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6th Year > Endo > Flashcards

Endo Flashcards

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1
Q

4 Cardinal symptoms of diabetes

A

Polyuria
Polydipsia
(Lethargy
Weight loss) less common in type 2

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2
Q

What are the primary causes of Diabetes

A

1 - autoimmune desturction of beta islet cells - check anti islet and anti GAD

2 - Low exercise with obesity and high calorie and alcohol excess

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3
Q

What are the secondary causes of diabetes

A

Drugs: Steroids, Tacrolimus, HAART, atypical neuroleptics, thiazides
Pancreatic: CF, Chronic Pancreatitis, HH, Ca
Endo: Cushings, phaeo, acromegaly

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4
Q

How do you remember the management for diabetes

A 
CCCC
Control - glucose
Complications Macro and micro
Competency - can they do it right, education re injection sites
Coping - psychologivcally, work etc.
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5
Q

What are the macrovascular complications of diabetes

A

Look at monitoring pulses in limbs, blood pressure and listening to the heart.

IHD, PVD, stroke

(recurrent UTI)

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6
Q

What are the MICROvascular complications of diabetes

A

Retinopathy, neuropathy, nephropathy

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7
Q

What do you give when a diabetic is 50

A

aspirin or before if they have other risk factors and been diabetic 10 years

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8
Q

What are the contraindications for metformin?

A

GFR less than 30
Tissue hypoxia - sepsis or MI
pre GA and iodinated contrast

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9
Q

side effects of metformin

A

GI sx - Nause and vomiting, diarrhoea and abdo pain

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10
Q

Which diabetic drugs increase insulin production

A

sulphonylureas - gliclazide/ glibenclamide
meglitinides - nateglinide

DPP-4 inhibitors - sitagliptine/linagliptine
GLP-1 Agonists - exenatide/ liraglutideboth via increases in GLP-1 effects
They also reduce glucagon secretion and delay gastric emptying

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11
Q

Which diabetic drugs increase the bodies sensitivity to insulin?

A

Biguanides - metformin

thiazolodinediones - piolitazone

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12
Q

liraglutide

A

GLP1 RA

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13
Q

Sitagliptine

A

DPP-4 inhibitor

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14
Q

Exenatide

A

GLP1RA

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15
Q

pioglitazone

A

thiazolidinedione

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16
Q

gliclazide

A

sulphonylurea

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17
Q

gibenclamide

A

sulphonylurea

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18
Q

Name 2 types of insulin regime

A

Biphasic and Basal Blous

Biphasic - Twice daily (before breakfast and dinner) mixture of long and short acting insulin often used for children and those with regular daily routine.

Basal bolus - one long acting before bed plus short acting before each meal with dose adjustment depending on the meal and associated with better outcomes

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19
Q

Causes of hypoglycaemia

A 
EXPLAIN
Overuse of insulin/ sensitisers with exercise
Drugs
Pituitary insufficiency
Liver Failure
Insulinoma
Addisons
imune
non pancreatic

Measure glucose, insulin, Ketones, Cpeptide

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20
Q

What are the common symptoms in acromegaly

A 
headache,
amenhorrhoea
arthralgia
carpal tunnel
bitemporal hemianopia
 face change, 
shoes and rings dont fit
snoring
parasthesias

May have accompanying hyperprolactinaemia - loss of libido, galactorrhoea, amehorrhoea, erectile dysfunction

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21
Q

What are the causes of acromegaly

A

99% pituitary adenoma

GnRH secretion from carcinoid tumour

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22
Q

signs of acromegaly

A 
large soft tissues - wide nose big ears
prognathia
macroglossia
wide teeth
goitre with a raised JVP
myopathy - standing up
ABDO - organomegaly, acanthosis nigricans
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23
Q

How do you diagnose acromegaly

A

IGF-1 raised screenign test

OGTT with GH (fails to suppress)

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24
Q

Complications of acromegaly

A

Endocrine - impaired glucose tolerance or DM
Cardiovascular - high BP, LVH, cardiomyopaty, IHD, Stroke
Neoplasia - Colorectal cacer

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25
treatment for acromegaly
Trans sphenoidal excision somatostatin analogues - actreotide GH antagonists - pegvisomant
26
What are the causes of diabetees insipidus
``` Cranial Idiopathic 50% Congenital Tumours Trauma ``` Nephrogenic Drugs: lithium, vaptans psychological
27
Name 6 causes of acanthosis nigricans
``` Endocrine: Obesity and metabolic syndrome Acromegaly Cushings Diabetes mellitus ``` Malignancy: pancreatic gastric
28
Name 4 causes of macroglossia
downs syndrome acromegaly hypothyroidism amyloidosis
29
How would you complete the examination of someone with acromegaly
``` Look at previous photos ECG - LVH+ischemia Urine dip glucose Colonoscopy if older epworth sleepiness score OSA ```
30
what are the complications of trans phenoidal excision of an adenoma
meningitis panhypopituitarism diabetes insipidus
31
Which hormones are released from the anterior pituitaru
``` ACTH/MSH TSH LH/FSH GH Prolactin ```
32
posterior pituitary hormones
ADH(vasopressin) | Oxytocin
33
What are the causes of a bitemporal hemianopia
``` Pituitary adenoma(compresses from below therefore loss is from the top down) Craniopharyngeoma(compresses from top therefore loss is from the bottom up) ```
34
Causes of a high prolactin
Dopamine antagonists - anti emetics and antipsychotics
35
Name 3 signs of diabetes mellitus seen in the hands
BM pricks on fingers Granuloma annulare - also associated with autoimmune thyroiditis and hyperlipidaemia. seen on the hands Cheiroarthropathy - prayer sign, cannot fully extend the wrists due to thivkened skin - tight and waxy
36
Name the causes of a Marcus Gunn pupil (RAPD)
``` CAC VISION - MS and Glaucoma most common Congenital Alcohol - other drugs Compresssion - Glaucoma, optic glioma, pituitary adenoma Vascular: DM/GCA/embolic event inflamatory - optic neuritis MS Sarcoid Infection - TB, herpes zoster, syphilis Odema - papillodema Neoplastic infiltration - lymphoma/leukaemia ```
37
Most common causes of marcuss gunn
glaucoma and MS
38
What type of goitre does graves disease give you?
diffusely enlarged with increased radioiodine uptage
39
what percentage of thyrotoxicosis does graves make up?
60%
40
What is graves associated with?
Type 1 diabetes vitiligo addisons disease
41
What would you see on the technecium uptake scan in thyroiditis
reduced uptake
42
What would you see on the uptake scan of a toxic multinodular goitre?
hot areas or nodules. almost always benign, however the goitre may contain other non functioning nodules which are malignant. also known as plummers disease. autonomously functioning nodules
43
How do you treat thyrotoxicosis?
Medical - beta blockers for symptomatic reduciton Carbimazole - inhibits TPO can titrate or block and replace Radioactive iodine - non pregnant or lactating however they often become hypothyroid rather than euthyroid Surgical thyroidectomy - damage to recurrent laryngeal nerve(2% risk)
44
Which conditions have a thyrotoxic phase?
hashimotos thyroiditis de quervains thyroiditis subacute lymphocytic thyroiditis
45
What is the most common cause of hypothyroidism in the UK?
atrophic thyroiditis
46
What antibodies are present in atrophic thyroiditis?
Anti TPO and Anti TSH
47
What are the primary causes of hypothyrodisism?
``` Iodine deficiency (world comonest) Atrophic thyroiditis (UK) Hashimotos thyroiditis (TPO +ve) subacute thyroiditis de quervains drugs: carbimazole, amiodarone, lithium thyroid agenesis ``` secondary causes include: post surgery or radiotherapy/radioiodine
48
What kind of goitre do you get in atrophic thyroiditis
no goitre - you get a lymphocytic infiltrate
49
Do you get a goitre in hashimotos thyroiditis?
Yes due to the regeneration after atrophy
50
How long does it take to see an improvement with levothyroxine treatment?
2 weeks
51
How do you manage myxodemic coma
``` Bloods correct hypoglycaemia Slowly replace t3/t4 IV hydrocortisone manage hypothermia and heart failure ```
52
what diseases is atrophic thyroiditis assocaited with?
Other autoimmune diseases namely addisons, pernicious anaemia and vitiligo.
53
What kind of goitre is seen in de quervains
diffuse PAINFUL | often witha preceeding viral infection such as coxsackie - giant cells on histology
54
What is the management for subacute lymphocytic thyroiditis?
self limiting | -typicaly seen post partum
55
What is the most common type of thyroid carcinoma
Papillary 80 (young patients 20 - 40) folliular 10 Medullary 5 anaplastic
56
What are the characteristics of a malignant nodule?
``` cold solitary men young age solid radiation exposure ```
57
What is the best treatment for MODY?
Sulphonylureas - gliclazide | very responsive
58
What is the gene linked with MODY
HNF1A | type 2 mody is glucokinase mutation
59
What is the treatment for pagets?
bisphosphonates
60
What are the complications of pagets?
1% bdevelop osteosarcoma bone thinckening fractures cranial nerve involvement - deafness
61
What is the management in hypothyroid?
TFT TPO/TSH antibodies screen for other autoimmunity
62
What are the causes of hyperparathyroidsism?
80% single adenoma 15% hyperplasia 4% multiple adenoma 1%carcinoma
63
What is the treatment of hypercalcaemia?
intravenous saline - 3-4 litres per day | bisphosphonates
64
Diabetic neuropathy definition?
occlusion of the vasa nervorum causes ischemia of myelinated and unmyelinated nerve fibres
65
What is sorbitol and how does it cause a peripheral neuropathy?
highly hydrophilic substance which is unable to pass throught he cell membrane so becomes trapped in neuronal scwann cells, causing swelling and cell death.
66
Name 5 symtpoms of an autonomic neuropathy?
Postural hypotension - fludrocortisone ED - sildenafil urinary retention gastroparesis - early satiety/gord/bloating
67
How to remember causes of a polyneuropathy?
``` MDTVIII Metabolic Drugs Toxins Vasculitic Inflammatory Infectious Inherited ```
68
froments sign?
ulnar nerve palsy - require help of the median nerve to hold a piece of paper
69
What should type 1 diabetics do when they are ill?
check blood glucose more regularly, check urinary ketones drink lots of water? dont stop insulin even if not eating much keep up caloric intake where possible with sugary drinks if they have a raised ketone at the same time as a raised sugar - they should take some insulin - daily dose /6
70
which diabetic agents cause weight gain?
thiazoledinediones | sulphonylureas
71
What are th e precipitants of an addisonian crisis?
stopping long term steroids surgery trauma infection
72
drugs that cause hypercalcaemia?
thiazides
73
what reduces the intestinal absorption of thyroxine?
iron tabs
74
tender vs non tender hyPER thyroid
tender - de quervains | non tender graves
75
contraindications to metformin
ESRF

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