Endocrinology Flashcards

Question

How is hypoglycaemia investigated?

Answer 1

Confirm low CBS with a RBS for exact value Blood for GH, IGF1, Cortisol, Insulin, c peptide, fatty acids, ketones, glycerol, BCAA, lactate, pyruvate Urine for organic acids

Answer 2

Transient neonatal hypoglycaemia (in utero insulin) Recurrent severe neonatal hypoglycemia (high insulin) -Iatrogenic insulin -Insulinoma -Sulfonylurea -Insulin receptor antibodies Ketotic hypoglycaemia (low reserves) -Liver disease -Glycogen storage disorders (inborn errors) -Low GH, ACTH, Addison, CAH

Answer 3

If Random serum cholesterol > 5.3 mM | Do Fasting serum cholesterol, triglyceride, LDL and HDL cholesterols (fasting lipid profile)

Answer 4

``` Obesity Hypothyroidism Diabetes mellitus Nephrotic syndrome Obstructive jaundice ```

Answer 5

``` AD LDL receptor defect 1:500 LDL>3.3 mM Skin and tendon xanthomas Fix of premature CAD ```

Answer 6

Statins Bile acid sequestrants Fibrates

Answer 7

Clinical state of glucocorticoid excess ACTH-->Glucocorticoids ACTH dependent (pituitary adenoma/ectopic ACTHoma, exogenous ACTH) ACTH independent (adrenal tumours, exogenous glucocorticoids)

Answer 8

``` Short stature Obese Hirsutism Striae Bruising Hypertension Glucose intolerance ```

Answer 9

1. Confirm with a suppression test (fail to suppress) - screen with ODST (1 mg at 2300 then sample at 0900) - confirm with LDDST (0.5 mg 6 hourly * 8 doses) 2. DDx with HDDST (2 mg 6 hourly * 8 doses)

Answer 10

``` Before birth (FHx, unexplained deaths) After birth -Screening (PKU, familial hyperchol) -Normal newborn becoming severely ill -Infant or child with severe hypoglucemia -Subacute regression (storage disease) -Dysmorphism ```

Answer 11

Galactosemia (poor feeding when given milk) Glycogen storage disease (hypoglycaemia) Phenylketonuria (DD with blue eyes at 6 months) Homocystinuria (DD with lens subluxation) Tyrosinemia (Liver failure)

Answer 12

``` Primary -CAH -Addison disease Secondary -hypopituitarism -long term glucocorticoid withdrawal ```

Answer 13

``` Acute salt losing crisis -Hyponatremia -Hyperkalemia -Hypoglycemia -Dehydration -Hypotension -Shock Chronic -Vomiting -Lethargy -Brown pigmentation -Growth failure -salt craving ```

Answer 14

Screen (low Na high K, low CBS, acidosis) Confirm (short synacthen test)

Answer 15

IV NS, 10%D and hydrocortisone | Emergency IM hydrocortisone kit

Answer 16

Spasms fits stridor diarrhoea (Prematures, severe rickets, hypoparathyroidism, DiGeorge Xd) Rx Diluted IV 10% cal gluconate, PO Ca and Vit D

Answer 17

``` High calcium Constipation Anorexia Lethargy Polyuria Polydipsia (Rx Rehydrate, diuretics, bisphosphonates) Occurs with adenomas, MEN ```

Answer 18

``` PTH normal but defective receptors. Short 4th metacarpal Learning difficulties short stature obesity subcutaneous nodules calcified basal ganglia ```

Answer 19

Systemic signs and Eye signs In teen girls or neonates of Graves mothers Exopthalmos, ophthalmoplegia, lid retraction, lid lag Anxiety, hunger, sweating, diarrhoea, LOW, tremor Rx - Carbimazole, propylthiouracil, beta blockers SE- neutropenia

Answer 20

Fetus depends on mothers T4 After birth there is a TSH surge which normalises within a week (prematures have low T4 and normal TSH)

Answer 21

Iodine deficiency Maldescent of thyroid/athyrosis Dyshormonogenesis Panhypopituitarism (micropenis, no testes descent)

Answer 22

``` Preventable cause of severe learning difficulties Common 1:4000 Minimal clinical features (Heel prick test - high TSH) Rx T4 after 2 weeks age Needs lifelong T4 ```

Answer 23

Down/Turner syndrome Autoimmune thyroiditis Females with growth failure and delayed bone age

Answer 24

Congenital FTT, feeding problems, prolonged jaundice, constipation, dry skin, coarse facies, large tongue, hoarse cry, goiter, umbilical hernia, DD Acquired Short females with delayed puberty, dry skin and hair, cold intolerance, slipped femoral epiphysis, learning difficulties, puffy eyes

Endocrinology Flashcards

(48 cards)