Endo

Question 1

Diabetes drugs

Answer 1

• metformin- blocks gluconeo, don’t use with kidney damage bc get high met levels —> LA
• sulfonylureas - gli-, increase insulin release so can cause hypogly, also siadh
• dpp4 inhib/glp ag- -gliptin, block glp metab
• thiazolodinediones - -glitazone, increase insulin sensitivity, don’t use with CHF
• sglt inhib - -flozin, act on kidneys, can cause uti
• insulin: glargine, degludec, detemir, nph are basal long acting, short acting for meals (eg aspart, lispro)
• glp analog injections (-tide)

Question 2

What to give if urine micro albumin is pos on DM

Answer 2

ACE-I

Question 3

Testing for hypercortisolism (Cushing)

Answer 3

First low dose dex suppression, if abnormal do 24 hour urine cortisol to confirm (higher spec)

Then test acth, then high dose dex for pituitary (suppressed) vs ectopic (not suppressed)

Question 4

Types of CAH

Answer 4

• 21 - low aldo, low cortisol, high androgens
• 11 - buildup of 11 deoxycorticosterone raises bp, high androgens
• 17 - buildup of 11 deoxycorticosterone raises bp, low androgen

Question 5

Non-acute Asthma tx

Answer 5

Inhaled bronchodilator (eg albut)
Then add chronic controller (eg inhaled steroid like fluticasone)
Then add laba (eg salmeterol) or Leukotriene antag (eg monteluk) or cromolyn or theophylline
Then oral steroids as last resort

Question 6

Acute asthma tx

Answer 6

Inhaled bronchodil, inhaled ipratrop (sama), bolus of steroids, o2

Question 7

Acute COPD workup and tx

Answer 7

• workup: o2, ekg, cxr, cbc, bmp, abg,
• tx: inhaled albut (saba) and ipratropium (sama), bolus of steroids, ctx and azithro for cap if cxr with infiltrate

Question 8

Chronic copd tx

Answer 8

Antimusc (ium or glycopyrr), saba (albut), laba (other erol), inhaled corticosteroids (less effective than in asthma)

Also give pneumococc and flu vax

Home o2 if po2 less than 55 or o2 sat less than 88, 60 and 90 if right heart failure

Question 9

Alpha 1 antitrypsin

Answer 9

Cirrhosis and copd - young age, no smoker, bullae in lung bases

Question 10

Sarcoidosis tx

Answer 10

Steroids

Question 11

Taper steroids if…

Answer 11

Over two week course

Bc of suppression of hpa axis when taking

Question 12

How to manage thyroglossal duct cyst

Answer 12

Resect given risk for recurrent infxn
But first ensure it’s not the only functioning thyroid tissue

Question 13

T1dm increased risk for other autoimmune diseases:

Answer 13

Thyroiditis and celiac

Question 14

T1dm initial testing

Answer 14

A1c every three months, baseline lipid panel (after glycemic control is established), screening for autoimmune (eg thyroid function, ttg), depression and ED screen

Then after five years, kidneys, eyes, neuropathy (vs t2dm start right away bc usually present later in course)

Question 15

Management of DKA

Answer 15

Start with hydration – 1 to 2 L of normal saline as bolus, followed by 500 mL per hour for the first four hours, followed by 250 mL per hour for the next few hours. Then 1/2 ns and add D5 one blood sugar drops below 250

Insulin – initial bolus of .1 units per kilogram followed by continuous infusion of .1 units per kilogram per hour

Replete k Unless K greater than 5.3, EKG changes, or kidney disease

Question 16

Classic CAH tx

Answer 16

Adrenal crisis - stress do hydrocortisone, which also acts as mineralocorticoid

Chronically, give glucocorticoid and mineral corticoid

Question 17

Relationship between estrogen and thyroid

Answer 17

Estrogen increases tbg, which normally decreases ft4, increasing tsh and t4 production. In hypothyroid, may need to increase Levo dose in high estrogen states like preg

Question 18

Meds that block conversion of t4 to t3

Answer 18

Beta blockers, steroids, ptu

Tx thyroid storm

Vs inhibits thyroid hormone secretion? KI, lithium