Endo Flashcards
(148 cards)
1
Q
mx for toxic multinodular goitre
A
radioiodine therapy
2
Q
drug that can cuase thyrotoxicosis
A
amiodarone
3
Q
pts with existing thyrotoxicosis should not receice
A
iodinated contrast as can worsen hyperthyroidism
4
Q
what is typically given for thyroid storm
A
IV propanol
5
Q
symptoms of thryroid storm
A
fever tachycarfia
6
Q
most common malignant cause of thyroid lump
A
papillary carcimoma
7
Q
first line imaging for if thyroid nodule is benign or malignnatn
A
US
8
Q
sick euthyroid presents sam on tfts as
A
secondary hypothyroidism
9
Q
sick euthyroid syndrome is common in hospiatlaised patietns and what is partciaulry low
A
T3
10
Q
when looking at TFTs what are you really looking at
A
TSH and free T4
11
Q
poor compliance iwth thyroixine willl have
A
high TSH and normal T4
12
Q
in secondary hypothyroidism what got to do before giving thyroxine
A
give steriod - prevent an adrenal crissi
13
Q
2 causes of hyperthyroidism
A
Graves
Toxic multinodular goitre
14
Q
what is the msot common complication of thyroid eye disease vs the most dangerous
A
common- exposure keratopathy
dangerous- optic neuropathy
15
Q
what causes a painful goitre and raised ESR
A
subacute thyroidits (de quervains)
16
Q
is riedel thyroiditis painful
A
no painless
17
Q
most common cause of iron def in dveloping world iodine def
A
18
Q
periods in hypo/hyper thryoidism
A
hypo - heavy
hyper- infrequent
19
Q
antibody associated with graves
A
tsh
20
Q
antibody associated with hashimotos
A
anti thyroid peroxidase
21
Q
mx of thyrotoxicosisi
A
propanol for symptoms
carbimazole - be aware of agranulocytosus
22
Q
cancer of thyroid that secretes calcitonin
A
medullary
23
Q
what thyroid cancer is difficult to treat ad can cause pressure symptoms
A
anaplastic
24
Q
cancer associted with hashimotos thyroiditis
A
lymphoma
25
tzds eg pioglitazone MOA
agonst to PPAR gamma receptr
26
effects of TZDS
weight gain
fluid retention so contraindicated in HF
monitor LFTs
increased risk of fracture and bladder cnacer
27
other s/e of sulphonylurea
weight gain
28
sulphonylureas end in
IDE
29
what works by increasing pacnreatic insulin secretion
sulphonylureas
30
treat sublincial hypothyridism if
TSH >10 in 2 sep occasions
consideer if TSH 5.5-10 & got sympptoms
31
subacute thyroidits is hypothyroid for months but when presents with painful goitre they are
hyperthyroid
32
mx of subacute thyroidits
self limiting
33
In sick euthyroid syndrome (now referred to as non-thyroidal illness) it is often said that everything (TSH, thyroxine and T3) is low. In the majority of cases however the TSH level is within the >normal range (inappropriately normal given the low thyroxine and T3).
34
gliflozin
SGLT2i
35
can lose weight with sglt2i
36
why should feet be closely monitored if takin sglt2i
as increased risk of feet ulcer or infction so icnrease risk of ampuatation
37
how does riedelds thryoiditis present
hard, fixed painless goitre as normal thyroid tissue is replaced by ense fibrous tissue
38
PTH secretect by parathyroid gland by what cells
Cheif
39
how Vit D works
increase dietry calcium absorption form intestine by increasin expression of calcium binding hormone
39
bones stones hroans of hypercaeliamia seen as
renal calculi, constipation, polyrua, abdo pain
40
what is the thign that causes hypercaleamia in squamous cell lung cancer
PTHrp
41
ix for proalctinoma
MRI
42
features of prolactinoma in men
impotence - reduces sexual desire, unable to sustain an erection
in women - loss of period
43
drugs for prolactinoma
dopamine agonsit eg cabergoline or bromocriptine
44
med that can icnrease prolactin
metoclopramide
45
osteitis fibrosa cystica - can lead to brown tumour seen in
priamry hyperparathyroidism
46
mx of priamry hyperaparathyrioidms
cause is adenoma msot likely so total parathyroidectmy
47
pts not suitable for surgery for pimary hyperparathyridms cna be given
cincalcet
48
used to be though that conns wa sthe most common cuase of primary hyperaldosteronism but what is now
adrenal hyperplasia
49
how does priamry hyperaldosteronism present
hypertension and hypokalaemia
50
first line ix in suspected priamry hyperaldosteronism
aldosterone/renin ratio
- if got aldosterone will be high and rennin low
51
what do after aldosterone/ renin ration
CT abdo to differentiate adenoma from bilateral hyperplasia
if this not show then can do adrenal venous sampling
52
what is given to treat if bilaterla hyperplasia
aldosterone antagonist eg spironolactone
53
in preg - increase in thyroxine binding globulin
increase in total thyroxine but does not affect the free thyroxine level
54
graves meds in preg
1st trimest er- propylthioricul
2- carbimazole
55
is preg safe with thyroxine
yep
56
pre diabetes if HBA1 between
42-47
57
impaired glucose tolernace if fasting
betwen 6.1-7 and
OGTT between 7.8 and 11.1
58
non fucntioning adenomas tend to present with compressive symptoms eg
visual problems and hormone defieicncies
59
what meds are used for GH secreting adenomas
somatostatin analgue eg ocretotide and GH receptor antagonistas eg pegvisomant
60
what MEN have pahechormoacytoma
MEN 2 A+B
61
test for phaechromocytoma
24hr urinary collection of metanerphine
( has replaced 24hr urinary collection of catecholamines)
62
what is the deficnive mx of phaeochromocytoma
surgery - give alpha blocker (phenoxybenzamine ) before beta blocker
63
what is low in secondrry hyperparathyroidism thats not in priamry
calcium
64
secondary hyperparathyroidism
chronic renal failure
65
differential of primary hyperparathyroidsm that howver has urine calcium:creatinine clearance ration <0.01
bening famialail hypocalciuric hypercalcaemia
66
overweight if BMI
25-30
67
obese if BMI over
30
68
drug that can be given for weight loss
orlistat- pancreatic lipase inhibitor
69
injection that can cause weight loss
liraglutide
70
neruoblastoma most common site
adrenal medulla
71
ix for neurobalstoma
raised urianry VMA and homovanillic lvelvs (HVA)
72
in myxoedema coma what needs to be given alognside thyroid replacemetn
Iv cortocsteriods until coexisting adrenal insufficiency has been exluded
73
how does myxoedema coma present
confusion and hypothermia
73
Men 1 is
MEN1 gene
74
Men 2 is what gene
RET ocogene
75
MODY is auto dom and onset is usually before
25y/o
76
when suspect MODY
persisten hyperglycaemia before 25 without typcial featuers of type 1 or 2
77
ix for MODY
genetic testign
78
MODY mx
some dont need anythign some respons well to sulpohynulreas
79
diabetic class used for pts with erratic lifestyles
Meglitinides
80
klinefelters
extra x
taller
small firm tests
gynaecomastia - increased risk of breast caner
elevated gonadotrophin but low testosterone
dx- karotype (chromosomal analysi s)
81
feature of insulinoma
dipplopia/ weakness just before a meal or early morning (hypogylcamie)
CT pancreas
81
insulinoma from what cells
Langerhan cells
82
boy with delayed puberty and alck of smell
Kallmann- LH/FSH are low/normal
testosterone supplementatioj
delayed puberty
83
beta blcokers reduce hypoglyaemic awareness
kiabet
83
what hormones should rise in normal perople after giving insulin
GH and cortisol
84
in liver and skeletal muscles glucose is stored as
glycogen
85
in fat cells glucose is stored as
triglycerides
86
insulin is released in resposen to
Ca
87
over repalcmetn with thyroxine increases
risk of osteoporisis
87
Iron and calcium carbonate tablets can reduce absorption of levothyroxine so should be
given 4hrs apart
88
Trousseau's sign: carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
Chvostek's sign: tapping over parotid causes facial muscles to twitch
89
treatment of hypoparathyroidism
alfacalcidol (vit D)
90
shortened 4th +5th metatarsal
pseudohypoparathyroidism
91
pseudopseudohypoparathyroidism
similar to pseudohypoaparathyroidism but normal biochem
92
perioral paraesthesia
hypocalcaemia
93
diagnosing pseudohypoparathyroidism
measuring urinary cAMP and phospahte levels follwoning an infusin of PTH
94
In HHS
give fluids
insulin should not be given unless blood glucose stops falling while giving IV fluids
give venous thromboembolism prophylaxis due to risk of thrombosus with hyperviscocity
94
response to hypoglayemia
after decreasing insulin secretion then is increased glucagon secretion
95
in HHS there is significnalt riased serum osmolarity calcualted by
2 x na + glcusoe +urea
96
hasimotos associated with what lymphoma
MALT
97
what testicualr cancer can cause gynaemiacsotai due to secreting hCG
seminoma
98
most common drug cause of gynaecomastia
spironolactone
99
how is growth hormone given
injection
100
initial mx of graves
propanol
101
how is carbimazole given
start high and gradually reduc e
102
radioiodine treatemnt for graves can worsen
thyroid eye disease
103
signs for graves to look for
exopthalmos
pretibial myxoedema
finger clubbing
104
NICE recommend 'HbA1c should be checked every 3-6 months until stable, then --- monthly'.
6
105
ambigious genitalia in newborn
5 alpha reductas def
106
male genotype with femlae phenotype
androgren insensitivty syndrome- vag and testes presnt but no uretus
107
legs or arm more likely to be affected first in diabetic neuroapthy
legs
108
prokinetic agents eg metoclopramide for
gastroparesis in diaebtics
108
dka
kussmaul resp
pear drop smell
abdo pain
polytira
109
Key points
glucose > 11 mmol/l or known diabetes mellitus
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick
dka
110
mx of DKA
fluids
think about insulin
dextrose once glucose under 14
replace K?
long acting insulin should be continued but short acting should be stopped
110
DKa should have been resovled within
24hrs
111
important complciation of fluid therapy in KDA especially in young people
DKA
112
peripheral arterial disease can be in diabetes and has
absent foot pulses, reduced ABPI, intermittent claudication
113
hba1c target if includes any drug that can cuase hypoglcyaemia
53
113
hba1 c target if lifestyle +metformin
48
114
can increase dose of metformin to aim for 48 but should only add a second drug if hba1c rises to
58
115
mx of type 2
lifestyle
metformin
SGLT2i/ dpp4 i/ pioglitzoe./ sulphynulreua
= can try triple tehrapy
116
if triple therapy not efecting
switch one of teh drugs for GLP-1
117
should you tay on metformin if start insulin
yep
118
cannot add a drug that is not metformin if hba1c not over 58
119
type 1 blood glucose
testing at least 4 times a day including before each meal and before bed
120
when give metformin in type 1
BMI over 25
120
insulin regime of choice in type 1
determir twice daily
121
what is not good at detecting type 1 diabetes
HbA1c - should do fasting and random glucose
122
frsit lien for cushings
overnight dexamaethsonse supression test
123
antivodies common in type 1
aniti Gad
islet cell
124
high dose dexamethsone suppression
if suppressed byu high dose = cushings disese = pituiarty andeoma
125
21 hydroxylase def
precocious puberty
females may have ambigious genitialia
salt wasting crisis
125
what confirms dx of 21alpha hydroxylase def
ACTH stimulation testing - give steriod to treat
126
what is given at high dsoes before being reduced when euthyroid
carbimazoel
127
syndrome that has severe hypoakalemai with normotension
Bartters syndroem
128
most common precipitatn od addisonian crisis
steriod withdrawl
129
mx of addisionian crisis
hydrocortisone
salien
130
hydrocrtison dose for addisons disease
split with majority given in the first half of day
131
addisons disease ix
short synathen test
132
loss of pubic hair in women can be
addisons disease
133
first lien mx for acromegaly
trans sphenoidal surgery
134
meds for agromegaly if surgery not suitabel
octreotide, pegivisomant, dopamine agonsits
135
first initial test for acromegaly
serum IgF-1 lelvels
then oral glucose tolerance test done to confirms theh dx
136
6% of pts with acromegaly have
MEN1
137
Petrosal sinus sampling of ACTH may be needed to differentiate between pituitary and ectopic ACTH secretion.
