Endocrine Flashcards by Reema .

-When to stop metformin ??

-Maximum dose of metformin per day?

GFR less than 30 ml/min (renal insufficiency)

-2000 mg

How well did you know this?

Not at all

Perfectly

Hypoglycaemia pt , what to do, if pt :
1- conscious
2- can’t tolerate orally
3- can’t access iv line
??

1- oral juice
2- iv 5% dextrose
3- IM glucagon

How well did you know this?

Not at all

Perfectly

-DKA pt, insulin regimen is?

-Hospitalized DM pt, best insulin regimen?

-(fixed regular)

-Basel ,bollus

How well did you know this?

Not at all

Perfectly

Best medication shown to reduce mortality in DM pt?
A. SGLT-2
B. GLP-1
C. Metformin

Sglt

How well did you know this?

Not at all

Perfectly

Ulcer on medial side ?
Artery or vein ?

Medial is vein
Lateral is Artery

How well did you know this?

Not at all

Perfectly

What is the appropriate rate to reduce glucose in a patient with DKA ?

And why not more?

6mmol/L per hour
Or 100mg/dl/h

-to prevent cerebral oedema

How well did you know this?

Not at all

Perfectly

Diabetic neuropathy ttt?

1- Amitriptyline
2-pregabalin
3- gabapentin

How well did you know this?

Not at all

Perfectly

-what is honeymoon period in DM?

-what is somogi effect?

when there is still residual pancreatic functioning cells , and u need to lower insulin dose in this period

-early morning hyperglycaemia , similar condition to Dawn phenomenon

How well did you know this?

Not at all

Perfectly

-side effect of amiodarone ?

-hyperthyroidism

How well did you know this?

Not at all

Perfectly

Sick euthyroid, what is the TSH ,T3 ,T 4 lab result?

Low TSH , high T4, N or low T3

How well did you know this?

Not at all

Perfectly

Graves disease management?

1- BB (propranolol) > protect the heart , given initially but in MCQs, choose methimazole!
2- antithyroid medications (PTU, methimazole -1st line ttt!-)
3-radioactive iodine
4- surgery

How well did you know this?

Not at all

Perfectly

Thyroiditis ttt??

1-BB
2- NSAID (more important than BB!!)

How well did you know this?

Not at all

Perfectly

-multi nodular toxic goiter/solitary toxic adenoma ttt?

-radio active iodine
-surgery

How well did you know this?

Not at all

Perfectly

-dose of thyroxine should be adjusted according to???
A. T3
B. T4
C.TSH
D. All TFT

-how many weeks should be pass before repeating TFT to adjust the dose???

-pt diagnosed with hypothyroidism and started thyroxine, came after 2 weeks from starting medication, TSH still high, what to do?

-According to TSH

-6 weeks

-continue same ttt, send home , follow up after one month ( 6 weeks most pass :)

How well did you know this?

Not at all

Perfectly

When to ttt subclinical hypothyroidism?? ( 3 indications)

See the pic

How well did you know this?

Not at all

Perfectly

Thyroid nodule, FNA is done, what is the management for each result is in the following:
1- class one or not diagnostic result?

2-class 2 or benign lesion

3- class 3 or atypia of undetermined significance/or follicular lesion of undetermined significance

4- class 4 or suspicious of follicular neoplasm

5- class 5 or suspicious of malignancy

6- class 6 or malignant lesion

1- Repeat FNAC

2-Follow up by US

3-Repeat FNAC

4-hemi thyroidectomy

5-hemi thyroidectomy or near total thyroidectomy

6- near total thyroidectomy

How well did you know this?

Not at all

Perfectly

Thyroid ca that is associated with increase level of calcitonin is???

Medullary carcinoma

How well did you know this?

Not at all

Perfectly

Approach of thyroid nodule ?

Start always with
1- TFT
Then
2-radioactive iodine uptake
3-US (usually done with radioactive iodine uptake test)
4-FNA
——————-
Note:after radioactive iodine test, if hot nodule is detected, no need to do US (risk of malignancy is low)
-in opposite, if cold nodule or euthyroid, FNA most be done , because of high risk of malignancy.

How well did you know this?

Not at all

Perfectly

-MC nerve injury after thyroidectomy is????
-post thyroidectomy and pt have hoarseness of voice+ repeated chocking, what nerve is injured?

Recurrent laryngeal nerve !

How well did you know this?

Not at all

Perfectly

-TSH is abnormal, what is the next step??

A. start treatment
B. T3
C. T4
D. Wait until symptoms appear

How well did you know this?

Not at all

Perfectly

pt came with hypothyroidism S and S, normal TSH, what is ur next step?

-repeat TSH after 4 weeks and if still normal , check T4, and T3

How well did you know this?

Not at all

Perfectly

Approach of hyperthyroidism in pregnancy?

-Methimazole is CI in the 1st trimester, PTU is indicated instead, u can use methimazole in the 2nd and 3rd trimester

-if gestational age not mentioned in the Q, choose PTU then.

How well did you know this?

Not at all

Perfectly

CI of methimazole use in hyperthyroidism?

severe eye disease ( graves)
-pregnancy first trimester

How well did you know this?

Not at all

Perfectly

-pt on thyroxine, came for follow up, his TSH is high but normal T4, what is the explanation for this condition?

-medication non compliance ( ماكان ياخذ علاجة الا قبل الموعد :)

How well did you know this?

Not at all

Perfectly

What are the Hyperparathyroidism lab results (Ca, phosphate, parathyroid hormone) for: 1-primary HPT 2-secondary HPT 3-tertiary HPT

1-(primary)mainly happen due to, Parathyroid gland adenoma (85%) , -Hyperplasia or multiple adenomas (∼ 15%) In rare cases: -Carcinomas (∼ 0.5%) -Idiopathic -Multiple endocrine neoplasia type 1 or 2 -Medication: lithium or thiazide diuretics 2- Secondary hyperparathyroidism caused by: -Chronic kidney disease (most frequent cause) -Malnutrition -Vitamin D deficiency (e.g., reduced exposure to sunlight, nutritional deficiency, liver cirrhosis) -Cholestasis Note: no matter what’s is the lab results, if u find low vit D3, go with secondary!!! 3-Tertiary hyperparathyroidism: caused by persistent secondary HPT Lab results: see the pic

-signs of hypercalcemia ?

-what are the indications for surgery when pt have primary HPT ?

Parathyroidectomy is done if any of the following is present: see the pic

- what is the galactorrhea approach ??

-cushing syndrome is suspected, what is ur approach??

First! Make sure , does cortisone high? See the pic Second, what is the cause of high cortisone? Measure the ACTH level (See the algorithm in another flash card) Note:** Diagnostic test for cushing is :low dose dexamethasone suppression test!!

-cushing disease is suspected, high cortisone is confirmed, what is ur next step??

-look for the cause, start by measuring ACTH level , see the algorithm below

-approach in adrenal insufficiency??

-1st (initial) cortisone level -2nd Short ACTH stimulation test (synacthen test)>>diagnostic!!! **in this test, cortisone will fail to increase in both primary and secondary adrenal insufficiency! -3rd measure the ACTH level to know the cause(see the pic for interpretation)

What is the Diagnostic test for cushing syndrome????

Diagnostic test for cushing is :low dose dexamethasone suppression test!!

-what is the adrenal insufficiency diagnostic test???

-short ACTH stimulation test or synacthen test.

Refractory HTN + Hypokalaemia, what ur next step???

-measure aldosterone -renin ratio!!!

-symptoms of Addison dis??? -difference between Addison disease and crisis ? ( only one difference)

1- see the pic 2- only difference is hypotension, addison disease > postural hypotension while crisis> persistent hypotension even after given proper iv fluid (MC happen after stressful event such as infection or surgery)

-Which type of adrenal insufficiency can be present with skin pigmentation?? -what is the reason of skin pigmentation in adrenal insufficiency?

-primary (pic) -high ACTH

-what is the type of cortisone given to adrenal insufficiency crisis???

-Hydrocortisone

- what is the most appropriate test to detect the cause of high cortisone in the pt body????

-high dose dexamethsone suppression test! (Be careful, low dose is diagnostic , high dose used to detect the exact cause )

-multiple endocrine neoplasia (MEN) syndrome (1,2a and 2b)??

1- DM type 2 pt since 12 ys , all her lab tests are normal, strict glycemic control, ask u about a way to prevent diabetic nephropathy ( secondary prevention) what is ur next step? 2- DM pt came for follow up, poor glycemic control, high creatinine, what is ur next step to prevent further progress of diabetic nephropathy in this pt after control of Blood suger?

1- order random urine micro-albuminuria level (pt not having diabetic nephropathy yet) 2- give ACE inhibitor therapy (already have the complication)

-hashimoto thyroiditis antibody name??? -graves antibodies?

-TPO ( thyroid peroxidase anti body) -TSI ,AKA ( TSHR or TRAB( thyrotropin receptor) )

What is the most common thyroid cancer in children and adults???

Papillary ca **M/C site of metastasis of papillary Ca is :LUNG!!!!!

- What r the pathology findings in papillary ca of thyroid??? -what is the prognosis of papillary ca of thyroid?

1- psamomma bodies 2-nuclear grooves 3- orphan annie’s Eye nuclei - Good prognosis!!

- M/C site of metastasis of follicular CA in thyroid? -age and gender ?? -how to diagnose??

-tumor spread by blood>>BONE!! (Present with bone pain and thyroid lump) -50-60 yo woman - see the pic مهممم

What is the Prolactin level in : -prolactinoma -hypothyroidism ??

- more than 150-200 -less than 100

45 y o Woman with more than 12 months amenorrhea , dx??

Clinical menopause

Which antibiotic should use with caution in diabetic pt??

-fluoroquinolones (such as ciprofloxacin ) Why? Dysglycemia causes (hypo hyper glycemia)

Regarding the size of thyroid nodule, when we can do FNA?

More than 1 cm

-echogenecity of malignant thyroid nodule appear in US as?? Hyper or hypo?

Hypoechoic

What are the classifications of pituitary adenoma? Sizes and effect? And ttt?

All types if asymptomatic then follow up with MRI, if symptomatic, first medical then surgical, medical such as : cabergoline (the best) or promocreptine ( both are dopamine agonist) 1-microadenoma (less than 10 mm-1cm-) 2-macroadenoma more than 1 cm Usually come with neurological deficit ( such as bitemporal hemianopia )

Poor candidate for surgery parathyriodectomy what to give??? -what if pt have osteoporosis??

-cinacalcet -biphosphanate

DM type 1, when screen celiac ?

At time of diagnosis and every 2 year if asymptomatic

What the type of thyroid ca that have the worst prognosis? And what is the ttt??

Anaplastic ca

Type of thyroid cancer arise from para follicular c cells, dx?? Most common electrolytes imbalance associated with this ca? What u need to screen before surgery in this cancer?

Medullary ca, it secrete calcitonin, associated with MEN 2A and 2 B Hypocalcemia Before surgery u need to screen for 1- hyperthyroidism 2- pheochromocytoma

How to dx medullry ca? What is the m/c site of METS?

How to diagnose DM?

Test results in DM and pre diabetic pt : FBS 2hr PP HBa1C When to follow up?

See the pic

Choice of drugs based based kn Hba1C in DM?? 5.7 - less than 7.5 ? 7.5-9 ?? 9 - 10?? When symptomatic with Hba1c more than 10 or random is 300 ???

Ttt of DM: What is biguanides MOA and give me 3 s/e??

biguanides (metformin) MOA: 🚫 gluconeogenisis 🚫 absorption of suger in GI Increase insulin sensitivity S/E: M/C is abdominal discomfort Lactic acidosis B12 deficiency

Give me 2 side effects of sulphonylureas + example of names

S/E: avoid in elderly, it cuz hypoglycaemia + weight gain