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Daisy Finals Revision > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Which autoantibodies are present in Graves’ disease?

A

TSH receptor stimulating autoantibodies

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2
Q

Which conditions are antinuclear antibodies present in?

A

Lupus, Sjorens, scleroderma, rheum conditions

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3
Q

Which antibodies are present in Hashimotos?

A

anti thyroglobulin autoantibodies

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4
Q

What conditions are anti TPO autoantibodies present in?

A

90% hashimotos and 70% graves

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5
Q

What is the first line drug therapy for T2DM?

A

No CVD risk - metformin
CVD risk - metformin then add SGLT-2 inhibitor (-gliflozins)

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6
Q

What is the 2nd line drug therapy for T2DM?

A

Add one of
1. DPP-4 inhibitor - eg gliptins
2. Pioglitazone - eg Actos
3. Sulfonylurea - eg gliclazide
4. SGLT-2 inhibitor (if NICE criteria met) - eg gliflozin

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7
Q

Adverse effects of SGLT2 inhibitors

A
  • UTI/genital infection
  • normoglycaemic ketoacidosis
  • inc risk of lower limb amputation
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8
Q

C-peptide levels in T1DM?

A

Low

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9
Q

How is insulin given in DKA in t1 diabetics?

A

FIXED rate insulin
Stop short acting insulin
Continue long-acting insulin

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10
Q

What is the INITIAL management of DKA?

A

IV fluids

Then IV insulin

Possible addition of potassium to fluids if hypokalaemic

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11
Q

Which drugs cause gynaecomastia?

A
  • spironolactone (most common)
  • cimetidine
  • digoxin
  • cannabis
  • finasteride
  • GnRH agonists
  • oestrogens, anabolic steroids
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12
Q

What visual field defect is caused by a pituitary adenoma?

A

Bitemporal hemianopia

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13
Q

What is used to investigate for acromegaly?

A

Serum IGF-1 levels
If elevated, test GH level following hyperglycaemia during oral glucose load

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14
Q

How does PTH affect calcium and phosphate?

A
  1. Increases osteoclast activity at bone -> inc ca and phos into bloodstream
  2. At kidney -> incs hydroxylation and activation of vit D.
  3. Kidney -> inc ca reabsorption (Ca ^) and inc phosphate excretion (dec phos) in raised PTH
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15
Q

pathology of cushings syndrome?

A

excessive cortisol

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16
Q

causes of cushings?

A

exogenous steroids
pituitary adenoma (inc ACTH)
adrenal adenoma
paraneoplastic

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17
Q

conditions resulting from cushings?

A

hypertension
T2DM
depression
osteoporosis

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18
Q

diagnostic test for cushings?

A

dexamethasone suppression test

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19
Q

treatment for cushings?

A

treat the cause

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20
Q

presentation in addisons?

A

fatigue
cramps
abdo pain
acute: vomiting, drowsiness and hypotension

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21
Q

what is the cause of hyperpigmentation in addisons?

A

excessive ACTH stimulates melanocytes

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22
Q

pathology of primary adrenal insufficiency?

A

= addisons
damaged adrenals, dec secretion of cortisol and aldosterone

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23
Q

pathology of secondary adrenal insufficiency?

A

dec ACTH from pituitary

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24
Q

pathology of tertiary adrenal insufficiency?

A

dec CRH from the hypothalamus

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25
Q

key biochemical finding in addisons?

A

hyponatraemia

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26
Q

diagnostic test for addisons?

A

short synacthen test

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27
Q

treatment in addisons?

A

hydrocortisone to replace cortisol
fludrocortisone to replace aldosterone

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28
Q

clinical feature specific to grave’s dx?

A

exophthalmos
diffuse goitre
pretibial myxoedema

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29
Q

causes of raised t3 and t4?

A

graves
toxic multinodular goitre
thyroiditis (eg de quervains)

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30
Q

symptomatic tx of grave’s?

A

propranolol

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31
Q

definitive tx options for graves?

A

carbimazole
propylthiouracil
radioactive iodine
surgery

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32
Q

dx: 45 yo F with tiredness, weight gain, low mood, dry skin and constipation

A

hypothyroidism (hashimotos thyroiditis)

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33
Q

antibodies ass w/ hashimotos thyroiditis?

A

anti TPO
anti thyroglobulin

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34
Q

what happens to TFTs in hashimotos thyroiditis?

A

TSH ^
T3/T4 - low

35
Q

other causes of low t3/4 and high tsh?

A

iodine deficiency
tx for hyperthyroidism
medications (eg lithium)

36
Q

tx for hypothyroidism?

A

levothyroxine

37
Q

3 criteria for DKA?

A

hyperglycaemia
ketosis
acidosis

38
Q

initial mgt of DKA?

A

FIG PICK
Fluids
Insulin
Glucose
Potassium
Infection (treat cause)
Chart fluid balance
Ketone monitoring

39
Q

which hormone is raised in acromegaly?

A

growth hormone

40
Q

most common cause of acromegaly?

A

pituitary adenoma

41
Q

visual field defect in acromegaly?

A

bitemporal hemianopia

42
Q

initial blood test in acromegaly?

A

insulin-like growth factor-1

43
Q

definitive management of pituitary adenoma?

A

trans-sphenoidal removal

44
Q

options for blocking growth hormone?

A

GH antagonist (pegvisomant)
somatostatin analogues (octreotide)
dopamine agonists (bromocriptine)

45
Q

which cancer does acromegaly increase the risk of?

A

colorectal

46
Q

how does PTH increase serum calcium?

A

inc osteoclast activity in bones
inc absorption in kidneys
inc vit D activity -> inc gut absorption

47
Q

how does hypercalcaemia present?

A

renal stones
bone pain
abdominal groans
psychiatric moans

48
Q

cause of primary hyperparathyroidism?

A

tumour

49
Q

cause of secondary hyperparathyroidism?

A

dec vit D or CKD (most common)

50
Q

cause of tertiary hyperparathyroidism?

A

hyperplasia

51
Q

calcium in primary, secondary and tertiary hyperparathyroidism?

A

1 - raised
2 - low or normal
3 - high

52
Q

which enzyme converts angiotensinogen to angiotensin I?

A

renin

53
Q

most common causes of conn’s?

A

adrenal adenoma
bilateral adrenal hyperplasia

54
Q

secondary causes of conn’s?

A

renal artery stenosis
renal artery obstruction
ht failure

55
Q

what happens to renin in primary hyperaldosteronism?

A

decreased

56
Q

what happens to renin in secondary hyperaldosteronism?

A

inc

57
Q

examination finding in conns?

A

hypertension

58
Q

electrolyte finding in conns?

A

hypokalaemia

59
Q

blood gas finding in conns?

A

alkalosis

60
Q

2 examples of aldosterone antagonists?

A

spironolactone
eplenerone

61
Q

where is ADH secreted?

A

posterior pituitary

62
Q

sodium findings in SIADH?

A

blood sodium LOW
urine sodium HIGH

63
Q

source of ectopic ADH?

A

small cell lung cancer

64
Q

treatment of SIADH?

A

fluid restriction
ADH receptor blockers eg tolvaptan

65
Q

concern with rapid changes in blood sodium?

A

central pontine myelinolysis

66
Q

other endocrine cause of hyponatraemia (other than SIADH)?

A

adrenal insufficiency

67
Q

common meds causing hyponatraemia?

A

diuretics
NSAIDs
SSRIs
carbemazepine

68
Q

causes of a low blood and urinary sodium?

A

sweating
diarrhoea
burns
vomiting

69
Q

what is cranial DI?

A

lack of ADH

70
Q

what is nephrogenic DI?

A

lack of response to ADH

71
Q

what is serum osmolality in DI?

A

high

72
Q

urine osmolality in DI?

A

low

73
Q

test of choice in DI?

A

water deprivation test

74
Q

urine osmolality after water deprivation in DI?

A

low

75
Q

urine osmolality after ADH in DI?

A

CRANIAL - HIGH
NEPHROGENIC - LOW
(head is higher than kidneys)

76
Q

medical tx for DI?

A

desmopressin

77
Q

pathology of phaeochromocytoma?

A

adrenal tumour releasing excess of adrenaline

78
Q

symptoms of phaeochromocytoma?

A

intermittent:
anxiety
sweating
headache
palpitations

79
Q

what part of the adrenal gland is affected in phaeo?

A

chromaffin cells in adrenal medulla

80
Q

genetic condition associated with phaeo?

A

MEN2

81
Q

10% rule in phaeochromocytoma?

A

10% bilateral
10% cancerous
10% outside the adrenals

82
Q

initial tests for phaeo?

A

24 hour urine catecholamines
plasma free metanephrines

83
Q

management of phaeo?

A

alpha blockers first (eg phenoxybenzamine)
beta blockers
adrenalectomy to remove tumour

84
Q
A

Daisy Finals Revision (25 decks)

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