Quiz Bowl Questions Flashcards
1
Q
A deficiency in what enzyme leads to congenital adrenal hyperplasia?
A
21-hydroxylase
2
Q
What is the most common electrolyte abnormality seen in adrenal insufficiency?
A
Hyponatremia
3
Q
What autoantibodies are most common in T1DM?
A
Islet autoantibodies
4
Q
Which type of diabetes is prone DKA?
A
T1DM
5
Q
What is the most common age to diagnose T1DM?
A
Bimodal; 4-6 and 10-14 years
6
Q
What neurological symptoms can present with T1DM?
A
Altered level of consciousness
7
Q
What is the main etiology for T1DM?
A
Autoimmune
8
Q
An A1c of what is diagnostic for T1DM?
A
6.5%
9
Q
An A1C of 7.2% leads to a 60% reduction in risk the following complications: diabetic
_____ and ______ and ______?
A
Retinopathy, neuropathy, and nephropathy
9
Q
A fasting glucose of what is diagnostic for T1DM?
A
Greater than 126 mg/dL
10
Q
What is a common skin finding in T2DM?
A
Acanthrosis nigricans
11
Q
What pancreatic cell type is dysfunctional in T2DM?
A
Beta cells
12
Q
Name a class of medication that can impair glucose tolerance?
A
Beta blockers, antipsychotics, thiazides, glucocorticoids
13
Q
What are common risk factors for developing T2DM?
A
increasing age, obesity, lack of physical activity, hypertension, dyslipidemia, CVD
14
Q
T2DM is more common in what racial/ethnic groups?
A
Black, AI, Hispanic/Latino
15
Q
What is the primary tool used to assess glycemic control?
A
A1c testing
16
Q
In hypogonadism, what lab is used to guide treatment?
A
Total serum testosterone
17
Q
What is hypogonadism?
A
Androgen insufficiency; patient with low testosterone levels
18
Q
What carcinoma of the thyroid is aggressive, not curable, and rare?
A
Anaplastic carcinoma
19
Q
What are signs and symptoms of a thyroid neoplasm?
A
Palpable thyroid nodule, fixed to adjacent structures; choking sensation; cervical LAD, neck fullness, hoarseness, vocal cord paralysis
20
Q
What do you see on x-ray in hyperparathyroidism?
A
Osteitis fibrosa cystica
21
Q
Primary hyperparathyroidism is related to overproduction of _____ due to enlarged gland
A
PTH
22
Q
Which pituitary incidentaloma is most common, macro or micro?
A
Micro
23
Q
What is the triad of Grave’s disease?
A
diffuse goiter, exophthalmos, pretibial myxedema
24
What does congenital hypothyroidism lead to?
Cretinism
25
What is the first-line treatment for Hyperthyroidism?
Radioactive iodine ablation
26
What is the initial test for thyroid dysfunction?
TSH
27
What is the most common primary cause of chronic adrenal insufficiency?
Addison's Disease
28
Acute adrenal crisis is caused by the abrupt discontinuation or withdrawal of?
Glucocorticosteroids
29
When it comes to treating hypoglycemia, what is the “rule of 15?”
Eat 15g of fast-acting carbs and wait 15 minutes before testing again
30
What blood glucose level is considered hypoglycemia?
Under 70 mg/dL
31
What blood glucose level is considered hyperglycemia?
over 180 mg/dL
32
Use of Afrezza requires routine monitoring with ____?
PFTs
33
The period of time when a person with T1DM experiences near normal blood sugar levels and reduced symptoms shortly after diagnosis is called _______?
The honeymoon phase
34
What medication should be administered in the case of severe hypoglycemia?
Glucagon
35
What is the ADA goal A1c for someone with T2DM?
7%
36
At what A1C level should you initiate medications for T2DM?
7.5%
37
In the absence of contraindications, what is the ideal first line drug to treat T2DM?
Metformin
38
Of all T2DM agents, what class of drugs, aside from insulin, carries the greatest risk of
hypoglycemia?
Sulfonylureas
39
All patients with diabetes, age _______, should be started on a moderate-intensity statin.
40-75
40
Primary hypogonadism results from failure of what gland(s)?
Testes
41
Secondary hypogonadism results from failure of what gland(s)?
Pituitary and/or hypothalamus
42
What is the inheritance pattern of multiple endocrine neoplasia?
Autosomal dominant
43
What is the most common thyroid neoplasm?
Papillary
44
What two physical exam signs may be seen in a patient with hypocalcemia?
Chovsteks and Trousseau's sign
45
In regards to a pituitary incidentaloma in a patient that is asymptomatic, what labs are appropriate to order?
Serum prolactin and IGF-1
46
Name the autoimmune disorder that causes the thyroid gland to be overactive
Grave's Disease or toxic diffuse goiter
47
Subclinical hypothyroidism is characterized by ____ TSH and _____ free T3 and T4.
Increased TSH with normal free T3/T4 levels
48
____ is characterized by abnormal thyroid hormones secondary to non-thyroidal illness.
Euthyroid sick syndrome
49
What level of the HPA axis is affected by secondary adrenal insufficiency?
Pituitary gland
50
What are the 3 clinical exam findings associated with Cushing’s syndrome related to
increased fat accumulation?
buffalo hump, moon facies, supraclavicular pads
51
Which antibodies do you order to differentiate between T1DM and T2DM?
Glutamic Acid Decarboxylast (GAD65)
52
What is the mainstay treatment of T1DM and what is the goal?
insulin required with a goal A1c of < 7%
53
What is the first disease modifying immunotherapy approved for use in the US for
T1DM?
Teplizumab
54
What is the physiology behind the autoimmune process of T1DM?
Destruction of insulin producing beta cells in the islets of Langerhans
55
What is the foot examination called that you perform in patients with diabetes?
Monofilament foot exam
56
What is the first line treatment for neuropathic pain in type II diabetics?
Gabapentin
57
What lab values suggest primary hypogonadism?
Low Testosterone, elevated LH and FSH
58
What are the endocrine society’s recommendations for screening for hypogonadism in the general population?
advises AGAINST screening the general populations
59
A patient presents with a fixed palpable nodule on the thyroid, a hoarse voice and lateral cervical lymphadenopathy. Based on what you know about the most common thyroid
neoplasm, what is the likely diagnosis?
Papillary tumor
60
Upon radioactive iodine uptake scan, you find the neoplasm does not take up any isotope.What is your next step in diagnosis and why?
US with lymph node assessment because this is suspicious for cancer
61
For severe hypoparathyroidism, what are the medications of choice?
Calcitriol and IV calcium
62
Pituitary tumors may present with ____ as a symptom due to compression of the optic
chiasm.
Bitemperol hemianopsia
63
Prolactinoma is a functional adenoma that secretes excess amounts of prolactin and is
typically treated with what pharmacologic treatment?
Dopamine agonist
64
____ is a diagnostic lab test used to diagnose Grave’s disease
Antithyroid peroxidase antibody (anti-TPO)
65
A diffuse, high-uptake radioactive iodine uptake scan test is indicative of what disease?
Grave's disease
66
_____ is a life-threatening emergency in hyperthyroidism in which a patient develops a
high fever, tachycardia, seizures, and confusion
Thyroid storm
67
A pediatric patient comes in with severely stunted physical growth, delayed cognitive
development, jaundice, an enlarged tongue, and an umbilical hernia. If the patient has a thyroid issue, what is on the top of your differential?
Cretinism
68
Would you expect plasma ACTH to be normal, high, or low in primary adrenal insufficiency?
normal or high in primary adrenal insufficiency
69
Describe the hormonal abnormalities and physical manifestations associated with 21-hydroxylase deficiency in congenital adrenal hyperplasia
Decreased cortisol & aldosterone
70
What are three possible musculoskeletal complications of T1D?
adhesive capsulitis, carpal tunnel syndrome, Dupuytren’s contractures
71
What are the two hormones that are out of balance in T1D and where are they secreted from?
Insulin and glucagon from the pancreas
72
Describe the expected lab findings in diabetic ketoacidosis for serum anion gap, bicarbonate, serum potassium
elevated anion gap, moderately/markedly reduced bicarbonate, potassium deficit
73
Which medication should be avoided in a patient with diabetic retinopathy?
Semaglutide
74
Why is exercise important for people with Type 2 DM?
though glucose needs insulin to aid in membrane transport into resting skeletal muscle and adipose tissue, glucose can enter working skeletal muscles without the help of insulin and be used in this way
75
Describe the monitoring involved with someone taking Metformin
B12 and Cr
76
List two physical exam components that are essential for patients diagnosed with T2D.
Fundoscopic eye exam and monofilament test
77
How often should you screen for diabetic nephropathy in a patient with T2D who does not have CKD?
annually
78
An 18yo male presents with concerns because he has not gone through puberty. You suspect hypogonadism and order a total serum testosterone and FSH/LH. What lab values would you suspect in primary hypogonadism?
Low testosterone and normal FSH
79
A 60 yo female presents to your clinic with concerns of weight gain specifically in her face and upper back. She also reports large purple “stretch marks” on her abdomen. She informs you that she is currently being treated for lung cancer. What type of lung cancer do you suspect she has and what is most likely causing her new symptoms?
Small cell lung cancer leading to paraneoplastic syndrome
80
What diagnostic study should be avoided in a suspected pheochromocytoma and why?
Fine needle aspiration because it can cause a hypertensive crisis
81
A patient presenting with a prolonged _______ infection should raise suspicion for Type I DM.
Candida
82
What are some of the adverse effects associated with TRT, the mainstay treatment for
hypogonadism?
Increased RBC production, acne, gynecomastia, sleep disturbances, prostate
enlargement, limited sperm production
83
When diagnosing hypogonadism, what hormone level must be drawn and when should it be preferably drawn for the most accurate level?
Blood levels for testosterone should be drawn → Preferably drawn before 10 am as
testosterone is naturally highest in the morning
84
Paraneoplastic syndrome is most commonly associated with what type of cancer?
small lung cell cancer
85
What is a key difference between pseudohypoparathyroidism and hypoparathyroidism?
Elevated PTH concentrations in pseudohypoparathyroidism. PTH concentrations would
be low in true hypoparathyroidism
85
What is the most common clinical manifestation of MEN1?
primary hyperparathyroidism
86
What is a complication that can occur from post-surgical intervention for hyperthyroidism and what is its presenting symptom?
Damage to the recurrent laryngeal nerve → Presenting symptom is often hoarseness
87
What is a class of medications and the most used medication for controlling symptoms of
hyperthyroidism?
Propranolol
88
Your diabetic patient presents with kussmaul respirations, fruity smelling breath, abdominal pain, and tachycardia. What electrolyte will most likely need repleting?
Potassium
89
Your T1DM patient’s labs return and the results suggest microalbuminuria.
What can you treat with?
ACE inhibitors
90
What drug class does semaglutide belong to and what 2 indications/uses does it have?
GLP-1 agonists; Ozempic for T2DM and Wegovy for weight loss
91
What T2DM drug class has a black box warning regarding heart failure?
Thiazolidinediones
92
What vitamin should be assessed when taking metformin?
Vitamin B12
93
What is the treatment for hypogonadism?
Testosterone replacement therapy
94
What is the classic symptom triad associated with pheochromocytoma?
1. Episodic headache
2. Sweating
3. Tachycardia associated w/ HTN
95
What is the difference between a functional tumor and an adenoma?
Functional tumor: hormone secreting
Adenoma: benign tumor
96
If a patient’s serum prolactin returns elevated, what is the next diagnostic tool you can use to evaluate for a pituitary tumor?
Brain MRI
97
Preferred treatment for toxic adenoma is ________
Radioiodine Ablation
98
What is cretinism and how do you treat it?
Congenital hypothyroidism, treat with levothyroxine
99
Striae are classic for Cushing’s Syndrome, describe the specific characteristics of
striae.
1. Reddish-purple streaks
2. Over 1 cm wide
3. Most commonly located on the abdomen
100
What is the best diagnostic test for a patient with suspected adrenal insufficiency and
what would it show?
High dose ACTH stimulation test, there will be no response (no increase in cortisol).
101
Name 2 of the 4 of the diagnostic criteria of DM?
1. A1C > 6.5%
2. Oral glucose tolerance test ≥ 200 mg/dL
3. Fasting plasma glucose (FPG) ≥126 mg/dL on at least 2 occasions
4. Random plasma glucose ≥ 200 mg/dL with classic signs/symptoms of hyperglycemia or
hyperglycemic crisis
102
At what value does glucose start to spill into urine?
180 mg/dL
103
What is a fault regarding A1c and its ability to assess glycemic control?
It cannot demonstrate glycemic variability or hypoglycemic episodes well.
104
At what eGFR should you NOT initiate Metformin?
below 45 mL/min/1.73 m2
105
Semaglutide (Ozempic) is proven to worsen which diabetes adverse effect?
Diabetic retinopathy
106
What are three signs and symptoms of hypogonadism?
decreased energy, depressed mood, impaired cognition, decreased muscle mass and
strength, diminished libido
107
What two alternative diagnoses need to be excluded before diagnosing someone with an “adrenal incidentaloma”?
Pheochromocytoma and subclinical Cushing’s syndrome
108
What are common symptoms of a pituitary incidentaloma?
abnormal breast milk production (galactorrhea), weight gain/loss, heat or cold
intolerance, irregular menses
109
What are the diagnostic labs for hyperthyroidism?
Decreased TSH, increased free T3 and T4
110
What is a rare, extreme form of hypothyroidism that has a high mortality rate and
often presents with severe signs of hypothyroidism?
Myxedema Coma
