Fellowship - July 2014 Flashcards by Black RoSe

Do rib fractures show up on bone scans?

Usually because they never really completely heal.

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Do old fractures show up on a bone scan?

Only if they haven’t completely healed.

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Which endocrine syndrome is associated with the physical exam finding of lipomas?

MEN-1

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Which endocrine disorder can cause vertical ridges on the nails?

Hypothyroidism

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Does radioactive iodine ablation suppress bone marrow?

It can theoretically.

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Estrogen can precipitate a porphyria attack.

True or false?

True

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Extreme hypertriglyceridemia can spuriously lower HbA1c.

True or false?

True

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Is fenofibrate associated with higher rates of pancreatitis?

Yes.

Either directly or through increased risk of gallstones.

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What percentage of microprolactinomas enlarge during pregnancy?

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What percentage of macroprolactinomas enlarge during pregnancy?

30%

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What do normal lymph nodes look like on ultrasound?

Dark with a white halo/spot in the middle.

Length more than twice the depth.

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When doing a FNA biopsy of the thyroid and you are moving the needle up and down in the nodule - should you do it fast or slow?

Fast

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During an FNA of the thyroid; do you get more cells if you spend a shorter or longer amount of time in the nodule?

More cells if you spend a shorter amount of time in the nodule.

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Which side is the marked side of the probe supposed to be pointing at?

Right side in transverse view.

Superior side in sagittal view.

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What does a horizontal line on a genetic family tree denote?

Marriage

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What does a double horizontal line in a genetic family tree denote?

Consanguinity

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What does fludrocortisone do to potassium levels?

Makes them lower.

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What does fludrocortisone do to renin levels?

Lowers them

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How many repeats should you have for good exome sequencing?

At least 20 or more.

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What percentage of cystic thyroid nodules shrink with levothyroxine suppression?

20%

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Is it a good idea to look at static thyroid ultrasound images?

No.

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What is a significant change in the size of a thyroid nodule on ultrasound?

20% in 2 dimensions

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Can you give contrast to patients with pheochromocytomas and paragangliomas?

Contrast agents are not as high osmolar volume as 20 years ago - so it is not an issue anymore and you can give contrast.

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Can patients be asymptomatic with pheochromocytomas?

Yes - they can subclinical pheochromocytomas/paragangliomas.

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What imaging modality is recommended to check for metastasis of paragangliomas or pheochromocytomas?

FDG-PET scan per endocrine society guidelines as opposed to I-123 MIBG scan.

How long after the surgery for pheochromocytoma or paraganglioma should you biochemically check for cure?

1 - 3 months.

What are Lisch nodules/iris hamartomas and pheochromocytomas associated with?

Neuro-fibromatosis type 1 (NF1) | Also known as von Recklinghausen's disease.

Which two genetic conditions can cause pheochromocytomas and renal cell carcinoma?

VHL | SDHB

Genetic transmission of SDHD.

Autosomal dominant with maternal imprinting (only gene from father is phenotypically expressed; gene from mother is transmitted to offspring but not phenotypically expressed).

What is the conventional order of measuring the thyroid lobes in ultrasound?

Length X Depth X Width

How many pictures of the thyroid gland need to be taken for billing purposes?

Name the pictures that need to be taken with thyroid ultrasound.

``` Right transverse inferior Right transverse mid Right transverse superior Right sagittal lateral Right sagittal mid Right sagittal medial Isthmus Left transverse inferior Left transverse mid Left transverse superior Left sagittal lateral Left sagittal mid Left sagittal medial ```

What measurement is the longest measurement in sagittal view when looking at a thyroid ultrasound?

Length

Which part of the thyroid gland needs to be measured when doing thyroid ultrasounds?

``` The length, depth and width of the 'mid' portion of the thyroid lobes, both right and left. The thickness (depth) of the isthmus in the transverse view. ```

When was single energy X-ray photon absorptiometry (SXA) scanning used for bone density measurements?

Late 1980's, early 1990's.

What sites can SXA measure?

Forearm

When did dual-energy X-ray photon absorptiometry (DXA) scanning start to be used to measure bone density?

1990's.

What sites can a DXA scan measure?

``` Spine Proximal femur/hip Forearm Total body Fingers ```

Is qualitative computed tomography (QCT) used to measure bone density in clinical practice?

No. It is only used for research purposes.

What sites can central QCT measure?

Spine | Proximal femur

What sites can peripheral QCT measure?

Forearm

What limitations does QCT have in the measurement of bone density?

The patient has to stay still for at least 30 minutes.

What are the indications for BMD for women and men with no risk factors for osteoporosis?

Women ages 65 years and older. | Men aged 70 years and older.

Does Medicare reimburse DXA scan for men with no risk factors for osteoporosis?

Is BMD testing indicated in women discontinuing estrogen?

Yes

What lipid disorder does lipoprotein lipase deficiency cause?

Hyperlipoproteinemia type 1

What is the inheritance pattern of familial lipoprotein lipase deficiency?

Autosomal recessive

What's is Ward's triangle (on DXA)?

A small area in the femoral neck with the lowest T-score in the hip. It is not clinically significant.

What is the most common site of fractures in the elderly?

Femoral neck

When is the forearm measured for BMD by DXA?

Hip and/or spine cannot be measured or interpreted. Hyperparathyroidism Very obese patients (over the weight limit for DXA table)

How do you calculate the bone mineral density? | Formula

Bone mineral content / Area

Standardised T-scores compared BMD to the BMD of ... ?

A 30 year old Caucasian woman.

Which score is used to assess BMD in men younger than 50 years old or pre-menopausal women?

Z-score

Can you tell whether there has been bone loss or there was low peak bone mass on DXA?

No. | Not unless you have old DXAs to compare.

Is age an independent risk factor for fracture?

Yes

Is BMD an independent risk factor for fracture?

Yes

By how much does fracture risk increase for every 1 standard deviation below the mean for BMD?

Fractures risk doubles for every 1 standard deviation below the mean for BMD.

Should the Ward's area or greater trochanter be used for the diagnosis of osteoporosis?

What is the WHO international reference standard for diagnosing osteoporosis?

T-score of - 2.5 or less at the femoral neck.

When can you diagnose osteoporosis?

If the T-score of the lumbar spine, total hip or femoral neck is - 2.5 or less in post-menopausal women and men over age 50.

How many vertebral bodies do you need to accurately read a DXA scan?

At least 2 vertebral bodies.

Should you include vertebrae with compression fractures or vertebroplasty in BMD while readings DXA scans?

When are vertebrae excluded from analysis of BMD based on T-score?

When there is a difference of more than 1 T-score (standard deviation) between two adjacent vertebrae.

Should you make a BMD based diagnostic classification based on a single vertebra?

Which forearm should be used when measuring BMD using DXA scan?

Non-dominant forearm

Why should you use caution while using GLP-1 agonists in renal insufficiency?

Because they can dehydrated because of nausea and vomiting.

What is a V-Go insulin pump?

Disposable insulin pump (every 24 hours) that delivers a fixed dose of basal insulin.

What does sirolimus do to triglycerides?

Raises triglycerides

Which statin should you not prescribe with gemfibrozil?

Simvastatin

What is the vegetarian equivalent of fish oil?

Algae

What is the mode of inheritance of sitosterolemia?

Autosomal recessive.

What is the main problem in sitosterolemia?

Plant sterols accumulate because they are all absorbed.

When you are using the bolus dose feature on the V-Go, how many units is one click equal to?

2 units

How many units per 24 hours do the following V-Go devices deliver? V-Go 20 V-Go 30 V-Go 40

20 units 30 units 40 units Respectively.

How many units of on demand bolus dosing are present in each V-Go device?

36 units Delivered in 2 unit increments

How many times can the V-Go bolus button be pressed in 24 hours?

18 times.

Can you use the V-Go device while getting an MRI?

What does heparin do to lipoprotein lipase?

Activates it.

What do you need to give to measure lipoprotein lipase?

Heparin

Which part hurts when you're doing a thyroid FNA?

Skin Muscle Thyroid capsule