High Yield Endocrine Questions - Cram the PANCE Already Passed

High Yield Endocrine Questions - Cram the PANCE Already Passed A patient presents to the office with polyuria and polydipsia. He has a family history of diabetes, and he wants to be tested to see if he is diabetic. He last ate 2 hours ago, and his blood glucose in the office was 156. His A1C comes back and reveals a result of 6.3, and his 2-hour glucose tolerance test revealed a blood glucose of 212. Which of these lab tests can definitively make the diagnosis of diabetes in this patient? 2-hour glucose tolerance test with a blood glucose of 212 Notes: BS in office was non-fasting so >126 criteria cannot be used to diagnose, A1C is elevated but needs to be 6.5 or higher to diagnose diabetes A 66 yo male presents to the office today because his diabetes is out of control lately and he would like some help getting his blood sugars back to normal. He only currently takes Metformin 1000 mg BID. You discuss a few different medications with him including Glipizide, Insulin Glargine, and Empagliflozin. He states his only fear with starting a new medication if low blood sugars. Which one of the medications discussed with the patient is least likely to cause hypoglycemia? Empagliflozin Notes: Glipizide is a sulfonylurea which are notorious as a class for causing low blood sugars, all types of insulin have potential to cause hypoglycemia. Empagliflozin (Jardiance) is an SGLT2 inhibitor which does not usually cause low blood sugar What is the most common type of thyroid cancer? Papillary thyroid carcinoma (roughly 8 out of 10 cases) A nonpregnant adult with Subclinical Hypothyroidism should be treated with thyroid hormone replacement (Levothyroxine) when they TSH reaches what level? TSH of 10 mU/L or higher A 27 yo female with history of bipolar disorder presents to the office complaining of fatigue, constipation, and weight gain. Labs are ordered and it is determined she is biochemically hypothyroid. What medication is this patient likely taking that lead to her diagnosis of hypothyroidism? Lithium Notes: Lithium is first line for bipolar, need TSH levels checked every 6-12 months on lithium since hypothyroidism is so prevalent. Lithium and amiodarone are infamous for causing hypothyroidism A 37 yo female presents to the office complaining that she is having trouble losing weight despite following a strict diet and exercising daily. On physical exam, you note central obesity, thin extremities, oily skin, and striae across her abdomen. A screening test to check for excess of what hormone should be checked in this patient? Serum cortisol Notes: Patient has classic signs of Cushing's (only classic sign missing is "buffalo hump") A patient with secondary hypothyroidism will have an abnormality in which part of the Hypothalamic-Pituitary-Thyroid Axis? Pituitary gland What is the most common cause overall for Cushing's Syndrome? Long-term, high dose use of glucocorticoids In a patient with diabetic ketoacidosis, after checking capillary glucose levels and urine ketones to confirm the diagnosis, what is the first therapeutic intervention that should be started in these patients? Start IV fluids (isotonic saline) A 69 yo male with type II DM over 25 years presents to the office today complaining of early satiety, epigastric discomfort, and post prandial nausea and bloating for many months. What is the likely diagnosis in this patient? Diabetic gastroparesis A patient with nephrogenic diabetes insipidus will likely have what response in urine output after a Desmopressin (ADH) stimulation test is performed? No change, will continue production of large amounts of dilute urine Notes: In nephrogenic DI, there is enough ADH produced but the kidneys are essentially "insensitive" to ADH. If they have central DI, they will improve with administration of Desmopressin. What medication class if given to a patient with a pheochromocytoma before initiating treatment with alpha-adrenergic blockers (phenoxybenzamine) can cause unopposed alpha constriction and lead to a hypertensive crisis? Beta blockers Notes: Unopposed alpha constriction can cause hypertensive crisis if beta blockers are started first What is the most common cause of hypothyroidism in the US? Hashimoto Thyroiditis Notes: US is a iodine sufficient area so autoimmune is most likely cause while iodine deficiency is most common cause worldwide A patient with history of Graves disease presents with bilateral, scaly, non-pitting, induration of the skin of the lower extremities with brown patches spreading throughout. What is the name of the likely diagnosis in this patient? Myxedema (pretibial which is most common) When treating a patient with Graves' Disease, which medication should be used in the first trimester? Propylthiouracil (PTU) Notes: In the first trimester of pregnancy is pretty much the only time PTU is preferred over methimazole, can switch to methimazole after the first trimester A patient develops bladder cancer and is suspected that one of the medications he uses for diabetes is to blame. Which diabetes medication is this patient likely taking? Pioglitazone (TZD class) Notes: Remember "pee-oglitazone" for its relationship with bladder cancer A patient with Cushing's Disease (pituitary) after administration of high dose dexamethasone will likely have what response in their serum cortisol levels? Suppression of serum cortisol Notes: Pituitary causes of Cushing's Disease will be the only cases where you will see suppression with administration of dexamethasone A 47 yo female presents to the office 2 weeks post-op after having a thyroidectomy performed. She complains of muscle cramping and muscle spasms as well as a tingling sensation in her extremities. An ECG is performed and prolongation of the QT interval is visualized. What is the likely cause of her symptoms? Hypocalcemia Notes: Iatrogenic cause of hypoparathyroidism resulting in hypocalcemia A 37 yo female presents to the office today because she has not had her period in 4 months. She is not sexually active and denies any chance of pregnancy. She also complains of headaches and a milky discharge from her breast. What is the first line medication class for the likely diagnosis? Dopamine agonists (cabergoline, bromocriptine) Notes: Patient likely has a prolactinoma which is the most common type of pituitary adenoma, dopamine inhibits prolactin Multiple endocrine neoplasia type I is a rare autosomal dominant disorder characterized by a predisposition to tumors most commonly in what 3 areas of the body? Parathyroid, pancreas, pituitary (3 Ps) A 56 yo male with a history of diabetes presents to the office today to review recent lab results. His labs show he is deficient in vitamin B12. Which medication is he likely taking for his diabetes that caused a deficiency in vitamin B12? Metformin Notes: Metformin can cause B12 deficiency in 5-10% of patients taking it What is the most aggressive type of thyroid cancer Anaplastic thyroid cancer Notes: Median survival time after diagnosis is only 3-7 months How soon after the initiation of thyroid hormone replacement (levothyroxine, etc) in a patient with primary hypothyroidism should the TSH be checked? 4-6 weeks A 42 yo male presents today to the office for routine labs. The results of the labs show an elevated TSH level and free T4 levels which are within normal limits. The patient is otherwise healthy and asymptomatic. What diagnosis should be suspected in this patient? Subclinical hypothyroidism Notes: These patients are generally asymptomatic with elevated TSH, normal T4 A physical exam is performed on a newborn female due to abnormalities detected at birth. The newborn has dry skin, swelling around the eyes, enlargement of the tongue, and an umbilical hernia palpated on exam. What nutritional deficiency should be suspected in the mother of the newborn? Iodine deficiency Notes: Newborn has classic symptoms of untreated congenital hypothyroidism, iodine deficiency as cause is not common in US A 37 yo female presents to the office today complaining of persistent fatigue combined with nausea, generalized abdominal pain, and brownish discoloration on her hands, elbows, and knees. Labs are ordered and reveal elevated serum potassium levels and a blood glucose of 63. What is the likely diagnosis in this patient? Primary adrenocortical insufficiency (Addison Disease) Notes: Primary because of the presence of hyperpigmentation of the skin and hyperkalemia which is generally only seen in primary and not secondary In the previous patient with primary adrenocortical insufficiency, would the ACTH levels be elevated or decreased? Elevated Notes: Primary involves adrenal dysfunction so pituitary would increase levels of ACTH while secondary involves pituitary dysfunction and decreased levels of ACTH A 36 yo female presents to the office complaining of fatigue, constantly feeling cold, dry skin, and weight gain. If thyroid hormone levels were drawn in this patient, what would the levels of TSH and Free T4 likely reveal? Elevated TSH and decreased Free T4 Notes: Classic symptoms of hypothyroidism A patient with hypothyroidism comes in for a routine follow-up and to review labs she had done to evaluate her thyroid hormone levels. She takes 50mcg of Levothyroxine daily and has been on this dose for the last 9 years with no issues. Her labs comes back indicating she is biochemically hypothyroid and her TSH is 11. She states she has not made any changes since the last visit and assures you that she always takes her Levothyroxine first thing in the morning and waits and hour before eating or taking any other pills. She has not started any new prescription medications, just an OTC medication she started a few weeks ago for some heartburn she has been experiencing. What is the likely cause of the patient's sudden increase in TSH? OTC heartburn medication Notes: Levothyroxine requires an acidic environment in the stomach to be absorbed and PPIs or antacids reduce acid in the stomach decreasing absorption. Need a 4 hour window between taking these meds and levothyroxine A 47 yo female has recently started methimazole for treatment of Graves' Disease. She often feels very jittery, anxious, and sometimes feels as if her heart is beating out of her chest. In addition to methimazole, what medication class can be used in this patient to rapidly improve her symptoms? Beta blockers What would be the first line medication to use in a patient with acromegaly due to a pituitary adenoma? Somatostatin analog (Octreotide or Lanreotide) Notes: Somatostatin analogs limit the release of growth hormone A 42 yo male presents to the office complaining of decreased libido and erectile dysfunction. He has a history of type II DM, HTN, HLD, and bipolar disorder. His medications include Zocor, Amlodipine, Metformin, and Risperidone. Labs are drawn which reveal an elevated prolactin level. What would be the first line treatment option for this patient? Discontinue offending agent (Risperidone) and find another agent for bipolar disorder What medication can be used in a patient with primary hyperparathyroidism to lower serum calcium and serum PTH that is not a candidate for surgery? Cinacalcet Notes: If the patient has osteoporosis too, you can use bisphosphonates A patient with a history of type I DM presents with tachycardia, weakness, altered mental status and fruity (acetone) breath. A finger stick is done bedside which reveals a blood glucose of 560 and his urine in positive for ketones. On physical exam, you notes deep, rapid, and labored breathing. These respirations are a compensatory mechanism for what acid-based disorder that has likely been present in this patient? High anion gap metabolic acidosis Notes: Patient has diabetic ketoacidosis (DKA), Kussmaul respirations A patient presents to the ED after sustaining a head injury in a motor vehicle accident. Since the accident, he has been urinating more frequently than normal and has developed an insatiable thirst. His urine is dilute and a finger stick blood glucose reading was 98. What is the first line treatment for the likely diagnosis in this patient? Desmopressin Notes: Diabetes insipidus (DI), recent head injury suggests it is a central DI and first line treatment is desmopressin A 46 yo male is diagnosed with SIADH. He has a history of seizures, asthma, hypothyroidism, and hyperlipidemia. He is taking atorvastatin, levothyroxine, albuterol (Lovaza), and carbamazepine. Discontinuation of which medication is recommended in this patient? Carbamazepine Notes: Almost all anti-convulsants have the potential to cause SIADH but carbamazepine is the one usually asked about What screening test should be done annually for diabetic patients to screen for early signs of diabetic nephropathy? Urinary albumin (spot urinary albumin to creatinine ratio) Notes: Used to be called microalbuminuria when >30 but now called moderately increased albuminuria (30-300), >300 is called severely increased albuminuria What is the most common cause of DKA? Infection (pneumonia, UTI) A patient with hypocalcemia has contraction of facial muscles provided by lightly tapping on the facial nerve just anterior to the ear. What is this known as? Chvostek sign A 64 yo female with history of type II DM presents to the office due to her blood glucose running higher for the past few months. She has made dietary changes as well as increasing her activity level with no improvement in her readings. She agrees to add another medication to her regiment and you discuss a few medications with her including Empagliflozin, Liraglutide, and Glipizide. She states her only requirement is that the medication will not cause her to gain weight. Which of the 3 medications discussed should be avoided? Glipizide Notes: Is the only sulfonylurea listed which can cause weight gain. The others typically cause weight loss What diagnosis should be ruled out in a patient who has a radioactive iodine uptake scan of the thyroid performed that shows little to no iodine uptake, also known as a cold nodule? Malignancy Notes: Usually fine needle aspiration is done A 46 yo male with a history of IBD, HLD, pancreatitis, renal failure, and trigeminal neuralgia is going to be started on metformin for his newly diagnosed type II DM. Which medical condition listed in his history would be a contraindication for starting metformin? Renal failure Notes: Increased risk of lactic acidosis with metformin, GFR cutoff is usually <30 What is the most common cause of hyperthyroidism? Graves disease A 46 yo female presents to the ED because she feels like her heart is beating out of her chest and is also complaining of a persistent headache. On exam she is diaphoretic, has a pulse of 122, and blood pressure of 162/108. Her labs show that her plasma fractionated metanephrines are significantly elevated. A CT of the head, abdomen, and pelvis are performed and discover a mass. For the likely diagnosis in this patient, where would the mass most commonly be located? Adrenals Notes: Pheochromocytoma A 67 yo male with a history of type II DM presents to the office today complaining of SOB that is increasingly getting worse. He has also noted some unexplained weight gain as well as swelling in his lower legs. On physical exam, pitting edema is noted in the lower extremities and rales are auscultated at the lung bases. He was started on a new oral diabetic medication a few months ago by his endocrinologist but he cannot remember the name. Which class of diabetes medication was he likely started on that led to this current presentation? Thiazolidinediones (TZDs) Notes: These have a black box warning for CHF, can cause or exacerbate CHF which is why they are rarely used A 45 yo male presents to the office complaining that his wedding band no longer seems to fit and some of his hats seem to be too small. He also complains of headache as well as some visual changes. What would the initial test of choice be for this patient to screen for the likely diagnosis? Insulin-like growth factor (serum IGF-1) Notes: Clear presentation for acromegaly A 72 yo female presents to the office today for a routine checkup. She forgot to bring her medication list but says she was started on a new medication for diabetes. She said all she can remember about the medication if that it is supposed to flush the glucose out through urine. Which class of medication is this patient likely taking? SGLT-2 inhibitor Notes: SGLT-2 inhibitors end in -gliflozin, remember "Glucose is flozin out of the body" What is the most common cause of primary hyperparathyroidism? Parathyroid adenoma An 86 yo female is brought to the ED today by rescue. She was found in her apartment unconscious by a neighbor who called 911. On exam her pulse is 46, BP is 82/52, and lab findings reveal her Free T4 levels are so low they are undetectable. A family member who accompanies the patient today states she normally has a nurse who comes to the house each day to dispense her medications but unbeknownst to the family, she has not showed up for over 3 weeks. What medication was this patient likely taking daily prior to the nurse not showing up? Levothyroxine Notes: Myxedema coma, extreme form of hypothyroidism A 36 yo female presents to the office complaining of fatigue, polyuria, and recurrent candidal infections. Screening for what condition should be performed in this patient? Diabetes Mellitus