Diabetes Mellitus
Diagnosis of Diabetes?
Hemoglobin A1c >/= 6.5%, fasting plasma glucose>126mg/dl, or 2-hour plasma glucose after a 75-gram carbohydrate challenge during an oral glucose tolerance test >200mg/dl, or RPG >200mg/dl
Most sensitive thyroid function test?
TSH
What are the functional zones of the adrenal gland?
Zona glomerulosa (mineralocorticoid), zona fasciculata (glucocorticoid), zona reticularis (DHEA - only significant in women)
Adrenal medulla - catecholamines
How is osteoporosis diagnosed clinically and on DEXA?
Osteoporosis can be diagnosed clinically based on fragility fractures, hip fracture, vertebral compression fracture, or a bone mineral density (T score) measurement of ≤−2.5.
Most common cause of primary amenorrhea?
Turner's Syndrome (XO)
Lifestyle modification recommendations from the diabetes prevention program for patients with pre-diabetes?
ADA recommends the DPP goals of 7% weight loss over 6 months and at least 150 min/week of moderate-intensity exercise to reduce the risk of diabetes development.
True or false, measurement of T3 is helpful in hypothyroidism?
False, Measurement of triiodothyronine in the setting of hypothyroidism is not necessary or recommended; normal levels are maintained unless hypothyroidism is severe.
t3 is useful in (1) in the evaluation of thyrotoxicosis to identify isolated T3 toxicosis, (2) to assess the severity of hyperthyroidism and response to therapy, and (3) potentially, to differentiate hyperthyroidism from destructive thyroiditis.
Initial testing for cushing's syndrome?
Overnight dexamethasone suppression test, salivary cortisol or 24hr urinary cortisol
Most appropriate test for to assess for vitamin D stores during assessment of vitamin D deficiency?
25-Hydroxyvitamin D is the storage form of vitamin D in the body, and measurement of 25-hydroxyvitamin D is the most appropriate test for assessing vitamin stores.
Criteria for diagnosis of PCOS?
After ruling out other causes;
2 of 3 -
1 Oligo/anovulation
2 Clinical or biochemical signs of hyperandrogenism
3 Polycystic ovaries on ultrasound
3 Antibodies that can be present in Type 1 Diabetes?
Glutamic acid decarboxylase (GAD65), tyrosine phosphatases IA-2 and IA-2β, islet cells, insulin, and zinc transporter (Zn T-8). Owing to highly automated available assays, GAD65 and IA-2 autoantibodies are recommended for initial screening. GAD65 autoantibodies have a high prevalence (70%) at the time of diagnosis and may remain detectable for years.
Initial treatment dose of levothyroxine in uncomplicated geriatric patients with hypothyroidism?
25-50 µg/day
Cut off for abnormal test when evaluating for primary aldosteronism?
Renin/aldosterone ratio >20 or aldosterone level >15
Medications that cause hypercalcemia?
Hydrochlorothiazide, lithium, vitamin D and vitamin A intoxication
What is the criteria to evaluate a couple for infertility?
Infertility evaluation is appropriate after 1 year of unprotected intercourse in women younger than age 35 years and after 6 months in women age 35 years or older.
Recommended second line therapy for T2DM after metformin in patients with established ASCVD, high risk for ASCVD, CKD or heart failure?
GLP 1 agonists or SGLT2 inhibitors (liraglutide and empagliflozin have stronger evidence)
For a newly pregnant patient with hypothroidism, who is in the first trimester, and is currently euthyroid, should her levothyroxine dose be:
1 - Increased by 30%
2 - Decreased by 30%
3 - Unchanged
4 - Stopped, and liothyronine started
1 - Increased by 30%
Treatment steps once pheochromocytoma has been diagnosed
1. alpha blockade (phenoxybenzamine or doxasozin)
2. Beta blockade
3. Surgery
Indications for surgery in primary hyperparathyroidism?
Calcium lvl >1mg/dl above normal
Osteoporosis or fragility fracture
Nephrolithiasis
Urine calcium >400mg/ml/day
CrCl <60 mL/min
In PCOS, name one treatment for each:
1. Hirsutism and menstrual dysfunction
2. Fertility
1. OCPs, weight loss, anti androgens such as spironolactone or Topical eflornithine (for hair growth), also metformin
2. Clomiphene citrate or letrozole
Options to reverse hypoglycemia unawareness? (a.k.a. asymptomatic hypoglycemia in patients with diabetes)
Lowering insulin doses, Continuous glucose monitor with alarm, some evidence to suggest islet cell transplants (done more regularly in the UK)
Treatment for Graves ophthalmopathy? (bonus for more than one answer)
Steroids, or teprotumumab, or even surgery
Treatment of choice in primary adrenal insufficiency?
1. Dexamethasone twice daily
2. Hydrocortisone twice daily
3. Hydrocortisone twice daily and fludrocortisone once daily
4. Prednisone twice daily
5. Prednisone twice daily and fludrocortisone once daily
3. Hydrocortisone twice daily and fludrocortisone once daily
(prednisone is once daily)
2 alternatives to bisphosphonates in osteoporosis, and their method of action.
Denosumab is a monoclonal antibody that inhibits osteoclast activation via RANK Ligand Inhibition
Teriparatide is recombinant PTH which stimulates bone growth rather than inhibit.
A 34-year-old transgender woman is evaluated during a routine examination. She desires gender-affirming hormone therapy. Her gender incongruence diagnosis has been made and confirmed by qualified medical providers. She smokes one pack of cigarettes per day, with a 15-pack-year history. Medical history is otherwise unremarkable. She takes no medications.
On physical examination, vital signs are normal. She has male hair distribution. Normal male genitalia are present. There are no evident inguinal hernias.
In addition to advising smoking cessation, which of the following is the most appropriate next step in management?
1. Initiation of an androgen blocker
2. Initiation of estradiol therapy
3. Refer for gender confirmation surgery consultation
4. Refer for discussion on fertility preservation options
5. Return for treatment 1 year after living in desired gender role
4. Refer for discussion on fertility preservation options
Because gender-affirming hormone therapy limits fertility, reproductive options should be discussed with patients prior to initiation.