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YR6 Images + Instruments > Endocrinology and Diabetes > Flashcards

Endocrinology and Diabetes Flashcards

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1
Q

Atypical features of T1DM

A

> 50
BMI >,25
Slow evolution of hyperglycaemia

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2
Q

Which drugs used in diabetes can cause hypos?

A

Sulfonylureas
Insulin

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3
Q

Which drugs used in diabetes can cause weight gain?

A

Thiazolidinedione: Pioglitazone

Sulfonylureas

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4
Q

Name a DPP4 inhibitor. What effect do DPP4 inhibitors have on weight?

A

Sitagliptin
No weight gain

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5
Q

Name a GLP1 mimetic. What effect do GLP1 mimetics have on weight?

A

Exenatide
Weight loss

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6
Q

What management can be used for painful diabetic neuropathy?

A

Amitriptyline
Pain Mx clinics

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7
Q

What drug can be used for gastroparesis in diabetes?

A

Metaclopramide

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8
Q

If on metformin and HbA1c >48 but <58 what should be done?

A

Increase dose

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9
Q

If on metformin and HbA1c >58 what should be done?

A

Dual therapy

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10
Q

Name a side effect of SGLT2 inhibitors

A

Fourniers Gangrene

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11
Q

5 causes of cranial DI

A

Idiopathic
Head injury
Pituitary surgery
Craniopharyngioma
Haemochromatosis

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12
Q

Nephrogenic DI causes

A

Lithium
Hypokalaemia
Hypercalcaemia
Tubulo-interstitial disease e.g. sickle cell
Genetic (ADH receptor)

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13
Q

S/S of DI

A

Polyuria
Polydipsia

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14
Q

Describe plasma and urine osmolality in DI

A

High plasma osmolality
Low urine osmolality

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15
Q

What test is used for diabetes insipidus?

A

Water deprivation test

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16
Q

Mx of nephrogenic DI

A

Thiazides
Low salt/ protein diet

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17
Q

Mx of cranial DI

A

Desmopressin

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18
Q

Name 2 ACTH dependent causes of Cushing’s syndrome

A

Cushing’s disease: pituitary tumour secreting ACTH

Ectopic ACTH: SLCL

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19
Q

Name 3 ACTH independent causes of Cushing’s syndrome

A

Iatrogenic: STEROIDs
Adrenal adenoma
Adrenal carcinoma

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20
Q

What is pseudo-cushing’s?

A

Mimics Cushing’s
Often due to alcohol excess/ severe depression
False +ve dexamethasone suppression test
Need insulin stress test to differentiate

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21
Q

What test is used for Cushing’s syndrome?

A
  1. Low dose overnight Dexamethasone suppression test
  2. High dose dexamethasone suppression test
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22
Q

Describe results of high dose dexamethasone suppression test in Cushing’s disease

A

Cortisol: Suppressed

ACTH: Suppressed

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23
Q

Describe results of high dose dexamethasone suppression test in Cushing’s syndrome due to other causes

A

Cortisol: Not suppressed

ACTH: Suppressed

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24
Q

What test can distinguish between pituitary and ectopic ACTH secretion?

A

Petrosal sinus sampling

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25
Medical Mx of Cushing's
Ketoconazole + Metyrapone inhibit glucocorticoid synth + secretion in adrenals
26
Surgical Mx of Cushings
Cushings disease: trans-sphenoidal hypophysectomy Adrenal adenoma: laprascopic excision
27
Most common cause of hypoadrenalism. What does this result in?
AI destruction (Addisons) Reduced cortisol + aldosterone
28
List 6 S/S of Addisons
Lethargy, weakness N+V WL + anorexia HYPERPIGMENTATION, vitiligo Hypotension Hypoglycaemia
29
Electrolytes in Addisons
Hyponatraemia Hyperkalaemia
30
What test is used for Addisons disease?
Short synACTHen test Plasma cortisol measured before + 30 mins after giving Synacthen 250ug IM (or 9am serum cortisol can be used)
31
Mx of Addisons
Hydrocortisone 2 divided doses (majority in 1st half of day) Fludrocortisone
32
Adrenal crisis Sx
Collapse Shock Pyrexia
33
Adrenal crisis Mx
100mg Hydrocortisone IM 1L NaCl over 30-60 mins +/- dextrose
34
Most common cause of primary hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
35
3 features of primary hyperaldosteronism
HTN Hypokalaemia: muscle weakness Metabolic alkalosis
36
What tests are used for primary hyperaldosteronism?
Aldosterone-renin ratio (high aldosterone + low renin) HRCT abdomen + adrenal vein sampling to distinguish between unilateral adenoma + bilateral hyperplasia
37
Management of primary hyperaldosteronism
Adrenal adenoma (Conns): surgery (laparoscopic adrenalectomy) Bilateral adrenocortical hyperplasia: Spironolactone
38
What is a phaeochromocytoma?
Catecholamine secreting tumour
39
5 S/S of phaeochromocytoma
HTN Headache Palpitations Sweating Anxiety
40
Ix for phaeochromocytoma
24 urinary metanephrines
41
Mx for phaeochromocytoma
1. Phenoxybenzamine 2. Propranolol 3. Surgery
42
What is Kallmann syndrome? What measurements are seen?
Hypogonadotrophic hypogonadism X-linked recessive Low Testosterone Low/ inappropriately norm LH + FSH
43
List 4 characteristics of Kallmann syndrome
Delayed puberty Hypogonadism Anosmia Normal/ above average height
44
Mx of Kallmanns syndrome
Testosterone supplementation Gonadotrophin supplementation for sperm production (fertility)
45
What is Klinefelter syndrome? What measurements are seen?
Primary hypogonadism High LH + FSH Low Testosterone
46
Name 4 S/S of Klinefelter syndrome
Taller than average Lack secondary sexual characteristics Gynaecomastia Infertile
47
What is Androgen insensitivity syndrome?
End organ resistance to Testosterone Genotypically MALE but have FEMALE PHENOTYPE
48
List 3 features of AIS
Undescended testes: Groin swelling "Primary amenorrhoea" Breast development
49
What results from an increased oestrogen: androgen ratio?
Gynaecomastia
50
List 4 drugs that cause an increased oestrogen: androgen ratio
Spironolactone Digoxin Cannabis Goserelin (GnRH agonist)
51
Pituitary adenoma classification by size
Microadenoma <1cm Macroadenoma >1cm
52
Pituitary adenoma classification by hormonal status
Secretory/ functioning: produces excess of a particular hormone Non-secretory/ functioning: doesn't produce a hormone to excess
53
Name 3 drugs that increase prolactin
Metoclopramide Domperidone Haloperidol
54
4 features of excess prolactin in women
Amenorrhoea Infertility Galactorrhoea Osteoporosis
55
3 features of excess prolactin in men
Impotence Loss of libido Galactorrhoea
56
3 S/S of macroadenomas
Headache Visual disturbances: bitemporal hemianopia S/S of hypopituitarism
57
Ix for prolactinoma
MRI
58
Medical Mx of prolactinoma
Cabergoline/ Bromocriptine (Dopamine agonists) Inhibit release of prolactin
59
Surgical Mx of prolactioma
Trans-sphenoidal hypophysectomy
60
Causes of hyperparathyroidism
Parathyroid adenoma (most common) Hyperplasia Multiple adenoma Carcinoma
61
S/S of hyperparathyroidism
Bones: pain/ fracture Stones: renal stones, polydipsia, polyuria Moans: peptic ulcers, anorexia, nausea, constipation Groans: depression
62
Bloods in primary hyperparathyroidism
High calcium Low phosphate High (or inappropriately normal) PTH
63
Definitive Mx for primary hyperparathyroidism
Total parathyroidectomy
64
Mx for primary hyperparathyroidism when surgery not suitable
Cinacalcet (calcimimetic)
65
2 main causes of hypercalcaemia
Primary hyperparathyroidism Malignancy
66
5 less common causes of hypercalcaemia
Sarcoidosis Acromegaly Thiazides Dehydration Thyrotoxicosis
67
4 causes of hypocalcaemia
Osteomalacia CKD Hypoparathyroidism (post thyroid/ parathyroid surgery) Acute pancreatitis
68
Features of hypocalcaemia
Cramping Arrhythmias: QT prolongation Tetany Numbness
69
2 specific signs of hypocalcaemia
Trousseau's sign: carpal spasm Chvostek's sign: facial muscle twitch
70
What is osteomalacia?
Softening of bones secondary to low vitamin D that leads to low bone mineral content
71
4 causes of low vitamin D
Deficiency: malabsorption, lack of sunlight, diet CKD Cirrhosis Drugs (anticonvulsants)
72
4 S/S of osteomalacia
Bone pain Bone/ muscle tenderness Fractures: esp. NOF Proximal myopathy- waddling gait
73
Bloods in osteomalacia
Low vit D Low calcium Low phosphate Raised ALP
74
3 features of organic ED
Gradual onset Sx Lack of tumescence Normal libido
75
7 features of psychogenic ED
Sudden onset Sx Decreased libido Good quality spontaneous/ self-stimulated erections Major life events Problems/ changes in relationship Previous psychological problems Hx premature ejaculation
76
7 RFs for ED
Age Obesity DM Dyslipidaemia HTN Smoking Alcohol
77
2 drugs that can cause ED
SSRIs B-blockers
78
Ix for ED
10y cardiovascular risk calculated (lipids + fasting glucose) Free testosterone (AM)
79
Mx of ED
Sildenafil (PDE5 inhibitor) Vacuum erection devices Stop cycling if >3h/ week
80
Which group should be referred to urology for ED?
Young men who has always had difficulty achieving an erection
81
What are the organic causes of ED?
Vasculogenic: CVD, HTN, PAD, obesity, DM Neurogenic (central): MS, PD, Stroke Neurogenic (peripheral): DM, CKD Endocrine: DM, primary/ secondary hypogonadism, hypo/hyperthyroidism, hyperprolactinaemia, Cushing's disease
82
7 features of hypothyroidism
Lethargy Weight gain Cold intolerance Skin changes: dry, non pitting oedema Constipation Menorrhagia CTS + decreased reflexes
83
What are the causes of primary hypothyroidism?
Hashimoto's (AI. most common) Subacute thyroiditis Post-thyroidectomy Drugs: lithium, amiodarone
84
Mx of hypothyroidism
Levothyroxine
85
What antibody is associated with hashimotos hypothyroidism?
Anti-thyroperoxidase (TPO)
86
Describe TFTs in hypothyroidism
High TSH Low T3 + T4

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