Sweet Dreams
What is the first line therapy to slow progression of nephropathy in patients with Diabetes Mellitus?
What is ACE/ARB.
What is the initial treatment of moderate to severe hypercalcemia?
What is aggressive hydration to replete volume loss and increase kidney excretion of calcium. Loop diuretics can be used in patient’s kidney failure or heart failure (volume-overloaded states).
What is the treatment for nonthyroidal illness syndrome (Euthyroid Sick Syndrome)?
Treatment not recommended due to lack of significant clinical benefit.
What is the most reliable case-detection test for primary aldosteronism?
What is plasma aldosterone:renin ratio (ARR).
An ARR greater than 20 with a plasma aldosterone concentration of at least 15ng/dL is a positive result.
What is the screening test for Acromegaly?
What is Insulin-like Growth Factor 1.
Metformin is contraindicated when GFR falls below ___ml/min/1.73m2?
What is 30ml/min/1.73m2.
Clinicians should start assessing benefits versus risks when GFR falls below 45ml/min/1.73m2 and Metformin is contraindicated at GFR <30ml/min/1.73m2.
Screening for osteoporosis in average risk postmenopausal women begins at what age?
What is Age 65.
Thyroid nodules greater than or equal to ___cm require fine needle aspiration?
What is 1cm.
What is the initial screening test for pheochromocytoma?
What is plasma free metanephrine levels or 24hr urine fractionated metanephrine and catecholamine levels.
Compression of the stalk of the pituitary gland leads to the overproduction of what hormone?
What is Prolactin.
What are the four diagnostic criteria for the diagnosis of Type 2 Diabetes Mellitus?
-FPG >=126
-2-Hour OGTT with Glucose>=200
-A1C>=6.5
-Random Glucose >=200 with symptoms of Hyperglycemia
What condition is characterized by mild hypercalcemia starting in childhood, low 24 hour urine calcium excretion, and/or family history of parathyroidectomy without resolution of hypercalcemia?
What is Familial Hypocalcicuric Hypercalcemia?
Usually asymptomatic and not treated with parathyroidectomy. Can be distinguished from primary hyperparathyrodisim by 24 hour urine collection for calcium and creatinine.
In Myxedema Coma, what medication is administered prior to administration of thyroid hormone?
What is stress dose steroids (100mg IV Hydrocortisone q8hr).
Used to treat possible concomitant adrenal insufficiency..
What is the most common cause of primary adrenal insufficiency?
What is autoimmune destruction of the adrenal glands.
What is the most common cause of pathologic non-tumor related hyperprolactinemia?
-What is medication-induced hyperprolactinemia.
Anti-Psychotics, SSRIs, Anti-HTN (Methyldopa and Verapamil) and other (Estrogen, Metoclopramide, Opiates, Cimetidine, Domperidone).
What is the preferential treatment for macular edema in the diabetic patient?
What is Anti-VEGF intravitreal injections.
What are two of the three neoplasms associated with PTHrP related hypercalcemia?
What is Breast Cancer, Renal Cell Carcinoma and Squamous Cell Cancers.
What are two indications for treatment of subclinical hyperthyroidism?
-Recommend for patients with TSH levels below 0.1µU/ml (0.1mU/L) with symptoms
-Cardiac risk factors/ Heart disease
-Osteoporosis
-Postmenopausal women not taking estrogen therapy or bisphosphonates.
After the diagnosis of Cushings Syndrome is established with 24hr Urine Free Cortisol and Dexamethasone testing, what is the next step in diagnosis?
What is measurement of ACTH to determine whether ACTH-dependent cause or ACTH-independent cause.
What are two test used to diagnose Diabetes Insipidus?
What is the water deprivation test and then desmopressin challenge if indicated.
What two autoantibodies are used to screen for immune-mediated Type 1 Diabetes Mellitus?
What are Glutamic Acid Decarboxylase (GAD65) and Tyrosine Phosphatase 1A-2 antibodies.
What are two indications for treatment of Paget Disease of the Bone?
What is bone pain; risk for fracture and progressive deformity that could compromise bone, joint, or neurologic function; and elevated alkaline phosphatase levels.
What is the treatment for Thyroid Storm that is responding poorly to medical therapy?
What is plasmapheresis or emergent thyroidectomy.
Definitive treatment is thyroidectomy or radioactive iodine ablation.
What agent is used as adjuvant therapy to the first line therapy for adrenocortical carcinoma?
What is Mitotane.
Adrenolytic agent that causes primary AI and requires daily glucocorticoid replacement therapy. First line therapies include open resection; debulking, radiation therapy, and/or chemotherapy (palliation).
What relatively new class of drugs is related to hypophysitis (inflammation and enlargement of the pituitary and pituitary stalk causing hormone defiencies)?
What are checkpoint-blocking antibodies.
(Nivolumab, Ipilimumab, Tremelimumab, Pembrolizumab) used to treat metastatic melanoma, renal cell carcinoma, non-small cell lung cancer and head/neck cancers.