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fourth year > endo high yield > Flashcards

endo high yield Flashcards

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1
Q

T3 and T4 high, TSH low

A

primary hyperthyroidism

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2
Q

TSH high, T3 T4 high

A

secondary hyperthyroidism

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3
Q

T3 T4 normal, TSH low

A

subclinical hyperthyroidism

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4
Q

Mx of toxic multinodular goitre

A

radioiodine therapy

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5
Q

Mx of Grave’s in preggers

A

propylthiouracil

-carbimazole contraindicated in pregnancy

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6
Q

sore throat and taking carbimazole/propylthiouracil

A

AGRANULOCYTOSIS

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7
Q

treatment of thyroid storm

A
  • fluids
  • anti-arrythmic meds
  • IV propanolol
  • anti-thyroid drugs: methimazole or propylthiouracil
  • Lugol’s iodine
  • dexamethasone
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8
Q

three phases of De Quervain’s thyroiditis

A

thyrotoxicosis
hypothyroidism
return to normal

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9
Q

low T3 T4 high TSH

A

primary hypothyroidism

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10
Q

TSH low T3 and T4 low

A

secondary hypothyroidism

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11
Q

TSH high T3 T4 normal

A

subclinical hypothyroidism

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12
Q

diagnostic criteria T1DM

A
  • Fasting glucose greater than or equal to 7mmol/l
    -Random glucose greater than or equal to 11.1mmol/l (or after 75g oral glucose tolerance test)
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13
Q

C-peptide levels in T1DM

A

low

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14
Q

why does DKA happen

A

consequence of inadequate insulin
-body can’t identify glucose in blood so liver starts producing ketones for fuel

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15
Q

Mx DKA

A

fluids - isotonic saline
Insulin - slow down once BG < 14
Glucose - monitor and add when less than 14
Potassium - add to replace and monitor
Infection - treat underlying triggers
Check fluid balance
Ketones - monitor

if ketones and acidosis haven’t resolved in 24hr - SENIOR REVIEW

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16
Q

HbA1c in pre-diabetes

A

42-47

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17
Q

diagnosis of T2DM

A
  • Fasting glucose greater than or equal to 7mmol/l
  • Random glucose greater than or equal to 11.1mmol/l
    (if patient is asymptomatic then this must be demonstrated on two different occasions)

HbA1c greater than 48

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18
Q

impaired glucose tolerance definition

A

fasting glucose < 7
OGTT 2 hour between 7.8-11.1

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19
Q

when is HbA1c target for T2DM 53 instead of 48

A

when they are put on a drug that may cause hypoglycaemia

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20
Q

Mx T2DM with CVD

A

metformin
once established:
add SGLT-2 inhibitor

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21
Q

causes of Cushing’s syndrome

A

Cushing’s disease
- Pituitary adenoma releasing excessive ACTH

Adrenal adenoma
- Adrenal tumour secreting excessive cortisol

Paraneoplastic syndrome
- Ectopic ACTH secreted by small cell lung cancer

Exogenous steroids
- Patients on long term corticosteroids at a high dose

CAPE

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22
Q

what is skin pigmentation in response to

A

raised ACTH

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23
Q

Ix for cushing’s

A

dexamethasone suppression test

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24
Q

normal result of low dose and high dose dexamethasone test

A

cotrisol production will be reduced in both low dose and high dose

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25
adrenal adenoma dexamethasone suppression test results
the cortisol will be raised in both the high dose and the low dose
26
pituitary adenoma dexamethasone suppression test result | cushing's disease
cortisol will only be suppressed by the high dose
27
ectopic ACTH dexamethasone suppression test result
no suppression at all ACTH also high which differentiates it from adrenal adenoma
28
what does aldosterone do
causes sodium and water retention = high BP low potassium
29
Ix for conn's | primary hyperaldosteronism
aldosterone/renin ratio -high aldosterone and low renin renin is low cause high BP suppresses it
30
most common cause of Conns
bilateral adrenal hyperplasia
31
Mx of Conn's
adrenal adenoma - surgery bilateral adrenocortical hyperplasia - aldosterone antagonist (Spironolactone)
32
what causes secondary hyperaldosteronism
excessive renin stimulating release of aldosterone -released due to disproportionately low BP in kidneys: - renal artery stenosis - HF - liver cirrhosis and ascites
33
what is Addison's
reduced cortisol and aldosterone -primary adrenal insufficiency -autoimmune destruction of adrenal glands
34
electolyte imbalance in addison's
hypoglycaemia hyponatraemia hyperkalaemia
35
Ix for Addisons + results of this test
short synacthen test if cortisol doesn't double after giving synthetic ACTH then = addison's to distinguish between primary and secondary: - ACTH high in primary - ACTH low in secondary
36
treatment of addison's
hydrocortisone (cortisol) fludrocortisone (aldosterone)
37
management in illness of addison's
hydrocortisone should be doubled fludrocortisone should stay the same
38
cause of secondary adrenal insufficiency
inadequate ACTH -surgery -tumours -radiotherapy -sheehan's syndrome -trauma
39
cause of tertiary adrenal insufficiency
exogenous steroids -hypothalamus stops releasing CRH when used to exogenous steroids, then when they are stopped it can't keep up causing drop in aldosterone and cortisol
40
managment of secondary and tertiary adrenal insufficiency
hydrocortisone
41
what does ADH do
acts on collecting ducts to reabsorb water from urine into blood
42
what is diabetes insipidus
cranial - deficiency in ADH secretion nephrogenic - kidneys are insensitive to ADH
43
Ix of DI
high plasma osmolality low urine osmolality water deprivation test ! -avoid water for 8 hours then given synthetic ADH (desmopressin) -if urine osmolality high after ADH then cranial -if still low after ADH then nephrogenic
44
addisonian crisis management
hydrocortisone saline include dextrose if hypoglycaemic once stable convert to oral replacement
45
cause of secondary hyperparathyroidism
-deficiency in vitamin D -chronic renal failure (leads to reduced absorption of calcium) leads to high PTH levels
46
what causes tertiary hyperparathyroidism
secondary -increase in PTH causes hyperplasia of the glands leading to more PTH secreation -so when u treat the cause of secondary, PTH secretion is still super high
47
phosphate levels when calcium is high
low
48
pepper pot skull
hyperparathyroidism -bones break down to release calcium (cause of the high PTH)
49
treatment of primary hyperparathyroidism in patients not suitable for surgery
cinacalcet -mimics calcium to reduce PTH secretion
50
hypocalcaemia ECG change
prolonged QT interval
51
low calcium, high phosphate
hypoparathyroidism
52
pseudohypothyroidism
low calcium, high PTH cells are insensitive to PTH
53
treatment of primary hypoparathyroidism
alfacalcidol
54
what is osteomalacia
softening of the bones secondary to low vitamin D
55
blood results for osteomalacia
low vit D low calcium, phosphate raised ALP (found in bone, when theres increased osteoblast activity then raised ALP)
56
what do non-functioning pituitary adenomas present as
hypopituitarism
57
SIADH results
euvolaemia hyponatraemia low serum osmolality high urine osmolality high urine sodium
58
which diabetes drugs shouldn't be used in HF
sulfonylureas
59
what can over replacement with thyroxine cause
-osteoporosis -worsening of angina -AF
60
most common drug cause of gynaecomastia
spironolactone -cimetidine -digoxin -canabis -finasteride -GnRH agonists -oestrogens, anabolic steroids
61
-flozins
SGLT-2
62
-zides
sulfonylureas
63
-tides
GLP-1 mimetics
64
-gliptins
DPP4 inhibitors
65
target BP for T2DM < 80 years
clinic: 140/90 ABPM: 135/85 same as normal bp targets
66

fourth year (29 decks)

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