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The Endocrinologist CME Examination: January/February 2003

CME Review Article: CME Program Examination
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Participation Instructions

Between four and seven articles published in each bi-monthly issue will be designated course reading. Those who are interested in earning CME credit for individual issues should read each article and then complete the examination included in the issue. The tuition for each issue’s CME activity is $20.

To earn CME credit, you must read the designated CME articles in that issue and complete that issue’s examination and evaluation assessment questionnaire, answering at least 70% of the examination questions correctly. Mail a photocopy of the completed page along with a check for $20 payable to Lippincott Williams & Wilkins to:

Lippincott Williams & Wilkins

Office of Continuing Education

530 Walnut Street, 2nd Floor East

Philadelphia, PA 19106

Only the first entry will be considered for credit and must be received by LWW by April 30, 2003. Acknowledgment will be sent to you within four to six weeks of participation.

For more information about this CME program, please contact James T. Magrann, Executive Director of Continuing Education, Lippincott Williams & Wilkins, 530 Walnut Street, 2nd Floor East, Philadelphia, PA 19106; Phone: 215-521-8696; Fax: 215-521-8637.

Lippincott Williams & Wilkins is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

LWW designates this educational activity for a maximum of six (6) hours in category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent completing the educational activity.

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The Endocrinologist CME Examination: January/February 2003


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REVIEW ARTICLE 1—Discovery of a Familial Lentiginosis-Multiple Endocrine Neoplasia Syndrome: The Carney Complex

1) Primary pigmented nodular adrenocortical disease (PPNAD)

a) Is a common accompaniment of ACTH-dependent Cushing syndrome.

b) Is a form of macronodular adrenocortical hyperplasia.

c) Was an incidental surgical finding in a young woman with Cushing syndrome.

2) PPNAD has been recognized in occasional individuals with

a) Familial cardiac myxoma.

b) Nonfamilial cardiac myxoma.

3) Abnormalities found in patients with PPNAD include all the following EXCEPT

a) Myxomatous breast tumors.

b) Widespread pigmented skin macules (lentigines).

c) Sertoli-cell tumor of the testis.

d) Malignant degeneration of the adrenocortical nodules.

e) Acromegaly secondary to a growth hormone-secreting pituitary adenoma.

4) In what has come to be called the “Carney complex,” myxomas are limited to the heart and breast tissue.

a) True

b) False

5) Because the Carney complex is inherited in a dominant manner, a sensible way of identifying familial cases is to

a) Perform routine echocardiographic studies in family members to detect a myxoma.

b) Profile adrenocortical function in all relatives of an identified case patient.

c) Examine a personal photograph.

d) Examine a family photograph.

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REVIEW ARTICLE 2—Nontoxic, Nodular Goiter: New Management Paradigms

6) Which statement about thyroidectomy as primary treatment for nontoxic nodular goiter is NOT correct?

a) It rapidly decompresses vital structures that may have been compromised by a rapidly enlarging goiter.

b) The risk of vocal cord paralysis is greater when a large goiter is removed.

c) Surgical mortality approximates 5%.

d) No more than about 10% of patients have recurrent goiter when evaluated 10 years postoperatively.

7) In a majority of patients, L-thyroxine treatment—given to suppress thyrotropin secretion—alters the natural course of nontoxic nodular goiter.

a) True

b) False

8) Several reports indicate that, 3 to 5 years after radioiodine therapy for nontoxic nodular goiter, thyroid volume is reduced on the order of

a) 20% to 25%

b) 50% to 60%

c) 75% to 80%

9) The most important late complication of radioiodine therapy is

a) Thyroid or extrathyroidal cancer.

b) Hypothyroidism.

c) Autoimmune hyperthyroidism.

d) Atrial fibrillation.

10) A single dose of recombinant human thyrotropin, given before radioiodine,

a) Increases radioiodine uptake.

b) Substantially lowers the dose of radioiodine needed to decrease thyroid volume.

c) Provides a more homogeneous distribution of radioiodine within a nodular goiter.

d) Has all of these effects.

e) Has none of these effects.

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REVIEW ARTICLE 3—Management of Lesions of the Pituitary Stalk and Hypothalamus

11) A highly infiltrative craniopharyngioma extending outside the sella is best managed by a ________ surgical approach.

a) transphenoidal

b) subfrontal

12) Among several types of primary tumor found in the pituitary stalk/hypothalamus region, one for which radiotherapy is much likelier than surgery to be curative is

a) Gangliocytoma.

b) Meningioma.

c) Glioma.

d) Germ-cell tumor.

e) Chordoma.

13) In deciding on treatment for lymphocytic hypophysitis, it is important to recall that

a) Transphenoidal surgery virtually always prevents progression of a visual field defect.

b) Diabetes insipidus may develop postoperatively.

c) Steroid treatment has established value in treating this condition.

d) A dopamine agonist may limit sellar enlargement.

14) When sarcoidosis involves the pituitary stalk/ hypothalamus region, a trial of ________ is warranted, reserving ________ for resistant cases.

a) Steroid / cyclophosphamide

b) Cyclophosphamide / steroid

15) A reasonable treatment approach when Langerhans-cell histiocytosis involves this region is

a) Surgery.

b) Radiotherapy.

c) Surgery followed by radiotherapy.

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REVIEW ARTICLE 4—The Diagnosis and Management of Hyperprolactinemia

16) All of the following have been associated with hyperprolactinemia EXCEPT

a) Renal failure.

b) Breast-feeding.

c) Cocaine abuse.

d) Skin lesions on the abdominal wall.

e) Psychotropic drugs.

17) Which individual is more likely to respond to pharmacotherapy?

a) One with a macroadenoma and a serum prolactin (PRL) above 200 mg/mL.

b) One with a parasellar lesion and a serum PRL less than 150 mg/mL.

18) The size of a prolactin-producing pituitary adenoma generally correlates positively with the serum PRL.

a) True

b) False

19) Compared with bromocriptine, the alternative dopamine agonist cabergoline

a) Has to be given at shorter intervals.

b) Only rarely leads to the complete elimination of a prolactin-secreting adenoma.

c) Is at least as effective, and possibly more effective, in reducing tumor volume.

d) Is ineffective in patients who previously received other dopamine agonist treatment.

20) In terms of relieving symptoms and normalizing the serum PRL, surgery is more successful in

a) Patients with a macroadenoma.

b) Patients with a microadenoma.

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REVIEW ARTICLE 5—The Liver, Liver Disease and Diabetes Mellitus

21) Patients infected by hepatitis C virus, especially those with cirrhosis, are at increased risk of developing

a) Type 1 diabetes mellitus (DM1).

b) Type 2 diabetes mellitus (DM2).

22) A study of patients with DM2 showed that the amount of insulin needed to lower blood glucose correlated directly with

a) Liver enzyme levels.

b) Serum bilirubin levels.

c) Hepatic fat content.

d) Liver size as demonstrated by imaging.

23) Increased insulin resistance is a feature of

a) Idiopathic hemochromatosis.

b) Primary iron overload.

c) Both of these conditions.

d) Neither of these conditions.

24) In patients with cirrhotic liver failure and so-called “hepatogenous diabetes,” liver transplantation reportedly

a) Cures diabetes in virtually all survivors.

b) Eliminates hypersecretion of insulin.

c) Improves regulation of blood glucose.

25) Severe hepatotoxicity

a) Has occurred with all oral hypoglycemic agents.

b) Occasionally complicates metformin therapy.

c) Has been a particular problem with troglitazone.

d) Is a “class effect” of the thiazolidinedione group of oral hypoglycemic drugs.

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The Endocrinologist CME Examination: EXAMINATION ANSWER SHEET

January/February 2003

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