Quiz Bowl Questions Flashcards
A deficiency in what enzyme leads to congenital adrenal hyperplasia?
21-hydroxylase
What is the most common electrolyte abnormality seen in adrenal insufficiency?
Hyponatremia
What autoantibodies are most common in T1DM?
Islet autoantibodies
Which type of diabetes is prone DKA?
T1DM
What is the most common age to diagnose T1DM?
Bimodal; 4-6 and 10-14 years
What neurological symptoms can present with T1DM?
Altered level of consciousness
What is the main etiology for T1DM?
Autoimmune
An A1c of what is diagnostic for T1DM?
6.5%
An A1C of 7.2% leads to a 60% reduction in risk the following complications: diabetic
_____ and ______ and ______?
Retinopathy, neuropathy, and nephropathy
A fasting glucose of what is diagnostic for T1DM?
Greater than 126 mg/dL
What is a common skin finding in T2DM?
Acanthrosis nigricans
What pancreatic cell type is dysfunctional in T2DM?
Beta cells
Name a class of medication that can impair glucose tolerance?
Beta blockers, antipsychotics, thiazides, glucocorticoids
What are common risk factors for developing T2DM?
increasing age, obesity, lack of physical activity, hypertension, dyslipidemia, CVD
T2DM is more common in what racial/ethnic groups?
Black, AI, Hispanic/Latino
What is the primary tool used to assess glycemic control?
A1c testing
In hypogonadism, what lab is used to guide treatment?
Total serum testosterone
What is hypogonadism?
Androgen insufficiency; patient with low testosterone levels
What carcinoma of the thyroid is aggressive, not curable, and rare?
Anaplastic carcinoma
What are signs and symptoms of a thyroid neoplasm?
Palpable thyroid nodule, fixed to adjacent structures; choking sensation; cervical LAD, neck fullness, hoarseness, vocal cord paralysis
What do you see on x-ray in hyperparathyroidism?
Osteitis fibrosa cystica
Primary hyperparathyroidism is related to overproduction of _____ due to enlarged gland
PTH
Which pituitary incidentaloma is most common, macro or micro?
Micro
What is the triad of Grave’s disease?
diffuse goiter, exophthalmos, pretibial myxedema
What does congenital hypothyroidism lead to?
Cretinism
What is the first-line treatment for Hyperthyroidism?
Radioactive iodine ablation
What is the initial test for thyroid dysfunction?
TSH
What is the most common primary cause of chronic adrenal insufficiency?
Addison’s Disease
Acute adrenal crisis is caused by the abrupt discontinuation or withdrawal of?
Glucocorticosteroids
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
What blood glucose level is considered hypoglycemia?
Under 70 mg/dL
What blood glucose level is considered hyperglycemia?
over 180 mg/dL
Use of Afrezza requires routine monitoring with ____?
PFTs
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
What medication should be administered in the case of severe hypoglycemia?
Glucagon
What is the ADA goal A1c for someone with T2DM?
7%
At what A1C level should you initiate medications for T2DM?
7.5%
In the absence of contraindications, what is the ideal first line drug to treat T2DM?
Metformin
Of all T2DM agents, what class of drugs, aside from insulin, carries the greatest risk of
hypoglycemia?
Sulfonylureas
All patients with diabetes, age _______, should be started on a moderate-intensity statin.
40-75
Primary hypogonadism results from failure of what gland(s)?
Testes
Secondary hypogonadism results from failure of what gland(s)?
Pituitary and/or hypothalamus
What is the inheritance pattern of multiple endocrine neoplasia?
Autosomal dominant
What is the most common thyroid neoplasm?
Papillary
What two physical exam signs may be seen in a patient with hypocalcemia?
Chovsteks and Trousseau’s sign
In regards to a pituitary incidentaloma in a patient that is asymptomatic, what labs are appropriate to order?
Serum prolactin and IGF-1
Name the autoimmune disorder that causes the thyroid gland to be overactive
Grave’s Disease or toxic diffuse goiter
Subclinical hypothyroidism is characterized by ____ TSH and _____ free T3 and T4.
Increased TSH with normal free T3/T4 levels
____ is characterized by abnormal thyroid hormones secondary to non-thyroidal illness.
Euthyroid sick syndrome
What level of the HPA axis is affected by secondary adrenal insufficiency?
Pituitary gland
What are the 3 clinical exam findings associated with Cushing’s syndrome related to
increased fat accumulation?
buffalo hump, moon facies, supraclavicular pads
Which antibodies do you order to differentiate between T1DM and T2DM?
Glutamic Acid Decarboxylast (GAD65)
What is the mainstay treatment of T1DM and what is the goal?
insulin required with a goal A1c of < 7%
What is the first disease modifying immunotherapy approved for use in the US for
T1DM?
Teplizumab
What is the physiology behind the autoimmune process of T1DM?
Destruction of insulin producing beta cells in the islets of Langerhans
What is the foot examination called that you perform in patients with diabetes?
Monofilament foot exam
What is the first line treatment for neuropathic pain in type II diabetics?
Gabapentin
What lab values suggest primary hypogonadism?
Low Testosterone, elevated LH and FSH
What are the endocrine society’s recommendations for screening for hypogonadism in the general population?
advises AGAINST screening the general populations
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
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
For severe hypoparathyroidism, what are the medications of choice?
Calcitriol and IV calcium
Pituitary tumors may present with ____ as a symptom due to compression of the optic
chiasm.
Bitemperol hemianopsia
Prolactinoma is a functional adenoma that secretes excess amounts of prolactin and is
typically treated with what pharmacologic treatment?
Dopamine agonist
____ is a diagnostic lab test used to diagnose Grave’s disease
Antithyroid peroxidase antibody (anti-TPO)
A diffuse, high-uptake radioactive iodine uptake scan test is indicative of what disease?
Grave’s disease
_____ is a life-threatening emergency in hyperthyroidism in which a patient develops a
high fever, tachycardia, seizures, and confusion
Thyroid storm
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
Would you expect plasma ACTH to be normal, high, or low in primary adrenal insufficiency?
normal or high in primary adrenal insufficiency
Describe the hormonal abnormalities and physical manifestations associated with 21-hydroxylase deficiency in congenital adrenal hyperplasia
Decreased cortisol & aldosterone
What are three possible musculoskeletal complications of T1D?
adhesive capsulitis, carpal tunnel syndrome, Dupuytren’s contractures
What are the two hormones that are out of balance in T1D and where are they secreted from?
Insulin and glucagon from the pancreas
Describe the expected lab findings in diabetic ketoacidosis for serum anion gap, bicarbonate, serum potassium
elevated anion gap, moderately/markedly reduced bicarbonate, potassium deficit
Which medication should be avoided in a patient with diabetic retinopathy?
Semaglutide
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
Describe the monitoring involved with someone taking Metformin
B12 and Cr
List two physical exam components that are essential for patients diagnosed with T2D.
Fundoscopic eye exam and monofilament test
How often should you screen for diabetic nephropathy in a patient with T2D who does not have CKD?
annually
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
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
What diagnostic study should be avoided in a suspected pheochromocytoma and why?
Fine needle aspiration because it can cause a hypertensive crisis
A patient presenting with a prolonged _______ infection should raise suspicion for Type I DM.
Candida
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
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
Paraneoplastic syndrome is most commonly associated with what type of cancer?
small lung cell cancer
What is a key difference between pseudohypoparathyroidism and hypoparathyroidism?
Elevated PTH concentrations in pseudohypoparathyroidism. PTH concentrations would
be low in true hypoparathyroidism
What is the most common clinical manifestation of MEN1?
primary hyperparathyroidism
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
What is a class of medications and the most used medication for controlling symptoms of
hyperthyroidism?
Propranolol
Your diabetic patient presents with kussmaul respirations, fruity smelling breath, abdominal pain, and tachycardia. What electrolyte will most likely need repleting?
Potassium
Your T1DM patient’s labs return and the results suggest microalbuminuria.
What can you treat with?
ACE inhibitors
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
What T2DM drug class has a black box warning regarding heart failure?
Thiazolidinediones
What vitamin should be assessed when taking metformin?
Vitamin B12
What is the treatment for hypogonadism?
Testosterone replacement therapy
What is the classic symptom triad associated with pheochromocytoma?
- Episodic headache
- Sweating
- Tachycardia associated w/ HTN
What is the difference between a functional tumor and an adenoma?
Functional tumor: hormone secreting
Adenoma: benign tumor
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
Preferred treatment for toxic adenoma is ________
Radioiodine Ablation
What is cretinism and how do you treat it?
Congenital hypothyroidism, treat with levothyroxine
Striae are classic for Cushing’s Syndrome, describe the specific characteristics of
striae.
- Reddish-purple streaks
- Over 1 cm wide
- Most commonly located on the abdomen
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).
Name 2 of the 4 of the diagnostic criteria of DM?
- A1C > 6.5%
- Oral glucose tolerance test ≥ 200 mg/dL
- Fasting plasma glucose (FPG) ≥126 mg/dL on at least 2 occasions
- Random plasma glucose ≥ 200 mg/dL with classic signs/symptoms of hyperglycemia or
hyperglycemic crisis
At what value does glucose start to spill into urine?
180 mg/dL
What is a fault regarding A1c and its ability to assess glycemic control?
It cannot demonstrate glycemic variability or hypoglycemic episodes well.
At what eGFR should you NOT initiate Metformin?
below 45 mL/min/1.73 m2
Semaglutide (Ozempic) is proven to worsen which diabetes adverse effect?
Diabetic retinopathy
What are three signs and symptoms of hypogonadism?
decreased energy, depressed mood, impaired cognition, decreased muscle mass and
strength, diminished libido
What two alternative diagnoses need to be excluded before diagnosing someone with an “adrenal incidentaloma”?
Pheochromocytoma and subclinical Cushing’s syndrome
What are common symptoms of a pituitary incidentaloma?
abnormal breast milk production (galactorrhea), weight gain/loss, heat or cold
intolerance, irregular menses
What are the diagnostic labs for hyperthyroidism?
Decreased TSH, increased free T3 and T4
What is a rare, extreme form of hypothyroidism that has a high mortality rate and
often presents with severe signs of hypothyroidism?
Myxedema Coma
