Endocrine Flashcards
1
Q
Primary ammenorhea
A
Failure to establish menstruation by the time of expected menarche
2
Q
Secondary ammenorrhoea
A
Cessation of menstruation in women with previous menses
3
Q
Definition of oligomenoorhoea
A
Menses occuring less frequently than < 35 days
4
Q
Causes of primary amenorrhoea in those with normal secondary sexual characteristics
A
Constituional delay
Pregnnacy
GU malformations
- imperforate hymen
- transverse septum
- absent vagina or uterus
Endocrine
- hypothyroidism
- hyperthyroidism
- hyperprolactinaemia
- cushings
- PCOS
Androgen insensitivity syndrome
5
Q
Causes of primary ammenorhoea in those with no secondary sexual characteristics
A
POI
- chromoosomal irregularities (e.g. turners and gonadal agensis)
- chemotherapy
- pelvic irridation
- autoimmune disease
hypothalamic dysfunction
- stress / execive exercise / weight loss
- chronic systemic illness (uncontrolled DM, severe renal and cardiac disorders, coeliac, cancer, infection)
- hypothalamic or pituitary tumours
- cranial irridation
- head injury
- kallmans syndrome
6
Q
Causes of ambigious genitalia
A
5-alpha-reductase deficiency
androgen secreting tumours
congenital adrenal hyperplasia
7
Q
WHat is sheehans syndrome
A
Pituitary infarction after major obstetric haemorrhage
8
Q
Pathology of T2DM
A
Peripheral insulin resistance (exists in overweight individuals)
Inadequate insulin secretion by pancreatic B cells
Decreased glucose transport into cells, causing hyperglycaemia
9
Q
If you suspect LADA (latent autoimmune diabetes in adults) what do you measure
A
Islet cell antibodies
10
Q
Impaired fasting glucose
A
> 5.6 but < 7
11
Q
Impaired glucose tolerance
A
2hr post OGTT value of 7.8 - 11.1
12
Q
HbA1c diagnostic of T2DM
A
> 48
13
Q
HbA1c of pre diabetes
A
> 42
14
Q
Examples of autonomic neuropathy
A
Postural hypotension
gastroporesis
Gustatory sweating
15
Q
What is assosiated with more severe symptoms of exopthalmos
A
Smoking
16
Q
Risk factors for thyroid eye disease
A
Genetics
Female
Smoking
Radioiodine therapy
Advanced age
Stress
Poorly controlled hypothyrodisim
17
Q
What is secondary hyperthyroidism usually secondary to
A
A TSH secreting tumoura
18
Q
What is subclinical hyperthyroidism
A
T3 AND T4 normal
TSH is supressed
19
Q
Most common cause of thyrotoxicosis
A
Graves disease
20
Q
Management thyrotoxicosis
A
Drugs
- carbimazole
- prophythiouracil
- CCBs
- BBs
Radioiodine therapy
Partial or total thyroidectomy
21
Q
What is the most common cause of thyrotoxicosis in people over 60
A
toxic multinodular goitre
22
Q
WHat can cause subclinical thyrotoxicosis
A
Thyroxine excess
Steriod therapy
Non thyroidal illness
Dopamine infusion
23
Q
Autoantibodies in thyrotoxicosis
A
TSH receptor Abs
Antithyroglobulin abs
Antimicrosomal abs (75% graves disease)
24
Q
What is proximal neuropathy in DM?
A
Patients develop severe burning/aching and lancinating pain in the hip and thigh
Followed by weakness and wasting of the thigh muscles, which often occur asymmetrically
25
Antibodies of hashimotos
Antithyroid microsomal
Antithyroglobulin antibodies
26
Treatment of graves in early vs late pregnancy
early - propothiouracil
late - carbimazole
27
What is urinary 5HIAA used to indicate
Neuroendocrine (carcinoid) tumours
28
Metabolic acidosis
Low Ph
Low HCO3
29
Metabolic alkalosis
High Ph
High HCO3
30
Respiratory acidosis
Low pH
higher PCO2
31
Respiratory alkalosis
High pH
Low PCO2
32
What is the anion gap
Sodium - (Chloride + Bicarb)
33
Normal anion gap
8-12
34
What does an anion gap of >20 indicate
an anion gap acidosis
35
What does an anion gap of 12 - 20 indicate
MAYBE an anion gap acidosis
36
Causes of non anion gap metabolic acidosis
Acute or chronic kidney disease
Renal tubular acidosis
GI loss
37
Causes of anion gap metabolic acidosis
Methanol intoxication
Uraemia
DKA
Paraldehyde
Isoniazid or iron overdose
Lactate
Ethylene glycol intoxication
salicylate overdose
38
Causes of chloride responsive metabolic alkalosis (i.e. will correct with NaCl)
Severe HF
Vomiting / NG suction
Loop and thiazide diuretics
39
Causes of chloride unresponsive metabolic alkalosis
primary hyperaldosteronism
Barter syndrome
Cushings syndrome
Depletion of magnesium
40
Causes of respiratory acidosis
Hypoventilation (accumulation of PCO2) due to problems with ventilation
41
Caues of respiatory alkalosis
Hyperventilation
42
What is pre proliferative diabetic retinopathy defined by
Cotton wool spots
Venous changes
Intra retinal vascular abnormalitie
43
WHat does background retinopathy comprise of
Haemorrhages
Hard exudates
Micro haemorrhages
44
What is proliferative diabetic retinopathy defined by
Retinal neovascularisation at the disc or elsewhere
45
What are the earliest lesions detected in diabetic retinopathy
Microaneurysms
46
Treatment of diabetic foot ulcer
Non removeable casting
To offload pressure
47
Diagnostic features of HHS
Glucose > 30
Serum osmolality >320
Profound dehydration
ph >7
Bicarb > 15
Small or absent ketonuria
Some alteration in consciousness
May also cause
Neurological signs
Hyperviscosity/increased risk of clots
48
When is PTH secreted
In response to low calcium
49
What is secondary hyperparathyroidism usually caused by
CKD
Low vit D
50
What is tertiary hyperparathyroidism usually caused by
Longstanding CKD
51
Features of hypercalcaemia
Weakness
Mood instability
Dehydrated
Abdominal pain
52
Cause of raised prolactin levels
Prolactin secreting pituitary tumour
Hypothyroidism
Acromegaly
53
Presentation of raised prolactin
Galactorrhoea
Ammenorhoea
54
What is the most common cause of hypercalcaemia in patients with non metastatic solid tumours and in some patients with NHL?
Secretion of parathyroid hormone related protein
Also called humeral hypercalcaemia of malignancy
55
Mutation of MEN1
mutation in MENIN gene
56
MEN1 predisposes patients to what
Pancreatic neuroendocrine tumours
Primary hyperparathyroidism (due to 4 gland hyperplasia)
Pituitary adenomas
Benign skin tumours - angiofibromas
High urinary calcium excretion
57
What do 80% of patients with MEN1 present with?
Hypercalcaemia due to hyperparathyroidism
58
Inheritance of familial hypocalcuiric hypercalcaemia and pathology
AD
Defect in the calcium sensing receptor
59
Features of familial hypocalcuric hypercalcaemia on investigation
Slightly elevated calcium and PTH levels
Urinary calcium excretion low
60
Mutation of MEN2a
RET gene
61
What does patients with MEN2a present with
Primary hyperparathyroidism (due to pituaitary adenoma)
Medullary thyroid cancer
Phaechromocytoma
62
What is pseudohyperparathyroidism and blood findings
Rare condition
caused by resistance to PT hormone
Results in low phosphate and calcium levels
High PTH
63
Treatment of prolactinoma
Dopamine agonists (usually cabergoline)
64
Diagnosis of cushings
1mg overnight dexamethasone suppression test
two midnight salivary cortisol levels
two 24 hr urinary free cortisol levels
65
Treatment of mild symptomatic subacute thyroiditis
Propranolol
NSAIDs
66
Presentation of subacute (De Quervians) thyroiditis
Mod-severe pain in thyroid often radiating to ears, jaw and throat
Several weeks Hx
Malaise
Low grade fever
67
What comes before subacute / de quervians thyroiditis
A viral illness
68
What is cranial Diabetes insipidus common after
Head injury
69
Presentation of cranial diabetes insipidus
Polyuria
Polydipsia
Hypernatraemia
NORMAL glucose
70
Two classes of diabetes inspidius
Cranial
Nephrogenic
71
Common causes of nephrogenic DI
Electrolyte derangements (hypercalcaemia, hypokalaemia)
Lithium
72
Diagnosis of diabetes inspidius
Water deprivation test
73
Treatment of cranial DI
Treating underlying cause
Ensuring adequate hydration
Sometimes high doses of DDAVP
74
Treatment of nephrogenic DI
Treating underlying cause
BFM may be trialled
75
Initial water deprivation test results in cranial DI
High plasma osmolality
Low urine osmolality
76
Urine osmolality post DDAVP in cranial DI
High > 600
77
Initital water deprivation test results in nephrogenic DI
High plasma osmolality
Low urine osmolality
78
Urine osmolallity post DDAVP in nephrogenic DI
Low urine osmolality
79
What is MEN1 assosiated with?
THE PS
Parathyroid tumours
Pitutary tumours
Pancreas tumours
Angiofibromas
80
What is MEN2a assosiated with
Parathyroid tumour
Phaechromocytoma
Medually thyroid cancer
81
WHat is Men 2b assosiated with
Phaechromocytoma
Medullary thyroid cancer
Marfanoid appearance
Mucosal neuromas
82
What is important in MEN2
Prophylactic Thyroidectomy
83
Genetics of MEN1
Defect in tumour suppressor gene
Menin gene
Chromosome 11
AD
10% of cases are sporadic
84
Genetics of MEN2
Mutations are rearranged during transfection (ret) proto-oncogene
AD
Defect in tumour supressir gene
Chromosome 10
85
What can both MEN syndromes be assosiated with
hypercalcaemia
86
Investigation for phaechromocytoma
24 hr urine catecholamines
Vanillymandelic acid
MIGB scan
MRI
87
What do medually thyroid cancers cause
Elevated calcitonin
88
Genetics of MODY
HNF1 alpha mutation
89
What cells does MODY affect
Beta cells of the pancreas
90
Delta cells of the pancreas prodcue what
somatostatin
91
Features of Batters syndrome
Increased urinary calcium excretion
Hypokalaemia
Metabolic alkalosis
Raised RAAS levels
92
What does secondary hyperparathyroidism occur from
CKD
93
Investigation for cushings
Overnight low dose dexamethsone suppression test
94
Presentation of porphyria cutanea tarda (PCT)
Hyperpigmentation and scarring
Blisterign and crusted lesions on back of hands and other areas that are prone to sun exposure
Hypertrichosis
Dark or reddish urine
Scarring alopecia
Oesotrens can precipitate development
95
Investigation findings of PCT
Substantial increase in porphyrins in plasma or urine
Assay of red bloods cells for UROD activity
96
Where is metformin metabolised
Liver
97
What drug can worsen thyroid eye disease
RAI
98
Treatment of amoidarone induced thyrotoxicosis
Proprothiouracil
+/- steriods if mixed picture
99
Diagnosis with hypercalcaemia and low urinary calcium excretion
Familial hypocalcuric hypercalcaemia (FHH)
100
Treatment of FHH
None
101
What does failing to concentrate urine post water deprivation test indicate
Diabetes insipidus
102
Diagnosis of insulinoma
Low glucose
High insulin
High C peptide
103
In weight restricted adults, what hormone is often high and why
Cortisol
Permanent state of physical stress on the body related to starvation or catabolic state
104
Pathology of hypercalcaemia in patients with carcinomas which are non metastatic
Secretion of parathyroid hormone related peptide by the tumour
105
Features of anaplastic thyroid carcinoma
Hard
Rapidly evolving
Regional lymphadenopathy
Stridor due to tracheal compression
106
What is the medical term for someone with a low BMI who has ammenorrhoea
Functional hypothalamic ammenorhoea (FHA)
107
Management of symptoms of hyperadrogenism in PCOS
co-cyprindiol
108
Features of androgen insensitvity syndrome
External female genitalia
Testes remain undescended
They do not menstruate at all
109
LH:FSH ratio in PCOS
Elevated
110
Features of turners syndrome
Short stature
Primary ammenorhoea
Delayed secondary sexual characteristics
Dyspraxia
Poor spatial awareness
Mild intellectual impariement
AS
Bicuspid aortic valve
Coarctation of the aorta
Increased risk of hypothryoidism
111
FSH and LH in primary ovarian failure
Elevated
112
FSH and LH in secondary ovarian failure
Normal or low
113
Treatment of macroprolactinoma
Dopamine agonist
114
Features of primary hyperaldosteronism
Hypokalaemia
Hypernatraemia
Metabolic alkalosis
Resistant HTN despite 3 agents
115
What is primary hyperaldosteronism secondary to a aldosterone secreting adenoma called
Conns syndrome
116
Investigation for primary hyperaldosteronism
aldosterone to renin ratio (HIGH)
117
Features of Liddles syndrome
Profound HTN
Hypokalaemia
Alkalosis
Suppressed RAAS
118
Genetics of turners syndrome
45X
119
How does glucagon cause rapid reversal of hypoglycaemia
Acitvates adenylate cyclase
120
Investigations of conns syndrome
Hypokalaemia
Suppressed renin
Elevated aldosterone to renin ratio
Saline suppression test
Adrenal venous sampling to localise the disease
121
Why is linagliptin beneficial
Not renally excreted
No increased risk for weight gain or hypoglycaemiaT
122
Thyroid cancer assosiated with hashiomotors
Thyroid lymphoma
123
Gases of DKA
Metabolic acidosis
Raised anion gap
124
Gases of addisons disease
Metabolic acidosiso
Normal anion gap
125
WHat is adrenal insufficiency
Inability of the adrenal glands to produce mineralcorticoids e.g. aldosterone
126
What is primary hypoadrenalism called
Addisons
127
Causes of secondary hypoadrenalism
Exogenous steriod use (most common cause)
ACTH deficiency, most commonly caused by a pituitary lesion
Withdrawl of longstanding steriod therapy
128
Presentation of CAH
Salt wasting
Ambigious genitalia
129
Non classical CAH presentation
Presents later in life
Hyperadronagism
Elevated testosterone and 17-OH progesterone
130
Which hormone is under continuous inhibition
Prolactin
By dopamine
131
Characteristic skin rash of a glucagonoma
Necrolytic Migratory Erythema
132
What is a glucangonoma
pancreatic alpha cell tumour that secretes glucagon
133
Investigation for a glucangonoma
Plasma glucagon levels
134
WHat test would confirm adrenal failure
Short synacthen test
135
WHat hormone causes increased skin pigmennation when it is in excess
ACTH
136
Most common functioning pituitary tumour
Prolactinoma
137
What molecule lingers and continues to cause a mild acidosis after DKA
Beta hyroxybuutryate
138
Treatment of gastroporesis in DM
Domperidone
139
How does glucagon resolve bradycardia
Promotes the formation of cyclic AMP
140
Treatment of ?DM in a pregnant patient who has no complications and fasting glucose < 7
1-2 weeks of lifestyle advice
If continues despite above, for metformin
141
Metabolic gas of cushings
Hypocholeraemic metabolic alkalosis
142
Increased incidence of which cancer is assosiated with acromegaly
CRC
143
What would make you concerned of a presentation of acromegaly
Normal weight
Skin tag formation
Excessive acne
Carpal tunnel syndrome
144
Investigation for acromegaly
ILGF1
145
What odd blood test can be coupled in addisons diseaseE
Elevated TSH
146
Diagnosis of graves disease
High TSH receptor antibody titres
147
Treatment of hyponatraemia in patients with SiADH
Fluid restriction
148
What part of the bone is impaired in osteoporosis
Trabecular bone
149
What is reidels thyroiditis
Rare chronic inflammatory disease of the thyroid gland characterised by dense fibroiss that replaces the normal thyroid parenchyma
150
Investigation for hyperadrenalism
Saline suppression test
151
How does tamoxifen work
Oestrogen receptor antagonist and partial agonist
152
Confirmatory test if you suspect hyperglycaemia secondary to acromegaly
GTT and GH levels
(high glucose and high GH)
153
Treatment of acromegaly
Cabergoline (dopamine agonist)
Octerotide (somatostain analogue)
Lanreotide (somatostatin anaglogue)
154
What is of significance of a rise in LH
Indicates ovulation will occur about 24 hrs after the LH peak
155
What is MODY characterised by
Raised HDL cholesterol levels
Preserved insulin sensitivity
Low renal threshold for glucose (glycosuria)
156
Is there any antibodies in MODY
No
157
What is the direct precursor to oestrogen
Testosterone
158
What is the prescence of maternal autoantibodies assosiated with
Miscarriage and pre term delivery
159
Which HLA subtype is most assosiated with type 1 diabetes and autoimmune thyroid disease
DR3
160
What renal condition can occur alongisde multiple autoimmune conditions and causes hypokalaemia?
Renal tubular acidosis type I
161
Treatment of solitary thryoid nodule causing thyrotoxicosis
RAI
162
Treatment of phaechromocytoma
urgent alpha blockade (phenoxybenzamine)
then B blockcade if required
Unilateral adrenectomy
163
OGGTT and GH
Should suppress GH to an undetectable level
164
WHat causes hirsituism in non classicical CAH
DHEA
165
Presentation of congential homocystinuria
Skeletal (marfan like features, scoliosis, OP)
ocular (lens dislocation or myopia)
neurological/psychiatric difficulties
Predisposition to thrombosis
Later development
- thrombosis, CV or cerebrovascular disease
166
Two categories of homocystinuria
Pyridoxine B6 resposnive or unresponsive
167
Pathology of type I homocystinuria
Problem with enzyme cysathione beta synthase (CBS)
AR inheritance
168
Blood tests of PCOS
Low sex hormone binding globulin (SHBG)
Raised free androgen index
169
Treatment of hyperlipidaemia in hypothyroidism
Will resolve with thyroxine therapy
170
How do bisphosphonates work
Inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis (cell death) and thereby slowing bone loss
171
What hormone is chiefly responsible for epiphyseal fusion and cessation of growth
Oestrogen
172
Examples of drugs causing hyperprolactinaemia
Haloperidol
Dopamine receptor agonists
Antidepressants
Verapamil
Metyhldopa
Opiates
H2 antagonists
173
WHat hormone is assosiated with endometrial shedding
Progesterone
174
Example of treatment for severe OP
Denosumab
175
How is melatonin naturally synthesised
Increased serotonin N-acetyltransferase
176
Most common S/Es of HRT
Breast tenderness
Bloating
Nausea
Leg cramps
Headache
177
Hyperlipoproteinaemia type IB has mutations for the gene coding for which protein
Apolipoprotein CII (APO CII)
178
When does barter syndrome present
< 5 yrs old
179
Prednisolone dose vs hydrocortisone dose
Pred dose - 25% of hydrocortisone dose
180
Mechanism of action of levonogestrel in emergency contraception
Delays ovulation
181
What is a serious potential S/E of anti thyroid drugs
Agranulocytosis
182
Ideal insulin regime for a new T1DM
Basal bolus regime
183
What is a pituitary apoplexy
Haemorrhage or infarction of the pituitary gland
Usually occurs in a pre-exisiting adenoma
184
Presentation of pituitary apoplexy
CN palsies
Headache
Collapse
Hypotension
185
Investigations of pituitary apoplexy
Pituitary hormone screen
MRI
186
Treatment of pituitary apoplexy
IV steriods
187
Primary cause of DKA
Lipolysis
188
Over 90% of people who have hypothyroidism have what
Dyslipidaemia
189
Assosiations of myoxedema coma (profound hypothyroidism)
Reduced T4
High TSH
Hypothermic
Unconscious
Heart failure
190
Antibodies assosiated with adrenal insufficiency
21-hyroxylase antibodies
Not always positive when measured
191
Blood tests of PCOS
High LH (ratio of LH to FSH high)
Normal FSH
Normal oestrogen
High testosterone
Low SHBG
192
Genetics of klenfielters syndrome
XXY genotype
(extra X chromosome)
193
Presentation of klenfielters syndrome
Usually diagnosed in late pubertal or adult life because of delayed sexual development or infertility
Tall stature
Gynaecomastia
Small testicular volumes
Infertility
194
Investigation for klenfelters syndrome
Chromosomal analysis
195
What is the common presentation of pagets disease
High ALP levels
Mixed lytic and sclerotic lesions
In a man who is otherwise systemically well
196
Treatment of pagets disease
Bisphosphonates
197
What is kallman syndrome assosiated with
A decreased sense of smell
198
Genetics of kallman syndrome
Familial
X linked
199
Features of kallman syndrome
Isolated GnRH deficiency
Hypogonadism (testosterone < 6)
Small and soft testes
Sparse axillary and pubic hair
200
Example of sulphonyura
Gliclazide
201
Example of GLP1 inhibitor
Semgaglutide
Liraglutide
202
WHat diabetic drug should be stopped in patients who have an unstable circulation post MI?
Metformin
203
Investigation for ACTH and GH deficiency in patients with suspected hypopituitism
Insulin stress test
204
WHat causes hypokalaemic periodic paralysis
muscle voltage gated calcium channel mutation
205
WHat can long term treatment with lithium cause
Frank hypothyroidism
206
Who are GLP1 inhibitors contraindicated in?
People with gastroporesis
207
Treatment of thyroid lymphoma
NOT treated by surgical excision
Chemotherapy and external beam radiotherapy
208
WHat part of the nephron is affected in CDI
Cortical and medullary collecting tubules
209
Investigation of conns syndrome
Aldosterone to renin ratio
(elevated aldosterone, suppressed renin)
210
WHat kind of drug is dapagliflozin
an SGLT2 inhibitor
211
How does dapagliflozin work
Increases renal glucose excretion
212
Time for rpt HbA1c
3 months
213
Cushings disease vs cushings syndrome
Disease - excess ACTH from anterior pituitary
Syndrome - excess cortisol from any source
214
S/Es pitoglitazone
HF due to water retention
215
How does metaclopramide cause hyperprolactinaemia
Binds to D2 receptors on pituitary lactotropes
216
How does sarcoidosis cause hypercalcaemia
Increased hydroxylation of vitamin D
217
Mechanism of action of silagliptin
DDPIV inhibitor
218
WHat mutation is seen in MODY
HNF 1 aplha mutation
219
Best imaging modality to assess for retrosterna extension of a thyroid goitre
CT chest
220
What happens to the urine osmolality post vasopressin administration in CDI
Rises > 50%
221
What kind of DI does lihtium cause
nephrogenic
222
What happens to the urine osmolality post vasopressing administration in NDI
The urine will fail to concentrate fully
Rise < 45%
223
What happens in men2b as opposed to men 2a
marfanoid appearance
224
Treatment of MODY
GLICLAZIDE
225
Which thyroid cancer has a very low risk of recurrence
Papillary
226
WHat is gietleman syndroem
Hypokalaemic metabolic alkalosis
Normal BP
Low calcium excretion
227
Inheritance of polyglandular syndrome 1
AR
228
Presentation of polyglandular syndrome 1
Hypoparathyroidism (90%)
Mucocutaneous candidasis
Adrenal insufficiency (60%)
Primary gonadal failure
Primary hypothyroidism
Hypopituitism/diabetes inspidus (rarely)
Malabsorption
Pernicious anaemia
Chronic active hepatitis
229
Inheritance of polyglandular syndrome 2
AR or AD or polygenic
230
Presentation of polyglandular syndrome 2
Adrenal insufficency (all patients)
Hypothyrodisim
T1DM
Gonadal failure
Diabetes insipidus (rare)
Vitiligo
Myasthenia gravis
alopecia
ITP
Pernicious anaemia
231
Treatment of secondary hyperparathyroidism
1-aplha calcidol
232
How is the diagnosis of carney complex made
Two features out of the following (or one in a first degree relative)
- spotty skin pigmentation
- myxoma
- endocrine tumours
- PMS
233
Genetics of carney complex
AD
Inactivating mutation of protein kinase A on chromosome 17
234
Which hormone drives the development of secondary sexual characteristics
Dihyrostestosterone
235
What test is the best for investigation of thyroid size
USS
236
When does psuedo cushings syndrome occur
Response to heavy alcohol consumption and obesity
Assosiated with elevated in cortisol but not to the extent that is seen in cushings syndrome itselt
237
What would suggest milk alkali syndrome
Young age
Dyspepsia
Raised bicarbonate
238
What is gordons syndrome also known as
Pseudohypoaldosteronism (mimics hypoaldosteronism)
239
Pathology of gordons syndrome
Failure of response to aldosterone
Aldosterone elevated due to lack of feedback inhibition
240
Presentation of gordons syndrome
short stature
intellectual impariement
dental abnormalities
Muscle weakness
Severe HTN by 3rd decade of life
Low fractional excretion of NA
Normal renal function
Hypercholeraemic metabolic acidosis
Low renin
High aldosterone
Hyperkalaemia
241
What are the features of von Hippel-Lindau disease
CNS and retinal hemangioblastomas
Renal cysts and carcinomas (occuring later)
Phaeochromocytoma
Pancreatic tumours (50% non functioning)
242
What does thyroid eye disease predispose your eyes to and why
Optic nerve compression
swelling of extraorbital muscles and orbital fat compresses the nerve
243
Treatment to induce ovulation in ladies with PCOS
Clomiphene
244
Mechanism of action of ondansetron
5-HT3 antagonist
245
What nerve is most suspceptible to damage during thyroid surgery and why
Right recurrent laryngeal nerve
Close to the bifructation of the right inferior thyroid artery
246
Mechanism of action of carbimazole
Thyroid perioxidase inhibitor
247
What DEXA scan finding confirms osteoporosis
T score of - 2.5 SD or below
248
Treatment of osteoporosis
Aledronate (significant GI S/Es)
Vitamin D
Calcium
249
Secondary prevention of osteoporosis
Oral bisphosphonate
Second line; alfacalcidol or calcitriol
250
Biochemical findings of pagets disease
Normal calcium
Normal phosphate
Raised ALP
251
RBCs in multiple myeloma
Rouleux formation
252
Levels of what are indicative of poor prognosis in multiple myeloma
Raised B2-microglobulin
Low levels of albumin
253
S/E sildenafil
Blood discolouration of eyes
254
Action of dapagliflozin
SGLT2 inhibitor
255
Mechanism of action of gliclazide
Increases glucose independent insulin release
256
What type of drug is gliclzide
Sulphonyurea
257
Treatment of raynauds
1. Nifedipine
2. Sildenafil
258
Guidelines for hydrocortisone and pred dosing in adrenal insufficiency
15-25mg/day in two divided doses of hydrocortisone
pred is 4x more potent than hydrocortisone
259
How to assess prognosis post operatively after removal of a phaechromocytoma
24 urinary catecholamines 2 weeks post removal
260
What type of receptor is the insulin receptor
Tyrosine kinase receptor
261
How does insulin primarily work
Inhibition of gluconeogenesis
262
What causes osteomalacia
Vitamin D deficiency
263
Alongside single joint disease, what can pagets disease present with
Hearing loss
264
What maternal pituitary hormone is recognised to fall in pregnancy
GH
265
MOST COMMON TYPE OF MODY
MODY-3
266
Mode of action of bisphosphonates
Impairment of osteoclast bone adherence
267
Which antibodies are the likely cause of neonatal hyperthyroidism
Thyrotropin receptor Abs
268
Drugs that reduce thyroxine absorption
Omeprazole
PO iron
Antacids
Bile acid resins
269
How does calcitonin work
Inhibitis osteoclast activity
270
Which malignancy is most at risk of in patients with hashimotos
NHL
271
What is the initital driver for the development of T2DM
Ectopic fat deposition
272
What vitamin deficiency is seen commonly in patients following gastric bypass surgery
zinc
273
WHat causes increased urination during drinking alcohol
Decreased aquaporin 2 channels
274
How does metofrmin primarily reduce blood glucose
Reduces hepatic glucose output
275
What should asymmetric diabetic retinopathy raise a suspicision of
ocular ischaemic syndrome on the side affected worse
276
What is ocular ischaemic syndrome usually due to and investigation
atherosclerosis in those aged 50 or over
Carotid doppler ultrasound
277
How does pioglitazone therapy work
Increases insulin sensitivity
278
