Endocrine

Question 1

Management of osteoporosis

Answer 1

Lifestyle

• calcium if dietary intake insufficient
• vitamin D: 400 IU a day unless immobile and lack outdoor, then 800
• maintain BMI over 19
• limit caffeine to 1-2 servings per day because it interferes with absorption and excretion
• weight-bearing exercise
• reduce alcohol
• stop smoking
• bisphosponates (alendronate)
• denosumab
• raloxifene (SERM)
• strontium ranelate

Question 2

Tests for osteoporosis

Answer 2

DEXA scan - T score < -2.5 SD

Question 3

Bisphosponate instructions, benefits and SE, CI

Answer 3

• take it first thing in the morning on empty stomach
• remain upright for 30 mins
• reduce vertebral, hip and non-vertebral fracture risk
• can cause jaw osteonecrosis and upper GI intolerance
• CI in renal dx

Question 4

Raloxifene dose, indication, SE, CI, benefit

Answer 4

60mg orally OD
For postmenopausal women
SE: hot flush and DVT
CI: history of VTE, unexplained uterine bleeding, renal/hepatic impairment
Reduces risk of vertebral fracture only, also breast cancer

Question 5

Denosumab dose, benefits, SE

Answer 5

60mg SC every 6 months
Increase BMD at lumbar spine, hip, reduces fractures
SE: MSK pain, hypocalcemia, hypercholesterolemia, eczema

Question 6

Hypothyroidism tests

Answer 6

TFTs, thyroid antibodies, cholesterol, anemia, ECG, ultrasound of thyroid

Question 7

Managing hypothyroidism

Answer 7

Levothyroxine 50-100 micrograms daily
Monitor TSH levels monthly first, when euthyroid can monitor 2-3 months and later 2-3 years.
To deal with weight: diet and exercise

Question 8

Hyperthyroid tests

Answer 8

TFTs, antithyroid peroxidase, radioisotope scan

Question 9

Managing hyperthyroidism

Answer 9

Refer to endocrinologist 
Monitor for CVS and osteoporosis 
Carbimazole/Propylthiouracil
Beta blockers for symptomatic relief 
Radioactive iodine
Thyroidectomy

Question 10

Carbimazole SE and monitoring

Answer 10

Review in 2-6 weeks

Agranulocytosis, nausea and vomiting, arthralgia, skin rash, pruritus

Question 11

Propylthiouracil SE

Answer 11

Hepatitis, liver failure, cutaneous reactions

Question 12

radioactive iodine salient points

Answer 12

• must continue anti- thyroid drugs Ho to 2-3 days prior for elderly/comorbids
• might be hypothyroid for a while after
• CI in pregnancy, lactation, thyroid CA
• cannot get pregnant for 6 months

Question 13

Management of hyperlipidemia

Answer 13

Lifestyle modification
- diet 
- exercise and LOW 
- stop smoking and alcohol 
Pharmaco 
Other RF for CVS dx: BP, DM

Question 14

If LDL target not achieved, what drug to give

Answer 14

Ezetimibe

niacin, bile acid resins