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Medicine for Finals > Endocrinology and Clinical Biochemistry > Flashcards

Endocrinology and Clinical Biochemistry Flashcards

1
Q

hypokalaemia: symptoms

A
  • muscle weakness
  • hypotonia
  • palpitations
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2
Q

hypokalaemia: causes

A
  • iatrogenic (fluids)
  • type 1 or 2 RTA
  • thiazide or loop diuretics
  • hyperaldosteronism
  • hypomagnesaemia
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3
Q

hypokalaemia: key investigation(s)

A
  • Mg
  • ECG
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4
Q

hypokalaemia: management

A

Mg replacement, then IV K replacement up to a maximum 10mmol/hr

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5
Q

hyperkalaemia: symptoms

A
  • tachycardia
  • palpitations
  • chest pain
  • SOB
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6
Q

hyperkalaemia: causes

A
  • pseudohyperkalaemia
  • iatrogenic (fluids)
  • renal disease (CKD or Type 4 RTA)
  • Addison’s disease (hypoaldosteronism)
  • potassium-sparing diuretics, NSAIDs, ACEi, trimethoprim
  • internal redistribution due to acidosis, low insulin, burns, rhabdomyolysis, tumour lysis syndrome, digoxin
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7
Q

hyperkalaemia: key investigation(s)

A
  • consider repeat
  • ECG
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8
Q

hyperkalaemia: management

A
  • calcium gluconate (cardiac protection)
  • IV insulin & dextrose or salbutamol (redistribute)
  • Lokelma or calcium resonium (eliminate)
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9
Q

hypernatraemia: symptoms

A
  • lethargy
  • weakness
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10
Q

hypernatraemia: causes

A

Hypervolaemia
- iatrogenic (fluids)
- hyperaldosteronism

Hypovolaemia
- dehydration
- osmotic diuresis
- diarrhoea
- loop diuretic

Euvolaemia
- diabetes insipidus (central or nephrogenic)

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11
Q

diabetes insipidus: causes

A

Central = pituitary tumour or haemorrhage

Nephrogenic = hypercalcaemia, lithium, post-obstructive diuresis

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12
Q

diabetes insipidus: investigation

A

8h water deprivation test causes increased plasma osmolality but stable (low) urine osmolality.

If desmopressin causes increased urine osmolality, indicates central cause

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13
Q

diabetes insipidus: management

A

central = desmopressin
nephrogenic = salt restriction and thiazides

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14
Q

hyponatraemia: symptoms

A
  • confusion
  • lethargy
  • weakness
  • seizure
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15
Q

hyponatraemia: causes

A

Normal osmolality:
- pseudohyponatraemia
- TURP syndrome

Hypervolaemia
- renal, heart or liver failure
- hypothyroidism
- nephrotic syndrome

Hypovolaemia:
- diuretics
- Addison’s disease
- GI losses
- burns

Euvolaemia:
- SIADH

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16
Q

SIADH: causes

A
  • haemorrhage or thrombosis
  • meningitis
  • GBS
  • post-operative
  • antipsychotics or anticonvulsants
  • ectopic source (small cell lung cancer)
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17
Q

hypernatraemia: key investigation(s)

A

urine output and osmolality (distinguishes renal vs. extra-renal fluid losses)

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18
Q

hyponatraemia: investigations

A

urinary sodium (distinguishes renal vs. extra-renal losses)

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19
Q

SIADH: management

A
  • fluid restriction
  • tolvaptan
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20
Q

hyper- and hyponatraemia: management

A
  • correct reversible causes
  • consider hypo/hypertonic fluids, correcting at same rate as onset to avoid central pontine demyelinosis
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21
Q

respiratory acidosis: causes

A
  • acute respiratory failure (e.g. asthma attack, opioids, benzodiazepines, acute obstruction)
  • COPD
  • paralysis
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22
Q

respiratory alkalosis: causes

A
  • hypoxia (e.g. PE, pneumonia, anaemia, HF)
  • anxiety
  • altitude sickness
  • aspirin
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23
Q

Anion Gap: calculation and normal range

A

(Na + K) - (Cl + HCO3)

12-16mmol/L

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24
Q

normal anion gap metabolic acidosis: causes

A
  • GI loss of HCO3 (diarrhoea, pancreatic fistula, ileal conduit)
  • renal tubular acidosis
  • acetazolamide
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25
Q

raised anion gap metabolic acidosis: causes

A
  • aspirin
  • ethylene glycol
  • methanol
  • metformin
  • liver failure
  • DKA
26
Q

metabolic alkalosis: causes

A
  • vomiting
  • loop diuretics
  • liquorice
  • hyperaldosteronism (associated with hyperK)
27
Q

primary hyperparathyroidism: causes

A

parathyroid adenoma or hyperplasia

28
Q

primary hyperparathryoidism: findings

A

PTH - raised
Ca - raised
Pi - low

29
Q

secondary hyperparathyroidism: causes

A
  • Renal failure (pathogenesis is failure of phosphate retention and Vit D activation)
  • Low vitamin D
30
Q

secondary hyperparathyroidism: findings

A

Vit D - low
Pi - high
PTH - high
Ca - low in end-stage

31
Q

tertiary hyperparathyroidism: causes

A

Long-term secondary hyperparathyroidism, due to which the parathyroid glands begin to act autonomously

32
Q

tertiary hyperparathyroidism: findings

A

PTH - very high
Ca - high

33
Q

secondary hyperparathyroidism: management

A
  • Vit D supplementation (alfacalcidol in CKD)
  • Pi binders
  • Consider Ca replacement
  • Cinacalcet
34
Q

malignant hyperparathyroidism: causes

A

Small cell lung cancer
Breast cancer
Renal cell carcinoma

35
Q

primary hypoparathyroidism: causes

A
  • iatrogenic
  • congenital (Di George)
  • Autoimmune
36
Q

Primary hypoparathyroidism: features

A

PTH - low
Ca - low
Pi - high

37
Q

Secondary hypoparathyroidism: causes

A
  • surgery or radiation
  • hypomagnesaemia
38
Q

Pseudohypoparathyroidism: findings

A

Ca - low (due to failure of target organs to respond to PTH)
PTH - may be high

39
Q

Pseudopseudohypoparathyroidism

A

Hypocalcaemia due to mutation in GNAS gene (AD)

40
Q

hypercalcaemia: symptoms

A
  • bones (pain and fractures)
  • stones (renal stones and nephrogenic DI)
  • groans (abdo pain, constipation, nausea)
  • psychic overtones (depression)
41
Q

hyperthyroidism: management

A

Carbimazole, either up-titrate to effect or block + replace approach (give levothyroxine)

In Grave’s Disease, treat for 12-18mo then withdraw. 50% relapse, in which case consider radioiodine or surgery.

42
Q

hypothyroidism: management

A

levothyroxine, aim to normalise TSH

43
Q

Addisonian crisis: presentation

A
  • hypotensive shock
  • tachycardia
  • pale, clammy, cold
  • oliguria
44
Q

Addisonian crisis: management

A
  • IV fluids
  • IV hydrocortizone
  • IV dextrose

Treat the cause

45
Q

Addison’s Disease: management

A

hydrocortisone (increase dose on sick days)

fludrocortisone (no sick day rules)

46
Q

Cushing’s Syndrome: management

A
  • medication review
  • for Cushing’s Disease: pituitary surgery
  • adrenal resection
47
Q

hyperaldosteronism: management

A
  • spironalactone (switch to eplerenone if gynaecomastia, impotence, mentrual dysfunction)
  • for Conn’s Disease: adrenelectomy
48
Q

Adrenal insufficiency: causes

A
  • Addison’s Disease (autoimmune)
  • Secondary causes (steroid withdrawal, TB, Waterhouse-Friderichson syndrome, CMV, infiltrating cancer, Sheehan syndrome)
49
Q

Cushing’s syndrome: causes

A
  • Cushing’s Disease (ACTH producing pituitary tumour)
  • Ectopic ACTH (small cell lung cancer, carcinoid)
  • benign adrenal adenoma or adrenal carcinoma
  • iatrogenic (steroid therapy)
50
Q

hyperaldosteronism: causes

A
  • Conn’s Disease (bilateral adrenocortical adenoma)
  • Bilateral adrenal hyperplasia
  • Secondary causes (renal hypoperfusion)
51
Q

hyperthyroidism: causes

A
  • Grave’s Disease (anti-TSHr, eye disease & pretibial myxoedema)
  • Toxic multinodular goitre or adenoma
  • de Quervain’s thyroiditis (post-viral)
  • amiodarone, lithium
  • post-partum
52
Q

hypothyroidism: causes

A
  • primary atrophic thyroiditis
  • Hashimoto’s thyroiditis (autoimmune infiltrate, goitre)
  • iodine deficiency
  • iatrogenic (post-thyroidectomy or radioiodine)
53
Q

DKA: management

A
  1. Fluids
  2. Check potassium and supplement in 2nd and 3rd bag if required
  3. Insulin 0.1unit/kg/hour
54
Q

DKA: criteria

A

hyperglycaemia > 11mmol/l
ketosis >3mmol/l
acidosis pH <7.3

55
Q

DKA: resolution criteria

A

pH >7.3
ketones <0.6mmol/l
bicarbonate >15mmol/l

56
Q

HHS: criteria

A

hyperglycaemia >35mmol/L
Osmolality >340mOsM/kg
hypernatraemia

57
Q

Type 1 (distal) RTA: causes

A
  • idiopathic
  • AID/inflammatory diseases (RA, SLE, Sjogren’s)
  • analgesic nephropathy
58
Q

Type 2 (proximal) RTA: causes

A
  • idiopathic
  • Fanconi syndrome
  • Wilson’s Disease
  • cystinosis
  • tetracyclines
  • carbonic anhydrase inhibitors
59
Q

Type 4 RTA: causes

A
  • hypoaldosteronism
  • diabetes mellitus
60
Q

Type 1 (distal) RTA: findings

A
  • metabolic acidosis
  • hypokalaemia
  • hypercalciuria (= renal stones)
61
Q

Type 2 (proximal) RTA: findings

A
  • metabolic acidosis
  • hypokalaemia
  • osteomalacia (low Vit D)
62
Q

Type 4 RTA: findings

A
  • metabolic acidosis
  • hyperkalaemia

Medicine for Finals (10 decks)

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