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Endocrine 2 Flashcards

(53 cards)

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1
Q

DM1

A 
Autoimmune
Pancreatic beta cells destroyed
(Islets of Langerhans)
No insulin produced
Glucose ^^^
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2
Q

DM2

A

Excess adipose tissue
Relative insulin deficiency
Glucose ^

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3
Q

Prediabetes

A

Not meeting DM2 criteria
Likely to develop DM2 in next few years
Require lifestyle interventions

Fasting glucose 6.1-6.9
HbA1c 42-47

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4
Q

DM2 risk factors

A

Age ^
Family history
Non-white

Sedentary lifestyle
Obesity
Stress

GDM
PCOS

HTN
Dyslipidaemia
CVD

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5
Q

DM clinical features

A

Polydipsia
Polyuria
Weight loss
Fatigue

Visual disturbances
Abdo pain
N/V

Recurrent infections

  • Candidal
  • Skin
  • UTI
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6
Q

Polydipsia/polyuria pathophysiology

A

Glycosuria
Water follows by osmosis
= Dehydration

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7
Q

DM investigations

A

Random plasma glucose > 11

Fasting plasma glucose > 6.9

OGTT - 75g glucose - Wait 2 hours - Positive > 11

HbA1c > 48

Urine dip - Ketones +++

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8
Q

DM1 management

A

Insulin

  • SC pump
  • 0.2-0.4 units/kg/day
  • BM self-monitoring
  • Pre-meal insulin correction dose
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9
Q

DM2 management - Lifestyle

A

Lifestyle changes (HbA1c 48-53)

  • Weight loss 5-10%
  • Physical activity
  • Reduce alcohol intake - Risk of hypo
  • Smoking cessation

Diet - Reduce sugar consumption

  • High fibre
  • Low GI foods
  • Low-fat dairy produts
  • Reduced saturated fats and TFAs
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10
Q

DM sick day rules

A 
Increase frequency of BM monitoring
Increase fluid intake - 3L / 24 hours
Maintain carbohydrate intake - Sugary drinks if necessary
Access to a mobile phone 
Continue medication - Except metformin
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11
Q

DM indications for admission

A 
Inability to tolerate oral fluids
Persistent diarrhoea
Significant ketosis - Despite additional insulin
BM > 20 - Despite additional insulin
Lack of support at home
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12
Q

DM2 management

A
  1. HbA1c 48-53 - Diet and exercise
  2. Metformin
  3. If HbA1c > 58 add…
    - Gliptin
    - Sulfonylurea
    - Pioglitazone
    - SGLT-2 inhibitor - Gliflozin
  4. If HbA1c > 58 - Add another
  5. If HbA1c > 58 and BMI > 35
    - Add GLP-1 mimetic
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13
Q

DM drugs MoA

A

Metformin - CI if eGFR < 30

  • Increases insulin sensitivity
  • Decreases hepatic gluconeogenesis

Sulfonylurea - Gliclazide

  • Risk of hypoglycaemia
  • Stimulates pancreatic B cells to produce insulin

Pioglitazone

  • Promote adipogenesis and FFA uptake
  • Weight gain

Gliptins

  • Increases incretin
  • Inhibits glucagon secretion
  • Risk of pancreatitis

SGLT-2 inhibitors - Inhibits renal reabsorption of glucose

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14
Q

DM complications

A

Microvascular

  • Neuropathy
  • Retinopathy
  • Neuropathy

Macrovascular

  • CVD
  • CHF
  • Stroke

Infection
DKA
Non-ketotic hyperosmolar state

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15
Q

DKA pathophysiology

A

Insulin deficiency + Glucagon ^
Triglycerides and AAs metabolised for energy
Increased serum glycerol and FFA
Glucagon converts FFA to ketones

Hyperglycaemia causes osmotic diuresis
Marked urinary loss of water and electrolytes

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16
Q

DKA clinical features

A

N/V
Abdo pain

Altered consciousness
Dehydration

Hyperventilation - Kussmaul breathing
Ketone breath - Pear drops

Sx of DM

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17
Q

DKA investigations

A

VBG

  • Hyperkalaemia
  • Hypokalaemia = Severe DKA
  • Metabolic acidosis
  • Serum osmolality ^^^

pH < 7.3
Serum ketones > 3
BM > 11
Bicarb < 15

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18
Q

DKA management

A

Fluid replacement

  • 500ml bolus over 10-15 minutes
  • 1L over 1 hour

Correct hypokalaemia - SandoK
Insulin - FR infusion

When glucose < 14 - Give 10% Dextrose

Safe rate of glucose reduction - 4-6 mmol/hr

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19
Q

DKA complications

A

Arrhythmias - Hypo/hyperkalaemia
VTE

ARDS
Gastric stasis
AKI

Cerebral oedema

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20
Q

Hyperosmolar hyperglycaemic state pathophysiology

A 
Hyperglycaemia
Osmotic diuresis
- Electrolyte abnormalities 
- Severe dehydration 
- Raised serum osmolality
- Hyperviscosity

Typically elderly DM2 patients
Develops over many days

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21
Q

Hyperosmolar hyperglycaemic state clinical features

A

Dehydration
Hypotension
Tachycardia

Fatigue
Lethargy
Weakness
Altered consciousness

N/V
Headaches
Papilloedema

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22
Q

Hyperosmolar hyperglycaemic state diagnosis criteria and management

Study These Flashcards
A
  1. Hypovolaemia
  2. Hyperglycaemia > 30 ± Ketonaemia/acidosis
  3. Serum osmolality > 320

Management

  • Fluid replacement
  • Correct electrolyte abnormalities
  • Normalise blood glucose
23
Q

Thyroid storm precipitating events

Study These Flashcards
A

MIST

Media - Contrast - Acute iodine load
Infection
Surgery
Trauma

24
Q

Thyroid storm clinical features

Study These Flashcards
A

Fever > 38.5

Tachycardia
Hypertension
HF

Confusion and agitation
N/V

Abnormal LFTs
Jaundice

25
Thyroid storm management
Symptomatic - Paracetamol BBs - IV propranolol Carbimazole Dex - Blocks conversion of T3 to T4
26
Myxoedema coma Symptoms and management
Confusion Hypothermia Management - IV thyroxine - IV Fluid replacement - IV corticosteroids - Correct electrolyte imbalance - Rewarming?
27
Thyroid cancers
Presentation - Thyroid nodule in a woman aged 30-50 Papillary carcinoma - 70% - Young females - Excellent prognosis Follicular adenoma - 20% - Solitary thyroid nodule Medullary carcinoma - 5% - Secrete calcitonin - 20% familial genetics Anaplastic carcinoma - 1% - Pressure symptoms - Elderly females - Chemo ineffective Lymphoma - Associated with Hashimoto's
28
Thyroid nodule investigations
TSH - Normal USS + FNB Laryngoscopy - Paralysed vocal cord? CT staging Serum calcitonin - Medullary carcinoma
29
Thyroid cancer management
Total thyroidectomy Radioiodine ablation TSH suppression - Levothyroxine Screen for recurrence - Yearly thyroglobulin levels
30
Hypoadrenalism
Primary - TB - Metastases - Meningococcal septicaemia - HIV - Antiphospholipid syndrome Secondary - Pituitary disorders - Tumours - Irradiation - Infiltration
31
Pituitary adenoma risk factors
MEN-1 Familial isolated pituitary tumours - FIPA Carney complex - CNC
32
Pituitary adenoma clinical features
Headaches Bitemporal hemianopia Central adiposity Reduced muscle mass Hypogonadism - Gynaecomastia - Amenorrhoea - Infertility - Loss of libido - ED Hypothyroidism Fatigue Osteopenia Adrenal insufficiency - Anorexia - N/V - Weakness
33
Pituitary adenoma investigations
Prolactin ^ IGF-1 - Low with GH deficiency Sex hormones - LH, FSH, testosterone, oestrogen Morning cortisol ACTH ACTH stimulation test Insulin tolerance test U&E - Hyponatraemia FBC - Anaemia CT/MRI
34
Pituitary adenoma management
Pituitary apoplexy - Hydrocortisone - Levothyroxine - Trans-sphenoidal resection Adenoma - Observation - Hormone replacement - Radiotherapy - Dopamine agonist - Bromocriptine / Cabergoline - Somatostatin analogue - Octreotide
35
PTH physiology and vit D synthesis
PTH released in response to low Ca - Increased bone resorption by OCs - More Ca released - Increased Ca reabsorption in kidneys - Increased vit D synthesis in kidney - Increased calcium and phosphate absorption from gut 25-hydroxyvitamin D Converted to 1,25-dihydroxyvitamin D Absorbed in gut
36
HyperPTH aetiology
Primary - Solitary adenoma Secondary - Hyperplasia Risk factors - Female - Age > 50 - Family history - MEN - Li treatment
37
HyperPTH clinical features
= Hypercalcaemia ``` Bones - Osteoporosis, osteopenia, pain Stones - Renal Moans - Depression and anxiety Groans - Abdominal pain and myalgia Thrones - Constipation ``` Sleep disturbances Fatigue Cognitive changes Paraesthesia
38
HyperPTH investigations
Calcium profile - Calcium ^ (Low in 2) - Phosphate ^ (Low in 2) - PTH ^ - ALP ^ Tech-99 scan ECG - Short QT Skeletal survey - Pepper pot skull Knee XR - Chondrocalcinosis
39
HyperPTH management
Parathyroidectomy + Vit D supplementation - Ergocalciferol + Alendronic acid + Cinacalcet
40
HypoPTH aetiology
Thyroid/parathyroid surgery Malnutrition Malabsorption Diarrhoea Chronic alcoholism Hypomagnesaemia AD conditions - CASR and GATA3
41
HypoPTH clinical features
Secondary to hypocalcaemia Tetany - Muscle twitches, spasms, cramps Perioral paraesthesia Trosseau's sign - Carpal spasm on inflation of BP cuff Chvostek's sign - Tapping parotid causes facial muscles to twitch ``` Depression Cognitive changes Anxiety Dry hair and brittle nails Cataracts ```
42
HypoPTH investigations and management
Calcium profile - Ca - LOW - PTH - LOW - Phosphate ^ - Vit D - LOW Albumin - Low albumin will falsely lower serum calcium - Ionised calcium accurately reflects physiological calcium Magnesium - LOW ECG - Prolonged QT Management - Calcium carbonate - Calcitriol
43
Hypernatraemia aetiology
Dehydration Osmotic diuresis DI Infancy Old age Renal concentrating deficit Iatrogenic - IV saline - Lithium - Mannitol
44
Hypernatraemia clinical features
CNS manifestations - Lethargy/weakness - Irritability - IC haemorrhage - Seizures - Stupor - Coma Weight loss - Hypovolaemia Hypo/tachy Decreased JVP Dry mucous membranes
45
Hypernatraemia investigations and management
Serum sodium Urine osmolality - Low - DI - High - Volume depletion Serum osmolality - High Management - Treat cause - Fluid replacement - DI - Desmopressin / Thiazide diuretic
46
Carcinoid syndrome aetiology
Metastases in the liver Serotonin released into systemic circulation Risk factors - MEN-1
47
Carcinoid syndrome clinical features
Flushing Palpitations Diarrhoea Abdo cramps Signs of RHF Cardiac murmurs Hepatomegaly
48
Carcinoid syndrome investigations and management
Serum chromogranin A/B ^^^ Urinary 5-hydroxyindoleacetic acid ^^^ Creatinine ^^^ LFTs Management - Somatostatin analogue - Octreotide
49
Multiple endocrine neoplasia
``` MEN-1 - 3Ps - Parathyroid - Pituitary - Pancreas + Adrenal + Thyroid ``` MEN-2a - 2Ps - RET oncogene - Medullary thyroid cancer - Parathyroid - Phaeochromocytoma MEN-2b - 1P - RET oncogene - Phaeochromocytoma - Marfanoid body habitus - Neuromas
50
Phaeochromocytoma
Catecholamine secreting tumour Associated with - MEN-2 - Neurofibromatosis - Von-Hippel Lindau syndrome 10% rule - Familial in 10% - Bilateral in 10% - Malignant in 10% - Extra-adrenal in 10% - Organ of Zuckerlandl
51
Phaeochromocytoma clinical features
HTN - 90% 1. Headaches 2. Palpitations 3. Diaphoresis ``` Hypertensive retinopathy Pallor DM Orthostatic hypotension Cafe au lait spots ```
52
Phaeochromocytoma investigations
24-hour urine collection - Catecholamines - Metanephrines - Normetanephrines - Creatinine MRI - Adrenal medulla Genetic testing
53
Phaeochromocytoma management
AB - Phenoxybenzamine BB - Propranolol + Surgical excision

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