?

A

During the neonatal period.

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59
Q

Are pregabalin and gabapentin drugs of the same class?

A

Yes

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60
Q

If diabetic neuropathic pain is not responding to a first-line agent then what is the next step?

A

Using a first line drug from a different class.

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61
Q

How long after pituitary surgery do IGF-1 levels continue to fall in patients with gigantism/acromegaly?

A

3 months or longer.

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62
Q

What should the glucose-suppressed GH level obtained 3 months after pituitary surgery be in patients who have been treated for acromegaly/gigantism?

A

Less than 0.5 ng/mL

63
Q

What is the likely diagnosis in a patient presenting with fatigue, new-onset diabetes and osteoporosis (with low testosterone)?

A

Hemochromatosis

64
Q

Which mutation can cause permanent neonatal diabetes?

A 
KCNJ11 mutation 
(Gene encoding the ATP-sensitive potassium channel)
65
Q

Which mutation can cause transient or permanent neonatal diabetes?

A

ABCC8

Gene encoding sulfonylurea receptor subunit

66
Q

Which mutation causes IPEX syndrome?

IPEX: immune dysregulation, polyendocrinology, and enteropathy

A

FOXP3 mutation

X-linked disorder

67
Q

What is the treatment for MODY 2?

A

Lifestyle modification.

68
Q

What gene encodes MODY 2?

A

GCK gene

69
Q

What is the mutation in DiGeorge syndrome?

A

22q11.2 deletion

70
Q

How is DiGeorge syndrome inherited?

A

Autosomal dominant

Most new cases are de novo mutations

71
Q

Developmental defect of third and four brachial pounches, leading to parathyroid aplasia or hypoplasia.

Diagnosis?

A

DoGeorge syndrome.

72
Q

Is the PTH level high or low in pseudohypoparathyroidism?

A

High

73
Q

Which gene is mutated in Wilson disease?

A

ATP7B gene

74
Q

What is the first-line drug for infertility treatment in women with PCOS?

A

Clomiphene citrate

75
Q

What is the second-line drug for infertility treatment in women with PCOS?

A

Recombinant human FSH

76
Q

What off label drug has limited data showing better outcomes in infertility treatment of women with PCOS than clomiphene citrate?

A

Letrozole

Aromatase inhibitor

77
Q

What’s the next step in an obese patient found to have low total testosterone?

A

Check free testosterone.

78
Q

What is the central-to-peripheral gradient for a positive inferior petrosal sinus sampling?

A

Greater than 2 at baseline.

OR

Greater than 3 after corticotropin-releasing hormone stimulation

79
Q

In non-classical congenital adrenal hyperplasia how are symptoms of the partial defect controlled, and ACTH suppressed?

A

Titrating the dose of a long-acting glucocorticoid like dexamethasone.

80
Q

What is Bruns-Garland syndrome?

A

Diabetic amyotrophy

81
Q

Which part of the nervous system is affected in diabetic amyotrophy?

A
  • Lumbosacral nerve roots

- Peripheral nerves

82
Q

Meralgia paresthetica has neuropathic symptoms in the distribution of which nerve?

A

Lateral femoral cutaneous nerve

83
Q

How much grapefruit juice affects drug metabolism of statins?

A

More than 500 mL a day

84
Q

Which is affected by grapefruit juice more…

Simvastatin or atorvastatin?

A

Simvastatin

85
Q

The prescribing information for statins raises concerns with excessive grapefruit juice consumption…

What is considered excessive?

A

> 1.2 liters/day

86
Q

Which three statins are not metabolized by CYP3A4 and therefore not affected by grapefruit juice?

A
  • Pravastatin
  • Rosuvastatin
  • Pitavastatin
87
Q

Which two molecular tests are currently in the market for assessing for malignancy in thyroid nodules?

A
  • Gene expression classifiers

- Mutation analysis panels

88
Q

Are gene expression classifiers used to identify nodules that are benign or those that are malignant?

A

Benign

It’s a ‘rule out’ test to identify benign nodules.

89
Q

Can a mutation analysis test reliably exclude malignancy in thyroid nodules with indeterminate cytology?

A

No.

Because approximately 40% of malignant nodules with indeterminate cytology do not harbor these genetic mutations.

90
Q

Is mutation analysis a good test to confirm the presence of malignancy in thyroid nodules with pathology that is suspicious for malignancy?

A

Yes.

They are good ‘rule in’ tests.

91
Q

If there is low risk of disease recurrence for thyroid cancer and microscopic disease is found after the surgery then what is the next step?

A

Suppressing the TSH to the lower range of normal.

92
Q

What else is needed to interpret the results of a selective arterial calcium stimulation test?

A

Knowledge of the particular arterial anatomy of the patient’s pancreas…

So the angiogram should be reviewed with the radiologist.

93
Q

What two hormone levels does drospirenone increase?

A
  • Aldosterone (both plasma and urine)
  • Plasma renin activity
94
Q

What enzyme does licorice inhibit?

A

11-beta-hydroxysteroid dehydrogenase type II

95
Q

What happens to the aldosterone level after ingesting licorice?

A

It deceases.

96
Q

What happens to the plasma renin activity after ingesting licorice?

A

It decreases.

97
Q

What is the target TSH for people aged 70 - 80 years?

A

4 - 6 mIU/L

98
Q

When is a referral for bariatric surgery indicated?

A
  • BMI > or = 40

OR

  • BMI > or = 35 with an obesity related co-morbidity
99
Q

What happens to urinary calcium when PTHrP increases?

A

It increases

100
Q

How does B-cell lymphoma usually cause hypercalcemia?

A

Mediated by excess 1,25-dihydroxyvitamin D (calcitriol)

101
Q

What happens to PTHrP when there is hypercalcemia secondary to excess 1,25-dihydroxyvitamin D (such as in lymphoma)?

A

It is suppressed.

102
Q

In a male-to-female transgender patient what should you do if the estrogen levels are still on the lower side but the patient’s triglycerides are high?

A

Start fibrates

103
Q

What should you consider in a patient with type 1 diabetes with an atypical presentation and family history of the same?

A

Genetic testing for MODY

104
Q

Parenteral nutrition can also exacerbate renal magnesium wasting.

True or false?

A

True

105
Q

What happens to the PTH levels with chronic magnesium deficiency?

A

Levels are low or inappropriately normal compared to the degree of hypocalcemia.

106
Q

What two things related to PTH can severe magnesium depletion produce?

A
  • PTH resistance
  • Decrease in PTH secretion
107
Q

Exogenous PTH injections can have a blunted response when used to treat hypocalcemia in what circumstances?

A

Magnesium deficiency

108
Q

In case of hypocalcemia and hypomagnesemia - which should be treated first?

A

Hypomagnesemia

109
Q

When hypocalcemia and hypomagnesemia coexist then how long should magnesium therapy continue for?

A

Until hypocalcemia resolves

110
Q

The attenuation values of pheochromocytomas are always greater than ____ Hounsfield units.

A

15

111
Q

What is elevated carbohydrate antigen 19-9 (CA 19-9) suggestive of?

A

Cholangiocarcinoma

112
Q

Cholangiocarcinoma can cause hypercalcemia by which two mechanisms?

A
  • PTHrP mediated

- Local destruction and release of calcium from bone

113
Q

Does excess 24,25-dihydroxyvitamin D cause hypercalcemia?

A

No

Inactive metabolite of vitamin D

114
Q

What are elevated fibroblast growth factor 23 levels associated with?

A

Tumor-induced osteomalacia

Acquired disorder with renal phosphate wasting that typically occurs with mesenchymal tumours

115
Q

Is tumour-induced osteomalacia associated with hypercalcemia?

A

No

116
Q

Does hypercortisolism cause hypercalcemia?

A

No

117
Q

What patient group did not benefit from statin use (no cardiovascular risk reduction)?

A

Patients with end-stage renal disease.

118
Q

What is the treatment of choice for hirsuitism in women with congenital adrenal hyperplasia?

A

Hormonal contraception

119
Q

What is statistically the most likely cause of primary adrenal failure in children?

A

Classic congenital adrenal hyperplasia.

120
Q

What is the most common mutation causing classic congenital adrenal hyperplasia?

A

CYP21A2

121
Q

Primary adrenal insufficiency in a child (not neonate/infant) with a behavioral disorder and mildly abnormal neurologic findings.

Diagnosis?

A

Adrenoleukodystrophy (ALD)

122
Q

Mutations in which gene causes adrenoleukodystrophy (ALD)?

A

ABCD1

123
Q

What is the most common cause of perioperative mortality associated with bariatric surgery?

A

Thromboembolic disease, particularly pulmonary embolism.

124
Q

What is the second most common cause of perioperative mortality associated with bariatric surgery?

A

Anastomotic leaks

125
Q

Is treated sleep apnea a cause of perioperative mortality associated with bariatric surgery?

A

No, only untreated sleep apnea.

126
Q

How should you treat patients with a TSH-secreting pituitary tumor who are not cured by the surgery?

A

Depot somatostatin analogue (octreotide or lanreotide)

This is usually effective in controlling TSH hypersecretion.

127
Q

What would be the first choice medication for osteoporosis in patients with active upper gastrointestinal problems (Barrett esophagitis, gastritis, duodenitis, ulcers etc)?

A

Intravenous bisphosphonates

128
Q

What is the Jod-Basedow phenomenon?

A

Iodine-induced hyperthyroidism in individuals with pre-existing autoimmunity because of supra-physiologic iodine loads (e.g. CT and coronary angiography).

129
Q

What is the Wolff-Chaikoff effect?

A

Inhibition of iodine organification in the presence of iodine overload leading to reduced formation and release of thyroid hormones.

130
Q

What is the escape phenomenon after the Wolff-Chaikoff effect?

A

Presence of autonomous thyroid function permits synthesis and release of excess quantities of thyroid hormone resulting in iodine-induced thyrotoxicosis about 8 - 10 days after the iodine load.

This is a response to the low inorganic iodine concentration which is a consequence of down-regulation of the sodium-iodide symporter on the basolateral membrane of follicular thyroid cells.

131
Q

What happens if there is failure to escape from the Wolff-Chaikoff effect after an iodine load?

A

Results in iodine-induced hypothyroidism.

132
Q

What should the TSH be in order to consider prophylactic anti-thyroidal medications before iodine loads (contrast studies) in patients thought to be high risk for iodine-contrast-media-induced hyperthyroidism?

A

Undetectable

133
Q

What does icodextrin metabolise to?

A

Maltose

134
Q

Which other sugars to glucose meters detect?

A
  • xylose
  • maltose
  • galactose
135
Q

What kind of glucose meter (and strips) should a patient on peritoneal dialysis with icodextrin use?

A

Glucose-specific monitors and strips.

www.glucosesafety.com

136
Q

How long does it take for icodextrin and maltose metabolites to be cleared in patients with significant renal dysfunction?

A

2 weeks or more.

137
Q

What is the recommended range of TSH in the first trimester of pregnancy?

A

0.1 - 2.5 mIU/L

138
Q

What is the recommended range of TSH in the second trimester of pregnancy?

A

0.2 - 3 mIU/L

139
Q

What is the recommended range of TSH in the third trimester of pregnancy?

A

0.3 - 3 mIU/L

140
Q

Which anti-hypertensives not affecting the renin-angiotensin-aldosterone system have the greatest protein lowering effect?

A
  • verapamil

- diltiazem

141
Q

What happens to methylmalonic acid and homocysteine levels in the setting of vitamin B12 deficiency?

A

They are elevated.

142
Q

What is necessary to protect the uterus from endometrial hyperplasia and cancer when estrogen is taken for menopausal symptoms in a women with an intact uterus?

A

Progesterone

143
Q

Which has less adverse effect on lipids - micronized progesterone or medroxyprogesterone?

A

Micronized progesterone.

144
Q

What dosage and regimen of medroxyprogesterone acetate has been demonstrated to prevent endometrial hyperplasia?

A
  • 5 - 10 mg for 12 days a month.

- 2.5 mg daily

145
Q

What can be considered to protect the uterus from endometrial hyperplasia and cancer when estrogen is taken for menopausal symptoms in a woman with an intact uterus if the patient cannot take any type of progesterone by mouth?

A
  • Levonorgestrel-coated intrauterine device
146
Q

Which is more effective at alleviating hot flashes in menopause - estradiol or venlafaxine?

A

Estradiol

147
Q

Which statins have the greatest triglyceride-lowering effect?

(Two)

A
  • High dose atorvastatin

- Rosuvastatin

148
Q

Has lowering triglycerides with prandial insulin been shown to reduce cardiovascular risk?

A

No

149
Q

If the PSA increases by more than ____ when a patient is on testosterone - then he should be referred to a urologist?

A

1.4 mg/mL

150
Q

What is the most likely location of an ectopic ACTH-secreting tumor in a young man?

A

In the thorax

151
Q

How would you screen for type 1 diabetes in a healthy patient who is concerned about her/his family history of type 1diabetes?

A

Referral to clinical research study that performs type 1 diabetes screening.

152
Q

Which opioid does not affect the gonadal axis?

A

Buprenorphine

153
Q

If there is marked thickening of the pituitary stalk on MRI then what hormone deficiency does the patient probably have?

A

Anti-diuretic hormone

Diabetes insipidus

ABIM - Endocrinology (17 decks)

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