Endocrinology

Question 1

DM1 symptoms

Answer 1

• 3P (polyuria, polydipsia, polyphagia)
• weight loss
• blurry vision
• reccurent infections

Question 2

DM1 or 2 diagnosis

Answer 2

1 of the following

1. random glucose >200 + symptoms
2. 2 fasting glucose >126
3. > 200 glucose 2 hours after 75g oral glucose
4. HBA1C >6.5

Question 3

short acting insulins (onset and duration) / dosage

Answer 3

1. aspart: 10-20mins (1-3 hours duration) / 3-4 times with meals
2. Lispro 5-10 (30-90 mins) - 3-4 times with meals
3. regular: 30-60 (5-8 hours) - 2 times with NPH

Question 4

interm acting insulins (onset and duration) / dosage

Answer 4

NPH: 2-4 hours (6-10 hours) - 2 times with NPH

Question 5

long-acting insulins (onset and duration) / dosage

Answer 5

1. Detemir 2h (20h) - 1-2 times

2. Glargine 1-4h (24) 1 time

Question 6

DM2 first-line treatment / GOAL?

Answer 6

lifestyle

The goal is HBA1C less than 7

Question 7

contraindications for metformin

Answer 7

1. renal failure
2. conditions predisposing lactic acidosis
3. with contrast agents

Question 8

Biganides - drugs/ SE

Answer 8

metformin

SE: lactic acidosis, diarrhea, GI, metallic testa, weight loss

Question 9

Sulfonylureas - drugs

Answer 9

1st generation: Chlorpropamide

2nd: glipizide, glyburide

Question 10

Sulfonylureas- SE / contraindications

Answer 10

SE: low gl, weight gain, type 4 hypersensitivity
contraindications: liver or renal disease

Question 11

Meglitinides - drugs - SE, contraindication

Answer 11

repaglinide
low gl
renal / liver

Question 12

a-glucosidase inh - drugs - SE, contraindication

Answer 12

• acarbose
• Flatulence, GI, High LFTs
  renal liver

Question 13

Thiazolidinediones - drugs - SE, contraindication

Answer 13

Rosi/pioglitazone
SE: LIVER, ANEMIA, EDEMA, HF
conraind: liver, HF

Question 14

GLP1 agonist - drugs - SE, contraindication

Answer 14

exenatide/liraglutide
SE: GI, weight loss, low gl
- renal

Question 15

Dipeptidyl peptidase inh - drugs - SE, contraindication

Answer 15

sitagliptin, vildagliptin
SE: GI, weight loss, low gl
- renal

Question 16

SGLT2 inh - drugs - SE, contraindication

Answer 16

Canaglifozin
SE: UTI, low gl
- renal

Question 17

DIABETIC ketoacidos vs HHS first line treatment

Answer 17

ketoac: insulin
HHS: fluids

Question 18

DIABETIC ketoacidos vs HHS first line treatment

Answer 18

ketoac: insulin
HHS: fluids

Question 19

hypothyroidism - check

Answer 19

best initial: TSH and free T4

- ALSO CHECK ANTITHYROID PEROXIDASE ANTIBODIES (HASHIMOTO)

Question 20

contraindication for radioactive iodine uptake

Answer 20

pregnancy

Question 21

contraindication for radioactive iodine uptake

Answer 21

pregnancy

Question 22

methimazol vs propylthiouracil in pregnancy

Answer 22

propylthiouracil

Question 23

methimazol vs propylthiouracil in pregnancy

Answer 23

propylthiouracil

Question 24

best initial test for a thyroid nodule (explain)

Answer 24

TSH
high –> US for biopsy
Low: iodide –> if cold fna
normal –> fna

Question 25

best initial test for high Ca (explain

Answer 25

PTH high --> 1ry hyperparathyroidism normal or low --> malignancy, sardoidosis, vitamin d etc

Question 26

high Ca treatment

Answer 26

1st: iv dliods 2nd: bisphosphonates + calcitonin if still --> furosemide

Question 27

T score - explanation

Answer 27

more than -1: normal -1 to - 2.5 osteopenia less than 2.5: osteoporosis less than 2.5 + fracture: severe osteoporosis

Question 28

osteoporosis: first line treatment

Answer 28

biphosphinates --> if doesnot work --> combination with SERM

Question 29

Best initial test for cushing

Answer 29

overnight dexamethasone test or measurement of urinary or salivary cortisol

Question 30

ACTH independed cushing - adenoma vs arcinoma

Answer 30

adenoma has low DHEA

Question 31

Addison disease - diagnosis

Answer 31

measure 8 am serum cortisol (lower than 5) and plasma ACTH to confirm low serum cortisol levels. Then check a cosyntropin stimulation test (cortisol (lower than 20) before and after administration of acth).

Question 32

acromegaly tests:

Answer 32

best initial: serum IGF-1 | next best: orgal glucose tolerance (GH before and 2 hours after 75g glucose --> failure to suppress confirm diagnosis)

Question 33

MEN 1 (werner syndrome)

Answer 33

PTH pancreatic islet cell tumor pituitary

Question 34

MEN 2A (sipple syndrome)

Answer 34

pth thyroid medullary pheo

Question 35

MEN 2B

Answer 35

``` thyroid medullary pheo neuromas galioneuromatosis of the colon Marfan like habitys ```

Question 36

pheo - best initial test

Answer 36

urinary or plasma free metanephrines and normetanephrines