Endocrine Flashcards
-When to stop metformin ??
-Maximum dose of metformin per day?
- GFR less than 30 ml/min (renal insufficiency)
-2000 mg
Hypoglycaemia pt , what to do, if pt :
1- conscious
2- can’t tolerate orally
3- can’t access iv line
??
1- oral juice
2- iv 5% dextrose
3- IM glucagon
-DKA pt, insulin regimen is?
-Hospitalized DM pt, best insulin regimen?
-(fixed regular)
-Basel ,bollus
Best medication shown to reduce mortality in DM pt?
A. SGLT-2
B. GLP-1
C. Metformin
Sglt
Ulcer on medial side ?
Artery or vein ?
Medial is vein
Lateral is Artery
What is the appropriate rate to reduce glucose in a patient with DKA ?
And why not more?
- 6mmol/L per hour
Or 100mg/dl/h
-to prevent cerebral oedema
Diabetic neuropathy ttt?
1- Amitriptyline
2-pregabalin
3- gabapentin
-what is honeymoon period in DM?
-what is somogi effect?
- when there is still residual pancreatic functioning cells , and u need to lower insulin dose in this period
-early morning hyperglycaemia , similar condition to Dawn phenomenon
-side effect of amiodarone ?
-hyperthyroidism
Sick euthyroid, what is the TSH ,T3 ,T 4 lab result?
Low TSH , high T4, N or low T3
Graves disease management?
1- BB (propranolol) > protect the heart , given initially but in MCQs, choose methimazole!
2- antithyroid medications (PTU, methimazole -1st line ttt!-)
3-radioactive iodine
4- surgery
Thyroiditis ttt??
1-BB
2- NSAID (more important than BB!!)
-multi nodular toxic goiter/solitary toxic adenoma ttt?
-radio active iodine
-surgery
-dose of thyroxine should be adjusted according to???
A. T3
B. T4
C.TSH
D. All TFT
-how many weeks should be pass before repeating TFT to adjust the dose???
-pt diagnosed with hypothyroidism and started thyroxine, came after 2 weeks from starting medication, TSH still high, what to do?
-According to TSH
-6 weeks
-continue same ttt, send home , follow up after one month ( 6 weeks most pass :)
When to ttt subclinical hypothyroidism?? ( 3 indications)
See the pic
Thyroid nodule, FNA is done, what is the management for each result is in the following:
1- class one or not diagnostic result?
2-class 2 or benign lesion
3- class 3 or atypia of undetermined significance/or follicular lesion of undetermined significance
4- class 4 or suspicious of follicular neoplasm
5- class 5 or suspicious of malignancy
6- class 6 or malignant lesion
1- Repeat FNAC
2-Follow up by US
3-Repeat FNAC
4-hemi thyroidectomy
5-hemi thyroidectomy or near total thyroidectomy
6- near total thyroidectomy
Thyroid ca that is associated with increase level of calcitonin is???
Medullary carcinoma
Approach of thyroid nodule ?
Start always with
1- TFT
Then
2-radioactive iodine uptake
3-US (usually done with radioactive iodine uptake test)
4-FNA
——————-
Note:after radioactive iodine test, if hot nodule is detected, no need to do US (risk of malignancy is low)
-in opposite, if cold nodule or euthyroid, FNA most be done , because of high risk of malignancy.
-MC nerve injury after thyroidectomy is????
-post thyroidectomy and pt have hoarseness of voice+ repeated chocking, what nerve is injured?
Recurrent laryngeal nerve !
-TSH is abnormal, what is the next step??
A. start treatment
B. T3
C. T4
D. Wait until symptoms appear
C!
- pt came with hypothyroidism S and S, normal TSH, what is ur next step?
-repeat TSH after 4 weeks and if still normal , check T4, and T3
Approach of hyperthyroidism in pregnancy?
-Methimazole is CI in the 1st trimester, PTU is indicated instead, u can use methimazole in the 2nd and 3rd trimester
-if gestational age not mentioned in the Q, choose PTU then.
CI of methimazole use in hyperthyroidism?
- severe eye disease ( graves)
-pregnancy first trimester
-pt on thyroxine, came for follow up, his TSH is high but normal T4, what is the explanation for this condition?
-medication non compliance ( ماكان ياخذ علاجة الا قبل الموعد :)
What are the Hyperparathyroidism lab results (Ca, phosphate, parathyroid hormone) for:
1-primary HPT
2-secondary HPT
3-tertiary HPT
1-(primary)mainly happen due to, Parathyroid gland adenoma (85%) ,
-Hyperplasia or multiple adenomas (∼ 15%)
In rare cases:
-Carcinomas (∼ 0.5%)
-Idiopathic
-Multiple endocrine neoplasia type 1 or 2
-Medication: lithium or thiazide diuretics
2- Secondary hyperparathyroidism caused by:
-Chronic kidney disease (most frequent cause)
-Malnutrition
-Vitamin D deficiency (e.g., reduced exposure to sunlight, nutritional deficiency, liver cirrhosis)
-Cholestasis
Note: no matter what’s is the lab results, if u find low vit D3, go with secondary!!!
3-Tertiary hyperparathyroidism: caused by persistent secondary HPT
Lab results: see the pic
-signs of hypercalcemia ?
-what are the indications for surgery when pt have primary HPT ?
Parathyroidectomy is done if any of the following is present: see the pic
- what is the galactorrhea approach ??
-cushing syndrome is suspected, what is ur approach??
First! Make sure , does cortisone high? See the pic
Second, what is the cause of high cortisone? Measure the ACTH level
(See the algorithm in another flash card)
Note:**
Diagnostic test for cushing is :low dose dexamethasone suppression test!!
-cushing disease is suspected, high cortisone is confirmed, what is ur next step??
-look for the cause, start by measuring ACTH level , see the algorithm below
-approach in adrenal insufficiency??
-1st (initial) cortisone level
-2nd Short ACTH stimulation test (synacthen test)»diagnostic!!!
**in this test, cortisone will fail to increase in both primary and secondary adrenal insufficiency!
-3rd measure the ACTH level to know the cause(see the pic for interpretation)
What is the Diagnostic test for cushing syndrome????
Diagnostic test for cushing is :low dose dexamethasone suppression test!!
-what is the adrenal insufficiency diagnostic test???
-short ACTH stimulation test or synacthen test.
Refractory HTN + Hypokalaemia, what ur next step???
-measure aldosterone -renin ratio!!!
-symptoms of Addison dis???
-difference between Addison disease and crisis ? ( only one difference)
1- see the pic
2- only difference is hypotension, addison disease > postural hypotension while crisis> persistent hypotension even after given proper iv fluid (MC happen after stressful event such as infection or surgery)
-Which type of adrenal insufficiency can be present with skin pigmentation??
-what is the reason of skin pigmentation in adrenal insufficiency?
-primary (pic)
-high ACTH
-what is the type of cortisone given to adrenal insufficiency crisis???
-Hydrocortisone
- what is the most appropriate test to detect the cause of high cortisone in the pt body????
-high dose dexamethsone suppression test!
(Be careful, low dose is diagnostic , high dose used to detect the exact cause )
-multiple endocrine neoplasia (MEN) syndrome (1,2a and 2b)??
1- DM type 2 pt since 12 ys , all her lab tests are normal, strict glycemic control, ask u about a way to prevent diabetic nephropathy ( secondary prevention) what is ur next step?
2- DM pt came for follow up, poor glycemic control, high creatinine, what is ur next step to prevent further progress of diabetic nephropathy in this pt after control of Blood suger?
1- order random urine micro-albuminuria level (pt not having diabetic nephropathy yet)
2- give ACE inhibitor therapy (already have the complication)
-hashimoto thyroiditis antibody name???
-graves antibodies?
-TPO ( thyroid peroxidase anti body)
-TSI ,AKA ( TSHR or TRAB( thyrotropin receptor) )
What is the most common thyroid cancer in children and adults???
Papillary ca
**M/C site of metastasis of papillary Ca is :LUNG!!!!!
- What r the pathology findings in papillary ca of thyroid???
-what is the prognosis of papillary ca of thyroid?
1- psamomma bodies
2-nuclear grooves
3- orphan annie’s Eye nuclei
- Good prognosis!!
- M/C site of metastasis of follicular CA in thyroid?
-age and gender ??
-how to diagnose??
-tumor spread by blood»BONE!! (Present with bone pain and thyroid lump)
-50-60 yo woman
- see the pic مهممم
What is the Prolactin level in :
-prolactinoma
-hypothyroidism
??
- more than 150-200
-less than 100
45 y o Woman with more than 12 months amenorrhea , dx??
Clinical menopause
Which antibiotic should use with caution in diabetic pt??
-fluoroquinolones (such as ciprofloxacin )
Why?
Dysglycemia causes (hypo hyper glycemia)
Regarding the size of thyroid nodule, when we can do FNA?
More than 1 cm
-echogenecity of malignant thyroid nodule appear in US as??
Hyper or hypo?
Hypoechoic
What are the classifications of pituitary adenoma? Sizes and effect? And ttt?
All types if asymptomatic then follow up with MRI, if symptomatic, first medical then surgical, medical such as : cabergoline (the best) or promocreptine ( both are dopamine agonist)
1-microadenoma (less than 10 mm-1cm-)
2-macroadenoma more than 1 cm
Usually come with neurological deficit ( such as bitemporal hemianopia )
Poor candidate for surgery parathyriodectomy what to give???
-what if pt have osteoporosis??
-cinacalcet
-biphosphanate
DM type 1, when screen celiac ?
At time of diagnosis and every 2 year if asymptomatic
What the type of thyroid ca that have the worst prognosis?
And what is the ttt??
Anaplastic ca
Type of thyroid cancer arise from para follicular c cells, dx??
Most common electrolytes imbalance associated with this ca?
What u need to screen before surgery in this cancer?
Medullary ca, it secrete calcitonin, associated with MEN 2A and 2 B
Hypocalcemia
Before surgery u need to screen for 1- hyperthyroidism 2- pheochromocytoma
How to dx medullry ca?
What is the m/c site of METS?
How to diagnose DM?
Test results in DM and pre diabetic pt :
FBS
2hr PP
HBa1C
When to follow up?
See the pic
Choice of drugs based based kn Hba1C in DM??
5.7 - less than 7.5 ?
7.5-9 ??
9 - 10??
When symptomatic with Hba1c more than 10 or random is 300 ???
Ttt of DM:
What is biguanides MOA and give me 3 s/e??
biguanides (metformin) MOA:
🚫 gluconeogenisis
🚫 absorption of suger in GI
Increase insulin sensitivity
S/E:
M/C is abdominal discomfort
Lactic acidosis
B12 deficiency
Give me 2 side effects of sulphonylureas + example of names
S/E: avoid in elderly, it cuz hypoglycaemia + weight gain
Dpp4 CI and S/E??
Contra indication in thiazolidiones? (DM ttt)
-such as rosiglitazone and pioglitazone-
What is the S/E of this medication?
Ppray inhibitors (only pioglitazone use now)
CI in HF!
S/E: wight gain, edema, osteoporosis.
GLP effect and CI??
الادوية الي تنتهي ب تايد tide!!
SGLT s/e
What is the Sglt medication that cuz toe amputation??
الادوية تنتهي ب فلوزين flozin
What are the 2 absolute indication to start insulin?
What is the effect of introducing insulin early??
DKA and ACS
Improve beta cell servival
How many injection of insulin does the type one DM take everyday?
4 , one basal 4 bolus
