Endocrinology ILOs Flashcards
(145 cards)
1
Q
Define T1DM and give its Aetiology
A
Metabolic disorder characterised by hyperglycaemia due to absolute insulin deficiency
Destruction of pancreatic beta cells by immune-mediated mechanism
2
Q
Give 2 symptoms and 2 risks of T1DM
A
Polyuria + polydipsia
Young age + HLA DR3 and HLADR4 genes
3
Q
Outline the pathophysiology of T1DM
A
- Subclinical until 90% beta cells destroyed
- Long-term hyperglycaemia = complications
4
Q
Give 4 investigations for T1DM
A
Fasting blood glucose >/= 7.0mmol/L
Random plasma glucose >/= 11.1mmol/L
Ketone testing +/- bicarbonate
Pancreatic auto-antibodies
5
Q
Give 3 treatment options for T1DM
A
Basal bolus insulin
BD mix regime
CHO counting
6
Q
Define T2DM
A
Deficits in insulin secretion and action leading to abnormal glucose metabolism and related metabolic derangement
7
Q
Give 3 predisposing factors for T2DM
A
Ageing
Physical inactivity
Obesity
8
Q
Give 2 symptoms and 2 risks of T2DM
A
S: Frequent infection + fatigue
R: Obesity + Black/Hispanic
9
Q
Outline the pathophysiology of T2DM
A
- More free fatty acids interfere with downstream insulin signalling
- insulin gets to receptor but glucose cannot be taken into muscles
10
Q
Give the diagnostic criteria for T2DM
A
2 of:
- Fasting plasma glucose >6.9mmol/L
- HbA1c 48 or greater
- Random plasma glucose >11.1
- Plus symptoms of hyperglycaemia
11
Q
What are the 3 microvascular complications of diabetes?
A
- Neuropathy
- Nephropathy
- Retinopathy
12
Q
Give 2 symptoms and 2 risks of diabetic neuropathy
A
S: Pain + loss of sensation
R: poorly controlled hyperglycaemia + reduced ankle reflexes
13
Q
Give 2 treatments for diabetic neuropathy
A
Glycaemic control
Pregabalin
14
Q
What pathology occurs in diabetic nephropathy?
A
Alteration in glomerular BM permeability and increase in intraglomerular pressure
15
Q
What 2 things may be seen on blood tests in diabetic nephropathy?
A
Raised albumin
Reduced eGFR
16
Q
Give 3 treatment options in diabetic nephropathy
A
Diabetic control
ACEI/ARB
Smoking cessation
17
Q
What pathological processes occur in diabetic retinopathy?
A
Loss of retinal supporting cells, BM thickening and blood flow changes
Ultimately retinal detachment and vision loss
18
Q
Give one treatment of diabetic retinopathy
A
Intravitreal Anti-VEGF therapy
19
Q
Give 3 macrovascular complications of diabetes and how they occur
A
MI, stroke, PAD
Hyperglycaemic causes increased vascular smooth muscle cells and decreased blood capacity
20
Q
Define DKA
A
Mostly occurring in T1DM (can be 1st presentation), medical emergency in which there is absolute insulin deficiency
21
Q
What causes DKA?
A
Trigger
Insulin deficiency
Hyperglycaemia and ketone
bodies formed by free fatty acids from the liver
Acidosis
22
Q
Give 3 symptoms of DKA
A
Polydipsia
Acetone breath
Kussmaul breathing
23
Q
What happens to K+ during DKA?
A
Insulin normally activates Na/K ATPase but this is reduced = K moving into bloodstream
Excess K then excreted by kidneys
Serum K looks normal but body is actually deplete
24
Q
Give the 3 parameters used to diagnose DKA
A
- Diabetes (blood glucose >11 or known diabetes)
- Acidosis (pH <7.3 or H+>45 or Bicarb <15)
- Ketonaemia (blood ketone >3 or urine ketone ++)
25
Give 3 triggers of DKA
Infection
Alcohol
MI
26
Give the 4 main management options in DKA
IV Fluid
IV Insulin
IV Dextrose
Correct hypokalaemia
27
Give 3 complications of DKA
Death
VTE
Cerebral oedema
28
Define HHS
Profound hyperglycaemia (glucose >30mmol/L), hyperosmolality and volume depletion in absence of significant ketoacidosis, commonly in T2DM
29
Give 3 causes of HHS
Infection
Acute illness e.g. stroke
Drugs e.g. beta blockers
30
What significant electrolyte abnormality occurs in HHS
Hypernatremia
31
Outline pathology of HHS and give 2 risks
Metabolic derangement due to insulin deficiency and increased counterregulatory hormones, residual insulin is present
Age >65
Infection
32
Give 3 investigations of HHS
Blood glucose high
Blood ketones negative or low
VBG = mild acidosis
33
Give 3 treatment options for HHS
IV fluid
Fixed rate insulin infusion
Potassium replacement
34
Give 2 treatments of mild hypoglycaemia
15-20g quick acting carbs
| Glucotabs
35
Give 2 treatments of moderate hypoglycaemia
Swallow glucogel squeezed between teeth and gums
Glucagon 1mg IM
36
Give 2 treatments of severe hypoglycaemia
100ml 20% glucose IV
| 150ml 10% glucose IV
37
Define gestational diabetes and give the cause
Glucose intolerance in pregnancy, usually 24-28 weeks
Resistance to insulin action normally increases during pregnancy but some women’s beta cells cannot compensate
38
Give 3 causes of secondary diabetes
CF
Cancer
Pancreatectomy
39
Why is there a higher risk of hypoglycaemia in secondary diabetes?
Loss of alpha cells producing glucagon as well as beta cells
40
What is monogenic diabetes?
Monogenic (change in single gene), autosomal dominant occurring age <25 with negative pancreatic autoantibodies
41
Define hypothyroidism and give 2 causes
Underproduction of T4 and T3 (active form) mainly due to primary hypothyroidism
- Hashimoto's thyroiditis
- Thyroidectomy
42
Give 4 symptoms of hypothyroidism
- Cold sensitivity
- Menorrhagia
- Weight gain
- Dry skin
43
Give 2 risk factors for hypothyroidism
- Iodine deficiency
| - Female
44
What 3 things may be seen on blood tests in hypothyroidism?
High TSH
Low T3/T4
+ thyroid antibody
45
What is the main treatment for hypothyroidism?
Levothyroxine
46
Give 3 causes of hyperthyroidism
- Grave's disease
- Thyroid nodules
- Drugs e.g. Amiodarone
47
Give 4 symptoms of hyperthyroidism
- Sweating
- Oligomenorrhoea
- Tremor
- Diffuse goitre
48
Give 3 investigations for Grave's disease
Low TSH
High T3/T4
Diffuse uptake on isotope scan
49
Give 3 treatments for Grave's disease
Carbimazole
Beta blockers
Radioactive iodine
50
What is a diffuse goitre vs a nodular goitre?
Diffuse: swollen and smooth
Nodular: Nodular and irregular
51
Define toxic multinodular goitre
Multiple functioning nodules resulting in hyperthyroidism, function independently of thyroid and are almost always benign
52
Give 3 investigations of a goitre
Neck exam
TSH
Thyroid US
53
Give 4 types of thyroid cancer
Follicular
Papillary
Anaplastic
Medullary
54
Give 3 risks for thyroid cancer
Head and neck irradiation
Female
30-40 years
55
Give 2 treatments for thyroid cancer
Surgery
| Radioiodine
56
Give 3 features of thyroid eye disease
Lid lag
Exophthalmos
Proptosis
57
Define hyperparathyroidism and give 2 causes
Autonomous overproduction of PTH resulting in hypercalcaemia
- Parathyroid adenoma
- Inherited e.g. MEN1
58
Give 2 symptoms and 2 risks of hyperparathyroidism
Bone pain and poor sleep
Female, age >50
59
Outline the pathophysiology of hyperparathyroidism
Normally high serum Ca would supress PTH but this does not happen and excessive PTH = over-stimulation of bone resorption with cortical bone more effected
60
Give 3 blood tests used in the investigation of hyperparathyroidism
```
Serum Ca (high)
Vitamin D (low)
ALP (raised)
```
61
Give 3 treatments for hyperparathyroidism
Parathyroidectomy
Vitamin D supplementation
Bisphosphonate
62
What is secondary hyperparathyroidism?
Any condition resulting in hypocalcaemia will elevate PTH levels
63
Define primary hypoparathyroidism
Relative or absolute deficiency of plasma PTH synthesis and secretion (low serum Ca, high serum phosphate)
64
Give 2 causes of hypoparathyroidism
Post surgical
| Genetic e.g. DiGeorge syndrome
65
Give 3 symptoms of hypoparathyroidism
Dry hair
Poor memory
Diarrhoea
66
How does hypoparathyroidism occur?
Hypocalcaemia results from deficient actions of PTH to reabsorb calcium from urine
67
Give 2 investigations of hypoparathyroidism
```
Serum Ca (low) - indicates Primary
ECG (prolonged QT)
```
68
Define secondary hypoparathyroidism
Physiological state in which PTH levels are low due to primary process that causes hypercalcaemia
69
Give 2 treatments for hypoparathyroidism
Calcium + calcitriol
| Diuretic
70
Define Addison's disease
Primary adrenal insufficiency causing decreased adrenal hormones of autoimmune cause
71
Give 3 symptoms of Addison's
Fatigue
Anorexia
Hyperpigmentation
72
What two electrolyte abnormalities may be seen in Addison's?
Hyponatraemia
| Hyperkalaemia
73
What test is commonly used in Addison's and what happens during it?
Short Synthacthen test: plasma cortisol measured before and 30 mins after IV ACTH
74
What is the treatment of Addison's disease?
Glucocorticoid plus mineralocorticoids
Androgen replacement
75
Define hypopituitarism and give 2 causes
Partial or complete deficiency of one or more pituitary hormones
- Pituitary adenoma
- Inflammatory lesion
76
Give 3 symptoms of hypopituitarism
Headache
Failure to thrive
Infertility
77
Give 4 tests used to investigate hypopituitarism
Na (low in ACTH/TSH deficiency, high in diabetes insipidus)
8am cortisol and ACTH (low)
TFTs
FSH and LH level
78
Give 2 treatments for hypopituitarism
Tx correctable causes
Hormone replacement (start with cortisol if all axes affected)
79
Define Cushing's syndrome
Clinical manifestation of hypercortisolism from any cause
80
Give 1 ACTH dependent and 1 ACTH independent cause of Cushing's
Dependent: Pituitary adenoma
Independent: Adrenal adenoma
81
Give 4 symptoms of Cushing's
- Buffalo hump
- Thin skin
- Striae
- Moon face
82
Give 4 investigations for Cushing's
- 24hr urinary free cortisol
- Urine cortisol:creat ratio
- Dexamethasone supression test (normal = undetectable)
- Late night salivary cortisol (normal = undetectable)
83
Give 2 treatment options for Cushing's
- Reduce/stop steriods
| - Tumour resection
84
Define acromegaly and give it's main cause
Chronic, progressive disease caused by excessive secretion of GH
Pituitary somatotropin adenoma
85
Give 3 features of acromegaly
Coarse facial features
Enlarged tongue
Visual field loss
86
Outline the pathology of acromegaly
Tumour chronically secretes excessive GH, stimulating insulin-like growth factor 1 producing = majority of symptoms
87
Give 3 investigations for acromegaly
Glucose tolerance test (glucose load fails to supress GH)
IGF-1 level elevated
Pituitary MRI – macroadenoma >1cm, invades surrounding structures
88
Give 2 treatments for acromegaly
Transsphenoidal surgery (non-curative)
Pituitary radiotherapy
89
Give 2 causes and 2 symptoms of hyperprolactinaemia
Causes:
- Prolactinoma
- Traumatic sectioning of pituitary stalk
Symptoms:
- Vaginal dryness
- Irregular periods
90
Give 2 investigations of hyperprolactinaemia
Prolactin level
| Pituitary MRI
91
Define PCOS and give 3 symptoms
Hyper-andorgenism and hyper-androgenaemia of unknown cause
- Oligo/anovulation
- Hirsutism
- Infertility
92
Give the 3 main pathological mechanisms involved in PCOS
Gonadotrophins (increased LH, decreased FSH)
Androgens (increased androgens and decreased SHBG)
Insulin (increased resistance)
93
Give 3 tests to investigate PCOS
- Serum 17-hydroxyprogesterone
- TFTs
- Serum prolactin
94
Give 3 PCOS treatments
Weight loss
Metformin
Clomifene (anti-oestrogen to inhibit -ve feedback and increase FSH)
95
Define primary gonadal failure in men and give 2 causes
Clinical syndrome that comprises symptoms and/or signs, along with biochemical evidence of testosterone deficiency
- Klinefelter's
- Cryptorchidism
96
Give 2 symptoms of primary gonadal failure in children and adults (men)
C: Slow growth + lack of secondary sexual characteristics
A: poor libido + depression
97
Outline the pathophysiology of primary gonadal failure in males
Injury to Leydig cells results in decreased testosterone production, while seminiferous tubule involvement results in decreased or absent spermatogenesis
98
Give 2 investigations and 2 treatments for primary gonadal failure in males
Testosterone level and semen analysis (1-3 days after ejaculation)
Androgen replacement + fertility Tx
99
Define primary gonadal failure in females and give 2 causes
Cessation of menses for more than 1 year before 40 years of age secondary to loss of ovarian function
- AI disease
- Genetic
100
Give 3 symptoms of primary gonadal failure in females
Hot flushes
Sleep disturbance
Vaginal dryness
101
Give 2 tests and 2 treatments of primary gonadal failure in females
- Serum FSH/LH + Serum estradiol
| - Combined hormone replacement + vaginal oestrogen
102
Define Klinefelter's syndrome and give 2 symptoms
Commonest genetic cause of hypogonadism in men, caused by XXY sex chromosomes clinically manifesting at puberty
Delayed puberty
Azospermia
103
Give 2 management options for Klinefelter's syndrome
Androgen replacement
| Fertility support
104
Define phaeochromocytoma and give 2 symptoms
Catecholamine producing tumour of chromaffin cells of adrenal medulla
- Headache
- Palpitations
105
Give 2 tests and 2 management options for pheochromocytoma
24hr urine catecholamines + plasma catecholamines
Alpha blocker then beta blocker
106
Define primary hyperaldosteronism and give 2 symptoms
Aldosterone production exceeds body’s need, commonest secondary cause of HTN
HTN + polyuria
107
Give 2 tests and 2 treatments for primary hyperaldosteronism
- Aldosterone-renin-ratio
- Saline suppression test
Tx:
- Unilateral adrenalectomy
- MR antagonists
108
What BMI defines obesity?
BMI>30
109
Give 2 causes and 2 risks for obesity
A: genetic + behavioural
R: hypothyroidism + hypercortisolism
110
Give 3 pathological mechanisms involved in obesity
Appetite
Leptin (secreted by adipose when substrate is plentiful, obese people in state of leptin resistance)
Hypothalamus (appetite regulation)
111
Give 4 management options for obesity
- Diet
- Exercise
- Orlistat (inhibits lipases)
- Bariatric surgery
112
Define hyperkalaemia and give 2 cause
Plasma K+>5.5mmol/l
- AKI
- CKD
113
Give 1 symptom and 1 sign of hyperkalaemia
Weakness
| Depressed/absent tendon reflexes
114
Outline why the kidneys are commonly implicated in hyperkalaemia
Kidneys responsible for 90% K excretion via GI tract so renal impairment is one of most common causes
115
Give 3 ECG changes seen in hyperkalaemia
Tall tented T waves
Wide QRS
Prolonged PR
116
Give 4 treatments for hyperkalaemia
- Calcium gluconate IV (10mls 10% in 10 mins)
- Insulin-glucose infusion
- Salbutamol
- Calcium Resonium
117
Define hypokalaemia and give 2 causes
Plasma K+ <3.5mmoll/L
- GI losses
- Diabetes insipidus
118
Give 2 symptoms of hypokalaemia
Weakness
| Muscle cramps
119
Give 2 ECG changes seen in hypokalaemia
U waves
| T wave flattening
120
Give 2 medical management options for hypokalaemia
Oral K+Cl- (Sando-K)
| IV Potassium
121
Define hypernatraemia and give 2 causes
Serum sodium >145mmol/L
- Severe diarrhoea
- Dehydration
122
Outline the pathology of hypernatraemia
Represents deficit of water relative to sodium, always associated with serum hyperosmolality
123
What is the common treatment of hypernatraemia?
Oral/IV fluid
124
Define hyponatraemia and give its three main, broad causes
Serum Na+ <135mmol/l
- Hypovolaemia
- Euvolaemia
- Hypervolaemia
125
Outline the pathology of hypovolaemia
Sodium falls due to excess water in the body due to retention and/or water intake relative to sodium
126
Give one treatment for Hypovolaemia hyponatraemia and one for eurovolaemic/normovolaemic
Hypo: NaCl 0.9% IV
Euvo/Normo: Fluid restrict
127
Define hypercalcaemia and give 2 causes
Serum Ca > 2.6mmol/L
- Hyperparathyroidism
- Myeloma
128
How is hypercalcaemia usually managed?
IV saline 0.9% at varying rate depending on severity
129
Define hypocalcaemia and give 2 causes
Serum Ca <2.2mmol/l
- Hypoparathyroidism
- Hypomagnesaemia
130
Give 2 symptoms of low calcium
Tetany
| Seizures
131
Give 2 treatments of hypocalcaemia
Oral Ca salts
| IV Ca in tetany
132
Define hypermagnesaemia and give one cause
Serum magnesium >1.1mmol/l
- Renal impairment
133
Give 2 symptoms of hypermagnesaemia
Nausea
| Flushing
134
How is hypermagnesaemia treated?
Mainly asymptomatic so no Tx needed
135
Define hypomagnesaemia and give 1 cause
Serum magnesium <0.7mmol/L
GI loss
136
Give 2 symptoms of hypomagnesaemia
Tremor
| Tetany
137
Give 2 treatment options for hypomagnesaemia
Oral supplement
| IV magnesium sulphate
138
Give 2 causes of respiratory acidosis
Opiates
| Asthma
139
Give 2 causes of respiratory alkalosis
Anxiety
| Hypoxia (increased RR)
140
Give 2 causes of metabolic acidosis
More acid production
| Renal bicarbonate loss
141
Give 2 causes of metabolic alkalosis
Vomiting
| Diarrhoea
142
What is the normal anion gap range?
4-12mmol/L
143
What does an increased anion gap indicate?
Increased acid production
| Acid ingestion
144
What does an decreased anion gap indicate?
Decreased acid production
| HCO3 loss
145
What happens in mixed picture acidosis/alkalosis?
CO2 and HCO3 move in opposite directions
