Endocrine

Question 1

MEN 1

Answer 1

Parathyroid, Pituitary adenoma, Pancreatic (insulin, gastrin, VIP)

Question 2

MEN 2A

Answer 2

Parathyroid, Medullary thyroid Ca, Pheo

Question 3

MEN 2B

Answer 3

Marfanoid, Medullary thryroid Ca, Pheo

Question 4

Thyroid Storm Tx

Answer 4

• ABCs
• Supportive care
• Beta-blockers (careful with hemodynamic status!)
• E.g. Propranolol 60-80mg PO q4-6h
• PTU (usually 200 mg PO q4h) THEN 1 hr later
• Lugol’s iodine 10 drops q8h
• Glucocorticoids (often AI co-exists, also helps to reduce fT4 to fT3 conversion

Question 5

TSH target during pregnancy

Answer 5

TSH <2.5

• Remember to if TSH >2.5 with positive TPO Ab—>Tx
  if TSH 4.0-10 with negative TPO —>Consider Tx
  If TSH >10 with negative TPO—> Defs Tx

Question 6

Hypothyroidism in pregnancy, how much should synthroid dose be increased by?

Answer 6

20-30%, extra pill Saturday and Sunday.

Question 7

Graves in pregnancy, what therapy should you use for first trimester? Beyond?

Answer 7

1st trimester= PTU

beyond=MMZ at lowest dose possible.

Question 8

Indications for statin initiation with DM?

Answer 8

• Clinical CVD
• Age ≥ 40
• Age >30 and diabetes duration > 15 years
• Microvascular disease
• Other CV risk factors

If LDL not in target can use ezetimibe or evolocumab

Question 9

Indications for ACE/ARB initiation with DM?

Answer 9

• Clinical CVD
• Age ≥ 55 with an additional CV risk factor or end organ damage (albuminuria, retinopathy, LVH)
• Microvascular disease

Question 10

Define Primary Amenorrhea

Answer 10

• Absent menses at age 16

* Absent sexual characteristics at age 13

Question 11

Define Secondary Amenorrhea

Answer 11

Definition: No cycles for >3 months in those with regular periods, or >6 months in those with irregular periods

Question 12

PCOS diagnosis criteria

Answer 12

2 of:
• Menstrual irregularity
• Biochemical or clinical hyperandrogenism
• Ultrasound findings of polycystic ovaries

Question 13

++ Symptoms, not very high prolactin = what effect?

Answer 13

++ Symptoms, not very high prolactin?

• Hook effect – lab peculiarity where very high levels of prolactin are read as low levels. If you dilute the sample, you can get a more accurate reading

Question 14

++ Prolactin, not very many symptoms, caused by what phenomenon?

Answer 14

++ Prolactin, not very many symptoms
• Macroprolactin – a type of prolactin multimer which is biologically inactive. It can be in the serum in very high levels and cause no symptoms. It only sticks around because its clearance is slow.

Question 15

High risk sonographic features of thyroid nodule?

Answer 15

– Hypoechoic
– Irregular margins – Microcalcifications – Taller than wide
– Extrathyroidal extension
– Interrupted rim calcifications – Lymphadenopathy
– >20% increase in 2 dimensions

Question 16

Who needs Bx of thyroid nodule? (based on US features)

Answer 16

1. High/Intermediate suspicion sonographic features:>1cm
2. Low suspicion sonographic features:>1.5cm
3. Could consider:Very low suspicion>2cm
4. Do not biopsy:Purely cystic nodules

Question 17

Diagnosis of DM (HgA1c, Fasting, 75 OGTT)

Answer 17

• Fasting glucose >= 7mmol/L
• HbA1c >=6.5%
• 2h 75g OGTT >=11.1 mmol/L
• Random BG >=11.1 mmol/L
(IFG: 6.1-6.9) (Pre diabetes: 6.0-6.4%)

Question 18

Who needs FASTING lipid profile?

Answer 18

History of TG> 4.5 mmol/L
DIABETES
CKD

Question 19

Lipid targets for treatment?

Answer 19

Target
LDL-C <2 mmol/L or >50% ↓ or
Non-HDL-C <2.6 mmol/L or
Apo B <0.8 g/L or

Note1: LDL>5 … 1o target is >50% ↓
Note2: If recent MI more aggressive consider target LDL <1.8 based upon IMPROVE-IT.

Question 20

How does hypomagnesium affect the ability to correct hypocalcemia?

Answer 20

Magnesium deficiency reduces PTH secretion and causes PTH resistance. Therefore think of hypomagnesemia in someone with apparent hypoparathyroidism.

Question 21

DDX for high RAIU (>25%) and low RAIU?

Answer 21

High= endogenous uptake (think PET SCAN). Therefore, Graves or toxic multinodular goiter
Low= increased thyroid hormone but not increased production. ie. leak. Ex. Thyroiditis

Question 22

What causes a falsely low RAIU? Ie. Graves disease but RAIU is low instead of high.

Answer 22

Ø CT scan (iodinated contrast)
Ø Amiodarone (iodine load)
Ø Iodine intake (e.g. kelp)

Question 23

Should always use MMZ over PTU for treatment of hyperthyroidism (less hepatotoxicity). What are 3 instances that you would use PTU over MMZ?

Answer 23

Ø Pregnancy (risk of aplasia cutis & cleft palate)- Defs use PTU for T1, can switch to MMZ thereafter
Ø Thyroid storm
Ø Minor MMZ reactions (if severe, then shouldn’t use anti-thyroid drugs at all)

Question 24

Sub-clinical hypothyroidism is defined at TSH up to 10 without changes to fT4. Treatment is indicated if TSH>10 or…

Answer 24

Ø Symptomatic
Ø Goiter
Ø Pregnant/pregnancy-planning
Ø Positive anti-TPO antibodies

Question 25

What is Romosuzumab?

Answer 25

Used in Osteoporosis treatment:
• Monoclonal anti-sclerostin antibody
• Sclerostin is produced by osteocytes and
inhibits bone formation.
• SC injection given monthly for 12 months

Question 26

Best treatment for glucocorticoid induced osteoporosis?

Answer 26

Teriparatide

Question 27

Drug doses for Ca + Vit D in OP?

Answer 27

Vitamin D 800-2000IU/day (if age>50) OR 400– 1000 IU/day (if age < 50 and low risk of deficiency).
• Target 25-OH vitamin D level≥75nmol/L
• Aim for total calcium intake of 1200mg/day

Question 28

Benefits of switching from BBIT to pump therapy

Answer 28

1. Less hypoglycemia
2. Improved QOL
3. Modest decrease in A1c

Question 29

Anti-hyperglycemics with CVD benefit?

Answer 29

Empagliflozin
Canaglaflozin
Liraglutide- +wt loss
Semaglutide- worsens retinopathy

Dapgliflozin–>reduced hospitalizations due to heart failure but no mortaligty benefit

Question 30

Side effects of Cana and Empagliflozin? Which one has higher risk of toe amputations?

Answer 30

Risk of euglycemic DKA
Possible perineal necrotizing fasciitis
GU infections

+ Toe amputations with Cana