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RACP 2023 > ENDO > Flashcards

ENDO Flashcards

1
Q

Components of FRAX?

A

Age,sex,weight,height
Prev fracture, hip fracture
Smoking
Steroids
RA
2* osteoporosis
Alcohol

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2
Q

Testosterone metabolites?

A

DHT and estradiol

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3
Q

Testosterone formed from?

A

cholesterol –> pregnelone

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4
Q

Features of carcinoid syndrome?

A

Flushing
R sided valvular disease
Diarrhea
Mesenteric fibrosis

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5
Q

How to diagnose carcinoid syndrome?

A

5-HIAA

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6
Q

Treatment carcinoid syndrome?

A

Octreotide

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7
Q

Classic skin changes in glucagonoma?

A

necrolytic migratory erythema

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8
Q

How to diagnose neuroendocrine tumour?

A

CTCAP NOT PET (slow growing)
Somatostatin scintigraphy (>90% have somatostatin receptors)

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9
Q

General management for neuroendocrine tumours?

A

Somatostatins

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10
Q

Most common cause of Conn’s?

A

Bilateral adrenal hyperplasia

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11
Q

What causes low/high uptake in an iodine scan?

A

LOW
- Ecogenous thyroid hormone
- Ectopic thyroid tissue
- Drugs
- Excess iodine
- Thyroiditis
- Struma ovarii: teratoma
- Amiodarone
- Metastatic follicular thyroid cancer

INCR
- Graves
- TMG
- Toxic adenoma
- TSH-oma
Hydatiform mole

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12
Q

Why do you need to be cautious with a statin + hypothyroidism?

A

Can predispose to statin induced myopathy + rhabdo

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13
Q

Cortisol mechanism of action?

A

Increased glucose levels [SLOW]

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14
Q

Low 21 hydroxylase results in?

A

Low Aldosterone and cortisol

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15
Q

Which hormones are produced from adrenal
- medulla
- cortex

A

Medulla:
- catecholamines

Cortex
- G: aldosterone
- F: cortisol
- R: DHEAS

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16
Q

Most specific sign of Cushings?

A

Skin changes = BIGGEST

weakness/myopathy
facial plethora
glucose intolerance

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17
Q

Screening tests of Cushings: which ones are best, and which ones can’t be used in certain situations

A

Urinary free cortisol: BEST
- no affected by CBG

Midnight salivary cortisol
- can’t use in shift workers

Dex suppression test

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18
Q

Cushing’s treatment

A

PITUITARY
- surgery
- radiation
- meds
ketoconazole
pasirotide
serotonin antagonists
GABA inhibitors
- last line
bilateral adrenalectomy + post op pituitary radiation (prevents Nelson’s syndrome)

GENERAL MEDS
- inhibits 11b hydroxylase + blocks steroid receptors
- metyrapone
- ketoconazole
- mitotane
- etomidate

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19
Q

Cushings disease/ ectopic ACTH causes

A

Disease
- MEN2
- USB8

Ectopic ACTH
· Small-cell lung carcinoma
· Non small-cell lung carcinoma
· Lung carcinoid tumours
· Pancreatic tumours
· Thymus tumours

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20
Q

Pheochromocytoma causes:

A
  • adrenal medulla
  • Chromaffin cells of adrenal medulla - MAJORITY
  • Abdominal sympathetic ganglia
  • Parasympathetic
  • Chest/abdo/pelvis
  • Head and neck: non secretory

Familial syndromes
○ MEN
○ Von Hippel Lindau
○ Neurofibromatosis type 1

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21
Q

Ix for pheochromocytoma?

A

Plasma free metanephrines/ normetanephrines
CTAP with contrast
MRI with contrast
PET DOTATE/ MIBG
Clonidine suppression testing

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22
Q

What antihypertensives can be used when doing a ARR?

A

Prazosin
Hydralazine
Verapamil

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23
Q

Ix done for Conns?

A

ARR
Confirm with salt suppression test
CT adrenals to see if unilateral/bilateral
Adrenal v sampling if considering management
- imaging can miss bilateral

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24
Q

Adrenal insufficiency
- autoimmune and genetic causes?

A

APS1: Addisons, candida, hypoparathyroidism
APS2: Addisons, DM, thyroiditis

X linked adrenoleukodystrophy
- demyelinating disease
- ABCD1 gene mutation –> accumulation LFCAs
- spastic paraparesis, neurogenic bladder, sexual dysfunction

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25
Q

Symptoms of acute/chronic adrenal insufficiency

A

Acute: abdominal pain, shock, hypovolemia CAN MIMIC SEPSIS

Chronic: hyper/hypo pigmentation

26
Q

Tests for adrenal insufficiency

A

Plasma ACTH, cortisol
Short synacthen
* Adrenal antibodies
○ 21-hydroxylase antibodies =AI Addisons
* VLCFA
○ X linked adrenoleukodystrophy
* mutation in 21 hydroxylase –> 17-OH progesterone increased + low alodsterone/ cortisol
○ CAH

27
Q

Tests for adrenal insufficiency

A

Plasma ACTH, cortisol
Short synacthen
* Adrenal antibodies
○ 21-hydroxylase antibodies =AI Addisons
* VLCFA
○ X linked adrenoleukodystrophy
* mutation in 21 hydroxylase –> 17-OH progesterone increased + low alodsterone/ cortisol
○ CAH

28
Q

How does CAH affect adrenal hormones?

A

mutation in 21 hydroxylase –> 17-OH progesterone increased + low alodsterone/ cortisol; high DHEAS

29
Q

How to diagnose CAH?

A

17-hydroxyprogesterone elevated

Failed short synacthen

30
Q

How to differentiate adenoma vs carcinoma/pheo on imaging?

A

BENIGN
Density < 10
Not vascular
> 50% washout at 10minutes
Small (however mets can be small too)
Homogenous
Smooth margins

31
Q

Adrenal carcinoma prognosticator? Treatment

A

Ki67 > 10%

Management
- Mitotane
- chemo
- surgical removal

32
Q

Relative steroid potency of
- Hydrocortisone
- Pred
- Methylpred
- Dex

A

1 - Hydrocortisone
4 - Pred
5 - Methylpred
25 - Dex

33
Q

Pancreas tissue functions?
Acini
Islet of langerhands
- Alpha
- Beta
- Delta

A

Acini
Islet of langerhans: digestive juices
- Alpha: glucagon
- Beta: insulin
- Delta: somatostatin

34
Q

Glucagon effects?

A

Increases gluoconeogenesis
Increases glycogenolysis
Increases energy expenditure
Increases ketogenesis/ lipolysis

35
Q

Testing for T1DM

A

GAD, IA2, ZnT8
C peptide

36
Q

Risks of DM if:
- affected mother
- affected father
- both parents affected
- sibling
- dizygotic twins
- monozygotic twins

A
  • affected mother 2-4%
  • affected father 5-8%
  • both parents affected 30%
  • sibling 5%
  • dizygotic twins 8%
  • monozygotic twins 50%
37
Q

Converting Hba1c to fructosamine?

A

HbA1c 6% is equivalent to 42 mmol/mol

then for every 1% increase in HbA1c there is an 11 mmol/mol increase i.e. 6% = 42 mmol/mol, 7% = 53 mmol/mol, 8% = 64 mmol/mol and 9% = 75 mmol/mol and so on.

38
Q

What can affect Hba1c?

A

INCREASE
- anemia
- alcoholism
- renal failure

DECREASE
EPO/Fe/B12/CLD administration
Aspirin
Vitamin C,E
Decreased lifespan: hemoglobinopathies, splenomegaly
hypertriglyceridemia

39
Q

Risks for T1DM

A

Other AI diseases
HLA DR3 and 4 –> risk
HLA DR2 –> protection

40
Q

Features of LADA?

A

Become more insulin dependent quickly; initially responsive to OHA’s
No C peptide
Antibodies (+)

41
Q

Genetic risk factor for T2DM?

A

TCFL72

42
Q

Effects of incretin?

A

Suppresses appetite
Inhibits gluneogenesis
Decreases glucagon
Increases insulin synthesis

43
Q

MODY definition?

A

Family history of onset < 25 years
No ketosis
Impaired insulins secretion
Hyperglycemia corrects without insulin for 2 years

44
Q

MODY types, gene association and clinical features

A

Check notes

45
Q

Penetrance of PCKD? What causes more severe disease: truncating or non truncating?

A

Complete penetrance
Non truncating cause stronger disease as affects proteins, than truncating disease

46
Q

Genes assoc with PCKD?

A

PKD1
PKD2: less severe

POLYCYSTIN 1

47
Q

Clinical features of PCKD?

A

KIDNEY
Flank pain
Bloating
UTI
Proteinuria, haematuria
HTN

OTHER
Ovarian cysts
Cerebral aneurysms
Cardiac valvular disease
Hepatic/ pancreatic cysts

48
Q

Diagnosis and classification of PCKD?

A

DIAGNOSIS
- Family history (+): > 3 cysts total or 2 in each kidney
- Family history (-): ? 10 cysts in each kidney + bilateral renal enlargement

CLASSIFICATION
- htKV + age

49
Q

Management PCKD

A

ACEI/ARB: improves CV mortality, reduces eGFR/TKV decline

Tolvaptam (vasopressin blocker)
- earlier start = more benefit

CTA/MRA

50
Q

AKI defined by?

A

Decr urine output
Decr Cr

51
Q

AI poly endocrine syndrome: describe type 1 and 2

A

1
- candidiasis mucocutaneous, addisons, hypoparahtyroid
- AI recessive

2

52
Q

AI poly endocrine syndrome: describe type 1 and 2

A

1
- candidiasis mucocutaneous, addisons, hypoparahtyroid
- AI recessive

2
- addisons
- t1dm
- thyroiditis
- polygenic

53
Q

MOST COMMON INITIAL SITE OF OA?

A

MOST COMMON INITIAL SITE: MEDIAL TIBIOFEMORAL CARTILAGE

54
Q

DI: results for neurogenic, nephrogenic and primary polydipsia post fluid deprivation and post desmopressin

A

Check notes

55
Q

How does lithium affect thyroid function>

A

Hypothyroidism

56
Q

How does amiodarone affect thyroid function?

A

Jod Basedow effect
Wolf Chaikoff effect:

Hyper/hypothyroidism

57
Q

How does heparin affect TFT?

A

TFTs appear to be secondary hyperthyroidism

58
Q

How does CMZ/Phenytoin affect TFT/s

A

Appears to be hypothyroidism primary

59
Q

Iodine uptake scan: increased and decreased uptake?

A

INCR
- Graves
- MNG
- Adenoma
- TSH-oma
- Hydatiform mole

DECR
- Struma ovarii
- Ectopic thyroxine
- Iodine excess
- Thyroiditis
- Amiodarone
- Metastatic follicular cancer

60
Q

What substances do these parts of the testes produce?
Theca cells
Granulosa cells
Leydig
Sertoli

A

Theca cells
- Ovarian androgens, mostly androstenedione and some testosterone, are produced in the theca cells, which respond to LH. The androgens diffuse across the basement membrane to the granulosa cells.

Granulosa cells
- in response to stimulation by FSH, produce aromatase, which converts the androgen precursors to estrone and estradiol.

Leydig
- testosterone

Sertoli
- spermatogenic substances
- Inhibin

61
Q

What substances do these parts of the testes produce?
Theca cells
Granulosa cells
Leydig
Sertoli

A

Theca cells
- Ovarian androgens, mostly androstenedione and some testosterone, are produced in the theca cells, which respond to LH. The androgens diffuse across the basement membrane to the granulosa cells.

Granulosa cells
- in response to stimulation by FSH, produce aromatase, which converts the androgen precursors to estrone and estradiol.

Leydig
- testosterone

Sertoli
- spermatogenic substances
- Inhibin: inhibits FSH

62
Q

Maximal time for GnRH production?
Water of lipid soluble?

A

GnRH: pulsatile
Water soluble

RACP 2023 (17 decks)

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