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MKSAP - Internal > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

how can you establish a dx. of DM?

A
  1. FPG > 126 mg/dL (7 mmol/L)
  2. random PG > 200 mg/dL (11.1 mmol/L)
    and symptoms OR
  3. OGTT > 200 mg/dL (11.1 mmol/L)
  4. HbA1c > 6.5%
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2
Q

impaired fasting glucose

A

fasting plasma glucose 100-125 mg/dL (5.6-6.9 mmol/L)

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3
Q

impaired glucose tolerance

A

OGTT at 2 hrs is 140-199 mg/dL (7.8 to 11.0 mmol/L)

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4
Q

diagnosis of metabolic syndrome

A
  1. BP > 130/85
  2. TG > 150, HDL < 40
  3. FPG > 110
  4. waist circumference > 40 in
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5
Q

Tx. for pt with impaired fasting glucose or impaired glucose toleracnce

A

intensive lifestyle change - 30 minutes of exercise daily and calorie-restricted diet

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6
Q

first line agent for newly diagnosed type II DM

A

metformin

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7
Q

in whom is metformin contraindicated in?

A

renal insufficiency pts

- Cr > 1.4 mg/dL for women and > 1.5 in men

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8
Q

side-effects/cons of rosiglitazone/pioglitazone

A

edema, weight gain
increased fracture risk in women
increased CV morbidity
high costs

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9
Q

what is exenatide approved for?

A

combination regimens with oral agents (tx. of DM 2) - inappropriate as monotherapy

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10
Q

hospitalized pt with uncontrolled diabetes - what should you tx with?

A

basal bolus insulin regiment consisting of long-acting insulin and rapid-acting insulin before meals

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11
Q

diabetic pt presents to eye doctor; on exam, hard exudates, microaneurysms and minor hemorrhages are seen; when questioned, the patient does not report any decline in vision

A

non-proliferative diabetic retinopathy

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12
Q

diabetic pt presents to eye doctor with loss of vision; on exam, cotton wool spots and neovascularization are visible - dz?

A

proliferative diabetic retinopathy

- fibrosis causes retinal detachment and vision loss

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13
Q

macular edema

A

new vessels in the eye become more permeable and leak serum (diabetic retinopathy)

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14
Q

what two interventions can decrease incidence and progression of diabetic retinopathy?

A

tight glycemic control

BP control

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15
Q

Tx. of proliferative diabetic retinopathy and macular edema

A

timed laser photocoagulation

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16
Q

what is the ideal insulin regimen to reduce episodes of hypoglycemia?

A

long acting basal insulin + rapid-acting insulin

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17
Q

long acting basal insulins

A

glargine
detemir
NPH - intermediate acting; 2x daily dosing

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18
Q

rapid acting preprandial insulins

A

lispro
aspart
glulisine

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19
Q

tests to establish dx. of DKA?

A

serum glucose, electrolytes, ketones and arterial blood gases

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20
Q

diagnostic criteria for DKA (4)

A
  1. blood glucose < 250 mg/dL
  2. anion gap metabolic acidosis (ph < 7.30)
  3. serum HCO3 < 15
  4. positive serum or urine ketones
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21
Q

diagnostic criteria for hyperosmolar hyperglycemic syndrome (5)

A
  1. blood glucose > 600 mg/dL
  2. arterial pH > 7.30
  3. serum HCO3 > 15
  4. serum osmolarity > 320
  5. absent serum or urine ketones
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22
Q

first step in management of hyperglycemia hyperosmolar syndrome

A

IVF with normal saline

- once volume status is restored, switch to hypotonic solutions for maintenance therapy

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23
Q

most effective Tx. of DKA (After IVF)

A 
insulin drip (IV)
- measure plasma glucose every 1-2 hours and adjust dose accordingly
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24
Q

can xanthelasma occur w/o hyperlipidemia?

A

yes, but it is mostly assoc with familial dyslipidemias

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25
clusters of erythematous papules typically on extensor surfaces associated with extremely high TG levels (> 3000)
eruptive xanthomas
26
tendon xanthomas
subcutaneous nodules on extensor tendons; assoc with familial hypercholesterolemia
27
plane xanthomas
yellow-red plaques found in skin folds of neck and trunk; assoc with familial dyslipidemias and hematologic malignancies
28
which endocrine disorder is assoc with elevated lipid levels?
hypothyroidism
29
first step in management of patients with isolated low HDL cholesterol
lifestyle interventions - exercise, tobacco cessation, weight reduction
30
non-HDL cholesterol goal
30 mg/dL above the patients LDL goal (so. approx 160)
31
what does the LDL-cholesterol goal depend on? (5)
``` smoking HTN older age (> 45 men, > 55 women) low HDL ( < 40) family hx of CAD ```
32
LDL-goal when pt has 0-1 risk factors?
LDL < 160 mg/dL - if below this, then repeat fasting lipid levels sometime in the future (every 5 years or shorter if closer to threshold)
33
indications for fibrate therapy
hypertriglyceridemia (TG > 200) in the setting of elevated non-HDL cholesterol levels
34
statin therapy in a pt with no-risk factors
LDL > 190 warrants tx. with statin in low risk patient
35
LDL cholesterol goal in pts with DM or previous MI?
LDL < 100 mg/dL
36
first line tx for elevated LDL cholesterol
statin, such as simvastatin
37
colestipol
interrupts bile acid reabsorption and reduces LDL by 10-15%; used as a second line drug with statins bc it acts synergistically to induce LDL receptors
38
ezetimibe
reduces LDL cholesterol by reducing its absoprtion in small intestine; reserved as adjunct to other meds if goal is not achieved or pt is allergic/intolerance to other meds
39
LDL goal in pts who have had stroke or transient ischemic attack
LDL < 100 mg/dL | - first line tx is with a statin
40
what tests should be done before initiating therapy for hypothyroidism?
aside from TSH and free T4, you don't need anything to make dx of Hashimotos i.e. anti-TPO abs are not necessary for dx
41
RAIU in thyrotoxicosis
above normal or high normal uptake (inappropriate in context of suppressed TSH level)
42
RAIU in thyroiditis or exposure to exogenous thyroid hormone
RAIU will be below normal
43
thyroglobulin levels are elevated in..
hyperthyroidism | destrustive thyroiditis
44
what causes a decreased thyroglobulin level?
exogenous intake of thyroid hormones | thyroidectomy/ radioactive iodine ablation
45
when should you do a FNA biopsy of a thyroid nodule?
any nodule > 1 cm in diameter | small nodules in pts with cancer risk factors
46
risk factors for thyroid cancer
``` extremes of age male sex history of head/neck irradiation family hx nodule > 1 cm (or rapid growth) hoarseness ```
47
when do you perform a thyroid scan and RAIU for a thyroid nodule?
in content of nodule and low TSH } may be a toxic nodule or multinodular goiter
48
appropriate management of hypothyroidism in pregnancy
check TSH and total T4 levels throughout pregnancy - may require an increase in levothyroxine dosage in first trimester
49
most appropriate medical regimen for pt with Graves' disease
atenolol (BB) and methimazole
50
diagnosis of post-partum thyroiditis
measurement of TSH and free-thyroxine levels
51
low TSH low free T3 low-normal free T4 elevated reverse T3
euthyroid sick syndrome | - pt usually has history of recent severe illness
52
next step after you diagnosed euthyroid sick syndrome
repeat thyroid function tests in 6-8 weeks
53
basic screening tests that should be done in everyone with a newly discovered adrenal incidentaloma
plasma catecholamine levels overnight dexamethasone suppression test aldosterone levels - if pt has HTN or hypokalemia
54
metastatic lesions to adrenal glands
``` high attenuation (Hounsfield units > 20) bilateral ```
55
primary adrenocortical carcinoma
large (>6 cm) with irregular borders and areas of necrosis
56
best screening test for primary hyperaldosteronism
serum aldosterone:renin ratio | - ratio > 20, when serum aldosterone is > 15 is consistent with primary hyperaldosteronism
57
partial suppression on high dose dexamethasone suggests?
ACTH secreting pituitary microadenoma | - high dose dexamethasone is usually not succesful in suppressing ACTH production
58
when is adrenal imaging indicated for hypercortisolism?
when you have high cortisol but normal/low ACTH level --> CT scan often shows a tumor
59
cosyntropin stimulation test
determines adrenal reserve | - used to detect adrenal insufficiency
60
next step in pt with partial suppression to dexamethasone test?
pituitary MRI
61
test of choice for diagnosing pheochromocytoma (in pt with symptoms and elevated catecholamine levels?
abdominal CT scan or MRI
62
in patient with signs of pheochromocytoma, but abdominal CT scan shows no masses - what do you do?
metaiodobenzylguandine (MIBG) scan | - reserved for pts with equivocal CT results, extra-abdominal catecholamine secreting tumor or suspected malignancy
63
suppressed ACTH and cortisol levels, with clinical findings of excess glucocorticoids
secondary adrenal insufficiency due to exogenous steroids
64
tx. of adrenal insufficiency in times of increased physiologic stress
stress dosage (10-time normal replacement dose) of IV hydrocortisone
65
Tx of acute adrenal insufficiency
IV fluids | IV hydrocortisone
66
prevention and tx. of osteoporosis
vitamin D and calcium supplementation
67
screening for osteoporosis
DEXA scan beg. at age 65 in women | - women age 60-64 should be screened if they are at higher risk (i.e. weight below 70 kg)
68
indications for pneumococcal vaccine
people age 65 yo or older people under 65 who live in long-term care facilities, have chronic illnesses or who are alaskan natives/american indians
69
MOA of bisphosphonates
pyrophosphate derivatives that bind to bone surface and inhibit osteoclastic bone resorption; lower fracture risk in osteoporosis patients
70
calcitonin for tx. of osteoporosis
nasal spray - increases bone mass in spine and decreases vertebral fractures (no effect on hip fractures) - 2nd line to bisphosphonates
71
teriparitide
stimulates osteoblastic bone formation; given as subcutaneous injection, should not be used for more than 2 years
72
who should teriparitide be avoided in?
increases risk of osteosarcoma; avoid in: - pts with Paget dz of bone - unexplained elevations of ALP - previous radiation involving skeleton - history of skeletal cancer
73
next best tx. in pt on alendronate who develops exacerbated symptoms of GERD?
IV zolendronate (once yearly infusion) or IV ibandronate every 3 months
74
indications for IV zolendronate
- when oral bisphosphonates are unsuccesful - oral BPs C/I (esophageal achalasia/stricture) - likely to be poorly absorbed (celiac, IBD) - pt is unable to remain upright for 30-60 min
75
who is teriparatide reserved for?
pts with high risk of fracture (T score > -.30) with previous vertebral fracture and contraindications to bisphosphonate use
76
definition of osteoporosis
presence of fragility fractures OR | bone mineral density T score less than -2.5 in pts w/o fragility fracture
77
osteopenia
BMD T score between -1 and -2.5

MKSAP - Internal (11 decks)

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