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endocrine Flashcards

1
Q

causes of hypoglycaemia

A 
DM
alcohol excess
quinine, SSRI
insulinoma
hypothyroid
hepatitis
renal dyalysis
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2
Q

what level of blood sugar should you treat for hypo?

A

<4.0mmol/L

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3
Q

hypoglycaemic and unconscious

A

10g glucose 20% through large vein

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4
Q

hypoglycaemic and conscious

A

glucogel/ oral glucose 10g

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5
Q

name some factors that would prompt critical care review in DKA

A 
ketones >6mmol/L
SBP<90
K <3.5
GCS<12
pH<7
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6
Q

3 criteria for diagnosis of DKA

A

capillary BM >11/ known DM
capillary ketones 3+mmol/L
venous bicarb <15mmol/L and/or pH <7.3

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7
Q

what insulin regime should be used in DKA

A

fixed rate IV insulin infusion- not sliding scale as inaccurate in overweight/ pregnancy

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8
Q

first bag of fluid in DKA

A

0.9% NaCl 1L over 1 hour unless hypotensive (500ml bolus-> no response call senior)

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9
Q

baseline investigations in DKA

A 
VBG hourly
CXR
ECG
urine dip
pregnancy test
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10
Q

what is the definition of resolution of DKA?

A

blood ketones <0.6 mmol/L and venous pH >7.3

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11
Q

what 2 things should you watch for when treating DKA?

A

hypoglyceamia

hypokalaemia

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12
Q

diagnostic criteria for DM

A

HbA1c >48
OR Fasting glucose > 7 mmol/L and a glucose tolerance test
OR random glucose > 11mmol/L (usually on 2 separate occasions)
Management

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13
Q

pathology of T1DM

A

T cell mediated destruction of B cells

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14
Q

what is an abnormal oral glucose tolerance test

A

give 75g anhydrous glucose, after 2 hours BM>11mmol/L

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15
Q

If DM and HTN what drug start on

A

ACEI regardless of age as also reduce risk of nephropathy and albuminurea

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16
Q

3 ways in which DM causes kidney damage

A

Glomerular damage
Ischemia caused by damage to efferent and afferent arterioles.
Ascending infection

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17
Q

what is often the first way in which diabetic nephropathy can be picked up?

A

albuminurea, note can cause episodes of nephrotic syndrome (hypoalbuminurea and oedema)

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18
Q

how might diabetic neuropathy present?

A

symmetrical mainly sensory neuropathy (stocking and glove)
acute painful neuropathy (often in shins)
mononeuropathy (carpal tunnel)
autonomic neuropathy (erectlie dysfunction, silent MI)

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19
Q

sulphonylurea (gliclazide)

A

hypo risk, low sodium, weight gain

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20
Q

DDP-4 inhibitor e.g. sitagliptin

A

risk of pancreatitis

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21
Q

at what eGFR is metformin contraindicated?

A

<30, 30-60 reduce dose

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22
Q

SGLT2 inhibitor e.g. empagliflozon

A

low hypo risk, lose weight, wee lots and UTI risk

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23
Q

side effects of metformin

A

epigastric pain, anorexia and diarrrhoea, avoid in severe liver/ kidney disease

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24
Q

complication of injecting insulin

A

lipohypertrophy of injection site, weight gain (makes you feel hungry)

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25
insulin requirement
0.5-1 unit/kg/day
26
target BP for diabetics
<130/ 80
27
target cholesterol for diabetics
<4.5
28
2 most common causes of hyperthyroidism
graves | nodular thyroid disease
29
what is the pathology in Grave's
TSH receptor stimulating antibodies
30
how is T3 released
hypothalamus releases thyrotropin releasing hormone-> anterior pituitary releases TSH-> thyroid releases T4, converted into T3 in liver/ kidneys
31
what eye changes can be seen in Grave's? note eye changes only in Grave's
exophthalmos ophthalmoplegia lid lag
32
name 2 other conditions that commonly occur with Grave's
AI conditions: myasthenia gravis, pernicious anaemia
33
how does a thyrotoxic storm present?
``` history of acute illness marked fever >38.5 siezures N+v+ diarrhoea jaundice death- arrhythmias ```
34
subclinical hyperthyroidism
symptoms present TSH normal/ low T4/ T3 normal
35
what scan is used to differentiate different causes of hyperthyroidism?
radionuclide scan
36
what benefit do BBs have in Grave's?
symptom control | reduce peripheral conversion of T4-> T3
37
What is the side effect of carbimazole to be aware of?
agranulocytosis, therefore sore throat etc come for FBC
38
what is the long term complication of hyperthyroidism?
osteoporosis
39
Toxic Multinodular Goitre
older female, high dietary iodine/ amiodarone
40
2 main causes of hypothyroidism
primary- autoimmune/ damage from radioiodine (also lithium, amiodarone, interferon) iodine deficiency
41
subclinical hypothyroidism
TSH high T3/T4 normal no symptoms
42
Hashimoto's pathology
T cells attack thyroid, causes firm and rubbery goitre (other causes of hypothyroid do not)
43
myxoedema
thickened, coarse skin in hypothyroidism
44
name 2 other conditions that commonly occur autoimmune hypothyroidism
addison's | pernicious anaemia
45
pre-tibial myxedema
hyperthyroidism, big fatty looking growth.
46
what effect does PTH have on the kidneys?
increases Ca resorption and phosphate excretion
47
what effect does PTH have on the intestine?
increases Ca absorption but requires vit D3 (25(OH)D)
48
what effect does PTH have on bone?
increases osteoclast activity causing release of calcium
49
symptoms of hypercalaemia
Stones (renal) Bones (bone pain) Groans (abdominal pain, nausea and vomiting) Thrones (polyuria) Psychiatric overtones (confusion and cognitive dysfunction, depression, anxiety, insomnia, coma)
50
secondary hyperparathyroidism
PTH high Ca low phosphorus high CKD-> chronic low Ca-> stimulation of PT. also due to malabsorption/ vitamin D deficiency
51
tertiary hyperparathyroidism
PTH very high Ca high phosphorus high due to long secondary hyperparathyroidism. Ca low phosphorus high CKD-> chronic low Ca-> stimulation of PT-> hypercalcaemia
52
primary hyperparathyroidism
PTH high Ca High phophorus low
53
what hormones does the adrenal cortex produce?
1. mineralocorticoids- e.g. aldosterone 2. glucocorticoids (anti-inflammatory e.g. cortisol) 3. androgens (oestrogen/ tesetosterone)
54
what is the function of aldosterone
raises blood sodium and lowers K by acting on distal tubule of the kidney
55
how is angiotensin II produced?
decreased renal perfusion-> increased renin released angiotensinogen from liver-> converted to angiotensin I by renin-> converted to angiotensin II by ACE on lung/ renal epithelium
56
effects of angiotensin II
increased H2O and salt retention therefore increased circulating volume (1. increased sympathetic activity, 2. arteriole constriction, 3. ADH secretion from post pituitary-> H20 reabsorption 4. aldosterone secretion)
57
aldosterone has what effect?
NaCl resorption and K excretion in kidneys
58
what is ACTH?
adrenodorticotropic hormonr: produced by anterior pituitary, releases cortisol
59
when should cortisol be measured?
8-9am
60
which hormones make up the management of addison's?
hydrocortisone- (glucocorticoid) | fludrocortisone- (mineralocorticoid)
61
2 main causes of Addison's?
AI disease | TB
62
How would an Addisonian crisis present?
severe hypotension/ dehydration | give Na and aldosterone replacement in CCU
63
what abnormal results may be shown on bloods in Addisons?
``` Na low K high Glucose low ACTH simulation- low rise in cortisol 08:00 cortisol low 08:00 ACTH low/ high depending on secondary/ primary hypercalcaemia anaemia ```
64
when should steroid dose be increased in Addisons?
doubled if intercurrent illness | take more day before strenuous exercise
65
hypopituitarism causing addison's (low cortisol and low ACTH) what else should you check?
T4 for hypothyroid
66
symptoms of cushings
moon face, buffalo hump, HTN, osteoporosis, striae, acne, hirstuism, amenorrhoea
67
which cancer most commonly causes hypercalcaemia?
SCC lung (releases PTH related peptide)
68
peptic ulceration, galactorrhoea, hypercalcaemia
multiple endocrine neoplasia 1
69
hypercalcaemia, thyroid cancer and phaeochromocytoma
MEN 2
70
hypertension hypokalaemia (e.g. muscle weakness) alkalosis
Conn's- hyperaldosteronism
71
pituitary adenoma causes what visual field loss
bitemporal hemianopia
72
which hormones may a pituitary adenoma secrete?
prolactin ACTH (causing cushings) GH may also be non-secreting and compress normal tissue leading to insufficiency of these
73
what would a pituitary blood profile entail
GH, prolactin, ACTH, FH, LSH and TFTs
74
reducing cholesterol by 10% gives what % reduction in CVD risk
20% reduction in cardiovascular disease risk after 3 years
75
what factors would make you query familial hypercholeserolaemia?
age <30 FHx total cholesterol >7.5
76
other than lifestyle/ genetic: 3 risk factors for hyperlipidaemia
hypothyroid T2DM medications (BB, thiazides, corticosteroids, COCP, antipsychotics)
77
what other bloods should you do in raised cholesterol?
fasting BM U+E LFT TSH
78
what is the target total cholesterol?
<4mmol/L
79
side effects of statins
myalgia GI upset abnormal LFT do LFT and CK baseline and repeat 4-8 weeks
80
symptoms of hypocalcaemia
muscle weakness and cramp/ tetany, numb fingers, convulsions, arrhythmias, stridor
81
most common causes of hypoparathyroidism
post-surgical, AI, radiotherapy of neck
82
most common type of thyroid cancer
papillary, often young female, good prognosis
83
single thyroid nodule
follicular adinoma (toxic thyroid nodule if produces hyperthyroidism)/ carcinoma
84
thyroid cancer with raised calcitonin
medullary cancer
85
illness-> hyperthyroid then hypothyroid when illness settles
De Quervain's thyroiditis
86
hypopituitarism may present as?
``` GH-stunted growth prolactin ACTH- low BP , increased thirst/ urination FH, LSH- irregular periods/ amenorrhoea TFTs- Hypothyroidism ```
87
hypopituitarism can be caused by
tumours radiation/ chemo/ surgery TB/ meningitis traumatic bleed
88
what is a pheochromocytoma?
neuroendocrine tumour of chromaffin cells of adrenal medulla. often cause HTN/ hyperglycaemia. found in MEN
89
congenital adrenal hyperplasia
excess androgen production, masculinization of women, feminization of men, or precocious sexual development in children
90
hypoaldosternism
fluid and salt loss | hyperkalaemia
91
abnormal growth of hair on a woman's face and body.
hirsuitism, caused by increased androgens
92
Hyperosmolar hyperglycemic nonketotic coma
signs of dehydration, weakness, legs cramps, vision problems, and an altered level of consciousness.
93
causes of diabetes insipidus
``` (ADH insufficiency/ insensitivity) head injury pituitary surgery idiopathic high Ca, low K Li genetic ```
94
diabetes insipidus presentation
polyuria/ polydipsia
95
diabetes insipidus investigation
high plasma osmolality, low urine osmolality
96
SIADH causes
SCC lung stroke, subarachnoid infection-TB drugs- SSRI/TCA/sulfonylureas
97
SIADH presentation
hyponatraemia secondary to the dilutional effects of excessive water retention

Year 5 (12 decks)

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