Endocrinology Flashcards
(210 cards)
1
Q
What substance causes acromegaly
A
Abundance of Growth Hormone -> excessive IGF-1
2
Q
What compound supresses GH
A
Somatostatin
3
Q
Name a chronic condition associated with acromegaly
A
T2DM
4
Q
Symptoms of Acromgealy
A
Large hands and feet
Macroglossia
Enlarged Heart
Fatigue
Erectile Dysfunction
5
Q
First line investigation of Acromgealy
A
Serum IGF-1 levels
6
Q
IF serum IGF-1 levels are raised, what should be done to confirm acromgealy
A
Oral Glucose Tolerance Test
7
Q
After diagnosing acromgealy, what should be done and why
A
MRI to check the size of the pituitary tumour (or CT if contraindictaed)
8
Q
First line treatment of acromegaly
A
Trans-sphenoidal surgery
Second Line: Pegovisomant (GH analogue) or Radiotherapy
9
Q
What follow-up is given to patients with acromegaly
A
ECHO for cardiomegaly and colonoscopy every 5 years
10
Q
What is Addison’s disease
A
Lack of adrenal function (glucocorticoid deficiency)
11
Q
What is the most common cause of Addison’s
A
Auto-immune issues
Then:
Surgical removal
Trauma
TB
WaterhouseFriderichsen Syndrome
12
Q
What injury can cause secondary adrenal insufficiency
A
Basilar skull fracture
Radiotherapy
13
Q
Clinical features of Addison’s
A
Hypotension
Fatigue
GI symptoms
Syncope
Pigmentation
Vitiligo
14
Q
What test is conducted to confirm Addison’s
A
SynACTHen test
15
Q
Renin levels in Addison’s
A
High
16
Q
Aldosterone levels in Addison’s
A
Low
17
Q
What initial blood tests can be done to check for Addison’s
A
U and Es
18
Q
Na+ levels in Addison’s
A
Low
19
Q
K+ levels in Addison’s
A
High
20
Q
Glucose levels in Addison’s
A
Low
21
Q
Cortisol levels in Addison’s
A
Low
22
Q
Treatment of Addisonian crisis
A
IV Fluids and Steroids
Glucose if hypoglycaemic
23
Q
How is Addison’s managed
A
Hydrocortisone (to replace glucorticoids)
Fludrocortisone (to replace mineralocorticoids)
24
Q
What cardiac condition is associated iwth carcinoid tumours
A
Pulmonary stenosis
25
Investigations for Cushing's Syndrome
24 hour urinary free cortisol
Dexamethasone supression test
26
What invetsigations are needed to localise the cause of Cushing's
Plasma ACTH levels
High dose dexamethasone supression test
Petrosal sinus sampling
MRI of the head
CT chest and abdo
27
Surgical management of Cushing's
Pituitary tumour resection
28
Medical management of Cushing's (usually first line to reduce size)
Metyrapone
or Ketoconazole/mifepristone
29
What defines Diabetes Insipidus
Urinarting more than 3L in 24 hours + Low osmolality (< 300 mOsm/kg)
Polydipisia and polyuria
30
Causes of Cranial Diabetes Insipidus
Head Trauma
Sarcoidosis
Meningitis
Sickle Cell Disease
Genetics
31
What metabolic disturbances can cause nephorgenic DI
Hypercalcaemia
Hypokalaemia
Hyperglycaemia
32
What genetic condition can cause nephrogenic DI
Wolfram's Syndrome
33
First Line Investigation of DI
U+Es, blood glucose (to rule out T2DM)
34
What serum osmolality is seen in DI
>295
35
What urine osmolality is seen in nephrogenic DI
<700
36
If diagnosis remains unclear from serum and urine osmolality, what test can be done
Fluid deprivation test
37
Management of cranial diabetes
Desmopressin
38
What serum levels should be monitored during desmopressin treatment and why
Na+ levels, as it causes hyponatraemia
39
Drug management of Nephrogenic DI
Thiazide diuretic
40
What blood glucose levels indicate DKA
>11.1 mmol/L
41
What blood ketones indicate DKA
>3 mmol/L
42
When ar eblood cultures indicated for DKA
If evidence of infection
43
When are ECGs indicated in DKA
To check for any changes if hypokalaemia is present
44
How should a DKA be managed in a patient who is alert
Try oral intake + SC Insulin
45
If a patient is vomiting, confused or dehydrated, how should DKA be managed
IV FLuids (10mls/kg 0.9% NaCl) + SC Insulin at 0.1 units/kg/hour 1 hour after starting IV Fluids.
46
If there is evidence of shock in a patient with DKA, how does management change
Increase IV fluid bolus from 10mls to 20mls/kg
47
What should be the first management steps for a DKA case where there is a coma
ABCDE approach
48
When should IV Insulin be stopped following SC insulin
1 hours after
49
What is the major complication of DKA
Cerebral Oedema
50
What bicarbonate levels indicated DKA
<15 mmol/L
51
What pH levels indicated DKA
Less tahn 7.3
52
Once plasma levels fall below 11.1 mmol/L, what should be done
Add 5% dextrose alongside IV fluids + correct Hypokalaemia
53
Should SC insulin be started before or after starting IV fluids in DKA
After
54
What serum levels hsould be monitored hourly in a DKA
Glucose, ketones and ECG
55
What should be added to the fluid if k+ ions are below 5.5mmol/L
K+
56
After the initial hour treatment with saline, how frequently should fluid be given in a DKA
1L 0.9% saline + 40mmol KCL, followed by another - 2L in total at 2 hours
Then again at 4 hours
Then again at 6 hours
57
By how much should serum ketone levels drop by per hour
0.5mmol/L/hour
58
If insulin rate is not achieved when managing a DKA, what should be done
Catherisation
59
If capillary glucose falls below 14 mmol/L, what hosul dbe done
125ml/hr 10% glucose alongside saline
60
insulin be stopped at what blood ketone level
<0.3 mmol AND pH>7,3 AND HCO3- >18mmol/L
61
What endocrinological condition can cause galactorrheoa in men
Hypothyroidism and Liver disease
62
Name three germ cell tumours that can cause gynecomastia
Sertoli Cell
Leydig Cell
Germ cell
63
What endocrinological condition causes gynecomastia
Hyperthyroidism
64
Name two medications that can cause gynecomastia
Spironolactone
Ketoconazole
65
Other than PCOS, name three endocrinological causes for hirsutism
CAH
Cushing's
Acromegaly
Insulin Resistance
66
Name two medications that cause hirsutism
Steroids
Phenytoin
67
What is Conn's Syndrome
Adrenal Adenomas
68
Name some features of hyperaldosteronism
Polyuria
Polydipsia
Lethargy
Hypertension
69
What metabolic disturbances are seen on blood tests in hyperaldosteronism
Metabolic alkalosis
Hypokalaemia
70
What medication can be given to assist hyperaldosteronism
Spironolactone or Eplenernone
71
What causes secondary hyperparathyroidism
Increased secretion of PTH by parathyroid glands IN RESPONSE to low calcium ions caused by kidney, liver or bowel disease
72
What is tertiary hyperparathyroidism
Autonomous secretion of PTH due to CKD
73
Name some causes of secondary hyperparatyhyroidism
Vit D deficiency
Pancreatitis
Rhabdomyolysis
Hungry bone syndrome
Calcium malabsorption
CKD
Pseudohypothyroidism
74
Describe Calcium, phosphate, PTH and ALP levels in Vit D deficiency
SECONDARY Hyperparathyroidism:
Calcium - Normal
Phosphate - Low
PTH - High
ALP - High
75
Describe Calcium, phosphate, PTH and ALP levels in CKD
Calcium - High
Phosphate - High
PTH - High
ALP - High
76
Describe Calcium, phosphate, PTH and ALP levels in Malabsorption
Calcium - Low
Phosphate - Low
PTH - High
ALP - Normal
77
Describe Calcium, phosphate, PTH and ALP levels in Pseudohypoparathyroidism
Calcium - Low
Phosphate - High
PTH - High
ALP - Normal/High
78
What results in tertiary hyperparathyroidism
Prolongued secondary hyperparathyroidism
79
What is tertiary hyperparathyroidism
Glands produce excessive PTH even after the hypocalcaemia is corrected
Usually caused by CKD
80
Management of hyperparathyroidism
Cincalcet (mimics action of calclium on tissues)
Total or partial parathyoridectomy
81
What is calcium ions floating in th eblood bound to
Calcium Oxalate
82
What are non diffusible calcium ions bound to
Albumin (calclium not needed for cellular processes)
83
What is active vitamin D called and where is it activated
1,25 Dihydroxy Vit D
84
Two actions of PTH
Stimulates breakdown of bone
Kidneys stop excreting calcium + get rid of phosphate ions
85
What glands are affected in Multiple Endocrine Neoplasia
Parathyroid Gland
Pancreas
Pituitary
86
Why do we get hyperphosphataemia in some secondary hyperparathyroidism cases
If there is kidney damage (e.g., CKD), phosphate cannot be filtered and stays in the blood
87
What serum level indicates likely secondary hyperparathyroidism over any other types
Low Vit D
88
Whatis chovstek sign and when is it seen
Hypocalcaemia - twitching of muscles (as they're eaisly excitable from lack of stimulation)
89
What kind of tremour is seen in hyperthyroidism
Fine tremour
90
What cancer can cause secondary hyperthyroidism
Choriocarcinoma
91
What symptom rleief is given for hyperthyroidism
Propranolol
92
What are the two medictaion sthat can be given to treat hyperthyroidism
Carbimazole
Propylthiouracil
93
When is carbimazole contraindicated in managing hyperthyroidism
First trimester (can be used after)
94
What is the first line managemnet in the first trimester or thyroid storm
Propylthiouracil
95
When should radio-iodine be indicated for management of hyperthyroidism
Multinodular goitre or adenomas
96
What condition is contraindicated for sue of radio-iodine
Graves eye disease
97
When is thyroidectomy indicated
Recurrence
Obstructing otehr strutcures
98
Side effect of thyroidectomy
Hypoparathyroidism
Hypocalcaemia
99
Management of thyroid storm
IV propranolol
IV Digoxin
Propylthiouracil through NG tube followed by Lugol's iodine 6 hours later
Prednisolone
100
What can precipitate a thyroid storm
Surgery
Trauma
Infection
101
What Cardiac complictaion is seen in hyperthyroidism
AF
102
Name three ways you can get hyperphosphataemia
Tumour Lysis Syndrome
Rhabdomyolygsis
Ingestion
103
What defines hypoglycaemia
<4.0 mmol/L
104
Name a non-diabetic drug that can cause hypoglycaemia
Beta blockers
105
What medical emergency causes hypoglycaemia
Sepsis
106
How can we differentiate between exogenous and endogenous causes of hypoglycaemia
High insulin + HIgh C-Peptide - endogenous
High insulin + low C-peptide - exogenous
107
Management of hypoglycaemia (still conscious and mild symptoms)
ABCDE
Eat 15-25g of carbs
AVOID chocolate
108
Management of severe hypoglycaemia
ABCDE
200ml 10% dextrose IV
1mg Glucagon IM
Treat seizure
109
What defines prediabetes fasting glucose
6.1-7 mmol/L
110
What defines an impaired fasting glucose tolerance test (pre-diabetes)
<7 mmol/L
2 hours: 7.8-11
111
What is seen on an X-Ray for osteomalacia
Looser Lines (ucencies going thorugh th ebone)
112
If Vit D Levels are below 25 nmol?L, what should be the appropriate management
High dose Vit D
113
If Vit D is between 25-50 nmol/L, how should this be treated
Maintenance therapy alnoe
114
How often should calcium levels be checked in oesteomalacia
Monthly
115
Risk Factors for Osteoporosis
SHATTERED FAMILY
Steroids
Hyperthyroidism, Hyperparathyroidism
Alchol + SMoking
Testosterone
Thin (BMI<22)
Early Menopause
Renal/Liver Failure
Erosive/Inflammatory bone disease
Diabetes
Family History
116
What age is an indication to use FRAX
Anyone over 75
Or under 50 if:
FH
Falls History
Previous hip fracture
Low BMI
Alcohol
Steroids
Basically anyone on Shattered Family
117
First Line treatment of osteoporosis
Bisphosphonates (weekly)
118
Side effects of bisphosphonates
Osteonecrosis of the jaw
AF
Stress fractures (atypical)
119
Second line management of osteoporosis
Denosumab
Raloxifene
Teriparatide
Strontium Renelate
120
TSH /T3/T4 levels in primary hypothyroidism
TSH High
T3 Low
T4 Low
121
TSH T3 T4 levels in secondary hypothyroidism
TSH Low
T3 Low
T4 Low
122
TSH T3 T4 in primary hyperthyroidism
TSH Low
T3 High
T4 High
123
TSH T3 T4 in secondary Hyperthyroidism
TSH High
T3 High
T4 High
124
Where do tumours in phaechromocytoma orginiate from
The adrenal medulla
125
Symptoms of phaeochromocytoma
Anxiety
Weight Loss
Palpitations
Sweating
Flushing
Hypertension
Tremour
126
What can precipitate phaeochromocytoma
Stress
Excercise
Surgery
Beta Blockers
Opiates
127
What invetsigation is used to diagnose phaeochromocytoma
Plasma metanephrines (FIRST LINE)
Then urinary metanephrines
128
What adrenal imaging is done for phaeochromocytoma
CT Chest Abdomen and Pelvis (not an MRI)
129
Definitive treatment of phaeochromocytoma
Resection of tumour
130
What is Type 1 renal tubular acidosis
Inability to excrete hydrogen ions
131
Signs of renal tubular acidosis type 1
Renal stones
Osteomalacia
UTIs
132
What syndrome is associated with Type 2 renal tubular acidosis
Fanconi Syndrome
133
What is Rhabdomyolysis
Breakdown of skeletal muscle
134
What causes rhabdomyolysis
Immobilistaion
Crush Injuries (hyperkalaemia)
Burns
Seizures
Excercise
135
Features of rhabdomyolysis
Muscle pain, swelling
Red/Brown Urine
AKI
136
WHat investigation should be done to check for rhabdomyolysis
Creatinine Kinase (5 folds higher than the upper limit)
Hyperkalaemia
Hyperphosphataemia
Hyperuricaemia
Hypocalcaemia
Think tumour lysis syndrome
137
What drugs can cause diabetes
Steroids
Phenytoin
Thiazides
Beta blockers
138
Name a skin condition seen with amiodarone
Stevens-Johnson Syndrome
139
How does amiodarone affect the colour of the skin
Grey discolouration
140
Which anti-diabetic drug can cause weight gain
Sulfonylureas
Thiazolidinediones
141
What HBA1c value defines diabetes
>48 mmol/mol
142
What fasting glucose level indicates diabetes
7.0 mmol/L or more
143
What random plasma glucose level indicates diabetes
11.1 mmol/L or more
144
What is MODY diabetes
Defects in beta-cell function that cause MILD hyperglycaemia in young people
145
Name som eendocrine conditions that can cause diabetes
CF
Cushing's
Acromegaly
Thyrotoxicosis
Phaeochromocytoma
146
What drugs can cause diabetes
Steroids
Thiazides
Atypical antipsychotics
147
Presentation of Type 2 diabetes
Polydipsia
Polyuria
Fatigue
Infections
Glucosuria
148
What HBA1c defines pre-diabetes
42-47
149
What fasting glucose level indicates pre-diabetes
6.1--6.9 mmol/L
150
What glucose tolerance result indicates prediabetes
7.8-11.1 mmol/l
151
What is the treatment target for diabetics and diabetics that have moved beyond just using metformin
Normal: 48
More than metformin: 53 mmol/mol
152
First line management of T2DM
Metformin
153
Second line management of T2DM
Sulfonylurea
Pioglitazone
DP44-inhibitor
SGLT-2 inhibitor
154
What is the third line management of T2DM
Triple therapy or metformin + insulin
155
What does pioglitazone treat diabetes
Thiazolidinedione:
Increases insulin sensitivity and reduces liver productino of glucose
156
Noteable side-effect for pioglitazone
Weight gain
157
What is the most common sulfonylurea
Glicazide
158
Side effect of glicazide
Hypoglycaemia
Weight Gain
Increased risk of CV disease
159
How is GLP-1 delivered
SC
160
What are the role of follicular cells
Produce T3 (triiodothhronine)
And T4 (thyroxine)
161
What is the most potent form of thyroid hormone
T3
So T4 -> T3 inside cells
162
What are the role of C cells (parafollicular cells)
Produce calcitonin
163
Role of calcitonin
Reduces Ca2+ in the blood + inhibits rebasorption of calcium ions at the kidneys
164
What are differentiated thyroid carcinomas
Where normal and DIFFERENTIATED follicular cells divide and differentiate into cancers
165
Name two types of differentiated thyroid carcinomas
Pappillary and follicular carcinomas
166
What is the most common tpye of thyroid cancer
Pappillary
167
Describe the spread of papillary carcinoams
The finger like projections (papillae) grow and block of the neighbouring lymph nodes
168
What is seen under a microscope for papillary carcinomas of the thyroid
Orphan annie eye
Psammoma Bodies
169
What is the difference in the way follicular carcinomas behave compared to papillary carcinomas
They can break through into blood vessels and spread haematoginously
170
What thyroid cancer arise from c-cells
medullary
171
What condition are medullary thyroid cancers associated with
MEN 2a and 2b
172
Appearance of medullary thyroid carcinomas
Single cancer in one lobe
173
What are anaplastic thyroid carcinomas
Where the cells of papillary or follicular cancers become unrecognisably different
174
GOLD standard for thyroid cancer diagnosis
Fine needle aspiration
175
When is a dextrose infusion indicated for DKA
If glucose levels fall below 14 mmol/L
176
What is the benefit of SGLT-2 inhibitors (e.g., empaglafloxin)
Reduces risk of CV events like Mi, stroke and death
177
How long before a meal should rapid acting insulin be used
10 minutes
178
How long does novorapid and humalog (rapid acting insulin) last
4 hours
179
HOw long does actrapid and humulin S (short acting insulin) last for
8 hours
180
What antibody is found in Graves' disease
Thyroid-stimulating hormone
181
What autoantibody is found in Hashimoto's thyroiditis
Thyroid peroxidase enzyme
182
If there is failure to suppress plasma concentration in the blood with high-dose dexamethasone suppression testing, where is the source of Cushing's
ectopic source of ACTH or tumour
183
What is De Quervain's thyroiditis
Transient hyperthyroidism from viral infections
184
Describe the sequence of action in de quervain's thyroiditis
Rapid hyperthyroidism followed by hypothyroidism after a few weeks
185
What is a block and replace regimen in hyperthyroidism
Usually you give 40mg of carbimazole to block the thyroid completely
Then give levothyroxine once daily to achieve euthyroidism
186
What is the criteria for radioactive iodine
Patient must be euthyroid
187
Signs toxic mulinodular goitre
Usually euthyroid actually
188
What is the GOLD standard diagnosis of hyperaldosteronism
Plasma aldosterone:renin ratio
189
What is Diabetes Inspidus
Deficiency of vasopressin
190
Should Metformin be started in people with eGFR <30?
No
191
What is a complication of Hashimoto's thyroiditis
Thyroid Lymphoma
192
What condition can cause HBa1c levels to be lower than expected
Hereditary spherocytosis
193
Management of hyponatraemia
Hypertonic Saline (1.8% NaCl) slowly - not more than 6 mmol//L in first 6 hours or 10mmol / 24 hours
194
Management of SIADH
FLuid Restriction - FIRST LINE
Then Demeclocycline (blocks ADH receptors) or Tolvaptan
195
Management of hypervolaemic hyponatraemia
Loop Diuretics
196
What meabolic disorder is found with steroid crises
Hypokalaemic metabolic alkalosis
197
Contraindications to metformin
eGFR <30
198
Contraindictation to DPP-4 (-Gliptins)
Hepatic and Heart failure
199
COntraindications to Pioglitazone
HF or Bladder cancer
200
Contraindications to slufonylureas
Hepatic and renal impairment (severe)
201
Contraindication to SGLT-2 inhibitor
eGFR <60
202
Contraindication to GLP-1
history of pancreatitis
203
What autoantibody is raised in people who have. ahigh likelihood of thyroid cancer e-occurence
Thyroglobulin antibodies
204
What tests are needed to diagnose hyperparathyroidism
Serum PTH, calcium, vit D, phosphates
24 hour urinary calcium levels
205
What is the first line management of diabetes T2 when renal impairment is involved
Gliclazide (sulfonylureas)
206
When should people be offered a 6 month TRIAL of thyroxine at GP
If TSH remains over 10 on TWO separate occasions
207
If you're asymptomatic for Diabetes, how many times should the blood test be repeated
Twice
208
Blood findings in Hyperosmolar hyperglycaemic state
Raised glucose with no changes in ketones
Raised osmolality
209
What are the results from fluid deprivation and giving desmopressin if psychogenic polydipsia is suspected
High urine osmolality in both
210
What is the main complication of giving too much levothyroxin e
Osteoporosis
