Endocrine Qs

Question 1

Tests that can diagnose DM?

Answer 1

Need each test x2:

1) fasting plasma glucose,
2) 2-hour postprandial glucose during an oral glucose tolerance test, or
3) hemoglobin A1c

Question 2

In pregnant patients with hyperthyroidism,, use what drug? (during which time?)

Otherwise, risk?

Answer 2

propylthiouracil, rather than methimazole,

1st trimester

aplasia cutis (absence of a portion of skin on the scalp in a localized or widespread area) and choanal atresia

Question 3

Management of prolactinomas during pregnancy?

Answer 3

formal visual field testing should be performed during each trimester

Question 4

A type II DM presents with DKA. Before starting oral therapy (and stopping insulin), should check (2 options)?

Answer 4

fasting C-peptide and glucose OR a glucagon-stimulated C-peptide should be measured 7 to 14 days after the correction of the acidosis

Question 5

Thyroid pathology that causes secondary amenorrhea? Mechanism?

Answer 5

Both hypothyroidism and hyperthyroidism

Hypothyroidism -> increased thyrotropin-releasing hormone through negative feedback -> stimulates prolactin secretion -> suppresses gonadotropin secretion.

Hyperthyroidism can cause rapid weight loss –> functional hypothalamic amenorrhea

Question 6

Treatment of subacute granulomatous (de Quervain) thyroiditis?

Answer 6

Supportive with NSAIDs for pain and BBs in thyrotoxic phase

Question 7

the need for pharmacologic therapy for postmenopausal bone loss is is based on?

Answer 7

10-year estimated fracture risk (20+% for a major osteoporotic fracture or 3+% for hip fracture).

Question 8

Marker highly associated with Graves disease?

Answer 8

Thyroid-stimulating immunoglobulins

Question 9

Requires repletion before serum calcium? Mechanism?

Answer 9

Magnesium. Low Mg levels impair parathyroid hormone secretion

Question 10

Urine and serum calcium goals in patients with hypoparathyroidism?

Answer 10

urine calcium goal is less than 300 mg/24 hours

serum calcium goal is between 8.0 and 8.5 mg/dL

Question 11

Normal TSH during pregnancy?

serum total T4 level?

Answer 11

0. 03 to 2.5

1. 5x normal

Question 12

In patients with primary hyperparathyroidism and concomitant vitamin D deficiency, 25-hydroxyvitamin D levels should be repleted to? Why?

Answer 12

30 ng/dL

to prevent further parathyroid hormone stimulation.

Question 13

Pt with pheocromocytoma needs a CT scan. May need premedication if? Why?

Answer 13

Administering iodine contrast

could incite a hypertensive crisis if pt has not received α-blockade

Question 14

Therapy for primary acromegaly?

Answer 14

transsphenoidal surgery

Question 15

Role of chemo in thyroid cancer?

Answer 15

Traditional chemotherapeutic agents, such as doxorubicin, are generally ineffective in the management of differentiated thyroid cancer

Question 16

Treatment of Hyperglycemia caused by chronic pancreatitis?

Answer 16

Insulin (no oral hypoglycemics since it a form of Type 1 DM)

Question 17

Treatment of Microprolactinomas in asymptomatic patients?

Answer 17

none

Question 18

Workup of primary hyperaldosteronism? If postive? If confirmed?

Answer 18

Aldosterone-plasma renin activity ratio –>

If positive, confirmatory testing with intravenous salt loading, fludrocortisone suppression testing, or captopril testing

adrenal imaging

Question 19

Treatment for primary hyperaldosteronism?

Answer 19

Surgery if unilateral cause

Mineralocorticoid receptor antagonists (such as spironolactone) are indicated for patients with a bilateral cause of primary hyperaldosteronism and those with a unilateral cause who refuse or are not candidates for surgery.

Question 20

A patients with multiple endocrine neoplasia type 2A needs thyroidectomy. Should undergo testing to?

Answer 20

exclude pheochromocytoma

Question 21

When to use HD for hyperCa?

Answer 21

Ca>18 and neurologic symptoms or AKI

Question 22

How do home ovulation kits work? Will give false positive in these pateints?

Answer 22

Measure LH spike

PCOS (baseline high LH)

Question 23

A bisphosphonate drug holiday is indicated for patients who have been?

Answer 23

on bisphosphonate therapy for 3 to 5 years, have had no progression of the disease, and have MINIMAL risk factors for additional fractures

Question 24

Patient with primary hyperparathyroidism. Who get surgery?

Answer 24

threshold for surgery.

-Total calcium >1SD bove upper limit of normal
Bone density in osteoporotic range
-age under 50
- AKI