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MKSAP KEY POINTS > Endocrine KPs > Flashcards

Endocrine KPs Flashcards

1
Q

When to use metformin for prevention of type 2 diabetes?

A

patients who are younger than 60 years of age, have a BMI greater than 35, or have a history of gestational diabetes

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2
Q

Treatment for gestational DM?

If fails?

A

Lifestyle modifcations

Insulin

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3
Q

Screening for a patient who has a history of gestational diabetes?

A

4 to 12 weeks postpartum and every 3 years thereafter.

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4
Q

Role of insulin > other therapy in type 1 DM?

A

reduces early microvascular disease

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5
Q

Metformin contraindicated with?

A

GFR<30

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6
Q

For ICU when to start IV insulin? Goal?

A

BG >200

140-200

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7
Q

Clinically significant hypoglycemia is defined as?

A

BG<54

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8
Q

Indication for moderate intensity statin?

A

diabetics 40+ years of age and an atherosclerotic cardiovascular disease 10-year risk less than 7.5%.

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9
Q

Indication for highintensity statin?

A

Pt with diabetes and known cardiovascular or vascular disease;

LDL cholesterol greater than 190 mg/dL (4.9 mmol/L),

atherosclerotic cardiovascular disease 10-year risk of equal to or greater than 7.5%.

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10
Q

How to prevent diabetic retinopathy? How to treat it?

A

Optimal blood glucose and blood pressure control

Laser photocoagulation

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11
Q

levated urinary albumin excretion is defined as?

A

> 30

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12
Q

Initial tests for pituitary incidentally noted masses? (5)

A

8 AM cortisol, thyroid-stimulating hormone, free (or total) thyroxine (T4), prolactin, and insulin-like growth factor 1.

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13
Q

Empty sella? Clinical correlation?

A

normal pituitary gland is not visualized or is excessively small on MRI

None

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14
Q

most common causes of hypopituitarism?

A

Pituitary tumors and surgery for pituitary tumors

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15
Q

patient with pituitary apoplexy or infarction - immediate next step?

A

Stress-dose glucocorticoid replacement

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16
Q

secondary (vs primary) cortisol deficiency

A

isolated glucocorticoid deficiency without mineralocorticoid deficiency

do not develop hyperpigmentation or bronzing of the skin (no ACTH)

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17
Q

Labs suggestive of secondary hypothyroidism?

A

Central hypothyroidism

inappropriately normal or low thyroid-stimulating hormone and low thyroxine (T4) (free or total) level

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18
Q

evaluation for growth hormone deficiency should be reserved for adults with at least one known pituitary hormone deficiency - why?

A

Isolated adult-onset growth hormone deficiency is extremely rare, and its clinical significance is debated

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19
Q

Treatment of central diabetes insipidus?

A

1-2x daily desmopressin

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20
Q

Patients with panhypopituitarism require lifelong replacement of ?

A

thyroxine (T4), cortisol, and antidiuretic hormone

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21
Q

Management of A patient with primary hypothyroidism and hyperprolactinemia?

A

thyroid hormone replacement with retesting of the prolactin level once the thyroid-stimulating hormone level has normalized.

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22
Q

first-line therapy for symptomatic patients with hyperprolactinemia and prolactinomas?

A

Dopamine agonists (bromocriptine and cabergoline)

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23
Q

Pt with acromegaly - adjuvant therapy for residual disease.

A

radiation therapy injectable somatostatin analogues

24
Q

Cushing disease v syndrome?

A

Disease - ACTH secreting pituitary adenoma

Any cause

25
Q

Treatment of Cushing’s disease?

A

transsphenoidal pituitary tumor resection

26
Q

Initial tests for Cushing syndrome?

A

vernight low-dose dexamethasone suppression test, 24-hour urine free cortisol, and late-night salivary cortisol.

27
Q

Pheochromocytomas are seen with? (4 genetic conditions)

A

MEN 2A/2B, NF1, VHL

28
Q

test if clinical suspicion of pheochromocytoma or paraganglioma is low?

Test if suspicion is high?

A

measurement of 24-hour urine fractionated metanephrines

plasma free metanephrines

29
Q

Long term management post-pheochromocytoma management?

A

lifelong annual plasma free metaephrines

30
Q

How to test for hyperaldo?

A

midmorning ambulatory plasma renin activity and plasma aldosterone levels

positive if aldo>15 or ratio>20

31
Q

When does an adrenal mass need to be removed?

A

Larger than 4 cm, pheo or “worrisome radiographic findings”

32
Q

Outline thyroid testing?

A

TSH ->

if high T4
if low, T4 AND T3

33
Q

Radioactive iodine uptake is only used in patients with?

A

Hyperthyroidism

34
Q

Do not use radioactive iodine if?

A

severe thyrotoxicosis, (radioactive iodine may provide additional substrate to the hyperfunctioning gland)

35
Q

Thionamides - adverse effects?

A

LFT abnormalities (PTU worse can can lead to hepatotoxicity), reversible agranulocytosis,

36
Q

Pt with subclinical hyperthyroidism - next step?

Treatment for subclinical hyperthyroidism is recommended when?

A

Repeat test in 6-12 weeks

TSH<0.1

37
Q

Lab that suggests Hasimoto?

A

TPO antibodies

38
Q

When to start thyroid supplementation for hypothyroidism?

A

TSH>10

39
Q

Medication that causes a temporary rise in TSH and low T3/T4?

A

Amiodarone

40
Q

those at highest risk for amiodarone-induced hypothyroidism?

A

women with preexisting thyroid peroxidase antibody positivity.

41
Q

In pregnant patients on levothyroxine replacement, likely need to change the dose by?

A

up 30-50%

42
Q

typical pattern of euthyroid sick syndrome?

A

Low T3/T4 with normal TSH

Then low TSH

43
Q

Outline management of thyroid nodule?

A

TSH -> if low, T3/T4 and radionuclide scan

If high, US, and FNA if >1 cm

44
Q

Malignancy risk in multinodular goiter v single nodule?

A

same

45
Q

Treatment of well-differentiated thyroid cancer ?

A

surgery, radioactive iodine, and levothyroxine suppression of thyroid-stimulating hormone

46
Q

most common causes of secondary amenorrhea?

A

pregnancy, structural abnormalities, and PCOS

47
Q

evaluation of primary and secondary amenorrhea?

If negative?

A

Prolactin, FSH, LH, estradiol, and TSH

Progesterone challenge for bleeding (if bleeds, not an estrogen problem -> likely PCOS)

48
Q

Measurement of testosterone levels is not recommended if?

Testosterone deficiency is diagnosed with?ee

If diagnosed, next step before replacement?

A

Regular AM erections, no gynomastia and normal testicular exam

Early AM total testosterone levels

Identigy the cause (prolactinoma, hemochromatosis, or intracranial mass.)

49
Q

Monitoring for patients requiring testosterone replacement therapy?

A

testosterone, prostate specific antigen, and hematocrit

50
Q

Best way to investigate semen for infertility?

A

Semen analysis obtained after 48 to 72 hours of abstinence from sexual activity

AND Need repeat for confirmation

51
Q

Unilateral gynecomastia - think? Next step?

A

malignancy. Mammogram.

52
Q

Classic symptoms of hypercalcemia?

A

Polyuria/polydipsia, constipation, Abdominal pain, AMS

53
Q

Primary hyperparathyroidism is diagnosed with?

A

elevated serum calcium levels, with an inappropriately normal or elevated intact parathyroid hormone level.

54
Q

Regardless of a DEXA result, a patient has osteoporosis if?

A

Vertebral compression fracture

55
Q

most common clinical manifestation of Paget disease of bone?

Treatment?

A

asymptomatic elevated alkaline phosphate levels.

nitrogen-containing bisphosphonate medications (alendronate, pamidronate, risedronate, and zoledronic acid).

MKSAP KEY POINTS (19 decks)

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