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Yr 3 MedEd > Endo 1 > Flashcards

Endo 1 Flashcards

(45 cards)

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1
Q

What is diabetes insipidus?

What are the two types of diabetes insipidus?

A

inadequate secretion of or insensitivity to vasopressin- causes hypotonic polyuria

  • Cranial- post. pituitary fails to secrete ADH
  • Nephrogenic: collecting ducts insensitive to ADH
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2
Q

Give 3 causes of cranial diabetes insipidus

Give 4 causes of nephrogenic diabetes insipidus

A

Cranial:
- Pituitary tumour, infection (meningitis), sarcoidosis
Nephrogenic:
- High Calcium, low potassium, lithium, inherited (AVPV2 gene), idiopathic

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3
Q

Give 3 features/ symptoms of a diabetes insipidus presentation

A
  • Polyuria- including nocturia- UO often > 3L
  • Polydipsia
  • Symptoms of hypernatraemia: lethargy, irritability, confusion.
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4
Q

What is the diagnostic investigation for diabetes insipidus?

How do the test results differ between cranial and nephrogenic diabetes insipidus?

A
  • Water deprivation test: water restricted for 8 hours, plasmas and urine osmolality measured every hour. After 8 hours give desmopressin and measure urine osmolality.
  • Cranial: Urine osmolality increase by >50% after desmopressin
  • Nephrogenic: Urine osmolality increases by <45% after desmopressin.
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5
Q

Which medication is used to treat cranial diabetes insipidus?

Which medication is used to treat nephrogenic diabetes insipidus?

A
  • Cranial: intranasal desmopressin

- Nephrogenic: Thiazide diuretic or NSAIDs: NSAIDs inhibit prostaglandin (Prostaglandin inhibits ADH).

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6
Q

How do the presentations of T1 and T2 diabetes mellitus differ?

A
  • T2 is polyuria and polydipsia.

- T1 is polyuria, polydipsia AND tiredness and weight loss, and DKA.

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7
Q

Give 4 signs of DKA.

A
  • N&V
  • Abdominal pain
  • Kussmaul breathing
  • Sweet breath
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8
Q

Give two risk factors for T1DM.

Give 4 risk factors for T2DM.

A

T1: HLA DR3/4, autoimmune conditions.
T2: Obesity, FH, ethnicity, drugs.

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9
Q

What are the fasting and random glucose measurements needed to diagnose diabetes.

A
  • Fasting >/= 7mmol/L

- Random: >11.1 mol/L

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10
Q

What is the normal range of sodium?

What is hyponatraemia caused by?

A
  • 135-145 mol/L

- Hyponatraemia caused by too much ADH- physiological or inappropriate

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11
Q

Give 3 causes of hypovolaemia with hyponatraemia.

Give 3 signs of hypovolaemia with hyponatraemia.

A
  • Diarrhoea
  • Vomiting
  • Diuretics
  • Reduced turgor
  • Postural hypotension
  • dry mucous membrane
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12
Q

Give 3 causes of hyponatraemia with euvolaemia.

Give 2 tests for a hyponatraemic patient with euvolaemia.

Give 3 further investigations if these tests were normal.

A
  • Hypothyroidism
  • Hypoadrenalism
  • SIADH- pneumonia/ cancer
  • TFTs
  • Short synACTHen: inject ACTH, cortisol will not rise in hypoadrenalism
  • Drug review, breast examination, CXR/ brain MRI
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13
Q

Give 3 causes of hypervolaemia with hyponatraemia

Give two signs of hypervolaemia with hyponatraemia

A
  • HF
  • Cirrhosis
  • Nephrotic syndrome
  • Oedema, raised JVP
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14
Q

Give 3 causes of hypernatraemia

A
  • N&V
  • Diabetes insipidus
  • primary aldosteronism- Conn’s syndrome
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15
Q

Give 5 signs of hypernatraemia.

What is the management of hypernatraemia?

A
  • Lethargy
  • Irritability
  • Thirst
  • Signs of dehydration
  • confusion
  • coma
  • fits
  • Management: replace water
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16
Q

What will the following investigations show in SIADH?

  • Serum Na
  • Urine Osm
  • Urine Na
A

Serum Na low, urine osmolality is high, urine sodium low.

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17
Q

Give 4 causes of SIADH?

A
  • CNS pathology
  • Lung pathology
  • Drugs: SSRI, TCA, Opiates, PPIs, carbamazepine
  • Tumours- don’t forget breast cancer.
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18
Q

Give 2 management steps for SIADH

A
  • Fluid restrict to 0.5-1L
  • If ineffective give demeclocycline or vasopressin receptor antagonist, e.g. tolvaptan- reduces responsiveness of collecting tubule cells to ADH.
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19
Q

Where is prolactin secreted from?

Which two hormones regulate this gland?

Study These Flashcards
A
  • Prolactin secreted from anterior pituitary
  • Thyrotrophin releasing hormone (TRH) increases prolactin secretion (as well as thyroid hormone synthesis).
  • Dopamine inihibits prolactin secretion.
20
Q

Give 4 causes of hyperprolactinaemia

Study These Flashcards
A
  1. Pituitary prolactinoma
  2. Hypothyroidism- increased TRH causes increased prolactin
  3. Drugs: METCLOPRAMIDE, antipsychotics (DA antagonists)
  4. Physiological; pregnancy/ breastfeeding
21
Q

Give 4 presenting features of hyperprolactinaemia in women and 2 in men.

Give 2 presenting features of tumour.

Study These Flashcards
A

Women: galactorrhea, amenorrhoea, infertility, loss of libido.
Men: infertility, loss of libido
Tumour: headache, loss of visual fields.

22
Q

Give 3 investigations (2 BT, 1 imaging) for hyperprolactinaemia

Study These Flashcards
A

Blood test: prolactin, TFTs

Imaging: Pituitary MRI

23
Q

Give the 1st and 2nd line management for hyperprolactinaemia

Study These Flashcards
A
  1. DA agonist, e.g. bromocriptine, cabergoline

2. Surgery

24
Q

Give 7 signs of hyperthyroidism

Study These Flashcards
A
  • Heat intolerance, sweating
  • Weight loss but good appetite
  • Diarrhoea
  • Irritable
  • Palpitations, irregular pules
  • tremor
  • menstrual irregularities in women, impotence in men.
25
Give 7 signs of hypothyroidism
- Cold intolerance - weight gain - Constipation - lethargy - bradycardia - Dry skin, cold hands - menstrual disturbance in females
26
What is the difference between hyperthyroidism and thyroiditis?
Hyperthyroidism: increased thyroid hormone synthesis Thyroiditis: increased release of stores thyroid hormone
27
What is the aetiology of Grave's disease. | What is Grave's triad?
- Autoantibodies to TSH receptor. Associated with other AI diseases. - Exopthalmos, pretibial myxoedema, thyroid acropachy (clubbing, soft tissue swelling, periosteal bone formation).
28
What is the aetiology of De Quervain's thyroiditis? What symptoms does it cause? What is the management?
- Post viral, high ESR. Causes painful goitre and fever. Self limiting (treat with NSAIDs).
29
In what 2 populations do you find toxic multinodular goitre?
Elderly and iodine deficient areas.
30
What would you expect to be the cause of a solitary nodule producing T3/4?
- Thyroid adenoma
31
What radioisotope scan findings would you expect to see from the following? - Grave's disease - De Quervain's thyroiditis - Toxic multinodular goitre - Adenoma
Graves: diffuses increased uptake- smooth diffuse goitre De Quervain's: No uptake Toxic MNG: Multiple areas of increased uptake Adenoma: single area of increased uptake
32
Give 5 causes of hypothyroidism
- Autoimmune Hashimoto's thyroiditis- commonest cause in West. - Iodine deficiency- commonest cause worldwide - Iatrogenic: post surgery, radioiodine, amiodarone - De Quervain's thyroiditis - Congenital thyroid dysgenesis
33
What is the management for hypothyroidism?
- Levothyroxine 25-200 micrograms per day- monitor TFTs in 6 weeks.
34
What are the features of the following types of thyroid cancer: - Papillary - Follicular - Medullary - Lymphoma - Anaplastic
Pap: most common, younger patients. RF: radiation exposure. Bzw: Psammoma bodies, Orphan Anne nuclei Fol: Middle aged women. Bzw: Hurthle cells Med: Associated with MEN2 Lym: Females, after pre-existing Hashimoto's Ana: Elderly females. Bzw: giant cells, pleomorphic hyper chromatic nuclei.
35
What is the usual aetiology of acromegaly?
- Adenoma secreting GH in pituitary. | GH stimulates release of IGF-1: causes growth of bones and soft tissue.
36
Give 7 presenting features of acromegaly
- Tight fitting shoes/ rings - Carpal tunnel syndrome - Coarse facial features - Increased sweating - hypertension - Insulin resistance - Sleep apnoea
37
Give 1 screening test, 1 diagnostic and 1 imaging investigation for acromegaly
- Screen: serum IGF-1 - Diagnostic test: Oral glucose tolerance test: acromegalic fail to suppress GH after 75g glucose load. - Imaging: MRI brain to visualise pituitary tumour. Cannot rely on GH secretion as it is pulsatile
38
Give the 1st and 2nd line management for acromegaly
1st: transphenoidal hypophysectomy 2nd: Somatostatin analogue e.g. octreotide
39
What is the inheritance pattern of MEN?
- Autosomal dominant.
40
Give 3 features of MEN 1
PPP - Parathyroid adenoma/ hyperplasia- hyperparathyroidism, high Ca. - Pancreas: insulinoma, gastrinoma - Pituitary: prolactinoma, acromegaly, adrenal, carcinoid tumours
41
Give 3 features of MEN 2.
TAP - Thyroid: medullary thyroid cancer in all - Adrenal: phaeochromocytoma; in 50% - Parathyroid hyperplasia
42
Give 3 features of MEN 3/ 2B
- Med thyroid carcinoma + phaeo as in MEN 2 - Mucosal neuromas: bumps on lips, cheeks, tongue, eyelid - Marfanoid appearance No hyperparathyroidism
43
What is carcinoid syndrome? Name 4 secretory products produced. Give 2 common sites for carcinoid tumours
- Constellation of symptoms caused by systemic release of humoral factors from carcinoid tumours - Produce secretory products: serotonin, histamine, tachykinins, prostaglandin - Appendix and rectum
44
Give 6 presenting features of carcinoid syndrome
- Paroxysmal flushing - Diarrhoea - Crampy abdominal pain - wheeze - sweating - palpitations
45
What is measured in urine to test for carcinoid syndrome? | What other investigation can be used?
- Measure increase in 5- HIAA levels: serotonin metabolite | - CT/ MRI to localise tumour

Yr 3 MedEd (31 decks)

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