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CFPC exam KM > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Diagnosis of T1DM

A

Requires 2 lab tests, or one and symptomatic.
FBG >/ 7
Non fasting >/11.1
2h 75g GTT >/ 11.1
HbA1c >/ 6.5

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2
Q

HbA1c goals per group

A

<7: most adults, most children
<7.5: children and adolescents <18
7.1-8: functionally dependent
7.1-8.5: recurrent severe hypoglycemias, decreased life expectancy, frail, elderly

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3
Q

Annal investigations for diabetics

A

Fasting lipid q1-3 years (1 year in kids)
Optometry
ACR
Foot exam
EKG

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4
Q

What BMs must be reported to the licensing body?

A

Any severe hypo while driving in past 12 months
>1 severe hypo while awake but not driving in past 6 months

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5
Q

When to refer for T1DM

A

ACR >60mg/mmol
eGFR <30
Pets with albumineria
>30% Cr in 3 month of starting ACEi/ARB
Retinopathy/vitreous hemp/macular edema

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6
Q

What to start if symptomatic hyperglycemia +/- metabolic decompensation in T2DM

A

Insulin +/- Metformin

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7
Q

Second line for T2DM if ASCVD, HF or >60 with 2 CV risk factors

A

SGLT2i - Empagliglozin, Dapagliflozin
GLP-RA - Semaglutide, Liraglutide

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8
Q

Second line for T2DM if no cardiac hx or risk factors but wanting cardiorenal benefit and weight loss

A

SGLT2i - Empagliglozin, Dapagliflozin
GLP-RA - Semaglutide, Liraglutide

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9
Q

Second line for T2DM if no cardiac hx or risk factors but wanting weight neutral and CV neutral

A

DPP4i - sitagliptin

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10
Q

Second line for T2DM if no cardiac hx or risk factors but increased hypoglycemias

A

Sulfonylureas - glicazide

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11
Q

What T2DM meds should be held in acute illness

A

Metformin, insulin secretagogues and SGLT2i

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12
Q

Diagnosis of DKA in peds

A

BG >11, venous ph < 7.3 or bicard <15, ketonemia or mod-large ketonuria

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13
Q

What to monitor in DKA

A

q1-2h glucose, lytes, urea, calcium, magnesium, phosphate, hematocrit, blood glasses, ECG (t-waves), fluid input/output, neuro

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14
Q

DKA rehydration in peds

A
  1. 0.9% NS 10ml/kg over 60 min, may repeat
  2. Replace remaining fluid deficit over 24-48 hours with 0.9% NS at 4-6.5mL/kg/hr with 40mmol/L of KCl
  3. When glucose < 16 or down by 5 then change to 0.45 or 0.9 % NS and add glucose to fluids

1-2h after IV fluid start IV insulin at rate of 0.05-0.1 units/kg/hr

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15
Q

DKA rehydration in adults

A
  1. Rehydrate
  2. Once euvolemic check correct sodium (Na + (3/10 x glucose) - 5). If corrected sodium low or low osmolality > 3mmol/kg/hr then continue NS. If normal or high and osmolality < 3mmol/kg/hr then switch to 0.45% NS.
  3. when glucose <14 do D5W or D10W to maintain glucose 12-14
  4. When K <5.5 and patient urinating, add KCl.W
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16
Q

What is the normal function of parathyroid

A

Decrease serum ionised calcium
Secrete PTH
Increase calcium reabsorption in disral renal tubular cells
Osteoclastic bone resorption
Conversion to D3
Increase calcium reabsorption from the gut

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17
Q

What is hyperparathyroidism associated with

A

Multiple endocrine neoplasia type 1 and 2a
Familial hypocalciuric hypercalcemia
Familial hyperparathyroidism

18
Q

What are the signs of symptoms of hyperparathyroidism

A

bones, groans, stones, and psychiatric understones

19
Q

What are the investigations for hyperparathyroidism

A
  • Likely increased calcium +/- PTH
  • If normal PTH that is abnormal in setting on high calcium - repeat 3 times to confirm
  • Low phosphate and high ALP
  • Decreased BMD
  • Albumin (corrected ca)
  • R/o vitamin d deficiency
  • R/o chronic renal insufficiency
  • R/o TSSH, malignancy, adrenal insufficiency
20
Q

How can you differentiate between FHH and HPT

A

Replace vitamin D
- In HPT this increases urinary calcium
- In FHH this does not

21
Q

What is the management of hyperparathyroidism

A

Primary:
Parathyroidectomy
Hypercalcaemia - hydration, loop diuretics, pamidronate or zolendronate

FHH - no parathyroidectomy
Screen family members

22
Q

What medications can cause hyperthyroidism

A

Lithium
Amiodarone
Iodide

23
Q

What is the etiology of Graves

A

Hyperthyroidism
Autoimmune
Antibodies against TSH receptor

24
Q

What is the etiology of toxic multinodular goiter

A

Hyperthyroidism
Higher risk in iodine deficit area
Insidious onset

25
Q

What is the etiology of toxic adenoma

A

Hyperthyroidism
Younger patients in iodine deficit area

26
Q

What is the etiology of thyroiditis

A

Hyperthyroidism
Subacute - hormones leak from inflamed gland, usually resolves in 8 months, can be recurrent
Lymphocytic + postpartum

27
Q

Which tumours can cause hyperthyroidism

A

Metastatic thyroid ca
Ovarian ca

Secrete TSH

28
Q

Signs and symptoms of hyperthyroidism

A

General: weight loss, heat intolerance
HEENT: lid lag, proptosis, periorbital edema, hair loss, goiter, thyroid tenderness, nodularity, bruit
CVS: palpitations, tachycardia, afib, widened pulse pressure, HTN
MSK: tremor, edema, pretibial myxoedema, muscle weakness
GU: amenorrhea

29
Q

What should you consider if TSH and T4 are high

A

MRI - suspect TSH secreting pituitary adenoma

30
Q

Treatment of primary hyperthyroidism

A
  1. Beta blocker
  2. Methimazole - for 12-18 months then taper and d/c if asymptomatic and normal TSH
    (3. Propylthiouracil. Risk of hepatic failure)

Radioactive iodine - high cure rate
Subtotal thyroidectomy treatment of choice in pregnancy and less than 40 y/o

31
Q

Signs and symptoms of thyroid storm

A

Fever***
CNS agitation
Tachycardia
CHF
GI
?Precipitant

32
Q

Investigations for thyroid storm

A

Low TSH
High fT4
Low Hb
High WCC
High glucose
High calcium
High LFTs

33
Q

Treatment for thyroid storm

A

Can be fatal
- Decrease thyroid synthesis - methimazole
- Inhibit hormone release - potassium iodide 5 drops
- Decrease HR - BB
- Support circulation - glucocorticoids, fluids, O2, cooling

34
Q

Causes of primary hypothyroidism

A

Chronic autoimmune thyroiditis
Postpartum thyroiditis (Hashimotos)
Thyroid sx
Iodine deficiency
Cancer
Drugs - amiodarone, lithium, iodine
Agenesis/dysgenesis of the thyroid

35
Q

Causes of central hypothyroidism

A

Pituitary adenoma
Pituitary damage
Infiltrative

36
Q

Signs and symptoms of hypothyroidism

A

General: Fatigue, weakness, coled intolerance, increased weight
Cognitive: depression, decreased memory, sleep dissturbance
HEENT: enlargement of tongue, hoarseness, goitre
CVS: bradycardia, pericardial effusion, HTN, CHF and angina
Resp: Decreased exercise capacity, muscle weakness, sleep apnea
GI: Constipation
Neuro: Parasthesia, muscle cramps, delayed relaxation of deep tendon reflexes, carpal tunnel
GU: menorrhagia, amenorrhea, impotence
Derm: perioribital edema, cool pale dry skin, hair loss, thinning lateral eyebrow, brittle nails

37
Q

Investigations for hypothyroidism

A

TSH
T4
Trab
TPOab
Thyroglobulin

38
Q

When not to treat subclinical hypothyroidism

A

If TSH <10, asymptomatic, not pregnant

39
Q

When to treat hypothyroidism

A

Elevated TPO antibodies
Goitre
Strong FH autoimmune disease
Pregnancy

40
Q

What to treat subacute granulomatous thyroiditis with

A

NSAIDs

41
Q

How often to monitor TSH in hypothyroid

A

6-8 weeks after starting dose and q6-8 weeks until in target

CFPC exam KM (16 decks)

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