Endocrinology Flashcards
(124 cards)
1
Q
How do you calculate the Insulin Sensitivity Factor ?
A
100/Total Daily Dose
2
Q
What does the insulin sensitivity factor tell you?
A
The amount your BSL will drop with 1 unit Insulin
3
Q
How do you calculate your meal ratio?
A
500/TDD
4
Q
What does your meal (carbohydrate) ratio mean?
A
How many units of Carbs 1 unit of Insulin will cover
5
Q
What is someone’s usual daily requirement of exogenous insulin?
A
0.5u/kg
6
Q
What % of your daily insulin is basal vs. prandial
A
50% each
7
Q
What cell mediates the development of T1DM?
A
T1DM is a T cell mediated process
8
Q
What HLA types increase the risk of T1DM
A
DR3/DQ2 and DR4/DQ8
9
Q
What is the most common Ab in T1DM?
A
Anti-GAD
10
Q
What are the other Antibodies in T1DM?
A
IAA, IA-2A/2B, ZnT8
11
Q
What is the risk of T1DM if you have 2 Abs?
A
60%
12
Q
What are the 3 criteria for LADA?
A
> 30 years old, 1+ Abs, No Insulin for the first 6/12
13
Q
Having which parent affected by T1DM gives you a higher risk of having T1DM?
A
Father >Mother
14
Q
What HLA type protects from T1DM development?
A
HLA-DR2
15
Q
Risk of developing T1DM if offspring of affected mother vs. affected father vs. both parents affected vs. non-twin sibling vs. monozygotic twin
A
3% vs. 6% vs. 30% vs. 5% vs. 50% life time risk
16
Q
Ethnicities that get T1b DM
A
African and Asian
17
Q
Drug that prevented T1DM development in those w. multiple autoAbs and IGT
A
Teplizumab
18
Q
What is an islet cell transplant good for?
A
hypoglycaemic unawareness
19
Q
Best bariatric surgery procedure
A
Roux-en-Y
20
Q
Most common MODY mutation
A
HFN1a
21
Q
Most common type of MODY
A
MODY 3
22
Q
MODY 3 rx
A
Sulphonylurea
23
Q
MODY 2 rx
A
Only in Pregnancy, otherwise not needed
24
Q
In gestational diabetes what could hypoglycemia indicate?
A
failing placenta
25
Placenta effect on insulin
Increases insulin resistance
26
Are TSHrAbs stimulating or blocking?
Usually stimulating, can block/be both in same pt
27
Medication that can falsely lower TSH and elevate T4
Biotin
28
T1 Amiodarone thyroid dysfunction is from? U/S finding? onset? mgmt
Increased iodine causes hyperthyroidism (JBasedow), U/S normal or increased, usually within 3 months, anti-thyroid meds
29
T2 Amiodarone thyroid dysfunction is from? U/S finding? onset? mgmt
directly toxic causing thyroiditis, reduced vascularity on U/S, usually 2-3 years, steroids or surgery
30
Endocrinopathies with lithium, there are four
Nephrogenic DI, hypothyroidism, hyperparathyroidism, distal RTA
31
When do you treat subclinical hyperthyroidism?
Age >65, TSH <0.1
32
When to treat subclinical hypothyroidism?
TSH >10
33
Which anti-thyroid drugs to use/when in pregnancy?
PTU 1st trimester (less placental t/f and otherwise risk of aplasia cutis/choanal/oesophageal atresia), CBZ in 2nd/3rd (hepatitis risk from PTU late)
34
TSH levels in pregnancy
BHCG acts like TSH, so elevated hormones and low TSH
35
Concerning thyroid nodules
taller than wide, >2cm, solid, hypoechoic, irregular margins, central microcalcification, no halo
36
mgmt of thyroid follicular neoplasm undetermined significance
hemithyroidectomy
37
Thyroid cancer most common type
papillary
38
worst thyroid ca prognosis
anaplastic
39
thyroid ca familial links
medullary
40
Medullary thyroid ca marker
calcitonin
41
Mgmt of thyroid ca
thyroidectomy, thyroxine to suppress TSH, RAI
42
sick euthyroid hormone changes
T3 always low or normal. Others do anything
43
Adrenal anatomy outer to inner
Glomerulosa, fasciculata, reticularis (GFR)
44
adrenal zone hormone production outer to inner
Mineralocorticoid, Glucocorticoid, Androgen
45
CAH enzyme deficiency
21-hydroxylase
46
CAH screening test
17-OH progesterone
47
Ab causative for AI adrenal insufficiency
21-OH Ab
48
If PAI but 21-OH Ab -ve, then which further 2 tests are required? and why?
CT adrenals and VLCFA. Adrenoleukodystrophy and e.g. adrenal haemorrhage/infiltration/necrosis
49
Primary aldosteronism confirmatory test after ARR is?
Seated saline suppression test
50
drug that causes the most false +ves in Aldo:renin is...
Beta blockers
51
Adrenal adenoma features
<3cm, smooth, round, homogenous, <10HU, not vascular, high washout, <1cm/year growth
52
Biochemical Ix of adrenal tumour, 3 tests are:
1mg DST, ARR, plasma metanephrines
53
rx of adrenal ca
mitotane
54
glucocorticoid receptor antagonist drug for cushing's
mifeprestone
55
action of metyrapone
11 beta hydroxylase inhibitor, prevents steroid synthesis, use in cushing's
56
PCOS needs 2/3 of:
oligo/anovulation, clinical/biochem hyperandrogenism, PCOvaries on imaging
57
Most important rx for PCOS
weight loss
58
primary ovarian insufficiency w. FHx. of same or evidence of retardation/tremor/ataxia, need to test for
fragile X: FMR1 gene, CGG triple repeat, >55 repeats are affected
59
hypogonadotrophic hypogonadism w. anosmia =
Kallman's
60
what does being overweight do to testosterone levels in males and why?
overweight -> low T because Insulin -> reduced sex HBG -> lower total T
61
low anti-mullerian hormone implies...
reduced ovarian reserve
62
What do thiazides do to ca?
reduce urinary ca excretion, hypercalcaemia
63
FHH due to mutation in:
CaSR
64
primary hyperpara should get surgery if...
<50 yrs of age, eGFR <60, Ca>2.8, T score < -2.5, previous asymptomatic vertebral fracture, nephrolithiasis/calcinosis
65
tubular maximal reabsorption of phosphate is an indicator of...
renal responsiveness to PTH
66
pseudohypoparathyroidism is due to...
resistance of action of PTH
67
finger changes in pseudohypoparathyroidism
4th and 5th MCP shortening
68
Ca and PO4 in pseudohypoparathyroidism...
Low Ca and high PO4
69
Hypophosphataemic Rickets is due to...
mutation in FGF23 -> unable to be cleaved
70
rx of hypoparathyroidism
ca carbonate + calcitriol. Calcium citrate if on PPI
71
what location are atypical femoral #s w. bisphosphonates?
subtrochanteric
72
define ONJ
exposed bone in maxfax region that doesn't heal within 8 weeks
73
MOA of Romosozumab
Sclerostin inhibitor
74
Who to start on osteoporosis therapy if on steroids
Previous #, age >70, pred >7.5mg/day
75
Which bone cells does PTH act on?
Osteoblasts -> RANKL -> osteoclassts
76
Hungry bone rx
aggressive Ca replacement until bones are full, and vitamin D
77
PTH effect on PO4 and mechanism
phosphaturic, impairs tubular reabsorption
78
Is primary or secondary adrenal insufficiency more severe?
primary
79
alkylating agent for aggressive pituitary tumours?
Temozolamide
80
What is copeptin?
cleaves in making ADH, correlates w. ADH production
81
What causes of hypopit are assoc. w. pregnancy?
post-partum lymphocytic hypophysitis, Sheehand's
82
Pan hypopit replacement drugs/dose
Glucocorticoids 10mg/m2 e.g. 20-30mg hydrocortisone/day; thyroxine; Men T gel or IM, Females COCP or HRT
83
Central DI due to issues in which anatomical location in brain?
hypothal
84
how do you confirm central vs. nephrogenic DI?
DDAVP response (central respond to it)
85
Mgmt of DI
intranasal DDAVP +/- oral, titrate to serum Na
86
Hyperprolactinaemia is usually due to...
stalk compression -> no dopamine inhibition
87
Hyperprolactinaemia causes what sx?
galactorrhoea, hypogonadism
88
mgmt of hyperprolactinaemia
dopamine agonists (e.g. Cabergoline), secondary might do surgery if smaller
89
Best screening for acromegaly
IGF-1
90
Usual cause of acromegaly is...
pituitary tumour, therefore should MRI
91
Mgmt of acromegaly
transsphenoidal tumour resection, RTx or medical
92
medical mgmt of acromegaly includes...
octreotide, pevisomant (GH receptor antagonist), cabergoline if hyper PRL
93
Top 3 causes of cushing's in order:
iatrogenic, pit adenoma, adrenal adenoma/ca
94
If ACTH INdependent cushing's, next test is...
CT adrenals
95
If suspect pituitary or ectopic Cushing's, you can do a...
high dose dex, which will suppress if pit; or do a CRH stim
96
If pit cushing's suspected, do 2 tests:
MRI and BIPSS (2:1 basal ACTH central:peripheral
97
Mx options for Cushing's
surgery, RTx, medical- ketoconazole, pasireotide (somatostatin analogue)
98
If you perform a bilateral adrenalectomy, you need to...
irradiate the pit due to risk of Nelson's syndrome
99
5 drugs for weight loss
phentermine, topiramate, naltrexone/bupropion, metformin, liraglutide, SGLT2
100
Denosumab must be followed up by...
bisphosphonate
101
Denosumab mechanism:
RANKL inhibitor, which usually promotes osteoclast maturation; secreted by osteoblasts
102
What does WNT normally do?
causes osteoblast proliferation
103
What inhibits WNT?
Sclerostin
104
4 meds that can cause ONJ
Bisphosphonates, Denosumab, Sunitinib, Bevacizumab
105
Raloxifene prevents
vertebral # only
106
teriparatide DOES NOT protect against
hip #
107
Dumping syndrome test
mixed meal
108
weight loss reduction surgery does not improve
mortality
109
DPP4-I that should not be used in heart disease
Saxagliptin
110
MOA and side effect of Pasireotide
high somatostatin receptor affinity as antagonist; for rx of refractory acromegaly and cushing's disease; hyperglycaemia
111
growth hormone replacement in adults is recommended in GH deficiency because of:
body composition, exercise capacity and bone and CV health
112
cabergoline MOA and side effect
dopamine receptor agonist; compulsive behaviours e.g. gambling, spending
113
alternative test to water deprivation test for diabetes insipidis
hypertonic saline stimulated plasma copeptin (precursor derived surrogate of arginine vasopressin); greater diagnostic accuracy than water deprivation test
114
Drug that improves PFS in radioiodine refractory differentiated TC
lenvatinib (MKI against VEGFR1, 2 and 3)
115
Promising/improving drug for locally advanced/ metastatic medullary thyroid ca
Vandetanib- TKi against RET
116
Primary target cell of PTH in bone
Osteoblast
117
What is the sequence of physiological responses to hypoglycaemia in a non-diabetic
reduced insulin -> increased glucagon -> adrenaline -> growth hormone and cortisol
118
additional effects of glucagon
increases lipolysis, fatty acid oxidation and ketogenesis, satiety, thermogenesis and energy expenditure, bile acid synthesis; decreases food intake
119
what effect does amiodarone have on the thyroid?
inhibits conversion of T4 to T3; transiently inhibits iodine transport and thyroid hormone synthesis.
120
What can artificially increase serum thyroglobulin assays and seem as if there is a recurrence of cancer?
Anti-thyroglobulin antibodies
121
Best recognised alternation in maternal thyroid physiology
increase in TBG in the first trimester, persisting until shortly after delivery
122
increased concentration of TBG in pregnancy triggers a concomittant increase in
maternal thyroid synthesis, elevation of total thyroxine and T3.
123
Causes of increased TBG
Oestrogen, methadone, heroin, tamoxifen/raloxifene, hepatitis
124
Causes of low TBG
Cushing's, acromegaly, androgens, nephrotic syndrome
