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Endo Flashcards

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1
Q

4 causes of hypovolaemic hyponatraemia with low urine sodium (<20)

A
  • normal kidney function
    a) vomiting
    b) diarrhoea
    c) trauma
    d) burns
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2
Q

3 causes of hypovolaemic hyponatraemia with high urine sodium (>20)

A
  • renal loss
    a) Addison’s
    b) diuretics
    d) renal failure (CKD)
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3
Q

3 causes of hypervolaemic hyponatraemia

A

a) heart failure
b) nephrotic syndrome
c) liver failure

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4
Q

causes of euvolaemic hyponatraemia with high urine sodium (>20)

A

SIADH

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5
Q

causes of euvolaemic hyponatraemia with normal urine sodium

A
  • hypothyroidism
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6
Q

what is pseudohyponatraemia

A

low sodium with high/normal serum osmolarity

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7
Q

causes of pseudohyponatraemia

A

normal serum osmo:
- hyperlipidaemia, hyperproteinaemia
high serum osmo:
- hyperglycaemia, mannitol

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8
Q

causes of SIADH

A

a) drugs: SSRIs, sulphonylurea, PPI
b) chest: small cell cancer, TB
c) neuro: infection, SAH

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9
Q

management of SIADH

A

fluid restriction + vaptans

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10
Q

effect of pituitary tumour on visual field

A

bitemporal hemianopia

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11
Q

management of hypervolaemic hyponatraemia

A

fluid restriction + furosemide

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12
Q

management of hypovolaemic hyponatraemia

A

slow infusion of saline

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13
Q

complication of untreated hyponatraemia

A

cerebral oedema

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14
Q

complications of rapid correction of hyponatraemia

A

osmotic demyelination syndrome (locked in syndrome)

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15
Q

3 causes of hypernatraemia

A
  • dehydration
  • diabetes insipidus
  • Conn’s, Cushing’s
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16
Q

complications of rapid correction of hypernatraemia

A

cerebral oedema

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17
Q

HPG axis in prolactinoma

A

i) too much prolactin stops kisspeptin in
hypothalamus
ii) less GnRH
iii) less LH & FSH
-> dopamine stops prolactin

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18
Q

what are other causes of raised prolactin

A
  • pregnancy
  • PCOS
  • metoclopramide
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19
Q

prolactinoma presentation in men

A

low libido
erectile dysfunction
infertility
gynaecomastia
headache
bitemporal hemianopia

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20
Q

prolactinoma presentation in women

A

low libido
amenorrhoea
infertility
galactorrhoea
headache
bitemporal hemianopia

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21
Q

prolactinoma investigations

A

i) urine beta HCG
ii) high prolactin > 6000
iii) low LH & FSh
iv) pituitary MRI

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22
Q

prolactinoma treatment

A

i) cabergoline (dopamine agonist)
ii) surgery only if cabergoline fails

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23
Q

acromegaly presentation

A

coarse facial features
big hands
prognathism
headaches
bitemporal hemianopia
sweating

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24
Q

acromegaly investigations

A

i) plasma IGF-1
ii) oral glucose tolerance test (diagnostic)
- GH rises instead of falling
iii) pituitary MRI

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25
acromegaly management
i) transsphenoidal surgery ii) octreotide if inoperable - also dopamine agonists
26
acromegaly complications
diabetes hypertension cardiomyopathy pseudogout
27
what is Addison's
autoimmune adrenal gland destruction
28
presentation of Addison's
hyperpigmentation weakness vomiting weight loss salt craving
29
electrolytes in Addison's
hyponatraemia hyperkalaemia metabolic acidosis hypoglycaemia
30
diagnostic test for Addison's
short synACTHen test
31
how to investigate secondary hypocortisolism (low ACTH)
insulin induced hypoglycaemia - normal should make ACTH
32
Addison's management
- hydrocortisone + fludrocortisone - sick day rules a) double steroid if ill b) inject hydrocortisone if unable to ingest
33
Addisonian crisis presentation
- collapse (hypoglycaemic) - abdominal pain - shock (hypotensive) - vomiting
34
what are causes of hyperkalaemia classified by 5 systems
- Endo: Addison's - Metabolic: metabolic acidosis - Drugs: ACEi, spironolactone - Renal: CKD, AKI - MSK: rhabdomyolysis
35
what are features of hyperkalaemia on an ECG
- bradycardia - tall tented T waves - wide QRS - absent P wave - prolonged PR
36
how to manage hyperkalaemia
i) cardiac monitor ii) IV calcium gluconate 10% iii) salbutamol nebs, insulin + dextrose iv) loop diuretics, haemodialysis, calcium resonium
37
what is the role of calcium gluconate in hyperkalaemia
protects the heart
38
what is the role of salbutamol and insulin in hyperkalaemia
drive potassium into cells
39
what are causes of hypokalaemia classified by 3 systems
- Endo: Cushing's, Conn's - Drugs: thiazides, loop diuretics - GI: vomiting, diarrhoea
40
what are features of hypokalaemia on an ECG
- U waves - small T waves
41
what are the 2 most common causes of hypercalcaemia
- primary hyperparathyroidism - malignancy
42
what is sick euthyroid syndrome
- normal TSH - low T4
43
what is subclinical hypothyroidism
- high TSH - normal T4 - no symptoms
44
what are four causes of hypothyroidism
- Hashimoto's - subacute thyroiditis - iodine deficiency - drugs: amiodarone
45
what are symptoms of hypothyroidism
- lethargy, weight gain, cold intolerance - menorrhagia - diffuse goitre
46
what is an investigation for Hashimoto's
- TFTs: high TSH, low T4 - anti TPO-antibodies
47
how do you manage hypothyroidism and what is one side effect
- levothyroxine - osteoporosis
48
what are the 4 types of thyroid cancer
- papillary - follicular - medullary - anaplastic
49
what are associations with papillary thyroid cancer
- young females - radiation exposure - spreads to lymph nodes
50
what are associations with follicular thyroid cancer
- older females - iodine deficiency
51
what are associations with medullary thyroid cancer
- secretes calcitonin - MEN-2
52
what are 3 features of thyroid cancer
- asymptomatic - pressure symptoms: hoarse voice, dysphagia - hard tethered nodule O/E
53
how would you investigate thyroid cancer
- normal TFTs - US guided FNA
54
how do you manage thyroid cancer
i) thyroidectomy ii) radioiodine ablation iii) levothyroxine
55
what are three causes of thyrotoxicosis
- Graves - subacute thyroiditis - post partum thyroiditis
56
what are the stages of postpartum thyroiditis
- thyrotoxicosis (give propranolol) - hypothyroidism - euthyroid
57
what are three features from examination and investigation that point towards subacute thyroiditis
- painful goitre - raised ESR - zero uptake on iodine scan
58
what is the triad of symptoms specific for Graves
- exopthalmos - pretibial myxoedema - diffuse goitre - acrophachy
59
what are features of hyperthyroidism
- tremour, heat intolerance, weight loss - palpitations (AF) - oligoamenorrhoea
60
how would you investigate thyrotoxicosis
- TFTs: low TSH, high T4 - anti-TSH antibodies for Graves - iodine uptake scan if unsure increased in Graves
61
what is the management for Graves disease
i) propranolol for symptoms ii) carbimazole iii) radioiodine or thyroidectomy
62
what is an important side effect of carbimazole
- agranulocytosis - careful for infections
63
what is an alternative for carbimazole used in pregnancy
propylthiouracil
64
what are two risks associated with a thyroidectomy
- damage to recurrent laryngeal nerve (hoarse voice) - damage to parathyroid glands (hypocalcaemia)
65
what are 5 complications of thyrotoxicosis
- AF - osteoporosis - thyroid eye disease - thyroid storm - high output heart failure
66
what are the features of a thyroid storm
- fever, tachy, confusion, vomiting - precipitated by surgery, infection
67
how do you manage a thyroid storm
- carbimazole + propranolol + hydrocortisone + potassium iodide
68
what is the most important risk factor for thyroid eye disease
smoking
69
what are the features of thyroid eye disease
- bilateral exopthalmos - lid lag - diplopia
70
how do you diagnose thyroid eye disease
- clinical - orbital MRI
71
how do you manage thyroid eye disease
- lubricants - steroids if severe
72
how do you manage subacute thyroiditis
NSAIDs
73
what is hyperosmolar hyperglycaemic state associated with
- T2DM - older patients
74
how does hyperosmolar hyperglycaemic state happen
- hyperglycaemia - glucose out through the kidneys - water follows - high serum osmolarity
75
what are 5 features of hyperosmolar hyperglycaemic state
- comes on over days - dehydration, polyuria - systemic: fatigue, vomiting - altered consciousness - hyperviscosity
76
what do you see in the bloods of hyperosmolar hyperglycaemic state
- FBC: hyperviscosity high platelets - U&Es: hypernatraemia, high serum osmolarity - hyperglycaemia
77
how do you calculate serum osmolarity
2Na + glucose + urea
78
how do you manage hyperosmolar hyperglycaemic state
i) IV fluids ii) insulin if glucose still high - VTE prophylaxis
79
how do you treat myxoedemic coma
IV thyroxine + hydrocortisone

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