Fellowship - August 2014 Flashcards
Does calcitonin cause diarrhea?
Yes
What percentage of thyroid nodules are benign?
95%
What happens to the labs from 24-hour urine when the pH is lowered artificially?
The readings are falsely lowered.
If the urine pH is extremely low (less than 4) what should you think of?
That the HCl from the urine container leaked.
What is a significant change in bone density on DXA?
More than 3%
What is the maximum cumulative dose of radioactive iodine you would want to give someone (roughly)?
600 mCi
If you have high pH and high uric acid what kind of stones are you at risk for?
Calcium oxalate stones
Name two causes of calcium phosphate stones.
- Frequent urinary tract infections.
- Hyperparathyroidism.
What Z-score is considered low density for age?
-2 or less
What happens to the phosphorus in hypoparathyroidism?
It is increased.
How often does the sestimibi scan not pick up parathyroid adenomas?
10 - 20%
How long does hypercalcemia secondary to sarcoidosis take to correct once steroids are started in the acute setting?
A few days.
What is the long term treatment of hypercalcemia secondary to sarcoidosis?
Hydroxychloroquine 200 mg PO qDay.
Treat the underlying disorder
Pioglitazone treats non alcoholic fatty liver disease.
True or false?
True
What is the detection rate of insulinomas with endoscopic US?
90%
Can chronic hepatitis C cause thyroiditis?
Yes
Is the cholesterol level low or high in abetalipoproteinemia?
Low
A mutation in which gene causes abetalipoproteinemia?
MTP
Microsomal transfer protein
What is the pattern of inheritance for abetalipoproteinemia?
Autosomal recessive.
Which vitamin deficiencies should you check for in abetalipoproteinemia?
Fat soluble vitamins;
- Vitamin A
- Vitamin D
- Vitamin E
- Vitamin K
What is Bassen-Kornzweig disease also known as?
Abetalipoproteinemia
What kind of red blood cells are found in abetalipoproteinemia?
Acanthocytes
If transaminases are elevated in a patient with abetalipoproteinemia then what is it likely due to?
Hepatic steatosis
Is molecular genetic testing of the MTP gene commercially available?
No
Not currently available.
Is low HDL associated with cataracts?
Yes
What syndrome should you think of in a patient with a goiter and sensorineural hearing loss?
Pendred Syndrome
Which gene is mutated in Pendred syndrome?
SLC26A4
Which organs is pendrin located in?
- Thyroid
- Inner ear
- Kidney
How long should you wait before doing a repeat FNA biopsy of the thyroid after the first one is indeterminate?
2 months
If you get a thyroid FNA biopsy result that shows atypical cells - what will happen if you repeat the biopsy in a couple of weeks?
You will get the same result - atypical cells. Because you disturbed the area with your needle.
Do you need to have a fasting laboratory value to evaluate the thyroid?
No
Is a thyroid lobectomy indicated if a thyroid nodule is greater than 4 cm?
No.
Not according to the guidelines but some people believe so.
Should you check for primary hyperaldosteronism when the potassium is low?
No
So you need to stop the aspirin before or after a thyroid fine needle aspiration?
No
What is the most common side effect of testosterone therapy in men older than 50 years?
Erythrocytosis
How much does the BMD increase with testosterone therapy?
2 - 10%
How much does testosterone therapy raise PSA?
0.3 - 0.6 ng/mL
If the PSA rises by ____ or more on testosterone therapy then the patient should be evaluated by a urologist.
1.5 ng/mL
A combination of goiter and sensorineural hearing loss raises the possibility of which syndrome?
Pendred syndrome.
What is the maximal dilution of urine?
50 mOsm/L
What are the serum urea levels in beer potomania?
Low
Because they don’t eat much protein.
How would you quickly correct hyponatremia in an acute setting?
100 ml of 3%
If a patient is on an insulin drip for any reason - how often should you check for electrolytes (potassium)?
At least every 4 - 6 hours.
Does hyperlipidemia type 4 or type 5 have triglycerides above 1000 mg/dL?
Type 5
Familial dysbetalipoproteinemia (type 3) has what configuration of Apolipoprotein E?
e2/e2
What is there more of when you get higher than 1000 mg/dL triglycerides…
VLDL or chylomicrons?
Chylomicrons.
Can Rosuvastatin decrease the HDL?
Yes
What hormone is a major trophic factor in fetal life?
Insulin
What is the best management step for hypertriglyceridemia?
Making the patient NPO.
Eating makes triglycerides go up.
What should you be concerned about if the thyroglobulin of a patient with known metastatic thyroid cancer suddenly drops (after it was previously detectable) with no intervention?
That the cancer is now de-differentiated and more aggressive.
How do you assess the progress of de-differentiated thyroid cancer?
PET scan
Why would a radiologist be uncomfortable ablating a toxic multinodular goiter if the thyroid uptake was normal?
Because a high dose of radioactive iodine needs to be used.
Do opioids inhibit or stimulate ACTH release?
Inhibit ACTH release.
Does IGF-1 level change with food intake?
Yes
What ratio of alpha to beta blockade do you need for pheochromocytomas/paragangliomas?
4:1
What is the ratio of alpha to beta blockade when using labetalol?
1:7
What endocrine disorder can cause auricular cartilage calcification?
Adrenal insufficiency
What happens to DHEA-S with age?
It decreases
If the DHEA-S is higher than ____ then you can rule out adrenal insufficiency?
53.5 microgram/dL
Should you check a DHEA-S if the patient has been on steroids recently?
No
What do steroids do to DHEA-S?
Suppress it.
