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Y3 Hard Qs > Endocrinology > Flashcards

Endocrinology Flashcards

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.

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2
Q

Which alpha blocker is used to control blood pressure in phaeochromocytoma?

A

Phenoxybenzamine

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3
Q

What is the common type of lung malignancy that gives rise to Cushing’s syndrome?

A

Small cell lung cancer

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4
Q

What is the name for an extra-adrenal Phaeochromocytoma?

A

A paraganglioma

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5
Q

What is the commonest cause of Hirsutism?

A

PCOS

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6
Q

What class of anti-hypertensive drugs are used to treat people with mineralocorticoid excess?

A

Potassium sparing diuretics

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7
Q

What are the hyperosmolar symptoms of diabetes?

A 
Polyuria
Polydipsia
Polyphagia
Visual blurring
Fatigue
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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.

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9
Q

Which are the main medications used to treat Grave’s disease?

A

Carbimazole and Propylthiouracil

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10
Q

What is the difference between wet and dry gangrene?

A

Gangrene is dead tissue. Wet gangrene represents bacterial infection.

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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

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12
Q

What are the essential components of ‘thyroid function tests’ for making a correct diagnosis?

A

TSH, T3, T4 and thyroid auto-antibodies.

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13
Q

What is the level of hypotonicity of plasma required to make a diagnosis of SIADH

A

Plasma osmolality < 270 mOsm/kg

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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.

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15
Q

Which diagnostic test is used to confirm diabetes insipidus?

A

Fluid deprivation test

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16
Q

What is the most important aspect of the management of an individual with diabetes long term?

A

Blood pressure control

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17
Q

What does the term Acromegaly mean?

A

Big limbs

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18
Q

What common electrolyte disturbance do you tend to get in Cushing’s syndrome?

A

Hypokalaemia

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19
Q

What is the name given to pituitary driven ACTH excess?

A

Cushing’s disease

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20
Q

Thyroid gland overactivity normally has what effect on TSH production?

A

TSH suppression

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21
Q

What is the level of urine osmolality required to make a diagnosis of SIADH

A

Greater than 100 mOsm/kg

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22
Q

How is the diagnosis of Addison’s disease confirmed?

A

Short synacthen test

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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

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24
Q

What are the bone complications of an early menopause?

A

Osteoporosis

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25
Q

How long can a person with type 1 diabetes live on average without insulin?

A

8 months

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26
Q

How does chronic renal failure cause hyperprolactinaemia?

A

Reduced renal clearance

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27
Q

What is the major cause of death in people with type 2 diabetes?

A

Cardiovascular disease

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28
Q

What are the results on the fluid deprivation that would suggest cranial diabetes insipidus?

A

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.

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29
Q

Which drug commonly used for bipolar disorder can cause nephrogenic diabetes insipidus?

A

Lithium

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30
Q

Which peripheral pulses are checked when undertaking a diabetic foot assessment?

A

Dorsalis pedis and posterior tibial pulses.

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31
Q

Which test can be used to confirm the presence of diabetic peripheral neuropathy?

A

Nerve conduction studies or electromyography

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32
Q

How is the diagnosis of Addison’s disease confirmed?

A

Short synacthen test

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33
Q

What is the chromosomal abnormality in Turner’s syndrome?

A

45 XO

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34
Q

What are the signs of testosterone excess in females

A

Amenorrhoea, hirsutism, deep voice, acne, frontal balding, large muscles and mood changes

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35
Q

Which technique is used to diagnoses peripheral arterial disease?

A

Ankle brachial pressure index (ABPI)

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36
Q

Which anti-emetic agents are useful in the treatment of gastroparesis?

A

Domperidone and Metoclopramide

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37
Q

What are the macrovascular complications of diabetes?

A

Myocardial infarction, stroke and peripheral arterial disease.

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38
Q

What is the most common type of diabetic neuropathy?

A

Peripheral neuropathy

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39
Q

What is a Charcot joint?

A

A neuropathic joint

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40
Q

What is the name of the iron loading disorder that can cause bronze diabetes and hypogonadism

A

Haemochromatosis

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41
Q

How is the diagnosis of adrenal insufficiency confirmed?

A

Short synacthen test

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42
Q

What is the aetiology of primary polydipsia?

A

Psychological

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43
Q

What is the best initial treatment of an Addisonian crisis?

A

IV fluids and IV steroids

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44
Q

What is the name for a large baby in utero?

A

Macrosomia

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45
Q

By which routes can testosterone replacement therapy be administered?

A

Oral, buccal, topical, intra-muscular.

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46
Q

What is the best test to confirm the diagnosis of Acromegaly?

A

Oral glucose tolerance test

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47
Q

What are the 2 main causes of Pseudocushing’s?

A

Alcohol excess and severe depression.

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48
Q

What drop in BP is required to diagnose postural hypotension?

A

A fall in systolic BP of 20mmHg or more.

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49
Q

What is the name of the stable plasma metabolite of Growth Hormone?

A

Insulin-like growth factor 1 (IGF-1)

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50
Q

Which metabolic conditions need to be excluded for a diagnosis of SIADH to be confirmed?

A

Adrenal failure, thyroid dysfunction and renal impairment

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51
Q

What causes the offensive egg smelling burps emitted by patients with gastroparesis?

A

Small gut bacterial overgrowth

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52
Q

What are the results on the fluid deprivation that would suggest nephrogenic diabetes insipidus?

A

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.

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53
Q

What are the complications of Acromegaly?

A 
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
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54
Q

What dose of IV Hydrocortisone should be administered acutely during an Addisonian crisis?

A

100mg IV. Which can be followed by 100mg IM 6 hourly.

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55
Q

What causes type 2 amiodarone induced thyrotoxicosis?

A

Thyroiditis

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56
Q

Which ethnic groups are at higher risk of gestational diabetes?

A

Middle eastern, south Asian and Afro-Caribean groups.

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57
Q

What is the name for excess fetal liquor (amniotic fluid)?

A

Polyhydramnios

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58
Q

What is the manifestation of optic chiasm compression by a pituitary tumour?

A

Bitemporal visual field defects

59
Q

What is the definitive treatment for Acromegaly?

A

Pituitary surgery / hypophysectomy

60
Q

What effect on the patients full blood count needs to be monitored in those on testosterone HRT.

A

Polycythaemia

61
Q

If a patient becomes hypopituitary post-surgery, what anterior pituitary hormones may they be deficient in?

A

LH, FSH, Growth hormone, TSH, Prolactin and ACTH

62
Q

What is the name of the enzyme process in which cholesterol is converted into cortisol?

A

Steroidogenesis

63
Q

What are the vasa nervorum?

A

The vasa nervorum are an irregular source of nutrition that supplies each peripheral nerve from adjacent blood vessels.

64
Q

What is the underlying aetiology of Grave’s disease

A

Auto-immune - caused by antithyroid antibodies

65
Q

How is successful pituitary surgery for Cushing’s disease confirmed?

A

Persistently low serum cortisol level of < 50 nmol/L

66
Q

What is the cause of Acromegaly?

A

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
Q

Apart from neurosurgery and medical therapy what other modalities of treatment can be used to treat pituitary tumours?

A

Radiotherapy

68
Q

What symptoms can identify heart disease?

A

Chest pain, dyspnoea, palpitations, peripheral oedema.

69
Q

What is the treatment for primary hypothyroidism?

A

Thyroid hormone replacement with levothyroxine

70
Q

How do patients often describe the pain caused by painful diabetic neuropathy?

A

Burning, aching, crushing, cramping or gnawing pain.

71
Q

What is the name given to the type of leg weakness that makes going up and down stairs difficult?

A

Proximal myopathy

72
Q

What is the name given to adrenal haemorrhage following meningococcal sepsis?

A

Waterhouse-Friedrichson syndrome

73
Q

What is the pattern of TFT’s you would expect in T3 toxicosis?

A

Suppressed TSH

Normal T4

Elevated T3

74
Q

What is the commonest cause of mineralocorticoid excess?

A

Bilateral adrenal gland hyperplasia

75
Q

What pattern of uptake would you expect to see on a thyroid uptake scan in a patient with type 1 amiodarone induced thyrotoxicosis?

A

Normal uptake

76
Q

What is the best way to avoid autonomic complications of diabetes?

A

Long term stable glucose control

77
Q

Which is the best screening test for Phaeochromocytoma?

A

Plasma metanephrines

78
Q

What are the GI symptoms associated with Addisons Disease ?

A

Nausea

Vomiting

Diarrhoea

Abdominal pain.

79
Q

What is the treatment of choice for Conn’s syndrome?

A

Laparoscopic adrenalectomy

80
Q

Which is the preferred opiate to use for painful diabetic neuropathy?

A

Tramadol

81
Q

What is the concentration of iodine in Amiodarone?

A

Iodine makes up 39% by weight of Amiodarone.

82
Q

How does excessive exercise cause amenorrhoea?

A

Hypothalamic regulation

83
Q

What is larval therapy?

A

The use of maggots to eat away dead wound tissue

84
Q

Which imaging technique is the best for diagnosing osteomyelitis in patients with diabetic foot ulcers?

A

MRI scanning

85
Q

What is a commonly used screening test for hyperaldosteronism?

A

An elevated aldosterone to renin ratio (ARR)

86
Q

What pattern of gonadotrophin and testosterone results would primary testicular failure give you?

A

Low testosterone, high LH and FSH.

87
Q

What is the purpose of a plain film X-ray in the assessment of diabetic foot ulceration?

A

To look for gas forming infections in the soft tissue (not to assess for osteomyelitis)

88
Q

What are the manifestations of hyperproalctinaemia in men?

A

Reduced libido
Erectile dysfunction
Infertility
Galactorrhoea

89
Q

What is a fetid foot?

A

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
Q

Which neurotransmitter pathways does Duloxetine act on to block painful diabetic neuropathy?

A

Duloxetine is an SNRI so block serotonin and noradrenaline reuptake.

91
Q

What is the ideal target HbA1c for most people with type 1 diabetes?

A

48 mmol/mol (6.5%)

92
Q

What causes type 1 amiodarone induced thyrotoxicosis?

A

Iodine toxicity

93
Q

What BMI cut off defines obesity?

A

30kg/m2

94
Q

Which medications can cause hirsutism?

A

Steroids, phenytoin and ciclosporin

95
Q

What is the major cause of death in people with diabetes?

A

Heart disease /MI

96
Q

What is the first line treatment for Acromegaly?

A

Transsphenoidal surgery

97
Q

How long do long acting insulin analogies such as Lantus tend to last for in the body?

A

18-24 hrs

98
Q

How does hyperglycaemia exacerbate postural hypotension?

A

High glucose levels lead to frequent urination which leads to dehydration and a reduction in circulating volume.

99
Q

What long term imaging / screening tests do patients with Acromegaly require?

A

Echocardiography and colonoscopy

100
Q

What causes type 1 diabetes?

A

Auto-immune pancreatic islet cell destruction

101
Q

What is the common metabolic complication of Acromegaly?

A

T2DM

102
Q

What is the commonest cause of ACTH dependent Cushing’s syndrome?

A

Pituitary adenoma (Cushing’s disease)

103
Q

What do NICE recommend as the first line insulin therapy in patients with type 2 diabetes?

A

Isophane / NPH insulin

104
Q

Which skin condition is commonly associated with Addison’s disease?

A

Vitiligo

105
Q

What electrolyte abnormalities might be associated with Addison’s disease?

A

Hyponatraemia

Hypokalaemia

Hyperuricaemia

106
Q

Which narcotics can cause hyperprolactinaemia?

A

Opiates and Cocaine

107
Q

What psychiatric symptom is most commonly found in hypothyroidism?

A

Depression

108
Q

If a diabetic ulcer is deep and exposes bone tissue what complication is highly likely?

A

Osteomyelitis

109
Q

How many litres of urine produced per day would be suggestive of diabetes insipidus?

A

3 or more litres

110
Q

Novorapid is what type of insulin?

A

Rapid acting insulin analogue

111
Q

What are the symptoms of hypogonadism?

A

Erectile dysfunction, loss of libido, muscle atrophy, central weight gain, reduction in beard growth and shaving frequency, depression.

112
Q

What class of drugs are used to treat macroprolactinomas?

A

Dopamine agonists

113
Q

What is the name of the long acting dopamine agonist used to treat hyperprolactinaemia?

A

Cabergoline

114
Q

Name some inflammatory disorders that can cause secondary adrenal insufficiency

A

Sarcoidosis

Histiocytosis X

Haemochromatosis

Lymphocytic hypophysitis

115
Q

What are the causes of cranial diabetes insipidus?

A

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
Q

What are the causes of Nephrogenic diabetes insipidus?

A

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
Q

What is the best time of day to measure testosterone levels

A

9am

118
Q

Early satiety is a feature of which GI complication of diabetes?

A

Gastroparesis

119
Q

What medication can be used to help the body retain salt

A

Fludrocortisone

120
Q

What pattern of gonadotrophins and sex steroids would you expect to see in premature ovarian failure?

A

Raised gonadotrophins

Low oestrogen

121
Q

How is an overnight dexamethasone suppression test performed?

A

1mg oral Dexamethasone taken at midnight followed by a 9am cortisol blood test.

122
Q

What is the name given to severe hypothyroidism leading to marked symptoms and a reduced level of consciousness?

A

Myxoedema coma

123
Q

What is the first line treatment for Cushing’s disease in the majority of cases?

A

Trans-sphenoidal surgery

124
Q

What are the 5 major risk factors for coronary heart disease?

A

Diabetes, family history, hypercholesterolaemia, smoking and hypertension

125
Q

Which antibodies would you initially test for in suspected Grave’s disease?

A

TSH receptor antibodies

126
Q

What are the medical treatment options to treat Acromegaly?

A

The main treatment is using a somatostatin receptor ligands (SLR) Other options include cabergoline (dopamine agonist) or pegvisomant

127
Q

Which sex tends to be more affected by thyroid disorders?

A

Females

128
Q

How is weight related amenorrhoea managed?

A

Encourage weight gain and refer to a dietician if necessary. If an eating disorder is suspected, consider referral to a psychiatrist.

129
Q

What classes of drugs can cause hyperprolactinaemia?

A

Anti-depressants, anti-emetics, neuroleptics, opiates, PPI’s.

130
Q

What is the likely cause of infertility if gonadotrophin and oestrogen levels are low?

A

Hypothalamic / pituitary problem

131
Q

Which of the tricyclic antidepressants has a role in the treatment of painful diabetic neuropathy?

A

Amitriptyline

132
Q

Which drugs are commonly associated with erectile dysfunction?

A

Alcohol and cannabis

133
Q

Which urgent blood tests should be taken during a suspected Addisonian crisis?

A

Electrolytes

Glucose

Cortisol

ACTH

134
Q

What are the symptoms of intermittent claudication?

A

Calf pain on walking

Relief by resting

135
Q

What is HHS characterised by?

A
  1. ) Severe hyperglycaemia
  2. ) Dehydration and renal failure
  3. ) Mild/absent ketonuria
136
Q

How Is the management of HHS carried out?

A

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
Q

What is the drug therapy pathway for those who can tolerate metformin in T2DM?

A

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
Q

What is the drug therapy pathway for those who cannot tolerate metformin in T2DM?

A

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
Q

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.

A

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
Q

How can you distinguish between primary adrenal failure and secondary adrenal insufficiency?

A

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
Q

What is the single most useful test for determining the cause of hypercalcaemia?

A

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
Q

Diabetes with the mutation in HNF - 1 alpha management?

A

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
Q

What is an Addisonian Crisis?

A

An Addisonian crisis is characterised by hyperkalaemic metabolic acidosis. Symptoms include abdominal pain, confusion, nausea, and vomiting.

144
Q

What can be caused by carbimazole?

A

Agranulocytosis

Y3 Hard Qs (8 decks)

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