Endocrine Flashcards
(133 cards)
1
Q
Hypoglycaemia with impaired GCS + IV access
A
give IV Glucose
100mL of 20% Glucose IV STAT
50%
2
Q
Hypoglycaemia with impaired GCS+ no IV access
A
IM glucagon
3
Q
Hypoglycaemia +GCS was not impaired
A
quick-acting carbohydrate such as GlucoGel®
4
Q
diagnosis of impaired fasting glucose?
A
fasting glucose greater than or equal to 6.1 but less than 7.0 mmol on 2 occasions
5
Q
mpaired glucose tolerance (IGT) +prediabetes
A
OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
HbA1c between of 42-47 mmol/mol is indicative of prediabetes………> diet +weight reduction سؤال
6
Q
Diabetes mellitus (type 2): diagnosis
A
if asymptomatic need two readings
1-fasting glucose greater than or equal to 7.0 mmol/l
2-random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
7
Q
ttt of (MODY) = mutation in the HNF -1 alpha.
A
Sulfonylureas (e.g. gliclazide) are the optimal treatment in HNF1A-MODY.
8
Q
The defenitive diagnostic test for acromegaly is
A
oral glucose tolerance with growth hormone measurements
9
Q
Management of Addison +intercurrent illness
A
glucocorticoid dose should be doubled
Double hydrocortisone dose, same fludrocortisone dose
10
Q
What is the primary mode of action of orlistat?
A
Pancreatic lipase inhibitor
11
Q
At what threshold of HBA1C should you consider adding a second agent?
A
58 mmol/mol (7.5%)
12
Q
you can titrate up metformin and encourage lifestyle changes to aim for a HbA1c of
A
48 mmol/mol (6.5%)
13
Q
High TSH+ Normal free T4
A
Subclinical hypothyroidism
14
Q
High TSH + Normal T4 or high + history og hypothyroidism
A
Poor compliance with thyroxine
15
Q
low TSH + Low T4
A
Secondary hypothyroidism
16
Q
High TSH + low T4
A
Primary hypothyroidism (Hashimoto’s thyroiditis)
17
Q
low TSH + high T4
A
Thyrotoxicosis (e.g. Graves’ disease)
18
Q
low or normal TSH + low T4 + low T3 +hospital inpatients
A
Sick euthyroid syndrome
A 56-year-old female is admitted to ITU with a severe pneumonia. Thyroid function tests are most likely to show:
19
Q
ttt of Subclinical hypothyroidism in patient aged over 80 y.o + symptomatic + TSH less than 10
A
‘watch and wait’ strategy, generally avoiding hormonal treatment’
20
Q
ttt of Subclinical hypothyroidism if < 65 years + symptomatic + TSH less than 10
A
give a trial of levothyroxine. If there is no improvement in symptoms, stop levothyroxine
21
Q
ttt of Subclinical hypothyroidism +Asymptomatic + TSH less than 10
A
if asymptomatic people, observe and repeat thyroid function in 6 months
22
Q
ttt of Subclinical hypothyroidism + TSH >10
A
start treatment (even if asymptomatic) with levothyroxine if <= 70 years
‘in older people (especially those aged over 80 years) follow a ‘watch and wait’ strategy, generally avoiding hormonal treatment’
23
Q
ttt of gastroparesis in diabetic patients ?
A
metoclopramide, domperidone or erythromycin (prokinetic agents)
24
Q
the most common cause of thyrotoxicosis
A
Graves’ disease
Only around 30% of patients with Graves’ disease have eye disease so the absence of eye signs does not exclude the diagnosis.
25
microprolactinoma less than 1 cm
macroprolactinoma > 1cm
Which is the best initial treatment?
dopamine agonists (e.g. bromocriptine) cabergolin is better than bromocriptine
then surgery if medical ttt is ineffective or if compression
26
hypothyroidism + non- tender goitre + anti-TPO
Hashimoto's thyroiditis
27
hypothyroidism + painful goitre
De Quervain's thyroiditis
28
Long-term corticosteroid use is linked to osteopaenia and osteoporosis, or osteomalacia.???
osteopaenia and osteoporosis
musculoskeletal: osteoporosis, proximal myopathy, avascular necrosis of the femoral head سؤال
29
the most appropriate initial management DKA
IV 0.9% NaCl bolus
30
Severe hypovolaemia + hyponatraemia + Hyperkalemia are suggestive of...............
Muscle aches, orthostatic hypotension, hyponatraemia and weight loss
addisonian crises
31
ttt of addisonian crises
1-hydrocortisone 100 mg im or iv
2--1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
3-continue hydrocortisone 6 hourly until the patient is stable. No fludrocortisone is required because high cortisol exerts weak mineralocorticoid action
4-oral replacement may begin after 24 hours and be reduced to maintenance over 3-4 days
32
Important adverse effects of SGLT2 inhibitors (end by liflozin)
1-genital infection (secondary to glycosuria) سؤال
2-diabetic ketoacidosis
33
tender goitre + hyperthyroidism + raised ESR + reduced uptake on technetium thyroid scan
Subacute thyroiditis (De Quervain's)
34
screening for medullary carcinoma
calcitonin
35
patient underwent bilateral adrenalectomy developed pigmentation of his skin and a right CN VI palsy+ headache and double vision
Nelson's syndrom
36
drugs causing Hyper Ca++
thiazides, سؤال calcium containing antacids
```
sarcoidosis*
vitamin D intoxication
acromegaly
thyrotoxicosis
Milk-alkali syndrome
dehydration
Addison's disease
Paget's disease of the bone**
```
most common causes:
1. Primary hyperparathyroidism: commonest cause in non-hospitalised patients
2. Malignancy: the commonest cause in hospitalised patients. This may be due to number of processes, including; bone metastases, myeloma, PTHrP from squamous cell lung cancer
37
3 P.............>
1- Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia.
2-Pituitary (70%)
3-Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
MEN type I
38
Medullary thyroid cancer + 2P
Parathyroid (60%)
Phaeochromocytoma
MEN type IIa
39
Medullary thyroid cancer + 1P
| Phaeochromocytoma
MEN type IIb
40
Which autoantibodies is diagnostic of Graves' disease, ?
TSH receptor stimulating autoantibodies
41
Which autoantibodies is diagnostic of Hashimoto?
anti-thyroid peroxidase antibodies
42
Type 2 diabetes blood pressure target
If no organ damage: < 140 / 80
If end-organ damage: < 130 / 80
43
if there is difficulty distinguishing type 1 diabetes from other types of diabetes.Consider measuring............
C-peptide
C-peptide will be low in individuals with type 1 diabetes mellitus (as the pancreas is not making enough insulin precursor, which breaks down to form C-peptide and insulin) , and normal or high in individuals with type 2 mellitus.
44
What is the classical visual field deficit seen in Acromegally??
bitemporal hemianopia due to compression of the optic chiasm
45
the NICE criteria for starting or continuing exenatide ( GLP-1 mimetics)?
1- BMI >= 35 kg/m² in people of European descent and there are problems associated with high weight, or
2- BMI < 35 kg/m² and insulin is unacceptable because of occupational implications or weight loss would benefit other comorbidities.
3-achieved a 11 mmol/mol (1%) reduction in HbA1c
4- 3% weight loss after 6 months
46
(most common drug cause gynaecomastia
spironolactone
47
nipple discharge, gynaecomastia and poor vision
prolactinoma
48
Which drug for DM2 is contraindicated in patients with heart failure.??
Pioglitazone (Thiazolidinediones) can cause fluid retention
49
Stones (renal)
Bones (bone pain)
Groans (abdominal pain, nausea and vomiting)
Thrones (polyuria)
Psychiatric overtones (confusion and cognitive dysfunction, depression, anxiety, insomnia, coma)
hypercalcaemia
50
Which electrolyte imbalance cause hypocalcaemia and render patients unresponsive to treatment with calcium and vitamin D supplementation.
Hypomagnesaemia
51
hyper ca++ and high PTH + normal urea and electrolyte
1ry hyperparathyroidism
52
In type 1 diabetics, a general HbA1c target...........
48 mmol/mol (6.5%)
53
Prediabetes is defined by a HbA1c of................
42-47 mmol/mol (6.0-6.4%)
54
Hormones reduced in stress response:............
Insulin
Testosterone
Oestrogen
55
mechanism of action of sitagliptin
Gliptins = Dipeptidyl peptidase-4 (DPP-4) inhibitors
56
impaired fasting glucose (IFG) - due to........
hepatic insulin resistance
57
impaired glucose tolerance (IGT) - due to.............
muscle insulin resistance
58
which type of impaired glucose more likely to develop T2DM and cardiovascular disease
patients with IGT are more likely to develop T2DM and cardiovascular disease than patients with IFG
59
Causes of raised prolactin..........
```
the p's
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines (Chlorpromazine سؤال
) , metoclopramide سؤال , domperidone
```
note: Cimetidine is generally associated with gynaecomastia rather than galactorrhoea.
60
hypertension (refractory)+ hypokalaemia + metabolic alkalosis
Conn's syndrome ( primary hyperaldosteronism)
61
the first-line investigation in suspected primary hyperaldosteronism..............
aldosterone/renin ratio.... should show high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)
following this a high-resolution CT abdomen and adrenal vein sampling is used to differentiate between unilateral and bilateral sources of aldosterone excess
62
carpal spasm on inflation of BP cuff to pressure above systolic... name of this sign ........
Trousseau's sign
63
tapping over parotid causes facial muscles to twitch
Chvostek's sign
64
patient is systemically unwell. She has recently started carbimazole for hyperthyroidism. What is the most important blood test to perform?
CBC to exclude agranulocyrosis
65
the best test to diagnose Addison's disease
The short synacthen (ACTH) test
66
TTT of hypothyroidism
Levothyroxine
67
Diabetic neuropathy
| first-line treatment:
amitriptyline, duloxetine, gabapentin or pregabalin
tramadol may be used as 'rescue therapy' for exacerbations of neuropathic pain
68
What rate should insulin be initially given in DKA ?
0.1 unit/kg/hour.
69
hyperglycemia + increased serum osmolarity + no ketosis.
hyperglycaemic hyperosmolar state
Illness and/or dehydration leads to the gradual development of hyperglycemia and increased intravascular osmolarity. There is no ketosis as basal insulin levels allow cellular uptake of plasma glucose.
DKA = hyperglycemia + Acidosis + Ketosis
70
Glutamic Acid Decarboxylase (GAD) Autoantibodies test help with diagnosis of ............
Latent autoimmune diabetes of adulthood (LADA)
71
patient on steroid + underwent surgery then become unwell + hypo Na + hyper K+ low glucose
Addisonian crisis
ttt Hydrocortisone 100mg IV
72
patient with iron-deficiency anaemia + hypothyroidism on l-thyroxin but TSH is still high. Why??
Iron reduces the absorption of thyroxine
| give at least 2 hours apart
73
which side effect is most likely to occur in patients taking gliclazide (Sulfonylureas) ?
weight gain
74
reducing peripheral insulin resistance
Glitazones are agonists of PPAR-gamma receptors
75
If HbA1c is in the pre-diabetes range (42-47 mmol/mol
what is the next step??
a fasting sample should therefore be arranged.
76
when to add another drug in ttt of DM 2
if the HbA1c has risen to >= 58 mmol/mol (7.5%)
77
Phaeochromocytoma Investigation : ........
24 hr urinary metanephrines, not catecholamines
78
high or normal PTH + high Ca + low P
Primary hyperparathyroidism
79
high PTH + normal or low Ca + high P
Secondary hyperparathyroidism ( seen in Renal failure )
80
high PTH + normal or high Ca + low or N P + high ALP
Tertiary hyperparathyroidism (end stage renal failure)
81
cushing cause hypokalaemic metabolic alkalosis or acidosis?
hypokalaemic metabolic alkalosis
82
How to assess for diabetic neuropathy in the feet
Test sensation using a 10 g monofilament
83
What is the best way that her risk of developing thyroid eye disease can be reduced?
stop smoking
84
the most likely adverse effect of radioactive iodine ?
hypothyroidism
85
which may reduce cerebral oedema??
high-dose dexamethasone
86
patient with DKA Shortly after the initiation of insulin he develops a cardiac arrhythmia. What is the cause??
hypokalemia
87
neuropathic pain + BPH ....... first ttt is .......
Pregabalin
Amitriptyline would normally be first choice but given his history of benign prostatic hyperplasia it is better to avoid amitriptyline due to the risk of urinary retention.
88
uptake of iodine-131 during thyroid scintigraphy in De Quervain's thyroiditis
reduced
89
diabetec patient on insulin applying for a HGV licence and asks for advice. What is the most appropriate advice?
Patients on insulin may now hold a HGV licence if they meet strict DVLA criteria
90
patient with hashimoto on ttt. What is the single most important blood test to assess her response to treatment?
TSH
91
What is the most appropriate management WITH Diabetic patients who have any foot problems other than simple calluses
should be followed up regularly by the local diabetic foot centre
92
increased ACTH production because of a pituitary adenoma
Cushing's disease Which is a specific type of Cushing's syndrome
93
patient with DM 2 developed diarrhea due to...........
Autonomic neuropathy
94
lung cancer + hyponatremia
diagnosis?
TTT?
SIADH
1st line..............> fluid restriction
2nd line..........> tolvaptan for acute .. or demeclocycline for chronic (ADH antagonist)
95
high serum Na + high plasma osmolarity + low urine osmolarity ??? دمه تقيل :D
Diabetes insipidus
96
LOW serum Na (dilutional hyponatremia) + LOW plasma osmolarity +high urine osmolarity ? دمه خفيف :D
SIADH
97
most common cause of addisons??
Iatrogenic.......> sudden stop of long term steroid
98
withdrawal of steroid............> vomiting + abdominal pain + postural hypotension ( dizziness in the morning)
diagnosis??
Addison
99
multiple myloma + vomiting + hypercalcemia
Ist line ttt??
long term ttt?
IV fluid + calcitonin
bisphosphonate
100
normal level of prolactine ?
normal ............> less than 400 m U\ L
101
level suggestive of microprolactinoma ?
less than 2000
102
level diagnostic of macroprolactinoma ?
more than 4000
103
Antihypertensive drug cause hyperkalemia ?
ACEI.
ARBs
K sparing duritics
104
ttt of hyperkalemia ?
1- stope the abusing drug
2- if ECG changes...............> IV Ca gluconate
3-If severe ............> Insulin + dextrose
```
C BIG K
C.......> Ca gluconate
B.........> BB salbutamol nabiluser
I............> Insulin
G.........> Glucose
K...........> K binding resin
```
105
what is the electrolytes abnormality seen in addison
HypOnatremia + HypeR kalemia + metabolic acidosis + hypoglycemia
106
what is the electrolytes abnormality seen in cushing and conns?
HypOkalemia + metabolic alkalosis + hypertension
107
addison + No hyperpigmentaion ..why??
it's 2ry adrenal insuffeciency ..........> low ACTH ...........> low MSH
108
LOW ca + LOW ph + high ALP
Osteomalecia
109
normal Ca and Ph + high ALP
Paget's
110
Normal Ca .ph. and ALP
Osteoporosis
111
child + symptoms of DM + glucose in urine
| next step??
fasting blood glucose
diagnostic one reading >7 + symptoms
or 2 readings >7 + Asymptomatic
*Note: oral glucose tolerance not used now cuz it's time consuming
112
hypothyroidism + swollen tender wrist
pseudogout .............> +ve birefringent crystals unlike gout
113
DM. insulin controlled + will undergo major surgery
| What is the most appropriate pre-operative management?
IV insulin sliding scale and continue until normal diet is re-established + check blood sugar / 4 hrs
114
DM. oral hypoglycemic controlled + will undergo major surgery
What is the most appropriate pre-operative management?
omit long acting hypoglycemic pre-op
| check blood sugar / 4 hrs
115
DM. oral hypoglycemic controlled + will undergo minor surgery
What is the most appropriate pre-operative management?
normal regimen
116
DM. insulin controlled + will undergo minor surgery
| What is the most appropriate pre-operative management?
omit insulin pre-op in the day of surgery + restart insulin once oral diet is reestablished + check blood sugar / 4 hrs
117
DM + Renal impairment
| What are the safest oral hypoglycemics?
pioglitazone
repaglinide
linagliptin
118
biguanide (metformin) contraindicated if .............
GFR less than 30
liver disease/ alcoholism / infection ...... precipitate to lactic acidosis
119
sulphonylurea C.I if............
renal impairment...........> hypoglycemia
| obese
120
pioglitazone C.I in ...............
heart failure
bladder cancer
fracture
121
DDP4 (Gliptine) C.I in..........
heart failure
pancreatitis
122
repaglinide C.I in...........
liver diseae
| but safe in kidney disease
123
high Ca + high albumin..........?
dehydration
124
high Ca + high ALP..............?
bone metastasis
thyrotoxicosis
sarcoidosis
125
high Ca + high calcitonin............?
B- cell lymphoma
126
history of lung cancer + hypercalcemia
| next investigation...??
ALP level
TO differentiate either it's due to high PT like hormone or due to bone metastasis
127
electrolye changes in small cell carcinoma ?
hyponatrenia due to SIADH
hyper calcemia due to paraneoplastic phenomenon
128
stopped alcohol..............> vomiting
| which electrolyte abnormality would be seen ??
low K+
129
which investigation is helpful in localizing the cause of cushing $?
high dose dexamethasone suppression test
if ectopic .........> will not be suppressed
if pitutary ...........> will be suppressed
130
fever + tachycardia + AF + hot intolerance
thyroid storm
131
ttt of thyroid storm?
```
Ps
BB
PTU= propylthiouracil
prednisolon..........> block conversion of T4 to T3
potassiun iodide
```
132
thyroid nodule > 1 cm most app investigation ?
FNAC
133
Drowsiness + increase thirst + history of cancer
| which electrolyte abnormality?
hyper ca++
bone metastasis is one of the most common causes of hyper ca
