Awesome Review Flashcards
3 ways to Diagnose Diabetes Mellitus
- Random plasma glucose > 200
- Fasting plasma glucose > 126
- HbA1c > 6.5 %
Which antibodies do you check to confirm
Autoimmune mediated Type 1 DM
GAD 65
IA-2
Metabolic Syndrome, GO!
Fasting Glucose > 100 Fasting TG > 150 BP > 130/85 Waist circumference: Female > 35 in and Males > 40 in HDL: Females
Patient with Type 2 Diabetes Mellitus, what lab test do you order before switching from insulin to PO antiglycemic?
c- peptide
Diagnose and treat this:
Pituitary Lymphocytic infiltration causing pituitary insufficiency, headaches, MRI showing sellar mass with suprasellar extension, especially peripartum
Lymphocytic Hypophysitis
Steroids!
What is Sheehan Syndrome?
Postpartum pituitary infarction
Check for secondary cortisol deficiency
How to monitor secondary hypothyroidism?
Free T4
Name 2 Medications to treat Prolactinoma
Bromocriptine and Cabergoline
Most common type of cancer in elderly woman with long standing hypothyroidism
Primary Thyroid Lymphoma
How to treat PCOS if she doesn’t want babies?
Combined OCP or progestin secreting IUD
Why ask about fertility when initiating testosterone therapy?
May result in oligospermia and infertility
Which Sulfonylurea increases mortality in elderly and CAD patients
Glyburide
Metformin is contraindicated in which patients
If Cr >1.4, liver disease or symptomatic heart disease
How do SGLT2 inhibitors work?
Block reabsorption of glucose by the kidney
Pee out Glucose
Causing genital mycotic infections and ketoacidosis
Which oral antiglycemic is good for obese patients failing insulin therapy with high post prandial blood sugars and gaining weight on short acting insulin agents?
Amylin Analogues
Ex- Pramlinitide
Slows gastric emptying and decreases glucagon secretion
Which oral antiglycemics should be avoided in CHF NYHA II since it can cause edema, along with weight gain and Osteoporosis?
Also improves Insulin sensitivity
Thiazolidinediones or glitazone such as Pioglitazone/Actos
How do alpha Glucosidase inhibitors work? Example- Acarbose
Inhibit breakdown of carbohydrates and decrease absorption of glucose
therefore giving juice in hypoglycemics won’t work, need IV dextrose
What does UNTREATED iron deficiency, folate and B12 deficiency anemia do to HbA1c?
Falsely elevated due to decreased RBC turnover and decreased reticulocyte count
What does Hemolytic anemia or HIV do to HbA1c?
Falsely lower HbA1c due to increased RBC turnover and increased reticulocyte
How to treat Diabetic Neuropathy?
amitriptyline and Despriamine
In elderly patients- give pregabalin
How often to check the following 1. HbA1c 2. Microalbuminuria 3. Lipid 4 Optho exam
- Quarterly
- Semiannual
- Annual
- Annual
Name 4 medications that block peripheral conversion of T4 to T3?
Propranolol
Glucocorticoids
PTU
Amiodarone
Best test to follow for primary hypothyroidism treatment
Not central hypothyroidism
TSH
Best test to follow for hyperthyroidism treatment
Total T3
What does Graves’ disease show in Radioiodine uptake (RAIU)
More than 35% uptake DIFFUSE
Focal uptake is toxic nodule
What does thyroiditis show in Radioiodine uptake (RAIU)?
Both exogenous and Amiodarone causes
Less than 5%
Best test to follow for central hypothyroidism aka hypopituitary hypothyroidism
Free T4
When to treat subclinical hypothyroidism?
Symptoms, TSH >6, osteoporosis, cardiovascular disease
Thyroiditis shows what change in thyroglobulin
Increased thyroglobulin
What is the Dx?
Tender thyroid, decreased RAI uptake
Sub Acute Thyroiditis
Antibodies to differentiate Graves’ disease and thyroiditis
TSH receptor antibodies in Graves
Anti TPO in BOTH
Hashimoto’s thyroiditis is associated with which antibodies
TPO
Thyroid Peroxidase Antibodies
Which thyroid antibodies do you monitor in cancer surveillance?
Thyroglobulin Antibodies
Your hypothyroid patient gets pregnant, what do you do to her dose?
Increase by 30-50% since requirement of thyroxine is increased in all trimesters
Target TSH
Treat Vitamin D deficiency
What level of 25 HydroxyD3?
50,000 units weekly x 8 weeks
Then 1000-2000 units daily
Level
What Vitamin D dose intake has fractures been found to be preventable?
800 units daily
MEN 1
Pituitary
Parathyroid
Pancreas
MEN 2 A
Medullary thyroid cancer
Pheochromocytoma
Parathyroid
MEN 2 B
Medullary thyroid cancer
Pheochromocytoma
Mucosal neuroma
What Vitamin D level is high in Sarcoidosis?
1,25 (OH)2 Vitamin D3
What happens to PTH, Calcium and Phosphate in Vitamin D deficiency?
PTH is high
Calcium is low
Phosphate is low
Which bisphosphonate has been shown to decrease mortality in patients with osteoporosis and fracture?
Zolendronate
Treat a patient with osteoporosis and chronic kidney disease
Denosumab- RANKL inhibitor
Medication to reverse ACE-I edema
Icanibant
When to remove adrenal incidentaloma?
If > 6 cm
If functioning (4-6cm)
Or if size increases >1 cm in 1 year
Treat hot flashes
Venlafaxine or Citalopram
Treat PMS
Paroxetine
And
Chocolate 🍩🍷🍪
Treat hypo active Sexual desire disorder
Filbanserin
