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Oishi's Final year flashcards > Endo > Flashcards

Endo Flashcards

1
Q

Which type of meds does MODY typically respond well to?

A

Sulfonylureas

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2
Q

MEN-1 features?

A

parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
pituitary (70%)
pancreas (50%, e.g. Insulinoma, gastrinoma)
also: adrenal and thyroid

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3
Q

How to screen for medullary thyroid cancer recurrence?

A

Serum calcitonin

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4
Q

Define impaired fasting glucose?

A

6.1 - 7mmol/L

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5
Q

Define impaired glucose tolerance at 2 hours?

A

Fasting plasma glucose <7mmol/L

At 2 hours 7.8 - 11.1

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6
Q

Which type of anti diabetic med is contraindicated in HF?

A

Pioglitazone (thiazolidinedione)

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7
Q

Severity of Graves’ eye disease? NO SPECS

A

No signs / symptoms
Only signs (e.g: upper lid retraction)
Signs & symptoms (including soft-tissue involvement)
Proptosis
Extra-ocular muscle involvement
Corneal involvement
Sight loss due to optic nerve involvement

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8
Q

5Bs of thyroid storm tx?

A

B- B-Blockers
B- Block synthesis (thionamides - carbimazole)
B- block release (wolff-chiakoff)- iodine
B- Block T4-T3 conversion (PTU, steroids, and even amiodarone- again wolff chiakoff)
B- Block enterohepatic circulation (i.e. bile acid sequestrants)

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9
Q

What acid base disturbance does Cushing’s syndrome cause?

A

Hypokalaemic metabolic alkalosis

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10
Q

Sick euthyroid syndrome findings?

A

low T3/T4 and normal TSH with acute illness

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11
Q

De Quervain’s thyroiditis tx?

A

Simple analgesia

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12
Q

SEs of thiazolidinediones? e.g. piaglitazone?

A 
Weight gain
Liver impairment
Fluid retention
Increased risk of fractures
Increased risk of bladder cancer
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13
Q

If a patient is admitted with DKA, what should happen to their long acting basal insulin?

A

It should be continued alongside IV insulin

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14
Q

How to stop IV insulin in a patient admitted with DKA?

A

Make sure they eat breakfast/lunch
Inject SC prandial insulin
Stop IV insulin 30 mins later

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15
Q

What does a high TSH but a normal fT4 suggest?

A

erratic compliance with thyroxine tx: patients who don’t take the medication regularly, but remember to take it immediately before a blood test is due

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16
Q

Features of acromegaly?

A 
Diabetic retinopathy
Prognathism
Macroglossia
Cardiomegaly
Hepatosplenomegaly
Colonic polyps
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17
Q

Causes of pseudo-Cushings syndrome?

A

Depression
Obesity
Alcohol excess
Liver enzyme inducers - phenytoin, phenobarbital and rifampicin

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18
Q

What should be used for alpha blockade in phaeo tx?

A

phenoxybenzamine

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19
Q

Test for carcinoid syndrome?

A

24hr urine 5HIAA

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20
Q

What scan for phaeo?

A

MIBG

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21
Q

DKA diagnostic criteria?

A

pH <7.3 and/or bicarbonate <15mmol/L.
Blood glucose >11mmol/L or known diabetes mellitus.
Ketonaemia >3mmol/L or significant ketonuria ++ on urine dipstick

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22
Q

How does Alcoholic ketoacidosis present?

A

low or normal glucose levels and usually occurs due to patients being able to tolerate oral nutrition resulting in a state of starvation with associated ketoacidosis

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23
Q

1st line mx for acromegaly? What is the alternative 1st line?

A

Trans-sphenoidal surgery

Octreotide (if surgery not suitable)

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24
Q

MEN 2A features?

A

Parathyroid hyperplasia
Medullary thyroid carcinoma
Phaeochromocytoma

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25
Q

Men 2B features?

A

Mucosal neuroma
Marfanoid appearance
Medullary thyroid carcinoma
Phaeochromocytoma

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26
Q

Thyroglobulin can be used as a tumour marker for which cancers?

A

Papillary

Follicular

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27
Q

Which thyroid cancer metastasises to lung and bone?

A

Follicular

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28
Q

Which thyroid cancer has orphan eyes appearance?

A

Papillary

29
Q

most common cause of primary hyperaldosteronism?

A

Bilateral idiopathic adrenal hyperplasia

30
Q

TD2M: What to do if a triple combination of drugs has failed to reduce HbA1c AND BMI >35?

A

metformin + sulfonylurea + GLP-1 mimetic is recommended, particularly if the BMI > 35

31
Q

Causes of raised prolactin?

A 
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines
Other drugs: 
metoclopramide
domperidone
chlorpromazine
haloperidol
very rare: SSRIs, opioids
32
Q

Most common cause of primary hyperparathyroidism?

A

Solitary parathyroid adenoma

33
Q

Alcoholic ketoacidosis mx?

A

infusion of saline and thiamine

34
Q

What cardiac abnormalities are associated with this carcinoid syndrome?

A

Pulmonary stenosis and tricuspid insufficiency

35
Q

Thyrotoxic storm tx?

A

beta blockers, propylthiouracil and hydrocortisone

36
Q

Causes of gynaecomastia?

A 
physiological: normal in puberty
syndromes with androgen deficiency: Kallman's, Klinefelter's
testicular failure: e.g. mumps
liver disease
testicular cancer e.g. seminoma secreting hCG
ectopic tumour secretion
hyperthyroidism
haemodialysis
drugs: spironolactone
37
Q

Drug causes of gynaecomastia?

A 
spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids
38
Q

Tx for myxoedema coma?

A

IV corticosteroids + IV thyroid hormone replacement

39
Q

MOA of gliptins?

A

dipeptidyl peptidase-4, DPP-4 inhibitors increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown
Incretins then increase insulin secretion by binding to beta cells on pancreas

40
Q

What is likely to cause osteomalacia + hypokalaemia

A

type 2 renal tubular acidosis

41
Q

Which type of renal tubular acidosis causes hyperkalaemia?

A

Type 4 renal tubular acidosis

42
Q

How to tell the difference between MODY and LADA?

A

LADA –> decreased insulin –> increased glucagon –> increased ketones
MODY –> normal insulin –> normal glucagon –> normal ketones
MODY is essentially T2 in young whereas LADA is T1 in elderly

43
Q

Risks of correcting sodium levels too quickly?

A

Hyponatraemia correction - osmotic demyelination syndrome

Hypernatreamia correction - cerebral oedema

44
Q

Mx of peripheral neuropathy?

A

amitriptyline (don’t prescribe if BPH), duloxetine, gabapentin or pregabalin

45
Q

How often must Insulin-dependent diabetics check their blood glucose when driving?

A

Every 2 hours

46
Q

How many units of insulin in most standard preparations?

A

100U in 1ml

47
Q

What can can reduce the absorption of levothyroxine and how can you prevent it?

A

Taking iron/calcium tablets

Take them 4 hours apart

48
Q

Diagnostic criteria for HHS?

A

hypovolaemia
hyperglycaemia (blood sugar > 30mmol/L) without significant ketones/acidosis
serum osmolality > 320mosmol/kg

49
Q

Which conditions predispose to pseudogout?

A

Acromegaly

Wilson’s

50
Q

Tx for gynaecomastia?

A

Aromatase inhibitors

Reversible cause tx

51
Q

Addison’s patient with intercurrent illness - what to do with their dose of steroids?

A

double the glucocorticoids

keep fludrocortisone dose the same

52
Q

Congenital adrenal hyperplasia biochemical abnormalities?

A

Increased plasma 17-hydroxyprogesterone levels
Increased plasma 21-deoxycortisol levels
Increased urinary adrenocorticosteroid metabolites

53
Q

Tx for hyperparathyroidism?

A
  1. Total parathyroidectomy

2. Cinacalcet

54
Q

How does Cinacalcet work?

A

Mimics action of calcium in parathyroid gland - reducing PTH and therefore Calcium

55
Q

Which form of Addison’s is associated with hyperpigmentation?

A

Primary Addison’s

56
Q

Causes of Addison’s?

A 
Primary causes:
tuberculosis
metastases (e.g. bronchial carcinoma)
meningococcal septicaemia (Waterhouse-Friderichsen syndrome)
HIV
antiphospholipid syndrome
Secondary causes:
pituitary disorders (e.g. tumours, irradiation, infiltration)
57
Q

1st line Tx of prolactinoma?

A

Cabergoline

Trans-sphenoidal surgery if unsuccessful

58
Q

What to do if TSH is between 4 - 10mU/L and the free thyroxine level is within the normal range?

A

<65 years + symptomatic: trial of levothyroxine - if no improvement in symptoms, stop levothyroxine
Older people (especially >80 years): ‘watch and wait’ strategy - generally avoid tx
Asymptomatic: observe and repeat TFTs in 6 months

59
Q

What to do if TSH is > 10mU/L and the free thyroxine level is within the normal range?

A

<=70: start tx even if asymptomatic

Older (especially >80): ‘watch and wait’

60
Q

Features of thyroid storm?

A

hyperthermia
tachycardia
jaundice
altered mental status

61
Q

Indications for surgery in primary hyperparathyroidism?

A

Elevated serum corrected Calcium >0.25mmol/L above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations below peak bone mass (T score lower than -2.5)

62
Q

Hypercalcaemia mx?

A

IV fluids

If Ca >3: + IV bisphosphonate

63
Q

osteoporosis guidelines if a postmenopausal woman has a fragility fracture?

A

put on bisphosphonates (there is no need for a DEXA scan)

64
Q

What to prescribe alongside bisphosphonates?

A

vitamin D and calcium supplementation should be offered to all women unless confident they have adequate calcium intake and are vitamin D replete

65
Q

Investigation findings in Kallman syndrome?

A

hypogonadotropic hypogonadism
Low testosterone
Low/inappropriately normal FSH and LH

66
Q

Investigation findings in Klinefelter’s syndrome?

A

hypergonadotropic hypogonadism
Low testosterone
High FSH and LH

67
Q

How to determine cause of Cushing’s?

A

If low dose doesn’t suppress cortisol - CUSHING SYNDROME

High dose helps determine specific cause
Cortisol and ACTH suppressed = pituitary adenoma
Cortisol NOT SUPPRESSED, ACTH SUPPRESSED = adrenal adenoma
Neither suppressed = Ectopic

68
Q

Breastfeeding women with hyperthyroidism. Tx?

A

PTU

69
Q

What is Nelson’s syndrome?

A

enlargement of an adrenocorticotropic hormone-producing tumour in the pituitary gland due to loss of negative feedback, following surgical removal of both adrenal glands in a patient with Cushing’s disease

Oishi's Final year flashcards (9 decks)

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