Endocrinology Flashcards
(143 cards)
1
Q
Most common type of hypothyroidism
A
Hashimoto’s
2
Q
TSH is released from where in the hypothalamus
A
Hypophyseal portal system
3
Q
2 medications that can cause hypothyroidism
A
Lithium and amiodarone
4
Q
Primary hypothyroidism can be secondary to what?
A
Drugs - Lithium and amiodarone
Iodine deficiency
Post total-body irradiation
Post-partum
5
Q
What mineral is needed to convert T4 into T3?
A
Selenium
6
Q
Carpal tunnel syndrome may be a sign of
A
Hypothyroidism
7
Q
Hashimoto’s blood findings
A
High TSH
Low T4
TPO (thyroid peroxidase) antibodies
8
Q
Faster-acting management for severe hypothyroidism?
A
Liothyronine sodium
9
Q
4 complications of untreated hypothyroidism
A
- CVD
- Pre-eclampsia
- Maternal anaemia
- Miscarriage
- Coma
10
Q
Excess T3/T4 and reduced TSH is a sign of
A
Hyperthyroidism
11
Q
Most common autoimmune hyperthyroidism
A
Graves Disease
12
Q
Pathophysiology behind Graves Disease
A
B cells produce thyroglobulin antibodies which mimic TSH. Bind to TSH receptor on follicular cells to stimulate release of thyroid hormones.
TSH receptor autoantibodies bind throughout the body causing eye/skin issues (cross reactivity).
13
Q
4 causes of a thyroid storm
A
- Stress - Childbirth, surgery
- Infection
- Stopping hyperthyroidism treatment
- Excess hypothyroidism treatment
14
Q
3 RF for Graves
A
Female, family history, smoking
15
Q
Tachycardia secondary to hyperthyroidism is caused by an increase in
A
ANP
16
Q
Pretibial oedema is seen in
A
Graves Disease
17
Q
Antibodies seen in Graves?
A
Thyroglobulin autoantibodies/TSHR autoantibodies
18
Q
Management for Graves (5 - 2 drugs; 3 other therapies)
A
- Beta blocker
- Anti-thyroid drugs: Carbimazole (weekly TFT) or carbimazole + levothyroxine
- Radioiodine therapy to destroy thyroid function
- Thyroidectomy
- Stop smoking
19
Q
Hypoparathyroidism causes
A
Hypocalcaemia and low vitamin D
20
Q
5 signs of hypoparathyroidism
A
- Paraesthesia
- Chvostek’s sign
- Trosseau’s sign
- Hypocalcaemia
- Hyperphosphataemia
21
Q
Primary hyperparathyroidism is caused by what 2?
A
Parathyroid adenoma and MEN
22
Q
Hypercalcaemia, hypophosphataemia, recurrent kidney stones and depression are signs of?
A
Hyperparathyroidism
23
Q
Bone pain and constipation could be signs of
A
Hyperparathyroidism
24
Q
Secondary hyperparathyroidism is caused by excess
A
PTH
25
2 causes of secondary hyperparathyroidism
1. Kidney issues
| 2. Vitamin D deficiency
26
Hyperphosphateaemia but low calcium and vitamin D are signs of
Secondary hyperparathyroidism
27
Diffuse goitre is often
Benign
28
5 causes of diffuse goitre
1. Graves
2. Hashimoto's
3. Congenital thyroiditis
4. Pregnancy
5. Puberty
29
A solitary thyroid nodule tends to be a
Cyst
30
Most common type of thyroid cancer in young females
Papillary
31
Most common type of thyroid cancer in middle-aged older women?
Follicular
32
5 signs/symptoms of thyroid cancer
1. Goitre
2. Hoarseness
4. Odynophagia
5. Dysphagia
5. Lymphadenopathy
33
Toxic multi nodular goitre causes
Hyperthyroidism
34
2 genes associated with T1DM?
HLA-D3 and HLA-D4
35
2 phases of T1DM
1. B-cell destruction - reduced/absent insulin
| 2. Alpha cell dysfunction - Glucagon is secreted inappropriately leading to extreme blood sugars
36
Deep, gasping breaths with a fruity smell, confusion and polyuria is a sign of
DKA
37
3 blood investigations in diabetes
1. Fasting plasma glucose > 7
2. Plasma glucose > 11.1 2 hours post 75 g oral glucose tolerance test
3. Glycated HbA1C
38
3 urinalysis findings in diabetes
1. Proteinuria
2. Ketones (following DKA)
3. Glucose
39
1st line treatment (except general lifestyle changes) in T2DM?
Metformin - anti-hyperglycaemic drug. No risk of hypoglycaemia as does not affect insulin.
40
2nd line treatment in T2DM (4 drugs)?
1. Sulfonylurea - Gliclazide
2. Thiazolidinedione = Pioglitazone
3. Dipeptidylpeptidase-4 inhibitor (GLIPTIN)
4. Sodium glucose co-transport 2 inhibitor/gliflozin
41
3rd line treatment for T2DM
Metformin, Sulfonylurea, Pioglitazone
| MSP
42
Metformin MOA and benefits
Reduce hepatic glucose output (glycogenolysis/gluconeogenesis) and increase skeletal muscle uptake.
Reduce sugar and reduce complication risks
43
Sulfonylurea MOA
Increase insulin secretion by blocking ATP-dependent K+ channels on b-cells in pancreas - raising calcium levels - promoting secretions
44
Pioglitazone MOA
Reduce insulin resistance
45
4th line treatment for T2DM
Metformin,
Sulfonylurea
Glucagon-like peptide 1 receptor agonist (-TIDES)
(MSG)
46
5th line treatment for T2DM
Insulin
47
5 causes of non-diabetic hypoglycaemia
1. Alcohol
2. Liver failure
3. Addison's disease
4. Islet's cell tumours
5. Hodgkin's disease - anti-insulin receptor antibodies
48
5 causes of hypercholesterolaemia
1. Familial hypercholesterolaemia
2. Hypothyroidism
3. T2DM
4. Glucocorticoids
5. Alcohol abuse
49
Addison's disease is caused by
Reduced production of adrenocortical hormones
50
The zona glomerulosa (outer zone) produces
Mineralocorticoids
51
The zona fasciculata (middle zone) produces
Glucocorticoids
52
The zona reticularis and the adrenal medulla produce
Androgens
53
What 3 hormones are diminished in Addison's?
1. Cortisol
2. Aldosterone
3. DHEA (androgen sex steroid synthesis)
54
4 causes of Addison's
1. Adrenal autoantibodies
2. Adrenal haemorrhage (anti-phospholipid syndrome, sepsis)
3. Pituitary issues
4. Hypothalamic issues - ACTH/CRH deficiency
55
A salty-food craving and unexplained weight loss could be a sign of
Addison's
56
Severe N&V with hypotension and fever is a sign of a
Adrenal crisis
57
Management in an adrenal crisi/cortisol deficiency (3)
1. Glucocorticosteroid - Hydrocortisone
2. Saline
3. Glucose
58
Management for Addison's
1. Glucocorticoid - Hydrocortisone
| 2. Mineralocorticoid - Fludrocortisone
59
Cushing's syndrome is defined as
Excess cortisol from any cause
60
3 causes of Cushing's
1. Long-term steroid use
2. Pituitary adenoma
3. Adrenal gland tumour
61
Thin skin, striae, dyslipidaemia and hypertension are signs of
Cushing's Syndrome
62
Cushing's Disease is defined as
Excess ACTH from anterior pituitary leading to excess cortisol
63
Main cause of Cushing's Disease
Anterior pituitary adenoma
64
3 investigations for Cushing's
1. ACTH bloods
2. Dexamethasone suppression test (stimulates cortisol)
3. ACTH stimulation test
65
Acromegaly is caused by excess?
Growth hormone post puberty
66
Acromegaly is caused by
Pituitary adenomas, secreting excess GH
67
Enlarging nose, separating teeth, snoring and excessive sweating are signs of
Acromegaly
68
Diabetes insipidus is defined as
Inability to concentrate urine
69
DI can be caused by what 2 main pathophysiology
1. Reduced vasopressin - Brain injury, pituitary surgery
| 2. Vasopressin insensitivity in the kidney - Lithium, CKD
70
What is vasopressin also known as?
ADH
71
5 RF for DI
1. Pituitary/hypothalamic disease
2. FH
3. Lithium
4. CKD
5. Hashimoto's
72
Polydipsia, polyuria and hypotonic urine are signs of
DI
73
What electrolyte imbalance is caused by DI?
Hyponatraemia
74
Gynaecomastia is caused by what underlying hormone
High oestrogen
75
5 causes of gynaecomastia
1. Normal physiology: Age - Newborn, puberty, old-age
2. Anabolic steroids
3. Impaired testosterone levels: PPIs, spironolactone
4. Medications that increase oestrogen
5. Prostate cancer treatment
76
What drug can combat gynaecomastia?
Tamoxifen
77
Galactorrhoea is defined as
Spontaneous milk flow associated with childbirth/nursing
78
3 causes of galactorrhea
1. Hyperprolactinaemia
2. Hyperthyroidism
3. Medication: SSRIs, antipsychotics, methyl-dopa, opioids
79
Pheochromocytoma is a tumour in what cell type located where?
Chromaffin cells in adrenal medulla
80
Brand name for metformin
Glucophage
81
Metformin advice for patients (4 points)
1. Continue with lifestyle changes
2. Take whole with or after food with water to minimise GI side effects
3. Notify doctors of metformin prior to CT/operations
4. Limit alcohol - lactic acidosis (weakness, muscle pain, diarrhoea)
82
Issue with weight gain in T2DM
More weight = more insulin resistance = worsened T2DM
83
3 metformin contraindications
1. eGFR < 30
2. AKI
3. IV contrast
84
3 metformin cautions
1. Alcoholism - hypoglycaemia risk
2. Hepatic impairment
3. CKD < 45 but > 30
85
3 side effects of metformin
1. Nausea
2. Vomiting
3. Taste disturbance
86
Dual therapy Hba1c aim
< 53 mmol/mol
87
Metformin and sulfonylureas only work when there is
Residual b-cell pancreatic function
88
2 benefits of metformin over other anti-diabetic drugs
1. No weight gain
| 2. No hypos
89
Sulfonylureas advice
1. Take with breakfast (30 mg -> 120 mg)
2. Lifestyle measures are still important
3. Be cautious of hypoglycaemia (sugar then starch)
4. Caution if poorly - side effects more likely
90
Contraindication of sulfonylureas
Pregnancy and breastfeeding = hypoglycaemia
91
3 side effects of sulfonylureas
1. GI upset
2. Hypoglycaemia
3. Weight gain
92
3 adverse effects of sulfonylureas
1. Hepatic toxicity
2. Drug hypersensitivity syndromes
3. Agranulocytosis
93
2 Abx to avoid with sulfonylureas due to increased exposure
1. Clarithromycin
| 2. Chloramphenicol
94
Dipeptidylpeptidase-4 inhibitors are also known as
Gliptins
95
Role of DPP-4 and MOA of DPP-4 inhibitors (gliptins)
DPP-4 hydrolyses incretins needed for stimulating insulin secretion/preventing glucagon release in the intestine
Inhibiting DPP-4 prevents hydrolysis of incretins, thus promoting insulin release and reducing glucose
96
Perk of using a gliptin over a sulfonylurea (glicazide)
Gliptins are less likely to cause hypoglycaemia as they work in the presence of incretins aka sugar/food
97
2 adverse side effects of gliptins
Pancreatitis and anaphylaxis
98
Gliptins are taken in a fixed combination tablet with
Metformin
99
What class of drug is pioglitazone?
Thiazdolidine
100
3 risks of pioglitazone, particularly in those who are elderly or with risk factors?
1. Bladder cancer
2. Heart failure
3. Increased risk of fractures
101
Pioglitazone works by
Reducing peripheral insulin resistance to decrease blood sugar
102
3 common side effects of pioglitazone
1. Visual disturbance
2. Weight gain
3. Numbness
103
Dose of pioglitazone and max daily dose
15-30 mg, max 45 mg
104
SGLT-2 inhibitors are also known as
Gliflozins
105
Anti-diabetic drug with the best vascular outcome
SGLT-2 inhibitors (gliflozin - canagliflozin)
106
MOA of SLGT-2 inhibitors/gliflozins
Inhibit reabsorption of glucose from renal tubule into the blood, promoting urinary glucose loss and reduced blood glucose
107
Anti-diabetic drug that promotes urinary glucose loss
SLGT-2 inhibitors
108
3 adverse side effects of SLGT-2 inhibitors
1. DKA
2. Foot disease - ulceration/osteomyelitis/gangrene
3. Fournier's gangrene (genitals/perineum gangrene)
109
3 side effects of SLGT-2 inhibitors
1. UTI
2. Constipation
3. Thirst/hypotension/syncope
110
GLP-1 receptor agonists include
Semaglutatide
111
MOA of semaglutatide
SC injected drug that activates glucagon-like peptide 1 receptor to increase insulin secretion, suppress glucagon secretion and slow gastric emptying
112
Anti-diabetic drug that can cause AV block or pancreatitis
GLP-1 receptor agonists
113
Addison's disease is what type of adrenalism
Hypoadrenalism
114
3 causes of primary Addison's
1. Autoimmune (anti-21-hydroxylase)
2. Adrenal haemorrhage - Waterhouse-Friderichsen (meningococcal septicaemia)
3. Infection (TB, HIV)
115
Hallmark symptom only seen in primary Addison's
Hyperpigmentation, particularly of palmar creases or mucosal/sun-exposed areas
116
Gold-standard test for Addison's and how is it performed
ACTH stimulation test - short Synacthen test
1. Measure plasma cortisol
2. Administer Synacthen 250 ug IM
3. Measure plasma cortisol 30 minutes later
117
Investigation for Addison's if ACTH test isn't available
9am morning cortisol
118
Patient education for Addison's (4)
1. Do not miss steroid doses
2. Medi bracelet/steroid card
3. Double dose if become unwell
4. Hydrocortisone injection in unwell
119
If morning cortisol comes back as < 500 nmol/l, what investigation should be done next?
ACTH stimulation
120
2 causes of ACTH dependent Cushing's (Disease or Ectopic)
1. Pituitary tumours
| 2. SLCC
121
3 causes of ACTH-independent causes of Cushing's Syndrome
1. Steroids
2. Adrenal adenoma
3. Adrenal carcinoma
122
What 2 conditions mimic Cushing's (pseudo)?
1. Alcoholism
| 2. Severe depression
123
Gold standard test for Cushing's
Overnight dexamethasone suppression test
+ve when there is a morning cortisol spike (not suppressed)
124
High TSH levels, low T4 levels and TPO antibodies are a sign of
Hashimoto's
125
Painful goitre with a raised ESR is
Subacute thyroiditis/de Quervain's
126
Fibrotic goitre is a sign of
Riedel's thyroiditis
127
Secondary hypothyroidism is suggestive of what pathology
Pituitary
128
Untreated congenital hypothyroidism can cause
CI
129
Dysgenesis of the thyroid refers to
Underdevelopment of the thyroid gland
130
Prolonged neonatal jaundice, puffy face, macroglossia and hypotonia are signs of
Congenital hypothyroidism
131
Reidel's thyroiditis is linked to what other fibrosis?
Retroperitoneal
132
Blood findings in subclinical hypothyroidism
Raised TSH, normal T4, sometimes antibodies
133
TSH > 10 in subclinical hypothyroidism in a < 70 year old warrants
Levothyroxine
134
2 underlying causes of pregnancy hyperthyroidism?
1. HCG rise in 1st trimester activates TSH receptors
| 2. Rise in thyroxine binding globulin, increasing total T4
135
5 issues linked to thyroid eye disease
1. Exophthalmos
2. Conjunctival oedema
3. Optic disc swelling
4. Ophthalmoplegia
5. Inability to close eyelids
136
2 skin complaints in Graves
1. Pretibial oedema
| 2. Erythematous oedematous lesions over lateral malleolus
137
3 points in thyroid acropathy
1. Clubbing
2. Soft tissue swelling of hands/feet
3. Periosteal new bone formation
138
Anti-thyroid drug given in pregnancy and biggest adverse effect
Propylthiouracil - hepatic injury
139
Complication of autoimmune hypothyroid conditions in the acute phase?
Thyroid storm
140
Nuclear scintigraphy finding in toxic MN goitre
Patchy uptake
141
Difference between MN goitre and toxic MN goitre
MN goitre - Euthyroid
| TMN goitre - Hyperthyroid
142
Hashimoto's is associated with what lymphoma
MALT
143
Raised calcitonin may be a sign of
Medullary thyroid cancer
