Internal Medicine Essentials Questions: Endocrine and Metabolism Flashcards

1
Q

In a case of suspected prolactinoma (galactorrhea, decreased libido, vaginal dryness and amenorrhea in a woman), you should first do _____________.

A

a serum prolactin level; only if that’s elevated should you do a pituitary MRI

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2
Q

Lab signs of adrenal insufficiency include ________________.

A

hypoglycemia and hyponatremia (hypokalemia can occur but is less typical)

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3
Q

True or false: you can have a very low TSH and still have hypothyroidism.

A

True!

Central hypothyroidism presents with a low TSH.

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4
Q

Hypothyroidism can cause what blood pressure anomaly?

A

Diastolic hypertension

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5
Q

All thyroid nodules greater than ________ in diameter should be biopsied.

A

1 cm

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6
Q

Give the quick rule of thumb for treating hypothyroidism in pregnancy.

A

Increase levothyroxine dose by 30% in the first trimester.

Note: the first trimester is when transplacental levothyroxine is the most important.

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7
Q

How should subclinical hypothyroidism be managed?

A

Repeat TSH in 6 months

Patients may report fatigue, but as long as their T4 is normal you should not give levothyroxine.

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8
Q

True or false: adrenal incidentalomas require no testing if there is no history or signs/symptoms of functional tumor or malignancy.

A

False

Even if the person has no features of functional tumor, you should still do a 24-hour dexamethasone suppression test, a urine metanephrines level, and renin/aldosterone assays.

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9
Q

Patients with ___________ adrenal insufficiency typically do not require mineralocorticoids.

A

central

The release of aldosterone is controlled by the renin-angiotensin-aldosterone system and thus is less dependent on ACTH.

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10
Q

Which test is best at diagnosing primary hyperaldosteronism?
•CT abdomen
•Renin:aldosterone ratio
• Dexamethasone suppression test

A

Renin:aldosterone ratio

CT abdomen could detect an adrenal adenoma, but because you can have hyperaldosteronism without an adenoma it is less useful.

Dexamethasone suppression is useful in diagnosing Cushing’s syndrome, so it is only indicated in those with systemic signs of Cushing’s (e.g., striae, hirsutism, weight gain).

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11
Q

During a mild illness (like a viral URI), the dose of hydrocortisone in a person with adrenal insufficiency should be ____________________.

A

increased threefold

Note: this is even if they don’t have symptoms of adrenal insufficiency.

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12
Q

The best two tests for diagnosing Cushing’s syndrome are ______________.

A

24-urinary cortisol levels or midnight salivary cortisol levels

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13
Q

Hypertension and what “classic triad” are pathognomonic of pheochromocytoma?

A
  • Diaphoresis
  • Palpitations
  • Headaches
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14
Q

For critically ill patients with diabetes who are admitted to the hospital, what glycemic range is recommended?

A

140 - 200

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15
Q

When patients with type 1 and type 2 diabetes get diagnosed, the suite of screening tests you do differs. Why? What tests are recommended for each?

A

• Type 1: lipid panel
- Patients typically present very soon after development of the disease, there’s not enough time for retinopathy or nephropathy to develop.

•Type 2: lipid panel, urine albumin-creatinine ratio, dilated fundoscopic exam
- T2DM patients can go years without knowing that they have diabetes, so there is time for these disorders to develop.

Note: the tests for T2 are recommended in T1 after five years of disease.

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16
Q

In patients with features of both types of diabetes (such as a 15-year-old who is obese), you can order ___________ to differentiate the two.

A

islet cell autoantibodies and antibodies to decarboxylase

17
Q

Explain the testing for diabetes diagnosis.

A

You need at least two of any of these things:
•A1c greater than 6.5%
•Fasting glucose 126 or greater
•Random glucose greater than 200
•Symptoms of hyperglycemia (e.g., polydipsia, polyuria, nephropathy, neuropathy, retinopathy)

If they only have one of the above, you should repeat testing.

18
Q

Per IMEQ, the best treatment for prediabetes is _____________.

A

diet and exercise

19
Q

How is hyperglycemic hyperosmolar syndrome different than DKA?

A

In HHS, there is enough insulin to suppress ketosis but not hyperglycemia, so those in HHS have hyperglycemia but are not acidotic.

20
Q

HHS is more common in type _______ DM.

A

2 (because you need some insulin to suppress ketosis.

21
Q

The goal of therapy in hyperglycemic hyperosmolar syndrome is ______________.

A

volume replacement with NS

In HHS, there is no acidosis but the hypertonic blood is filtered in excess by the kidneys and leads to volume loss.

22
Q

The USPSTF recommends that DEXA screening begin at ______ in women.

A

age 65

23
Q

In those with osteoporosis and esophageal disorders (including GERD), ___________ are recommended. Cost, however, is a frequent prohibitive factor.

A

IV zolendronic acid (basically IV alendronate)

24
Q

What is teriparatide?

A

Recombinant PTH (like the TA teaching with the PhD in the Sketchy scene)

It is reserved for severe cases of osteoporosis (T less than -3.5).

25
Q

Osteoporosis is defined by Z score 2.5 SD less than the mean or _____________.

A

fragility fractures

26
Q

Even if a person’s DEXA score is not 2.5 SD below the mean, they should still be given alendronate if ______________.

A

their 10-year risk of osteoporotic fracture is greater than 20% or the risk of hip fracture is greater than 3%

27
Q

If a man in his fifties has osteoporosis, you need to screen for _______________.

A

secondary causes; men in their fifties very rarely have primary osteoporosis