Endocrino Flashcards
(149 cards)
1
Q
++ sx but not very high prolactin ?
++ PRL but not very many sx ?
A
Hook effect : lab peculiarity where veyr high levels of PRL are read as low levels : dilute the sample
Macroprolactin : surestimation
2
Q
1mg dex suppression test positive ?
A
Cortisol > 140
3
Q
20F with early onset HTN. She had low potassium at time of diagnosis of HTN. She is on amlodipine and an OCP. Her creatinine and K are now normal. Aldo:Renin 160 (<80 is normal). What do you do next?
a) Repeat ARR off amlodipine
b) Repeat ARR off OCP
c) Repeat ARR on both amlodipine and OCP
d) 24h urine aldo collection
A
a) Repeat ARR off amlodipine
OCP affects Renin concentration but not the Renin activity (what is measured), amlodipine leads to false neg.
4
Q
8MG DEX signification in cushing syndrome ?
A
- if 8mg dex suppresses am cortisol : cushing due to pituitary cause
ORDER MRI SELLA - if 8mg does not suppress cortisol : ectopic ACTH
ORDER CT the chest of malignancy
5
Q
A 34 year-old woman with Graves disease, who has been euthyroid on methimazole 5mg PO daily for the past year, recently tested positive for pregnancy. She is referred for thyroid management in pregnancy. Which of the following is NOT appropriate?
a) Discontinue all anti-thyroidal medications to avoid teratogenicity
b) Check thyroid function tests every 4 weeks during pregnancy
c) Switch to PTU 300mg PO BID and continue until GA 16 weeks
d) Check TRAb titre immediately and check again at GA 18-22 weeks
A
Switch to PTU 300mg PO BID and continue until GA 16 weeks
Switching is an option but too high of a dose based on 1MMZ:20PTU conversion
TraB should be checked as low titres in early pregnancy can help predict successful withdrawal of ATD
6
Q
Adrenal incidentaloma : suggestive of malignancy ?
A
- Size over 4cm
- Hounsfield Units > 10
- < 50% delayed contrast washout
- Calcifications, extension, ADP
- Hx of malignancy
7
Q
Alternatives neuroleptics not associated with weight gain ?
A
Aripiprazole
Ziprasidone
Lurasidone.
8
Q
Amenorrhea with high FSH and low estradiol : dx ?
A
Primary ovarian insufficiency
9
Q
Anticonvulsants and BB associated with weight gain ?
A
Valproate, carbamazepine, GABAPENTIN
Propanolol
10
Q
Associated illness in Paget disease ?
A
Hearing loss, compressive neuropathies, osteoarthritis, osteosarcoma
11
Q
Chronic liver disease on A1C ?
A
Decreased
12
Q
CI to GLP1 ?
A
Personal or family history of medullary thyroid cancer or MEN 2
Hx or pancreatitis or pancreatic cancer
13
Q
Contraindications to RAI tx in Graves disease ?
A
Pregnancy, breatsfeeding, mod-sev orbitopathy, thyroid cancer
Delay pregnancy for 6 months after tx
14
Q
Criterias for surgical management of hyperparathyroidism ? Name 7.
A
-Serum total calcium > 0.25 mmol/L above upper limit
-T-score <= -2.5 at L-spine, total hip, femoral neck or distal 1/3 radius
-Fractures (Vertebral only; by X-ray, CT, MRI or VFA)
-Age<50
-Urine calcium >6.25 mmol/d (>250mg/d) in women or >7.5 mmol/d in men (>300mg/d)
-Stones or nephrocalcinosis by x-ray, ultrasound, or CT
-Creatinine clearance < 60 mL/min (stage 3 CKD)
15
Q
Cushing syndrome dx if ACTH high vs low ?
A
High or inappropriately N : pituitary adenoma or ectopic source
= PITUITARY MRI +/- IPSS if MRI N or adenoma < 6-9mm
Low : adrenal adenoma or adrenal carcinoma
= CT ADRENALS
16
Q
DDX of a goiter ?
A
TSG in Hashimoto
Thyroid receptor antibodies in Graves
BhCG in pregnancy
17
Q
Definition of nephropathy in db ?
A
- Random urine ACR > 20
- ACR > 2 x 2 on 3 months
- eGFR < 60 x 2 on 3 months
18
Q
Diagnosis of OP clinically ?
A
- Fragility fracture
OR - Absolute fx risk of 20% or more over the next 10 years
19
Q
Differential of acquired hypoparathyroid ?
A
Hypomagnesemia causes PTH resistance
Hypermagnesemia reduces PTH synthesis / secrretion
Post surgical
Infiltrative disease
Auto immune polyglandular syndrome type 1
20
Q
DKA diagnosis ?
A
Arterial pH ≤ 7.3
Serum bic ≤ 15
AG ≥ 12
Positive serum and/or urine ketones
BG is usually ≥ 14
21
Q
DLP tx : who needs add on tx ?
A
1) If started on LDL > 5
Add on if LDL ≥ 2.5 (or < 50% reduction) or Apo B ≥ 0.85 or non HDL C ≥ 3.4
2) if ASCVD
Add on if LDL ≥ 1.8 or Apo B ≥ 0.7 or non hDL ≥ 2.4
22
Q
Does OCP affects plasma aldo/renin ratio ?
A
No OCP affects renin concentration but not the renin activity
23
Q
Dx if virilization in women ?
A
Tumor related androgen production : adrenocorticocarcinoma
24
Q
Epidemiology and atypical femoral fractures ?
A
Asian women high risk
25
Gestational transient thryotoxicosis associated with ? Name 4.
Hyperemesis gravidarum
Molar pregnancy
Multiple gestation
Choriocarcinoma
26
Glyburide and DFG ? Gliclazide and DFG ?
Glyburide avoir if DFG < 60
Gliclazide preferred but dose reduction
27
Grave’s orbitopathy treatment ?
Mild : artifical tears / opthalmic gels / selenium supplementation x 6 months
Mod-sev : IV gluco + MMF
28
Highest specificity feature for thyroid cancer on US?
Microcalfications
29
How can you prevent atypical femoral fractures ?
drug holiday for oral/IV biphospho for 3-6 years
30
How do you adjust synthroid dose in pregnancy for pre existing hypoT4 ?
Need 30-35% more LT4 : take an extra pill on saturdays and sundays
31
How do you diagnose FHH ?
Urine calcium : creat ratio < 0.01 so less than 1%
UCa x (creat umol/L / 1000)
Ca x UCreat mmol/L
32
How do you treat hypoparathyroidism ?
- Ca and active vitamin D (calcitriol or alfacalcidol)
- PTH theray can be considered if insufficient
= low calcium with low or N PTH with high PO4 and low 1,25 vit D
33
How do you treat secondary hyperparathyroidism ?
For CKD patients :
- vit D
- phosphate restriction
- non calcium phosphate binders
Cinacalcet if on dialysis with target PTH
34
How long should the patient be on denosumab before reevaluation ?
Reass after 6-10 yr
If stop at ≤ 4 doses transition to biphosphonates 6m after the last dose for 1y
If stop at ≥ 5 doses refer to OP expert as risk of rapid bone loss
35
How long should the patient be on teriparatide or romosozumab ?
Teriparatide x 24mo / Romo x 12 mo
then transition to antiresorptive agent
36
How much do you want to correct plasmatic osmolality in DKA / HHS ?
Eviter une correction trop rapide de l’osmolarité sérique : max 3 mmol/kg/h
37
How to clinically dx familial hypercholesterolemia ?
LDL > 5 with no secondary causes
AND 1 of three
- Positive fam hx
- Early coronary heart disease (< 65 women < 55 men)
- Physical findings
38
Hypercalcemia : if PTH, Ca and PO4 all high think ?
Kidney : tertiary hyperparathyroidism
39
Hyperparathyroidism medical management ?
- Vit D > 75
- Ca intake per nutritional guidelines
- Biphospho + denosumab to improve BMD
- Cinacalcet to reduce Ca
40
Hyperprolactinemia : disruption of the stalk : how high is PRL ? if prolactinoma ? if pharmacologic ?
- Prl rarely > 100 if disruption of the stalk
- If prolactinoma prl around 100
macroadénome avec PRL < 100-150 prob non sécrétant
- PRL 25-100 si pharmaco sauf risperdal qui peut donner des valeurs > 200
41
HyperPTH : calcium and phosphate in same or opposite direction ?
Opposite direction
42
Hyperthyroidism TSH < 0.005 having CT scan with contrast : what should you give ?
PTU 200 po
43
In PCOS : LH and FSH ?
LH > FSH
44
Indication for bariatric surgery ?
- BMI 35-40 and 1 serious comorbidity
- BMI ≥ 40 without comorbidity
45
Indications for surgery in tertiary hyperpara ?
- Rrefractory hyperPTH despite vit D analogues / calcimimetics
- Hypercalcemia severe/sx
- Calciphylaxis
- Progressive bone disease
46
Indications for tx in Paget disease ?
- Sx
- Disease with high risk of fx
- Hyper Ca (should not happen if immobile)
- ALP > 2x ULN
- Pre orthopedic surgery
47
Investigation in Paget Disease ?
- Plain XRs first of suspicious areas
- If asx : skeletal surveys/series
- If dx confirmed : bone scan to determine the extent of disease
48
Lab pattern : FFH ?
Calcium high
PO4 low
PTH high
Ca U low < 0.01
49
Lab pattern in calcium : thiazides ?
Calcium high
PO4 N or low
PTH low or high if unmask primary hyperparathyroidism
Ca U low
50
Lab patterns : primary hyperPTH ?
High Ca
Low PO4
High PTH
High urine calcium
51
Lab patterns with calcium : lithium ?
Calcium high
PO4 low
PTH high
UrineCa low
LIKE FHH !
52
Labs in Paget disease ?
High PAL +/- bone specific ALP without other abdormalities
53
LDL goal :
- LDL > 5
- DM or CKD
- Intermed FRS or high FRS
- ASCVD or AAA in 2e prevention
- LDL > 5 : < 2.5
- DM or CKD : < 2
- FRS : < 2
- ASCVD/AAA : < 1.8
54
Male hypogonadism investigation ?
- morning fasting TT +/- free testoterone if condition that alter SHBG
- if low = LH and FSH
if high it’s primary = klinefelter
if low it’s secondary = PRL, iron sat
55
Measure androgen levels if normal hirsutism score ?
- do NOT measure androgen levels in women with a N hirsutism score and N menses
56
MEN 1?
Pituitary adenoma
Parathyroid
Pancreatic (insulin, VIP, gastrin)
57
MEN 2A and 2B ?
Medullary cancer and pheo
2A : + parathyroid
2B : + marfanoid, mucosal neutromas
58
Min DFG for DPP4i ?
If DFG < 15 OK for linagliptin 5 or sitagliptin 50
59
Min DFG for GLP1 ?
Limited data available if < 15
60
Min DFG for metformin ?
- Avoid if < 15
- 500 if < 30
- 1g if < 45
61
Min DFG for SGLT2 ?
Can continue until dialysis
62
Myxedema coma tx ?
- IV levothyroxine load 200-400 mcg x 1 then 1.6 mcg/kg (multiple by 75% if given IV and lower dose if cardiac/old)
- IV glucocorticoids until AI R/O
- IV liothyronine 5-20mcg x 1 then q8h
- Supportive measures
63
Obesity increases cancer ?
YES 20% of all cancers attributed to obesity
Colon, kidney, esophagus, endometrium, post menopausal breast
64
Parathyroid mediated process : Ca and PO4 ?
OPPOSITE DIRECTION
65
pH in DKA vs HHS ?
bic in DKA vs HHS ?
AG ?
DKA pH < 3 and bic < 15 and AG > 12
HSS pH > 7.3 and bic > 15 and AG < 12
66
Pharmacotherapy for weight loss in diabetic patients ?
For Db2 patients and BMI > 27
1) liraglutide 3 mg
2) naltrexone-bupropion combination
3) orlistat
67
Pharmacotherapy for weight loss in non diabetic patients?
Indicated if BMI ≥ 30 or ≥ 27 with adiposity related complications (gallbladder, gout, NADLD, Db)
Semaglutide 2.4, liraglutide 3, naltrexone/bupropion, orlistat
68
Pheochromocytoma : treatment ?
- Alpha blockade with phenoxybenzamine or doxazosin
- Beta blockade only AFTER high dose alpha blockade
- Avoid surgery until at least two weeks of adequate alpha blockade, with liberal salt and fluid intake
- Phentolamine IV PRN peri op
69
Pre requisite before surgery in graves patients ?
should be euthyroid
opthlamopathy should be stable and INACTIVE x > 6 months
70
Premenopausal hirsutism : treatment ?
First line is OCP
Second line is spironolactone with OCP as teratogenic
71
Reticulocytosis on A1c ?
Decreased
72
Secondary causes of high LDL ?
- Obstructive liver disease
- HypoT4
- Nephrotic syndrome
- Anorexia
73
Should you do an autoimmune screening in type 1 diabetes pts?
Should check TSH, anti TPO Ab at dx and q2-5y thereafter as AI thyroid disease develops in 10-30%
74
Should you order 8mg dex in cushing syndrome ?
NO DO NOT PICK as poor test characteristics so not recommended
Use MRI +/- IPSS instead
75
Should you screen asx pregnant women with TSH ?
No routine screening if asx
76
Should you screen for hyperladosteronism for all adrenal incidentaloma ?
Only if HTN +/- hypoK
77
Should you use PTU or MMZ in hyperT4 ?
Use MMZ instead of PTU because less hepatotoxic EXCEPT in the following
situations:
- First trimester of pregnancy
- Thyroid storm
- Minor MMZ reactions
78
Statin indication ? Name 4.
- LDL ≥ 5 (or Apo B ≥ 1.45 or non HDL C ≥ 5.8)
- Guideline for db
- CKD : > 50y and eGFR < 60 or ACR > 3
- ASCVD
79
Subclinial hypoT4. What is the target TSH throughout pregnancy ?
Target TSH ≤ 2.5
80
Subclinical Hypothyroidism in pregnancy : what to do if TSH 2.5-4 ? if ≥ 4 ?
TSH 2.5-4 :
Do not treat if negatives TPO
Treat if positive TPO
TSH ≥ 4:
Treat if positive TPO or if > 10
Consider treating if 4-10
81
Subclinical hypothyroidism in pregnancy : what to do if TSH ≤ 2.5 ?
Do not treat
82
TCAs associated with weight gain ?
SSRIs ?
Amitryptiline, nortriptyline, doxepin
Paroxetine, citalopram
83
Thyroid and PRL ?
HypoT4 causes high PRL
84
Thyroid nodules : what are high risk features ?
HYPOechoic
Irregular margins
MICROCALFICATIONS
Taller than wide
Peripheral rim calcifications
> 20% increase in 2 dimensions …
85
Thyroid nodules : who needs a bx ?
- If TSH N or high
- If TR5 > 1cm or TR4 > 1.5cm or TR3 > 2.5 cm
86
Thyroid storm treatment ?
- Propanolol 60-80 q 4-6h or 20-40mg if unsure
- PTU 200 PO q4h THEN lugol iodone 10 drops q8h 1 hour after
- Glucocorticoids
87
Tx options for hypoglycemia ?
- 15g glucose
- 150mL juice / soft drink
- 15mL honey
88
Use of EPO, Fe or B12 on A1c ?
Decreased A1c
89
Vitamin D deficiency on lab patterns ?
Low calcium
Low PO4
High PTH
Normal/high Ca U
90
Vitamin D mediated process : calcium amd phosphate ?
SAME DIRECTION
91
What are causes of secondary male hypogonadism ?
Pituitary adenoma, hypPRL, hemochromatosis, anabolic steroids, obesity, opiods, DM2
92
What are the 4 causes of low PTH in context of hypercalcemia ?
Thiazides (low or high)
Vitamin D excess
PTHrP
Osteolysis
93
What are the CI to biphosphonates and denosumab ?
HYPOCALCEMIA is a CI
For biphospho : < ClCr 30-35 for oral or <35 for IV
94
What are the CI to teriparatide ?
CrCl < 30
Paget
HyperCa
Skeletal Rads
Unexplained ALP
CAUTION IF NEPHROLITHIASIS
95
What are the side effects of biphosphonates ?
- Eoesphageal / GI intolerance
- MSK arthalgies
- Flu like infusion reaction (IV zole)
- AFF, ONJ
96
What are the sites of major osteoporotic fractures ?
Hip, vertebra, humerus, pelvis
97
What are the target capillary glycemia ?
FBG 4-7 and 2h post meal 5-10
98
What are the three causes of low urine calcium in context of hypercalcemia ?
FHH
Lithium
Thiazides
99
What are the TSH goals in thyroid cancer ?
Low risk cancer : TSH goal 0.5-2
Intermediate-risk cancer : TSH 0.1-0.5
HIGH RISK : TSH < 0.1
NEEDING RAI IS HIGH RISK
100
What is gestational transient thyrotoxicosis ?
Generally self limited and improved by 14-18 weeks
Use BB if REALLY necessary for sx but do NOT give PTU/MMZ
hCG stimulates the TSH receptor causing high T4 and low TSH
101
What is the A1c treatment target if planning pregnancy ?
≤ 7% or ≤ 6.5% if possible and safe
102
What is the T4 goal for Graves’ in pregnancy ?
Use the lowest possible dose fot T4 at high-normal range
103
What is the tx of Paget disease ?
- IV zoledronic acid 5 IV q 1yr is 1st choice
- Oral biphospho but low dosage
alendronate 40 x 6 mo
risedronate 30 x 2 mo
2nd line if intolerant is calcitonin
104
What to do if mild subclinical hyperthyroidism in pregnancy ?
monitor, does not require automatic anti thyroid drugs considering risk to fetus
105
When is a statin indicated even though patient is LOW RISK ?
EXCEPTIONS
1) LDL C > 5 or ApoB > 1.45 or non HDL C > 5.8
2) FRS 5-9% with LDL ≥ 3.5 or non HDL C ≥ 4.2 or Apo ≥ 1.05 particulary if fam hx / Lpa >/= 100nmolperL / coronary artery calcium > 100
106
When is ACEi/ARB indicated in db ?
- > 55 with risk factor or end organ damage (albuminuria, retinopathy, LVH)
- Clinical CVD or microvascular disease
107
When is RAIU falsely low in hyperthyroidisn ?
if there is an interfering factor (e.g. recent iodine load via IV contrast or amiodarone, use of thionamide medications)
108
When is statin indicated in diabetes ?
- Age 40 ou > 30 and db > 15 y
- Clinical CVD
- Microvascular disease
- Other CV risk factors
109
When should romosozumab or teriparatide be considered ?
If vertebral body height loss > 40% OR > 1 vertebral fx and T score ≤ -2.5
110
When should you add icosapent ethyl 2g BID ?
Fasting TG ≥ 1.5-5.6 AND
- ASCVD on max tolerated statin with LDL > 1
OR
- DM on max tolerated statin with ≥ 1 CV risk factor
111
When should you add PCSK9i ?
- 2nd agent if LDL > 5
- Consider if ASCVD or AAA and LDL > 2.2 / PSCK9 benefic pt
112
When should you ask for lipoprotein a ?
AT LEAST ONCE is required in DLP
If > 100 needs earlier and more intensive behavioural modification
113
When should you ask for spine X ray / vertebral fracture assessment ? Name 3.
- ≥ 65 yr with T score ≤ 2.5
- 10yr fx risk 15-19.9%
- Clinical signs (height loss, occiput to wall > 5cm, rib-pelvis < 2 fingers)
114
When should you ask for TPO-Ab in pregnant patients ?
If TSH > 2.5
Subclinial hypoT4.
115
When should you dose TSH-R Ab in graves’ in pregnancy ?
Check Ab titer in second trimester and if very high 3x ULN need increased fetal monitoring for fetal graves as Ab cross the placenta
116
When should you order a fasting lipid panel ?
Non fasting acceptable as long as TG ≤ 4.5 otherwise do fasting
117
When should you prescribe NaHCO3 in DKA ?
Consider if in choc or pH < 7
No proven benefit in studies
118
When should you reassess BMD and fx risk in a OP patient not on therapy ?
If fx risk ≥ 15% in 3 yr
Otherwise in 5-10 years
119
When should you reassess BMD and fx risk in a OP patient on therapy ?
3 years later
Initial tx for 3-6 y but treat 6y if history of hip, vertebral or multiple non vertebral fx or risk factors ++
120
When should you stop methimazole before radioactive iodine ablation ?
Should be off methimazole for at least 2-3 days
121
When should you introduced D5 or D10 in DKA/HHS ?
Once glucose reaches 14 add D5W or D10W to IV fluids to maintain plasma glucose of 12-14 mmol/L
122
Which agent in T2D reduced the risk of non fatal stroke ?
GLP 1
123
Which antithyroidal medications for graves’ in pregnancy ?
If treating for symptoms, use PTU in the first trimester (conversion ~1mg MMZ:20mg PTU), MMZ after that (or discontinue all ATDs if possible!)
- Patients on MMZ <10mg/d or PTU <200mg/d may try discontinuing
124
Which OP medication causes rapid bone loss if d/c ?
Denosumab q 6 months
= prolia
Risk if dosing delayed by more than 1 mo
125
Which SGLT2 to avoid if bladder cancer ?
Dapa
126
Who should you screen for OP based on osteoporosis canada 2023 ?
Obtain BMd and calculate FRAX :
- ≥ 70 with no risk factors
- 65-69 with 1 risk factor
- 50-64 with previous fracture or ≥ 2 risk factors
127
Who should you treat with pharmacotherapy for osteoporosis ?
HIGH RISK
- 10yr fracture risk ≥ 20%
- T score ≤ 2.5 and age ≥ 70
- Hip, vertebra or ≥ 2 OP related fractures
Intermediate benefit if :
- 10yr fx risk 15-19.9% or T score ≤ 2.5 and age < 70 yr
128
With what agent is atypical femoral fractures and osteonecrosis of jaw described ?
Biphosphonates
Denosumab
Romosozumab
129
Causes of primary male hypogonadism : primary vs secondary causes ?
Primary : high FSH/LH : klinefleter, chemo, testicular trauma, autoimmune, systemic illness
Secondary: low FSH/LH : pituitary adenoma, hyperPRL, hemochromatosis, anabolic steroids, obesity, opiods DM2
130
Insulines prémélangées en Db1 ?
A proscire car ne permettent pas aux patients de faire un ajustement fin des glycémies
131
Comment débuter de l'insuline ?
0,5 x kg pour db 2
0,3 x kg pour db 1
puis 0,7 lente et 0,3 de rapide
132
Façon la plus adéquate de suivre fonction thyroidienne ?
A- Suivi TSH et T3 libre
B - Suivi TSH et T4 libre
C- Suivi TSH
D- Suivi T3 et T4 libres
Suivi TSH
133
Post corticothérapie : quelle dose pour un axe supprimé ?
3 semaines de pred au dessus de 20mg de prednisone ou équivalent OU apparence cushingoide
134
Post corticothérapie : risque intermédiaire nécessitant d'évaluer axe ?
- Prednisone 5-20mg plus de 3 semaines
- Attention prednisone 5 HS
- Attention inh CYP3A4
135
Tx diabète MODY vs LADA?
MODY généralement sulfo 1e ligne puis MTF + sitagliptine puis insuline
LADA on cesse HGO et débute insuline
MODY : adénomes hépatiques, hx familiale de db en jeune âge avec IMC N; hyperglycémies surtout post prandiales
136
Dose de propanolol en hyperT4?
30 à 160mg/jour en 1 à 4 doses
Typiquement 60 PO BID
137
Méthimazole ou lugol pré ablation à l'iode en hyperT4 ?
Non méthimazole doit être arrêter avant ablation et effet en plusieurs semaines
Non lugol bloquerait la captation prétx
138
Si fracture atypique sous biphosphonate : quel agent pour tx OP ?
teriparatide
PAS de denosumab
139
Combien de temps avec de recontrôler la TSH post introduction de synthroid ?
4 à 6 semaines
140
Fausse augmentation de la glyquée?
Déficit en fer
141
Fausse diminution de la glyquée?
Thalassémie
142
Taille minimum pour biopser un nodule thyroidien?
Min 1 cm si TR5
143
Médicaments qui causent ostéoporose ?
Gluco
Phénytoine, phénobarbital
Aromatase inibiteur
Héparine
Chimio, cyclosporine
GnRH agonsites and antagonistes
144
Comment supplémenter en calcium un patient post chx bariatrique?
Calcium Citrate et NON calcium carbonate
car non absorbé dans un milieu achlorhydrique
145
Quel agent pour un diabétique hypertendu ?
IECA/ARB, DHP CCB, thiazide
Si combinaison avec IECA : DHP CCP plutôt que thiazide mais OK si enjeu de K
146
Combinaison avec IECA/ARB si diabétique et HTA?
DHP CCB plutôt que thiazide
Mais si enjeu de K :thiazide long action comme chlortalidone
147
Exemple de thiazide longue action?
Chlorthalidone
148
Effet du pamidronate sur la calcémie ?
Une diminution importante de la calcémie est généralement observée 24 à 48h après l'administration de pamidronate de sodium et la normalisation est obtenue normalement dans les 3 à 7j
149
Dose de synthroid chez patient connu MCAS ou au dessus de 65 ans ?
On veut commencer avec 25 ou 50 mcg die
