Endocrinology Workshop

Question 1

What should be the correct starting dose of levothyroxine?

Answer 1

25mcg daily or on alternative days, increased slowly by 25mcg every 4-6 weeks until managed.

Question 2

What impact would high dose levothyroxine have on a patient with angina?

Answer 2

Make it worse.

Question 3

What is the dose of aspirin for seconday prevention of cardiovascular disease?

Answer 3

75mg

Question 4

What is the reference range to aim for in those with newly diagnosed primary hypothyroidism?

Answer 4

Lower half of: 0.4 - 2.5mU/L

Question 5

What is the statin of choice for those recieving treatment for secondary prevention of cardiac disease?

Answer 5

80mg Atorvastatin.
LFTs, baselin U&Es, myopathy,
Initially, 3 months, Annually.
Cholesterol reduction, aim for 40% reduction in non-HDL.

Question 6

What are the targets for cholesterol reduction?

Answer 6

40% non-hdl reduction.

Question 7

Why should levothyroxine be taken on empty stomach?

Answer 7

Food can reduce absorption by up to 40%.

Question 8

How long should hyperthyroid patients be on beta blocker?

Answer 8

Only until the condition is managed.

Question 9

What is the target cholesterol range?

Answer 9

5mmol/L

Question 10

What are the main type of medication used to treat hyperthyroidism?

Answer 10

Thionamides.

Carbimazole and propylthiouracil.

Question 11

How long do patients normally take thionamides before any benefit?

Answer 11

A month or two.

Question 12

How does Carbimazole functions?

Answer 12

Inhibits the organification of iodide and hence, the synthesis of thyroid hormones.

Question 13

Why do patients taking Carbimazole need to be aware of the development of sore throats?

Answer 13

Immunosupressive activity - very important.

Question 14

Of spontaneuous causes of Cushings, what percentage are due to pituitary ACTH producing tumour?

Answer 14

70%

Question 15

Of spontaneuous causes of Cushings, what percentage are due to ectopic ACTH production?

Answer 15

15%

Question 16

Of spontaneuous causes of Cushings, what percentage are due to a primary adrenal tumour?

Answer 16

15%

Question 17

Why are pituitary adenomas hard to identify?

Answer 17

MRI only detects 70% of them, <1cm in size.

Question 18

Food reduces the absorption of levothyroxine by how much?

Answer 18

40%

Question 19

Aspirin is used for _______ prevention of cardiovascular disease.

Answer 19

Secondary never primary.

Question 20

What is the TSH reference range?

Answer 20

0.4 - 4.0mU/L

Question 21

What can cause AF?

Answer 21

Hyperthyroidism.

Question 22

What monitoring is important for carbimazole?

Answer 22

Sore throat - immunosuppressive.

Question 23

A curb score of 3 indicates what?

Answer 23

Severe infection

Question 24

What would be an appropriate CAP treatment?

Answer 24

Co-amoxiclav 1.2g TDS IV

Clarithryomycin 500mg BD IV

Question 25

How often should co-amoxiclav for CAP be administered and at what dose/route?

Answer 25

Co-amoxiclav 1.2g TDS IV

Question 26

How often should clarithromycin be administered and at what dose/route?

Answer 26

Clarithromycin 500mg BD IV

Question 27

What is an appropriate dose of a VTE prophylactic agent?

Answer 27

Dalteparin 5000UI s/c od.

Question 28

Why do we need to control the hydrocortisone/steroid doses of a person in hospital who has addisons disease?

Answer 28

So that their body can cope with the stress of being in hospital.