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Endocrine Flashcards

(43 cards)

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1
Q

Management of hypocalcaemia

A

Acute:
Calcium gluconate

Maintenance:
Calcitriol + calcium carbonate/citrate

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2
Q

Management of hyperkalaemia

A

Calcium gluconate
Sodium bicarbonate (used in metabolic acidosis)
Insulin + glucose (used in CKD)
Sodium/calcium polystyrene sulfonate (to remove from bowel lumen)

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3
Q

Management of hyperphosphataemia

A

Calcium carbonate

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4
Q

Management of hypercalcaemia

A

Sodium chloride (for rehydration)
Bisphosphonates
Prednisolone (in vitamin D toxicity)

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5
Q

Management of hypokalaemia

A

Oral potassium supplements
IV potassium chloride
Potassium-sparing diuretics – spironolactone, amiloride (for maintenance)

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6
Q

Management of hyponatraemia

A

Fluid restriction

Sodium chloride

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7
Q

Management of hypernatraemia

A

Oral fluid replacement

5% dextrose infusion

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8
Q

Management of Addisonian crisis

A

Hydrocortisone + IV fluids

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9
Q

What is Addison’s disease?

A

Primary adrenal insufficiency

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10
Q

What is Conn’s disease?

A

Primary hyperaldosteronism

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11
Q

Causes of Conn’s disease

A

Adrenal adenoma (80%)
Bilateral adrenal hyperplasia (10%)
Adrenal carcinoma
Unilateral adrenal hyperplasia

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12
Q

What is Cushing’s syndrome?

A

Hypercortisolism

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13
Q

Causes of Cushing’s syndrome

A

Iatrogenic
ACTH-secreting pituitary adenoma (Cushing’s disease)
Cortisol-secreting adrenal adenoma/hyperplasia/carcinoma
ACTH-secreting ectopic tumour (e.g. SCLC)

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14
Q

Signs of Cushing’s syndrome

A 
CUSHINGOID:
Cataracts
Ulcers
Skin – striae, thinning, bruising, acne
Hirsutism, hypertrichosis, buffalo hump
Increased blood pressure
Necrosis
Glucose intolerance
Osteoporosis, central obesity
Immunosuppression
Different face (moon-like facies, plethora)
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15
Q

Dexamethasone suppression test

A

Low dose:
Suppression = normal
No suppression = Cushing’s syndrome

High dose:
Suppression = Cushing’s disease
No suppression = other cause

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16
Q

Causes of hypercalcaemia

A

Metabolic:

  • Hyperparathyroidism (primary - parathyroid adenoma, secondary - response to hypercalcaemia in CKD)
  • Vitamin D intoxication
  • Hyperthyroidism
  • Sarcoidosis
  • Milk-alkali syndrome

Malignant:

  • Breast cancer
  • SCC of lung
  • Multiple myeloma
  • Bone metastases

Congenital:
-Familial hypocalciuric hypercalcaemia

Drugs:

  • Lithium
  • Thiazides
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17
Q

Clinical features of hypercalcaemia

A
  • Stones - polyuria, polydipsia, nephrolithiasis
  • Bones - bone pain, osteoporosis, arthritis
  • Abdominal moans - constipation, N/V, peptic ulcers, abdominal pain, anorexia, pancreatitis
  • Psychic groans - depression, lethargy, weakness, confusion, coma, impaired memory
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18
Q

Clinical features of hyperthyroidism

Study These Flashcards
A

GTFO THYROIDISM:

  • Goitre
  • Tremor
  • Fine, brittle hair
  • Ophthalmoplegia - NO SPECS:
    • No signs
    • Only signs - lid lag, lid retraction
    • Soft tissue - periorbital swelling, conjunctival infection, chemosis
    • Proptosis
    • Extraocular (diplopia)
    • Corneal abrasions
    • Sight loss
  • Thirst
  • Heart - tachycardia, AF, palpitations, hypertension
  • Yawning (fatigue)
  • Reduced weight with increased appetite
  • Oligo/amenorrhoea
  • Intolerance to heat
  • Diarrhoea
  • Irritability, restlessness
  • Sweating
  • Muscle weakness
19
Q

Signs of thyroid malignancy on U/S

Study These Flashcards
A 
Hypoechogenicity
Microcalcifications
Increased vascular flow
Irregular borders
Absence of halo
20
Q

Causes of hypocalcaemia

Study These Flashcards
A

Metabolic:

  • Vitamin D deficiency
  • Hypoparathyroidism (iatrogenic, congenital, autoimmune, infiltrative)
  • Hypomagnesaemia (malnutrition, PPI/thiazides/loop diuretics, alcohol, IBD, coeliac disease, DKA)
  • Hypermagnesaemia (renal failure)
  • Hyperphosphataemia (renal failure, hypoparathyroidism)

Systemic:

  • Sepsis
  • Burns
  • Renal failure
  • Acute pancreatitis
  • Rhabdomyolysis
  • Tumour lysis syndrome
  • Hyperventilation
  • Blood transfusions

Drugs:

  • Bisphosphonates
  • Calcitonin
21
Q

Order of pituitary hormone loss

Study These Flashcards
A

GH, LH, FSH, TSH, ACTH, prolactin

22
Q

Myxoedema coma

Study These Flashcards
A
  • Decompensated hypothyroidism, usually in older women with long-standing, undiagnosed or undertreated hypothyroidism
  • Precipitated by infection, cold, disease or drugs
  • Causes altered mental state and hypothermia
  • Treated with T3 and active warming
23
Q

Stages of diabetic retinopathy

Study These Flashcards
A

Early - microaneurysms, blot haemorrhages, hard exudates
Diabetic maculopathy - macular involvement
Background retinopathy - macular sparing
Pre-proliferative retinopathy - cotton-wool spots, venous loops and beading
Proliferative retinopathy - neovascularisation

24
Q

Frequency of eye monitoring in DM

Study These Flashcards
A

If normal - every 2 years

Identified retinopathy, long duration DM or high HbA1c - every year

25
Frequency of foot monitoring in DM
If normal - every year | Identified abnormalities - every 3-6 months
26
Screening of diabetic nephropathy
Every year: - Albumin/creatinine ratio (spot random urine sample) - eGFR
27
Osteoporosis vs. osteomalacia
Osteomalacia: painful; risk factors include limited sun exposure and renal failure; low vitamin D, phosphate and calcium, and high ALP and PTH Osteoporosis: painless until fracture; risk factors include age and glucocorticoid use; normal metabolic levels
28
Risk factors for osteoporosis
Age, female, FHx SHATTERED: -Steroid use -Hyperthyroidism, hyperparathyroidism, hypercalcaemia -Alcohol, smoking, sedentary lifestyle, caffeine -Thin (BMI
29
DXA scan interpretation
Normal: T ≥ -1 Osteopenia: -2.5
30
Management of osteoporosis
Lifestyle: - Dietary calcium - Exercise - Smoking cessation - Sunlight exposure Falls prevention: - Exercise - Well-fitting, slip-resistant shoes - Vision - Blood pressure - Sensory loss - Medication review - Chronic diseases - Parkinson's, OA, DM - Cognitive status - Environment - lighting, clutter, grab rails, shower chair Medications: - Calcium + vitamin D - Bisphosphonates (alendronate) (PO) - Denosumab (SC) - Teriparatide (SC) - Strontium ranelate (PO) - Raloxifene (PO)
31
Pathophysiology of Paget's disease
Intense focal bone resorption and cavity formation Deposition of structurally abnormal bone in cavities Chronic sclerosis
32
Blood results in Paget's disease
Elevated ALP and ESR/CRP | Normal calcium and vitamin D
33
MEN-1 syndrome
3Ps (1 letter): Pituitary adenoma Parathyroid hyperplasia Pancreatic islet cell tumour
34
MEN-2 syndrome
PMP (2 letters): Parathyroid hyperplasia Medullary thyroid cancer Phaeochromocytoma
35
Features of papillary thyroid cancer
Orphan Annie analogies: - Slow-growing - Good prognosis (well behaved) - Orphan Annie nuclei (cleared out appearance) - Psammoma bodies (Greek psammos = sand; Annie's dog is Sandy)
36
Diagnosis of DM
FBG ≥7.0 mmol/L RBG ≥11.1 mmol/L OGTT 2-hr ≥11.1 mmol/L HbA1c ≥6.5%
37
Glycaemic targets
HbA1c ≤7% Fasting/preprandial BSL 6-8 mmol/L Postprandial BSL 6-10 mmol/L
38
Management of DKA
``` BLS SPIDEER: -Saline -Potassium -Insulin -Dextrose -Embolism (heparin) -Eat nothing (NPO) -Reason (treat cause) ```
39
Clinical features of hypoglycaemia
TIREDD: - Tachycardia, palpitations - Irritability, anxiety - Restlessness - Excessive hunger - Depressed conscious state - Diaphoresis, pallor
40
Management of hypoglycaemia
Conscious, alert - sweetened fluids or glucose tablets Conscious, drowsy - IV dextrose Unconscious - IM glucagon
41
Hypoglycaemic unawareness
Absence of symptoms Contributing factors: - Autonomic neuropathy (reduced adrenaline secretion) - Brain desensitisation (after frequent episodes) - Beta blockers (blunted effect of adrenaline)
42
Blood pressure target in T2DM
≤130/80 mmHg with ACEIs
43
Secondary prevention of T2DM
Glycaemic targets Lipid targets Blood pressure target

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