Temporary Until Decks Synced

Question 1

What is first line bone maintenance treatment for patients on glucocorticoids?

Answer 1

Calcium and vitamin D supplementation

Question 2

What do glucocorticoids do for bones?

Answer 2

Decrease intestinal absorption of calcium
Increase calcium excretion in urine
Accelerate bone resorption

Question 3

How should treatments on glucocorticoids therapy for over three months (or 6 months if low dose, meaning <10mg/day) be monitored?

Answer 3

Baseline densitometry, and test repeated every year as long as therapy continues

Question 4

What if a patient is on glucocorticoids and has very high risk of osteoporosis?

Answer 4

Add bisphosphonates (alendronate) to calcium and vitamin D supplementation

caution in premenopausal women bc of teratogenic risk

Question 5

Sensitivity: definition + calc

Answer 5

The probability of a diseased person testing positive

Sensitivity = True positives / (True positives + False negatives)

Question 6

Specificity: definition + calc

Answer 6

The probability of a nondiseased person testing negative

Specificity = True negatives / (True negatives + False positives)

Question 7

Positive predictive value: def + calc

Answer 7

The probability that disease is present given a positive result

PPV = True positives / (True positives + False positives)

Question 8

Negative predictive value: def + calc

Answer 8

The probability that disease is absent given a negative result

NPV = True negatives / (True negatives + False negatives)

Question 9

Positive likelihood ratio: def + calc

Answer 9

A ratio representing the likelihood of having the disease given a positive result

LR+ = Sensitivity + (1-Specificity)

Question 10

Negative likelihood ratio: def + calc

Answer 10

A ratio representing the likelihood of having the disease given a negative result

LR- = (1-Sensitivity) / Specificity

Question 11

Diabetic ketoacidosis in children: clinical features

Answer 11

Polyuria/nocturia
Polydipsia, polyphagia
Vomiting, abdominal pain
Weight loss, fatigue
Kussmaul respirations (deep, rapid breathing)
Dehydration

Question 12

Diabetic ketoacidosis in children: laboratory findings

Answer 12

Glucose >200 mg/dL
Bicarbonate <15 mEq/L
PH <7.3
Anion gap >14
Serum/urine ketones

Question 13

Diabetic ketoacidosis in children: management

Answer 13

10 mL/kg isotonic fluid bonus over 1 hour

Insulin infusion + isotonic fluids with potassium

Question 14

Diabetic ketoacidosis in children: complications

Answer 14

Cerebral edema

Question 15

How should one evaluate toxicity of a cardiotoxic agent such as doxorubicin or daunorubicin?

Answer 15

Radionucleotide ventriculograohy

Question 16

Conditions that alter thyroxine-binding globulin (TBG): increased TBG

Answer 16

Estrogens (eg pregnancy, OCs, HRT) & estrogenic medications (eg tamoxifen)
Acute hepatitis

Question 17

Conditions that alter thyroxine-binding globulin (TBG): decreased TBG

Answer 17

Androgenic hormones
High-dose glucocorticoids/hypercortisolism
Hypoproteinemia (eg nephrotic syndrome, starvation)
Chronic liver disease

Question 18

What does thyroxine-binding protein (TBG) do?

Answer 18

More than 99% circulating thyroid hormone (T4, T3) is bound to TBG. Free thyroid hormone is cleared by the kidneys so TBG makes sure adequate hormone available for tissue delivery. Patients who start estrogen therapy need higher dose of levothyroxine to saturate the binding sites bc they develop relative hypothyroidism.

Question 19

What do bile acid-binding resins (eg cholestyramine) do to intestinal levothyrozine absorption?

Answer 19

Decrease absorption.

Iron, fiber, antacids also decrease absorption.

Question 20

What agents are used to treat thyrotoxicosis and thyroid storm, and through what mechanism?

Answer 20

Glucocorticoids, beta blockers, and proplythiouracil

They inhibit peripheral deiodination of T4 to T3.

Question 21

What drugs and substances inhibit thyroid hormone secretion?

Answer 21

Lithium, potassium iodide, and Luton solution (elemental iodine and potassium iodide)