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Final year Medicine > endo > Flashcards

endo Flashcards

1
Q

Pioglitazone side effects

A 
Weight gain
Fractures
Fluid retention (C.I HF)
bladder cancer
Liver impairment
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2
Q

Ix Cushings syndrome

A

24h urinary cortisol

Overnight dexamethasone suppression test
Pitadenoma-high dose -> reduced.cortisol,highACTH

ACTH low, cortisolnoteffected ->adrenal adenoma, (cushings syndrome)

high acth, unaffected cortisol -> ectopic acth

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3
Q

Raised prolactin effect

A

Impotence, libido loss, galactorrhea

women : amenorrhea, galactorrhea

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4
Q

Causes of raised prolactin

A 
Prolactinoma
pregnancy
oestrogens
stress, exercise, sleep
acromegaly
PCOS
Hypothyroid
Metoclopramide, domperidone
phenothiazines
haloperidol
SSRIs, opioids
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5
Q

drug cause of hypercalcaemia

A

thiazide

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6
Q

Levothyroxine in pregnancy

A

increase dose by 50% at 4-6w

increase in TBG
measure TSH in each trimester.
breastfeeding safe.

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7
Q

dx HHS

A

hypovolaemia
glucose>30
serum osmolality >320

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8
Q

Mx HHS

A

Fluid replace0.9% saline
positive balance of 3-6 L by 12h

monitor serum osmolarity, glucose, sodium .

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9
Q

Addisons causes

A

sepsis
surgery -> exacerbations
adrenal haemorhage
steroid withdrawal

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10
Q

Mx addisons

A

100mg Hydrocortisone IM /IV
1 litre saline + dextrose 30-60m
continue steroids 6hly until stable
continue maintainence after 24h

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11
Q

tx prolactinoma

A

bromocriptine

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12
Q

pituitary adenoma ix

A

bloods - GH, prolatin, ACTH, FSH, LH, TFTs
formal visual field testing
MRI brain

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13
Q

de quervains phases

A
  1. hyperthyroid. painful goitre ESR
  2. euthyroid
  3. hypothyoid
  4. normal
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14
Q

thyroid globally reduced uptake

A

de quervains

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15
Q

Thyrotoxic storm

A

b blocker
propothyouracil
hydrocortisone

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16
Q

Causes of bitemporal hemianopia

A 
Neoplastic 
- pituitary macroadenoma
-suprasellar meningioma
craniopharyngioma
chiasmatic glioma
Non neoplastic
aneurysm /ectatic carotid artery
epidermoid cyst
sarcoid
dermoid cyst
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17
Q

Causes of carpal tunnel syndrome

A 
Idiopathic
soft tissue swelling
pregnancy
menopause
gout
acromegaly
rheumatoid
myxoedmea
amyloidosis
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18
Q

Features of acromegaly

A 
Prognathism
cardiomegaly
Colonic polyps
macroglossia
hepatosplenomegaly
30-50
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19
Q

Ix acromegaly

A

OGTT + measure GH
-failure of normal suppression of GH to < 2 in response to glucose load.

MRI pituitary adenoma

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20
Q

Mx acromegaly

A

Bromocriptine, cabergoiline
somatostatin analogues

External beam irradiation (older)

Younger, pressure sx. Transsphnoidal hypophysectomy.

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21
Q

Ix cushings

A

24 h urinary free cortisol
Overnight dex suppression test.
(1mg at midnight) then check 9am cortisol
mRI pituitary, petrosal venous sinus samploing - confirm pituitary source

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22
Q

Ix secondary HTN

A 
CT adrenals
Renal USS
Dexsuppression test
plasma metanephrines
Renin: aldosterone ratio
MIBG scan
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23
Q

Mx phaeo

A

alpha blockers - phenoxybenzamine

24
Q

SIADH ix

A

urine osmolality >100
Urine Na >40
plasma osmolality <290

25
Q

SIADH causes

A 
Stroke, 
cancer
lung abscess
sepsis
neuro disease
26
Q

SIADH tx

A

Mild: fluid restriction
Severe: specialist - hypertonic NaCl 1.8% , controlled.
Demeclocycline if resistant.

27
Q

Mx malignancy related hypercalcemia

A

IV fluids

Bisphosphonates (oral/IV)

28
Q

Growth hormone deficiency in adults symptoms

A 
Anxiety and depression
body fat waist increase
low libido
fatigue
isolation
heat and cold sensitivity

Ix: AGHDA questionarre
Blood tests.

29
Q

Thyroid storm precipitants

A 
Thyroid/non thyroid surgery
trauma
infection
acute iodine load (ct contrast media) 
DKA
MI
30
Q

thyroid storm features

A 
fever
tachy
confusion
N+V
HTN
HF
LFTs
Abdo pain
31
Q

Thyroid storm Mx

A 
IV fluids
analgesia
IV/oral propranolol
Propothyouracil
Hydrocortisone IV
Cardiac monitoring
Urgent endo review

Hyperthyroid mx: Carbimazole 40mg OD

32
Q

Addisons features

A 
Mouth pigmentation
tiredness
SOB
Wt loss
Polyuria
Headaches
Dizziness. 
postural hypotension

Hyponatremia
Hyperkalaemia
raised urea. (mineralocorticoid deficiency)

33
Q

Addisons ix

A

random cortisol + matched ACTH

Short synacthen test. <550
if secondary, could be normal if onset within 4weeks.
if longstanding lack of ACTH, adrenals will atrophy.

34
Q

Causes of primary addisons

A 
Autoimmune. 70%
post infectous (TB, fungal, HIV) 20%
35
Q

Tx addisons

A

Hydrocortisone

Fludrocortisone.

36
Q

Carcinoid syndrome features

A 
Abdo pain
Diarrhoea
Weight loss
Flushing (worse w Etoh/exercise)
Hyper/hypotension
Bronchospasm
Dizziness
Wheezing on exercise
can get cushings.
Tumour in argentaffin cells produces 5HT.
Most commonly appendix/distal ileum,
1/3 Mets (most to liver)
Syndrome = Mets
Asw MEN1.
Tricuspid regurg/stenosis. 50-60%.
37
Q

Carcinoid syndrome ix

A

Plasma serotonin
24h urine 5 HIAA
(check diet/drugs before)

CT CAP
Endoscopic ultrasound.

Somatostatin receptor scintigraphy.

38
Q

Complications of Carcinoid syndrome

A

Vit B3 malabsorption (Pellagra)- diarrhoea, dementia, dermatitis.

Pulmonary stenosis
Hepatic mets
Desmoplastic tumours in mesentery.

39
Q

Carcinoid syndrome mx

A

Antihistamines - itching and flushing.

Octreotide - block release of mediateors, diminishing effect tho,

Alpha interferon - reduce tumour size.

Surgical resection.
Ablation.
Chemo.
Loperamide.

40
Q

DKA features

A 
Anorexia
lethargy
polydipsia
polyuria
dehydration
abdo pain
vomiting
coma
Hyperventilation
41
Q

Salicylate OD features

A 
Dehydration
Vomiting
Hyperventilation
Vertigo
Sweating
tinnitus
hypokalaemia.
42
Q

HHS features

A

longer deterioration
dehydration
glucose >35
Osmolality >340

43
Q

DKA dx criteria

A 
Glucose >11.1 /Known DM
Ketonuria ++ 
bicarb <15
pH <7.3
metabolic acidosis with raised AG.
44
Q

Causes of raised AG:

A 
phosphate
lactate
ketones
urate
salicylate/biguanides poisoning.
45
Q

AG equation

A

Na + K - (Cl + Hco3) = 10-18mmol/L

46
Q

Mx DKA

A
  1. FLUIDS
    14 G cannula in 2 ACFs
    0.9% sodium chloride (1L bolus) -> 1L over 1h.
    then 1L over 2-4h then 1L over 4-6h.
  2. INSULIN
    If glucose >20 + delay, IM 10U insulin.

otherwise 50U insulin 50ml 0.9% Sodium chloride (0.1u/kg/h)

  1. Replace Potassium .e.g. 40 mmol in 1L over 6h
    if <3.5 -> HDU.

Cardiac monitor
Monitor GCS

get MSU, blood ketones, blood cultures, CXR, monitor U+Es, gucose, bicarb.
at 2h, and then 4h intervals.

Catheterise if no urine. aim 0.5ml/kg/h.
NGT if vomiting.
LMWH.

aim to reduce glucose 4-6/h, and bicarb >15. and correct acidosis.
once glucose <14 -> 10% dextrose. 125ml/h.

Resolution
Blood ketones <0.3
pH>7.3
bicarb >18.

once eating, 1+ less ketonuria -> SC insulin.

47
Q

Causes of hypomagnesemia

A

GI - Diet, malabsorption, diarrhoea/vomiting, pancreatitis, alcohol.

MI

Renal failure, DM, DKA - insulin.

Diuretics, aminoglycosides, adrenergics

Symptoms: arrythmias, weakness, asthma. coma.

48
Q

Osmolality equation

A

2 (na + K) + (urea + glucose)

280-300.

49
Q

Phaeo sx

A 
Sweats,
anxiety 
restlessness
chest tightness
palpitations
HTN
Precipitants:
Stress,
surgery
parturition
Smoking
alcohol
TCAs
Cheese.

Tx: Alpha then B blockade.

50
Q

Thyroid eye disease

A

Lid lag, lid retraction
More common in smokers.

Graves: proptosis, periorbital oedema, diplopia, grittines, increased tears.

Tx: artificial tears, eye ointment, dark glasses.
Diuretics, radiotherapy for oedema

visual acuity loss, colour loss -> optic nerve compression -> pred, surgery.

51
Q

Tx Hyperthyroid

A

Carbimazole 30-60mg OD -> reducing according to t4.
for 12-18months/PTU.

or can give block replace 40mg/day for 6months plus thyroxine if hypothyroid.

B blockers - tremor, palps, agitation.

Surgery - total/subtotal thyroidectomy
complications: Recurrent laryngeal nerve palsy, hypoparathyroid, haematoma.

Radioiodine 1311.

52
Q

Carbimazole SE

A

Agranulocytosis 0.1%
Maculopapular rash 5%
Pruritus
Jaundice

53
Q

DM: definitions

A 
Diabetes:
Fasting glucose > 7
Glucose tolerance test 
(75g glucose) 
Plasma glucose >11.1 at 2h.

2h : 7.8-11.1 = impaired glucose tolerance.
impaired fasting glucose 6-7.

54
Q

Diabetic retinopathy

A

BG:
Venodilation
Microaneurysms
Hard exudates

Preproliferative: soft exudates

Proliferative: new vessels.

55
Q

hypertensive

A

Silver wiring
AV nipping
cotton wool spots/flame haemorrhages
papilloedema

Final year Medicine (18 decks)

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