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Finals - Systems Paper > Endocrine/Metabolic > Flashcards

Endocrine/Metabolic Flashcards

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1
Q

Identify familial hypercholesteraemia

A

Total cholesterol > 7.5

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2
Q

Treatment familial hypercholesteraemia

A

High dose statins

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3
Q

Treatment hypercalcaemia

A

Rehydration within saline then bisphosphonates

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4
Q

Identify hypocalcaemia

A

Tetany - twitching, cramping, spasm

Trouseus sign

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5
Q

Treatment hypocalcaemia

A

IV calcium gluconate

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6
Q

Common causes hyperkalaemia

A

AKI
Metabolic acidosis
Addisons
Drugs

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7
Q

ECG findings hyperkalaemia

A

Peaked T waves
Loss p wave
Broad QRS
Sinusoidal

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8
Q

Treatment hyperkalaemia

A

1) ECG
2) IV calcium gluconate - stabilise cardiac membrane
3) Calcium resonium - remove calcium from body

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9
Q

Common causes hypokalaemia

A

Alkalosis:

  • vomiting
  • hyperaldosteronism

Acidosis:

  • diarrhoea
  • renal tubular acidosis
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10
Q

Identify hypokalaemia

A

Muscle weakness, hypotonia

ECG - U waves, small T waves, prolong PR

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11
Q

Hypernatraemia treatment

A

Lower with caution due to risk cerebral oedema

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12
Q

Cause of hyponatraemia if urinary Na >20

A

Hypovolaemia:

  • diuretics
  • addisons

Euvolaemia:

  • SIADH
  • hypothyroidism
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13
Q

Cause of hyponatraemia if urinary Na <20

A

Na depression:

  • diarrhoea, vomiting
  • burns

Water excess:

  • secondary hyperaldosteronism to HF or liver cirrhosis
  • nephrotic syndrome
  • psychogenic polydipsia
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14
Q

Treatment hyponatraemia

A

Hypovolaemia - saline
Euvolaemia - fluid restriction 500 to 1L/day
Hypervolaemia - fluid restriction

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15
Q

Treatment acute hyponatraemia with severe symptoms

A

Hypertonic saline (3% NaCl)

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16
Q

Treatment SIADH

A

Fluid restriction

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17
Q

Drugs which cause SIADH

A

SSRI
TCA
Carbamazepine
Sulphonylureas

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18
Q

Primary prevention hyperlipiademia

A

20mg atorvastatin

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19
Q

Secondary prevention hyperlipidaemia

A

80mg atorvastatin

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20
Q

Differentiate between type I and II diabetes

A

Decreased C-peptide in type 1

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21
Q

Diabetes diagnosis criteria

A

Glucose:

  • fasting 7
  • random 11.1

HbA1c:
- 48

If asymptomatic needs done twice

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22
Q

Pre-diabetes criteria

A

Fasting glucose 6.1-7

HbA1c 42-47

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23
Q

Treatment hypoglycaemia

A

Awake - oral glucose tablet or gel

Unconscious - IM glucagon or IV glucose 20% if IV access

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24
Q

Treatment diabetic ketoacidosis

A

1) Isotonic saline

2) IV insulin 0.1 units/kg/hour

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25
What to do with insulin in diabetic ketoacidis
Long acting continue, stop short acting
26
Treatment diabetic nephropathy
1) Amitryptylin, duloxetine, gabapentin, pegrabulin 2) Try another 3) Tramadol and refer to pain management clinic
27
Treatment T2 diabetes
1) Metformin 2) If 58 + sulphonylurea/gliptin/pioglitazone/SGLT2 3) Triple therapy if still 58, metformin always one 4) Insulin OR 4) Metformin + sulphonylurea + GLP if obese instead of insulin
28
T2 HbA1c targets
On one drug - 48 | On two or more - 53
29
Primary v secondary hypothyroidism
Primary - TSH raised and T3/4 low | Secondary - both low
30
Treatment hypothyroidism
Levothyroxine
31
Identify hashimotos thyroidism
Hypothyroidism Firm non tender goitre Anti-thyroid peroxidase antibodies
32
Identify sub acute (de quervains) thyroiditis
Phases - hyperthyroidism with painful goitre, euthyroid, hypothyroid, normal Globally reduced uptake on thyroid scintigraphy
33
Treatment subacute thyroiditis
Supportive
34
Identify Graves disease
``` Hyperthyroidism Eye disease - exopthalmos Pretibial myoxedema TSH receptor stimulating antibodies Diffuse, homogenous increased uptake on scintigraphy ```
35
Treatment Graves
1) Propranol to control symptoms and refer 2) Carbimazole in seconary care 3) Radioactive iodine
36
Identify toxic multinodular goitre
Hyperthyrodism | Patchy uptake
37
Treatment toxic multinodular goitre
Radioiodine therapy
38
What is addisons
Primary hypoadrenalism - decreased cortisol and aldosterone
39
Identify Addisons
Hyperpigmentation Hypoglycaemia Hyperkalaemic acidosis, hyponatraemia
40
Diagnose addisons
1) ACTH stimulation test (short synthen test)
41
Treatment addisons
Hydrocortisone and fludrocortisone therapy
42
Addisons during concurrent illness
Double glucocorticoid
43
Primary hyperparathyroidism common cause
Solitary adenoma
44
Identify primary hyperparathyrodism
Increased PTH Increased Ca Decreased phosphate
45
Most common secondary hyperparathyroidism cause
CKD
46
Identify secondary hyperparathyroidism
Increased PTH Decreased or normal Ca leading to bone disease Increased phosphate Decreased vit D
47
Common tertiary hyperparathyroidism cause
Ongoing hyperplasia of gland after correction of underlying renal problem
48
Identify tertiary hyperparathyroidism
``` Increased PTH (massive) Increased or normal Ca Decreased or normal phosphate Decreased or normal vit D Increased ALP ```
49
Xray finding primary hyperparathyroidism
Pepperpot skull
50
Treatment primary hyperparathyroidism
Definitive - total parathyroidectomy | Cant have surgery - calcimometic (eg cinacalet)
51
Treatment hypoparathyroidism
Alfacalcidol
52
Bone profile in hypoparathyroidism
Low PHH Low Ca High phosphate
53
What is pseudohypoparathyroidism
Target cells insensitive to PTH due to abnormality, associated with low IQ and short stature
54
Pseudohypoparathyroidism bone profile
Decreased Ca Increased PTH Increased phosphate
55
Identify phaechromocytoma
Hypertension with hypokalaemia Headaches Palpitations Anxiety
56
Diagonsis phaechromocytoma
24h urinary metanephrines
57
Treatment phaechromocytoma
1) Alpha blockers - phenoxybenzamine | 2) Surgery definitive
58
Common cause acromegaly
Increased GH secretion from pituitary adenoma
59
Diagnosis acromegaly
1) Serum IGF1 | 2) OGTT to confirm
60
Treatment acromegaly
1) Transphenoidal surgery | 2) Medication - octreotide
61
What is cushings syndrome
Hyperadrenalism - too much cortisol ACTH dependent cause: - cushings disease (most common), due to pituirary tumour - ectopic ACTH production from tumour ACTH independent cause: - steroids - adrenal adenoma
62
Blood gas for cushings syndrome
Hypokalaemic metabolic alkalosis
63
Diagnosis cushings syndrome
1) Overnight dexamethasone suppresion test
64
Suppression test results for ectopic ACTH secretion
Cortisol - not supressed | ACTH - not supressed
65
Suppression test results for cushings disease
Cortisol - suppressed | ACTH - suppressed
66
Suppresion test results for adrenal adenoma
Cortisol - not suppressed | ACTH - supressed
67
Identify diabetes insupidus
Polyuria and polydipsia Low K No evidence diabetes
68
Diagnose diabetes insupidus
Water deprivation test | - plasma osmolarity increased and urine decreased
69
Treatment diabetes insupidus
Cranial - desmopressin | Nephrogenic - thiazides
70
Treatment addisonian crises
Hydrocortisone IM/IV | Saline +/- dextrose
71
GLP1 drugs
End in -ide exenatide liraglutide
72
GLP1 mechanism
Glucagon mimic, increasing insulin
73
DPP4 drugs
Ends in -gliptan vildagliptin sitagliptin
74
Mechanism DPP4
Decreased peripheral breakdown incretins
75
What drug to use T2 diabetes no weight gain
GPP-4
76
Causes lower HbA1c than expected
Sickle cell anaemia G6PD deficiency Hereditory spherocytosis
77
Causes higher HbA1c than expected
Splenectomy
78
Identify hyperosmolar hyperglycaemic state
Nausea and vomiting, impaired consicous Hypovolaemia Marked hyperglycaemia without ketoacidosis or acidosis Raised serum osmolarity
79
Treatment hyperosmolar hyperglycaemic state
1) Saline | 2) After fluids insulin at 0.05units/kg/hour
80
Calculate serum osmolarity
2Na + glucose + urea
81
MEN1
3Ps - parathyroid - pituitary - pancreas
82
MEN 2a
2Ps - parathyroid - phaeochromocytoma
83
Men 2b
1P | - phaeochromocytoma
84
Identify myoxodemic coma
Confusion Hypothermia Hypothyroidism
85
Treatment myoxodemic coma
IV corticosteroid IV thyroid replacement IV fluid
86
SGLT2 inhibitors
Ends in -flozin
87
SGLT2 mechanism
Increase urinary glucose excretion
88
SGLT2 adverse
Fourmiers gangrene
89
SGLT2 weight gain or loss
Often lose weight
90
Sulphonylureas mechanism
Increase pancreas insulin secretion
91
Sulphonylureas adverse
Hypoglycaemia | Weight gain
92
Sulphnylureas drugs
Glicazide
93
Most common thyroid cancer
Papillary
94
Thyroid cancer secretes calcitonin
Medullary
95
Treatment thyroid storm
Beta blockers
96
Diabetic medication contraindicated by HF and bladder cancer
Pioglitazone
97
Example thiazolidinedione
Ends in -glitazone
98
1ml of insulin is
100 units
99
Mechanism thiazolidinedione
Reduce peripheral insulin resistance

Finals - Systems Paper (20 decks)

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