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PACES > Endo > Flashcards

Endo Flashcards

1
Q

why is pH normal in HHS but not in DKA

A

there is relatively normal insulin in HHS, so this prevents lypolysis and hence ketongenesis

Because pH remains normal, it may go unoticed until glucose levels severely high

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2
Q

Most common cause of hypothyroidism in developed world

A

Hashimoto’s

10 X most common in women
Anti TPO and anti Thyroglobulin antibodies
Associated with other autoimmune and also development of MALT lymphoma

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3
Q

Most common autoantibodies in Graves’

A

TSH receptor stimulating antibodies

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4
Q

Examination in thyroid disease

A

Head to toe
Weight

Hands - sweaty, dry, tremor, Thyroid acropachy
Pulse - tachy etc
Brain - mood, energy, sleep
Hair loss
Eyes - pain, change in vision, double vision
Mouth - smoking!
Neck - lumps, pain (thyroiditis), bruie
Chest - palpitations
Pelvis - change in bowels , periods, pregnancy
Legs - proximal myopathy, pretibial myxoedema

Previous Meds

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5
Q

Contraindications of radioiodine therapy

A
  • Pregnancy (incl 4-6months after radioio treatment)
  • Age <16yr
  • Thyroid eye disease may get worse so relative contraindication
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6
Q

supplements that might affect thyroid

A

iodine containing products…seaweed!

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7
Q

Thyrotoxicosis in pregnancy…management

A
  • propylthiouracil in first trim
  • then carbimazole

• If painful goitre, raised ESR could be subacute so NSAIDs only

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8
Q

Common consequences of acromegaly

A
  • T2DM
  • Hypertension
  • Cardiovascular disease - ischaemic and LVH, doesn’t improve after treatment
  • Bitemporal hemianopia
  • 33% have sleep apnoea, but tends to improve after treatment
  • 30% have premalig colononic polyps, and 5% develop cancer

colonoscopic screening, starting at the age of 40 years

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9
Q

Severe thyroid eye disease management

A

Refer
High dose methylpred (60mg) or IV
Can use selenium for mild moderate disease
Topical lubricants

Can consider immunomodulators or radiotherapy or surgery

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10
Q

When you consider Crit Care in DKA

A

GCS <12
SpO2 <92
K < 2.5

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11
Q

Confirmation of DKA

A

Glucose >11
pH <7.3 and/or bicarb <15
Blood ketones >3 or urine present

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12
Q

Main side effect of carbimazole

A

Risk of agranulocytosis

Also advised to use Propylthiouracil if trying for baby/first trimester

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13
Q

Treatment timeline with hyperthyroidism

A

Offer Medical, radioiodine, or surgery - patient preference

Carbimazole for 18-24 months
Trial stopping
30% that’s it forever

Toxic multinodular goitre radioiodine works really well if first place though

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14
Q

Management of acute thyrotoxicosis

A
  • IV Propranolol
  • Propylthiouracil
  • Potassium iodide (Lugol’s iodine)
  • Dexamethasone (blocks T4 to T3 conversion)
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15
Q

Pseudohypoparathyroidism

A

PTH receptor malfunction

So low Ca and high Phos, but PTH is appropriately high (due to the low level of calcium in the blood)

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16
Q

Shortening of fourth and/or fifth metacarpal

A

Albright’s hereditary osteodystrophy

pseudohypopara
-hypocalcaemia and elevated PTH levels -

17
Q

Antibodies in Addison’s

A

adrenal antibodies

18
Q

Most common associated autoimmune conditions in Addison’s

A

Vitiligo

19
Q

Risks of hyperthyroidism

A
  • Arrhythmias and osteoporosis
  • Higher all cause mortality
  • Worse outcomes in preg

meta-analysis found subclinical hyperthy was associated with a 24% increased risk of all-cause mortality and 29% increased risk of coronary heart disease mortality (!)

20
Q

what are the investigations to confirm Cushing’s

A 
Midnight Cortisol
Dexamethasone suppression test
24h urinary cortisol 
Salivary cortisol
Inferior petrosal sinus sampling to determine if there is a pituitary source
MRI or CT
21
Q

Management of prolactinoma

A

Cabergoline, very effective, unlikely to need surgery

22
Q

Management for acromegaly

A

Treat with Somatostatin Analogues (Octreotide) then transphenoidal surgery
+/- radiotherapy

23
Q

Multiple endocrine neoplasia 1

A

3 Ps
• Parathyroid (95%)
• Pituitary (70%)
• Pancreas (50%) insulinoma, gastrinoma (causing Zollinger-Ellison syndrome: epigastric pain and diarrhoea)

.. hypercalcaemia

24
Q

Patient presenting with lactating, amenorrhoea, previous surgery for “high calcium”

A

Previous hyperparathyroidism

? MEN 1

25
Q

Endo causes of hypertension

A
  • Primary aldosteronism (High Na, Low K, alkalosis, tetany, muscle weakness, nocturia, or polyuria) …elevated aldosterone/renin ratios
  • Phaechromocytoma (rare but important; 10% are malig)
  • Cushing’s syndrome
  • Acromegaly
  • Obesity
  • OSA
  • Hypo/Hyperthyroidism
  • Primary hyperparathyroidism
26
Q

How do you test / manage primary hyperaldosteronism

A
  • elevated aldosterone/renin ratios
  • Stop ACEi, beta blocker, CCB
  • Fludrocortisone suppression test measuring aldosterone
  • Or salt loading test
  • Lifelong mineralocorticoid receptor antagonists (Spiro) for bilat
  • Adrenalectomy for uni
27
Q

Diagnosis of Acromegaly

A
  •   Raised IGF-1
  •   Non‐suppression of GH after an oral glucose tolerance test
  •   CT/MRI pituitary fossa: pituitary adenoma
  •   and test other pituitary function
28
Q

Diabetes Management

A

• Metformin
• Add SGLT2 inhib (gliflozin) if CVD IHD or QRISK >10%
•

29
Q

Management of osteoporosis

A

High risk:
• All women > 65y, and all men > 75y
• > 50y with fragility #, risk factors, history of falls

Get DXA scan if :
• 10-year fracture risk of > 10% (FRAX score)
• >50y and fragility #
• <40 with major risk factor

If T-score is lower than -2.5
• Exercise 
• Bisphosphonates
• Calcium / Vit D 
• Consider HRT
30
Q

SE of bisphosphonates

A
  • GI disturbance
  • bone/joint pain

Rarely:
• Osteonecrosis of the jaw - jaw pain, swelling, and redness
====> So get dental check up first!
• Atypical stress fractures = new onset hip, groin, or thigh pain

31
Q

Causes of thyrotoxicosis

A

• Graves’ disease (most common)

  • Toxic multinodular goitre (non-tender thyroid nodules, usually older presentation)
  • De quervain’s thyroiditis (painful, post viral)
  • Amiodarone-induced thyroiditis
  • Subacute thyroiditis (painless, e.g. post partum)

• Hashimoto’s (can be hyper in early stages)

32
Q

Presentation of toxic multinodulr goitre

A
  • non-tender
  • thyroid nodules
  • usually older presentation than graves’
  • (second most common hyperthy after Graves’)
33
Q

How to get an insulin pump?

A

• Buy one (£2000-3000, lasts 4-8 years)

NICE recommends if:
• You can’t get to target HbA1c without severe hypos
• HbA1c >69 despite multiple injections

Your consultant might recommend if you’re:
• regularly injecting insulin
• checking your blood glucose at least 4 times a day
• carb counting

34
Q

needle phobic diabetic?

A
  • MDT approach to assess
  • Might be options with fewer injections a day (mixed /biphasic regimens)
  • Can offer therapy e.g. CBT
  • needle-free insulin devices using high-pressure
35
Q

different hyperparathyroidisms

A

• Primary hyperpara

  • high or normal PTH
  • high Ca
  • (usually low Phos)

• Secondary hyperpara

  • low Ca
  • high PTH
  • (usually high Phos)

• Tertiary hyperpara (hx of CKD and 2nd hyperpara)

  • high PTH
  • high Ca
  • (usually high Phos)

PACES (13 decks)

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