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Endocrine Flashcards

1
Q

What antibodies do we check for type 1 diabetes?

A

GAD65 and IA-2

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2
Q

How treat hypoglycemia unawareness?

A

lowering insulin dose and allowing average plasma glucose to rise for several weeks

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3
Q

How diagnose Type 2 diabetes?

A

Elevated fasting glucose >126 x 2
Random glucose > 200 with symptoms (no need for repeat)
A1c > 6.5 x2
2 hour glucose after OGTT > 200 x2

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4
Q

When start screening for type 2 diabetes?

A

USPSTF - age 40 and up if overweight, earlier if risk factors

ADA - overweight adults with one add’l risk factor and all patients 45 or older

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5
Q

What is the most effective way to minimize a patient’s risk of developing diabetes?

A

Intensive weight loss and dietary / lifestyle modification (not metformin!)

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6
Q

If a patient is non adherent with multiple insulin injections is there adherence likely to increase by using an insulin pump?

A

no

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7
Q

In what situations will the A1c be falsely low?

A

hemolytic anemia, patients taking Epo, patients with AKI

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8
Q

What is the GFR threshold for Metformin (At least according to boards guides)

A

GFR 30

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9
Q

when should screening for complications begin in patients with type 1 diabetes and type 2 diabetes?

A

type 1 - five years after diagnosis

type 2 - immediately

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10
Q

What intensity statin is recommended for:

Diabetes and avg cardiovascular risk?

A

Age 40 and up, ASCVD < 7.5 -> mod intensity statin

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11
Q

What intensity statin is recommended for:

Diabetes and CAD, peripheral vascular dz and ASCVD > 7.5?

A

High intensity statin

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12
Q

How treat diabetic mononeuropathy? ex. 3rd nerve palsy

A

trick question, do not treat, resolves spontaneously

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13
Q

How dx HHS

A

isms > 320, glucose > 600, low or no serum ketones and a relatively normal arterial pH and bicarb

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14
Q

How treat HHS?

A

Volume resuscitate with NS
IV insulin AFTER expanding intravascular volume
SubQ insulin when patient is eating and glucose is < 200

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15
Q

How diagnose DKA?

A

hyperglycemia, ketosis and hypovolemia, pH < 7.3, bicarb < 15, Anion gap

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16
Q

How treat DKA?

A

Normal saline, (1/2 normal if serum sodium is high or normal), then insulin, K repletion, glucose when plasma glucose < 250. Continue insulin and glucose until anion gap is normal

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17
Q

Should you stop insulin infusion in DKA before complete clearing of ketones?

A

No, not according to Board Basics, ‘will cause relapse of DKA”

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18
Q

What are the inpatient glucose goals for critically ill patients

A

140 to 180

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19
Q

When should pregnant women be screened for gestational diabetes?

A

24 to 28 weeks gestation with 75gm 2 hour OGTT

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20
Q

How often should women with gestational diabetes be screened for diabetes after delivery?

A

annually

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21
Q

How are pregnant women with gestational diabetes treated differently than non pregnant adults?

A
  • insulin is preferred after dietary changes
  • ACE, ARBs and cholesterol lowering drugs should be stopped
  • eye exam once per trimester
  • aggressive BP control with methyldopa, b-blockers (except atenolol), CCBs and hydral
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22
Q

Patient without diabetes, fasting glucose <60, asymptomatic, should they be evaluated?

A

NO! (see page 83 board basics)

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23
Q

How can C peptide testing be used to evaluate non diabetic fasting hypoglycemia?

A

marker of endogenous insulin production, cleavage product of insulin production.

Elevated iso: surreptitious use of oral hypoglycemic agents, insulinoma

Low iso surreptitious use of exogenous insulin

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24
Q

Workup of suspected insulinoma?

A

72 hour fast: measure glucose, insulin and peptide. If glucose <45, insulin > 5-6 and c peptide elevated then proceed with abdominal imaging

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25
Q

When suspect hypopituitarism?

A

primary target organ hypo function PLUS headache or loss of peripheral vision

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26
Q

If concerned about pituitary apoplexy, how should you treat?

A

glucocorticoids until AI has been ruled out

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27
Q

How classify pituitary adenomas?

A

microadenoma <10mm

macroadenoma >= 10mm

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28
Q

If you see:
galactorrhea and amenorrhea

Next steps?

A

serum prolactin level to assess for prolactinoma

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29
Q

If you see:
enlargement of hands, feet, nose, lips or tongue and increased spacing of teeth

Next steps?

A

Serum IGF-1 and OGTT to assess for acromegaly

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30
Q

If you see:
Prox muscle weakness, facial rounding, centripetal obesity, striae, diabetes and HTN

Next steps?

A

24hr urine cortisol excretion, Dex suppression test or late night salivary cortisol, elevated serum ACTH level to assess for Cushing’s

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31
Q

Goiter and hyperthyroidism

Next steps?

A

Check TSH and T4 for TSH secreting pituitary adenoma (rare)

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32
Q

How manage prolactinoma if:

- microprolactinoma, normal menses

A

observation

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33
Q

How manage a prolactinoma if:

symptomatic

A

medication such as a dopamine agonist like cabergoline (preferred to bromocriptine), can stop if prolactinoma no longer seen on imaging but need to repeat testing because recurrence rates are up to 50%

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34
Q

How manage a pituitary adenoma secreting GH, ACTH or TSH or if have mass effect or unresponsive to meds

A

surgery

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35
Q

How to confirm the diagnosis of diabetes insipidus?

A

urine osms less than 200 and inability to increase urine concentration during a water deprivation test

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36
Q

How you differentiate between Central and nephrogenic DI?

A

Desmopressin challenge. If the urine concentrates and that indicates central. Next order an MRI the pituitary gland. If The test is negative then order a kidney ultrasound.

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37
Q

How does subacute thyroiditis typically present?

A

Firm and painful thyroid gland

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38
Q

What can happen as a result of all forms of destructive thyroiditis

A

Permanent hypothyroidism

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39
Q

What does the term hyperthyroidism refer to?

A

Increased thyroid hormone production and release

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40
Q

What are some signs of hyperthyroidism in older adults

A

Atrial fibrillation, heart failure, depression

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41
Q

How does one diagnose thyroid storm?

A

Clinical diagnosis. Life threatening hyperthyroidism associate cardiac decompensation, fever, delirium and psychosis

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42
Q

How does one diagnose hyperthyroidism?

A

TSH and free T4. If TSH is suppressed and T4 is normal, order free T3

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43
Q

How does exogenous thyroid hormone impact thyroglobulin levels?

A

decreases thyroglobulin levels. can use this to diagnose surreptitious use of thyroid hormone

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44
Q

What is the diagnosis: elevated TSH, elevated T3, elevated free T4?

A

Secondary hyperthyroidism from a pituitary tumor

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45
Q

Diagnosis from RAIU scan: diffuse homogeneous increased uptake

A

Graves disease

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46
Q

Diagnosis from RAIU scan: patchy areas of increased uptake

A

Toxic multi nodular goiter

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47
Q

Diagnosis from RAIU scan: focal increased uptake with decreased uptake uptake in the rest of the gland

A

Solitary adenoma

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48
Q

Diagnosis from RAIU scan: decreased or no uptake

A

Iodine load, thyroiditis, surreptitious ingestion of thyroid hormone

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49
Q

Radioactive iodine therapy is first-line for what diagnoses?

A

Toxic multinodular goiter
Toxic adenoma

  • do not use in pregnancy or breast-feeding

Typically restores euthyroidism

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50
Q

What medication is first-line for Graves disease?

A

Methimazole

SE: agranulocytosis, drug rash, hepatotoxicity

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51
Q

What medication is first line for Graves disease in the first trimester and preferred in thyroid storm?

A

PTU (Propylthiouracil)

SE: Agranulocytosis, drug rash, hepatotoxicity (more common than with Methimazole)

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52
Q

What is the preferred treatment and definitive therapy for severe Graves opthalmopathy?

A

Thyroidectomy (also first line if local symptoms from bulk effect)

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53
Q

Management of thyrotoxicosis: treatment for sympathetic nervous system symptoms

A

Atenolol or propranolol

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54
Q

Management of thyrotoxicosis: preparation for thyroidectomy

A

Methimazole

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55
Q

Management of thyrotoxicosis: severe Graves ophthalmopathy

A

Methimazole or thyroidectomy

avoid radioactive iodine because can cause worsening ophthalmopathy

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56
Q

Management of thyrotoxicosis: pregnancy

A

PTU the first trimester
Methimazole in 2nd and 3rd
NO radioactive iodine

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57
Q

Management of thyrotoxicosis: subclinical hyperthyroidism

A

Methimazole if TSH <0.1

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58
Q

Management of thyrotoxicosis: subacute thyroiditis

A

NSAIDs or glucocorticoids for pain
Beta blockers for symptoms
levothyroxine for symptomatic hypothyroidism
Repeat thyroid studies in 4-6 months
50% of patients thyroid studies will normalize without intervention

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59
Q

Management of thyrotoxicosis: suspicious nodule

A

Fine needle aspiration followed by thyroidectomy if Malignant

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60
Q

Management of thyrotoxicosis: thyroid storm

A

PTU
Iodine potassium solutions
glucocorticoids
beta blockers

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61
Q

If you see a patient with a fever or sore throat on PTU or Methimazole what should you presume?

A

agranulocytosis

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62
Q

What labs does a patient with central hypothyroidism have?

A

low TSH and low T4 (both suppressed)

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63
Q

Is an antithyroid peroxidase antibody assay needed to make the diagnosis of Hashimoto’s thyroiditis?

A

no, but high levels are associated with higher risk of permanent hypothyroidism

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64
Q

What other lab findings can be seen in hypothyroidism?

A
  • elevated prolactin
  • low sodium
  • increased CK, AST, cholesterol
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65
Q

hypothyroidism labs in an inpatient – what should you do?

A

repeat labs in 4-8 weeks, usually recover

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66
Q

Do you need a thyroid scan and radioactive iodine uptake test to diagnose hypothyroidism?

A

NO

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67
Q

What’s the diagnosis? elevated TSH and normal T4

A

subclinical hypothyroidism - only treat if TSH > 10 (per Board Basics book), if pregnant or want to become pregnant

68
Q

What can decrease levothyroxine absorption?

A

celiac disease
ca and iron supplements
PPIs

69
Q

Treatment for myxedema coma?

A

levothyroxine and hydrocortisone (continue hydrocortisone until adrenal insufficiency has been ruled out)

70
Q

By what % should you increase Levothyroxine dose during pregnancy?

A

30% (2 extra pills a week)

check TFTs regularly during pregnancy

71
Q

First next steps when find a thyroid nodule?

A

ultrasound and TSH

72
Q

Thyroid nodule - TSH is low, what is the next step?

A

low TSH suggests a benign and autonomously functioning thyroid adenoma.
- order RAIU scan to confirm dx and rule out additional nonfunctioning nodules within a multi nodular goiter

73
Q

When should you get a fine needle aspiration biopsy for a thyroid nodule?

A

all nodules > 1cm with suspicious sonographic features and a normal TSH

nodules <1cm in patients with risk factors for thyroid cancer or suspicious sonographic characteristics

74
Q

when should you check a calcitonin level in a patient with a thyroid nodule?

A

only if they have hyperCa or a family history of thyroid cancer or MEN2

75
Q

How are benign thyroid nodules managed?

A
  1. serial US - rule out malignancy if they grow or develop concerning ultrasound characteristics
76
Q

How should hyper functioning solitary thyroid nodules be treated?

A

radioactive iodine ablation or hemithyroidectomy

77
Q

When should patients with a thyroid nodule have surgery?

A
  • continued nodule growth despite normal initial FNAB results
  • non diagnostic results on repeat FNAB
  • patients with malignant cytology
  • large multinodular goiters associated with compressive symptoms
78
Q

What tests are first line for Cushing syndrome?

A
  • 1mg overnight dexamethasone suppression test (positive if fails to suppress cortisol to <3)
  • 24 hour urine cortisol
  • elevated late night salivary cortisol
79
Q

If a patient who is being worked up for Cushing’s has an elevated cortisol level, what is the next step?

A

ACTH level to distinguish between ACTH dependent and independent hypercortisolism

80
Q

If a patient who is being worked up for Cushing’s has a high ACTH level (>20pg/mL) what is the next step?

A

pituitary MRI or CT

81
Q

If a patient who is being worked up for Cushing’s has a low ACTH level (<5pg/mL) what is the next step?

A

Adrenal CT

82
Q

If a patient who is being worked up for Cushing’s has a high ACTH level and no tumor on cranial imaging, what is the next step?

A

8mg dex suppression test to differentiate between pituitary tumor and ectopic tumor ACTH production.

  • no suppression of cortisol -> ectopic tumor
  • > next step is CT chest + AP
  • if suppression is achieved -> pituitary source -> intrapetrosal sinus sampling for ACTH
83
Q

What is the treatment for Cushing syndrome?

A

surgical resection of adrenal, pituitary or ectopic tumor

bisphosphonates for treatment of hypercortisolism

84
Q

what is the definition of an adrenal incidentaloma?

A

> 1cm adrenal mass discovered incidentally

85
Q

What is workup of adrenal incidentalomas?

A
  • 1mg overnight dex suppression test
  • 24 hour urine metanephrines and catecholamines
  • plasma Aldo and renin if HTN or hypoK
86
Q

Treatment of an adrenal incidentaloma?

A

surgery if >4cm or functioning

monitoring if <4cm (6-12 month f/u) + repeat hormone testing

87
Q

How do we diagnose hypoadrenalism?

A

8:00am serum cortisol <3

values >18 exclude the diagnosis

88
Q

How do we differentiate between primary and secondary adrenal insufficiency?

A

elevated morning ACTH (>20pg/mL) -> adrenal CT

suppressed or ‘normal’ ACTH (<5pg/mL) -> pituitary MRI

89
Q

What do we do if someone has a non diagnostic AM cortisol to evaluate for hypoadrenalism?

A

stimulation testing with ACTH

90
Q

If a patient is diagnosed with autoimmune adrenal insufficiency, what else should they be tested for?

A

thyroid disease, type 1 diabetes, other autoimmune endocrine diseases

91
Q

what is the treatment for hypoadrenalism?

A

4mg Dex and IV fluids if suspect an acute processes (do NOT wait for labs to come back, dex will NOT interfere with serum cortisol assay)

Hydrocort 10-30mg/dL. Oral fludricort only if primary adrenal insufficiency. Increase up to 10x for stress like surgery. Do not need fludricort if the patient is on >40 of hydrocortisone

92
Q

Can you prescribe dexamethasone for chronic replacement therapy for hypoadrenalism?

A

NO!

93
Q

What diseases are pheos associated with?

A

VHL
NF type 1
MEN 2

94
Q

How do we diagnose a pheochromocytoma?

A
  • 24 hour urine metanephrines and catecholamines if LOW pretest probability
  • plasma metanephrines when clinical suspicion is high (known hereditary syndrome or compatible symptoms)
95
Q

If someone has positive biochemical tests for a Pheo, what are the next steps?

A

MRI or CT of abdomen and pelvis

If those are equivocal, then a radioactive MIBG scan can aid in localization

96
Q

What is the treatment for a Pheo?

A

Surgery
phenoxybenzamine to control BP prep
Give IV saline to maintain intravascular volume
can use nitroprusside or phentolamine intra-op to control BP

97
Q

What can happen if you give beta blockade before alpha blockade in a patient with a pheo with HTN?

A

severe paroxysmal hypertension

98
Q

How prevalent is hyperaldo in patients with HTN?

A

up to 14%!

99
Q

What are the diagnostic criteria for hyperaldo?

A

plasma Aldo to renin ratio >20
plasma aldo level >15

give a high salt load -> will not suppress aldosterone in patients with an aldosterone adenoma

100
Q

When should you think about hyperaldo?

A

HTN, hypoK, FH of primary hyperaldo

101
Q

What BP meds can interfere with hyperaldo testing?

A

spironolactone and eplerenone because they antagonize the aldosterone receptor

102
Q

If a patient has hyperaldo confirmed on lab tests, what are the next steps?

A

CT or MRI of adrenals

adrenal vein sampling prior to surgery to determine source of aldosterone secretion if imaging is unrevealing

103
Q

what is the treatment for hyperaldosteronism?

A

spironolactone or eplerenone for adrenal hyperplasia
laparoscopic adrenalectomy for an Aldo producing adenoma
can also add on a thiazide

104
Q

Do all patients with hyperaldo have hypoK?

A

NO, only 50%

105
Q

Most common cause of primary ammenorrhea

A

50% due to chromosomal disorders, most common is Turner syndrome (XO)

106
Q

Diagnosis: lack of secondary sex characteristics, growth retardation, webbed neck, skeletal abnormalities

A

Turner syndrome

107
Q

What is the diagnostic workup for primary amenorrhea?

A

pregnancy test
karyotype
FSH, LH, TSH, prolactin
pelvic US

108
Q

What is the definition of secondary amenorrhea

A

absence of menstruation for 3 cycle intervals OR 6 consecutive months in women with previous menstrual flow

109
Q

Common med offenders for secondary amenorrhea?

A

newly initiated OCPs
antipsychotics
reglan

110
Q

What is the diagnostic workup for secondary amenorrhea?

A

pregnancy (most common cause!)
pelvic US to dx Asherman syndrome (fibrous uterine scarring)

if above workup is negative:
- estradiol, FSH, LH, TSH, prolactin

111
Q

Diagnosis for cause of secondary amenorrhea:
low estradiol
low or inappropriately normal FSH and LH

A

hypogonadotrophic hypogonadism

ddx:

  • hypothyroid
  • hyperprolactin
  • hypothalamic (stress, weight loss, exercise)
  • pituitary (tumor, Sheehan syndrome)
112
Q

Patient with hypogonadotrophic hypogonadism what is the next step in their workup?

A

progesterone challenge test

  • > no bleeding indicates low estrogen, measure estrogen level
  • > bleeding indicates normal estrogen and suggests possible hyperandrogenism (ex. PCOS)
113
Q

Diagnosis for cause of secondary amenorrhea:

  • low estradiol
  • elevated FSH and LH
A

hypergonadotrophic hypogonadism

ddx:

  • premature ovarian insufficiency
  • chemo
  • pelvic radiation
114
Q

What is the treatment for secondary amenorrhea?

A

treat underlying disorder

estrogen and progesterone replacement until menstruation returns OR age 50 years to prevent osteoporosis

For hypothalamic amenorrhea: reduce exercise, improve nutrition and attend to emotional needs

115
Q

Patient comes in with hirsutism and oligomenorrhea, what is the most likely diagnosis?

A

PCOS

116
Q

What are the diagnostic criteria for PCOS?

A

2 of the following:

  • ovulatory dysfunction
  • lab or clinical evidence of hyperandrogenism (hirsutism, acne)
  • US evidence of polycystic ovaries
117
Q

Lab evidence suggestive of PCOS?

A

mildly elevated testosterone and DHEAS levels
LH/FSH ratio greater than 2:1

*only need to order when ruling out androgen producing neoplasm, otherwise PCOS is a clinical diagnosis

118
Q

What diagnosis should you suspect in a woman with rapidly progressive hirsutism or virilization?

A

androgen secreting ovarian or adrenal tumor

119
Q

Treatment for PCOS?

A
  • intensive lifestyle modification
  • if want to get pregnant: OCP and spironolactone for hirsutism
  • if want to get pregnant: clomid or letrozole
120
Q

What is the definition of infertility

A

inability to conceive after 1 year of intercourse without contraception in women <35, or 6 months if => 35

121
Q

How diagnose testosterone deficiency?

A

two 8am total testosterone levels below reference range

if equivocal, measure free testosterone by equilibrium dialysis or mass spec

if low -> measure LH, FSH and prolactin

122
Q

If a patient is having regular morning erections, no gynecomastia and normal genitalia exam should you measure serum testosterone?

A

no!

123
Q

What should you monitor while giving testosterone treatment?

A

PSA and hematocrit

124
Q

What can result from testosterone therapy?

A

small testicles and male infertility

125
Q

What is the most common cause of hypercalcemia in outpatients?

A

primary hyperparathyroidism

126
Q

Lab findings in primary hyperparathyroidism?

A

elevated PTH, low phos

127
Q

Lab findings in hypercalcemia of malignancy?

A

low PTH, pos is normal or low

128
Q

Lab findings in multiple myeloma?

A 
low PTH
elevated Pos
AKI
Anemia
hyperCa

Dx: serum and urine protein electropheresis

129
Q

Labs in sarcoid and other granulomatous diseases?

A

low PTH
phos elevated
calcitriol elevated (especially in sarcoid)

130
Q

Workup for hyperCa?

A

iCal to exclude pseudohypercalcemia caused by an increase in plasma proteins that can bind calcium

PTH
Phos
Cr
25-OH D

131
Q

Next step in patients with hyperCa and normal PTH?

A

Measure urine Ca to exclude familial hypocalciuric hypercalcemia

132
Q

Next step if hyperparathyroid is confirmed and surgery is indicated?

A

sestamibi scan to look for an adenoma

133
Q

What is the most common manifestation of MEN1?

A

primary hyperparathyroid

134
Q

Treatment for hyperCa?

A

volume resuscitation with normal saline (LR contains Ca)
IV bisphosphonates and serum calcitonin
Oral steroids if HyperCa is from multiple myeloma or sarcoid

135
Q

Should you use loop diuretics to treat Ca?

A

Boards Basics says NO, unless the patient has kidney or heart failure, in which case you should first volume expand and then use loop diuretics (see page 102 in board basics…I know this is not what we do in reality)

136
Q

What is the most common manifestation of MEN2?

A

medullary thyroid cancer

137
Q

What lab should you check in all patients with primary hyperparathyroid?

A

serum vit d!

50% of patients have coexisting vit D deficiency

138
Q

When should patients with primary hyperpara go to surgery?

A
  1. symptomatic with hypercalcemic complications: stones, bones, etc.
  2. asymptomatic patients with
    - elevated serum Ca level >1mg/dL above ULN
    - GFR <60
    - DEXA with T score < 2.5
    - age <50

**need to carefully trend Ca post op

139
Q

How should you treat patients with primary hyperpara who are not surgical candidates?

A

cinacalcet or bisphosphonates

140
Q

When should women undergo DEXA screening?

A

65yo

Sooner if increased risk using FRAX tool with 10yr risk > 8.4%

141
Q

how often should you repeat DEXAs?

A

q10-15 years if normal or slightly low BMD and no risk factors

142
Q

is primary osteoporosis associated with any abnormalities on lab testing in the absence of fractures?

A

NO

143
Q

DEXA range for osteopenia

A

T score -1 to -2.4

144
Q

DEXA range for osteoporosis

A

T score less than 2.5

also diagnosed by fragility fracture (fracture from a fall at standing height or lower)

145
Q

MCC osteoporosis in women and men?

A

women: estrogen deficiency
men: testosterone deficiency

146
Q

Tx for osteoporosis?

A
  • smoking cessation
  • decrease EtOH
  • resistance exercises
  • sunlight
  • Vit D and Ca supplementation
147
Q

What are indications to treat someone with anti resorptive therapy for low bone density?

A
  • osteoporosis
  • osteopenia with high-risk factors
  • prior fragility fracture

cost effective with FRAX >20% for major osteoporotic fracture and or risk of hip fracture >3%

148
Q

What bisphosphonates are first line?

A

alendronate or risedronate

149
Q

what bone density meds are recommended in patients with stage 4 CKD?

A

denosumab - monoclonal antibody that inhibits osteoclast activation

150
Q

what can you use to treat pain from osteoporotic fractures?

A

calcitonin

151
Q

Are the effects from denosumab sustained after the treatment is stopped?

A

NO!

152
Q

How long should you treat with bisphosphonates for?

A

At least 5 years can then consider a drug holiday

153
Q

What are risks with osteoporosis drugs?

A

oral bisphosphonates: erosive esophagitis and atypical hip fracture

IV bisphosphonates and denosumab: osteonecrosis of the jaw

teriperidate: assoc with osteosarcoma

154
Q

how long can you treat with teriperidate for?

A

max 2 years (risk of osteosarcoma)

155
Q

Should you use estrogen replacement therapy for postmenopausal women with osteoporosis?

A

NO

156
Q

Can you combine teriperidate with a bisphosphonate?

A

NO

157
Q

Which patients should not receive IV bisphosphonates?

A

severe hypocalcemia and CKD

158
Q

When should you get a follow up DEXA after starting therapy for osteoporosis?

A

24 months

159
Q

how treat osteomalacia related to vit d deficiency?

A

oral ergocalciferol 1000 to 2000 U/d and Ca 1g/d

160
Q

When should you look for osteomalacia?

A

patients with fractures, nursing home residents (says the book)

161
Q

What is the best test for Vit D levels?

A

25-OH D

162
Q

What counts as a vit d replete level?

A

> = 20 says national academy of medicine

163
Q

What patients have lower level of Vit D from meds or medical conditions?

A

obesity

glucocorticoids

orlistat

malabsorptive disorders

164
Q

what is the recommended treatment dose for vit d deficiency?

A

50,000 IU of ergo or cholecalciferol then maintenance therapy 1500 to 2000 u /daily

165
Q

Paget’s disease: workup?

A

isolated alk phos elevation -> bone scan -> follow up xrays

treat with bisphosphonates

166
Q

Should you routinely screen for Vit D deficiency?

A

No, not in healthy populations

high value care

Boards (11 decks)

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