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YR6 Images + Instruments > Endocrinology and Diabetes > Flashcards

Endocrinology and Diabetes Flashcards

1
Q

Atypical features of T1DM

A

> 50
BMI >,25
Slow evolution of hyperglycaemia

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2
Q

Which drugs used in diabetes can cause hypos?

A

Sulfonylureas
Insulin

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3
Q

Which drugs used in diabetes can cause weight gain?

A

Thiazolidinedione: Pioglitazone

Sulfonylureas

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4
Q

Name a DPP4 inhibitor. What effect do DPP4 inhibitors have on weight?

A

Sitagliptin
No weight gain

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5
Q

Name a GLP1 mimetic. What effect do GLP1 mimetics have on weight?

A

Exenatide
Weight loss

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6
Q

What management can be used for painful diabetic neuropathy?

A

Amitriptyline
Pain Mx clinics

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7
Q

What drug can be used for gastroparesis in diabetes?

A

Metaclopramide

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8
Q

If on metformin and HbA1c >48 but <58 what should be done?

A

Increase dose

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9
Q

If on metformin and HbA1c >58 what should be done?

A

Dual therapy

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10
Q

Name a side effect of SGLT2 inhibitors

A

Fourniers Gangrene

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11
Q

5 causes of cranial DI

A

Idiopathic
Head injury
Pituitary surgery
Craniopharyngioma
Haemochromatosis

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12
Q

Nephrogenic DI causes

A

Lithium
Hypokalaemia
Hypercalcaemia
Tubulo-interstitial disease e.g. sickle cell
Genetic (ADH receptor)

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13
Q

S/S of DI

A

Polyuria
Polydipsia

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14
Q

Describe plasma and urine osmolality in DI

A

High plasma osmolality
Low urine osmolality

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15
Q

What test is used for diabetes insipidus?

A

Water deprivation test

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16
Q

Mx of nephrogenic DI

A

Thiazides
Low salt/ protein diet

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17
Q

Mx of cranial DI

A

Desmopressin

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18
Q

Name 2 ACTH dependent causes of Cushing’s syndrome

A

Cushing’s disease: pituitary tumour secreting ACTH

Ectopic ACTH: SLCL

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19
Q

Name 3 ACTH independent causes of Cushing’s syndrome

A

Iatrogenic: STEROIDs
Adrenal adenoma
Adrenal carcinoma

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20
Q

What is pseudo-cushing’s?

A

Mimics Cushing’s
Often due to alcohol excess/ severe depression
False +ve dexamethasone suppression test
Need insulin stress test to differentiate

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21
Q

What test is used for Cushing’s syndrome?

A
  1. Low dose overnight Dexamethasone suppression test
  2. High dose dexamethasone suppression test
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22
Q

Describe results of high dose dexamethasone suppression test in Cushing’s disease

A

Cortisol: Suppressed

ACTH: Suppressed

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23
Q

Describe results of high dose dexamethasone suppression test in Cushing’s syndrome due to other causes

A

Cortisol: Not suppressed

ACTH: Suppressed

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24
Q

What test can distinguish between pituitary and ectopic ACTH secretion?

A

Petrosal sinus sampling

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25
Q

Medical Mx of Cushing’s

A

Ketoconazole + Metyrapone inhibit glucocorticoid synth + secretion in adrenals

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26
Q

Surgical Mx of Cushings

A

Cushings disease: trans-sphenoidal hypophysectomy
Adrenal adenoma: laprascopic excision

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27
Q

Most common cause of hypoadrenalism. What does this result in?

A

AI destruction (Addisons)
Reduced cortisol + aldosterone

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28
Q

List 6 S/S of Addisons

A

Lethargy, weakness
N+V
WL + anorexia
HYPERPIGMENTATION, vitiligo
Hypotension
Hypoglycaemia

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29
Q

Electrolytes in Addisons

A

Hyponatraemia
Hyperkalaemia

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30
Q

What test is used for Addisons disease?

A

Short synACTHen test
Plasma cortisol measured before + 30 mins after giving Synacthen 250ug IM
(or 9am serum cortisol can be used)

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31
Q

Mx of Addisons

A

Hydrocortisone 2 divided doses (majority in 1st half of day)
Fludrocortisone

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32
Q

Adrenal crisis Sx

A

Collapse
Shock
Pyrexia

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33
Q

Adrenal crisis Mx

A

100mg Hydrocortisone IM
1L NaCl over 30-60 mins +/- dextrose

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34
Q

Most common cause of primary hyperaldosteronism

A

Bilateral idiopathic adrenal hyperplasia

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35
Q

3 features of primary hyperaldosteronism

A

HTN
Hypokalaemia: muscle weakness
Metabolic alkalosis

36
Q

What tests are used for primary hyperaldosteronism?

A

Aldosterone-renin ratio
(high aldosterone + low renin)

HRCT abdomen + adrenal vein sampling to distinguish between unilateral adenoma + bilateral hyperplasia

37
Q

Management of primary hyperaldosteronism

A

Adrenal adenoma (Conns): surgery (laparoscopic adrenalectomy)

Bilateral adrenocortical hyperplasia: Spironolactone

38
Q

What is a phaeochromocytoma?

A

Catecholamine secreting tumour

39
Q

5 S/S of phaeochromocytoma

A

HTN
Headache
Palpitations
Sweating
Anxiety

40
Q

Ix for phaeochromocytoma

A

24 urinary metanephrines

41
Q

Mx for phaeochromocytoma

A
  1. Phenoxybenzamine
  2. Propranolol
  3. Surgery
42
Q

What is Kallmann syndrome?
What measurements are seen?

A

Hypogonadotrophic hypogonadism
X-linked recessive

Low Testosterone
Low/ inappropriately norm LH + FSH

43
Q

List 4 characteristics of Kallmann syndrome

A

Delayed puberty
Hypogonadism
Anosmia
Normal/ above average height

44
Q

Mx of Kallmanns syndrome

A

Testosterone supplementation
Gonadotrophin supplementation for sperm production (fertility)

45
Q

What is Klinefelter syndrome? What measurements are seen?

A

Primary hypogonadism
High LH + FSH
Low Testosterone

46
Q

Name 4 S/S of Klinefelter syndrome

A

Taller than average
Lack secondary sexual characteristics
Gynaecomastia
Infertile

47
Q

What is Androgen insensitivity syndrome?

A

End organ resistance to Testosterone
Genotypically MALE but have FEMALE PHENOTYPE

48
Q

List 3 features of AIS

A

Undescended testes: Groin swelling
“Primary amenorrhoea”
Breast development

49
Q

What results from an increased oestrogen: androgen ratio?

A

Gynaecomastia

50
Q

List 4 drugs that cause an increased oestrogen: androgen ratio

A

Spironolactone
Digoxin
Cannabis
Goserelin (GnRH agonist)

51
Q

Pituitary adenoma classification by size

A

Microadenoma <1cm
Macroadenoma >1cm

52
Q

Pituitary adenoma classification by hormonal status

A

Secretory/ functioning: produces excess of a particular hormone

Non-secretory/ functioning: doesn’t produce a hormone to excess

53
Q

Name 3 drugs that increase prolactin

A

Metoclopramide
Domperidone
Haloperidol

54
Q

4 features of excess prolactin in women

A

Amenorrhoea
Infertility
Galactorrhoea
Osteoporosis

55
Q

3 features of excess prolactin in men

A

Impotence
Loss of libido
Galactorrhoea

56
Q

3 S/S of macroadenomas

A

Headache
Visual disturbances: bitemporal hemianopia
S/S of hypopituitarism

57
Q

Ix for prolactinoma

A

MRI

58
Q

Medical Mx of prolactinoma

A

Cabergoline/ Bromocriptine (Dopamine agonists)
Inhibit release of prolactin

59
Q

Surgical Mx of prolactioma

A

Trans-sphenoidal hypophysectomy

60
Q

Causes of hyperparathyroidism

A

Parathyroid adenoma (most common)
Hyperplasia
Multiple adenoma
Carcinoma

61
Q

S/S of hyperparathyroidism

A

Bones: pain/ fracture
Stones: renal stones, polydipsia, polyuria
Moans: peptic ulcers, anorexia, nausea, constipation
Groans: depression

62
Q

Bloods in primary hyperparathyroidism

A

High calcium
Low phosphate
High (or inappropriately normal) PTH

63
Q

Definitive Mx for primary hyperparathyroidism

A

Total parathyroidectomy

64
Q

Mx for primary hyperparathyroidism when surgery not suitable

A

Cinacalcet (calcimimetic)

65
Q

2 main causes of hypercalcaemia

A

Primary hyperparathyroidism
Malignancy

66
Q

5 less common causes of hypercalcaemia

A

Sarcoidosis
Acromegaly
Thiazides
Dehydration
Thyrotoxicosis

67
Q

4 causes of hypocalcaemia

A

Osteomalacia
CKD
Hypoparathyroidism (post thyroid/ parathyroid surgery)
Acute pancreatitis

68
Q

Features of hypocalcaemia

A

Cramping
Arrhythmias: QT prolongation
Tetany
Numbness

69
Q

2 specific signs of hypocalcaemia

A

Trousseau’s sign: carpal spasm
Chvostek’s sign: facial muscle twitch

70
Q

What is osteomalacia?

A

Softening of bones secondary to low vitamin D that leads to low bone mineral content

71
Q

4 causes of low vitamin D

A

Deficiency: malabsorption, lack of sunlight, diet
CKD
Cirrhosis
Drugs (anticonvulsants)

72
Q

4 S/S of osteomalacia

A

Bone pain
Bone/ muscle tenderness
Fractures: esp. NOF
Proximal myopathy- waddling gait

73
Q

Bloods in osteomalacia

A

Low vit D
Low calcium
Low phosphate
Raised ALP

74
Q

3 features of organic ED

A

Gradual onset Sx
Lack of tumescence
Normal libido

75
Q

7 features of psychogenic ED

A

Sudden onset Sx
Decreased libido
Good quality spontaneous/ self-stimulated erections
Major life events
Problems/ changes in relationship
Previous psychological problems
Hx premature ejaculation

76
Q

7 RFs for ED

A

Age
Obesity
DM
Dyslipidaemia
HTN
Smoking
Alcohol

77
Q

2 drugs that can cause ED

A

SSRIs
B-blockers

78
Q

Ix for ED

A

10y cardiovascular risk calculated (lipids + fasting glucose)
Free testosterone (AM)

79
Q

Mx of ED

A

Sildenafil (PDE5 inhibitor)
Vacuum erection devices
Stop cycling if >3h/ week

80
Q

Which group should be referred to urology for ED?

A

Young men who has always had difficulty achieving an erection

81
Q

What are the organic causes of ED?

A

Vasculogenic: CVD, HTN, PAD, obesity, DM

Neurogenic (central): MS, PD, Stroke
Neurogenic (peripheral): DM, CKD

Endocrine: DM, primary/ secondary hypogonadism, hypo/hyperthyroidism, hyperprolactinaemia, Cushing’s disease

82
Q

7 features of hypothyroidism

A

Lethargy
Weight gain
Cold intolerance
Skin changes: dry, non pitting oedema
Constipation
Menorrhagia
CTS + decreased reflexes

83
Q

What are the causes of primary hypothyroidism?

A

Hashimoto’s (AI. most common)
Subacute thyroiditis
Post-thyroidectomy
Drugs: lithium, amiodarone

84
Q

Mx of hypothyroidism

A

Levothyroxine

85
Q

What antibody is associated with hashimotos hypothyroidism?

A

Anti-thyroperoxidase (TPO)

86
Q

Describe TFTs in hypothyroidism

A

High TSH
Low T3 + T4

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