MKSAP: Endo

Question 0

What should the dose of metformin be held on the day that a pt has radiographic procedure that will be using contrast? When should it be restarted?

Answer 0

• bc metformin will accumulate in a pt that has renal insufficiency and cause lactic acidosis
• radiocontrast can be nephrotoxic and cause renal insufficiency
• resume once renal fctn normalizes

Question 1

What is usually the level of prolactin in a nonpregnant female with a prolactinoma?

Answer 1

> 200 ng/mL

Question 2

3 Criteria for dx Diabetes?

Answer 2

1. Fasting glucose on 2 occasions > 126
2. Glucose tolerance test of > 200
3. Random glucose of > 200 + symptoms

Question 3

2 criteria for predibetic glycemic states?

Answer 3

1. 2-hour glucose tolerance test of 140-199 = impaired fasting glucose
2. Fasting glucose of 100-125 = impaired fasting glucose

Question 4

What is the recommended prepradial glucose for diabetics?

Answer 4

-glucose 90-130

Question 5

What is the recommended 2-hour postprandial glucose for diabetics?

Answer 5

• < 180

Question 6

What creatinine levels should metformin not be used in?

Answer 6

• men > 1.5

- women > 1.4

Question 7

Which pts are thiazolidinediones contraindicated in? Why?

Answer 7

• type II DM pts with heart failure

- thiazolidinediones increase fluid retention and can cause decompensated heart failure

Question 8

Alcoholic ketoacidosis v. DKA?

Answer 8

• have similar sx and can mimic DKA

- blood glucose conc is the key difference –> it will be normal or low in setting of ketoacidosis

Question 9

Name 6 coronary artery dz equivalents? What should they be treated for?

Answer 9

1. Clinical coronary artery dz
2. Symptomatic carotid artery dz
3. Peripheral artery dz
4. Abdominal aortic aneurysm
5. Diabetes mellitus
6. Framingham risk score of > 20%
   - should be tx with lipid-lowering therapy

Question 10

Definition of subclinical hyperTH?

Answer 10

-low or undetectable TSH level with free T4 and free T3 are within reference range

Question 11

What are women with subclinical hyperthyroidism at an increased risk for?

Answer 11

-atrial fibrillation (3-fold increased risk!)

Question 12

4 features of myxedema coma? What is it typically preceded by?

Answer 12

1. Progressive obtundation
2. Hypothermia
3. Hypotension
4. Bradycardia

Question 13

What happens to the thyroid hormone requirement during pregnancy?

Answer 13

-increases by 30-40%

Question 14

Grave’s dz: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?

Answer 14

• PE: diffusely enlarged thyroid gland
• elevated iodine uptake
• homogenous uptake of tracer

Question 15

Toxic multinodular goiter: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?

Answer 15

• PE: nodular to palpation
• elevated iodine uptake
• heterogenous uptake of tracer

Question 16

Hyperfunctioning adenomatous thyroid nodule: physical exam findings of thyroid? Radioactive iodine uptake? Uptake of tracer?

Answer 16

• PE: palpable nodule
• increased iodine uptake
• “hot” nodule on tracer uptake

Question 17

What is the main tx for symptomatic thyroiditis?

Answer 17

-beta blocker –> for tachy or palpitations that may occur during the thyrotoxic phase

Question 18

What bone mineral density is diagnostic for osteoporosis?

Answer 18

• <-2.5 SD below the young adult mean

Question 19

4 Recommendations to prevent cortico-steroid induced osteoporosis?

Answer 19

1. Calcium supplementation
2. Vit D supplememntation
3. DEXA scan before tx
4. Bisphosphanates if tx will be >3 mnths

Question 20

5 Major risk factors for osteoporosis?

Answer 20

1. Personal hx of a fracture as an adult
2. History if fragility fracture in a first-degree relative
3. Low body weight (<127 lbs)
4. Current smoker
5. Oral corticosteroid use for > 3 mnths