Endocrinology Flashcards
(151 cards)
1
Q
What are features of Kallman syndrome?
A
- Delayed pubtery
- Hypogonadism
- Loss of smell
- Low sex hormones
- Normal/above average height
2
Q
How is Kallman syndrome managed?
A
- Testosterone supplementation
- Sex hormones supplementation for fertility
3
Q
What is vitamin D deficiency associated with?
A
Hypocalcaemia
4
Q
Patients with high calcium, low PTH with cancer risk factors?
A
Think malignancy
5
Q
What is the management of hypoglycaemia with impaired GCS?
A
IV Glucose if access
6
Q
What characterises tertiary hyperparathyroidism?
A
- extremely high PTH
- moderately raised calcium
7
Q
What is the management of new onset graves disease to control symptoms?
A
- Propranolol
- Carbimazole used to induce remission
8
Q
Any change in vision for someone with thyroid eye disease needs what?
A
Urgent review by specialist
9
Q
What is the target HBa1c for those on hypoglycaemic medications for T2DM?
A
53
10
Q
What conditions make up MEN Type 2?
A
Medullary thyroid cancer, hypercalcaemia - parathyroid hyperplasia, phaeochromocytoma
11
Q
What would you see on blood test results for hypercalcaemia secondary to malignancy?
A
- Raised calcium
- low PTH
- low phosphate
- raised PTHrP
12
Q
What is the mode of action of orlistat?
A
inhibiting gastric and pancreatic lipase to reduce the digestion of fat
13
Q
What should patients on long-term steroids do during intercurrent illness?
A
Double steroid doses
14
Q
What adjunct can be used alongside orlistat for obese patients with one weight related co-mobidity?
A
Liraglutide
15
Q
Subclinical hyperthyroidism is associated with what?
A
atrial fibrillation, osteoporosis and possibly dementia
16
Q
What should be monitored to detect recurrence of medullary thyroid cancer?
A
Serum calcitonin
17
Q
What is definitive management of primary hyperparathyroidism?
A
Total parathyroidectomy
18
Q
Confusion, hypothermia, hyporeflexia, bradycardia, seizures and signs of hypothyroidism?
A
Myoxedema coma
19
Q
Patients with type I diabetes and a BMI > 25 should be considered for what?
A
Metformin alongside insulin
20
Q
Asymptomatic patients with abnormal HbA1c/fasting glucose need what?
A
Second abnormal reading
21
Q
hypothyroidism + goitre + anti-TPO triad suggests what?
A
Hashimotos thyroiditis
22
Q
Thyrotoxicosis with tender goitre?
A
Subacute thyroiditis / De Quervains
23
Q
What are sick day rules for T1DM?
A
- Insulin should not be stopped
- Increased frequency of checking blood sugars
- Drink atleast 3L fluids
- Replace meals with carbohydrate drinks if appetite is reduced
24
Q
What are sick day rules for T2DM?
A
- Stop oral hypoglycaemics and restart once eating and drinking is back to normal for 24-24 hours
- Do not stop insulin if using
- Monitor blood glucose more frequently as needed
25
Which drugs can cause galactorrhoea?
- Metoclopramide, domperidone
- Haloperidol
26
Who should diabetic foot problems be referred to?
Local diabetic foot centre
27
What does a patchy uptake on nuclear scintigraphy suggest?
Toxic multinodular goitre
28
Long term steroid use can lead to what?
Avascular necrosis
29
Steroids can cause what in the muscles?
Proximal myopathy
30
Which hormones are decreased in response to stress?
- Insulin
- Testosterone
- Oestrogen
31
What are the features of sick euthyroid syndrome?
Low T3/T4 with normal TSH during acute illness
32
What imaging should be done for those with suspected Cushings syndrome?
CT adrenal glands
33
2nd line medication for obese patient with T2DM?
DPP-4 inhibitors as least likely to cause weight gain
34
What would be seen on thyroid scintigraphy for someone with De Quervains thyroiditis?
Reduced iodine uptake
35
Peptic ulceration, galactorrhoea, hypercalcaemia all suggest what?
MEN type 1(pancreas, parathyroid, pituitary)
36
Glucocorticoid therapy can induce what?
Neutrophilia
37
What would be the urine osmolality for someone with primary polydipsia?
-Initially low
- After fluid deprivation: High
38
What features would be atypical for suspected T1DM?
- Age > 50
- BMI > 25
- Slow progression of hyperglycaemia
39
What tests should patients undergo if atypical presentation of T1DM?
- C peptide and diabetic autoantibodies
40
What is the treatment of a thyrotoxic storm?
- Beta blockers, IV fluids, propylthiouracil and steroids
41
What should women with hypothyroidism do when they are pregnant?
Increase thyroid hormone replacement by upto 50%
42
Presentation of HHS
1) Hypovolaemia
2) Hyperglycaemia
3) Significantly raised serum osmolarity
4) Absence of ketoacidosis.
43
What blood sugars suggest impaired fasting glycaemia?
Between 6.1 and 6.9
44
What are the target blood sugars for T1DM?
Waking - 5-7
Other times: 4-7
45
What can worsen thyroid eye disease in patients with Graves?
Radioiodine treatment
46
What does a raised C-peptide help to distinguish?
Raised - T2DM
Low = T1DM
47
Management of subclinical hypothyroidism?
Check TPO antibodies
48
If 3 diabetic drugs are not helping, what should be done?
Switch one of them for a GLP-1 e.g. exenatide
49
Side effect of piogliotazone
Peripheral oedema
50
Patient who have 2 hypoglycaemic episodes need what?
Surrender driving licence
51
How should steroid doses be altered during illness with Addisons?
Glucocorticoid e.g. hydrocortisone -> doubled
Fludrocortisone -> kept the same
52
What are the diabetic specific autoantibodies?
anti-GAD
53
Which diabetes med increases risk of bladder cancer?
Thiazolidinedione e.g Pioglitazone
54
Over replacement with thyroxine increases the risk of what?
Osteoporosis
55
Fluids resuscitation in DKA?
1L of IV 0.9% NaCl over 1 hour - if systemic BP >90
500ml of IV 0.9% NaCl over 5 mins if systemic BP <90
56
What would be the expected metabolite results in Cushings?
Hypokalaemia with metabolic alkalosis
57
Erratic blood glucose control, bloating and vomiting
Gastroparesis
58
What should every person with insulin be given for emergencies?
Glucagon kit
59
Headaches, amenorrhoea, visual field defects suggests what?
Prolactinoma
60
Thyrotoxicosis with tender goitre?
De Quervains thyroiditis
61
Elevated prolactin with secondary hypothyroidism and hypogonadism?
Non-functioning pituitary adenoma
62
increased TSH levels and normal T4 suggests what?
Poor compliance with thyroxine
63
What can mimic Cushings disease?
Excess alcohol consumption
64
Increased plasma 17-hydroxyprogesterone levels is suggestive of what?
Congenital adrenal hyperplasia
65
Primary vs secondary hyperaldosteronism?
If renin is high, secondary cause is likely i.e. renal artery stenosis
66
hyponatraemia, reduced plasma osmolality and increased urine osmolality suggests what?
SIADH
67
Symptoms of acromegaly?
- Spade like hands and feet
- Frontal bossing
- Macroglossia
- Headaches
- Bitemporal hemianopia
- Sleep disturbances
- Carpal tunnel
- HTN
68
What is the main cause of death in patients with acromegaly?
CVD
69
What are some signs of hypothyroidism?
- Dry hair/skin
- Goitre
- Mental slowness
- Ataxia
- Peripheral neuropathy
- Slow/relaxing reflexes
70
What are some signs of hyperthyroidism?
- Tachycardia
- AF
- Goitre
- Palmar erythema
- Brisk reflexes
71
Hashimotos vs Graves antibodies
Graves - anti TSH reception antibodies
Hashimotos - anti TPO antibodies
72
Where does thyroid gland originate from embryologically?
Foramen caecum
73
What are symptoms of neuroglycopenia?
- Coma
- Seizures
- Drowsiness
- Confusion
74
What are causes of hypoglycaemia in non-diabetic patients?
- Liver failure
- Addisons
- Alcohol binging
- Pituitary insufficiency
- Insulin secreting tumour
75
What happens to periods with hypo and hyperthyroidism?
Hypo - heavy periods
Hyper - irregular/no periods
76
Low serum calcium, low serum phosphate, raised ALP and raised PTH
Osteomalacia
77
What is latent autoimmune diabetes of adulthood and maturity onset diabetes of the young?
LADA - Late onset T1DM - usually aged 30-50
MODY - earl onset T2DM - usually under 25
78
What cardiac manifestations can occur with carcinoid syndrome?
- Pulmonary stenosis and tricuspid insufficiency
79
Management of an incidental pituitary mass?
Lab investigations to assess hormone hypersecretion/hypopituitarism
80
What is alcoholic ketoacidosis?
A euglycemic form of ketoacidosis occurring in alcoholics
- When they don't eat and they become malnourished, they start breaking down ketones
- Presents with metabolic acidosis, elevated ketones and normal/low glucose
- Tx with IV saline and thiamine
81
Depression, nausea, constipation, bone pain
Primary hyperparathyroidism
82
What is an important complication of fluid resus in DKA in children?
Cerebral oedema
83
When to start dextrose infusion in DKA?
When blood glucose is <14
84
Vit D deficiency vs CKD as cause of hyperparathyroidism
Vit d - low calcium and phosphate
CKD - low calcium but raised phosphate
85
What differentials for SIADH must be considered
Severe hypothyroidism + adrenal insufficiency
86
What is Klinefelters syndrome?
- 47 XXY
- Tall and slender male with small testes and gynaecomastia
- Low testosterone with raised FSH:LH
- Managed with HRT + regular monitoring for polycythaemia and DEXA scans for bone mineral density
87
Microvascular vs macrovascular complications of diabetes?
Micro - nephropathy, neuropathy, retinopathy
Macro - CVD/Stroke, MI, PVD
88
What is the pathophysiology of DKA?
Insulin deficiency produces glucose production in the liver;
lipolysis also occurs; fatty acids are broken done to form ketone
bodies which produce a metabolic acidosis
89
What should patients taking steroids be made aware of?
- carry steroid card
- medic alert bracelet
- know how to change dose for sick days
- carry emergency IM hydrocortisone
90
What sensation will be affected first in diabetic neuropathy?
Vibration
91
What findings may be present with diabetic neuropathy on feet?
- Joint deformity
- Painless ulcer
- Diminished reflexes
92
Vomiting in poorly controlled diabetic patient?
Think gastroparesis
93
carpal tunnel syndrome can be associated with what?
Acromegaly
94
What is the most common complication of thyroid eye disease?
Exposure keratopathy
95
What is the management of de Quervains thyroitidits?
Conservative with analgesia
96
What is the most common cause of Cushings syndrome?
Pituitary tumour secreting ACTH (Cushings disease)
97
What can cause low HbA1c?
Sickle cell/G6PD
Hereditary spherocytosis
Haemodialysis
98
Splenectomy can cause what?
Raised Hba1c
99
What is the key parameter to monitor in HHS?
Serum osmolality
100
How to differentiate between unilateral and bilateral sources of aldosterone excess?
High res CT
If normal, adrenal venous sampling
101
Moderate-severe aortic stenosis is a C/I to what?
ACE inhibitors
102
hypertension, hypokalaemia, and metabolic alkalosis
Conn's syndrome
103
Management of myoxedemic coma?
Thyroxine + Hydrocortisone
104
Management of thyroid storm?
Beta blockers, propylthiouracil and hydrocortisone
105
How should HHS fluids be given?
Slow infusion
106
What are signs of hypercalcaemia on ECG?
Short QT, J waves
107
Which diabetic medication is approved in CKD?
DPP inhibitors
108
What is the medical management for acromegaly?
- Somatostatin analogues e.g ocreotide
109
What is the diagnostic test for acromegaly?
Oral glucose tolerance test
110
What enzyme is deficient in congenital adrenal hyperplasia?
21-hydroxylase
111
What serum marker is raised in CAH?
17-OH progesterone
112
How does CAH present?
- Ambiguous genitalia
- Acne
- Hirsutism
- Delayed puberty
113
How is CAH managed?
- Glucocorticoid (hydrocortisone) and mineralocorticoid (fludrocortisone) replacement
114
If patients are asymptomatic for DM, what do you need?
2 abnormal readings
115
What are side effects of gliotazones?
- Weight gain
- Increased risk of fractures
- Fluid retention
116
Iron tablets/calcium carbonate tablets can have what effect?
Reduced absorption of levothyroxine -> give 4 hours apart
117
How does Cushing's disease present on dex suppression test?
ACTH and cortisol suppressed
118
What time gap should be kept when titrating metformin doses?
1 week
119
Which cancer is Hashimotos thyroiditis associated with?
MALT lymphoma
120
Thyrotoxicosis can lead to what?
high output cardiac failure
121
When should treatment with statins be discontinued?
If serum transaminase concentrations rise to 3 times the upper limit of reference ranges
122
Why does Cushing's cause tanned appearance?
ACTH has a stimulatory effect on the melanocytes due to affinity for the MSH receptor
123
Why does impaired hypoglycaemia awareness occur?
neuropathy of parts of the autonomous nervous system
124
Management of subclinical hypothyroidism
TSH > 10 - Consider thyroxine if this is present on 2 separate occasions atleast 3 months apart
TSH 5.5-10 - Consider 6 months of thyroxine if <65 and there are symptoms of hypothyroidism
If asymptomatic/older - watch and wait
125
What do each of the zones of the adrenals produce?
Zona glomerulosa - Mineralocorticoids - Aldosterone
Zona fasciculata - Glucocorticoids - Cortisol
Zona reticularis - Androgens
Medulla - Adrenaline/Noradrenaline
126
hyperkalaemic, hyponatraemic, hypoglycaemic metabolic acidosis
Adrenal Crisis - Addisons
127
How quickly should ketones fall in DKA?
Atleast 0.5 per hour
128
What are primary causes of hypogonadism?
- Trauma
- Mumps
- Iatrogenic
- Klinefelter's syndrome
129
What is the most common thyroid cancer?
- Papillary
130
What is the management of non adrenal adenoma hyperaldosteronism?
Spironolactone
131
Which cells of pancreas are affected in diabetes?
Beta pancreatic islet cells
132
What genetic mutations might T1DM have?
HLA-DR3/4
133
What time should serum cortisol be taken?
9am
134
Treatment of choice for toxic multinodular goitre?
Radioactive iodine
135
Osteoporosis in a man?
Check testosterone
136
What is the management of Addisonian crisis?
- Hydrocortisone
- 1L Saline
137
How do DPP-4 inhibitors work?
Increase incretin levels by reducing their peripheral breakdown
138
How should the dose of hydrocortisone be taken in someone with Addisons?
Majority in first half of the day
139
What should be corrected before giving bisphosphonates?
Hypocalcaemia
Vit D deficiency
140
Patient >75 with fragility fracture?
Start bisphosphonate without needing to do DEXA
141
What dose of glucose gel should be given to a patient with a low blood sugar?
10-20g
142
Which HTN drug an cause sexual dysfunction?
Thiazide-like diuretics e.g indapamide
143
How long should metformin be discontinued for after CT with contrast?
48 hours
144
In primary prevention of CVD, what should the non-HDL cholesterol reduce by?
>40% within the first 3 months
145
What should be done after treatment with bisphosphonates for 5 years?
Repeat DEXA and FRAX and stop if score <-2.5
146
Which diabetes medication is linked to Fournier's gangrene (necrotising fasciitis of the genitals)?
SGLT-2 inhibitors
147
What is the investigation of choice for suspected insulinoma?
72 hour fast
148
Ferrous sulphate can interact with what?
Levothyroxine
149
Management of hyperglycaemia in someone who has started enteral feeding?
Insulin
150
Management of steroid induced diabetes?
Sulfonylureas e.g. gliclazide
151
