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Royal College Exam > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

How do you diagnose diabetes?

A

If positive, need to confirm on a second day. No need if positive AND symptomatic:

A1c > 6.5%
Fasting glucose > 7
2h 75g oGTT >= 11.1
Random glucose >= 11.1

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2
Q

how do you prevent/treat atypical femoral fractures?

A

Prevent: consider drug holiday on oral bisphosphonates for 5 years (IV for 3 years) - DO NOT STOP IN HIGH RISK PTs

Treat: stop bisphosphonate. Consult ortho. ? teriparatide

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3
Q

How do you screen and diagnose acromegaly?

A

Screen: IGF1 level
Diagnose: 75g glucose suppression

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4
Q

How do you screen for cushing’s?

A

Need 2/3 of:

Midnight salivary cortisol
1mg dex suppression test
24 hour urine free cortisol

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5
Q

How do you treat hypoglycemia episode?

A

Mild to moderate - 15g glucose/sucrose tabs
Severe (require assistance) 20g glucose tab

If taking acarbose, NEED TO GIVE DEXTROSE OR MILK OR HONEY

Unconscious = 1mg glucagon IM or 10-25g of dextrose IV

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6
Q

How do you treat Paget’s disease of the bone?

A

IV bisphosphonate

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7
Q

How does ACTH help in diagnosis of Cushing’s?

A

If ACTH high, consider pituitary or ectopic source. Need 8mg Dex supp test. If suppressible, likely pituitary source. Otherwise CT chest for ectopic source.

If ACTH low, consider adrenal adenoma/carcinoma. NEED CT ADRENAL

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8
Q

How does Mg affect Ca balance?

A

Low Mg reduces PTH secretion and causes PTH resistance

Low Mg = hypoPTH = High PO4 and LOW Ca

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9
Q

How does PTH affect calcium and phosphate?

A

Increases calcium and decreases phosphate

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10
Q

How does thiazide affect PTH?

A

May cause low PTH due to associated hypercalcemia, but can also unmask primary hyperPTH and cause increase in PTH

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11
Q

how does vitamin D affect calcium and phosphate?

A

Both go same direction.

I.e granulomatous disease = hyper Ca hyper PO4

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12
Q

How much do you expect to reduce LDLs with initiation of statins?

A

20-40% reduction for starting dose

Additional 6% for each doubling of dose

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13
Q

What are “automatic” high risk features for future osteoporotic fractures?

A
  1. Prior fragility fracture AND prolonged use of steroids (>=7.5mg/d x 3 months)
  2. Hip or Spine fracture
  3. > 1 fragility fracture
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14
Q

What are 3 benefits to switch from basal bolus regimen to continous subcutaneous insulin infusion for type 1 diabetics?

A

Small improvement in A1c
Increased treatment satisfaction and QoL
Reduction in severe hypoglycemia if high rates of baseline severe hypos

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15
Q

What are 3 situations when target of A1c should be < 8.5%

A

Recurrent severe hypo/hypo unawareness
Decreased life expectancy
Frail elderly with dementia

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16
Q

What are antithyroid drug options? When should you use them?

A

Methimazole and PTU

MMZ > PTU EXCEPT
Pregnancy
Thyroid storm
Minor MMZ reactions

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17
Q

What are components of MEN1 syndrome?

A

PPP

Parathyroid
Pituitary adenoma
Pancreatic (insulin, gastrin, VIP)

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18
Q

What are components of MEN2A syndrome?

A

PMP

Parathyroid
Medullary thyroid
Pheochromocytoma

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19
Q

What are components of MEN2B syndrome?

A

MMP

Marfanoid, mucosal neuromas
Medullary thyroid
Pheochromocytoma

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20
Q

What are contraindications to radioactive iodine ablation?

A

Pregnancy, breast feeding, moderate to severe orbitopathy (can worsen orbitopathy)

Need to stop methimazole for 2-3 days prior
If given with orbitopathy, need steroids

21
Q

What are high risk features of thyroid nodule ultrasound?

A 
hypoechoic
irregular margins
Microcalcifications or interrupted rim calc.
Taller than wide, extend beyond thyroid
lymphadenopathy
>20% increase in 2 dimensions
22
Q

What are indications for surgery for primary HyperPTH?

A

Stay The Fudge Away U Silly Calcium

Serum calcium > 0.25 upper limit
T score < 2.5 at L spine, hip, femoral neck or distal radius
Fractures 
Age < 50
Urine calcium > 10mmol/d (>400mg/d)
Stones or nephrocalcinosis
Creatinine clearance <60ml/min
23
Q

What are indications for surgery in tertiary hyperparathyroidism?

A

Refractory hyperPTH despite vit D analogues/calcimimetics
Hypercalcemia severe/symptomatic
Calciphylaxis
Progressive bone dx

24
Q

What are JAMA RCE findings of osteoporosis?

A 
Weight < 51kg (LR+ 7.3)
Wall-occiput distance > 0cm (LR+ 4.6)
Rib pelvis distance <2 finger width (LR+ 3.8)
Tooth count < 20 (LR+ 3.4)
Self-reported hump back (LR+ 3.0)
25
Q

What are radiographical and biochemical findings of Paget’s disease of bone?

A

Elevated ALP without other abnormalities

XR: thickened cortices with tunnelling and accentuated trabeculae.

26
Q

What are redflags for adrenal incidentaloma?

A

Size >4cm (proceed with surgery)
Hounsfield Units > 10 (>20 need surgery)
<50% delayed contrast washout

27
Q

What are screening and confirmatory testing for Pheochromocytoma?

A

Screen: 24hr urine metanephrines/catecholamines

Confirm: MR abdo or CT abdo with delayed contrast washout

28
Q

What are statin indicated conditions?

A 
Clinical atherosclerosis
AAA
DM
CKD
LDL > 5.0
29
Q

What are surgical indications for pituitary tumours?

A

Hormonal hypersecretion
Hormonal hypofunction
Mass effect
Hemorrhage

NOT PROLACTINOMA = medical

30
Q

What are treatments for prolactinoma?

A

Dopamine agonists

Cabergoline > Bromocriptine

31
Q

What are vascular indications for statin in diabetes?

A 
Clinical CVD
Age >=40
Age > 30 and diabetes > 15 yrs
Microvascular disease
Other CV risk factors
32
Q

What are contraindications to GLP-1 agonists?

A

Concern for retinopathy (Semaglutide), family/personal history of medullary thyroid Ca or MEN2, pancreatitis.

33
Q

What is screening test for Conn’s?

A

Plasma Aldo to renin ratio (must be off MRA, ACEi, beta blocker, clonidine etc)

34
Q

What is the 25-OH vitamin D and Calcium level target for osteoporosis?

A

> =75nmol/L 25-OH vit D

>= 1200mg/day Ca

35
Q

What is the 8 AM cortisol cutoff for adrenal insufficiency? What is the cutoff for ACTH stim test?

A

<83 very likely AI
>500 very unlikely AI

Anthing in between gets ACTH stim
Cortisol should be > 500 at 30min or 60min
If not, then AI

36
Q

What is the management strategy for subclinical hypothyroidism in pregnancy?

A

Treat with target < 2.5 if TSH>10, TSH>4 and anti-TPO antibody negative, or TSH>2.5 and anti-TPO antibody positive.

37
Q

What should the blood glucose be for diabetics to drive?

A

> 4.0 (4 to DRIVE)

If hypoglycemic episode, should wait 40 minutes after treatment and BG should be > 5.0

38
Q

When should you treat subclinical hypothyroidism?

A 
Symptomatic
Goiter
TSH > 10
Pregnancy/prengnancy planning
Positive anti-TPO antibodies
39
Q

When should you instruct diabetics not to drive?

A

Any episode of severe hypoglycemia while driving in the last 12 months

More than 1 episode of severe hypoglycemia while awake (not driving) in the past 6 months for private, 12 months for commercial

40
Q

When should you screen for Conn’s syndrome?

A

Refractory HTN on >= 3 drugs
Spontaneous hypokalemia < 3.5 or severe diuretics induced hypoK < 3
Adrenal incidentaloma

41
Q

When should you screen for nephropathy? What screens as positive?

A

5 years after diagnosis in Type 1
All type 2

Random urine ACR > 20, or eGFR < 60

42
Q

When should you start insulin in a newly diagnosed type 2?

A

If they have symptoms of hyperglycemia with metabolic decompensation i.e.:

Polyuria
Polydipsia
Weight loss 
Volume depletion
HHS/DKA
43
Q

When should you switch agents in osteoporosis?

A

Treatment failure - fragility # or progressive decline in BMD despite therapy for a yr

FIRST RULE OUT OTHER SECONDARY CAUSES OF OSTEOPOROSIS. Switch to another first line agent. Ensure non-pharma interventions in place

44
Q

When should you use propanolol for hyperthyroidism?

A

Symptom control especially for elderly, resting HR >90 or CVD

45
Q

Which diabetes agents are safe for EGFR < 15?

A

Lina/sitagliptin
Repaglinide (secretagogue)
Pio/Rosiglitazone
Insulins

46
Q

Who needs biopsy for thyroid nodule?

A
  1. High/intermediate sonographic features > 1cm
  2. Low suspicion sonographic features > 1.5cm
  3. Maybe very low suspicion > 2cm

DO NOT BIOPSY PURE CYSTIC NODULES

47
Q

What are findings of diabetic amyotrophy?

A

Proximal motor neuropathy, pain, decreased reflexes, asymmetric at onset, no sensory impairment.

48
Q

What medications must be held prior to testing for hyperaldosteronism (e.g. multiple antihypertensives, adrenal incidentaloma, diuretic-induced hypokalemia)?

A 
ACE/ARB
MRA
Beta blockers
Clonidine, methyldopa
DHP-CCB

Royal College Exam (15 decks)

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