Fellowship Flashcards
What is the starting dose of Simvastatin?
40 mg. (To practice evidence based medicine you have to do what they do)
Hyperthyroidism: How would you dose methimazole if the free T4 is less than 2 ng/L?
10 mg/day.
Hyperthyroidism: How would you dose methimazole if the free T4 is 2 - 4 ng/L?
20 mg/day.
Hyperthyroidism: How would you dose methimazole if the free T4 is 4 - 6 ng/L?
30 mg/day
Hyperthyroidism: How would you dose methimazole if the free T4 is more than 7.8 ng/L?
20 - 30 mg bid or tid. Doses more than 40 mg/day not really more effective.
What should you check in all females before starting anti-thyroid drugs?
Pregnancy test.
Which anti-thyroid drug can be used in the first trimester of pregnancy?
PTU (Propylthiouracil).
If a patient with hyperthyroidism is pregnant and in the second or third trimester then which anti-thyroid drug would you use?
Methimazole.
Which five antibodies are associated with diabetes mellitus type 1?
- Anti-GAD (glutamic acid decarboxylase) 65 antibody.
- Islet cell antibody.
- Insulinoma associated protein 2 auto-antibody.
- Insulin auto-antibody.
- Zinc transporter 8 antibody
How long after starting anti-thyroid drugs should the WBC be checked?
3 - 7 days.
How should you change the dose of levothyroxine during pregnancy?
Increase by 20%. (Give 1 - 2 extra pills on the weekend).
Does it matter whether or not metformin is given in divided doses?
No it does not.
Why is metformin given in divided doses?
Because it causes diarrhea and GI upset if given all together.
How long does metformin take to show effects?
About 6 weeks.
Ideal method of initiating a patient on metformin.
Start with 250 mg after breakfast and dinner everyday. After a week or two 500 mg after dinner and breakfast. After another week or two 750 mg twice a day and then 1000 mg twice a day. This reduces GI complaints.
What is the likelihood of an identical twin having type 1 diabetes mellitus if the other twin has it?
About 30%.
What is the likelihood of an identical twin having type 2 diabetes if the other twin has it?
Almost 100%.
If the blood glucose is very high then why do the patients need very large amounts of insulin and take a long time to come back to normal?
They have hyperglycemic toxicity or glucose toxicity.
It’s better to just put them on a drip in the beginning to bring them down to normal sooner.
If you have diabetic retinopathy then do you have nephropathy?
You can. But not necessarily.
What’s the best treatment for very high triglyceridemia in a diabetic?
Insulin
What test can you order to determine a patient’s average blood glucose over the past 2 - 3 weeks?
Fructosamine test. (Glucose also binds to albumin, not just hemoglobin; and albumin only stays in circulation for 2 - 3 weeks.
What’s the most common cause of death in DKA patients?
Arrhythmias secondary to hypokalemia.
What does intensive treatment of hyperglycemia do to retinopathy in diabetic pregnant women?
Makes it worse in the short term. Long term treatment improves retinopathy regardless.
What are the main risk factors for developing lactic acidosis with metformin?
Older age and chronic kidney disease with creatinine clearance of less than 60.