exam 3

Question 1

what is somogyi?

Answer 1

the notion that nocturnal hypoglycemia causes hyperglycemia the following morning - has been discredited

Question 2

dawn phenomenon

Answer 2

an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugar (glucose) relevant to people with diabetes. It is different from chronic Somogyi rebound in that dawn phenomenon is not associated with nocturnal hypoglycemia.

Question 3

FSH, LH, ACTH, TSH, prolactin and GH are all hormones from the :

Answer 3

Anterior pituitary

Question 4

Posterior pituitary produces:

Answer 4

oxytocin, ADH

Question 5

causes of hyperprolactinemia:

Answer 5

anterior pituitary adenoma, hypothyroidism,
mass effect
various drugs( SSRIs, antipsychotics, cocaine, alpha-methyldopa)

Question 6

amenorrhea is a symptom of anterior pituitary adenoma in:

Answer 6

women

Question 7

best initial test for hyperprolactinemia:

Answer 7

prolactin level

most accurate test is MRI

Question 8

hyperprolactinemia tx:

Answer 8

dopamine agonists

Question 9

excess GH secretion due to a macro adenoma is:

Answer 9

Acromegaly

Question 10

onset of acromegaly is usually between __ and __ yrs old:

Answer 10

20 -40

Question 11

Skeletal changes, coarsening of facial features, enlargement of hand/feet, deepening of voice, carpal tunnel syndrome, CHF are all s/s of :

Answer 11

acromegaly

Question 12

best initial test for acromegaly:

Answer 12

IGF-1 level

MRI needed for definitive diagnosis

Question 13

tx for acromegaly:

Answer 13

best initial and most effective therapy is transphenoidal resection.

best medical therapy is octreotide

Question 14

posterior pituitary stores and releases ______ and ______ made by the hypothalamus:

Answer 14

oxytocin and ADH

Question 15

causes of central diabetes insipidous:

Answer 15

trauma or tumor make up 50% of cases
25% idiopathic
25% come from anoxia, meningitis, radiation

Question 16

pt with otherwise normal physical who reports polyuria, polydipsia, nocturne, enuresis, is consuming lots of water and peeing often, likely has:

Answer 16

diabetes insipidus

Question 17

labs to evaluate for diabetes insipidus:

Answer 17

CMP, UA, plasma ADH

low ADH: central DI
normal/high ADH: nephrogenic ADH

Question 18

dx for diabetes insipidus:

Answer 18

clinical - water deprivation test

Question 19

Of the medications metformin, glyburide, rosiglitazone, and NPH insulin, which should be used with caution in a person with severe sulfa allergy?

Answer 19

glyburide

Question 20

the mechanism of pioglitazone is as a:

Answer 20

insulin sensitizer

Question 21

the meglitinide analogues are particularly helpful adjuncts in DM2 care to minimize risk of:

Answer 21

postprandial hyperglycemia

Question 22

what is the most common adverse effect noted with alpha-glucosidase inhibitor use?

Answer 22

GI upset

Question 23

GLP agonists such as bydureon and victor are contraindicated in pts with _______

Answer 23

gastroparesis

Question 24

in a healthy person, what percentage of the body’s total daily physiological insulin secretion is released as basally?

Answer 24

50-60%

Question 25

of metformin, glipizide, insulin and pioglitazone, which medication is less likely to be effective in controlling plasma glucose after five yrs or more of DM2?

Answer 25

glipizide

Question 26

the most common presentation of hyperparathyroidism is:

Answer 26

asymptomatic elevation of serum calcium

Question 27

name the three ways PTH raises serum calcium concentration:

Answer 27

1) by acting directly on bone to release Ca into the extracellular fluid 2) by acting directly on the kidney to decrease renal loss of calcium 3) by acting directly on the intestinal tract, through the activation of Vit D, to increase dietary calcium absorption

Question 28

the inappropriate secretion of PTH in the setting of hypercalcemia is:

Answer 28

primary hyperparathyroidism

Question 29

the appropriate increased secretion of PTH in the setting of low or normal serum calcium concentration is:

Answer 29

secondary hyperparathyroidism, | can be caused by Vit D deficiency or renal failure

Question 30

prolonged secondary hyperparathyroidism in which hypercalcemia develops is:

Answer 30

tertiary hyperparathyroidism

Question 31

inappropriately low secretion of PTH in the setting of hypocalcemia

Answer 31

hypoparathyroidism

Question 32

in 80% of cases of primary hyperparathyroidism, excess PTH is caused by :

Answer 32

a single parathyroid adenoma

Question 33

amenorrhea or low volume menstrual flow; hyperreflexia with a characteristic "quick out-quick back" action; proximal muscle weakness and tachycardia is most likely:

Answer 33

hyperthyroidism

Question 34

menorrhagia; overall hyporeflexia with characteristic slow relaxation phase, the "hung up" patellar deep tendon relfex and bradycardia in severe cases is most likely:

Answer 34

hypothyroidism

Question 35

the measurement of _____ is the most helpful test to confirm an abnormal TSH level:

Answer 35

free T4

Question 36

on a thyroid scan, a "cold spot" is most consistent with:

Answer 36

thyroid cyst

Question 37

a painless thyroid mass and TSH level of less than 0.1IU/mL in a 35 yr old F is most consistent with:

Answer 37

autonomously functioning adenoma

Question 38

fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise suspicions of :

Answer 38

thyroid malignancy

Question 39

what is the most cost effective method of distinguishing a malignant from a benign thyroid nodule?

Answer 39

fine needle aspiration biopsy

Question 40

_____ ______ is a possible side effect of excessive levothyroxine use:

Answer 40

bone thinning

Question 41

at what interval should TSH be reassessed after a levothyroxine dosage is adjusted?

Answer 41

6 to 8 weeks

Question 42

"stones, bones, moans and psychiatric overtones": nephrolithiasis, fractures, weakness, bone pain, and pain, neuronal hypo activity: confusion, lethargy nephrogenic diabetes insipidus are all s/s of?

Answer 42

primary hyperparathyroidism

Question 43

factors associated with increased risk of thyroid cancer include:

Answer 43

- hx of radiation to the head or neck ( especially in childhood) - nodules in its younger than 20yr or older than 70 - men are at higher risk than women - more common in its with Graves dx. - fam hx of thyroid cancer.

Question 44

first step in evaluating a thyroid nodule:

Answer 44

Check TSH levels thyroid ultrasonography

Question 45

if a thyroid nodule larger than 1 cm is found, then:

Answer 45

proceed to fine needle aspiration

Question 46

regardless of thyroid nodule size, the nodule should be biopsied if ultrasonography suggests:

Answer 46

extra capsular invasion by the lesion or shows cervical lymphadenopathy

Question 47

hyper functioning thyroid nodules ______ need to be biopsied

Answer 47

do not

Question 48

thyroid nodules, regardless of size, should be biopsied if pt has hx of _______, _______ or ________ in a first degree relative

Answer 48

head and neck irritation, thyroid cancer, MEN type 2

Question 49

first line tx for hyper functioning thyroid nodules:

Answer 49

radioactive iodine 131 ablation

Question 50

thyroid nodules 4 cm or larger is an independent predictor of ________

Answer 50

malignancy -diagnostic lobectomy is recommended, FNA can miss a malignant focus, result in false benign

Question 51

benign nodules should be followed with repeat ultrasonography _________ after initial FNA

Answer 51

6 to 18 months - if nodules have not grown significantly at the follow up exam, interval may be extended to 3-5 yrs. - if nodule has grown, repeat FNA should be performed with US guidance

Question 52

31 yr old F with insomnia, tremor, weight loss despite increased appetite, goiter, sensitivity to heat, menstrual changes and exophthalmos most likely has:

Answer 52

Graves dx PE: high HR, goiter, warm/moist skin and fine tremor

Question 53

Best initial test for graves dx is _______ ;the most accurate test is ___________________

Answer 53

TSH level serology for thyroid stimulating immunoglobulin.

Question 54

Best initial therapy for graves dx:

Answer 54

propanolol to control sx

Question 55

best therapy for graves dx:

Answer 55

radioiodine ablation should not be used in children and pregnant women, definitive therapy in theses cases would be subtotal thyroidectomy

Question 56

best medication for pregnant women with graves dx who cannot have radio iodine ablation:

Answer 56

PTU or methimazole

Question 57

in graves dx, a radioactive uptake iodine scan is done if TS immunoglobulins test is not available and result would be:

Answer 57

confluent, no hot spots, nodules

Question 58

If a nodule(toxic adenoma) or multiple nodules( toxic multi nodular goiter/plummers dx) is appreciated upon PE, and an elevated TSH level with RAIU showing hot spots is found, should it be biopsied?

Answer 58

no need to biopsy because carcinomas are non functional

Question 59

_________ thyroiditis, ________ thyroiditis and ______ thyroiditis can all present with transient hyperthyroidism

Answer 59

subacute ( will present with pain and tenderness around thyroid) lymphocytic/postpartum Hashimoto's

Question 60

the uptake in a RAIU thyroiditis scan is:

Answer 60

low, because gland is damaged. this differentiates it from Graves dx, where uptake is high.

Question 61

medications that can trigger thyroiditis include: ________, _________, ________ and ________

Answer 61

lithium, interferon alfa, interleukin -2, and amiodarone

Question 62

A ____ and _____panel should be obtained before starting an antithyroid med:

Answer 62

CBC with Diff Hepatic panel

Question 63

Free T4 and total T3 should be obtained ____ weeks after starting a thionamide and every ___ to ____ weeks after with dosage adjusted based on results

Answer 63

4 weeks 4-6 weeks

Question 64

an antithyroid med would be continued for ___ to ___ months, then tapered or discontinued if the ____ level is normal at the time.

Answer 64

12 to 18 months TSH level

Question 65

_______ ________ ________ should be suspected in older adults with a markedly elevated white blood cell count and an enlarged liver or spleen.

Answer 65

Chronic lymphocytic leukemia

Question 66

unlike most Type 2 DM pts, DM1 pts often present with_____ and ______ in addition to polyuria, polydispsia and a plasma glucose of 126 mg/dL or more after an overnight fast documented on more than one occasion.

Answer 66

ketonuria and weight loss