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Endo Flashcards

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1
Q

Why is thinning of pubic and axillary hair is seen in females with Addison’s disease?

A

Due to reduced production of testosterones from the adrenal gland

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2
Q

What medication is used in patients with stress incontinence who don’t respond to pelvic floor muscle exercises and decline surgical intervention? How does it work?

A

Duloxetine (SNRI)- increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve -enhance contraction of the urethral sphincter.

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3
Q

What is the characteristic pattern of C-peptide in Insulin abuse?

A

Low C-peptite
C-peptide is cleaved from proinsulin when endogenous insulin is produced, so low levels indicate that the insulin present is exogenous (take synthetic insulin) rather than produced by the pancreas.

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4
Q

What is the relationship of C-peptide and proinsulin; to insulin that is seen in a Insulinoma

A

Directly proportional,
Increased ratio of proinsulin to insulin

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5
Q

How does alcohol cause hypoglycaemia?

A

Effect of alcohol on the pancreatic microcirculation → redistribution of pancreatic blood flow from the exocrine into the endocrine parts → increased insulin secretion

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6
Q

What type of cancer are people with acromegaly at increased risk of?

A

Colorectal cancer
Patients with acromegaly have an initial colonoscopy at age 40, and enter a surveillance program based on the results of the colonoscopy.

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7
Q

At which point in the menstrual cycle do progesterone levels peak?

A

Luteal (secretory) phase-Progesterone is secreted by the corpus luteum following ovulation.

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8
Q

Is the level of GLP-1 in type 2 diabetes mellitus increased/decreased?

A

Decreased
(GLP-1), a hormone released by the small intestine in response to an oral glucose load

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9
Q

What are the targets to continue GLP-1 mimetic prescription?

A

A > 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months

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10
Q

What drugs can cause SIADH?

A

carbamazepine, sulfonylureas, SSRIs, tricyclics

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11
Q

What are the causes of SIADH?

A

MINDO

Malignancy
-small cell lung cancer
also: pancreas, prostate
Neurological
-stroke
-subarachnoid haemorrhage
-subdural haemorrhage
-meningitis/encephalitis/abscess
Infections
-tuberculosis
-pneumonia
Drugs
-sulfonylureas* (glimepiride and glipizide)
-SSRIs, tricyclics
-carbamazepine
-vincristine
-cyclophosphamide
Other causes
-positive end-expiratory pressure (PEEP)
-porphyrias

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12
Q

What happens if you correct hyponatraemia too quickly

A

Cerebral pontine myelosis

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13
Q

What are the autoantibodies involved in Grave’s disease?

A

Autoantibodies
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)

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14
Q

What is a rare feature of uterine fibroids with relation to RBC production?

A

Polycythaemia secondary to autonomous production of erythropoietin

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15
Q

What is the inheritance pattern of familial hypecholestrolaemia?

A

Autosomal dominant

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16
Q

What is the Simon Broome criteria for FH?

A

Simon Broome criteria:
-in adults total cholesterol (TC) > 7.5 mmol/l and LDL-C > 4.9 mmol/l or children TC > 6.7 mmol/l and LDL-C > 4.0 mmol/l, plus:
-for definite FH: tendon xanthoma in patients or 1st or 2nd degree relatives or DNA-based evidence of FH
-for possible FH: family history of myocardial infarction below age 50 years in 2nd degree relative, below age 60 in 1st degree relative, or a family history of raised cholesterol levels

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17
Q

What are the features of type 1 renal tubular acidosis (distal)?

A

Hypokalaemia, nephrocalcinosis, hyperchloraemic metabolic acidosis (normal anion gap).

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18
Q

How does Pioglitazone (thiazolidinedione) cause fluid retention?

A

agonists to the PPAR-gamma receptor and reduces peripheral insulin resistance and thus increases glucose uptake by the adipose tissue and skeletal muscle
-leads to an increase in plasma volume, which may result in peripheral oedema

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19
Q

What is Gitelman’s syndrome? What are its features?

A

-defect in the thiazide-sensitive Na+ Cl- transporter in the distal convoluted tubule.
-Features
normotension
hypokalaemia
hypocalciuria
hypomagnesaemia
metabolic alkalosis

Explanation: impaired sodium reabsorption causing increased sodium delivery to the collecting ducts where sodium reabsorption in exchange for potassium and hydrogen ions takes place. This leads to excessive loss of potassium (hypokalaemia) and hydrogen ions (resulting in metabolic alkalosis).

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20
Q

What is an extremely common side effect of acarbose (inhibitor of intestinal alpha glucosidases)?

A

Flatulence
-decreased absorption of starch and sucrose-prevents the degradation-so increased carbohydrate load in the colon

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21
Q

What is Bartter’s syndrome? What. are its features?

A

autosomal recessive-results from a defective Na+ K+ 2Cl- cotransporter (NKCC2) channel in the ascending loop of Henle

-think of Bartter’s syndrome as like taking large doses of furosemide (loop diuretic)

Features
-usually presents in childhood, e.g. Failure to thrive
-polyuria, polydipsia
-hypokalaemia
-normotension
-weakness

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22
Q

What is the inheritance pattern of MODY?

Study These Flashcards
A

Autosomal dominant

23
Q

How does carbimazole work?

Study These Flashcards
A

It blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

24
Q

What is the MOA of propylthiouracil

Study These Flashcards
A

-central mechanism of action-thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
- peripheral action by inhibiting 5’-deiodinase which reduces peripheral conversion of T4 to T3

25
How is insulinoma diagnosed and managed?
Dx: By supervised prolonged fasting (demonstrating inappropriately high insulin levels during a period of hypoglycaemia) and CT pancreas Mx: diazoxide and somatostatin, surgery
26
How does prednisolone cause neutrophilia?
-Demargination of neutrophils via the endovascular lining. -Delayed migration of neutrophils into tissue. -Release of immature neutrophils from bone marrow.
27
What is the MOA of meglitinides?
It binds to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells to increase pancreatic insulin secretion
28
What is the most common cause of hyperaldosteronism? What are the common features?
Bilateral idiopathic adrenal hyperplasia -hypokalaemia, refractory HTN, metabolic alkalosis
29
What is the genetic concordance of identical twins in T1DM vs T2DM?
T1DM-genetic concordance of 40%. It is associated with HLA-DR3 and DR4. It is inherited in a polygenic fashion T2DM-almost 100% concordance in identical twins and no HLA associations
30
What if if a triple combination of drugs has failed to reduce HbA1c in T2DM
Switching one of the drugs for a GLP-1 mimetic, particularly if the BMI > 35
31
What is the MOA of sulphonylureas?
It binds to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells (closes the potassium-ATP channels)
32
What is the pattern of TFTs in non-thyroidal illness syndrome (NTIS), also known as euthyroid sick syndrome?
It is often said that everything (TSH, thyroxine and T3) is low or TSH will be normal
33
What is Pendred syndrome and its features?
This condition results from mutations in the SLC26A4 gene that leads to impaired iodide organification during thyroid hormone synthesis. Features: goitre, mild hypothyroidism, euthyroid status, Autosomal recessive inheritance, bilateral sensorineural deafness
34
How is Pendred syndrome diagnosed?
-Via genetic testing (Pendred syndrome (PDS) gene, chromosome 7), -audiometry -MRI imaging - look for characteristic one and a half turns in the cochlea, compared to the normal two and a half turns.
35
How does PTH and PTHrP behave in hypercalcaemia secondary to malignancy?
PTH is low, although PTHrP may be raised- eg; in squamous cell lung ca
36
Do you need two readings to dx diabetes in a symptomatic patient?
No, only in an asymptomatic patient
37
Untreated, severe hyponatraemia may result in cerebral oedema, which in turn can cause brain herniation. How should acute severe, symptomatic hyponatraemia be treated? What could over rapid tx result in?
Hypertonic saline Over-rapid correction may result in osmotic demyelination syndrome.
38
What are MSK adverse effects of long-term steroid use?
Avascular necrosis, osteoporosis ,proximal myopathy
39
What drug may be useful if there is concern about anticholinergic side-effects in frail elderly patients for urge incontinence?
Mirabegron
40
What is the pathophysiology of osmotic demyelination syndrome?
Develop secondary to astrocyte (and possibly oligodendrocyte) apoptosis -chronic hyponatraemia → loss of osmotically active organic osmolytes from astrocytes. These provide protection against cerebral oedema -organic osmolytes cannot be replaced quickly enough when the brain volume begins to shrink in response to the correction of hyponatraemia -the dehydrated astrocytes and oligodendrocytes undergo apoptosis or other forms of injury → demyelination
41
What important advice should be given to someone with hypercalcaemia secondary to malignancy
Advice about maintaining good hydration (drinking 3-4 L of fluid per day), provided there are no contraindications (such as severe renal impairment or heart failure).
42
What is the first line test for acromegaly?
Serum IGF-1 to confirm- OGTT- finding lack of suppression of GH to < 1 µg/L following documented hyperglycemia during an oral glucose load.
43
What does the water deprivation test for primary polydipsia show after fluid deprivation and after desmopressin?
urine osmolality after fluid deprivation: high urine osmolality after desmopressin: high
44
What are the features and management of subacute (De Quervain's) ?
Thyrotoxicosis with tender goitre-history of following a viral illness,initial hyperthyroid phase. -Mx: usually self-limiting, simple analgesia
45
What investigation is used for subacute (De Quervain's) ?
thyroid scintigraphy: globally reduced uptake of iodine-131
46
What is the cause of Kallmann's syndrome? What are its typical features?
-Failure of GnRH-secreting neurons to migrate to the hypothalamus. -Lack of smell (anosmia) in a boy with delayed puberty. -LH, FSH levels are inappropriately low/normal
47
What is a common complication of thyroid eye disease?
Exposure keratopathy -proptosis of the eyeballs and eyelid retraction lead to difficulty in completely closing the eyes.
48
Why does ferritin increase in someone who has pneumonia?
It is an acute phase reactant which is a protein whose plasma concentrations increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation.
49
What are examples of negative acute phase proteins?
During the acute phase response the liver decreases the production of other proteins (sometimes referred to as negative acute phase proteins). Examples include: albumin transthyretin (formerly known as prealbumin) transferrin retinol binding protein cortisol binding protein
50
What is Nelson's syndrome and its features?
Nelson's syndrome is a rare clinical manifestation that occurs as a complication of bilateral adrenalectomy, which is a procedure used to control hypercortisolism in patients with Cushing's disease. Clinical triad of hyperpigmentation, excessive adrenocorticotropin secretion, and a corticotroph adenoma.
51
What is Hyperuricaemia associated with?
Hyperlipidaemia and hypertension. Metabolic syndrome
52
What are the values for Impaired glucose tolerance (IGT)?
fasting plasma glucose less than 7.0 mmol/l OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
53
What is the management of hypovolaemic hyponatraemia?
Rehydration with sodium chloride 0.9% or a balanced crystalloid (Hartmann's) -avoid rapid correction --central pontine myelinolysis
54
What is Trousseau's sign and Chvostek's sign seen in hypocalcaemia?
Trousseau's sign -carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic -wrist flexion and fingers are drawn together Chvostek's sign -tapping over parotid causes facial muscles to twitch

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