Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NEED TO KNOW Before Exams!!! > Endo > Flashcards

Endo Flashcards

1
Q

Treatment for Graves disease

A
  • Carbimazole, either titrated to effective dose or given concurrent with
    thyroxine to prevent iatrogenic hypothyroidism
  • Beta-blockers (eg. propanolol) for rapid symptom control
  • Radioiodine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is cortisol produced

A

Adrenal cortex - zona glomerulosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the pathophysiology of a phaeochromocytoma

A

Neoplasia of adrenal medulla
-Which secretes catecholamines (NAd, Adr)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Biochemical investigation for pheochromocytoma

A

Plasma (and urinary) metanephrines (will be raised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How to avoid hypertensive crisis in surgery

A

Give phentolamine (an Alpha receptor blocker)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hypothyroidism diff

A

Primary
* thyroid gland dysfunction (1 mark)
so have high TSH but low T3 and T4 / thyroid hormone (1 mark)
Secondary
pituitary gland dysfunction (1 mark)
so have so have high TRH low TSH and low T3 and T4 / thyroid hormone (1 mark)
Tertiary
hypothalamic dysfunction (1 mark)
so have low TRH low TSH and low T3 and T4 / thyroid hormone (1 mark)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name 1 primary and 1 secondary cause of nephrogenic diabetes insipidus

A

Primary (1 mark)
inherited / genetic mutation
Secondary (1 mark)
Polycystic kidney disease
Hydronephrosis
Fanconi syndrome
Renal amyloidosis
Hypercalcemia
HIV infection
Iatrogenic - drug or surgery induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name 1 cause of cranial diabetes insipidus

A

Brain tumor
Head injury
Meningitis or encephalitis
Sarcoidosis
Aneurysms
Sickle cell anaemia
Sheehans syndrome
Iatrogenic - drug or surgery induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Pathology of coeliac

A

In coeliac disease, auto-antibodies are created in response to exposure to gluten that target the epithelial cells of the intestine and lead to inflammation. There are two antibodies to remember: anti-tissue transglutaminase (anti-TTG) and anti-endomysial (anti-EMA). These antibodies relate to disease activity and will rise with more active disease and may disappear with effective treatment.

Inflammation affects the small bowel, particularly the jejunum. It causes atrophy of the intestinal villi. The intestinal cells have villi that help absorb nutrients from the food passing through the intestine. The inflammation causes malabsorption of nutrients and the symptoms of the disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Coeliac gold standard

A

Biopsy of the duodenum showing :
Raised intraepithelial lymphocytes
Crypt hyperplasia
Villous atrophy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Acute pancreatitis has a range of complications of variable likelihood. Clinicians must be aware of the complications of acute pancreatitis and how likely they are to occur. Name 3 complications of acute pancreatitis and label their likelihood of occurrence as high medium low

A

Acute renal failure = high
Sepsis = medium
Acute respiratory syndrome = medium
Pancreatic pseudocyst = low
Pancreatic abscess = low
Ascites/ pleural effusion = low
Enteric fistula = low
Chronic pancreatitis = low
Abdominal compartment syndrome = low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sarah is a 44 year old lady with a family history of sarcoidosis. She is chatting to the nurse about the disease and wants to know what signs and symptoms to look out for are. Name the triad present in sarcoidosis and give 3 clinical features of the triad

A

Lofgren’s triad (1 mark)
erythema nodosum (1 mark)
bilateral hilar lymphadenopathy (1 mark)
polyarthralgia / pain in more than 1 joint (1 mark)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the steps of old RBCs being excreted starting with haemolysis of the old RBCs

A

Haemolysis = RBC destruction - no marks
(Producing protoporphyrin ring / biliverdin) which then becomes unconjugated bilirubin (which is lipid soluble)
Unconjugated bilirubin entres hepatocytes and at hepatocytes its conjugated via uridine glucuronyl transferase (UGT)
Conjugated bilirubin leaves the hepatocytes via bile canaliculi / then bile ducts / then bile ducts / then hepatic ducts / then common hepatic duct into gall bladder where its concentrated. Gallbladder releases the conjugated bilirubin into the duodenum via the common bile duct
Bacterial proteases convert conjugated bilirubin into urobilinogen
90% of this is excreted making stool dark brown
10% is reabsorbed and then excreted by the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

There are 4 main patterns of MS. Briefly describe relapsing remitting MS and progressive relapsing MS

A

Relapsing remitting = have an autoimmune attack / flare which causes a rapid development in symptoms followed by a period of remission / remyelination where symptoms improve and return to a constant level but this new baseline has more disability than before
Progressive relapsing = a steady increase in disability with flares superimposed. After each flare there is a period of remission / remyelination where symptoms improve but they return to a level of steady increase in disability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Charcot’s neurological triad

A

Used for multiple sclerosis

dysarthria
Nystagmus
Intention tremor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Hormones anterior pituitary

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Main feature of U&E detection

A

hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clinical examination of hypocalcaemia

A

Chvostek’s sign - tap over the facial nerve causes spasm of the facial muscles
Trousseau’s sign - inflate the blood pressure cuff to 20mmHg above systolic for 5 minutes and the
hand should form a claw.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Role of PTH

A

PTH increases bone remodelling and turnover. PTH stimulates osteoclasts to reabsorb bone mineral
which liberate calcium into blood (breaks down bone).
* PTH increases the amount of calcium reabsorbed in the kidney which means that less is excreted in
urine.
* PTH decreases phosphate reabsorption in the kidney.
* PTH decreases phosphate reabsorption in the kidney, increasing the amount excreted.
* PTH increases absorption of Ca2+ in the gut.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does carbimazole

A

Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, this
leads to decreased thyroid hormone production.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Options for blocking GH

A

Dopamine agonists (bromocriptine)
Somatostatin analogues (ocreotide)
GH antagnoists (pegvisomant)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Key Signs in Cushing

A

Abdominal Striae
Moon Face
Buffalo Hump
Thinning of skin
Acne

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

G.S for acromegaly

A

Oral glucose tolerance test (GTT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The effects of superantigens?

A

A molecule that causes non-specific polyclonal T-cell activation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hyperosmolar vs DKA

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

SGLT-2 inhibitors

A

SGLT-2 inhibitors are increasingly being recommended. Older patients often have a QRISK score above 10%, making them fall into the “high risk” category for cardiovascular disease. NICE suggests considering SGLT-2 inhibitors alongside metformin as part of the first-line treatment in type 2 diabetics at high risk of cardiovascular disease. SGLT-2 inhibitors are recommended second-line as part of dual therapy in these patients. The significant potential side effect to remember is diabetic ketoacidosis.

increased frequency of urinary tract infections and genital thrush due to lots of sugar passing through the urinary tract. Secondly, diabetic ketoacidosis. Patients starting SGLT-2 inhibitors are counselled about the features of DKA and when to seek emergency medical input.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Toxic multinodular goitre (also known as Plummer’s disease)

A

where nodules develop on the thyroid gland, which are unregulated by the thyroid axis and continuously produce excessive thyroid hormones. It is most common in patients over 50 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Taking carbimazole

A

the risk of acute pancreatitis in patients taking carbimazole. In your exams, look out for a patient on carbimazole presenting with symptoms of pancreatitis (e.g., severe epigastric pain radiating to the back).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Both carbimazole and propylthiouracil can cause

A

Both carbimazole and propylthiouracil can cause agranulocytosis, with a dangerously low white blood cell counts. Agranulocytosis makes patients vulnerable to severe infections. A sore throat is a key presenting feature of agranulocytosis. In your exams, if you see a patient with a sore throat on carbimazole or propylthiouracil, the cause is likely agranulocytosis. They need an urgent full blood count and aggressive treatment of any infections.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Congenital hypothyroidism is screened for on the

A

newborn blood spot screening test.

31
Q

Dexamethasone suppression test results

A
32
Q

Hyperaldosteronism is worth remembering as the most common cause of

A

Hyperaldosteronism is worth remembering as the most common cause of secondary hypertension.

33
Q

Phaeochromocytomas are more common in certain genetic disorders:

A

Multiple endocrine neoplasia type 2 (MEN 2)
Neurofibromatosis type 1
Von Hippel-Lindau disease

34
Q

Anti-TTG and anti-EMA antibodies are IgA

A

Anti-TTG and anti-EMA antibodies are IgA. Some patients have an IgA deficiency. When you test for these antibodies, it is important to test for total Immunoglobulin A levels because if total IgA is low because they have an IgA deficiency then the coeliac test will be negative even when they have coeliacs. In this circumstance, you can test for the IgG version of anti-TTG or anti-EMA antibodies or simply do an endoscopy with biopsies.

35
Q

Remember, “Distend Him” said the obstructed bowel
Bold is small Bowel

A

Remember, “Distend Him” said the obstructed bowel
Diverticulitis
IBD (CD & UC), Ischaemic Bowel disease
Surgery (adhesions)
Tumours
Endometriosis
Neonanatal Hirschsprung’s
**Duodenal gallstones
**
Hernias
Intussusception
Malrotation

36
Q

Oesophageal cancer procedure

A

Ivor- Lewis procedure

37
Q

Why does urea go up in upper GI bleeds

A

The reason urea rises in upper GI bleeds is that the blood in the GI tract gets broken down by the acid and digestive enzymes. One of the breakdown products is urea and this urea is then absorbed in the intestines.

38
Q

Perianal disorders

A
39
Q

GOODSALL’S RULE

A

Can be used clinically to predict the trajectory of a fistula tract, depending on the location of the external opening .

40
Q

Staghorn Calculus

A

A staghorn calculus is where the stone forms in the shape of the renal pelvis, giving it a similar appearance to the antlers of a deer stag. The body sits in the renal pelvis with horns extending into the renal calyces. They may be seen on plain X-ray films.

Most commonly, this occurs with stones made of struvite. In recurrent upper urinary tract infections, the bacteria can hydrolyse the urea in urine to ammonia, creating the solid struvite.

41
Q

Renal caliculi

A
42
Q

Causes of AKI

A
43
Q

AKI criteria by NICE

A

Rise in creatinine of ≥ 25 micromol/L in 48 hours
Rise in creatinine of ≥ 50% in 7 days
Urine output of < 0.5ml/kg/hour for > 6 hours

44
Q

IgA vs Post streptococcus

A
45
Q

Immune complex diseases

A
46
Q

f you come across a patient in your exam with the combination of acute renal failure and haemoptysis, think of two conditions:

A

Goodpasture syndrome and granulomatosis with polyangiitis (AKA Wegener’s granulomatosis). Goodpasture syndrome is associated with anti-GBM antibodies, whereas Wegener’s granulomatosis is a type of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA). Patients with Wegener’s granulomatosis may also have a wheeze, sinusitis and a saddle-shaped nose.

47
Q

Nephrotic syndrome

A
48
Q

The notable side effect of alpha-blockers like tamsulosin is

A

postural hypotension. If an older man presents with lightheadedness on standing or falls, check whether they are on tamsulosin and check their lying and standing blood pressure. The most common side effect of finasteride is sexual dysfunction (due to reduced testosterone).

49
Q

Varciocle and renal cell carcinoma

A

The right testicular vein drains directly into the inferior vena cava. The left testicular vein drains into the left renal vein. Most varicoceles (90%) occur on the left due to increased resistance in the left testicular vein. A left-sided varicocele can indicate an obstruction of the left testicular vein caused by a renal cell carcinoma.

50
Q

Hydrocele is

A

transilluminated

51
Q

Trimethoprim (often associated with high rates of bacterial resistance)
Nitrofurantoin (avoided in patients with an eGFR <45)

A

Nitrofurantoin needs to be avoided in the third trimester as there is a risk of neonatal haemolysis (destruction of the neonatal red blood cells).

Trimethoprim needs to be avoided in the first trimester as it works as a folate antagonist. Folate is essential in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (e.g., spina bifida). It is not known to be harmful later in pregnancy but is generally avoided unless necessary.

52
Q

Escherichia coli. E. coli are

A

gram-negative, anaerobic, rod-shaped bacteria

53
Q

Wernicke-Korsakoff Syndrome (WKS)

A

Features of Wernicke’s encephalopathy
Confusion
Oculomotor disturbances (disturbances of eye movements)
Ataxia (difficulties with coordinated movements)

Features of Korsakoffs syndrome
Memory impairment (retrograde and anterograde)
Behavioural changes

54
Q

Autoantibodies for Autoimmune hep

A

Type 1 Autoantibodies:

Anti-nuclear antibodies (ANA)
Anti-smooth muscle antibodies (anti-actin)
Anti-soluble liver antigen (anti-SLA/LP)

Type 2 Autoantibodies:

Anti-liver kidney microsomes-1 (anti-LKM1)
Anti-liver cytosol antigen type 1 (anti-LC1)

55
Q

Kernicterus

A

Kernicterus is a type of brain damage caused by excessive bilirubin levels

56
Q

Gilbert syndrome

A
57
Q

How is biliary colic caused

A

Fat entering the digestive system causes cholecystokinin (CCK) secretion from the duodenum. CCK triggers contraction of the gallbladder, which leads to biliary colic. Patients with gallstones and biliary colic are advised to avoid fatty foods to prevent CCK release and gallbladder contraction.

58
Q

The criteria for the Glasgow score can be remembered using the PANCREAS mnemonic (1 point for each answer):

A

P – Pa02 < 8 KPa
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)

59
Q

Ascites patho

A

Ascites is basically fluid in the peritoneal cavity. The increased pressure in the portal system causes fluid to leak out of the capillaries in the liver and bowel and in to the peritoneal cavity. The drop in circulating volume caused by fluid loss into the peritoneal space causes a reduction in blood pressure entering the kidneys. The kidneys sense this lower pressure and release renin, which leads to increased aldosterone secretion (via the renin-angiotensin-aldosterone system) and reabsorption of fluid and sodium in the kidneys. Cirrhosis causes a transudative, meaning low protein content, ascites.

60
Q

Hepatic encephalopathy

A

Confusion
Asterixis: ‘liver flap’, arrhythmic negative myoclonus with a frequency of 3-5 Hz

Constructional apraxia: inability to draw a 5-pointed star
Triphasic slow waves on EEG

61
Q

It is worth noting that a new onset of diabetes, or a rapid worsening of glycaemic control type 2 diabetes, can be a sign of pancreatic cance

A

It is worth noting that a new onset of diabetes, or a rapid worsening of glycaemic control type 2 diabetes, can be a sign of pancreatic cancer. Keep pancreatic cancer in mind if a patient in your exams or practice has worsening glycaemic control despite good lifestyle measures and medication.

62
Q

Liver Table

A
63
Q

MSK table

A
64
Q

NICE guidelines for Disease Modifying Anti-Rheumatic Drugs (DMARDs):

A

First line is monotherapy with methotrexate, leflunomide or sulfasalazine. Hydroxychloroquine can be considered in mild disease and is considered the “mildest” anti rheumatic drug.
Second line is 2 of these used in combination.
Third line is methotrexate plus a biological therapy, usually a TNF inhibitor.
Fourth line is methotrexate plus rituximab

65
Q

Biological Therapies

A

The most important biologics to remember are the TNF inhibitors adalimumab, infliximab and etanercept and it is also worth remembering rituximab. The others are very unlikely to come up in your exams but are worth being aware of. Just remember they all lead to immunosuppression so patients are prone to serious infections. They can also lead to reactivation of dormant infections such as TB and hepatitis B.

66
Q

Side effects of
Methotrexate
Leflunomide
Sulfasalazine
Hydroxychloroquine
Anti-TNF medications
Rituximab

A

Methotrexate: Bone marrow suppression and leukopenia and highly teratogenic
Leflunomide: Hypertension and peripheral neuropathy
Sulfasalazine: Male infertility (reduces sperm count)
Hydroxychloroquine: Nightmares and reduced visual acuity
Anti-TNF medications: Reactivation of TB or hepatitis B
Rituximab: Night sweats and thrombocytopenia

67
Q

T score classification

A
68
Q

Joint X ray for gout

A
69
Q

In a young patient presenting with a single acutely swollen joint, always think of

A

In a young patient presenting with a single acutely swollen joint always think of gonococcus septic arthritis until proven otherwise. Gonorrhoea infection is common and delaying treatment puts the joint in danger. In your exams it might say the gram stain revealed a “gram-negative diplococcus”. The patient may have urinary or genital symptoms to trick you into thinking of reactive arthritis but remember that it is important to exclude gonococcal septic arthritis first as this is the more serious condition.

70
Q

Septic arhtritsi + osteomyeltis first line

A

Flucloxacillin plus rifampicin is often first line

71
Q

Patho for DKA

A

DKA is caused by uncontrolled lipolysis which results in an excess of free fatty acids that are ultimately converted to ketone bodies

72
Q

DKA resolution is defined as

A
  • pH >7.3 and
  • blood ketones < 0.6 mmol/L and
  • bicarbonate > 15.0mmol/L
73
Q

Patho for Hyper Osmolar hyperglycaemic state

A

hyperglycaemia → ↑ serum osmolality → osmotic diuresis → severe volume depletion

NEED TO KNOW Before Exams!!! (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions