Usmle Step 2: Endocrinology Qbank

Front 1

Features of primary hyperaldosteronism?

Back 1

HTN, hypokalemia, metabolic alkalosis, suppressed plasma renin activity and elevated plasma aldosterone levels

Hypokalemia: muscle cramps, polyuria, elevated glucose levels

Front 2

Factitious thyrotoxicosis

Back 2

results from ingestion of excessive exogenous thyroid hormone due to psychiatric dz or attempted wt loss.

suspect in a person with low BMI and efforts at weight loss --> palpitations, sweating, weight loss, hyperactivitiy and diarrhea
- goiter and exophthalmos classically MISSING

bx would reveal FOLLICULAR ATROPHY due to suppression of endogenous thyroid hormone production

Front 3

GI manifestations of diabetes

Back 3

diabetic autonomic neuropathy - postprandial bloating, early satiety, constipation and diarrhea.

Metoclopramide (drug of choice), bethanechol and erythromycin are useful in the management of gastroparesis

Front 4

Radioiodine therapy is more likely to cause permanent hypothyroidism in what form of hyperthyroidism?

Back 4

Graves' disease (since whole thyroid gland is hyperfunctional --> complete uptake results in complete thyroid ablation)

more likely euthryroid in toxic adenoma and multinodular goiter

Front 5

Drugs of choice for diabetic neuropathy

Back 5

TCA (worsen urinary sx due to cystopathy and orthostatic hypotension due to CV autonomic neuropathy), alternatively gabapentin

also NSAIDs (though avoided in renal dysfunction)

Front 6

T3/T4 and TSH levels in generalized resistance to thyroid hormones

Back 6

high serum T3/T4 with normal or mildly elevated TSH levels

pts typically have features of HYPOTHYROIDISM despite having elevated free thyroid hormones

Front 7

initial important step in the management of non-ketotic hyperglycemic coma

Back 7

When hypovolemia is present, NORMAL SALINE should be started initially and then replaced with 0.45% saline.

Because of the large volumes of glucose induced osmotic diuresis, pts may require up to 8-10 liters of normal saline to reach the euvolemic state.

Front 8

Pts with rapid breathing and h/o weight loss, polydipsia, and polyuria

Back 8

suspect DKA in stuporous patients

Front 9

Features of metabolic syndrome

Back 9

- abdominal obesity: Men waist circum > 40 inches; women > 35 inches
- fasting glucose > 100-110
- BP > 130/80
- TriG > 150 mg/dL
- HDL cholesterol: Men < 40 mg/dL; Women < 50 mg/dL

Front 10

suspected MENIIa syndrome patient. Next steps?

Back 10

Genetic testing

If positive for RET proto-oncogene mutation, total thyroidectomy is indicated (almost 100% will develop invasive medullary thyroid carcinoma

Front 11

Most beneficial therapy in the progression of diabetic nephropathy?

Back 11

strict BP control (not glycemic control!)

only intervention that has conclusively been shown to reduce the decline in GFR once azotemia develops.

Front 12

HbA1C: describe test and what it means

Back 12

HbA1C is formed by nonenzymatic glycosylation of Hbg - level is independent of plasma glucose level, and is reflective of the avg blood glucose level within the preceding 3 month period.

Generally, every 1% increase in HbA1c corresponds with a 35 mg/dL increase in the mean plasma glucose level

Front 13

Main substrates of gluconeogenesis

Back 13

alanine, lactate and glycerol 3 phosphate

PYRUVATE is an intermediate of alanine during the process of gluconeogenesis

Front 14

What should be measured alongside the serum calcium level?

Back 14

serum albumin level --> must calculate corrected total serum calcium value.

With every 1 g/dL change in serum albumin from 4 g/dL, serum calcium changes by 0.8 mg/dL

Front 15

glucose readings:

10PM: 100
3AM: 50
7AM: 200

Reason for morning hyperglycemia?

Back 15

SOmogyi effect occurs when counterregulatory hormones kick in during period of nocturnal hypoglycemia (likely due to amount of insulin given), thereby resulting in early morning hyperglycemia

Front 16

Hirsutism developing in a menopausal woman --> what is the next step in management and what is the likely dx?

Back 16

Highly suggestive of androgen-secreting neoplasm of the ovary or adrenal

Serum testosterone and DHEAS levels are helpful in delineating hte site of excess androgen production

Elevated testosterone with normal DHEAS: ovarian source

Elevated DHEAS with relatively normal testosterone: adrenal source

DHEA is secreted from both the ovaries nad adrenals, whereas DHEAS, a sulfated form of DHEA, is speifically secreted from the adrenals.

Front 17

Characteristics of osteomalacia, rickets, paget's dz, osteoporosis, and osteogenesis imperfecta as it relates to the bone

Back 17

Osteomalacia: defective mineralization of the bone
Rickets: defective mineralization of the bone and cartilage
Paget's dz: disordered skeletal remodeling
Osteoporosis: low bone mass with normal mineralization
Osteogenesis imperfecta: defective formation of collagen