Endocrinology Flashcards
(95 cards)
1
Q
What are the microvascular comps of DM?
A
Retinopathy
Nephropathy
Neuropathy
2
Q
Define Mody
A
Rare autosomal dominant form of type 2 DM that affects the young
3
Q
What fasting glucose level is dx of diabetes?
A
> 7
4
Q
When is HbA1c not a useful measure?
A
pregnancy
haemoglobinopathies
children
5
Q
What random plasma glucose is dx of diabetes?
A
11.1
6
Q
What tx can ophthalmology do to try and prevent progression of diabetic retinopathy?
A
Laser therapy
7
Q
Which autoantibodies are raised in type 1 DM?
A
Anti-GAD
Islet cell Abs
8
Q
Which test can hep differentiate type 1 DM from type 2?
A
C peptide
9
Q
At what HbA1c level would you start a patient on a second diabetic drug?
A
58
10
Q
What example drug would you commence if metformin alone has failed to tx dm?
A
Sulphonylurea (e.g. gliclazide)
11
Q
What is the main side effect of metformin?
A
GI upset (lactic acidosis if low GFR)
12
Q
What is a key benefit of using metformin?
A
Doesn’t cause hypoglycaemia
13
Q
What is the triad of symptoms present in HHS?
A
Hypovolaemia
Marked hyperglycaemia (>30)
Osmolality >320
14
Q
How does HHS px/
A
Extreme dehydration with altered mental state
15
Q
What is the tx for HHS?
A
Rehydrate slowly with 0.9% saline over 48 hrs
only use insulin if glucose not falling with fluids
16
Q
What can precipitate HHS/
A
Infection MI Dehydration Diuretics Poor control
17
Q
Which features make up metabolic syndrome?
A
Truncal obesity Hypertension reduced HDLs High triglycerides Pre-diabetes
18
Q
Which diseases is metabolic syndrome associated with?
A
T2DM
NAFLD
PCOS
CVD
19
Q
What BMI would class you as underweight?
A
Less than 18.5
20
Q
Which medications commonly cause obesity?
A
Corticosteroids Antidepresssants (esp mirtazapine) Sulphonylurea lithium Beta blockers
21
Q
Which drug can help tx obesity?
A
Orlistat (lipase inhibitor)
22
Q
Which conditions does untreated hypothyroidism predispose you to?
A
Heart disease
Dementia
23
Q
Which drugs most commonly cause hypothyroidism?
A
Lithium
Amiodarone
24
Q
Name some causes of hypothyroidism
A
Atrophic hypothyroidism Hashimotos thyroiditis Postpartum thyroiditis Drugs Iodine deficiency Thyroidectomy
25
What's the most common cause of hypothyroidism in the UK?
Atrophic hypothyroidism (no goitre)
26
What risks are associated with overmedication of levothyroxine?
Osteoporosis
| arrhythmia (AF)
27
What are the causes of hyperthyroidism?
Grave's disease
Toxic adenoma
Toxic multinodular goitre
De Quervains
28
Which antibodies are positive in graves?
Anti-TSH receptor Abs
29
Signs of thyroid eye disease
```
Lid lag
Lid retraction
Opthalmoplegia
Exophtalmus
diplopia
```
30
Which two drugs are used in the long term mx of hyperthyroidism?
Carbimazole
| Propylthiouracil
31
What is the main side effect associated with carbimazole?
Agranulocytosis leading to neutropaenic sepsis
32
What are the comps associated with hyperthyroidism?
```
HF
Angina
AF
Osteoporosis
Gynaecomastia
Thyroid storm
```
33
What is first line tx for thyroid storm?
propranolol IV
34
Which drugs would you give after propranolol to tx thyroid storm?
Carbimazole PO
Lugols solution
IV hydrocortisone
35
What is the most common cause of thyroid cancer?
Papillary carcinoma
36
Which drugs commonly cause hypercalcaemia?
THIAZIDES
| LITHIUM
37
Which causes of hypercalcaemia cause a raised ALP?
Bone metastases
Sarcoidosis
Thyrotoxicosis
Lithium
38
What does high calcium and low phosphate typically suggest?
Primary hyperparathyroidism
39
What would causes hypercalcaemia with raised/normal phosphate and normal ALP?
Myeloma
Vit D excess
Sarcoidosis
40
Which malignancies most commonly metastasise to bone?
Breast, kidney, bronchus, thyroid, prostate
41
What is the definitive tx for primary hyperparathyroidism?
Surgery
42
What conservative measure would you suggest to patient with mild primary hyperparathyroidism to prevent formation of renal stones?
Overhydration
43
What tx would protect BMD in primary hyperparathyroidism?
bisphosphonates
44
What is tx for acute severe hypercalcaemia?
Rehydrate (4-6l saline over 24 hours)
| IV bisphosphonates
45
What biochemical abnormalities would suggest secondary hyperparathyroidism?
High PTH, low calcium, high phosphate, low vit D
46
How can you treat secondary hyperparathyroidism due to CKD?
Calcitriol
| Gut phosphate binders
47
What are the causes of hypocalcaemia?
```
CKD
Hypoparathyroidism (e.g. post-surgery)
Vit D deficiency!!
Drugs
acute pancreatitis
```
48
What are the sx of hypocalcaemia?
```
Cramps
Perioral numbness
Carpopedal spasm (trousseaus sign)
Convulsions
psychosis
```
49
What is chvosteks sign?
Tapping of facial nerve causes ipsilateral twitching of facial muscles (seen in hypocalcaemia)
50
How do you adjust calcium for albumin level?
+0.1 for every 4g/L albumin is below 40
| -0.1 for every 4g/L albumin is above 40
51
Why do you need to adjust calcium for albumin level?
Only unbound albumin is physiologically important
52
Which hormone do pituitary adenomas most commonly produce in ranking order/
Prolactin > GH > ACTH > TSH > LH/FSH
53
What are the local effects of a pituitary adenoma?
Headache
| Visual field defects
54
How does a craniopharyngioma px?
Headache
Visual field defect
Hypopituitarism
55
What is the drug tx for prolactinoma?
Bromocriptine or cabergoline
56
What are the three main causes of raised prolactin?
Prolactinoma
Pregnancy/puerperium
Antipsychotics
57
How does prolactinoma px in men?
Erectile dysfunction and loss of libido
| +- mass effect
58
Which two conditions does acromegaly increase the risk of?
T2DM
| colon cancer
59
What are the symptoms of acromegaly?
```
Acroparaesthesia
Amennorhoea
Decreased libido
Headache
Increased sweating
Snoring
Arthralgia
back ache
```
60
What are the signs of acromegaly?
Increased growth of hands
Macroglossia
Acanthosis nigricans
carpel tunnel syndrome
61
How is acromegaly diagnosed?
OGTT (measure GH)
| Serum IGF-1
62
Why is a random GH test poorly diagnostic for acromegaly?
Secretion is pulsatile
63
How is acromegaly treated?
1) Transphenoidal surgery
| 2) Somatostatin analogues (e.g. octreotide) +- radiotherapy
64
What are the causes of cushings syndrome?
Iatrogenic (steroids)
Adrenal adenoma
```
Cushings disease
Ectopic ACTH (e.g. Small cell lung Ca)
```
65
What are the first line tests for cushings syndrome?
Overnight dexamethasone suppression test or 24h urinary free cortisol
66
Which antibodies are raised in autoimmune Addisons disease?
21-hydroxylase autoantibodies
67
What electrolyte abnormalities are seen in Addisons disease?
Low sodium
Raised potassium (memory tool = add k up, k conns down)
Low glucose
68
What test is diagnostic for Addisons disease?
Synacthen test (short ACTH stimulation test)
69
Which conditions is addisons associated with?
vitiligo
T1DM
pernicious anaemia
thyroid disorders
70
How do you manage Addisonian crisis?
Bloods for cortisol and ACTH
U & Es (for sodium and potassium)
IV HYDROCORTISONE STAT
71
What are the features of conn's syndrome?
Oedema (water and Na retention)
HTN
Hypokalaemia (weakness, cramps, paraesthesia)
72
What are the causes of secondary hyperaldosteronism?
```
Reduced renal perfusion:
renal artery stenosis
diuretics
CCF
accelerated hypertension
```
73
What are the Ix for hyperaldosteronism?
U & E
BP
ALDOSTERONE:RENIN ratio
74
What does a high aldosterone:renin ratio tell you?
PRIMARY hyperaldosteronism
75
Aet of hyperkalaemia
AKI and CKD
Addisons
Drugs (spironolactone, ACE-I/ARB, NSAID, heparin, beta blockers)
Burns, rhabdomyolysis, trauma
76
What ECG changes indicate hyperkalaemia?
Loss of P waves
PR prolonged
QRS widened
Peaked T waves
77
What are the main causes of hypokalaemia?
Diuretics
GI fluid loss (chronic diarrhoea)
hyperaldosteronism (conn's/cushings etc)
78
What are the sx of hyperkalaemia/
```
Fast irregular pulse
Chest pain
Weakness
Palpitations
Light-headedness
```
79
What are the sx of hypokalamia?
```
Muscle weakness
Hypotonia
Hyporeflexia
Cramps
Tetany
palps
light-headedness
```
80
What should you not do when tx hypokalaemia?
never give IV K+ as fast stat bolus!!
81
What are the ECG signs of hypokalaemia?
Small T waves
Prominent U waves
Long PR
Depressed ST segment
82
Which other electrolyte is important to check and correct in hypokalaemia?
magnesium
83
Define phaeochromocytoma
Catecholamine producing adrenal tumour
84
What are the main Ix for phaeochromocytoma?
24h urine for metanephrines/metadrenaline
| Abdo CT
85
What is first line tx for phaeochromocytoma?
```
alpha blockade (e.g. phenoxybenzamine) pre-operation
(only give beta blocker once BP controlled)
```
86
What molecule is released by tumours in carcinoid syndrome?
Serotonin
87
What are two of the most common symptoms of carcinoid syndrome?
Flushing
| Diarrhoea
88
Which cells form the tumour in carcinoid tumours?
enterochromaffin cells
89
What is the 1st line Ix for DI?
water deprivation test
90
What happens to urine and serum osmolality in DI?
Urine osmolality low
| Serum osmolality normal/high
91
What is the consequence of hydrated a DI patient with severe hypernatraemia too rapidly?
Cerebral oedema
92
How do you distinguish cranial DI from nephrogenic DI?
Give desmopressin and look for response during water deprivation test
MRI head
93
What are the three biochemical features of SiADH?
Concentrated urine
Hyponatraemia
Low plasma osmolality
(absence of hypovolaemia or oedema)
94
What can cause siADH?
Malignancy (e.g. small cell lung Ca)
CNS disorders
TB
drugs
95
How do you tx hyponatraemia?
Rule out drug causes - THIAZIDE DIURETICS
| Tx cause and fluid restrict
