Week 2

Question 1

What is the radiology mode of choice for examining thyroid nodules?

Answer 1

ultrasound

Question 2

What does a positive TSI indicate?

Answer 2

Grave’s disease

Question 3

Does TSH respond immediately to medications?

Answer 3

No, takes about 6 weeks to see changes in TSH

Therefore, you should use Free T4 testing instead

Question 4

What is the most common cause of a goiter / hypothyroidism worldwide?

Answer 4

iodine deficiency

Question 5

Does pregnancy normally cause a goiter?

Answer 5

no

Question 6

If both lab values are moving in the same direction (ex: TSH and T4), what does this indicate?

Answer 6

this indicates a secondary, upstream problem rather than a primary (ex: thyroid) problem

Question 7

What serves as adjuvant therapy for differentiated thyroid cancer?

Answer 7

radioactive iodine

Question 8

Which type of thyroid nodules hot or cold have a higher risk of malignancy?

Answer 8

cold

a cold nodule should be biopsied through fine needle aspiration (FNA)

Question 9

What does radioactive iodine uptake in the thyroid look like when you are taking amiodarone?

Answer 9

it is decreased because amio competes for binding sites on the thyroid and less radioactive iodine is uptaken

Question 10

In thyroiditis what does radioactive uptake look like?

Answer 10

undetectable

Question 11

In thyroiditis what does TSH / free T4 look like?

Answer 11

low TSH and high T4

Question 12

Which thyroid cancers are associated with increased levels of TBG?

Answer 12

Papillary and follicular thyroid carcinoma

Question 13

What causes edema of the face? Which thyroid disorder is this associated with?

Answer 13

glycosaminoglycans

hypothyroidism

Question 14

If you are taking exogenous iodine what does the radioactive iodine uptake scan look like?

Answer 14

not much uptake

Question 15

How long after radioactive iodine should you avoid pregnancy?

Answer 15

6 months

Question 16

What are the 3 different treatment options for hyperthyroidism?

Answer 16

Antithyroid drugs (ATD), radioactive iodine, surgery

Question 17

What is the effect of bisphosphonates on bone density?

Answer 17

decrease osteoclast activity which increases bone density

Question 18

What are the most common side effects of bisphosphonates?

Answer 18

GI side effects such as GERD

Question 19

What makes the diagnosis of osteoporesis regardless of T-scores?

Answer 19

fragility fractures

Question 20

Describe the different diagnoses provided by DEXA scan

Answer 20

Osteoporosis is defined as T score of −2.5 or less

Osteopenia is defined as a T score of between −1 and −2.5.

Question 21

What is the first line treatment of osteoporosis?

Answer 21

Bisphosphonates

Question 22

What is the most common cause of primary hypothyroidism?

Answer 22

Hashimotos

Question 23

Which type of pituitary adenoma can produce hormones?

Answer 23

microadenoma

Question 24

What can distinguish Graves from other causes of hyperthyroidism?

Answer 24

the presence of eye symptoms

Question 25

What does asymmetry of thyroid point to?

Answer 25

toxic adenoma

Question 26

What should you do first when treating patients with thyrotoxicosis?

Answer 26

Beta-blockade

Question 27

Which beta blockers are cardioselective?

Answer 27

A-BEAM atenolol, esmolol, metoprolol, ...

Question 28

After you ablate a thyroid with iodine what do you need?

Answer 28

levothyroxine to treat the hypothyroidism

Question 29

What are the effects on thyroid hormone on the bones?

Answer 29

increased bone formation

Question 30

What does FRAX tell you?

Answer 30

if osteopenia needs treatment

Question 31

Acarbose

Answer 31

alpha glucosidase inhibitor that is only associated with mild decreases in A1c significant GI side effects

Question 31

Which diabetes drugs are the only drugs associated with weight loss?

Answer 31

GLP-1 agonists -tide drugs

Question 32

Pioglitazone

Answer 32

a type of thiazolidinedione that is associated with weight gain and fluid retention

Question 33

What are the effects of hyperglycemia on appetite?

Answer 33

increased appetite

Question 34

What 3 conditions does DM cause in the micro-vasculature?

Answer 34

1) Retinopathy 2) Diabetic neuropathy 3) Microvasculature of the glomerulus

Question 35

What type of drug is metformin?

Answer 35

decreases gluconeogenesis

Question 36

How do glitazones work?

Answer 36

improve peripheral sensitivity to insulin

Question 37

How do sulfonyureas / meglitinides work?

Answer 37

stimulate pancreatic insulin secretion (C-peptide will also be raised)

Question 38

What is the MOA of SGLT-2 inhibitors?

Answer 38

prevent glucose reabsorption in the PCT and therefore more is excreted in urine

Question 39

What is the ending of SGLT-2 inhibitors?

Answer 39

-flozin

Question 40

If you have an insulinoma will C-peptide also be increased?

Answer 40

yes

Question 41

What lab values do you see with an mesenchymal tumor ? Why?

Answer 41

hypoglycemia with low insulin and low C-peptide these tumors secrete other factors that cause hypoglycemia like IGF-2. Therefore the insulin and C-peptide production would be lowered

Question 42

what are the 2 long acting forms of insulin?

Answer 42

glargine insulin degludec

Question 43

what are the 3 forms of short acting insulin?

Answer 43

lispro aspart glulisine

Question 44

what are the intermediate forms of insulin?

Answer 44

regular insulin NPH insulin

Question 45

What imaging should you use for thyroid or parathyroid?

Answer 45

start with ultrasound and then move to CT

Question 46

What imaging should you use for adrenal glands?

Answer 46

CT scan

Question 47

What imaging should you use for pituitary gland?

Answer 47

MRI

Question 48

If you see a thyroid gland that is not as white/dense as normal, what are you suspecting?

Answer 48

iodine deficiency

Question 49

What does ectopic thyroid tissue look like?

Answer 49

3 lobes of thyroid (one might be sitting anterior midline of neck) this will all be denser / white in color! Since it is made of thyroid tissue

Question 50

What does a cyst look like?

Answer 50

this will be darker and more the color of water than thyroid tissue

Question 51

What organ is most likely to cause metastatic disease to the adrenal glands?

Answer 51

lung

Question 52

What does calcification on the adrenal glands point to?

Answer 52

infection or hemorrhage can be Waterhouse-Friedman syndrome

Question 53

What are signs of a pituitary adenoma on MRI?

Answer 53

will look like it has a head and body like a snowman this points to a pituitary adenoma