Endocrine KPs

Question 1

When to use metformin for prevention of type 2 diabetes?

Answer 1

patients who are younger than 60 years of age, have a BMI greater than 35, or have a history of gestational diabetes

Question 2

Treatment for gestational DM?

If fails?

Answer 2

Lifestyle modifcations

Insulin

Question 3

Screening for a patient who has a history of gestational diabetes?

Answer 3

4 to 12 weeks postpartum and every 3 years thereafter.

Question 4

Role of insulin > other therapy in type 1 DM?

Answer 4

reduces early microvascular disease

Question 5

Metformin contraindicated with?

Answer 5

GFR<30

Question 6

For ICU when to start IV insulin? Goal?

Answer 6

BG >200

140-200

Question 7

Clinically significant hypoglycemia is defined as?

Answer 7

BG<54

Question 8

Indication for moderate intensity statin?

Answer 8

diabetics 40+ years of age and an atherosclerotic cardiovascular disease 10-year risk less than 7.5%.

Question 9

Indication for highintensity statin?

Answer 9

Pt with diabetes and known cardiovascular or vascular disease;

LDL cholesterol greater than 190 mg/dL (4.9 mmol/L),

atherosclerotic cardiovascular disease 10-year risk of equal to or greater than 7.5%.

Question 10

How to prevent diabetic retinopathy? How to treat it?

Answer 10

Optimal blood glucose and blood pressure control

Laser photocoagulation

Question 11

levated urinary albumin excretion is defined as?

Answer 11

> 30

Question 12

Initial tests for pituitary incidentally noted masses? (5)

Answer 12

8 AM cortisol, thyroid-stimulating hormone, free (or total) thyroxine (T4), prolactin, and insulin-like growth factor 1.

Question 13

Empty sella? Clinical correlation?

Answer 13

normal pituitary gland is not visualized or is excessively small on MRI

None

Question 14

most common causes of hypopituitarism?

Answer 14

Pituitary tumors and surgery for pituitary tumors

Question 15

patient with pituitary apoplexy or infarction - immediate next step?

Answer 15

Stress-dose glucocorticoid replacement

Question 16

secondary (vs primary) cortisol deficiency

Answer 16

isolated glucocorticoid deficiency without mineralocorticoid deficiency

do not develop hyperpigmentation or bronzing of the skin (no ACTH)

Question 17

Labs suggestive of secondary hypothyroidism?

Answer 17

Central hypothyroidism

inappropriately normal or low thyroid-stimulating hormone and low thyroxine (T4) (free or total) level

Question 18

evaluation for growth hormone deficiency should be reserved for adults with at least one known pituitary hormone deficiency - why?

Answer 18

Isolated adult-onset growth hormone deficiency is extremely rare, and its clinical significance is debated

Question 19

Treatment of central diabetes insipidus?

Answer 19

1-2x daily desmopressin

Question 20

Patients with panhypopituitarism require lifelong replacement of ?

Answer 20

thyroxine (T4), cortisol, and antidiuretic hormone

Question 21

Management of A patient with primary hypothyroidism and hyperprolactinemia?

Answer 21

thyroid hormone replacement with retesting of the prolactin level once the thyroid-stimulating hormone level has normalized.

Question 22

first-line therapy for symptomatic patients with hyperprolactinemia and prolactinomas?

Answer 22

Dopamine agonists (bromocriptine and cabergoline)

Question 23

Pt with acromegaly - adjuvant therapy for residual disease.

Answer 23

radiation therapy injectable somatostatin analogues

Question 24

Cushing disease v syndrome?

Answer 24

Disease - ACTH secreting pituitary adenoma

Any cause

Question 25

Treatment of Cushing's disease?

Answer 25

transsphenoidal pituitary tumor resection

Question 26

Initial tests for Cushing syndrome?

Answer 26

vernight low-dose dexamethasone suppression test, 24-hour urine free cortisol, and late-night salivary cortisol.

Question 27

Pheochromocytomas are seen with? (4 genetic conditions)

Answer 27

MEN 2A/2B, NF1, VHL

Question 28

test if clinical suspicion of pheochromocytoma or paraganglioma is low? Test if suspicion is high?

Answer 28

measurement of 24-hour urine fractionated metanephrines plasma free metanephrines

Question 29

Long term management post-pheochromocytoma management?

Answer 29

lifelong annual plasma free metaephrines

Question 30

How to test for hyperaldo?

Answer 30

midmorning ambulatory plasma renin activity and plasma aldosterone levels positive if aldo>15 or ratio>20

Question 31

When does an adrenal mass need to be removed?

Answer 31

Larger than 4 cm, pheo or "worrisome radiographic findings"

Question 32

Outline thyroid testing?

Answer 32

TSH -> if high T4 if low, T4 AND T3

Question 33

Radioactive iodine uptake is only used in patients with?

Answer 33

Hyperthyroidism

Question 34

Do not use radioactive iodine if?

Answer 34

severe thyrotoxicosis, (radioactive iodine may provide additional substrate to the hyperfunctioning gland)

Question 35

Thionamides - adverse effects?

Answer 35

LFT abnormalities (PTU worse can can lead to hepatotoxicity), reversible agranulocytosis,

Question 36

Pt with subclinical hyperthyroidism - next step? Treatment for subclinical hyperthyroidism is recommended when?

Answer 36

Repeat test in 6-12 weeks TSH<0.1

Question 37

Lab that suggests Hasimoto?

Answer 37

TPO antibodies

Question 38

When to start thyroid supplementation for hypothyroidism?

Answer 38

TSH>10

Question 39

Medication that causes a temporary rise in TSH and low T3/T4?

Answer 39

Amiodarone

Question 40

those at highest risk for amiodarone-induced hypothyroidism?

Answer 40

women with preexisting thyroid peroxidase antibody positivity.

Question 41

In pregnant patients on levothyroxine replacement, likely need to change the dose by?

Answer 41

up 30-50%

Question 42

typical pattern of euthyroid sick syndrome?

Answer 42

Low T3/T4 with normal TSH Then low TSH

Question 43

Outline management of thyroid nodule?

Answer 43

TSH -> if low, T3/T4 and radionuclide scan If high, US, and FNA if >1 cm

Question 44

Malignancy risk in multinodular goiter v single nodule?

Answer 44

same

Question 45

Treatment of well-differentiated thyroid cancer ?

Answer 45

surgery, radioactive iodine, and levothyroxine suppression of thyroid-stimulating hormone

Question 46

most common causes of secondary amenorrhea?

Answer 46

pregnancy, structural abnormalities, and PCOS

Question 47

evaluation of primary and secondary amenorrhea? If negative?

Answer 47

Prolactin, FSH, LH, estradiol, and TSH Progesterone challenge for bleeding (if bleeds, not an estrogen problem -> likely PCOS)

Question 48

Measurement of testosterone levels is not recommended if? Testosterone deficiency is diagnosed with?ee If diagnosed, next step before replacement?

Answer 48

Regular AM erections, no gynomastia and normal testicular exam Early AM total testosterone levels Identigy the cause (prolactinoma, hemochromatosis, or intracranial mass.)

Question 49

Monitoring for patients requiring testosterone replacement therapy?

Answer 49

testosterone, prostate specific antigen, and hematocrit

Question 50

Best way to investigate semen for infertility?

Answer 50

Semen analysis obtained after 48 to 72 hours of abstinence from sexual activity AND Need repeat for confirmation

Question 51

Unilateral gynecomastia - think? Next step?

Answer 51

malignancy. Mammogram.

Question 52

Classic symptoms of hypercalcemia?

Answer 52

Polyuria/polydipsia, constipation, Abdominal pain, AMS

Question 53

Primary hyperparathyroidism is diagnosed with?

Answer 53

elevated serum calcium levels, with an inappropriately normal or elevated intact parathyroid hormone level.

Question 54

Regardless of a DEXA result, a patient has osteoporosis if?

Answer 54

Vertebral compression fracture

Question 55

most common clinical manifestation of Paget disease of bone? Treatment?

Answer 55

asymptomatic elevated alkaline phosphate levels. nitrogen-containing bisphosphonate medications (alendronate, pamidronate, risedronate, and zoledronic acid).