Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Royal College Exam > Endocrinology > Flashcards

Endocrinology Flashcards

(48 cards)

Start Studying
1
Q

How do you diagnose diabetes?

A

If positive, need to confirm on a second day. No need if positive AND symptomatic:

A1c > 6.5%
Fasting glucose > 7
2h 75g oGTT >= 11.1
Random glucose >= 11.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

how do you prevent/treat atypical femoral fractures?

A

Prevent: consider drug holiday on oral bisphosphonates for 5 years (IV for 3 years) - DO NOT STOP IN HIGH RISK PTs

Treat: stop bisphosphonate. Consult ortho. ? teriparatide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you screen and diagnose acromegaly?

A

Screen: IGF1 level
Diagnose: 75g glucose suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you screen for cushing’s?

A

Need 2/3 of:

Midnight salivary cortisol
1mg dex suppression test
24 hour urine free cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you treat hypoglycemia episode?

A

Mild to moderate - 15g glucose/sucrose tabs
Severe (require assistance) 20g glucose tab

If taking acarbose, NEED TO GIVE DEXTROSE OR MILK OR HONEY

Unconscious = 1mg glucagon IM or 10-25g of dextrose IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do you treat Paget’s disease of the bone?

A

IV bisphosphonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does ACTH help in diagnosis of Cushing’s?

A

If ACTH high, consider pituitary or ectopic source. Need 8mg Dex supp test. If suppressible, likely pituitary source. Otherwise CT chest for ectopic source.

If ACTH low, consider adrenal adenoma/carcinoma. NEED CT ADRENAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does Mg affect Ca balance?

A

Low Mg reduces PTH secretion and causes PTH resistance

Low Mg = hypoPTH = High PO4 and LOW Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does PTH affect calcium and phosphate?

A

Increases calcium and decreases phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does thiazide affect PTH?

A

May cause low PTH due to associated hypercalcemia, but can also unmask primary hyperPTH and cause increase in PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how does vitamin D affect calcium and phosphate?

A

Both go same direction.

I.e granulomatous disease = hyper Ca hyper PO4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How much do you expect to reduce LDLs with initiation of statins?

A

20-40% reduction for starting dose

Additional 6% for each doubling of dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are “automatic” high risk features for future osteoporotic fractures?

A
  1. Prior fragility fracture AND prolonged use of steroids (>=7.5mg/d x 3 months)
  2. Hip or Spine fracture
  3. > 1 fragility fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are 3 benefits to switch from basal bolus regimen to continous subcutaneous insulin infusion for type 1 diabetics?

A

Small improvement in A1c
Increased treatment satisfaction and QoL
Reduction in severe hypoglycemia if high rates of baseline severe hypos

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are 3 situations when target of A1c should be < 8.5%

A

Recurrent severe hypo/hypo unawareness
Decreased life expectancy
Frail elderly with dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are antithyroid drug options? When should you use them?

A

Methimazole and PTU

MMZ > PTU EXCEPT
Pregnancy
Thyroid storm
Minor MMZ reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are components of MEN1 syndrome?

A

PPP

Parathyroid
Pituitary adenoma
Pancreatic (insulin, gastrin, VIP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are components of MEN2A syndrome?

A

PMP

Parathyroid
Medullary thyroid
Pheochromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are components of MEN2B syndrome?

A

MMP

Marfanoid, mucosal neuromas
Medullary thyroid
Pheochromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are contraindications to radioactive iodine ablation?

Study These Flashcards
A

Pregnancy, breast feeding, moderate to severe orbitopathy (can worsen orbitopathy)

Need to stop methimazole for 2-3 days prior
If given with orbitopathy, need steroids

21
Q

What are high risk features of thyroid nodule ultrasound?

Study These Flashcards
A 
hypoechoic
irregular margins
Microcalcifications or interrupted rim calc.
Taller than wide, extend beyond thyroid
lymphadenopathy
>20% increase in 2 dimensions
22
Q

What are indications for surgery for primary HyperPTH?

Study These Flashcards
A

Stay The Fudge Away U Silly Calcium

Serum calcium > 0.25 upper limit
T score < 2.5 at L spine, hip, femoral neck or distal radius
Fractures 
Age < 50
Urine calcium > 10mmol/d (>400mg/d)
Stones or nephrocalcinosis
Creatinine clearance <60ml/min
23
Q

What are indications for surgery in tertiary hyperparathyroidism?

Study These Flashcards
A

Refractory hyperPTH despite vit D analogues/calcimimetics
Hypercalcemia severe/symptomatic
Calciphylaxis
Progressive bone dx

24
Q

What are JAMA RCE findings of osteoporosis?

Study These Flashcards
A 
Weight < 51kg (LR+ 7.3)
Wall-occiput distance > 0cm (LR+ 4.6)
Rib pelvis distance <2 finger width (LR+ 3.8)
Tooth count < 20 (LR+ 3.4)
Self-reported hump back (LR+ 3.0)
25
What are radiographical and biochemical findings of Paget's disease of bone?
Elevated ALP without other abnormalities | XR: thickened cortices with tunnelling and accentuated trabeculae.
26
What are redflags for adrenal incidentaloma?
Size >4cm (proceed with surgery) Hounsfield Units > 10 (>20 need surgery) <50% delayed contrast washout
27
What are screening and confirmatory testing for Pheochromocytoma?
Screen: 24hr urine metanephrines/catecholamines Confirm: MR abdo or CT abdo with delayed contrast washout
28
What are statin indicated conditions?
``` Clinical atherosclerosis AAA DM CKD LDL > 5.0 ```
29
What are surgical indications for pituitary tumours?
Hormonal hypersecretion Hormonal hypofunction Mass effect Hemorrhage NOT PROLACTINOMA = medical
30
What are treatments for prolactinoma?
Dopamine agonists Cabergoline > Bromocriptine
31
What are vascular indications for statin in diabetes?
``` Clinical CVD Age >=40 Age > 30 and diabetes > 15 yrs Microvascular disease Other CV risk factors ```
32
What are contraindications to GLP-1 agonists?
Concern for retinopathy (Semaglutide), family/personal history of medullary thyroid Ca or MEN2, pancreatitis.
33
What is screening test for Conn's?
Plasma Aldo to renin ratio (must be off MRA, ACEi, beta blocker, clonidine etc)
34
What is the 25-OH vitamin D and Calcium level target for osteoporosis?
>=75nmol/L 25-OH vit D | >= 1200mg/day Ca
35
What is the 8 AM cortisol cutoff for adrenal insufficiency? What is the cutoff for ACTH stim test?
<83 very likely AI >500 very unlikely AI Anthing in between gets ACTH stim Cortisol should be > 500 at 30min or 60min If not, then AI
36
What is the management strategy for subclinical hypothyroidism in pregnancy?
Treat with target < 2.5 if TSH>10, TSH>4 and anti-TPO antibody negative, or TSH>2.5 and anti-TPO antibody positive.
37
What should the blood glucose be for diabetics to drive?
>4.0 (4 to DRIVE) If hypoglycemic episode, should wait 40 minutes after treatment and BG should be > 5.0
38
When should you treat subclinical hypothyroidism?
``` Symptomatic Goiter TSH > 10 Pregnancy/prengnancy planning Positive anti-TPO antibodies ```
39
When should you instruct diabetics not to drive?
Any episode of severe hypoglycemia while driving in the last 12 months More than 1 episode of severe hypoglycemia while awake (not driving) in the past 6 months for private, 12 months for commercial
40
When should you screen for Conn's syndrome?
Refractory HTN on >= 3 drugs Spontaneous hypokalemia < 3.5 or severe diuretics induced hypoK < 3 Adrenal incidentaloma
41
When should you screen for nephropathy? What screens as positive?
5 years after diagnosis in Type 1 All type 2 Random urine ACR > 20, or eGFR < 60
42
When should you start insulin in a newly diagnosed type 2?
If they have symptoms of hyperglycemia with metabolic decompensation i.e.: ``` Polyuria Polydipsia Weight loss Volume depletion HHS/DKA ```
43
When should you switch agents in osteoporosis?
Treatment failure - fragility # or progressive decline in BMD despite therapy for a yr FIRST RULE OUT OTHER SECONDARY CAUSES OF OSTEOPOROSIS. Switch to another first line agent. Ensure non-pharma interventions in place
44
When should you use propanolol for hyperthyroidism?
Symptom control especially for elderly, resting HR >90 or CVD
45
Which diabetes agents are safe for EGFR < 15?
Lina/sitagliptin Repaglinide (secretagogue) Pio/Rosiglitazone Insulins
46
Who needs biopsy for thyroid nodule?
1. High/intermediate sonographic features > 1cm 2. Low suspicion sonographic features > 1.5cm 3. Maybe very low suspicion > 2cm DO NOT BIOPSY PURE CYSTIC NODULES
47
What are findings of diabetic amyotrophy?
Proximal motor neuropathy, pain, decreased reflexes, asymmetric at onset, no sensory impairment.
48
What medications must be held prior to testing for hyperaldosteronism (e.g. multiple antihypertensives, adrenal incidentaloma, diuretic-induced hypokalemia)?
``` ACE/ARB MRA Beta blockers Clonidine, methyldopa DHP-CCB ```

Royal College Exam (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions