MKSAP-Endo

Question 1

LDL too high if?

Answer 1

LDL >130 in healthy pts
LDL >100 in high-risk patients
LDL >70 in extremely high-risk patients

Question 2

Start fibrate therapy if?

Answer 2

Triglyceridemia>200 and Non-HDL cholesterol above goal (30 + LDL goal ~ 160 in healthy patients)

Or if patient has coronary heart disease equivalents (diabetes for referral vascular disease)

Question 3

Five major cardiovascular risk factors?

Answer 3

Smoking
Hypertension
Age (men >45 for women >55)
HDL <40
Family History

Question 4

Non-HDL cholesterol goal in healthy patients? Formula?

Answer 4

<160

30 + LDL goal

Question 5

In patients with no risk factors, start statin if?

In diabetics, start statin if?

Answer 5

LDL>190 (optional below this)

LDL>100

Question 6

Niacin in diabetics?

Answer 6

can cause glucose intolerance

Question 7

Normal Values of TSH, T3, T4? (estimates)

Answer 7

0.5-5.0
2-3
5-12

Question 8

Only test needed to diagnose hypothyroidism before treatment?

Hyperthyroidism?

Answer 8

TSH

Radioactive iodine uptake scan; thyroglobulin (if suspect exogenous use)

Question 9

Goal TSH, T4 ranges for pregnant patients? why?

Answer 9

TSH at low normal
T4 at 1.5 times normal (5-12 is normal)

Estrogen increases thyroid-binding globulin

Question 10

Methimazole vs PTU

Answer 10

faster onset and fewer side effects vs PTU

Question 11

Incidentally discovered adrenal adenoma - work up?

Most common abnormality associated with incidentalomas?

Answer 11

metanephrines and overnight Dexamethasone suppression test (rare for incidentalomas to make ALDO or androgens)

subclinical cushings

Question 12

Metabolic syndrome criteria?

Answer 12

BP >130/85
triglyceride >150
HDL-cholesterol 110
waist circumference >40

Question 13

Greatest ways to reduce risk of developing diabetes in prediabetics?

Answer 13

Rosiglitazone/Pioglitazone (not used because high cost/side effects) > lifestyle changes > metformin

Question 14

Metformin contraindicated with?

Answer 14

Cr>1.4 in women and 1.5 in men

Question 15

Pt with diabetic retinopathy - mech? management?

Answer 15

neovascular proliferation; panretinal photocoagulation

Question 16

Pt with advanced DM2 on insulin - do not?

Answer 16

switch to oral agents - glycemic control will deteriorate

Question 17

Pt with HONK - how much fluid resuscitation? Do not give K until?

Answer 17

1/2 deficit in first 24 hours and rest over next 3 days

Urine output is verified

Question 18

See xanthoma - expect elevation in (be specific)?

Answer 18

triglycerides > 3000

Question 19

Thyroid nodule - when to biopsy? operate?

Answer 19

> 1 cm; >4 cm

Question 20

Lab values to diagnose primary hyperALDO?

Answer 20

ALDO/Renin > 20

Question 21

Main causes of renovascular HTN in pt 55?

Answer 21

fibromuscular disease vs vascular disease

Question 22

Suspected pheo - test?

Answer 22

CT>Metaiodobenzylguanidine (MIBG) scan

Question 23

Pt with adrenal insufficiency in time of increased physiological stress (infection) - tx?

Answer 23

stress dose of steroids (10x normal dose in a day over 4 injections)

Question 24

Osteoporosis - drugs and mech?

Answer 24

Bisphosphate > Raloxifene (SERM)

Teriparatide (increases osteoblastic activity) if T-score under -3.0