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218 Cards in this Set
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Does dopamine have a positive of negative impact on prolactin?
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negative
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Do you see hyper or hypo prolactinemia when using dopamine?
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hypOprolactinemia
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When using a dopamine antagonist, what do you find?
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Hyper prolactinemia
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Does TRH have a positive of negative impact on prolactin?
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positive
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What will you get in hypothyroidism and effect prolactin?
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Hyperporlactinemia
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Does prolactin have a positive or negative effect on GnRH?
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negative
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So a pt. with hyperprolactinemia, will they have high or low gonadal activity?
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LOW
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A pt. with galactorrhea, amenorrhea, infertility will have high or low prolactin?
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High
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A pt. with impotence and infertility will have high or low prolactin?
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High
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40yo male c/o of HA, decreased libido during w/u found to have low testosterone, gecreased fsh, and prolactin level is 800 on exam found to have bitemporal hemianopia, most likely diagnosis? How do you confirm?
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Prolactinoma
confirm with MRI or CT |
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What is the treatment of any pituitary turmor what do you do and which is the exception?
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Surgical removal of any pituitary tumor EXCEPT prolactinoma
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How do you treat prolactinoma?
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bromocriptine or carperogaline
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Pt. is pregnant what should you do if they have prolactinoma, what shoud you do?
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Monitor through regular vision exam
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What is the S/E of carpergoline?
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vascular fibrosis of the heart valve
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What are the drugs associated with hyperprolactinemia?
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Risperidone, Haldol, phenothiazine, methyldopa, metoclopramide, verapamil
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What labs so you order on a female pt. with galactorrhea?
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Preg test
Prolactin level TSH |
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Young female with amenorrhea, weakness, galactorrhea...during w/u preg. is neg. Prolactin level is 100, LH, FSH, cortisol is normal, TSH is 25. T4 is 3. How would you manage this pt.
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Start synthroid--levothyroxine
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50 y/o male with c/o headache, arthritis, and enlarging shoes and glove size, and increased hat size. On exam has prominent jaw, and increase soft tissue in palm and sole, large tongue, in the lab increased glucose...most likely diagnosis?
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ACromegaly
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What is the best screening test for acromegaly?
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IGF-1
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If the screening test for acromegaly is equivocal, what do you do to confirm?
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Oral glucose suppression test...and check GH level
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If IGF-1 is elevated, how do you confirm the test? Do you do MRI to confirm immediately?
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Oral Glucose suppression test
No, don't do MRI immediately |
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What is symptomatic treatment of Acromegaly with pituitary tumor? What if this treatment is not an option, then what you do?
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Transphenoidal surgery
you should give octreotide +/- carpergoline |
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What are some of the complications of acromegally?
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Sleep apnea, CTS, Pseudogout, Colon Ca, Colon polyps, Cardiomyopathy, AO regurg,
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What do you suspect when you see hypogonadism and anosmia? What will you see in lab, and what is treatment?
What is the treatment if they want to have children/ |
Kallman's
Low LH, FSH, testosterone Children= GnRH |
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A long distance runner came with c/o amenorrhea, and FSH, LH are low, and prolactin is normal and no pregnancy...what is the next best step?
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No further work-up required
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Why do you replace cortisol before thyroid hormone in a hypopituitariy pt?
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b/c pt. can develop Addisonian crisis
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DM pt. has frequent hypoglycemia before it was difficult to control the diabetes. Slowly you are decreasing the diabetic medications...what is going on?
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Pt. may have hypopitutarism, or addisionism--(where cortisol is going down) or
RF---pt. may need less dose of the medication |
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26 y/o came with weakness, impotence and as a child has h/o ALL, treated with Chemo and intracranial radiation. Labs suggest TSH normal, free T4 low, cortisol low, and LH/FSH normal.
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hypopitutary d/t radiation
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10 y/o with HA, visual disturbance, poor sexual development, increased prolactin level, CT head shows dense suprasellar calcification, most likely diagnosis? What is the treatment?
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Craniopharyngeoma
Treatment is surgery |
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If a pt. comes with signs of depression...what do you need to r/o?
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Hypothyroid
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What is treatment of levothyroxine in pt. with CAD or elderly?
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Low dose levothyrox. to prevent ischemia
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Pt. on lithium with low T4 and High TSH, what should you do?
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Treat the hypothyroidism, evne though this is Lithium induced hypothyroidism
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Pt. on amiodorone with a low T4 and High TSH what is the cause of hypothyroidism? What shoud you do?
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Amiodorone induced hypothyroidism.
Cont. amiodorone and treat the hypothyroidism with levothyroxine |
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A pt. on treatment for a hypothyroidism on synthroid is changing insurance companies and they support only generic medication, what should you do incrase dose, decrease dose or cont. same dose?
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Cont. same dose and Recheck TSH level in 6 weeks b/c effect of generic meds can be low
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Hypothyroid pt. goes on vacation for 4 days and forgets her medication, she calls you to ask you to call the pharmacy to fill the Rx. What do you do?
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Tell her as long as she doesn't go beyond 7 days, she can take the medication when she comes back
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Pt.on synthroid for 10 years, stopped taking medication 6 months ago, now what do you want to do?
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Check TSH and if it is still high; start her on medication, and tell her she will need it all her life
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A young pt. on synthroid 50 mg for 6 weeks after TSH was 30, but then found to TSH to 20, what should you do?
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Double the dose to 100mg...why? b/c TSH is still considered high even though it came down
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A 65 y/o pt. on synthroid 50 mg for 6 weeks after TSH was 30, but then found to TSH to 20, what should you do?
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Increase the dose to 62.5mg..why b/c TSH is still high, but b/c pt. is elderly or if they had CAD you only increase by 12.5
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A pt. on synthroid gets pregnant, what should you do?
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Increase synthroid and check TSH level in 6 weeks.
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A pt on synthroid that is post-menopausal is wanting to take estrogen for side effects, what should you do?
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Incrase the medication and check TSH in 12 weeks after starting estrogen
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Pt. planned for elective surgery, in the w/u he was found to have hypothyroidism, what should you do?
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Post-pone surgery until pt. is euthyroid
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Pt. needs emergency surgery, in the w/u he was found to have hypothyroidism, what should you do?
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Do the surgery
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70 y/o male came with change in mental status, during the winter season and found in snow. Pt. is comatose, hypothermic, bradycardic, skin is dry, with loss of hair, eyes are puffy, most likely diagnosis? is it hypothermia or myxedema coma
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myxedema coma
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What must you r/o for every new onset AFib pt?
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Hyperthyroidism
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What should you order to diagnose Hyperthyroidism once you know there is high T4 and low TSH?
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RAI-U
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If RAI-U is diffuse, what should you think of?
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Grave's
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If RAI-U is focal, what should you think of?
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Toxic Adenoma
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If RAI-U is decreased, what should you think of?
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thyroiditis or facticious
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How do you differentiate btwn thryroidistis or factious?
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Thyroiditis--glands are large and tender
Factitious--small and non-tender |
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Young female with insomnia, wt. loss, palpitation, tremor and on examination thyroid gland is NOT enlarged...it's normal. In the lab, total T4 is 3 which is low, and TSH is 0.2 (low), RAI-U--is 2%--low; most likely diagnosis is it graves, toxic, factitous T3, factious T4 or thyroiditis?
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Factious T3, b/c gland is small and non-tender,and T4 is LOW
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What are the exceptions to increase thyroglobulin in hyperthyroidism?
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Factitious
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If a pt. comes with symptoms of hyperthyroidism and tell you pt. has other autoimmune problems, what is teh next step to evaluate the pt?
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TSH receptor Ab.
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What is the treatment of hyperthyroidism?
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propranolol--for symptomatic relief
Radioiodine treatment Methimazole or PTU |
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What must be done before radioiodine therapy or surgery?
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Give pt. Methimazole or PTU
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What happens to a hyperthryoid pt. after treatment? What do you do to manage it?
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Pt. can become hypothyroid and you give them synthroid
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What is the treatment for preg. and Hyperthryoid?
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PTU
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Is breast feeding allowed on PTU or Methimazole?
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Yes
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Pt. on PTU or Methimazole can develop? What should you tell your pt? What if your f/u is normal...what do you tell teh pt.
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Agranulocytosis
Tell pt. to stop the drug if they develop sore throat or fever and to come to the office so you can check CBC |
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Pt. with thyrotoxicosis, has afib, fever, deliruium, tachycardia, and diarrhea...what is the most likely diagnosis? how do you treat this?
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Thyroid storm-
Propranolol, PTU, and corticosteroids, and Potassium Iodide |
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Pt. with recent h/o of URI came with symptoms of thyrotoxicosis, whith painful enlargement of throid. On exam thyroid is large and tender, most likely diagnosis?
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Subacute thyroiditis aka DeQuirvan's thyroiditis
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What is the treatment of DeQuirvan's?
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Aspirin and Propranolol
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Chronic lymphocytic thyroiditis.(Hashimotos)..autoimmune thyroiditis, with large glands that are non-tender can they be hyperthyroid?
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yes, they get transient thyrotoxicosis and become hypothyroid.
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What happens in post-partum thyrotoxicosis? What is treatment?
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transient thyrotoxicosis and become hypothyroid and then they get euthyroid.
Symptomatic, with propranolo and aspirin |
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Pt. is intubated and septic and has low thyroid values.
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Sick euthyroid syndrom
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Preg. pt. referred to you by an OB, has increased total T4 is increased and free T4 is normal; TSH is normal, total T4 is increased?
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Increased Total T4 is due to increase TBG in preg.
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What if you see conjunctivitis, and chemosis, and exophthalmos, and doesn't improve with PTU and Methimazole...what is the diagnosis?
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Grave's Ophthalmopathy
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What is the treatment of graves ophthalmotpahty?
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Retrobulbar radiation and prednisone
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What are 2 drugs that cause hyperthyroidism?
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Amiodarone and Lithium
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Is a cold or hot nodule active?
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Hot
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Which malignancy of thyroid resembles like normal tyroid cells?
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Follicular
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Which thyroid cancer will present with flushing and diarrhea?
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medullary
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What thyroid cancer will have increased calcitonin?
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medullary
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If a pt. has medullary thyroid ca. and wants their family members screened for the the risk of cancer, what should you do in the family?
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Check calcitonin levels
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How to follow thyroid cancer after surgery?
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measure thyroglobulin levels
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What is the most common thyroid cancer/
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Papillary thyroid ca.
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Pt. with hypothyroid and on levothyroxine came to f//u with a TSH of 0.2 (low), what should you do?
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decrease the dose of synthroid
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What are some complications of giving too much thyroid hormone?
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can develop osteoporosis, or arrythmia
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Pt. with h/o of papillary ca. of thyroid s/p thyroidectomy on levothyroxine (synthroid 100mg /day) ; TSH is low, what should you do? Why do you do this?
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Cont. the same dose
B/c pt. has a thyroid cancer and you want the TSH level to be low. |
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Pt. with h/o thyroid problem on levothyroxine (synthroid 100mg /day) ; TSH is low, what should you do? Why do you do this?
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Lower the dose of synthroid
Why? B/c this is a normal pt. she is not a thyroid cancer patient. |
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which antibody is positive in a Type I DM?
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GAD--glutamic ACid dehydrog
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What do you suggest to a DM woman on metformin with nausea, vomiting, and abdominal discomfort?
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Cont. the medication, this is a common side effect.
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If a pt. comes with Increased BUN/ Creat, what should you do in this DM pt. on metformin?
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Stop the metformin
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Pt. comes with a serum creatinine of 1.5 in a woman who is on metformin...what shoud you do?
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D/C the metformin
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Pt. on metformin going for contrast CT abdomen, what should you do? Why? When cna you restart it?
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D/C metformin
B/c pt. can develop contrast nephropathy and develop lactic acidosis REstart teh med in 2 days |
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How does sulfonureas work?
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they stimulate insulin release from pancreatic B cells.
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Which sulfonurea drug is preferred in pts with Chronic Kidney disease?
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Glypizide
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Which sulfonurea drug is preferred in elderly pts?
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gLYpizide
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What medication can you use in sulfa allergic pts instead of sulfonylurea?
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meglitinides (repaglinide adn nateglinide)
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Which DM drugs decrease insulin resistance by improving peripheral uptake of glucose?
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Thiazolidinediones
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What is a common side effect of thiozolidinedione? What should you do?
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Fluid retention
You should discontinue the med. |
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what must you monitor when prescribing thiazolidinediones?
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LFT every 2 months
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What is the risk of rosiglitazone (Avandia)
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risk of heart attack
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Is there a peak in the long acting (Glargine) Lantus?
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no
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What's the target of HBA1c?
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7
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What should you think of when you see a high blood sugar in the morning and at 3 am it's low, what should you do?
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give lower NPH at bed time instead of giving it at dinner time.
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What should you do if you see a 7 am blood sugar high, but at 3 a.m. there is also high blood sugar?
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Don't give the high dose of NPH at dinner
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How long after diagnosis of Type I DM, when shoudl you send them for routine exams (eye, foot, and renal)
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after 5 years
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How long after diagnosis of Type II DM, when shoudl you send them for routine exams (eye, foot, and renal)
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Immediately
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Does a pt. develop retinopathy or nephropathy first in DM?
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Retinopathy
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What should you measure and maintain when you see DM retinopathy?
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Retinopathy---maintain BP <130/80
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Earliest manifiestion of DM nephropathy?
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microalbumin
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If pt. has DM nephropathy, what is the most impt. thing to manage and monitor?
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Tight BP control
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Someone has been diagnosed with DM nephropathy, what do you want to know?
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When was the last eye exam
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what is the treatment of DM nephropathy?
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ACEI
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Why do we use ACEI in DM nephropathy?
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1. Control BP
2. Decrease progression of the disease |
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What vaccine do you give to a DM?
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influenza yearly
single pneumococcal |
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what is the target LDL do you want for a DM?
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less than 100 and pref. 70
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What kind of fluids will you give a pt. in DKA?
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Normal saline, b/c they are usually dehydrated
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When do you give D5 in a DKA pt? WHY?
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When the glucose gets to 250 , why? B/c you want to take care of the ketonemia
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What will be the level of potassium of serum in a DKA pt?
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serum potassium will be high, but body potassium will be LOW
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When do you order insulin NPH?
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if serum ketone is negative
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How often shoudl you ofder finger stick glucose when pt. is on IV Insulin?
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Every hour
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When do you start to supplement with KCl in a DKA pt.
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When K<4.5mmol/L
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Pt. in DKA with a blood sugar is 800, ketones are strongly posittive started on IVF of normal saline and IV Insulin...blood glucose is now 200, what shoudl you do?
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Continue insulin and change the Normal saline to D5W
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Pt. was in DKA and on IVF and IV insulin, and after acidosis improve, pt. ketones were negative, insulin was discontinued, and pt. started on sliding scale of insulin. After 3 hours, finger stick was high, and serum ketones were positive again, what happened?
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Subcut insulin was not administered before discont. IV insulin
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What is the goal of a DM pt. with high LDL?
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Less than 100, ideally 70
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Type II DM pt. came with change in mental status, and while in the ER developed sz. and blood glucose was 900, serum ketones were negative, and BUN/Creat. was high...what is teh diagnosis?
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Nonketotic Hyperosmolar
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young child less than 5 yo being treated for DKA, and after 4 hours of treatment c/o HA and started vomiting and became lethargic, with change in mental status, bradycardic. what is the most likely diagnosis? whats the next step in management?
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Cerebral edema
Increase rate of IVF and give mannitol |
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Can you give short acting insulin on the mornign of surgery?
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NO
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What type of saline shoudl be given to a diabetic before surgery?
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D5 or D5 1/2 NS to avoid hypoglycemia
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What should you think of when you see a pt. with a partial or total gastrectomy and gets reactive hypoglyceia after 2-3 hours fo meal what should you do?
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Acarbose
and order low carb; high prot. diet |
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DM pt. comes with hypoglycemia and finger stick glucose is LOW, WHAT will you do? What if you can't get a IV line, what should you do?
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Give D50 50cc and keep on D5w for the maintenance.
Give Glucagon IM or Sub Q |
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If cause of hypoglycemia is sulfonurea, what should you do with these pts?,
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pt. should be in the hospital for at least 24 hours.
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If a pt. comes to you with symptoms of hypoglycemia but is starting to have RF, what should you do?
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Decrease the dose
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Pt. comes wiht symptoms of hypoglycemia with sugar of 135, and is a (nurse, pharmacist, or family member has acess), what shoudl you check and find?
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C-peptide should be checked and it should be LOW.
If c-peptide is High, think of Insulinoma |
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Why do neonatals develop hypoglycemia?
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Some problem with Glycogen metab.
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Newborn has large tongue,and abdominal wall is not closed and organs are protruding into the base of umbilical cord, what is the next important thing to do?
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Check the blood sugar level
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What is the treatment for a pt. of Neonatal hypoglycemia?
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Start enteral feeding,
IV Glucose if no response then, hydrocortisone IV |
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What labs will you draw if you get a neonatal hypoglycemia?
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CBC, BMP, serum insulin, serum cortisol, ACTH level, GH, Thyroxin Level, UA
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A diabetic pt. comes with dizziness and found to have postural hypotension, hat shoud you do?
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Give fludrocortison and elastic stocking
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A diabetic pt. comes with nausea,, daily vomiting, fullness after they eat...what study should you do? What treatment should you give>?
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Gastric emptying studying
Metoclopromide before a meal, and erythromycin |
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A diabetic pt. comes with abd. PAIN, nausea, vomiting, and fullness after eating, what is the next study you should do?
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Endoscopy---order this if you see pain
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A diabetic pt. comes with decreased ability to sense a full bladder, what study should you order? What would you treat with?
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Cystometrogram
Treat with bethenechol, behav. training, and you may have to do intermittent cath |
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A diabetic pt. comes with erectile dysfunction, what study can you order? What can you treat with
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Doppler U/S
treat with Viagra |
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A diabetic pt. comes with thin yellow atrophic plaque with telangiectasia on the anterior surface of leg, what is the treatment?
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Topical steroid
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A diabetic pt. comes with atrophy of subQ fat, what do you do to prevent it?
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rotation of injection site
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Why do you get increased pigmentation with Addison's diseaese?
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Increased ACTH
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What is the best screeing test of Addison's test? When you see Addison's what other things you should think of ?
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Cosyntropin stim test (ACTH stimulation)
Other autoimmune d.o |
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Pt. on chronic steroids that went for surgery and then went into shock, what happened? What shoud be given before surgery?
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Stress related adrenocortico insuff.
Give stress dose of steroid |
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What is Cushing's---too much or too little cortisol?
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Too much
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What is the problem with Pituitary adenoma?
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increased ACTH called Cushing Disease
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What type of lung ca is assoc. with Cushing?
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small cell lung
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How do you confirm diagnosis first of hypercortisolism?
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Elevated 24 hr. cortisol
Elevated 11pm or midnight salivary or plasma cortisol Low Dose-dexamethasone suppression test showing imparied suppression of cortisol secretion |
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Measure and determine the cuase of hypercortisolism
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Measures plasma ACTH
If it is high the ACTH dep form If it is low--then ACTH indep form---do adrenal imaging |
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If you find and elevated ACTH and you need to determine the source, what shoudl you do, and what does it mean?
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HiGH DOSE DEXAMETHASONE TEST
If it suppresses then it's a pit. adenoma If it does not suppress---ectomic |
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Pt. with weakness, central obesity, easy bruisability, 24 urine cortisol is elevated, ACTH is low, what would you do next...CT brain?, ches? or abdomen?
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CT scan of the abdomen
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What is the treatment of Cushing's disease?
What is the treatment of Adreanal mass? Waht is treatment of ectopic ACTH? |
Trans-sphenoidal surgery
Mass--surgery Ectopic= surgery If not a candidate---ketoconazole |
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High dose steroid, Lupus, lupus with steroid, sickle cell ds....what are they likely to get?
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Avascular necrosis
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Pt. with high calcium, what is the first thing to do?
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PTH level
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What if Ca and PTH are both elevated? what is most likely cause? What drug would you consider to give you this?
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Primary hyperPTH
Lithium---causes high PTH, High Ca...discont. Lithium |
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What if Ca is high and PTH is normal or slightly low, with urine ca less than 200 mg/day...what should you think of? So what is the mech of action?
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Familial benign hypocalciuric hypercalcemia (FBHH)...it is a family hx.
Prob. with Ca receptors in the kidney |
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What if you see Ca is high and PTH is low, what should you think of ?
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Malig (squamous cell ca)---PTHrp, excessive Ca intake or Vit D intox, or Sarcoid secreteing Vit D3
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What should yo think of when you see high Ca, high PTH, and low phosphate?
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Primary HyperPTH
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What should you do if pt. is symptomatic and hyperPTH?
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Surgery
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What if you have a young,, Ca is more than 1mg above normal, have renal stones, urine Ca >400mg?
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Send pt. for surgery
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Pt. with pain, high Ca, high PTH and they go for surgery, what are the metabolic complications after surgery?
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Low Ca + Low phos +Low mag
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What is the most common complication with hoarse voice is due to?
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Recurrent laryngeal nerve injury
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How do you treat hypercalcemia pt?
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IVF and Loop diuretics (Furesomide)
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How do you treat hypercal. due to malignancy?
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Calcitonin and bisphosphonate
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Why do we give calcitonin and Bisphoshatnate together?
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B/c calcitonin works faster
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What do you treat hypercalcemia in sarcoid?
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Give steroid
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What is difference btwn pseudohypoPTH and pseudo-pseudohypoPTH?
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in Pseudo-pseudo PTH the calcium will be normal
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pt. with bony pain, increased calcium, decrased PTH, anemia, increased BUN/Cr, what next test would you like to order?
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Multiple myeloma....protein electrophoresis
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Alcohol abuser, wth nausea, vomiting, muscle spasm, K-2.9, Ca-6.5 and K and Ca are both being supplemented, but these values don't correct, what do you do next?
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Check Mg
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What are the most common fx in osteoporosis?
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Vertebral fx
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What lab can you order in Osteoporosis pt>
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Vit D level
TFT--r/o thyrotoxicosis Estrogen-- IgA endomysial Ab and Tissue transglutaminase Ab --r/o Celiac ds |
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What drugs do you look for if you suspect osteoporosis?
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steroid, heparin, SSRI, Rosiglitazone
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What do you order to prevent osteoporosis?
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Calcium
Vit D Exercise |
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What to you order to TREAT osteoporosis?
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Calcium
Vit D Bisphosphonate (Alendronate or Risedronate) |
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What is the side-effect of bisphophonates?
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esophagitis--take this med on empty stomach with water adn don't lie down for 30 min
bone osteonecrosis |
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What are the IV Bisphosphonate?
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Palmidronate IV every 3-6 months; Zoledronate Q 6-12
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Can bisphosphonate be giver for prophylaxisis?
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Yes---in a pt. on chronic steroid
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What do you do if a pt. can't tolerate oral bisphophonate?
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IV bisphosphoneate or Raloxifene
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If you want to give a pt Roloxifene or IV Bisphos and has H/o of DVT what will you do?
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Give IV Bisphos..b/c you can't give Raloxifene
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how often do you repeat a DEXA scan in osteoporosis?
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every 1-2 years
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55 y/o female with a hip fx.
T-score is -3 with a h/o DVT, which of the following drug would you like to start, what drug will you start in addition to Ca, and Vit D....estrogen?, Raloxifene? or Alendronate? |
Alendronate, b/c estrogen and Raloxifene increases risk of DVT
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Pt. with bone pain, has deafness, phosphorus is normal, Alk phos is HIGH, what do you think?
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Paget's ds.
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When you see alk phos high, what should you think of ?
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Bilirary or Bone disease
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What is the most sensitive test to diagnose Paget's?
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Bone scan
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What will you find in the urine in an Pagets' disease pt?
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hydroxyproline d/t incresed bone resorption
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What is the treatment for a Pagets pt. with no symptoms?
What is the treatment for a Paget's pt. with symptoms? |
No treatment
Symptoms==Bisphosphonate |
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When you see hirsituism and they mention abnormal DHEA, what do you think?
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Adrenal
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When you see hirsituism and they mention abnormal
17-OH, what do you think? |
CAH
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When you see hirsituism and they mention abnormal testosteron, what do you think?
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Ovarian
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What is CAH due to?
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CYP 21 A2 (21 OH defic)
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What labs will you find in CAH?
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low cortisol and aldosterone
increased androgen |
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cincreased DHEA, normal 17OH, and increased testosterone, what is the next diagnositc test?
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CT abdomen--looking for adrenal problem
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Pt. has hirsituism and normal DHEA, normal 17OH, and increased testosterone, what is the next diagnositc test?
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US of pelvis...looking for an ovary problem
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What is the treatment of a girl with CAH and ambig. genitelia?
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glucocorticoid (hydrocortisone) and may need reconstructive surgery
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What if treatment of CAH in a salt-wasting form of CAH?
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fludrocortisone + Glucocortoid
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35 y/o male who is a long distance runner, married to Miss America for 2 years, came for workup of infertility, and on exam there is a muscular man with gynecomastia, testicular atrophy, decreased sperm count, what is the most impt. history information you want to know?
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Is there any use of anabolic steroids
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MaLE pt. came for w/u of infertility, he is a tall man with gynocomastia, small testes, azospermia, what is the diagnosis?
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Klienfelters
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Malel with infertility with anosmia, most likely diagnosis?
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Kallmans
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What is the definition of obesity?
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BMI >30
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When can you offer medication to an obese pt?
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BMI > 30 persistently
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When can you offer surgery for an obese pt.?
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BMI > 40
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What are teh drugs for obesity?
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SSibutramine (Meridia)
Orlistat (Xenical) |
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What is teh side effect of Xenical?
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flatulence, fecal urgency, incontinence, steatorrhea
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How do you screen for hyperlipidemia? What is the other way?
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Fasting lipid profile
Total cholesterol and HDL |
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Treatment of Hyperlipid is based on ?
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LDL
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What is the LDL target in a CAD equivalent? What do you prefer?
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LDL < 100
Prefer < 70 |
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If there are 2 or more Risk factors in hyperlipidemia what is the target of LDL?
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Less than 130
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If there are 1 or more Risk factors in hyperlipidemia what is the target of LDL?
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LDL less than 160
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what is normal triglyceride level?
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TG < 150
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What is more impt. a low cholesterol diet or a low fat diet?
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LOW Cholesterol diet, avoid trans-fat
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What has the max. amount of cholesterol?
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Egg yolk
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What lipid drugs can cause rhabdo?
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Gefibrozin or Cyclosporine
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When do you start fibrates?
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Always start on statins, but if TG is > 500 then start fibrates
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Which lipid drug has equally good effect on ALL 3 cholesterol? Why don't we use it first?
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Nicotinic Acid;
We don't use it cuz it causes flushing and itchiness |
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When do you add Ezetimibe with statins?
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You add it if the pt. is on the maximum amt. of statin and still LDL is high.
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What is the best drug to use if the only prob. is bad HDL? What if they can't tolerate it?
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Start nicotinic acid
Can't tolerate---use fibrates |
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What if you have what drug to use for low HDL and high TG?
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use Fibrates
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What is the best drug to use if pt. is on statin and want to start fibrate which will you give?
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gemfibrozil
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what is the best statin to give if you want to give cyclosporine or fibrate?
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Pravastatin
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why do we prefer pravastatin and fluvastatin as choice of statins?
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Less muscle toxicity
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Pt. on protease inhibitors should be on which type of statin?
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Pravastatin, fluvastatin or Rosuvastatin
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What does grape fruit juice do to statins?
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Increase the side effect of statin
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When is the earliest you should start to screen kids for cholesterol?
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2 years old
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