Endocrinology, diabetes and metabolic medicine Flashcards Preview

MRCP mistakes > Endocrinology, diabetes and metabolic medicine > Flashcards

Flashcards in Endocrinology, diabetes and metabolic medicine Deck (39)
Loading flashcards...
1

Osteoporosis treatment

1. Bisphosphonates 2. If not tolerated, then denosumab (RANK ligand inhibitor, 6 monthly injection) 3. Teriparatide alternative to densumab but daily injection 4. Raloxifene (not as effective as the ones above but reduces Breast Ca risk) 5. Strontium ranelate last because increase DVT risk

2

MODY gene defects

MODY 2 and 3 most common 2 -> glucokinase mutations 3 -> HNF alpha mutation, very responsive to sulfonylurea

3

Turner Syndrome karyotype and presentation

XO karyotype. Short stature, borderline hypertension, short neck, low set ears, primary amenorrhoea + other congenital abnormaltieis, such as horseshoe kidney or bicuspid aortic valve

4

Kallmann's syndrome

Absent sense of smell due to lack of development of olfactory bulb

5

Bilateral undescended testis associations

XY karyotype but androgen insensitivity syndrome. Female external genitalis

6

Klinefelter Syndrome karyotype and presentations

XXY karyotype. Male genitalia (small testis), low testosterone and toruble entering sexual relationship

7

HRT in woman with amenorrhoea for less than 1 year

sequential rather than continuous (if no risk factors for breast cancer)

8

Abnormal anion gap indicators

([Na+]+ [K+]) –([Cl–]+ [HCO3–]) A normal value is 3-16 High anion gap: KARMEL Ketones Aspirin (and paracetamol, and other toxins) Renal Failure Methanol Ehylene Glycol Lactate Normal anion gap acidosis: Diarrhoea Renal tubular necrosis High volume IV saline Addisons

9

Solitary toxic nodule treatment

Treatment dose radioiodine for those who finished family PArtial thyroidectomy for those where radioiodine is CI (e.g. small children)

10

First line treatment in Paget's

IV zoledronate now over oral risedronate

11

In DKA, what product is kept in the body longest?

Acetone, acetoacetate and beta-hydroxybutyrate formed. Only acetoacetate levels do not drop rapidly.

12

What does hashimoto's put you at an increased risk of?

60x risk of thyroid lymphoma. Rapidly enlarging mass with blurred margins USS and biopsy are the appropriate next steps

13

Diagnostic testing in Cushings

Phase 1 Screening tests: a) raised free urinary cortisol (easiest) b) overnight low dose dexamethasone suppression test c) salivary late night cortisol Phase 2 diagnostic test: 48 hour dexamethsone suppresstion test and measurement of serum ACTH levels ACTH should be suppressed in adrenal disease Phase 3: If ACTH stayed high on 48hr testing, now need to differentiate between ectopic source or pituitary. Do high dose test -> if manipulation of ACTH levels then likely pituitary.

14

Hormone under constant inhibition?

Prolactin is under constant inhibition from dopamine

15

What treatment can worsen graves' opthalmopathy?

Radioiodine, unclear mechanism Prednisolone can be used for decompensated graves eye disease

16

Hypoparathyroidism and pseudo(pseudo)hypoparathyrodissm

HypoPTH: normal renal function in light of hypocalcemia, hyperphosphataemia and low PTH -> congenital will present with short stature, chronic muscle pain and weakness

 

Pseudo-> resistance to PTH so PTH levels will be high.

17

Types of hyperparathyroidism

18

Biochemical picture hyperparathyroidism

19

Classical congenital adrenal hyperplasia presentation vs non-classical

CCAH: Normal pubic and axillary hair but ambigious genitalia/clitoromegaly and salt wasting in extreme cases

NCCAH: precocious puberty and androgenisation/subfertility in later years. No salt wasting

20

Lithium and thyroid

Lithium often causes hypothyroid within 2 years of starting. Start thyroxine and continue lithium

21

TOurette tx

Start risperidone

22

Thyroid eye disease tx

rituximab

23

Diabetes manangement

DPP4 is used when BMI is obese

SGLT2 is used when heart failure

 

If triple therapy fails, consider use of GLP-1 mimetic or insulin based treatment

24

Types of MODY

25

Diagnosis of diabetes

26

1st line for prolactinoma

Cabergoline

27

Octreotide used in...?

it's somatostatin analogue and is used in acromegaly and carcinoid syndrome

28

MDMA OD hyperthermia tx how?

Mechanical cooling measures

 

Dantrolene used in malignant hyperthermia

29

Primary hyperaldosteronism blood pressure control

Spironolactone (aldosterone antagonist)

30

Rare metabolic diseases and their gene defects