Fellowship - September 2014 Flashcards
What kind of stones does high urine pH predispose to?
Calcium phosphate
What does potassium citrate do to urine pH?
Makes it higher.
Is it preferable to be NPO before calcium measurement?
Yes
How long should you overlap the insulin infusion and the insulin pump when transitioning from the drip?
4 hours
What two circumstances need to be present to get hypercalcemia in Paget’s Disease?
- Immobilization
- Impaired renal function
How many types of FHH (familial hypocalciuric hypercalcemia) are they?
3
If you are ruling out FHH with a 24-hour urine then the patient should be vitamin D replete?
True or false?
True
How many milligrams is Zometa injection?
4 mg
How many milligrams is Reclast?
5 mg
Should you order a karyotype in a female with primary amenorrhea if the the FSH is high or low?
High
Can prolactinomas cause unilateral breast discharge?
Yes
How does fat appear on a T1 acquisition MRI?
Bright / white
How does the CSF appear on T1 acquisition image MRI?
Dark
What does Angptl3 do to lipoprotein lipase?
Inhibits it
What does Angplt4 do to lipoprotein lipase?
Inhibits it
Which is better at inhibiting lipoprotein lipase…
Angplt3 or Angptl4?
Angptl4
Betatrophin and Angptl8 are the same thing.
True or false?
True
Betatrophin and Angptl3 are the same thing.
True or false?
False
Betatrophin and Angptl4 are the same thing.
True or false?
False
How wide is a normal Achilles’ tendon?
15 mm or less
What’s the most specific physical exam finding for familial hypercholesterolemia?
Tendon xanthomas
When you are converting mmol/L to mg/dL does it matter whether you use the glucose, triglyceride or cholesterol one?
Yes it does.
They convert to different values.
99% of iodine goes to the thyroid cells, where does the remaining 1% go?
Salivary glands.
When is sperm count zero with low semen volume?
2 conditions
- Obstruction (partial or complete)
- Retrograde ejaculation.
What does IGF-1 do to bone and cartilage?
Causes growth.
Does IGF-1 worsen or improve glucose tolerance?
Worsens glucose tolerance.
Does IGF-1 change protein and fat metabolism?
Yes
Which type of type 1 diabetes does not have antibodies?
Type 1b diabetes mellitus
When do you lower the dose of a statin?
Consider lowering the dose if the LDL less than 40 mg/dL on two occasions.
What syndrome occurs if you treat refractory Cushing’s disease (pituitary adenoma) with bilateral adrenalectomy?
Nelson’s syndrome
What is the best anti-diabetic agent to use in cirrhosis?
Insulin
How much glucose load is given during an oral glucose tolerance test to confirm acromegaly?
75 grams
What two things are tested for at baseline when an oral glucose tolerance test to confirm acromegaly is done?
- Glucose
- Growth Hormone
How often and for how long are glucose and growth hormone levels drawn during oral glucose tolerance test to confirm acromegaly?
Every 30 minutes for two hours.
At what level of growth hormone is the oral glucose tolerance test negative for acromegaly?
When the Growth Hormone level falls to less than 0.3 mcg/L.
Does acromegaly cause diastolic dysfunction or systolic dysfunction?
Diastolic dysfunction.
What two findings on echocardiography contribute to diastolic dysfunction in acromegaly?
- Intraventricular septum thickening.
- Left posterior wall hypertrophy.
Which cells do pheochromocytomas arise from?
Catecholemine-producing chromaffin cells in the adrenal medulla.
Average blood glucose = 126 mg/dL
HbA1c = ?
6%
Where are extra-adrenal pheochromocytomas most commonly located?
(Hint: 5 places)
- Carotid body of the head and neck.
- Mediastinum.
- Along-side sympathetic ganglia close to IVC and abdominal aorta.
- Organ of Zuckerkandl
- Near urinary bladder.
If a patient has polyuria in the setting of Uosm > 300 mOsm/kg then what it is usually due to?
Solute diuresis: most commonly because of diuretics or hyperglycemia.
What represents a person’s vitamin D stores?
25-hydroxy vitamin D or 1,25-hydroxy vitamin D?
25-hydroxy vitamin D.
If someone has been on high dose steroids intermittently every few days for a number of years - how would you taper their steroids?
Check their adrenal axis and if normal then just stop them.
If adrenal axis cannot be checked because of recent steroid use then put them on a physiologic dose of steroids and check the adrenal axis when convenient.
Should type 1 diabetics be taken off insulin for any amount of time?
(Excepting hypoglycemia recovery because there is too much insulin on board).
No.
What is the mechanism of action of Mipomerson (Kynamro)?
Hint: Inhibits synthesis of… ?
Inhibits apolipoprotein B-100 synthesis.
What are the three main side effects of Somatostatin Analogs?
- Abdominal cramping and bloating: usually improves over the first few months of treatment.
- Gallstones: usually do not cause acute cholecystitis.
- Pancreatitis: rare.
What is the initial dose of octreotide LAR in acromegaly?
10 mg IM qMonth
How often is the dose of octreotide LAR increased when titrating up for the treatment of acromegaly?
Every 2 - 3 months.
What is the maximum dose of octreotide LAR?
40 mg IM qMonth
Does increased calcium intake during lactation completely prevent bone loss?
No.
Does having celiac’s disease, increase or decrease the risk of hip fracture?
Increases risk.
Do diabetics have an increased incidence of pancreatitis?
Yes.
Which sulfonylurea is best to use in renal failure?
Glipizide.
How many types of familial partial lipodystrophies are they?
7
(5 in the literature, and 1 recently reported autosomal recessive (CIDEC) and 1 new gene to be reported by Dr. Garg).
What is a minimal trauma fracture?
Falling from standing height.
What are the two main components of bone volume?
- Osteoid
- Bone Mineral
Which 3 statins are not affected by grapefruit juice?
Fluvastatin
Pravastatin
Rosuvastatin
Pomegranate juice used with statins may precipitate rhabdomyolysis.
True or false?
True.
There are some case reports.
What do high levels of corticosterone do to aldosterone synthetase?
Inhibits it (down-regulates expression).
Mechanism of ivacaftor?
Opens up the sweat chloride channels in cystic fibrosis with certain genotypes causing narrow channel.
One of two things must be shown in a paper demonstrating a new association of a SNP with disease. What are these two things?
- Replication of association in an independent cohort.
- Functional data for that particular SNP.
