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Year 3 Conditions > Endo > Flashcards

Endo Flashcards

1
Q

What percentage of people dont know they have T2DM

A

25%

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2
Q

What is onset of T1DM

A

Acute- present severely

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3
Q

Symtoms of T2DM

A

Lethargy and tiredness

Polyuria and polydipsia

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4
Q

Pathology of T2DM

A

Going to urinate loads so drink sugary drinks and sugar slowly rises- osmotic diuresis causes loss of water and rise in glucose and sodium- hyperosmolar

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5
Q

How does T2DM lead to stroke

A

Blood becomes like treacle

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6
Q

Microvascular complications of DM

A

Glycolysation of basement membrane proteins leading to leaky capillaries
Nephropathy
Retinopathy
Neuropathy

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7
Q

Microvascular complications of DM

A

Dyslipidaemia, HTN, hypercholesterolaemia
IHD
CVA
Peripheral gangrene

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8
Q

How does T2DM worsen MIs

A

Nerves are damaged so dont feel it then go into HF

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9
Q

What is seen under fundoscope in T2DM

A

Hard exudates

Blot haemorrhages

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10
Q

Background diabetic retinopathy

A

HARD EXUDATES
blot haemorrhages
Microaneurysm

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11
Q

Treatment for background diabetic retinopathy

A

Improve blood glucose control

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12
Q

How to treat pre-proliferative retinopathy

A

Pan retinal photocoagulation

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13
Q

Danger of preproliferative stage

A

New vessels can grow that are very thin so risk of bleeding and if they do will cause patients to go blind

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14
Q

Management of diabetic retinopathy

A

Screen regularly
Improve blood glucose control
Warn patient that danger signs are there
If preproliferative stage then needes pan retinal photocoagulation which destroys area of periphery in eye

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15
Q

Does glucose control improve symptoms T2DM

A

Yes

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16
Q

What in fundoscope indicates pre proliferative retinopathy

A

Cotton wool dots

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17
Q

When is T2DM control the most important

A

First 20 years

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18
Q

Why is early T2DM control so important

A

Legacy impact- control at the start protects you for many years as delays heart attacks

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19
Q

What cant you do with elderly T2DM patients who have had diabetes for a few years and atheromas

A

Intensively control diabetes as increases risk of sudden death

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20
Q

Management of T2DM

A 
Diet and exercise
Metformin
Sulphonylureas- glicazide
Insulin sensitisers
Insulin
Incretins
Gliptins
SGLT 2 inhibitors
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21
Q

When do you give short acting insulin

A

30 mins before meals

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22
Q

Metformin side effect

A

Diarrhoea

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23
Q

Problems with insulin T2DM

A

Cant drive HGV
Hypos common even in good control
Weigth gain as makes you hungry due to glycosuria stopping so calories saved

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24
Q

What does GLP 1 do

A

Stimulates insulin production and reduce gastric emptying

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25
What is name given to GLP 1 analogues
Incretins
26
What do gliptins do
DDP4 inhibitors that reduce GLP 1 breakdown
27
Main problem of glycosuria
Thrush and UTIs
28
Which patients are SGLT inhibitors most effective in
Renal patients and HF patients
29
What happens to BP in T2DM
Increases
30
Kidney disease has massive impact on prognosis in T2DM
Yes
31
Signs of nephropathy T2DM
Microalbuminuria
32
Mangement of T2DM nephropathy
Glucose control Bood pressure control ARB or ACEi- Inhibition of RAS Stop smoking
33
What is useful about ACEi
they prevent renal failure in patients with a lttle microalbuminuria
34
What patients cant you give ACEi to
Bilateral renal artery stenosis
35
Implications of renal failure
Acidosis Electrolyte imabalnces Secretory failure
36
Symptoms of renal failure
``` Tiredness nand lethargy SOB due to oedema Nocturia, twitching, feeling cold Loss of appetite, weight loss, nasty taste Anaemia Renal bone disease- aches and pains ```
37
If no renal replacement symptoms
``` Hyperkalaemia PO Nausea Malnutrition Fits Coma ```
38
What are renal replacement therapies
Peritoneal dialysis Haemodialysis Transplant
39
3 categories for hyponatraemia
Hypovolaemic Euvolaemic Hypervolaemic
40
Causes of hypovolaemic hyponatraemia
Vomiting Diarrorhoea ACEi
41
Causes of hypervolaemic hyponatraemia
Cardiac failure Cirrhosis Nephrotic syndrome
42
Causes of euvolaemic hyponatraemia
Hypothyroidism Adrenal insuffiency SIADH
43
Urinary sodium in hypovolaemia
Low
44
Urinary sodium in hypervolaemia
Low
45
Investigations euvolaemic hyponatraemia
TFTs | Short Synacthen test
46
Causes of SIADH
CNS pathology Lung pathology Drugs Tumours
47
Drug causes of SIADH
TCA Carbamezapines SSRIs PPIs
48
What in endo question does postural hypotension indicate
Rules out hypovolaemia
49
Ways to assess volume status
Look at mucous membranes | Postural hypotension
50
Urine osmolality in euvolaemic hyponatraemia
Increased
51
Most common causes of hyponatraemia
SIADH
52
What is onycholysis
Detatchment of nail from nail bed
53
Causes of onycholysis
Trauma Thyrotoxicosis Fungal infection Psoriasis
54
Most appropriate investigation for DKA after CBG and ABG
Capillary ketones
55
When can ALP be raised
Liver obstruction | Bone disease
56
Bone disease that increases ALP
Pagets Fracture Malignancy
57
Blood features of primary hyperparathyroidism
High calcium | Low phosphate
58
Which drug has been proven to prevent diabetes
Metformin
59
What is most effective way to prevent diabetes
Diet and exercise
60
Treatment of malignancy related hypercalcaemia
Bisphonates IV | Rehydration
61
In thyrotoxicosis what happens to appetite
Increased appetite
62
Menstrual effects of thyrotoxicosis
Oligo-or amenorrhoea
63
What do you hear if auscultate a graves disease thyroid
Bruit
64
Features of thyroid in graves disease on examination
Smoothly enlarged | Bruit audible
65
Treatment for thyrotoxicosis
Carbimazole
66
Main side effect of carbimazole
Agranulocytosis
67
How can agranulocytosis present post carbimazole
Mouth ulcers Sore throat Fever
68
What is aim of thyroxine treatment in terms of T4
T4 in upper half of range
69
What can happen to T4 and TSH levels if not regularly taking medication
T4 normal but TSH still high as will take medication just before bloods but this is too soon to suppress TSH
70
Immediate management for phaeochromocytoma
Alpha blockade then beta blockade pre surgery
71
Presentation of phaeochromocytoma
Palpitations Sweating Chest tightedness Anxiety
72
What are phaeochromocytomas normally precipitated by
Surgery Anti-depressant Stess Alcohol and smoking
73
What is secondary hyperthyroidism caused by
Pituitary tumour
74
Thyrotoxicosis without hyperthyroidism can be caused by
Overuse of thyroxine Post partum thyroiditis De quervains thyroiditis Amiodarone toxicity
75
What can be sign of acute thyroiditis
Painful goitre
76
Opathalmic features of all cases of thyrotoxicosis
Lid retraction | Lid lag
77
What are lid lag and lid retraction caused by
Hypersympathetic activity
78
Who is opthalmology more common amongst in thyrotoxicosis
Smokers
79
2 things a high TSH and T4 suggest
Secondary hyperthyroidism | Poor complicance with hypothyroid meds
80
2 drugs given for hyperthyroidism and how they work
Caribimazole and propylthiouracil | Throid peroxidase inhibitor
81
Dose of carbimazole
Initially 30-60mg pper day but slowly reduce down to 5-10mg according to their regular blood tests which will show when patient is euthyroid
82
What drugs are normally given alongside carbimzole and
Beta blockers
83
What is euthyroid
Normal thyroid function
84
Two types of thyroid surgery
Total or subthyroid surgery- subthyroid aims to remove enough tissue so that they arent hyperthyroid
85
Complications of thyroid surgery
Haematoma Laryngeal nerve damage Hypothyroidsim Hypoparathyroidism
86
Chemical ablation of thyroid
Radioiodine 131
87
Complications of carbimazole
Maculopapular rash Pruritis Jaundice
88
Blood test used to analyse serum noradrenaline and adrenaline
Plasma metanephrines
89
Blood test to diagnose phaeochromocytoma
Plasma metanephrines
90
What is an MIBG scan
Patient given radioactive iodine and its uptake is monitored across the body
91
What are MIBG scans used to detect
Neuroblastomas or phaeochromocytoma
92
What is advised to all patients with primary or secondary hypoadrenalism who get a fever or flu
Double their hydrocortisone/prednisolone dose
93
What are Sx of adult with growth hormone deficiency
Low mood General malaise Fatigued
94
Test done on adults with suspected GH deficiency
AGHDA- is a quality of life questionnaire
95
What are you thinking when patient presents with abdo pain after an infection affecting any part of body
Thyroid storm
96
Treatment of thyroid storm
Anithyroid meds B blockers Steroids
97
Why is beta blocker use used for thyroid storms
Treats tachycardia and tremors | Inhibits peripheral conversion of T4-T3
98
When should you not do s thyroidectomy
When patient is under stress such as acutely unwell
99
What test can show uninodules on thyroid
Radioiodine uptake
100
When should radioiodine uptake not be checked
When patient very ill so only useful in later management- can precipitate a thyroid storm
101
What is most common arrythmia in thyrotoxicosis
AF
102
What are precipitants of thyrotoxicosis
``` Stress such as infection, cancer and pregnancy Thyroid surgery MI DKA Any surgery Radioiodine uptake ```
103
What is acromegaly
Excess growth hormone in adults that leads to growth of the hands face and feet
104
What is acromegaly called in children
Gigantism
105
When does hypothalamus release growth hormone releasing hormone
Every couple of hours and is affected by stresses on body
106
Stresses on body that increase growth hormone release
``` Hungry Exercise Trauma Anxiety Low blood glucose Increased sleep ```
107
How is GH release limited
Too much GHRH When GH reaches its target cells they release samatomedins which inhibit GH release GH and somatomedins inhibit GHRH release
108
GH effects in liver, bones and muscles
Bones- stimulates osteoblasts Muscle- growth Liver- release glucose
109
Insulin effects of GH
Xs glucose release leads to insulin resistance in cells so insulin increases in blood and become diabetic
110
What does GH stimulate release of in bones, kidneys, liver and muscle on top of somatomedin
ILGF 1 | Which promotes cell division and stops apoptosis
111
Main cause of acromegaly
Pituitary adenoma
112
Rarer causes of acromegaly
Hypothalamic tumour | Ectopic tumours
113
Sx of acromegaly
``` Soft tissue growths in face, hands and feet Bony growth in feet, hands and lower jaw Protrusion of forehead Organomegaly Increased sweating ```
114
Time course for acromegaly
Takes years to notice
115
Complications of acromegaly
HF from cardiomegaly Carpal tunnel syndrome Diabetes mellitus Colon cancer from polyps
116
Diagnosis of acromegaly
Oral glucose tolerance test | MRI of pituitary
117
Oral glucose tolerance test in acromegaly
GH should be suppressed after large consumption of glucose but in acromegaly will be very high
118
Contraindicating factors that may affect oral glucose tolerance test
Hypothyroidism Cushings Poorly controlled DM
119
What is prognathism
Protrusion of lower jaw- seen in acromegaly
120
What is macroglossia
Enlarged tongue
121
Features of acromegaly
``` Diabetes- all its consequences Cardiomegaly Carpal tunnel syndrome- parasthesia Colonic polyps Macroglossia Prognathism ```
122
Treatment of acromegaly
``` Trans-sphenoidal hypophysectomy External beam radiation Somatostatin analogues GH receptor antagonists Cabergoline ```
123
What is primary adrenal insufficiency
Can’t produce enough hormones from adrenals in particular aldosterone and cortisol
124
Where is aldosterone made
Zona glomerulosa
125
Role of aldosterone
Increase sodium réabsorption Decrease sodium Increase BP and volume
126
Effect of aldosterone on pH
Increases pH as increases H excretion
127
Where is cortisol made
zona fasiculata
128
What is cortisol used for
Physical and mental stress
129
What stimulates ACTH
Corticotrohin releasing hormones
130
Role of cortisol in terms of glucose
Increases blood glucose
131
How does cortisol increase blood glucose
Gluconeogenesis from liver Causes muscle and adipose to release amino acids and free fatty acids respectively for this Opposite to insulin
132
What are glucocorticoids
Cortisol
133
What are mineralocorticoids
Aldosterone
134
Role of adrenal in terms of sex features men
Produce dehydroepiandrosterone Precursor to testosterone Development of male reproductive organs Development of secondary sex features such as Addams apple
135
Role of adrenal in terms of sex features women
``` Produce dehydroepiandrosterone Precursor to testosterone Growth spurt Armpit and pubic hair Libido ```
136
Chronic causes adrenal insufficiency
``` Developing world Autoimmune Metastatic cancer Developed TB ```
137
What is chronic adrenal insufficiency called
Addisons
138
Acute cause of adrenal insufficiency
Waterhouse friederichsen syndrome
139
What is waterhouse friederichsen syndrome
Hypertensive crisis leads to bursting of adrenal vessels meaning it fills with blood
140
What does adrenal insufficiency suggest about the damage to adrenal
Majority of it is damaged- adrenal gland has high functional reserve whereby only a small proportion can churn out a lot of cells
141
ABG finding of addisons
Metabolic acidosis
142
Blood findings of addisons
Low sodium High potassium High urea Low pH
143
Sx of addisons- aldosterone
``` Craving salty foods Nausea and vomiting Fatigue Dizziness when standing Low BP Postural hypotension ```
144
What do Sx of addisons depend on
Which layer is affected by damage
145
Sx of addisons- cortisol
Weak tired and disoriented in times of stress in particular Hyperpigmentation Weight loss
146
Why do you get hyperpigmentation in addisons
Reduced negative feedback on pituitary so increases POMC release which is broken down into ACTH and MSH
147
What layers are most commonly affected in addisons
Glomerulosa and fasiculata | Rare for reticularis to be affected
148
Sx addisons- testosterone women vs men
Men very few Sx as testes main source Women loss of pubic and armpit hair Low libido
149
Acute presentation of addisons
``` Fever Confused to coma Low BP Vomiting Abdo pain ```
150
Chronic presentation of addisons
``` Abdo pain Weakness Joint and muscle pain Tired and anorexia Weight loss Often missed and insidious but can have addisonian crisis which is precipitated by a stressor ```
151
Addisonian crisis presentation
Low BP leading to LOC Vomiting and diarrorhoea Back and leg pain Abdo pain
152
How is addisons diagnosed
Short synacthen test where given ACTH and monitor cortisol response
153
Treatment for addisons
Hydrocortisone and fludrocortisone | Must be adherent or addisonian crisis
154
What is a carcinoid tumour
Tumour of neuroendocrine cells that line for example the lungs and GI tract which produce large numbers od serotonin or bradykinin for example depending on where they are
155
What is carcinoid syndrome
Paraneoplastic syndrome that develops secondary to a carcinoid tumour that starts releasing excess hormones
156
Hormones that can be released from carcinoid tumours
Serotonin Histamine Bradyknin Prostaglandins
157
Primary sites of carcinoid tumours
All gastro organs including appendix Lungs Ovaries
158
What is often necessary for carcinoid syndrome to develop
Metastase to liver meaning there is dysfunction in the breakdown of the hormone
159
What is serotonin broken down to
5-hydroxyindoleacetic acid which passes out in urine
160
Diagnosing phaeochromocytomas
Urine catecholamines Plasma metanephrines Abdo CT MIBG scan
161
Most commonly affected valve in carcinoid
Tricuspid or pulmonary
162
Investigations for carcinoid
urinary 5-HIAA CT of whole trunk Echo
163
Carcinoid effects of increased histamine and bradykinin
Flushing | Itching
164
Carcinoid effects of increased serotonin
Fibrosis of heart valves Bronchoconstriction- asthma Pellagra
165
What is pellagra
Series of symptoms caused by a lack of niacin malabsorption
166
Sx of pellagra
Diarrorhoea Dermatitis Dementia 3ds
167
Most common sites of carcinoid
Distal ileum and appendix
168
Typical carcinoid syndrome
``` Cancer of that site Sx Diarrorhoea Weight loss Asthma Flushing Pellagra ```
169
What worsens carcinoid symptoms
Stress on body such as exercise | Alcohol
170
What is first T2DM drug given
Metformin if not contraindicated
171
What is initial management of T2DM
Monotherapy- should be metformin if not contraindicated or get diarrorhoea- and is Hb1ac is monitored after 3 months and if isnt improved or maintained then add another agent such as an incretin or basal insulin If patient has long standing T2DM, CKD or established atherosclerotic disease then add a SGLT2 inhibitor
172
Example of SGLT 2 inhibitors
Empagliflozin
173
Which diabetes drug classes were shown to reduce all cause and cardiovascular mortality
SGLT2i | Incretins
174
Side effects of SGLT2i
Genital skin infections
175
Side effects of gliptins
Pancreatitis | Retinopathy
176
What fasting glucose is used to diagnose diabetes
Over 7
177
What random glucose is used to diagnose diabetes
Over 11.1
178
What is dose given in impaired glucose tolerance
75g OGTT
179
What result suggests an impaired glucose tolerance
7.8-11
180
How does daibetic neuropathy present
Glove and stocking distribution
181
O/E graves
Exopthalmos Smooth goitre Pretibial myxoedema Tremor
182
How will technetium nuclear medicine scan show in graves
Diffuse increased uptake
183
Risk factors for thyroid cancer
``` FHx Radiation Any goitre Iodine deficiency Obesity Asian origin ```
184
Examination findings of thyroid cancer
Lymphadenopathy | Lumps in neck
185
Common met site of thyroid cancer
Lung
186
Investigations of thyroid cancer
USS | Uptake scan technetium
187
How will thyroid cancer show up on Nuclear medicine uptake scan
Cold nodules
188
Types of thyroid cancer
Papillary Follicular Medullary Anaplastic
189
Management post thyroid cancer
Thyroxine and radio-iodine
190
What causes bitemporal hemianopia
Pituitary tumour
191
Sx of prolactinoma
Bitemporal hemianopia Amenorrhoea Galactorrhoea Sexual dysfunction
192
What is example of dopamine agonist
Cabergoline
193
Differentiate between macro and microprolactinoma
Either side of 1cm
194
Treatment for prolactinomas
Cabergoline rather than surgery as medicines can shrink it completely
195
Presentation of acromegaly
Headache Sweating Tingling in fingers Poor sleep and snoring
196
Why do you get poor sleep and snoring in acromegaly
Obstructive sleep apnoea
197
What causes tingling in fingers in acromegaly
Carpal tunnel syndrome
198
Initial test in suspected acromegaly
IGF-1
199
What presents with snoring, poor sleep, sweating, tinginling in fingers and headache
Acromegaly
200
Test used to confirm acromegaly
Oral glucose tolerance test
201
Sx of cushings that are very general
Central obesity Fatigue Depressed
202
Discriminatory cushing Sx
``` Bruising Thin skin Myopathy Striae DM and osteoporosis at young age ```
203
Framework for amenorrhoea/oligomenorrhoea
``` Pregancy Hypothalamus Pituitary Thyroid Ovaries ```
204
What can cause hypothalamic amenorrhoea/oligomenorrhoea
Excess exercise | Low BMI
205
What can cause amenorrhoea/oligomenorrhoea related to pituitary
Excess prolactin | Low LH/FSH
206
What does PCOS present with
Hirsutism | amenorrhoea/oligomenorrhoea
207
Presentation of hirsutism and amenorrhoea/oligomenorrhoea
PCOS
208
What is blood sign of ovarian failure
High FSH
209
What presents with polyuria, arrythmia and weakness
Hypokalaemia
210
What does hypokalaemia present with
Polyuria Arrythmia Weakness
211
Differentials for hypokalaemia
Vomiting/diarrorhoea Diuretics Primary hyperaldosteronism
212
Causes of hyperaldosteronism
Bilateral hyperplasia | Conns
213
How to check for hyperaldosteronism
Aldosterone:renin ratio
214
Why do hypovolaemic hyponatraemic patients have urinary low sodium
ADH insufficiency
215
Effects of PTH on kidney
Reabsorb calcium Excrete phosphate Produce calcitriol
216
Effects of calcitriol
GI calcium and phosphate absorption
217
Effect of acidosis on calcium
Increases serum calcium
218
Investigations for hypercalcaemia
PTH Phosphate DEXA CT to look for potential PTH secreting tumours
219
Presentation of DKA
``` Anorexia Lethargy Polydipsia Polyuria Dehydration Abdo pain Vomiting Coma ```
220
``` What presents with Anorexia Lethargy Polydipsia Polyuria Dehydration Abdo pain Vomiting Coma ```
DKA
221
How is DKA diagnosed
Raised plasma glucose or history of diabetes | Metabolic acidosis with increased anion gap
222
Immediate treatment of DKA
IV fluid resucitation (0.9% NaCl) followed with IV bolus of insulin onsliding scale
223
What is most important ion to replace in DKA
Potassium as is driven into cells by insulin
224
Classical triad for new diabetes
Hyperphagia Polydipsia/polyuria Tiredness
225
Classical cushings presentation
``` Truncal obesity HTN Fatiguability and weakness Amenorrhoea Hirsutism Striae Oedema Glycosuria Polyuria ```
226
Common examination test for cushings used
Ask patient to get up without using hands and will have no hope
227
Most common cause of cushings
Excess glucocorticoid use
228
Causes of cushings
Excess glucocorticoid use Adrenal adenoma Ectopic ACTH
229
What can cause polyuria other than renal problems
Diabetes and DKA Hypercalcaemia Cushings Hypokalaemia
230
What other than DM presents with polyuria and glucosuria
Cushings
231
Test used to diagnose cushings
Overnight dexamethasone suppression
232
How does overnight dexamethasone test work
Take dexamethasone at midnight which should suppress ACTH then measure 9am cortisol
233
Presentation of hyponatraemia
``` Confusion Dizziness and collapse Anorexia Seizures Weakness Arrythmia ```
234
Treatment of hyponatraemia
Hypertonic sodium chloride Fluid resus Demeclocycline
235
MOA demeclocycline
Can be used to block ADH in renal tubule
236
What causes increase in new diabetes diagnoses in february
Viruses
237
Which diabetes has more of a genetic component
T2DM
238
How young can people be to first get T2DM
Even in children
239
What can cause T1DM
Viral pancreas destruction
240
Differences in DKA and HHS presentation
DKA presents very acutely in teenagers with T1DM | HHS presents in T2DM patients with or without existing knowledge and will have insidious onset
241
What can cause HHS
People arent hydrating properly drinking lots of lucozade and coke so hyperglycaemic
242
What must always consider when patients get UTIs in older ages
Diabetes as glycosuria
243
Differences in DKA and HHS serum glucose
DKA- 20 | HHS- extremely high can be 99
244
Differences DKA vs HHS sodium osmolality
DKA slighly high | HHS even higher
245
Differneces in causes of confusion in DKA vs HHS
DKA acidosis | HHS hyperosmolar state drawing water out of brain
246
Treatment for HHS
Normal saline with starch and then also insulin
247
Difference DKA vs HHS treatment
DKA fluid can be given faster
248
What would you think of in hepatomegaly with diarrorhoea
Carcinoid tumours
249
Alpha blockade used in phaeochromoctoma
Phenoxybenzamine
250
Endocrine tumours that increase BP
Conns | Phaeochromocytoma
251
Treatment for conns
Spironolactone
252
What drug is used to in treatment of cushings
Metyrapone
253
Difference between cushings disease and syndrome
Cushings syndrome is term for too much cortisol in body but cushings disease a pituitary tumour
254
Glucocorticosteroid drug replacements
Hydrocortisone and prednisolone
255
Mineralocorticoid drug replacements
Fludrocortisone
256
Most common form of hypothyroidism in young person
Hashimotos hypothyroidism- chronic autoimmune thyroiditis
257
What condition are antithyroid peroxidase ABs seen in
Hashimotos
258
What presents with low mood, body aches and polydipsia
Hypercalcaemia
259
What happens to ALP in vit D overdose
Low as calcium suppresses all bone turnover
260
Investigations for hyperthyroidism and their results
ESR- raised Antithyroid peroxidase TSH rarely done as expensive
261
When would you always do TSH test
If pregnant as ABs can cross placenta and cause thyrotoxic fetus
262
What would be included in yearly T2DM review
``` Retinopathy Foot assessment of sensation and doppler for vascular supply U&E Serum cholesterol Hba1c Weight loss ```
263
Presentation of renal carcinoma
Haematuria Weight loss Pain in flank
264
Causes of haematuria
Renal carcinoma | Transitional cell carcinoma
265
First line investigation of haematuria
US
266
What cant renal US pick up
Transitional cell carcinomas
267
Management of hypovolaemic hyponatraemia
IV fluids
268
Management of euvolaemic hyponatraemia
Fluid restrict
269
Management of hypervolaemic hyponatraemia
Fluid restrict
270
What does urinary sodium of less than 20mmol/L suggest
Hypovolaemia
271
What does urinary sodium of more than 20mmol/L suggest with hyponatraemia
SIADH
272
Causes of SIADH
``` SC lung cancer CNS infections Brain tumours Anti-depressants Anti-epileptic ```
273
Causes of hypokalaemia
``` Mouth - Reduced dietary intake - Vomiting - salbutamol Kidney area - Conns - Cushings - loop and thiazide diuretics Anus - diarrorhoea ```
274
Causes of hyperkalaemia
``` Addisons ACEi/ARB K+ Sparing diuretics Renal failure Pseudohyperkalaemia ```
275
Example of K sparing diuretics
spironalactone
276
What happens in pseudohyperkalaemia
If RBCs are haemolysed their K leaks out into sample leading to error in measurement
277
When would you suspect pseudohyperkalaemia
K measurement doesnt fit with rest of clinical picture
278
What is one organ PTH affects but calcitriol not
Bone
279
Symptoms of hypercalcaemia
``` Stones- kidney stone Bones- fractures Abdominal moans- dyspepsia Thrones- polyuria, constipation Psciatric overtones- depression, psychosis ```
280
Management of hypercalcaemia
Aggressive IV fluid resus and treat cause
281
What is problem of DKA
Acidity increases and enzymes cant function
282
Complication of DKA
Coma and death
283
Treatment for DKA
IV fluids Fixed rate insulin Monitor K+, glucose and ketones
284
When patient has hyponatraemia what is first thing you should do
Exclude pseudohyponatraemia by looking at serum osmolality
285
What happens in pseudohyponatraemia
The serum osmolality is normal or high and hyponatraemia is an artefact of this- sodium is main ion in blood so if that is low would expect the whole serum osmolality to be low
286
What can cause pseudohyponatraemia with high osmolality
Hyperglycaemia Mannitol Glycine
287
What can cause pseudohyponatraemia with normal osmolality
High protein | High lipids
288
Signs of hypervolaemic patient
Raised JVP | Oedema
289
What can hypovolaemic hyponatraemia be classified into
Whether urine sodium is low or high | If high suggests renal failure as normally kidneys should respond to low sodium by stimulating ADH
290
What can cause hypovolaemic hyponatraemia with high urine sodium
Diuretics Renal failure Addisons
291
What can cause hypovolaemic hyponatraemia with low sodium in urine
Vomiting and diarrorhoea Third space losts Cutaneous losses ie burns and sweating
292
In euvolaemic hyponatraemia what can causes be classified into
High or low total urine osmolality
293
What will give a high urine osmolality in euvolaemic hyponatraemia
SIADH as very little water will be passed out
294
Causes of low urine osmolality euvolaemic hyponatraemia
Psychogenic polydipsia Iatrogenic fluid overload Severe hypothyroidism
295
What is danger of correcting hyponatraemia too quickly
Pontine myelinolysis
296
How will hypoglycaemic patient appear
Sweating and tachycardic as increased adrenergic activity
297
Treatment of hypoglycaemia options
Dextrose gel in mouth 50ml of 20%insulin IV Glucagon IM
298
Why do only type 1 diabetics get DKA
Ketogenesis is inhibited even by a very small amount of insulin
299
Overall which has a greater effect on calcium- PTH or calcitriol?
Calcitriol
300
Overall which has a greater effect on phosphate- PTH or calcitriol?
PTH reducing it | Calcitriol increases it by reabsorption
301
Causes of primary hyperparathyroidism
Parathyroid adenoma | Prathyroid hyperplasia
302
Blood finding of primary hyperparathyroidism
High PTH High phosphate High calcium
303
What is the name of secondary hyperparathyroidism
Osteomalacia
304
Causes of osteomalacia
Vitamin D deficiency CKD Liver disease
305
Blood findings of osteomalacia due to Vit d deficiency
Low calcium | Low phosphate
306
Blood findings of osteomalacia due to LIVER DISEASE
Low calcium | Low phosphate
307
Blood finding of osteomalacia due to CKD
Low calcium | High phosphate
308
Blood finding of tertiary hyperPTH
High calcium | High phosphate
309
What happens in tertiary hyperPTH
Chronic kidney disease means cant produce calcitriol so calcium level permenantly low so parathyroid continuously releases PTH as no neg feedback therefore gets autonomously released
310
How to classify causes of hypercalcaemia
High PTH | Low PTH
311
High PTH causes of hypercalcaemia
Pimary hyperPTH | Tertiary hyperPTH
312
Low PTH causes of hypercalcaemia
``` Bone mets Myeloma Paraneoplastic lung SqCC Sarcoid Thiazide diuretics ```
313
How to classify causes of hypocalcaemia
High PTH | Low PTH
314
High PTH causes of hypocaclaemia
Osteomalacia
315
Low PTH causes of hypocalcaemia
Autoimmune hypoparathyroidism
316
Clinical examination signs of hypocalcaemia
Chvostek sign- tapping facial nerve | Trousseaus sign- tight BP cuff
317
What are rfx for primary hyperPTH
HTN | Men -1+2
318
What is MEN-1
Multiple endocrine neoplasia 1. Pituitary tumours + pancreatic tumours+PTH gland hyperplasia
319
What is MEN-2a
Multiple endocrine neoplasia 2. Phaeochromocytoma+ medullary thyroid cancer+PTH gland hyperplasia
320
What is osteomalacia called in children
Rickets
321
3 ways of being vitamin d deficient
Poor dietary intake Poor sunlight Malabsorption
322
Signs and symptoms of osteomalacia
Bone pain and fractures Proximal myopathy Fatigue
323
Signs and symptoms of rickets
Bowed legs | Knock knees
324
Investigations for primary hyperPTH and findings
``` Bloods: (FBC, CRP) U&E LFTs - ALP normal Calcium up Phosphate down PTH up or normal Imaging Head x ray- pepper pot skull Hand X ray- Subperiosteal bone resorption (radial aspects) Acro-osteolysis ```
325
Skull x ray finding of primary hyperPTH
Pepper pot skull
326
Hand x ray finding of primary hyperPTH
Subperiosteal bone resorption | Acro-osteolysis
327
What is acro-osteolysis
Resorption of distal phalanges
328
Investigations for osteomalacia and their findings
``` Bloods: (FBC, CRP) U&E- altered if due to CKD LFTs - ALP up Calcium down Phosphate down or up depending on cause PTH up ```
329
Osteomalacia imaging findings
Loosers pseudofractures | Rachitic rosary
330
What is rachitic rosary
Nodularity at costochondral junctions
331
Treatment of acute primary hyperparathyroidism
IV fluids | Bisphosphonates if still high
332
Management plan of primary hyperparathyroidism
Surgical total parathyroidectomy If not healthy enough for surgery then Cinacalcet (drug class: calcimemetic)
333
What is main risk of total parathyroidectomy
Damage to rcurrent laryngeal nerve
334
Treatment of acute osteomalacia causing hypocalcaemia
IV calcium gluconate
335
Management of osteomalacia due to vit d deficiency
Inactive Vit D- ergocalciferol | Calcium
336
Management of osteomalacia due to CKD
Calcium | Active Vit D- alfacalcidol
337
What is acropachy and what do you see it in
Swelling of the fingers and clubbing | Associated with graves
338
What is a hygroma cyst
Mygroma is an abnormality of the lymph system
339
Where are cystic mygromas only found and what is their defining feature
Posterior triangle | Transilluminate
340
What is a branchial cyst
Congenital cyst found in anterior triagnle that is from failure of branchial cleft development
341
What is defining feature of branchial cyst
Cholesterol crystals inside
342
Where are dermoid cysts in neck found
Midline
343
What are dermoid cysts
Failures of skin development
344
Where are thyroglossal cysts found
Midline
345
How to tell if lump is thyroglossal cyst
Will move when stick tongue out
346
What does goitre mean
Swelling of the whole thyroid gland
347
Most common cause worldwide of goitre
Iodine deficiency
348
5 causes of goitre
``` De Quervains Graves Iodine deficiency Toxic nodular goitre Hashimotos can ```
349
What is another name for de quervains
Subacture thyroiditis
350
Red flags for neck lump
``` Child Lymphadenopathy Radiation Hoarseness Fhx Stridor ```
351
Why do graves goitre have bruits
Very vascularised
352
What are some possible salivary gland pathologies
Stones Infection Cancer
353
How to tell neck lump is carotid aneurysm
Pulsatile | Bruit
354
What is the name of a carotid body tumour
Paraganglioma
355
Paraganglioma on examination of the lump
Pulsatile but no bruit
356
How to differentiate between paraganglioma and carotid aneurysm
no bruit in paraganglioma
357
Which thyroid tumour often presents with local lymphadenopathy
Papillary
358
Which thyroid cancer do you often get from iodine deficiency
Follicular
359
What thyroid tumour do you often get in MEN 2
Medullary
360
What is complication of sebaceous cysts
Get infected
361
How do sebaceous cysts appear
Skin coloured with punctures | Can get infected so become filled with pus
362
Palpitations history for phaeochromocytoma
Histroy over last few weeks, of sporadic in nature lasting around 5 minutes that are associated with headaches, nausea and vomiting Keep feeling anxious
363
Examination findings of phaeochromocytoma
Small mass over adrenals that when palpated results in symptoms Papilloedema
364
Initial investigations for phaeochromocytoma
Serum metanephrines- catecholamines are less reliable as released in response to stress
365
Confirmation investigations for phaeochromocytoma
CT/MRI/MIBG 24hr urine metanephrines Genetic testing
366
Management of phaeochromocytoma
ABS Alpha blockade- phenoxybenzamine Beta blockade- atenolol Surgery
367
Typical patient presenting with thyroid storm
Middle aged women with graves- peak incidence 60
368
Management of thyroid storm
Propanolol | Then carbimazole or propylthiouracil
369
What is addisons crises normally precipitated by
Stressors of dehydration, illness etc
370
Which sex are addisonian crises more common in
Females
371
Best initial test for addisons
9am cortisol
372
Management of addisons
Glucocorticosteroids Glucose Long term- glucocorticoids and mineralocorticoids and then increased doses during times of stress
373
Common cause of waterhouse friederichsen syndrome
Infections such as neisseria meningitidis
374
Treatment of hypovolaemic hyponatraemia
0.9% saline | 3% hypertonic saline if unresponsive
375
What is pagets disease
Disorder of bone remodelling
376
Risk factors for pagets disease
Elderly | Family history
377
What are 3 phases to pagets disease
Lytic Mixed Sclerotic
378
What are symptoms of pagets disease
Fragility fractures Insidious onset bone pain Nerve compression
379
What bones are commonly affected in pagets
Skull Pelvis Femur
380
Common results of nerve compresssion in pagets
Sensorineural hearing loss | Sciatica
381
Signs on examination of pagets
Bone enlargement | Warm skin over painful areas
382
Bloods ordered for pagets and findngs
``` FBC U&E LFTs Clacium normal Phosphate normal PTH normal Serum CTX up Serum P1NP up ```
383
What is of serum CTX a marker of
Bone resorption marker
384
What is of serum P1NP a marker of
Bone formation marker
385
Imaging for pagets
X ray | Tec 99- show lytic areas
386
Primary causes for osteoporosis
Post menopausal | Elderly
387
Symptoms of osteoporosis
Often asymptomatic Fragility fractures Back pain
388
Secondary causes of osteoporosis
Drugs- steroids, thyroxine, alcohol Endo- cushings, hyperPTH,, hyperT GI- coeliac, IBD
389
Classic osteoporosis fractures
Neck of femur Wrist- colles Lumbar spine wedge fractures Neck of humerus
390
Bloods in osteoporosis
All normal
391
Imaging used in osteoporosis
DEXA scan
392
What is a T score
Bone mineral density compared to young healthy person
393
What is a Z score
BMD compared to age matched individual
394
Osteoporosis range for T score
Under -2.5
395
Osteopenia range for T score
Between -1 and -2.5
396
Normal T score
Over -1
397
Pakistani woman in bone questions
Osteomalacia
398
Patient presents with muscle weakness and bone pain
Osteomalacia
399
ALP in osteomalacia
Up
400
What causes HTN with elevated Na and low K
Conns tumour causing hyperaldosteronism
401
Investigations of conns
24 hr BP Aldosterone renin ration CT scan
402
What is a potent vasodilator used in phaeochromoctytoma surgery
Sodium nitropusside
403
What is LADA
Latent autoimmune diabetes of adults
404
How does LADA present
Diabetes of insidious onset that presents in older age with exact symptoms of T1DM often with a strong family history- even pancreatic islet cells antibodies present.
405
What is problem of LADA
Often diet and medication have no impact on disease condition
406
What is name of syndrome from NET producinh gastrin
Zollinger ellison
407
What is problem of zollinger ellison syndrome
Lots of peptic ulcers
408
What happens when have NET producing insulin
Hypoglycaemia
409
What is name of syndrome from NET producing serotonin
Carcinoid
410
What is staining marker for NET
Chromogranin
411
Where are gastrin NETs normally from
Pancreas or duodenum
412
Where do NETs often originate
``` Lungs Thymus Inestines Rectum Sigmoid ```
413
Dose for short synACTHen test
250ug
414
Confirmation test for addisons
short synACTHen | Cortisol very low still
415
Causes of Addisons
TB Autoimmune Mets
416
Bilateral adrenal tumours ddx
MEN CAH Primary tumour that has metastasised
417
Dose of levothyroxine
50-100mg OD
418
When cant you give propanolol with carbimazole
HB | Asthma
419
If have panhypopituitarism what are main hormones that need replacing
Testosterone Cortisol Thyroxine
420
What glucocorticoid is preferred in addisons
Prednisolone as has a longer half life meaning doesnt have to be given 3 times a day which leads to three peaks of cortisol- thus uncoupling from physiological dirurnal cycle
421
Why do addisons sufferers have lower life expectancy
Cortisol cycle uncoupled from its physiological one
422
Which drug not available for NHS is best glucorticoid replacement and its problems
Plenadren | Severe diarrorhoea
423
For T1DM what is their insulin regime
Background insulin to suppress ketoacidosis | Bolus insulin before meals
424
Between what range of glucose does the sympathetic nervous system get activated
2.5-3.5
425
What is defined as hypoglycaemia in diabetic patient
Below 4
426
What is defined as hypoglycaemia in non diabetic patient
Below 2.2
427
When cant you use TSH to check levothyroxine dose
Panhypopituitarism
428
Drugs causing hyponatraemia
``` Loop Thiazide PPIs ACEi SSRI Carbamezapines Desmopressin ```
429
What are insidious onset symptoms of T2DM
Tiredness Polyuria Polydipsia
430
What are subacute onset symptoms of T2DM
Lethargy Polydipsia Polyuria Opportunistic infections causing balanitis in men and vulvae pruritus in women
431
How is T1DM diagnosed
Symptomatic and 1 test above 7 fasting 11 random Or Asymptomatic and 2 tests same as above
432
Causes of hypothyroidism
Iodine deficiency Hashimotos Subacute thyroidtis Post partum thyroiditis
433
Initial tests for Cushing
24hr urine collection | Late night salivary cortisol
434
After 24hr urine collection what is next test in Cushing diagnosis
Low dose dexamethasone and measure ACTH | If low will be an adrenal tumour
435
After low dose dexamethasome what is next test in Cushing diagnosis
High dose dexa If ACTH suppressed then pituitary tumour so Cushing diseas If still high then ectopic ACTH
436
Acromegaly typical presentation
Headaches Changes in appearance Visual problems
437
Later presentation of acromegaly
Hirsutism Diabetes HTN Growths in hands
438
Test for acromegaly
OGTT will still see elevated GH so do MRI
439
What are 3 sites graves IgG can affect and their effects
Eye- exophthalmos, visual disturbances Legs- pretibial myxoedema Fingers- acropachy and clubbing
440
How does de quervains present
Hyperthyroid signs Fever Painful neck lump Progresses to hypothyroid
441
Examination and investigation findings of de quervains
Goitre Tachy Raised ESR
442
What is plummers disease
1 nodule on thyroid that doesnt respond to antithyroid meds
443
What is a simple goitre
Idio[athic enlargement of the thyroid associated with thyroid ABs that has no symptoms
444
Goitre without symptoms of thyroid disease
Simple goitre
445
What is riedels thyroiditis
Rare inflammatory condition leading fibrosis of thyroid that is asymptomatic
446
Stony and wooden thyroid on percussion
Riedels thyroiditis
447
Most common sx addisons
Postural hypotension Pigmentation of scars and creases Vitiligo Wt loss
448
What is pathognomonic for MND
Bulbar involvement
449
Symptoms of diabetes insipidus
Polyuria Polydipsia Dehydration
450
What are 3 options for causes of diabetes insipidus
Cranial Nephrogenic Psychogenic
451
First test for diabetes insipidus and how they will do in test
Fluid deprivation Nephrogenic and cranial urine will remain hyposmolar Psycogenic will become concentrated
452
Definitive test for diabetes insipidus | Cranial and nephrogenic results
Desmopressin Cranial urine will become hyperosmolar Nephrogenic urine will become hyposmolar
453
Causes of cranial diabetes insipidus
Tumour Granulomatous infiltration Trauma
454
Causes of nephrogenic diabetes insipidus
Lithium | Familial
455
What would be cause of diabetes insipidus in psych patient
Psycogenic | Or lithium if bipolar
456
Symptoms of hypocalcaemia
Tingling in fingers Hyperrefelxia Stridor from laryngospasm Long QT
457
What would be a thyroid cyst on examination
Fluctuant or soft mass
458
What is a main danger of phaeos as seen in house
Vasoconstriction leading to tissue death
459
What is general size of Conns and phaeos tumours
Small in conns
460
If patient has statin resistance and familial hyper cholesterolaemia whatcdrug can be given
Evolocumab- a PCSK9i
461
What is 5 AHA used for
Carcinoid syndrome
462
Side effects of levothyroxine
Osteoporosis | AF
463
If have panhypopituitarism what think
Potential GH deficiency
464
In thyrotoxicosis what is preferred anti-thyroid med
PTU

Year 3 Conditions (33 decks)

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