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Year 6 > Endocrinology > Flashcards

Endocrinology Flashcards

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1
Q

Which vitamin deficiency does carcinoid syndrome cause?

A

Pellagra - vitamin B3

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2
Q

Carcinoid syndrome main investigation

A

5-hydroxyindoleacetic acid

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3
Q

Carcinoid syndrome blood investigation for liver mets

A

Elevated chromogranin A

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4
Q

Carcinoid syndrome management

A

Surgical resection
Somatostatin analogues

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5
Q

Bloods in subclinical hyperthyroidism

A

Low TSH
Normal T3 and T4

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6
Q

Thyroid isotope finding in Grave’s disease

A

Diffuse uptake

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7
Q

Management of Grave’s disease in order

A

Propranolol
Carbimazole

Radioiodine if resistant
Thyroxine to prevent hypo

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8
Q

Prolactinoma presentation in women

A

Amenorrhoea
Galactorrhoae

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9
Q

Prolactinoma investigations

A

High prolactin (150-200)
Pituitary MRI
Visual field testing

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10
Q

Prolactinoma management

A

Dopamine agonists - cabergoline, bromocriptine
Trans-sphenoidal surgery

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11
Q

Gene in MEN type 1, 2, 3

A

1) MEN1
2) RET
3) RET

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12
Q

Where does MEN 1, 2 and 3 affect

A

MEN1
Pituitary
Pancreas
Parathyroid

MEN2
Parathyroid
Phaeochromocytoma
Medullary thyroid

MEN3
Phaeochromocytoma
Medullary thyroid

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13
Q

Medical treatment of obesity

A

Orlistat: pancreatic lipase inhibitor
Liraglutide: GLP-1 mimetic

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14
Q

Osteoporosis DEXA

A

Less than -2.5

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15
Q

Osteopaenia DEXA

A

-1 to -2.5

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16
Q

Osteoporosis management

A

Hip protectors
Falls risk assessment

Bisphosphonates
Calcium and vitamin D if low

HRT

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17
Q

Osteoclasts and osteoblasts in Paget’s disease

A

Excessive osteoclastic resorption
Increased osteoblastic activity (builds bone)

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18
Q

Paget’s investigations

A

Raised ALP

X-rays: osteolysis, thickened skull, lytic/sclerotic lesions
Bone scan: increased uptake in active lesions

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19
Q

Paget’s management (asymptomatic and symptomatic)

A

Asymptomatic: monitor
Symptomatic: bisphosphonates e.g. oral risedronate or IV zoledronate

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20
Q

Paget’s complications

A

Deafness
Bone sarcoma

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21
Q

Phaeochromocytoma investigations

A

24-hour urinary metanephrines

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22
Q

Phaechromocytoma management

A

Stabilise with alpha-blocker then beta-blocker

Surgery

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23
Q

Which hormones are elevated in PCOS?

A

Prolactin
Testosterone

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24
Q

Rotterdam criteria for PCOS

A

Oligo-anovulation
Clinical or biochemical hyperandrogenism
Polycystic overies or increased ovarian volume in one or both ovaries

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25
PCOS management
Weight loss COCP Metformin +/- clomifene Gonadotrophins
26
Thyroid cancer with good prognosis
Papillary
27
Thyroid cancer with low calcium and why
Medullary Calcitonin secretion (opposite of PTH)
28
3 types of thyroid cancer
Papillary Follicular Medullary
29
TSH in thyroid cancer
Normal
30
Thyroid cancer investigations
Bloods - TFTs, FBC, LFTs Imaging - thyroid USS, uptake if hyper/hypothyroid Fine-needle aspiration
31
Most common cause of Conn's
Bilateral adrenal hyperplasia
32
Presentation of Conn's
HTN Symptoms of hypokalaemia (muscle cramps, polyuria, polydipsia)
33
Conn's investigations
Bloods - raised plasma aldosterone:renin (low renin from negative feedback from high aldosterone) Imaging - CT abdo
34
Conn's management
Adrenal adenoma: surgery Adrenal hyperplasia: spironolactone
35
Addison's most common cause
Autoimmune (UK) TB (worldwide)
36
Addison's symptoms
Salt-craving Hyponatraemia Hyperkalaemia Hypoglycaemia Hyperpigmentation
37
Addison's investigations
9am serum cortisol Short synACTHen test (no rise in cortisol)
38
Management for addison's
Hydrocortisone Fludrocortisone MedicAlert bracelet Hydrocortisone for injection in adrenal crisis
39
Advice for addison's management if intercurrent illness
Double dose of hydrocortisone, but keep fludrocortisone the same
40
What is Cushing's 'disease'?
ACTH-producing pituitary tumour
41
Cancer releasing ectopic ACTH
Small cell lung cancer
42
Cushing's investigations
Overnight dexamethasone suppression test - suppressed: normal - not suppressed: Cushing's syndrome - suppressed by high dose: pituitary - not suppressed by high dose: ectopic (high acth) or adrenal (low acth) Inferior pituitary petrosal sinus sampling
43
Cushing's management
Surgery
44
Hypoparathyroidism presentation
Hypocalcaemia - CATs go numb (cos they don't have enough milk) - Convulsions, Chvostek's - Arrhythmias - Tetatny, Trousseau's - Numbness
45
Pseudohypoparathyroidism pathophysiology and presentation
Enough PTH but target is insensitive Low IQ, short stature, shortened 4th and 5th MCPs Hyperparathyroidism biochemical picture
46
Pseudopseudohypoparathyroidism difference to pseudohypoparathyroidism
Normal biochemical picture
47
Management of severe hypocalcaemia
IV calcium gluconate 10ml 10% over 10mins ECG monitoring
48
Most common cause of hyperparathyroidism
Solitary adenoma
49
Primary hyperparathyroidism presentation
Hypercalcaemia Bones Stones Abdominal groans Psychic moans (it's too much (calcium) to handle)
50
Phosphate in CKD and vitamin D deficiency
High in CKD Low in vitamin D deficiency
51
Tertiary hyperparathyroidism PTH, calcium, phosphate
High PTH High calcium Low phosphate (untreated CKD)
52
Hypercalcaemia management
IV saline Bisphosphonates
53
Most common form of hypothyroidism
Hashimoto's thyroiditis
54
Is subacute thyroiditis hypo or hyperthyroid?
Hyper then hypo
55
Antibodies in Hashimoto's
Anti-thyroid peroxidase Anti-thyroglobulin
56
Management of hypothyroidism
Levothyroxine
57
T1DM diagnosis
Random glucose >=11.1 Fastin glucose >=7.0 2-hour glucose >=11.1
58
Management of T1DM
Basal-bolus insuline 1) Subcutaneous 2) Insulin pump (motivated, skilled, family support if child)
59
Example of long-acting insulin
Insulin detemir (Levemir)
60
Example of rapid-acting insulin
Insulin aspart (NovoRapid)
61
T2DM investigations
Same as T1 but also HbA1c >=48 Need one of the above on two separate occasions if asymptomatic
62
What investigation finding suggests impaired glucose tolerance?
Fasting glucose 6.1-7.0
63
T2DM management
1) Conservative 2) Metformin 3) Change to DPP-4 inhibitor e.g. sitagliptin (or SGLT-2 inhibitor e.g. dapagliflozin. If CVD risk: add this if metformin is still fine, or sulfonylurea e.g. gliclazide but this has weight gain effects)
64
HbA1c target if taking sulfonylurea
53
65
Cranial diabetes inspidus causes
Head injury Haemochromatosis
66
Nephrogenic diabetes inspidus causes
Genetic Lithium Hypercalcaemia
67
Investigation for diagnosis of diabetes inspidus
Serum calcium to check other differentials Water deprivation test (8 hours - urine still diluted) Desmopressin stimulation test - central DI responds
68
Management of central and nephrogenic diabetes inspidus
Central: desmopressin Nephrogenic: manage fluid intake, sodium restriction, treat cause
69
5 causes of SIADH
Small cell lung cancer Subarachnoid haemorrhage TB SSRIs Sulfonylureas
70
Investigations for SIADH
High urine osmolality and sodium Serum hypotonic hyponatraemia
71
SIADH management
Fluid restriction IV hypertonic saline slowly Treat cause
72
Hypokalaemia ECG
U waves Small T waves Prolonged PR interval ST depression
73
What defiency can cause hypokalaemia?
Magnesium deficiency
74
Hypokalaemia management
Oral Sando-K IV infusion if not tolerated or <2.5
75
Which drugs can cause hyperkalaemia
Sprinolactone, amiloride ACE inhibitors NSAIDs LMWH Tacrolimus
76
Hyperkalaemia ECG
Peaked T waves Loss of P waves Broad QRS Sinusoidal VF
77
Management of hyperkalaemia and when do to this
>=6.5 or ECG changes IV calcium gluconate Insulin + dextrose infusion Nebulised salbutamol Calcium resonium enema (removal) Loop diuretics (removal) Dialysis if persistent Treat cause
78
Diabetic retinopathy stages
1 (mild non-proliferative) - 1+ microaneurysms 2 (moderate non-proliferative) - microaneurysms, blot haemorrhages, hard exudates, cotton wool spots 3 (severe non-proliferative) - microaneurysms and blot haemorrhages in 4 quadrants, intraretinal abnormalities in 1 quadrant 4 (proliferative) - retinal neovascularisation, fibrous tissue anterior to retinal disc
79
Management of diabetic retinopathy
All - optimise glycaemic control, regular ophthal review Non-proliferative - panretinal laser photocoagulation is severe Proliferative - panretinal laser photocoagulation, intravitreal VEGF inhibitors

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