Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MED4 CPY > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the name of the diagnostic criteria for DM?

Draw the table of details

A

American Diabetic Association

  1. Fasting plasma glucose
    • > = 7: DM
    • 5.6~7: IFG
  2. 2h post-OGTT glucose / Random plasma glucose
    • > = 11.1: DM
    • 7.8~11: IGT

(5678, 711)

  1. HbA1c
    • > =6.5%: DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Time of fasting for fasting plasma

A

> =10h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Procedure for 2h post-OGTT plasma glucose

A

overnight fasting >=8h
1. Record plasma glucose at t0
2. Drink 75g anhydrous glucose in 300ml water in 10 mins
3. Sit quietly and check at 120min (additional check at 60min in case of pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

FP and FN of HbA1c results (4+3)

A

FP: splenectomy, pregnancy, IDA, prolonged aspirin intake

FN: splenomegaly, haemolytic anaemia, anti-oxidant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Alternative for HbA1c

A

Fructosamine (reflect 1~3 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Gestational diabetes diganosis by OGTT

A

[t0]
5.1~6.9: GDM
>=7: DM

[60min]
>=10: GDM

[120min]
8.5~11: GDM
>=11.1: DM

(511085)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of gestational diabetes (2)

A

macrosomia –> difficult labour
faetal hyperinsulinaemia –> neonatal hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Monitoring of glycation level for DM patients (3)

A

Point-of-care glucometry
Lipid profiles
Albuminuria & GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ADA therapeutic goals for DM patients
(HbA1c, pre-prandial BG, post-prandial BG, SBP, DBP, TG, LDL-C, HDL-C)

A

<7%
5~7.2
<10
<130
<80
<1.7
<1.8
>1.1 for male, >1.3 for female

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Vascular complications of DM (6)

A

retinopathy, neuropathy, nephropathy
cerebrovascular disease, CAD, PVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

2 ketones and their formation in DKA

A

acetoacetate, beta-hydroxybutyrate

↓ insulin/glucagon ratio –> ↑ lipolysis & FA oxidation –> ketoacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Precipitating factors of DKA / HHS (2)

A

stress
discontinued injection of insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

HHS full form

A

Hyperosmolar hyperglycaemic state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Na and K status in DKA / HHS

A

early hypoNa, late hyperNa
N or hyperK but total K deficit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain for the hyperK in DKA

A

ICF to ECF shift caused by insulin deficiency & hyperosmolality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Whipple’s triad

A
  1. plasma glucose <=2.5 by laboratory method
  2. hypoglycaemic symptoms
  3. symptoms relief after elevation of plasma glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Aetiology of hypoglycaemia (fasting, reactive)

A

Fasting:
- excessive utilization: insulin administration, oral hypoglycaemic, insulinoma, extra-pancreatic tumours
- diminished glucose production: adrenal insufficiency, GH deficiency, liver disease, renal disease, autoimmune cause

Reactive:
- post-gastrectomy syndrome

Others: alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Further testing for fasting hypoglycaemia (4)

A

Serum insulin
C-peptide
IGF-2, IGFBP3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Triple function test for pituitary deficiency

A
  1. insulin tolerance test
  2. GnRH stimulation test
  3. TRH stimulation test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Hyperprolactinaemia DDx

A

Physiological: pregnancy, stress
Primary: Prolactinoma
Secondary: NFPAH, dopamine depleting / receptor blocking agents, hypothalamic disease
Tertiary: Primary hypothyroidism
Others: chronic renal failure, liver cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Free androgen index

A

= T/SHBG *100

> =5: hyperandrogenaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Klinefelter syndrome

A

47, XXY (primary hypogonadism in men)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Turner syndrome

A

45, X (primary hypogonadism in women)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Kallmann syndrome, Prader-Willi syndrome

A

hypogonadotrophic hypogonadism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Aim for progesterone withdrawal test
investigation of amenorrhoea
26
Iodine deficiency and excess aetiology (2+3)
Deficiency: pregnancy, malnutrition Excess: contrast, amiodarone, eye drops & ointments
27
Jod-Basedow effect
failure to downregulate NIS in iodine excess --> hyperthyroidism
28
Wolff Chaikoff effect
iodine exposure --> inhibit iodide organification Failure of escape --> hypothyroidism
29
Anti-thyroid antibodies involved in Dx of Hashimoto thyroiditis (2)
Anti-Tg Ab Anti-TPO Ab
30
Anti-thyroid antibody involved in diagnosis of Graves disease
Thyoid stimulating IgG (TSI)
31
3 MC causes of hyperthyroidism
1. Graves' disease 2. Toxic multinodular goitre / Plummer's disease 3. Toxic adenoma
32
Anti-thyroid drugs (2): mechanisms, preference
Carbimazole, Propylthiouracil Mechanisms: inhibit TPO, iodination, coupling (PTU inhibits peripheral conversion of T4 to T3) Preferences: PTU in pregnancy and thyroid storm
33
Which iodine is used for thyroid scan? Which is used for radioactive iodine treatment?
I-123 I-131
34
Management of hypothyroidism and monitoring (2)
L-thyroxine Monitoring: TSH, cortisol
35
3 zones of adrenal cortex
zona glomerulosa, zona fasciculata, zona reticularis
36
Screening test for Cushing syndrome (3)
1. Overnight dexamethasone suppression test 2. 24h urine free cortisol 3. Late night salivary cortisol
37
RR for insulin
<3
38
RR for C-peptide
<0.6
39
Discriminatory tests for Cushing syndrome (3)
1. Plasma ACTH 2. High dose dexamethasone suppression test 3. CRH stimulation test
40
Interpretation of high dose dexamethasone suppression test
50% suppression ==> pituitary problem ⨉ suppression ==> ectopic ACTH
41
MC cause for renal artery stenosis in young patients
fibromuscular dysplasia
42
Gene for apparent mineralocorticoid excess (AME) (pathogenesis)
HSD11β2 ↓ 11β-hydrosteroid dehydrogenase type 2 --> ↑ cortisol binds to mineralocorticoid receptors --> pseudohyperaldosteronism
43
Confirmatory test for hyperaldosteronism
Salt loading test / saline suppression test / captopril test
44
Salt loading test: measurement (2, RR)
urine aldosterone (<38) urine Na (>200)
45
Discriminatory tests for hyperaldosteronism (Interpretations)
1. Spot aldosterone-renin ratio - ↑ : primary - N/ ↓: secondary 2. Postural test - physiological rise: bilateral adrenal hyperplasia - paradoxical fall: Conn's syndrome
46
Test for adrenal insufficiency (Interpretation)
Short synacthen test a. cortisol rise <200 above baseline: primary cause b. cortisol rise >200 above baseline with level <500: secondary cause c. cortisol rise >200 above baseline with level >550: normal
47
MC congenital adrenal hyperplasia
21-hydroxylase deficiency
48
RR for overnight dexamethasone suppression test
<50
49
Screening tests for suspecting phaeochromocytoma (3) and the second line test for borderline results
1. 24h urine catecholamines, metanephrine, VMA 2. Plasma catecholamines 3. Plasma metanephrines 1. Overnight clonidine suppression test
50
Overnight clonidine suppression test interpretation
NA/Cr >60 or adrenaline /Cr >20 : phaeochromocytoma
51
Investigation for midgut carcinoid tumour
urine 5-HIAA
52
Side effects of anti-thyroid drugs
Allergy, agranulocytosis, hepatotoxicity
53
What is the HVA/VMA ratio that indicates a poor prognosis for neuroblastoma?
<1
54
Secretion of carinoid tumour in different regions
Foregut: 5-HT, His Midgut: serotonin Hindgut: /
55
Metabolic pathways of tyrosine & tryptophan
tyrosine => DOPA => dopamine => NA => A - D => HVA - NA => notmetanephrine => VMA - A => metanephrine => VMA tryptophan => 5-HT => serotonin => 5-HIAA
56
Which CAH leads to androgen deficiency?
17α hydroxylase deficiency
57
How does DM lead to abnormal lipid profile?
High VLDL —> high TG —> high LDL-C —> low HDL-C - hyperinsulinemia & hyperglycaemia → + hepatic VLDL synthesis → ↑ hepatic release of TG & LDL - insulin resistance → ↓ inhibition of lipolysis in adipocytes - insulin resistance → ↓ lipoprotein lipase activity of muscles and adipocytes
58
Why urine ketostix could be negative in severe DKA?
↑ NADH/NAD ratio → acetoacetate converts to β-hydroxybutyrate → FN in urine ketostix
59
Examples of extra-pancreatic tumour that leads to tumour-associated hypoglycaemia (2)
retroperitoneal fibrosarcoma, hepatoma
60
How does liver disease lead to hypoglycaemia?
↓ glycogen reserve
61
How does renal disease lead to hypoglycaemia?
multifactorial uraemia --> inhibit liver gluconeogenesis & lead to poor appetitie ↓ insulin clearance
62
2nd causes of hyperaldosteronism (3)
renal artery stenosis juxtaglomerular apparatus tumour renin-secreting tumour
63
How does DM lead to atherosclerosis?
apoB glycation --> ↓ affinity of LDL to LDL-R --> ↓ LDL catabolism --> ↑ LDL in circulation --> atherosclerosis
64
normal GH response in glucagon stimulation test
up to 20 ng/mL
65
FP for 24h urine catecholamine, metanephrine, VMA (4)
medications (e.g. β blockers, α blockers...), food (e.g. caffeine, tobacco), physical stress, OSA
66
Why is glucagon stimulation test not used anymore for phaeochromocytoma?
hypertensive crisis risk
67
Risk for overnight clonidine suppression test
hypotensive crisis
68
Compare pros and cons between urinary and plasma metanephrines (3+4)
Urine: a. Pros: - well-established, widely available - urinary conc. make analysis relatively easy - easy to implement b. Cons: - 24h collection inconvenient for patients - reliability problem - difficult to control dietary & daily life influence - inappropriate for patients with renal failure Plasma (the opposite)
69
Why genetic testing should be considered in all patients who present with PPGL? (3)
- >= 1/3 of all patients with PPGLs have disease-causing germline mutations - mutations of SDHB lead to metastatic disease commonly - earlier diagnosis & treatment of PPGLs & other manifestations in relatives
70
Suppression test for high prolactin level
Bromocriptine suppression test
71
DDx for high testosterone level (in female) (3)
polycystic ovarian syndrome Cushing syndrome (active adrenal) ovarian tumour
72
How does hypothyroidism lead to high lipid profile?
low LDL-R & lipoprotein lipase activity --> LDL cannot be recycled back to liver --> ↓ LDL metabolism —> remain in circulation --> ↑ cholesterol
73
Confirmation laboratory test for GH secreting tumour
IGF-1
74
Management of DKA / HHS (5)
Insulin Rehydration KCl Close monitoring Treat underlying cause

MED4 CPY (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions