Endocrinology Flashcards
(144 cards)
1
Q
What is the first line investigation for acromegaly?
A
If a patient shows some of typical clinical features of acromegaly e.g. increased sweating, headaches, hands and feet enlargement, or many of the conditions associated with acromegaly or a pituitary mass, it is recommended to measure IGF-1
The OGTT test is recommended to confirm the diagnosis if IGF-1 levels are raised.
2
Q
Which alpha blocker is used to control blood pressure in phaeochromocytoma?
A
Phenoxybenzamine
3
Q
What is the common type of lung malignancy that gives rise to Cushing’s syndrome?
A
Small cell lung cancer
4
Q
What is the name for an extra-adrenal Phaeochromocytoma?
A
A paraganglioma
5
Q
What is the commonest cause of Hirsutism?
A
PCOS
6
Q
What class of anti-hypertensive drugs are used to treat people with mineralocorticoid excess?
A
Potassium sparing diuretics
7
Q
What are the hyperosmolar symptoms of diabetes?
A
Polyuria Polydipsia Polyphagia Visual blurring Fatigue
8
Q
Can testosterone replacement restore male infertility?
A
No, because it does not act on sperm producing cells in the testes. Gonadotrophin therapy is required for this to happen.
9
Q
Which are the main medications used to treat Grave’s disease?
A
Carbimazole and Propylthiouracil
10
Q
What is the difference between wet and dry gangrene?
A
Gangrene is dead tissue. Wet gangrene represents bacterial infection.
11
Q
What symptoms might you see in a patient with primary hyperthyroidism?
A
Weight loss
Anxiety
Heat intolerance
Sweats
GI upset
Palpitations
Oligo-/amenorrhoea
Irritability
12
Q
What are the essential components of ‘thyroid function tests’ for making a correct diagnosis?
A
TSH, T3, T4 and thyroid auto-antibodies.
13
Q
What is the level of hypotonicity of plasma required to make a diagnosis of SIADH
A
Plasma osmolality < 270 mOsm/kg
14
Q
Which test can confirm the diagnosis of Diabetes Insipidus?
A
Patients are allowed fluids overnight but then fast for 8 hours during the day accompanied by hourly weights, urine volume and paired osmolalities. If body weight reduces by 5%, the test is ceased early. After 8 hours, the patient is given IM desmopressin and the urine volume and paired osmolalities are measured over the next 4 hours.
15
Q
Which diagnostic test is used to confirm diabetes insipidus?
A
Fluid deprivation test
16
Q
What is the most important aspect of the management of an individual with diabetes long term?
A
Blood pressure control
17
Q
What does the term Acromegaly mean?
A
Big limbs
18
Q
What common electrolyte disturbance do you tend to get in Cushing’s syndrome?
A
Hypokalaemia
19
Q
What is the name given to pituitary driven ACTH excess?
A
Cushing’s disease
20
Q
Thyroid gland overactivity normally has what effect on TSH production?
A
TSH suppression
21
Q
What is the level of urine osmolality required to make a diagnosis of SIADH
A
Greater than 100 mOsm/kg
22
Q
How is the diagnosis of Addison’s disease confirmed?
A
Short synacthen test
23
Q
What are the common symptoms of an underactive thyroid?
A
Lethargy
Tiredness
Weakness
Cold intolerance
Weight gain
Myalgia
Constipation
Dry hair
Skin thickening
Infertility
24
Q
What are the bone complications of an early menopause?
A
Osteoporosis
25
How long can a person with type 1 diabetes live on average without insulin?
8 months
26
How does chronic renal failure cause hyperprolactinaemia?
Reduced renal clearance
27
What is the major cause of death in people with type 2 diabetes?
Cardiovascular disease
28
What are the results on the fluid deprivation that would suggest cranial diabetes insipidus?
Cranial diabetes insipidus is diagnosed by low urine osmolality (less than 300 mOsm/kg) after fluid deprivation but then normalised osmolality after desmopressin is given since the underlying pathology is deficiency in hormone quantity.
29
Which drug commonly used for bipolar disorder can cause nephrogenic diabetes insipidus?
Lithium
30
Which peripheral pulses are checked when undertaking a diabetic foot assessment?
Dorsalis pedis and posterior tibial pulses.
31
Which test can be used to confirm the presence of diabetic peripheral neuropathy?
Nerve conduction studies or electromyography
32
How is the diagnosis of Addison's disease confirmed?
Short synacthen test
33
What is the chromosomal abnormality in Turner's syndrome?
45 XO
34
What are the signs of testosterone excess in females
Amenorrhoea, hirsutism, deep voice, acne, frontal balding, large muscles and mood changes
35
Which technique is used to diagnoses peripheral arterial disease?
Ankle brachial pressure index (ABPI)
36
Which anti-emetic agents are useful in the treatment of gastroparesis?
Domperidone and Metoclopramide
37
What are the macrovascular complications of diabetes?
Myocardial infarction, stroke and peripheral arterial disease.
38
What is the most common type of diabetic neuropathy?
Peripheral neuropathy
39
What is a Charcot joint?
A neuropathic joint
40
What is the name of the iron loading disorder that can cause bronze diabetes and hypogonadism
Haemochromatosis
41
How is the diagnosis of adrenal insufficiency confirmed?
Short synacthen test
42
What is the aetiology of primary polydipsia?
Psychological
43
What is the best initial treatment of an Addisonian crisis?
IV fluids and IV steroids
44
What is the name for a large baby in utero?
Macrosomia
45
By which routes can testosterone replacement therapy be administered?
Oral, buccal, topical, intra-muscular.
46
What is the best test to confirm the diagnosis of Acromegaly?
Oral glucose tolerance test
47
What are the 2 main causes of Pseudocushing's?
Alcohol excess and severe depression.
48
What drop in BP is required to diagnose postural hypotension?
A fall in systolic BP of 20mmHg or more.
49
What is the name of the stable plasma metabolite of Growth Hormone?
Insulin-like growth factor 1 (IGF-1)
50
Which metabolic conditions need to be excluded for a diagnosis of SIADH to be confirmed?
Adrenal failure, thyroid dysfunction and renal impairment
51
What causes the offensive egg smelling burps emitted by patients with gastroparesis?
Small gut bacterial overgrowth
52
What are the results on the fluid deprivation that would suggest nephrogenic diabetes insipidus?
In nephrogenic diabetes insipidus, urine osmolality remains low even after desmopressin is given since the underlying pathology is impaired ability to respond to the hormone.
53
What are the complications of Acromegaly?
```
Visual fields defect
Hypopituitarism
Obstructive sleep apnoea
Type two diabetes mellitus
Arthritis
Carpal tunnel syndrome
Hyperhidrosis
Hypertension
Increased risk of colonic polyps
Ischaemic heart disease
Cerebrovascular disease
Congestive cardiac failure
Increased prevalence of regurgitant valvular heart disease
```
54
What dose of IV Hydrocortisone should be administered acutely during an Addisonian crisis?
100mg IV. Which can be followed by 100mg IM 6 hourly.
55
What causes type 2 amiodarone induced thyrotoxicosis?
Thyroiditis
56
Which ethnic groups are at higher risk of gestational diabetes?
Middle eastern, south Asian and Afro-Caribean groups.
57
What is the name for excess fetal liquor (amniotic fluid)?
Polyhydramnios
58
What is the manifestation of optic chiasm compression by a pituitary tumour?
Bitemporal visual field defects
59
What is the definitive treatment for Acromegaly?
Pituitary surgery / hypophysectomy
60
What effect on the patients full blood count needs to be monitored in those on testosterone HRT.
Polycythaemia
61
If a patient becomes hypopituitary post-surgery, what anterior pituitary hormones may they be deficient in?
LH, FSH, Growth hormone, TSH, Prolactin and ACTH
62
What is the name of the enzyme process in which cholesterol is converted into cortisol?
Steroidogenesis
63
What are the vasa nervorum?
The vasa nervorum are an irregular source of nutrition that supplies each peripheral nerve from adjacent blood vessels.
64
What is the underlying aetiology of Grave's disease
Auto-immune - caused by antithyroid antibodies
65
How is successful pituitary surgery for Cushing's disease confirmed?
Persistently low serum cortisol level of < 50 nmol/L
66
What is the cause of Acromegaly?
Acromegaly is a condition resulting from excessive growth hormone secretion, usually due to a secreting pituitary adenoma.
The abundant circulating growth hormone results in excessive production of insulin like growth factor (IGF-1) which is responsible for inappropriate growth.
67
Apart from neurosurgery and medical therapy what other modalities of treatment can be used to treat pituitary tumours?
Radiotherapy
68
What symptoms can identify heart disease?
Chest pain, dyspnoea, palpitations, peripheral oedema.
69
What is the treatment for primary hypothyroidism?
Thyroid hormone replacement with levothyroxine
70
How do patients often describe the pain caused by painful diabetic neuropathy?
Burning, aching, crushing, cramping or gnawing pain.
71
What is the name given to the type of leg weakness that makes going up and down stairs difficult?
Proximal myopathy
72
What is the name given to adrenal haemorrhage following meningococcal sepsis?
Waterhouse-Friedrichson syndrome
73
What is the pattern of TFT's you would expect in T3 toxicosis?
Suppressed TSH
Normal T4
Elevated T3
74
What is the commonest cause of mineralocorticoid excess?
Bilateral adrenal gland hyperplasia
75
What pattern of uptake would you expect to see on a thyroid uptake scan in a patient with type 1 amiodarone induced thyrotoxicosis?
Normal uptake
76
What is the best way to avoid autonomic complications of diabetes?
Long term stable glucose control
77
Which is the best screening test for Phaeochromocytoma?
Plasma metanephrines
78
What are the GI symptoms associated with Addisons Disease ?
Nausea
Vomiting
Diarrhoea
Abdominal pain.
79
What is the treatment of choice for Conn's syndrome?
Laparoscopic adrenalectomy
80
Which is the preferred opiate to use for painful diabetic neuropathy?
Tramadol
81
What is the concentration of iodine in Amiodarone?
Iodine makes up 39% by weight of Amiodarone.
82
How does excessive exercise cause amenorrhoea?
Hypothalamic regulation
83
What is larval therapy?
The use of maggots to eat away dead wound tissue
84
Which imaging technique is the best for diagnosing osteomyelitis in patients with diabetic foot ulcers?
MRI scanning
85
What is a commonly used screening test for hyperaldosteronism?
An elevated aldosterone to renin ratio (ARR)
86
What pattern of gonadotrophin and testosterone results would primary testicular failure give you?
Low testosterone, high LH and FSH.
87
What is the purpose of a plain film X-ray in the assessment of diabetic foot ulceration?
To look for gas forming infections in the soft tissue (not to assess for osteomyelitis)
88
What are the manifestations of hyperproalctinaemia in men?
Reduced libido
Erectile dysfunction
Infertility
Galactorrhoea
89
What is a fetid foot?
An extensive combined infection involving bone and soft tissue.
Fetid foot represents a combined deep-skin and soft-tissue infection caused by pathogens involved in chronic osteomyelitis
90
Which neurotransmitter pathways does Duloxetine act on to block painful diabetic neuropathy?
Duloxetine is an SNRI so block serotonin and noradrenaline reuptake.
91
What is the ideal target HbA1c for most people with type 1 diabetes?
48 mmol/mol (6.5%)
92
What causes type 1 amiodarone induced thyrotoxicosis?
Iodine toxicity
93
What BMI cut off defines obesity?
30kg/m2
94
Which medications can cause hirsutism?
Steroids, phenytoin and ciclosporin
95
What is the major cause of death in people with diabetes?
Heart disease /MI
96
What is the first line treatment for Acromegaly?
Transsphenoidal surgery
97
How long do long acting insulin analogies such as Lantus tend to last for in the body?
18-24 hrs
98
How does hyperglycaemia exacerbate postural hypotension?
High glucose levels lead to frequent urination which leads to dehydration and a reduction in circulating volume.
99
What long term imaging / screening tests do patients with Acromegaly require?
Echocardiography and colonoscopy
100
What causes type 1 diabetes?
Auto-immune pancreatic islet cell destruction
101
What is the common metabolic complication of Acromegaly?
T2DM
102
What is the commonest cause of ACTH dependent Cushing's syndrome?
Pituitary adenoma (Cushing's disease)
103
What do NICE recommend as the first line insulin therapy in patients with type 2 diabetes?
Isophane / NPH insulin
104
Which skin condition is commonly associated with Addison's disease?
Vitiligo
105
What electrolyte abnormalities might be associated with Addison's disease?
Hyponatraemia
Hypokalaemia
Hyperuricaemia
106
Which narcotics can cause hyperprolactinaemia?
Opiates and Cocaine
107
What psychiatric symptom is most commonly found in hypothyroidism?
Depression
108
If a diabetic ulcer is deep and exposes bone tissue what complication is highly likely?
Osteomyelitis
109
How many litres of urine produced per day would be suggestive of diabetes insipidus?
3 or more litres
110
Novorapid is what type of insulin?
Rapid acting insulin analogue
111
What are the symptoms of hypogonadism?
Erectile dysfunction, loss of libido, muscle atrophy, central weight gain, reduction in beard growth and shaving frequency, depression.
112
What class of drugs are used to treat macroprolactinomas?
Dopamine agonists
113
What is the name of the long acting dopamine agonist used to treat hyperprolactinaemia?
Cabergoline
114
Name some inflammatory disorders that can cause secondary adrenal insufficiency
Sarcoidosis
Histiocytosis X
Haemochromatosis
Lymphocytic hypophysitis
115
What are the causes of cranial diabetes insipidus?
Cranial diabetes insipidus may be a result of a genetic condition or an acquired condition, such as trauma to the head, tumours, inflammatory conditions e.g. sarcoidosis, cranial infections e.g. meningitis, vascular conditions e.g. sickle cell disease or idiopathic.
116
What are the causes of Nephrogenic diabetes insipidus?
Nephrogenic diabetes insipidus may be caused due to a genetic condition or an acquired condition, such as drugs e.g. lithium, metabolic disturbances e.g. hypercalcaemia, hypokalaemia, hyperglycaemia, chronic renal disease or postobstructive uropathy.
117
What is the best time of day to measure testosterone levels
9am
118
Early satiety is a feature of which GI complication of diabetes?
Gastroparesis
119
What medication can be used to help the body retain salt
Fludrocortisone
120
What pattern of gonadotrophins and sex steroids would you expect to see in premature ovarian failure?
Raised gonadotrophins
| Low oestrogen
121
How is an overnight dexamethasone suppression test performed?
1mg oral Dexamethasone taken at midnight followed by a 9am cortisol blood test.
122
What is the name given to severe hypothyroidism leading to marked symptoms and a reduced level of consciousness?
Myxoedema coma
123
What is the first line treatment for Cushing's disease in the majority of cases?
Trans-sphenoidal surgery
124
What are the 5 major risk factors for coronary heart disease?
Diabetes, family history, hypercholesterolaemia, smoking and hypertension
125
Which antibodies would you initially test for in suspected Grave's disease?
TSH receptor antibodies
126
What are the medical treatment options to treat Acromegaly?
The main treatment is using a somatostatin receptor ligands (SLR) Other options include cabergoline (dopamine agonist) or pegvisomant
127
Which sex tends to be more affected by thyroid disorders?
Females
128
How is weight related amenorrhoea managed?
Encourage weight gain and refer to a dietician if necessary. If an eating disorder is suspected, consider referral to a psychiatrist.
129
What classes of drugs can cause hyperprolactinaemia?
Anti-depressants, anti-emetics, neuroleptics, opiates, PPI’s.
130
What is the likely cause of infertility if gonadotrophin and oestrogen levels are low?
Hypothalamic / pituitary problem
131
Which of the tricyclic antidepressants has a role in the treatment of painful diabetic neuropathy?
Amitriptyline
132
Which drugs are commonly associated with erectile dysfunction?
Alcohol and cannabis
133
Which urgent blood tests should be taken during a suspected Addisonian crisis?
Electrolytes
Glucose
Cortisol
ACTH
134
What are the symptoms of intermittent claudication?
Calf pain on walking
| Relief by resting
135
What is HHS characterised by?
1. ) Severe hyperglycaemia
2. ) Dehydration and renal failure
3. ) Mild/absent ketonuria
136
How Is the management of HHS carried out?
The central management of HHS is supportive care and slow metabolic resolution. Patient with HHS often have a deficit of over 8 litres. Caution to avoid rapid fluid replacement as rapid osmolar shifts can cause cerebral oedema.
First priority should be fluid resuscitation. The commencement of an insulin sliding scale would be a close second and in reality, would probably be prescribed at the same time although some schools of thought advise waiting 1 hour before starting insulin to avoid rapid changes and pontine myelinolysis. The fluid alone will lower the blood sugar and some argue that giving insulin straight away can lower the osmolality precipitously.
137
What is the drug therapy pathway for those who can tolerate metformin in T2DM?
Metformin is still first-line and should be offered if the HbA1c rises to 48 mmol/mol (6.5%)* on lifestyle interventions
if the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should be added from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%) then triple therapy with one of the following combinations should be offered:
→ metformin + gliptin + sulfonylurea
→ metformin + pioglitazone + sulfonylurea
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered
138
What is the drug therapy pathway for those who cannot tolerate metformin in T2DM?
if the HbA1c rises to 48 mmol/mol (6.5%)* on lifestyle interventions, consider one of the following:
→ sulfonylurea
→ gliptin
→ pioglitazone
if the HbA1c has risen to 58 mmol/mol (7.5%) then a one of the following combinations should be used:
→ gliptin + pioglitazone
→ gliptin + sulfonylurea
→ pioglitazone + sulfonylurea
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%) then consider insulin therapy
139
A 34-year-old lady is admitted with recurrent episodes of non-specific abdominal pain. On each admission all blood investigations are normal, as are her observations. On this admission a CT scan was performed. This demonstrates a 1.5cm nodule in the right adrenal gland. This is associated with a lipid rich core. Urinary VMA is within normal limits. Other hormonal studies are normal.
Benign incidental adenoma
This is typical for a benign adenoma.Benign adenomas often have a lipid rich core that is readily identifiable on CT scanning. In addition the nodules are often well circumscribed.
140
How can you distinguish between primary adrenal failure and secondary adrenal insufficiency?
Skin hyperpigmentation
Primary adrenal failure is where the problem is located in the adrenal gland. As the adrenal gland isn't functioning as normal it is secreting a smaller amount of cortisol than it should be. This leads to the pituitary gland responding to this drop in cortisol by secreting more ACTH. ACTH is derived from a larger precursor called pro-opiomelanocortin (POMC), which also happens to be a precursor for beta-endorphin (which isn't important in this case) and melanocyte stimulating hormone (MST). MST, as the name suggests, stimulates melanocytes giving the hyperpigmentation that can be seen in primary adrenal failure.
This process is not seen in secondary adrenal insufficiency, as the underlying mechanism of this is hypopituitarism. This means that, as opposed to a lack of cortisol production as in primary disease, the problem is from a lack of ACTH. A lack of ACTH production means that there is also a lack of POMC, and hence a lack of MST.
141
What is the single most useful test for determining the cause of hypercalcaemia?
Parathyroid hormone levels are useful as malignancy and primary hyperparathyroidism are the two most common causes of hypercalcaemia. A parathyroid hormone that is normal or raised suggests primary hyperparathyroidism.
142
Diabetes with the mutation in HNF - 1 alpha management?
Maturity onset diabetes of the young (MODY) - type Hepatic Nuclear Factor 1 Alpha (HNF1A). HNF1A accounts for 70% of MODY cases. Sulfonylureas (e.g. gliclazide) are the optimal treatment in HNF1A-MODY.
143
What is an Addisonian Crisis?
An Addisonian crisis is characterised by hyperkalaemic metabolic acidosis. Symptoms include abdominal pain, confusion, nausea, and vomiting.
144
What can be caused by carbimazole?
Agranulocytosis
