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PSBIM 2024 recall > Endocrinology > Flashcards

Endocrinology Flashcards

recall

1
Q

OGTT positive values in pregnancy (24-28 weeks)

A

FBS 92
1 hr 180
2hr 153

(Any 1 positive = GDM)

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2
Q

WHR and waist circumference cut off to be a clinical risk factor for T2DM

A

WHR >/= 1 in males
WHR >/= 0.85 in females

Waist circum >/= 90cm in males
Wast circum >/= 80cm in females

(Unite Guidelines)

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3
Q

Target pre prandial CBG in nonpregnant adults

A

80-130mg/dL

*Postprandial <180mg/dL

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4
Q

Target pre prandial CBG in older/high risk adults

A

90-140mg/dL

*Postprandial <200mg/dL

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5
Q

Consider Metformin in these individuals with IFG and IGT who are very high risk for progression to DM

A

Age <60 yes
BMI >35
Women with history of GDM
(HPIM)

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6
Q

Antidiabetic agents that act in a glucose dependent manner

A

GLP1 receptor agonists
DPPIV inhibitors

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7
Q

Hallmark of proliferative diabetic retinopathy

A

Neovascularization in response to retinal hypoxemia

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8
Q

Definition of albuminuria in DKD

A

Urinary albumin to creatinine (UACR)
>30mg/g on a spot specimen

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9
Q

Two FDA approved oral agents used for pain associated with diabetic neuropathy

A

Duloxetine, pregabalin

May also respond to TCAs, venlafaxine, carbamazepine, tramadol, or topical capsaicin products (patch)M

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10
Q

Most common pattern of dyslipidemia in DM

A

Hypertriglyceridemia and reduced HDL

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11
Q

Antidiabetic agents that promote weight gain

A

TZD, SU, Insulins

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12
Q

Antidiabetic agents that promote weight loss

A

SGLT2 inhibitors, GLP1 receptor agonist, Amylin agonist

*Metformin - moderate weight loss / weight neutral

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13
Q

Maximum dose for Metformin

A

2grams/day

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14
Q

Target glycemic goals for hospitalized patients

A

(1) in critically or non–critically ill patients: glu- cose of 7.8–10.0 mmol/L or 140–180 mg/dL

(2) in selected patients: glucose of 6.1–7.8 mmol/L or 110–140 mg/dL with avoidance of hypoglycemia

(3) perioperative period should be 80–180 mg/dL (4.4–10.0 mmol/L)

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15
Q

Monitoring of thyroid function in maternal hypothyroidism

A

Every 4-6 weeks during first half of pregnancy then 6-8 weeks after 20 weeks AOG

*Increase LT4 to once a day to NINE DOSES / WEEK

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16
Q

Management of myxedema coma

A

IV levothyroxine is initially given as single IV bolus at 200-400mcg/IV followed by daily oral dose of 1.6ug/kg/day

Hydrocortisone 50mg/IV every 6 hours

External warming if Temp < 30C

If severe hyponat - hypertonic saline
If severe hypogly - IV glucose
Avoid hypotonic solutions

17
Q

Antithyroid meds starting dose

A

Methimazole 10-20mg every 8 or 12 hours (half life of 6h)

PTU 100-200mg every 6-8 hours ((90m half life, shorter, hepatotoxic hence indications are only: 1st trim of pregnancy, thyroid storm, and patients with minor adverse rx to methimazole. Monitor LFTs if on PTU)

*TFTs repeated after 4-6 weeks
Dose is titrated based on FT4 levels Euthryoidism after 6-8 weeks of
TSH is often suppressed for several months

18
Q

Management of thyrotoxic crsis

A

Large doses of PTU 500-1000mg loading and 250mg every 4 should be given orally or by NGT/Rectum
If no PTU –> methimazole 20mg q6h

1 hour after PTU –> SSKI 5 drops every 6h to block thyroid hormone synthesis via Wolff- Chaikoff

Propanolol 60-80mg q4h or 2mg IV every 4h
Hydrocortisone 300mg IV bolus then 100mg q8h

19
Q

Management of severe ophthalmopathy with optic nerve involvement

A

Pulse therapy with IV methylpred (500mg onc a week for 6 weeks then 250mg once a week for 6 weeks)

Orbiatl decompression via transantral route

Teprotumumab – 10mg/kg IV and 20mg/IV every 3 weeks for 21 weeks for active thyroid eye disease

20
Q

Management of silent thyroiditis

A

-Brief course of propranolol 20-40mg 3-4x a day
-LT4 replacement may be required but should be withdrawn after 6-9 months once recovered

*Glucocorticoids not indicated
Antithyroid not indicated

21
Q

Types of amiodarone induced thyrotoxicosis (AIT)

A

Type 1 - associated with underlying thyroid abnormality (preclinical Graves’ disease or nodular goiter)

Type 2 - in individuals with no intrinsic thyroid abnormalities

21
Q

Management of subacute thyroiditis (thyrotoxic, hypothyroid, recovery)

A

Aspirin 600mg every 4-6 hours of NSAIDS
Glucocorticoids if inadequate or with marked local/systemic symptoms (Prednisone 15-40mg dependending on severity, tapered over 6-8 weeks)

LT4 replacement may be needed if hypothyroid phase is prolonged * but only. Low dose 50-100 ug/daily

*Antithyroid not indicated

22
Q

Effects of Amiodarone on thyroid function (4)

A

(1) acute, transient suppression of thyroid function

(2) inhibition of T4 to T3 conversion causing either euthyroid hyperthyroxinemia or increased dosage requirement in LT4-treated hypo- thyroid patients

(3) hypothyroidism in patients susceptible to the inhibitory effects of a high iodine load; and

(4) thyrotoxicoMainstaysis that may be caused by either a Jod-Basedow effect from the iodine load, in the setting of MNG or incipient Graves’ disease, or a thyroiditis-like condition due to a toxic effect on thyroid follicular cells

23
Q

Maintstay of thyroid canccer treatment

A

LT4 suppression of TSH

Target normal TSH 0.5-2.0miU/L
If at intermediate/high risk of recurrence target lower!!

0.1-0.5mIUmL (intermediate)

<0.1mIU/L if high risk and with mets

24
Q

Drugs used in tx of Cushing’s disease

A

Pasireotide - somatostatin receptor ligand; SE: hyperglycemia
Osilodrostat - oral 11beta hydroxylase inhibitor, SE: GI symptoms, hypokalemia, hypertension, QTc prolongation
Ketoconazole - SE hepatic transaminases, gynecomastia, impotence, GI upset, edema
Mifepristone - for hyperglycemia, does not target pituitary tumor
Metyrapone - acne, hirsutism
Mitotaine - suppress cortisol hypersecretion

25
Q

Definition of diabetes insipidus

A

24h urine vol >40mL/kg body weight and
24h urine osm <280mosm/L

26
Q

Initial hormonal tests when suspecting pituitary adenoma (5)

A

(1) basal prolactin (PRL)

(2) insulin-like growth factor (IGF)-1

(3) 24-h urinary free cortisol (UFC) and/or overnight oral dexamethasone (1 mg) suppression test

(4) α subunit, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)

(5) thyroid function tests

27
Q

Indications for bone mineral density testing

A
  1. Women age >65, men >70
  2. Younger postmenopausal women,
    women in menopausal transition, men
    50-69 with clinical risk factors for fx 3. Adults who have a fracture at or after
    age 50
  3. Adults with condition (e.g. RA) or taking
    medication (e.g. steroids at daily dose of >5mg pred or euivalent for >3 months associated with low bone mass or bone loss
28
Q

Treatment for mineralocorticoid excess from unilateral adrenal mass

A

<40 yrs, laparoscopic adrenalectomy

> 40 years, adrenal vein sampling
if positive proceed to unilateral adrenalectomy
if negative, Drug treatment (spironolactone/ epleronone/amiloride)

29
Q

Difference between primary and secondary adrenal insufficiency

A

Primary - loss both glucocorticoid and mineralocorticoid secretion
Secondary - loss of glucocorticoid only

*adrenal androgen secretion impaired in both

30
Q

Characteristic biochemical feature of primary adrenal insufficiency

A

Hyponatremia

31
Q

Most common cause of primary adrenal insufficiency

A

Autoimmune adrenalitis

32
Q

Treatment of acute adrenal insufficiency

A

Immediate initiation of rehydration – saline infusion at 1L/h with continuous cardiac monitoring

Glucocorticoid replacement – bolus hydrocortisone 100mg then 200mg hydrocortisone x 24h

Mineralocorticoid replacement initiated once daily hydrocortisone dose has been reduced to <50mg (Fludrocortisone 100-150ug)

33
Q

Initial tests screen for hormone excess in investigating adrenal mass (4)

A

Plasma metanephrines or 24-h urine for metanephrine excretion

Dexamethasone 1 mg overnight test; if positive; also perform plasma ACTH, midnight salivary cortisol (≥2x), 24-h urine for free cortisol excretion (≥2x)

Plasma aldosterone and plasma renin in patients with hypertension and/or hypokalemia

If tumor >4 cm: Serum 17-hydroxyprogesterone, androstenedione, and DHEAS

34
Q

Dx of adrenal insufficiency using short cosyntropin test

A

Cutoff for failure is usually defined at cortisol levels of <450–500 nmol/L (16–18 μg/dL) sampled 30–60 min after ACTH stimulation

35
Q

Treatment for chronic adrenal insufficiency

A

Administer at dose that replaces physiologic daily cortisol production

Oral hydrocortisone 15-25mg in 2-3 divided dose

at least half of the dose should be given in the morning

PSBIM 2024 recall (9 decks)

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