Endocrinology

Question 1

DM II, drowsy, serum glucose 45mmol/L, urine ketones negative, serum osmolarity 352 mmol/L, serum Na 145 mmol/L Dx, Tx

Answer 1

Dx : Hyperosmolar hyperglycemia Tx : Aggressive fluid replacement 1. 1L NS/hr 2. calculate the corrected Na level and Fluid therapy ( 4~14ml/kg/hr) accordingly - if high (>145) –> half NS - if normal (135-145) –> half NS - if low (<135)–> NS 3. start fluid therapy first and think about insulin and K

Question 2

The most common cause of diabetic ketoacidosis?

Answer 2

Acute infection followed by noncompliance with insulin

Question 3

normal serum glucose level?

DM target glucose level? before meal, after meal?

Answer 3

random, <11.1 mmol/L (200mg/dl)

before meal : 4-7mmol/L

after meal : 5-10mml/L

Question 4

DM Dx criteria?

fasting? random blood glucose?

when do you take OGTT?

Answer 4

fasting > 7.0mml/L , random > 11.1 mmol/L ==> DM

Do OGTT if fasting 5.5-6.9 mmol/L or random 5.5-11 mmol/L

Question 5

Acromegaly screening & definitive test?

Answer 5

• screening : IGF-1 level
• definitive test : OGTT with serial growth hormone measurements

Question 6

euthyroid sick syndrome

T3 level, T4 level, TSH level?

Answer 6

low T3

low or normal T4

low or normal TSH

Question 7

65 yrs, low TSH, normal freeT3, free T4

Dx? Tx?

Answer 7

Dx : subclinical hyperthyroidism

Tx with anti thyroid therapy if followng

1. >65 yrs old
2. postmenopausal women not on estrogen or bisphosphonate
3. presense of cardiac risk factors, hear disease, or osteoporosis.
4. presense of hyperthyroidism symptoms

Question 8

the most common cause of hypothyroidism in australia?

Answer 8

chronic lymphocytic thyroiditis

Question 9

obesity in children

what to rule out first??

Answer 9

hypothyroidism (TSH)

then

cushing’s syndrome (early morning cortisol, over night dexamethasone suppression)

Question 10

DM II, target

total cholesterol

triglyceride

LDL

HDL

preprandial glucose

postprandial glucose

HbA1c

Answer 10

total cholesterol : < 4 mmol/L

triglyceride : < 2 mmol/L

LDL : < 2mmol/L

HDL : > 1 mmol/L

preprandial glucose : 6-8 mmol/L

postprandial glucose : 8-10 mmol/L

HbA1c : <7%

Question 11

Diabetic neuropathy.

what to do (what to exclude) before starting pregabalin?

Answer 11

check VitB12 ( metformin can lower VitB12)

TFT (to exclude hypothyroidism)

assess for autoimmune neuropathy

Question 12

the best predictor of obesity and its associated risk?

Answer 12

waist-to-hip ratio

Question 13

At what level of prolactin increase

do you suspect prolactinoma?

Answer 13

> 6000 units

Question 14

subclinical hypothyroidism should be treated in what kind of patients?

Answer 14

2. patients with symptom
3. postmenopausal women not on estrogen or bisphosphonate.
4. patients with cardiac risk factors, heart disease or osteoporosis

Question 15

FDA blackbox warning for which DM drug?

amputation

congestive heart failure

Thyroid C-cell tumor

Answer 15

• amputation : SGLT-2 inhibitor (canagliflozin)
• congestive heart failure : thiazolidinediones (ploglitazone, rosiglitazone)
• Thyroid C-cell tumor : GLP-1 RA (liraglutide, exanatide)