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MKSAP > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What autoantibodies should you test for in immune mediated type 1 DM?

A
  • glutamic acid decarboxylase
  • tyrosine phosphatase IA-2
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2
Q

in patients taking an ACEi or Angiotensin receptor blocker, what is a simple initial test that can rule out mineralocorticoid excess?

A
  • plasma renin activity measurement
    > a non suppressed renin level rules out primary aldosteronism/ mineralocorticoid excess
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3
Q

thyroid nodule: what initial test to send for?

A

TSH

  • low TSH -> should ix with thyroid scintigraphy
  • normal/high TSH -> US
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4
Q

Indications for fine needle aspiration biopsy of subcentimeter thyroid nodules?

A
  • symptomatic
  • pathologic lymphadenopathy
  • extra thyroidal extension
  • history of childhood radiation exposure
  • familiar thyroid cancer syndrome
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5
Q

When should subclinical hyperthyroidism be treated?

A

TSH <0.1mU/L + cardiac risk factors, heart disease, high risk for osteoporosis or symptoms

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6
Q

how to adjust levothyroxine dosing in pregnant women with preexisting hypothyroidism?

A

increase the dose empirically by 30%

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7
Q

what ix to do for primary/secondary amenorrhoea after ruling out pregnancy?

A
  • FSH
  • TSH, T4
  • Prolactin
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8
Q

Patients with PCOS should be screened for…?

A
  • prediabetes/ DM
  • hypercholesterolaemia
  • obesity
  • HTN
  • obstructive sleep apnoea
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9
Q

how to diagnose male hypogonadism?

A

two low 8AM fasting serum total testosterone measurements

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10
Q

Should you give testosterone therapy in men planning for fertility?

A

no
- it impairs spermatogenesis

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11
Q

what is the calcium-creatinine clearance ratio in Familial hypocalciuric hypercalcaemia?

A

calcium creatinine clearance ratio of <0.01

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12
Q

treatment of Paget’s disease?

A

bisphosphonates
- iv zoledronic acid

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13
Q

what is a preferred 2nd line anti-diabetic drug after metformin in patients with established atherosclerotic CV disease or multiple risk factors e.g. HLD, obesity?

A

GLP1 receptor agonist (e.g. dulaglutide) or SGLTi (dapagliflozin)

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14
Q

incidentally discovered adrenal mass, what must you test for?

A

test for hypercortisolism
- even in the absence of typical symptoms

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15
Q

incidentally discovered adrenal mass: when do you also screen for pheochromocytoma?

A

if unenhanced CT attenuation >10 Hounsfield units, even in the absence of HTN

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16
Q

incidentally discovered adrenal mass: when do you also screen for hyperaldosteronism?

A

if there is also HTN or hypoK

17
Q

how to follow up an incidentally discovered adrenal mass, asymptomatic patient with no evidence of mild autonomous cortisol excess and benign imaging phenotype?

A

repeat imaging at 12 months

18
Q

hyperandrogenism + markedly elevated dehydroepiandrosterone dulfate (DHEA) levels?

A

usually adrenal source

  • given that adrenal glands are the major source of DHEAS
    (recommend to do CT Abdo when serum DHEAS >700μg/dL (19.0 μmol/L))
19
Q

what labs to monitor in a transgender male taking testosterone masculinising therapy?

A

Hb
- testosterone can cause erythrocytosis
- recommend to monitor 3 monthly for 1st year then annually

20
Q

what are some common conditions that cause upregulated conversion of 25 hydroxy vitamin D to 1-25dihydroxy Vit D with resultant hyperCa?

A

granulomatous tissue
- fungal infection, TB, sarcoid, lymphoma

21
Q

what is the next ix to send after diagnosing someone with Cushing’s syndrome?

ie. positive low dose dexamethasone suppression test, high 24h urine free cortisol measurement, high late-night salivary cortisol measurement

A

ACTH

  • to see if pt has ACTH dependent or independent Cushing’s syndrome
22
Q

In ACTH - independent Cushing’s syndrome ie. ACTH suppressed, what is the next ix to organize?

A

CT abdo to image the adrenals or MRI
- to look for cortisol-secreting adrenal adenomas and rarely, carcinomas

23
Q

In ACTH dependent Cushing’s syndrome, what ix would you do next?

A

MRI pituitary to look for pituitary tumour secreting ACTH

24
Q

In ACTH dependent Cushing’s syndrome without a pituitary tumour visualised on MRI, what test can help to differentiate between an ectopic source of ACTH and a pituitary source?

A

High dose 8mg dexamethasone suppression test

  • if pituitary source, responds to the negative feedback and suppressed the 8am cortisol by >50%
25
Q

if planning to stop denosumab/ teriparatide, what medication must you start?

A

alendronate
- prevent bone loss of new bone during withdrawal of drug

26
Q

diagnosis of pituitary apoplexy? (sudden haemorrhage or infarction of a pituitary adenoma)

A

urgent pituitary MRI.
-> then urgent neurosurgical consultation re: need to decompress the optic apparatus to preserve or restore vision

27
Q

when should pregnant women with risk factors for T2DM (e.g. PCOS) be screened for gestational diabetes?

A

screen at time of positive pregnancy test

then again at 24-28 weeks using OGTT

28
Q

what can happen to patient with multi nodular goitre after CT scans?

A

can cause thyrotoxicosis
due to administration of iodine

  • sources of iodine include contrast media, amiodarone, kelp, OTC expectorants and vaginal douches
29
Q

indications for parathyroidectomy in patients with primary hyperparathyroidism?

A
  • age < 50 years
  • serum calcium 1mg/dL (0.3 mmol/L) or greater above ULN
  • Cr Cl <60ml/min
  • 24h urine ca >400 mg/dL
  • increased risk kidney stones
  • bone disease: (fragility fractures), DEXA T score <-2.5
30
Q

long term mx of ketosis prone type 2 DM?

A

metformin

31
Q

how may obesity lead to a falsely low level of total testosterone?

A

obesity lowers sex hormone binding globulin levels -> can lead to false low level of total testosterone

-> should measure free testosterone

32
Q

what ix to differentiate between Type 1 and type 2 amiodarone-induced thyrotoxicosis?

A

Thyroid US with Doppler studies
-> Type 1 (increased vascularity)
-> Type 2 (decreased vascularity; destructive thyroiditis)

33
Q

first ix in the workup of female infertility associated with normal menstrual cycles?

A

midluteal phase serum progesterone level

34
Q

what ix to do if suspecting primary hyperaldosteronism but pt taking an ACEi or ARB?

A

elevated serum renin level - > basically excludes hyperaldosteronism

35
Q

when to check CA125 levels in patients with an ovarian cyst?

A

post menopausal women with adnexal masses

MKSAP (9 decks)

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