Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

2021-2022 Endo Review Rearr. > SAS/Review > Flashcards

SAS/Review Flashcards

1
Q

How do the onset and durations of regular insulin and NPH insulin differ?

A
  • Regular insulin
    • Onset in 30 min - 1 hr
    • Duration 5-8 hrs
  • NPH insulin
    • Onset 1-2 hours
    • Duration 14-18h

=> if you are giving a patient with diabetes an overnight tube feed over the course of 12 hours, use NPH insulin

Even though I for some reason thougth that NPH insulin is rarely used now?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Does teriparatide result in bone formation or bone resorption?

A

Formation

(if given intermittently)

Teriparatide = PTH analog

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

For people with a uterus:

  • Average age of pubertal onset:
  • Average age of menarche onset:
A
  • Average age of pubertal onset: 10 years (normal - 7/8 - 13)
  • Average age of menarche onset: 12.5 years
    • ​Usually when Tanner 4 breast development is present
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What hormone levels do you expect (in general) for:

  • Central precocious puberty
    • Gonadotropins:
    • Sex steroids:
  • Peripheral precocious puberty
    • Gonadotropins:
    • Sex steroids:
A
  • Central precocious puberty
    • Gonadotropins: high
    • Sex steroids: high
  • Peripheral precocious puberty
    • Gonadotropins: low
    • Sex steroids: high
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the effects of the following insulin-mediated pathways

  • PI3K:
  • Ras/MAPK:
A
  • PI3K: Stores energy
    • GLUT4 activation
    • Glycogen synthesis
    • Lipid synthesis
    • Protein synthesis
  • Ras/MAPK: Uses the energy to grow
    • Gene expression
    • Cell growth and differentiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What factors are required to diagnose hypoglycemia? (3)

A

Whipple’s triad

  • Symptoms of hypoglycemia
  • Low plasma glucose concentration (measured by blood draw)
  • Relief of symptoms when plasma glucose level is raised

Possible sx of hypoglycemia include = behavioral change, confusion, fatigue, seizure, loss of consciousness, palpitations, tremor, anxiety, sweating, hungerm paresthesias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What hormone levels (in general) do you expect during mini-puberty of infancy?

A

Gonadotropins: pubertal

Estradiol: pubertal

May see breast development (thelarche) and pubic hair (pubarche) - this is normal, as long as it regresses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which hormone is the primary driver of prenatal growth?

A

Fetal insulin

Remember; maternal insulin does not cross the placenta, but maternal glucose does

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which diabetes medication is most likely to increase peripheral insulin sensitivity?

A

Pioglitazone

(Thiazolidinedions in general)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
A

Medullary thyroid carcinoma

  • MEN-1 = Pituitary, parathyroid, pancreatic
    • Men have 1 PPP
  • MEN-2 = Medullary thyroid, pheochromocytoma
    • 2A + parathyroid hyperplasia
    • 2B + Marfanoid appearance, mucosal neuromas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When in 3% NaCl indicated to treat hyponatremia?

A
  • Rapid development of hyponatremia => correction should be rapid
  • Acute symptoms

Chronic hyponatremia = use conivaptan (vasopressin receptor blocker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which medications would decrease the size of a somatotroph adenoma? (2)

Which would only treat the symptoms? (1)

A

Somatotroph adenoma = GH secreting pituitary adenoma

  • Decrease size:
    • Octreotide
    • Cabergoline (use this esp if there is also prolactin secretion)
  • Treat symptoms
    • Pegvisomant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which medication would help with post-prandial hyperglycemia AND cause weight gain?

  1. glimepiride
  2. pioglitazone
  3. sitagliptin
  4. canagliflozin
A

A. glimepiride

  • Sulfonylureas (-amide or -ride) -> weight gain
  • TDZs (-glitazones) -> weight gain, but not great for post-prandial
    • These drugs increase peripheral insulin sensitivity, but not fast acting
  • DPP-4 inhibitors (-gliptin) -> weight neutral/modest weight loss
  • SGLT-2 inhibitors (-flozin) -> cause weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What abnormal heart rhythm is associated with severe Graves’ disease?

A

Atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What electrolyte abnormalities will be present in a patinet with 21-alpha-hydroxylase deficiency? (3)

A

Acidosis

Hyponatremia

Hyperkalemia

Also dehydration, hyperpigmentation (high ACTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which lab would you order to evaulate the function of a patient’s hypothalamic-pituitary-growth axis if you could only order 1?

A

IGF-1

  • Synthesized in the liver in response to GH
  • GH normally has variabl elevels throughout the day; difficult to get an accurate/useful reading
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe the “typical” patinet with MODY

A
  • Strong family hx of diabetes
    • Not common in T1DM
  • Normal BMI, generally active/healthy
    • Not clinicallly consistant with T2DM

MODY is a rare cause of diabetes, but high on the ddx if the pt is young with normal BMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

List the ranges for fasting glucose for each of the following conditions

  • Normal:
  • Impaired fasting glucose:
  • Diabetes:
A
  • Normal: <100
  • Impaired fasting glucose: 100-125 (inclusive)
  • Diabetes: >125
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most common cause of acromegaly?

A

GH-secreting pituitary adenoma (aka somatotroph adenoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
A

A. Denosunab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What kind of receptor does calcitonin have?

A

GPCR

22
Q

What medication(s) would you give to treat low testosterone and oligospermia?

A

LH and FSH

Giving testosterone alone would not stimulate spermatogenesis

23
Q

Which class of diabetes medication is associated with increased risk of candidiasis and UTI?

A

SGLT-2 inhibitors (-flozin)

24
Q

Are the changes seen in acromegaly reversible?

A

Cartilage and soft tissue changes are reversible

Bone changes are not

25
Q

What is the most likey cause of a calcified pituitary mass in a teenager?

A

Craniopharyngioma

26
Q
A

c. RET mutation analysis
* The only diagnostic option listed

27
Q

Which electrolyte is most important to monitor when giving insulin to correct DKA?

A

Postassium

  • DKA will often have high serum potassium (but low absolute)
  • Insulin -> increased Na/K ATPase activity -> shovels K into cells
    • -> lowers serum K
  • Start repleting K along with insulin as soon as the patient is no longer hyperkalemic
28
Q

When a patient comes in with elevated calcium, what is the next test you should order?

(if you can only pick one)

A

Parathyroid hormone

  • High or normal PTH => primary hyperparathyroidism
    • “inappropriately normal” in the setting of high Ca2+
  • Low PTH => PTH-independent cause of hypercalcemia
    • PTH should be low in the setting of high Ca2+
    • Suspect malignancy, thiazides, Vitamin D or A toxicity, Hyperthyroidism, adrenal insufficiency, sarcoidosis
29
Q

What is the body’s main source of fuel on day 8 of starvation?

A

Ketone bodies

(Brain is still using mostly glucose)

30
Q
A

B. Inhibition of hepatic gluconeogenesis

Insulin = storage hormone

31
Q

How will lisinopril (an ACE inhibitor) affect renin and aldosterone levels?

A

Increased renin

Decreased (to normal) aldosterone

32
Q

Which diabetes medication is most likely to decrease hepatic gluconeogenesis?

A

Metformin

33
Q

What is the mechanism behind hyperglycemia-induced complications?

A

Formation of advanced glycation end products (AGEs)

  • Due to non-enzymatic glycation
  • Also, increased sorbital may play a role
34
Q

What signaling pathway is activated when GLP-1 binds to its receptor?

What are the effects? (3)

A

Gs -> cAMP

  • Insulin secretion
  • Decreased gastric emptying
  • Decreased glucagon release
35
Q
A

D. Von-Hippel Lindau

  • Hemangioblastomas + renal masses are pathognomonic for Von-Hippel Lindau
  • MEN-2B no renal masses
  • Paraganglioma is an extra-adrenal pheochromocytoma
  • NFM-1 would also have skin findings (cafe-au-lait spots, subcutaneous neurofibromas)
36
Q
A

A

  • Decreases glucagon release
  • Inhibits catabolic processes
  • Increases glucose uptake by myocytes and adipocytes (GLUT4)
37
Q

What findings are pathognomonic for Von-Hippel Lindau? (2)

A

Hemangioblastomas + renal masses together

38
Q
A

D. Septo-optic dysplasia

(Kallmann syndrome is not a midline CNS defect?)

39
Q

Malignancy can cause hypercalcemia

Which mechanisms are responsible for this in the following malignancies?

  • Solid tumors:
  • Multiple myeloma:
  • Lymphoma, leukemia:
A
  • Solid tumors: PTHrP secretion
    • ​Squamous cell carcinoma of the lung, head/neck tumors, kidney carcinoma, ovary carcinoma
  • Multiple myeloma: Local bone resorption
  • Lymphoma, leukemia: Ectopic expression of 1-alpha-hydroxylase -> increaed calcitriol (active vitamin D)
    • Renal cell cancer, if overproducing 1-alpha-hydroxylase
40
Q

List the ranges for 2-hour glucose for each of the following conditions

  • Normal:
  • Impaired glucose tolerance:
  • Diabetes:
A
  • Normal: <140
  • Impaired glucose tolerance: [140-200)
  • Diabetes: ≥200
41
Q

How does Van Wyk Grumbach affect puberty?

A

Van Wyk Grumbach = severe primary hypothyroidism

  • High TSH
  • -> Cross reacts with FSH and LH receptors
  • -> precocious puberty with delayed growth
42
Q

Which drug is used to treat osteomalacia?

A

Calcitriol

Osteomalacia = defect in bone mineralization, usually 2/2 vitamin D deficiency

43
Q

A patient with medullary thyroid cancer is found to have a germline mutation in the RET protooncogene

What genetic syndrome do you suspect?

A

MEN-2

  • 2A more likely than 2B
  • Must check catecholamine levels before surgery
    • Need to know if the pt has a pheo before taking them to surgery
44
Q

For a patient with with Graves’ disease, which treatment would your recommend?

  1. Radioiodine
  2. Thyroidectomy
A

b. Thyroidectomy

Radioiodine can cause exacerbation of Graves’

(When thyroid is dying it can release the pre-stored thyroid hormone)

45
Q

List 2 diabetes medicaions assoiciated with weight loss

A

GLP-1 agonists

SGLT2 inhibitors

46
Q

What is the effect of prolactin on LH and FSH?

A

Prolactin -> decreased LH/FSH secretion

  • Increased prolactin -> amenorrhea, galactorrhea
47
Q

Your suspect your patient has Hashimoto’s thyroiditis because of hair and skin changes, lethargy, and fatigue, among other symptoms

How should you manage this patient?

A

Give levothyroxine to treat hypothyroidism

BUT

Before you start that, check adrenal function

  • Overlap between pts with Hashimoto’s and Addison’s
  • If concurrent Addison’s (hypocortisolism), need to replete cortisol first - giving levothyroixine first will further stress the adrenals -> CRASH
48
Q

Which type of bone is most at risk of fracture in the setting of hyperparathyroisism?

A

Corticol bone > trabecular bone

  • Trabecular bone = axial skeleton, hips, ankle
  • Cortical bone = long bones
  • Hyperparathyroidism = increase bone resorption*
  • reabsorption is along the surface of trabecular bones, but tunnels through cortical bones*
49
Q

Which MEN-1 - associated tumor has the highest penetrance?

A

Parathyroid adenoma

  • MEN-1 = Pituitary, parathyroid, pancreatic
    • Men have 1 PPP
    • Most will have parathyroid adenoma by age 50

MEN-1 = mutation in menin gene on chromosome 11

50
Q

What is the first sign of central puberty in a person with a uterus?

A

Thelarche (breast development)

First sign = testicular enlargement in people with testicles

51
Q

Which insulin preparation has the longest duration of action?

A

Glargine (20-24h)

Detemir is also long acting, (16-20h)

52
Q

What is your diagnosis of a patient with low TSH, low T4, and normal T3?

  1. Hypothyroid
  2. Euthyroid
  3. Hyperthyroid
A

a. Hypothyroid
* Even though the pt has normal T3, low T4 = hypothryroid

2021-2022 Endo Review Rearr. (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions