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MKSAP - Internal > Endocrine > Flashcards

Endocrine Flashcards

1
Q

how can you establish a dx. of DM?

A
  1. FPG > 126 mg/dL (7 mmol/L)
  2. random PG > 200 mg/dL (11.1 mmol/L)
    and symptoms OR
  3. OGTT > 200 mg/dL (11.1 mmol/L)
  4. HbA1c > 6.5%
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2
Q

impaired fasting glucose

A

fasting plasma glucose 100-125 mg/dL (5.6-6.9 mmol/L)

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3
Q

impaired glucose tolerance

A

OGTT at 2 hrs is 140-199 mg/dL (7.8 to 11.0 mmol/L)

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4
Q

diagnosis of metabolic syndrome

A
  1. BP > 130/85
  2. TG > 150, HDL < 40
  3. FPG > 110
  4. waist circumference > 40 in
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5
Q

Tx. for pt with impaired fasting glucose or impaired glucose toleracnce

A

intensive lifestyle change - 30 minutes of exercise daily and calorie-restricted diet

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6
Q

first line agent for newly diagnosed type II DM

A

metformin

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7
Q

in whom is metformin contraindicated in?

A

renal insufficiency pts

- Cr > 1.4 mg/dL for women and > 1.5 in men

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8
Q

side-effects/cons of rosiglitazone/pioglitazone

A

edema, weight gain
increased fracture risk in women
increased CV morbidity
high costs

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9
Q

what is exenatide approved for?

A

combination regimens with oral agents (tx. of DM 2) - inappropriate as monotherapy

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10
Q

hospitalized pt with uncontrolled diabetes - what should you tx with?

A

basal bolus insulin regiment consisting of long-acting insulin and rapid-acting insulin before meals

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11
Q

diabetic pt presents to eye doctor; on exam, hard exudates, microaneurysms and minor hemorrhages are seen; when questioned, the patient does not report any decline in vision

A

non-proliferative diabetic retinopathy

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12
Q

diabetic pt presents to eye doctor with loss of vision; on exam, cotton wool spots and neovascularization are visible - dz?

A

proliferative diabetic retinopathy

- fibrosis causes retinal detachment and vision loss

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13
Q

macular edema

A

new vessels in the eye become more permeable and leak serum (diabetic retinopathy)

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14
Q

what two interventions can decrease incidence and progression of diabetic retinopathy?

A

tight glycemic control

BP control

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15
Q

Tx. of proliferative diabetic retinopathy and macular edema

A

timed laser photocoagulation

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16
Q

what is the ideal insulin regimen to reduce episodes of hypoglycemia?

A

long acting basal insulin + rapid-acting insulin

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17
Q

long acting basal insulins

A

glargine
detemir
NPH - intermediate acting; 2x daily dosing

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18
Q

rapid acting preprandial insulins

A

lispro
aspart
glulisine

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19
Q

tests to establish dx. of DKA?

A

serum glucose, electrolytes, ketones and arterial blood gases

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20
Q

diagnostic criteria for DKA (4)

A
  1. blood glucose < 250 mg/dL
  2. anion gap metabolic acidosis (ph < 7.30)
  3. serum HCO3 < 15
  4. positive serum or urine ketones
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21
Q

diagnostic criteria for hyperosmolar hyperglycemic syndrome (5)

A
  1. blood glucose > 600 mg/dL
  2. arterial pH > 7.30
  3. serum HCO3 > 15
  4. serum osmolarity > 320
  5. absent serum or urine ketones
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22
Q

first step in management of hyperglycemia hyperosmolar syndrome

A

IVF with normal saline

- once volume status is restored, switch to hypotonic solutions for maintenance therapy

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23
Q

most effective Tx. of DKA (After IVF)

A 
insulin drip (IV)
- measure plasma glucose every 1-2 hours and adjust dose accordingly
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24
Q

can xanthelasma occur w/o hyperlipidemia?

A

yes, but it is mostly assoc with familial dyslipidemias

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25
Q

clusters of erythematous papules typically on extensor surfaces associated with extremely high TG levels (> 3000)

A

eruptive xanthomas

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26
Q

tendon xanthomas

A

subcutaneous nodules on extensor tendons; assoc with familial hypercholesterolemia

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27
Q

plane xanthomas

A

yellow-red plaques found in skin folds of neck and trunk; assoc with familial dyslipidemias and hematologic malignancies

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28
Q

which endocrine disorder is assoc with elevated lipid levels?

A

hypothyroidism

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29
Q

first step in management of patients with isolated low HDL cholesterol

A

lifestyle interventions - exercise, tobacco cessation, weight reduction

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30
Q

non-HDL cholesterol goal

A

30 mg/dL above the patients LDL goal (so. approx 160)

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31
Q

what does the LDL-cholesterol goal depend on? (5)

A 
smoking
HTN
older age (> 45 men, > 55 women)
low HDL ( < 40)
family hx of CAD
32
Q

LDL-goal when pt has 0-1 risk factors?

A

LDL < 160 mg/dL
- if below this, then repeat fasting lipid levels sometime in the future (every 5 years or shorter if closer to threshold)

33
Q

indications for fibrate therapy

A

hypertriglyceridemia (TG > 200) in the setting of elevated non-HDL cholesterol levels

34
Q

statin therapy in a pt with no-risk factors

A

LDL > 190 warrants tx. with statin in low risk patient

35
Q

LDL cholesterol goal in pts with DM or previous MI?

A

LDL < 100 mg/dL

36
Q

first line tx for elevated LDL cholesterol

A

statin, such as simvastatin

37
Q

colestipol

A

interrupts bile acid reabsorption and reduces LDL by 10-15%; used as a second line drug with statins bc it acts synergistically to induce LDL receptors

38
Q

ezetimibe

A

reduces LDL cholesterol by reducing its absoprtion in small intestine; reserved as adjunct to other meds if goal is not achieved or pt is allergic/intolerance to other meds

39
Q

LDL goal in pts who have had stroke or transient ischemic attack

A

LDL < 100 mg/dL

- first line tx is with a statin

40
Q

what tests should be done before initiating therapy for hypothyroidism?

A

aside from TSH and free T4, you don’t need anything to make dx of Hashimotos i.e. anti-TPO abs are not necessary for dx

41
Q

RAIU in thyrotoxicosis

A

above normal or high normal uptake (inappropriate in context of suppressed TSH level)

42
Q

RAIU in thyroiditis or exposure to exogenous thyroid hormone

A

RAIU will be below normal

43
Q

thyroglobulin levels are elevated in..

A

hyperthyroidism

destrustive thyroiditis

44
Q

what causes a decreased thyroglobulin level?

A

exogenous intake of thyroid hormones

thyroidectomy/ radioactive iodine ablation

45
Q

when should you do a FNA biopsy of a thyroid nodule?

A

any nodule > 1 cm in diameter

small nodules in pts with cancer risk factors

46
Q

risk factors for thyroid cancer

A 
extremes of age
male sex
history of head/neck irradiation
family hx
nodule > 1 cm (or rapid growth)
hoarseness
47
Q

when do you perform a thyroid scan and RAIU for a thyroid nodule?

A

in content of nodule and low TSH } may be a toxic nodule or multinodular goiter

48
Q

appropriate management of hypothyroidism in pregnancy

A

check TSH and total T4 levels throughout pregnancy - may require an increase in levothyroxine dosage in first trimester

49
Q

most appropriate medical regimen for pt with Graves’ disease

A

atenolol (BB) and methimazole

50
Q

diagnosis of post-partum thyroiditis

A

measurement of TSH and free-thyroxine levels

51
Q

low TSH
low free T3
low-normal free T4
elevated reverse T3

A

euthyroid sick syndrome

- pt usually has history of recent severe illness

52
Q

next step after you diagnosed euthyroid sick syndrome

A

repeat thyroid function tests in 6-8 weeks

53
Q

basic screening tests that should be done in everyone with a newly discovered adrenal incidentaloma

A

plasma catecholamine levels
overnight dexamethasone suppression test
aldosterone levels - if pt has HTN or hypokalemia

54
Q

metastatic lesions to adrenal glands

A 
high attenuation (Hounsfield units > 20)
bilateral
55
Q

primary adrenocortical carcinoma

A

large (>6 cm) with irregular borders and areas of necrosis

56
Q

best screening test for primary hyperaldosteronism

A

serum aldosterone:renin ratio

- ratio > 20, when serum aldosterone is > 15 is consistent with primary hyperaldosteronism

57
Q

partial suppression on high dose dexamethasone suggests?

A

ACTH secreting pituitary microadenoma

- high dose dexamethasone is usually not succesful in suppressing ACTH production

58
Q

when is adrenal imaging indicated for hypercortisolism?

A

when you have high cortisol but normal/low ACTH level –> CT scan often shows a tumor

59
Q

cosyntropin stimulation test

A

determines adrenal reserve

- used to detect adrenal insufficiency

60
Q

next step in pt with partial suppression to dexamethasone test?

A

pituitary MRI

61
Q

test of choice for diagnosing pheochromocytoma (in pt with symptoms and elevated catecholamine levels?

A

abdominal CT scan or MRI

62
Q

in patient with signs of pheochromocytoma, but abdominal CT scan shows no masses - what do you do?

A

metaiodobenzylguandine (MIBG) scan

- reserved for pts with equivocal CT results, extra-abdominal catecholamine secreting tumor or suspected malignancy

63
Q

suppressed ACTH and cortisol levels, with clinical findings of excess glucocorticoids

A

secondary adrenal insufficiency due to exogenous steroids

64
Q

tx. of adrenal insufficiency in times of increased physiologic stress

A

stress dosage (10-time normal replacement dose) of IV hydrocortisone

65
Q

Tx of acute adrenal insufficiency

A

IV fluids

IV hydrocortisone

66
Q

prevention and tx. of osteoporosis

A

vitamin D and calcium supplementation

67
Q

screening for osteoporosis

A

DEXA scan beg. at age 65 in women

- women age 60-64 should be screened if they are at higher risk (i.e. weight below 70 kg)

68
Q

indications for pneumococcal vaccine

A

people age 65 yo or older
people under 65 who live in long-term care facilities, have chronic illnesses or who are alaskan natives/american indians

69
Q

MOA of bisphosphonates

A

pyrophosphate derivatives that bind to bone surface and inhibit osteoclastic bone resorption; lower fracture risk in osteoporosis patients

70
Q

calcitonin for tx. of osteoporosis

A

nasal spray - increases bone mass in spine and decreases vertebral fractures (no effect on hip fractures)
- 2nd line to bisphosphonates

71
Q

teriparitide

A

stimulates osteoblastic bone formation; given as subcutaneous injection, should not be used for more than 2 years

72
Q

who should teriparitide be avoided in?

A

increases risk of osteosarcoma; avoid in:

  • pts with Paget dz of bone
  • unexplained elevations of ALP
  • previous radiation involving skeleton
  • history of skeletal cancer
73
Q

next best tx. in pt on alendronate who develops exacerbated symptoms of GERD?

A

IV zolendronate (once yearly infusion) or IV ibandronate every 3 months

74
Q

indications for IV zolendronate

A
  • when oral bisphosphonates are unsuccesful
  • oral BPs C/I (esophageal achalasia/stricture)
  • likely to be poorly absorbed (celiac, IBD)
  • pt is unable to remain upright for 30-60 min
75
Q

who is teriparatide reserved for?

A

pts with high risk of fracture (T score > -.30) with previous vertebral fracture and contraindications to bisphosphonate use

76
Q

definition of osteoporosis

A

presence of fragility fractures OR

bone mineral density T score less than -2.5 in pts w/o fragility fracture

77
Q

osteopenia

A

BMD T score between -1 and -2.5

MKSAP - Internal (11 decks)

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