Endocrinology Flashcards
(180 cards)
1
Q
Classification of Pre-diabetes
A
Hb1Ac- 42-47
2
Q
Medication for T2DM and examples
A
Thiazindine- pioglitazone
Gliptins- sitagliptin
Sulphonlyureas- glicazide, glibenclamide
SGLT2- dapaflozin
3
Q
CI and uses of T2DM medications
A
Metformin- lactic acidosis, <GFR 30
Sulphonylureas- CI Ketoacidosis as causes hypos, caution in high BMI as causes weight gain
Thiazol- pioglitazone- weight gain, abnormal LFT, bladder cancer- CI in HF and bladder cancer
Gliptins- Good to use if overweight
Caution if GFR <45
DPP4 inhibitor- increase incretin- increase insulin
Empagliflozin- CI GFR <60 - good for HF, can help loos weight?
4
Q
When to add medications in T2DM
A
Metformin when >48
Add another if >58
5
Q
What medication to use if CKD 4 and T2DM
A
Sitagliptin or gliclazide
6
Q
Signs and sx of DM
A
Fatigue, polydipsia, polyuria
Neuropathy- gastroparesis, neuropathic pain
Foot- screen annually
Nephropathy- ACR yearly, microalbuminurea first sx
7
Q
Mx of secondary symptoms of DM
A
Gastroparesis- metoclopramide
Neuropathic pain- amitriptyline
Nephropathy- ACEi- protective in DM and CKD but toxic in AKI
if ACR >30
8
Q
Monitoring ACEi in DM nephropathy
A
Expect a drop since dilation
If GFR drop >20% stop
If less continue
9
Q
Diagnosis of DKA
A
DM- BM >11
Ketones >3
Acidosis- ph <7.3
Develops rapidly
10
Q
Causes of DKA
A
Infection
Alcohol
Trauma
Insulin missed
11
Q
Tx of DKA
A
Fluid bolus 500ml in 15 mins- then 1L/hr
Insulin- 0.1g/kg/hr
Potassium
10% dextrose when BM <14
VTE prophylaxis
12
Q
Dx of HHS
A
pH >7.3
BM >30
Osmolarity- >320
Develops over few days
13
Q
Tx of HHS
A
1L in first hour
then 500ml/hr for 4 hours
250ml for next 4 hours
14
Q
When to investigate neck lump
A
> 1cm- USS +/- FNA
15
Q
Cause of simple goitre
A
Iodine deficiency
16
Q
Several hot nodules with thyrotoxicosis vs single hot
A
Plummers vs
Single toxic adenoma
17
Q
Causes of diffuse goitre
A
De Quervains- painful, hx of infection- reduced uptake
Graves- exophthalmos, pretibial myxoedema
18
Q
Mx of Graves
A
40 mg Carbimazole
Propanolol
Or radioiodine- CI with eye disease, pregnanacy
2nd- PTU
19
Q
Causes of hypothyroid
A
Hashimotos
Iodine deficiency
Viral thyroiditis- hypo phase
20
Q
Types of thyroid cancer and Tx
A
Papillary- common- thyroidectomy
Follicular- “
Medullary- parafollicular C cells - phaeo screen- “
Anaplastic - palliative
21
Q
Complications of thyroid surgery
A
Early
Haematoma- obstruction- remove clips
Recurrent laryngeal nerve pasy- right side- damage to 1- hoarse voice, both- obstruction- tracheotomy
Hypoparathyroid- low calcium
Thyroid storm- propanolol and antithyroid
22
Q
Tx of myoxedema coma
A
IV thyroxine
IV fluids
IV HC
23
Q
Sx of Addisons
A
WT loss
N/V, abdo pain, GI
Hyperpigmentation
Postural hypotension
Vitiligo
24
Q
Causes of Addisons
A
AI
TB
Mets
Haemorrhage- Waterhouse Friedrichson
CAH
25
Addisonian Crisis Sx
Shocked- high HR, cpostural drop, confused
Hypoglycaemia
26
Cause of Addisonian Crisis
Infection- sepsis, meningoccocoaemia- WHF
Trauma
Surgery
Stopping steroids
27
Ix for Addisons
SynthACTHen - measure cortisol
28
Mx of Addisonian crisis
IM/IV HC- 1st
IV fluid bolus - 2nd
Continue fluids and convert to PO dex
29
Main types of pituitary tumours
Prolactinoma> non secreting > GH secreting > ACTH secreting
30
Sx of hyperprloactinaemia
Amenorrhoea
Infertility
Galactorrhoea
↓ libido
ED
31
Sx of acromegaly
Coarse face
Macroglossia
Proximal weakness
Headache
DM
Increase BP
32
Ix of acromegaly
IGF1 then OGTT with serial GH measurements
33
Mx of acromegaly
Trans-sphenoidal
2nd- octretide
34
Causes of Cushings
Exogenous- GC therapy
Endogenous- Cushing disease- ACTH dependent pituitary
ACTH independent- adrenal adenoma
35
Ix for Cushings
11pm salivary cortisol- if low not Cushings
- LDDST- 1mg DM- measure cortisol before 9am
Measure ACTH too
Confirm Cushings- IPSS- determines whether pituitary or ectopic
36
Tx of Cushings
Pituitary adenoma- surgery
Adrenal mass- adrenalectomy + steroids replace- can cause nelson syndrome- don't do bilateral- enlargement of pituitary- compression ++ACTH- hyperpigmentation
Ectopic- ketoconazole
37
Sx of Conns syndrome
Med resistant HTN
Hypokalaemia - causing muscle weakness
Paraesthesia
38
Sx of Cushings
Metabolic hypokalaemia alkalosis
Proximal myopathy
DM
Striae
HTN
Moon face
Fat pad
39
ECG changes with Conns
Flat/Inverted T waves
ST depression
U waves
Long QT and PR
40
Ix of Conns
Plasma aldosterone/ renin ratio - high low
Then HR-CT + adrenal vein sampling- differentiates between bilateral hyperplasia
41
Tx of Conns
Spironolactone then surgery
42
Causes of secondary hyperaldosteronism
RAS- high renin due to poor perfusion
Aldo : renin- high high
43
Cause of hypernatraemia
Conns syndrome
RAS- high RAS
GI loss
Diabetes insipidus
44
Signs of hyponatraemia
Hypovolaemia- tachycardia, low urine Na- best
Hypervolaemia- high JVP, peripheral and resp oedema
45
Causes of hyponatraemia
Hyper- excess water, ADH
Cardiac failure
Cirrhosis- vasodilation due to excess NO- low BP- high ADH
Renal failure
Euvolaemic- SIADH, hypovolaemia, adrenal insufficiency
Hypo- D+V, diuretics
46
Causes of SIADH
4 Cs
CNS pathology- stroke
Cancer- SCLC
Chest- pneumonia
Carbmazepine and SSRI, TCA, PPI
Surgery
47
Ix of euvolaemic hyponatraemia
TFTs
Short SynACTHen - adrenal
plasma and urine osmolatrity- SIADH
48
Causes of hyperkalaemia
Low GFR
NSAIDs
DM
ACEi and ARB
Addisons
Spironolactone
49
Mx of hyperkalaemia
10ml 10% Calcium glutinate
10U insulin
120ml 20% dextrose
50
Causes of hypokalaemia
GI Loss
Hyperaldosterone- RAS/Conns
Diuretics
Insulin
Alkalosis
51
Mx of hypokalaemia
Oral KCl- 2.5-3.5
Severe <2.5- IV KCl
52
Types of HyperPTH
Primary- adenoma
Secondary- CKD, vit D def
Tertiary- end stage renal
53
Types of MEN
1- pituitary adenoma, parathyroid, pancreatic
2A- parathyroid, medullary, phaeo
2B- marfanoid, neuroma, medullary, phaeo
54
What can cause a lower than expected HbA1c
Sickle
G6PD
HS
Haemodialysis
55
DM has CKD and previous MI what prescribed
No metformin
SGLT2
56
When to stop IV insulin to SC in DKA
When eating and drinking normally
Ketones <0.6
pH >7.3
Bicarbonate >15
57
If struggling to dx between T1DM and T2 what test can you use
C peptide
58
Primary, secondary and tertiary hyperparathyroid biochem
Primary
PTH high
Ca High
P Low
Secondary
PTH High
Ca Low/N
Vit D low
Tertiary
PTH V high
Ca High
P high
59
Tx of hypercalcaemia
Fluids 3-4L daily
Bisphosphonates ?
60
What to do If ketonaemia and acidosis and not resolved by 24 hours
Endocrine review
61
Sx of hypocalcaemia
Cramps, twitching, spasms
Trousseau sign
Chvosek
62
Mx of hypocalcaemia
Severe- tetany, spase, prlonged QT
IV calcium- 10ml 10% in 10 mins
63
Max rate of potassium from peripheral line
10mmol/hr
So 40 mmol in 4 hours
64
What electrolyte deficiency can cause abnormal calcium absorption
Magnesium
65
Effects of hyperthyroid on the bones
Osteoporosis
66
MEN 1
Pituitary
Parathyroid
Pancreatic- can cause Zollinger ellison- many ulcers
67
MEN 2A
Parathyroid
Phaeo
Medullary thyroid
68
MEN 2B
Medullary thyroid
Marfanoid
Phaeo
69
What requirements are there for insulin dependant DM for driving
Check blood sugar every 2 hours
70
Sick day rules of DM
Increase monitoring of glucose
Normal regime
71
Rate of fixed insulin rate in DKA
0.1 units/kg/hour
so if 70kg in 2hrs
14 units
72
What is acropachy and what is it associated with
Swelling/clubbing of fingers
Graves disease
73
Addisons treatment for those who are vomiting
IM HC until vomitting stops
74
MOA of gliptins
DPP4 inhibitors- increase incretins GLP
75
MOA of exanitide
GLP1 mimics
76
If hyperkaleamia first thing you do
ECG
Ca gluconate with insulin and dextrose if >6.5
77
Daily HC treatment of addisons
Majority in the first half of day
Less in evening
e.g 20mg in morning, 10 in eve
78
TX of HTN in afro carribean with DM
ARB
79
Sodium <120 tx
Hypertonic solution 3%
80
When does a diabetic need to surrender their licence
If 2 hypoglycaemic episodes requiring help
81
Scintigraphy of Graves vs thyroiditis
Uptakes is high in Graves
82
Thyroid disease affecting periods
Hyper- oligo /ameno
Hypo- menorrhagia
83
Sick day rules T1DM
Increase frequency of glucose monitoring
3L of fluid
If unable to eat- sugary drinks
84
Patients on long term steroids on sick days
Double steroids
85
SE of thyroxine therapy
OP
Angina worsen
AF
86
Non functioning pituitary adenoma sx
Headache- pressure affects
Hypopituitism
87
Medical treatment of prolactinoma
Carbergoline
Dopamine agonist - inhibits prolactin release
88
Cushing acid imbalance
Hypokalaemia metabolic alkalosis
Due to K+ excretion causing H+ excretion
89
Polyuria and polydyspia ix order
Calcium then water deprivation test
90
When is hyperkalaemia treated
>6.5
ECG changes
91
Ix of phae
Urine metanephrines
92
SE of metformin and what to change it to
Diarrhoea
Change to modified release
93
Drugs that cause prolactinoma
Dopamine antagonist such as metoclopramide
94
When is exanitide used
If cannot tolerate triple therapy and BMI >35
95
Addison disease and ill what should you do
Double Hydro
Keep fludro the same
96
Tx of SIADH
Fluid restrict
Demeclocyline
97
Subclinical hypothyroidism tx
If 2 separate occasions 3m apart with elevated TSH 5.5-10 and symptoms
or >10
Give thyroxine for 6 months
98
When to prescribe SGLT2
If T2DM develop CVD, high risk for CVD or CHF
Q risk >10
99
What tests should men with ED get
Morning testosterone
Lipids
100
Where should you avoid cannulating in diabetess
In feet due to formation of diabetic ulcer
101
Main complications of fluid resuscitations in DKA
Cerebral oedema- seizures
102
Alcoholic KA tx
Saline and thiamine
103
How to work out how long a person should be on FRII for
Weight x 0.1
To give units per hour
Divide that by how many units given
104
Which hormone is lost first in pituitary dysfucntion
GH
105
Which drug can cause thyrotoxicosis
Amiodarone
106
Hypoglycaemic unawareness mx
Reduce insulin
Set higher glucose targets
107
If acromegaly but decline surgery mx
Ocretide
SomatoStatin receptor ligand
108
Removal of thyroid gland and tingling
Hypocalcaemia
109
Impaired fasting glucose and tolerance
6.1-7- fasting
2hr- 7.8-11.1 tolerance
110
If thyrotoxicosis what order of tx do you give
Propanolol
Thioamine- PTU/carbimazole
Surgery only for Graves of not suitable , toxic nodules if radio iodine unsuitable
111
If thyrotoxicosis what order of tx do you give
Propanolol
Thioamine- PTU/carbimazole
Surgery only for Graves of not suitable , toxic nodules if radio iodine unsuitable
112
Main RF for eye disease in Graves
Smoking
113
If gyna on spironolactone what should you do
Swap to eplerenone
114
If TSH low and T4 high on levothyroxine what should you do
Reduce T4
Recheck in 6 weeks
115
What drugs affect TSH
Ferrous sulphate
Reduce absorption
Raised TSH
116
Acromegaly affect on prolactin
Raised in 1/3- galactorrhea
117
Drug that mimics calcium on the sensor causing PTH to lower
Cinacalcet- good if not suitable for surgery
118
DM with neuro pain and BPH
Amitrip is usually 1st but because its a TCA in BPH can cause urinary retention so should give pregabalin
119
If Aldo high and CT inconclusive what next Ix
Adrenal venous sampling
Distinguishes between unlateral and bilateral
120
Sick euthyroid results
Normal TSH
Low T4
During illness
No tx
121
Steroid therapy TFT results
Low TSH normal T4
122
Poor compliance With thyroxine TFT
High TSH
Normal T4
123
Alcohol affect on electrolytes
Hypernatraemia- suppression of ADH
124
Conns disease affect on urination frequency
Increased urination
125
Lithium DI test results
Since it causes nephrogenic DI
Urine osmolality will not change after desmopressin
126
RF of graves
Females
Smoker
30-60
Vit D deficient
127
Kleinfelters blood results
High LH and FSH
Low test/oest
Primary hypogonadism
128
DI urine osmolality levels
<600
Give desmo- >600 if cranial
129
What drug can reduce hypoglycaemic awareness
BB
Since suppress adrenergic sx
130
When to tx subclinical hypothyroid
If TSH >10- on 2 separate occasions 3m apart
or
<65 and symptomatic and TSH high 3m apart- trail of thyroxine
If >80- watch and wait
131
What to screen for in t1dm
Coealiac
132
Tx of nephrogenic DI
Chlorothiazide
133
Where does papillary thyroid cancer spread to early
Cervical LN
134
Where does follicular thyroid cancer spread to
Vascular
135
Most common cause of primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
136
If have foot problems in DM other than calluses what should you do
Refer to local diabetic foot centre
137
Common complication of insulin therapy in DKA and its tx
Hypophosphataemia
Infusion given if severe
138
Why dont you correct hypernatraemia too fast
As it causes cerebral oedema
139
Other types of DM
LADA- in adulthood- perhaps other AI condition - type 1
MODY- affecting production of insulin - younger
140
Rapid correction of hyper and hyponatraemia and their sx
Hypo correction- osmotic demyelination syndrome- spastic paresis
Hyper correction- cerebral oedema- confused
141
What other sx can carcinoid cause
Can secrete ACTH causing Cushing sx
142
If going to start SGLT2 what do you have to do first
Ensure metformin is titrated up
Max- 1g BD
143
What should be stoped before contrast
Metformin
144
When to refer for bariatric surgery
Early if
Very obese 40-40 BMI
Other conditions caused by obesity
145
When are SGLT2 CI
GFR <60 - T2DM
GFR <30 in CVS
146
How are GLP 1 delivered
SC
147
Order of tx in phaechromocytoma
Alpha first- phenoxybenzamine
Beta second
148
Vision problems after bilateral adrenalectomy
Nelson syndrome- growth of pituitary after surgery
149
Thyroid cancer with high calcitonin
Medullary
150
What can mimic Cushings
Alcohol
151
Lytic vs sclerotic bone lesion causes
Sclerotic- mets
Lytic- Paget and MM
152
Glucose targets for T1DM
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
153
Electrolyte risk with giving packed RBC after blood loss
Hyperkalaemia
154
Normal anion gap and causes of raised
10-18
Raised- Methanol, Uraemia, DKA, Lactate, ethylene, salicylates
155
Differentiating between primary and secondary adrenal failure by sx
Primary- hyperpigmented skin
156
Units per ml of insulin
100
157
Likely cardiac problems caused by thyrotoxicosis
High output cardiac failure
158
Dx of T2DM
Symptomatic and >7 fasting or >11.1 random/OGTT
Asymptomatic- 2 abnormal HbA1c or glucose levels
159
When should you test for C peptide and DM autoantibodies
Type 1 diabetes is suspected but the clinical presentation includes some atypical features
>age 50 years
>BMI of 25 kg/m²
160
Hashimoto is associated with which cancer
MALT lymphoma
161
When to surrender licence to DVLA if diabetic
If 2 or more hypos whenever
162
Pioglitazone SE
Fluid retention
163
Presents With high HR, BP, AF, purulent sputum what do you give
Beta blockers, propylthiouracil and hydrocortisone
There storm caused by infection
164
Apart from drug induced, what else can cause hypoglycaemia
Liver failure
Addisons
165
Pepper pot skull dx
Hyper parathyroid
166
Tx of Paget
Bisphosphonates
167
When to refer for Barietric surgery
BMI 40-50 and other co morbidities
Or >50
168
Cause of gynaecomastia
Hyperprolactinaemia
Testicular atophy
Kleinfelters
Increased oestrogen- liver failure
Spironolactone, anti psychotics
169
Cause of amenorrhoea
Primary- Turners, anorexia
Acromegaly AI hep
Hyperprolactinaemia
Hyperthyroid
Haemachromatosis
Sarcoid
170
Cause of amenorrhoea
Acromegaly
Hyperprolactinaemia
AI Hep
Hyperthyroid
Haemachromatosis
Sarcoid
171
High dex suppression test results
High dex- suppresses ACTH in Cushing disease
Adrenal adenoma- cortisol not suppressed but ACTH suppressed
Ectopic- ACTH not suppressed
172
Differentiating exogenous insulin and insulinoma
Give insulin
If insulinoma- C peptide will not fall
Others- will fall
173
Hba1c targets for T2DM
48
53 if on a drug that can cause hypoglycaemia
Or if above 58 and on drug
174
What drug worsens glucose tolerance
Thiazides
175
If TPO abs positive but T4 is still normal dx and tx
Subclinical euthyroid
If 2x with TSH >10 3 months apart or TSH 5.5-10 with symptoms- Levothyroxine 6m
176
Blood tests for thyroid cancers
Medullary- calcitonin
Papillary- Thyroglobulin
177
SE of radio iodine
Hypothyroid
178
Causes of cranial DI
Haemachromatosis
Craniopharygoma
179
Graves with exophthalmos tx
Carbimazole 12-18 months
180
Amiodarone induced hypothyroid tx
Continue and give thyroxine
