SPIDER 1. IV fluids,saline or hartmanns 2. Balance electrolytes especially K 3. IV insulin infusion 4. Treat underlying cause 5. Avoid complications

Endo Flashcards by Ang Qing Kang Dominic

Common Signs and symptoms of hyperthyroidism

1)Heat intolerance
2)Tachycardia and palpitations
3)Heat intolerance
4)Weight loss
5)Miscarriage
6)Nervousness and irritability
7)Poor sleep
8)Shakiness and myopathy:hand tremors
9)Diarrhoea
10)Shorter or lighter menstrual periods(oligomenorrhea)

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Atypical signs and symptoms of hyperthyroidism

Atrial fibrillation in elderly
Single nodule mass in elderly(toxic adenoma)
Apathy
Steatorrhea(malabsorption syndrome)
Acute psychotic Attack:violence and anger
Young onset osteoporosis

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Endocrinology causes of osteoporosis

Hyperthyroidism
Cushing’s syndrome
Hypogonadism

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Signs of thyrotoxic periodic paralysis

-Suddenly unable to move eg getting up from toilet
-More common in Asians
-Together with typical hyperthyroidism signs(?)

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Causes of orbital swelling

Hyperthyroid
Angioedema in allergic run
Raynaud’s disease

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Difference in texture of Graves and Hashimotos

Graves thyroid tends to be soft, Hashimoto will be firm

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Indications for PTU use over carbimazole

1) 1st and 2nd trimester of pregnancy
2) Thyrotoxic storm(because of inhibition of peripheral conversion of t3 to t4

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Indications for thyroidectomy

4Cs
Cancer
Compression
Cosmetics
Complications

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Risk of thyroidectomy

1) Vocal cord palsy and stridor
2) post operative hypocalcemia
3) Early onset dementia if not compliant to medications,because of complete removal of thyroid

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Signs of thyrotoxic/thyroid storm

Young,high fever,tachycardia and goitre

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What is the renal threshold level for glucose?

about 160–180 mg/dL (8.9-10 mmol/L), the proximal tubule becomes overwhelmed and begins to excrete glucose in the urine. This point is called the renal threshold for glucose (RTG).

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6Is of DKA and HHS

Insulin: Undiagnosed or noncompliant
Infection: UTI, pneumonia etc
Inflammation: cholecystitis, pancreatitis etc
Infarction: AMI,stroke etc
Intoxication: Alcohol,toxins
Iatrogenic: drugs,surgery

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Mx of DKA acronym

SPIDER

Saline
Potassium
Insulin
Dextrose
Electrolyte abnormalities+ Eat nothing
Reason(underlying)

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Sx of DKA

Polyuria(due to glucosuria)
Dehydration
N/V
Abdominal pain
Kussmaul breathing
Sweet breath(acetate)

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In thyroid PE carotid bruit,thyroid acropachy and oncolysis is specific for?

Graves

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Causes of Addison disease(primary adrenal insufficency)

Ischemic injury and necrosis due to shock(Waterhouse Friderichsen syndrome)
DIVC
Trauma(blunt or postoperative)
R
enal mass causing hemorrhage
. Short course of corticosteroids
Autoimmune causes
Infectious causes eg TB, CMV
Infiltrative causes( amyloidosis, Hemochromatosis)
VTEs
Vitamin B5 deficiency

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Management of DKA

SPIDER

IV fluids,saline or hartmanns
Balance electrolytes especially K
IV insulin infusion
Treat underlying cause
Avoid complications

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Types of diabetes insipidus

CDI: Central
NDI: Nephrogenic

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Antihypertensive contraindicated in pheochromocytoma

Beta blocker: releases peripheral adrenaline at B2, may cause hypertensive crisis

USE alpha blocker: phenoxybenzamine

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Mx of pheochromocytoma

Pharmacological: Alpha blocker phenoxybenzamine

Surgical: Adrenalectomy

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Condition that is most specific for Pretibial Myxedema

Graves disease, esp TrAb positive

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Gold standard test for acromegaly

Growth hormone suppression test with 75g OGTT and 30mins serial HGH measurements

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Causes of tiredness in acromegaly patient

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DM
Anemia
OSA
Panhypopituitarism

Management of acromegaly

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Dopamine agonists eg bromocriptine

Surgical: Trans sphenoidal surgery

Script for acromegaly mx

"Acromegaly is a complex condition which will require involvement of the patient, endocrinologist and neurosurgeon Patient education should be first followed by referral to neurosurgeon But it is difficult to completely treat so subsequent pharmacotherapy(3 drugs) and radiotherapy will be required Complications such as orthopedic,endocrine, CVS and GI will have to be managed"

Drug for pheochromocytoma

PHEnoxybenzamine for PHEochromocytoma

Signs suggestive of myxedema coma in comatose patient

Bradycardia and hypothermia(not commonly seen in other causes of collapse)

SEs of metformin

Lactic acidosis

SEs of SGLT2

1. Euglycemic KA 2. Hypotension

SE of pioglitazone

Fluid overload

Mx of severe Hypoglycemia

D50 IV 40ml stat IM glucagon 1mg if no IV access

Mx of mild hypoglycemia

15g oral dextrose

When to suspect secondary HTN

1) Young HTN 2) Treatment resistant HTN(despite 3 anti hypertensives) 3) Features of swcondary etiologies

Drug of choice for pheochromocytoma

Alpha blocker NOT beta, will cause pheochromocytoma crisis

Mx of acute addisonian crisis

1) 100mg bolus IV hydrocortisone then 200mg infusion 2) 1l crystalloids 3) Treat precipitant

Test for suspected Addisons disease

Random serum cortisol and ACTH

What is the short synacthen test for

Synthetic ACTH to test for adrenal response in producing cortisol

Cause of Hyperpigmentation in Addisons disease

High ACTH activates melanocytes in skin

Amount of time after giving PTU/carbimazole to give Lugols Iodine in thyroid storm

1hr

MOA of teriperatide

PTH analogue. PTH in pulses instead of being chronically high has an Anabolic effect

Min Creatinine Clearance for bisphosphonates

Causes of central diabetes insipidus

1. Pituitary tumor 2. Neurosurgical intervention 3. Sheehan and RT?

Causes of nephrogenic diabetes insipidus

1) Uncontrolled hyperglycemia 2) Drugs eg lithium 3) Electrolytes eg HyperCa, hypoK 4) Renal disease eg ADPKD 5) inherited(rare)

4 stages of hypertensive retinopathy

1. Silver wiring 2. AV nipping 3. Cotton wool spots, dot and blot hemorrhages 4. Papilloedema

Cause of metabolic acidosis with hypoK

Renal Tubular Acidosis Hyperglycemic emergency?

Cause of hypertension with hypokalemia

1. Conn's syndrome 2. Cushing syndrome 3. Pheochromocytoma 4. Hyperthyroidism

Causes of metabolic alkalosis

1. Conn's syndrome 2. Cushing syndrome 3. Liddle syndrome

Doses for HyperK mx

Calcium gluconate: 10ml 10% over 10mins Iv insulin 10units 20ml D50

magic number for Calcium and Vit D intake

1000mg of Ca and 1000U of vit D

When is slow bolus calcium gluconate diluted in 100ml and infused over 1hr

Post thyroidectomy

Syndromes a/w pheochromocytoma

1. MEN 2A/2B 2. Neurocutaneous syndromes - NF1 - Sturge Weber - Tuberous Sclerosis - Von Hippel Lindau

GFR cutoff for bisphosphonate use for osteoporosis

30ml/min/1.73m^2

Which endocrinopathies are adrenal vein sampling useful for

Only for hyperaldosteronism -No role in Cushings or pheochromocytoma

Bone vs Liver ALP is heat sensitive

ALP from bone pathologies is heat sensitive( BONE BURNS)

Endo Flashcards

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