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medicine can be fun > Endo > Flashcards

Endo Flashcards

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
Q

acromegaly management

A

i) transsphenoidal surgery
ii) octreotide if inoperable
- also dopamine agonists

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26
Q

acromegaly complications

A

diabetes
hypertension
cardiomyopathy
pseudogout

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27
Q

what is Addison’s

A

autoimmune adrenal gland destruction

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28
Q

presentation of Addison’s

A

hyperpigmentation
weakness
vomiting
weight loss
salt craving

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29
Q

electrolytes in Addison’s

A

hyponatraemia
hyperkalaemia
metabolic acidosis
hypoglycaemia

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30
Q

diagnostic test for Addison’s

A

short synACTHen test

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31
Q

how to investigate secondary hypocortisolism (low ACTH)

A

insulin induced hypoglycaemia
- normal should make ACTH

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32
Q

Addison’s management

A
  • hydrocortisone + fludrocortisone
  • sick day rules
    a) double steroid if ill
    b) inject hydrocortisone if unable to ingest
33
Q

Addisonian crisis presentation

A
  • collapse (hypoglycaemic)
  • abdominal pain
  • shock (hypotensive)
  • vomiting
34
Q

what are causes of hyperkalaemia classified by 5 systems

A
  • Endo: Addison’s
  • Metabolic: metabolic acidosis
  • Drugs: ACEi, spironolactone
  • Renal: CKD, AKI
  • MSK: rhabdomyolysis
35
Q

what are features of hyperkalaemia on an ECG

A
  • bradycardia
  • tall tented T waves
  • wide QRS
  • absent P wave
  • prolonged PR
36
Q

how to manage hyperkalaemia

A

i) cardiac monitor
ii) IV calcium gluconate 10%
iii) salbutamol nebs, insulin + dextrose
iv) loop diuretics, haemodialysis, calcium resonium

37
Q

what is the role of calcium gluconate in hyperkalaemia

A

protects the heart

38
Q

what is the role of salbutamol and insulin in hyperkalaemia

A

drive potassium into cells

39
Q

what are causes of hypokalaemia classified by 3 systems

A
  • Endo: Cushing’s, Conn’s
  • Drugs: thiazides, loop diuretics
  • GI: vomiting, diarrhoea
40
Q

what are features of hypokalaemia on an ECG

A
  • U waves
  • small T waves
41
Q

what are the 2 most common causes of hypercalcaemia

A
  • primary hyperparathyroidism
  • malignancy
42
Q

what is sick euthyroid syndrome

A
  • normal TSH
  • low T4
43
Q

what is subclinical hypothyroidism

A
  • high TSH
  • normal T4
  • no symptoms
44
Q

what are four causes of hypothyroidism

A
  • Hashimoto’s
  • subacute thyroiditis
  • iodine deficiency
  • drugs: amiodarone
45
Q

what are symptoms of hypothyroidism

A
  • lethargy, weight gain, cold intolerance
  • menorrhagia
  • diffuse goitre
46
Q

what is an investigation for Hashimoto’s

A
  • TFTs: high TSH, low T4
  • anti TPO-antibodies
47
Q

how do you manage hypothyroidism and what is one side effect

A
  • levothyroxine
  • osteoporosis
48
Q

what are the 4 types of thyroid cancer

A
  • papillary
  • follicular
  • medullary
  • anaplastic
49
Q

what are associations with papillary thyroid cancer

A
  • young females
  • radiation exposure
  • spreads to lymph nodes
50
Q

what are associations with follicular thyroid cancer

A
  • older females
  • iodine deficiency
51
Q

what are associations with medullary thyroid cancer

A
  • secretes calcitonin
  • MEN-2
52
Q

what are 3 features of thyroid cancer

A
  • asymptomatic
  • pressure symptoms: hoarse voice, dysphagia
  • hard tethered nodule O/E
53
Q

how would you investigate thyroid cancer

A
  • normal TFTs
  • US guided FNA
54
Q

how do you manage thyroid cancer

A

i) thyroidectomy
ii) radioiodine ablation
iii) levothyroxine

55
Q

what are three causes of thyrotoxicosis

A
  • Graves
  • subacute thyroiditis
  • post partum thyroiditis
56
Q

what are the stages of postpartum thyroiditis

A
  • thyrotoxicosis (give propranolol)
  • hypothyroidism
  • euthyroid
57
Q

what are three features from examination and investigation that point towards subacute thyroiditis

A
  • painful goitre
  • raised ESR
  • zero uptake on iodine scan
58
Q

what is the triad of symptoms specific for Graves

A
  • exopthalmos
  • pretibial myxoedema
  • diffuse goitre
  • acrophachy
59
Q

what are features of hyperthyroidism

A
  • tremour, heat intolerance, weight loss
  • palpitations (AF)
  • oligoamenorrhoea
60
Q

how would you investigate thyrotoxicosis

A
  • TFTs: low TSH, high T4
  • anti-TSH antibodies for Graves
  • iodine uptake scan if unsure increased in Graves
61
Q

what is the management for Graves disease

A

i) propranolol for symptoms
ii) carbimazole
iii) radioiodine or thyroidectomy

62
Q

what is an important side effect of carbimazole

A
  • agranulocytosis
  • careful for infections
63
Q

what is an alternative for carbimazole used in pregnancy

A

propylthiouracil

64
Q

what are two risks associated with a thyroidectomy

A
  • damage to recurrent laryngeal nerve (hoarse voice)
  • damage to parathyroid glands (hypocalcaemia)
65
Q

what are 5 complications of thyrotoxicosis

A
  • AF
  • osteoporosis
  • thyroid eye disease
  • thyroid storm
  • high output heart failure
66
Q

what are the features of a thyroid storm

A
  • fever, tachy, confusion, vomiting
  • precipitated by surgery, infection
67
Q

how do you manage a thyroid storm

A
  • carbimazole + propranolol + hydrocortisone + potassium iodide
68
Q

what is the most important risk factor for thyroid eye disease

A

smoking

69
Q

what are the features of thyroid eye disease

A
  • bilateral exopthalmos
  • lid lag
  • diplopia
70
Q

how do you diagnose thyroid eye disease

A
  • clinical
  • orbital MRI
71
Q

how do you manage thyroid eye disease

A
  • lubricants
  • steroids if severe
72
Q

how do you manage subacute thyroiditis

A

NSAIDs

73
Q

what is hyperosmolar hyperglycaemic state associated with

A
  • T2DM
  • older patients
74
Q

how does hyperosmolar hyperglycaemic state happen

A
  • hyperglycaemia
  • glucose out through the kidneys
  • water follows
  • high serum osmolarity
75
Q

what are 5 features of hyperosmolar hyperglycaemic state

A
  • comes on over days
  • dehydration, polyuria
  • systemic: fatigue, vomiting
  • altered consciousness
  • hyperviscosity
76
Q

what do you see in the bloods of hyperosmolar hyperglycaemic state

A
  • FBC: hyperviscosity high platelets
  • U&Es: hypernatraemia, high serum osmolarity
  • hyperglycaemia
77
Q

how do you calculate serum osmolarity

A

2Na + glucose + urea

78
Q

how do you manage hyperosmolar hyperglycaemic state

A

i) IV fluids
ii) insulin if glucose still high
- VTE prophylaxis

79
Q

how do you treat myxoedemic coma

A

IV thyroxine + hydrocortisone

medicine can be fun (12 decks)

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