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Rhi’s MSRA > Endocrinology/metabolic > Flashcards

Endocrinology/metabolic Flashcards

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1
Q

How does diabetic peripheral sensory neuropathy present?

A

Glove and stocking distribution
Numbness, pain, paraesthesia
Significant motor neuropathy uncommon

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2
Q

Most common cause of SIADH?
Other causes

A

-most common: IDIOPATHIC.
Others:
-CNS ie tumour, infection, GBS, MS
-Pulmonary ie tumour, pneumonia, CF
-Drugs ie vasopressin, NSAIDs, diuretics, carbamazepine, TCAs, SSRIs,
-Surgery

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3
Q

Older patient, has AF, has irregular, bumpy, nodular thyroid and minimal tremor. Most likely Dx?

A

Toxic multinodular goitre

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4
Q

Most common cause of hypOthyroidism in developing countries?

A

Hashimoto’s thyroiditis

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5
Q

Younger patient, with smooth diffuse goitre marked hyperthyroid symptoms, likely Dx?

A

Grave’s disease!
-younger age group
-smooth diffuse goitre
-more marked syx than for toxic MNG

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6
Q

What is Grave’s disease?

A

Autoimmune disorder - TSH receptor stimulating antibodies - excessive secretion & hyperplasia causing toxic diffuse goitre

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7
Q

Risk factors for Grave’s?

A

FH or personal hx of autoimmune disorders ie T1DM

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8
Q

What is toxic multinodural goitre caused by?
Risk factors?

A

2 or more autonomously functioning thyroid nodules (adeonomas) that secrete thyroid hormones
-RF: age (>60), iodine deficiency ie Denmark

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9
Q

TSH and T3/4 levels in hyperthyroidism?
-subclinical hyperthyroidism?

A

-Low TSH, raised T3/4
-Subclinical: low TSH, normal T3/4

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10
Q

Symptoms of hypOcalcaemia? & 2 signs?

A

Paraesthesia
Tetany
Carpopedal spasm (wrist flexing & fingers drawn together)
Muscle cramps
-Chvostek’s sign - twitching of face after tapping on facial nerve
-Trousseau’s sign - carpopedal spasm after compression of upper arm with BP cuff

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11
Q

ECG changes in hypercalcaemia?

A

Shortened QT
Severe: J waves may be seen

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12
Q

3 things that characterise DKA?

A

-blood glucose >11 (or known DM)
-Ketonaemia >/=3mmol or significant ketonuria (>2 on urine stick)
-acidosis: pH <7.3 or bicarbonate <15

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13
Q

How to calculate plasma osmolality?
How high should it be for DKA?

A

2Na + urea + glucose
>290 for DKA

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14
Q

Cut off HbA1c to diagnose diabetes mellitus?

A

42 (6.5%)

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15
Q

70 y/o woman - muscle weakness and diffuse bone pain. Reduced serum calcium. Most likely Dx?

A

Osteomalacia

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16
Q

Patient with PVD started on enalapril for HTN. Renal impairment develops 2 weeks later. Most likely Dx?

A

Renal artery stenosis

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17
Q

Treatment options for hyperhidrosis?

A

-Topical: 1st line = aluminium chloride. Others: Iontophorrsis, Botox, anticholinergics
-Systemic: anticholinergics, CCBs
-Surgical: Symphathectomy, surgical excision/liposuction, laser

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18
Q

4 aspects of SIADH?

A

-hyponatraemia (<125)
-elevated urine osmolality (>500)
-excess urine sodium excretion (>20)
-decreased serum osmolality (<260)

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19
Q

Cause of T1DM?

A

Loss of beta cells (which produce insulin) in the islets of Langerhans in the pancreas —>insulin deficiency

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20
Q

Cause of T2DM?

A

Insulin resistance or reduced sensitivity -most commonly related to central obesity

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21
Q

Most common cause of primary hyperparathyroidism?

A

Solitary parathyroid gland adenoma

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22
Q

Causes of primary hypoparathyroidism?

A

-Failure of the gland from autoimmune causes (ie pernicious anaemia, vitiligo, congenital)
-Removal of/trauma to the parathyroid glands ie thyroid surgery (note NOT secondary hypoparathyroidism - this is distinct state in which PTH levels are low in response to primary process that causes hypercalcaemia)

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23
Q

What is secondary hyperparathyroidism?
Most common causes?

A

-Excessive secretion of PTH by parathyroid glands in response to hypOcalcaemia
-Chronic renal failure, low Vit D

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24
Q

What is pseudohypoparathyroidism?

A

Rare autosomal dominant disorder - target cells fail to respond to PTH

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25
Acromegaly - cause? -not common presentation symptoms? -other symptoms?
-Increased unregulated growth hormone production, usually from GH secreting pituitary tumour -Headaches, visual field defects (usually bitemporal hemianopsia from pressure on optic chiasm) -Enlargement of extremities, hyperhidrosis, coarsening facial features, frontal bossing, macroglossia, arthritis, OSA, glucose intolerance, HTN, CHF…
26
65 y/o, joint pain, constantly tired, polydipsia, tanned skin. Hepatomegaly on examination. Dx?
Haemachromatosis
27
Triad of (late onset) symptoms of haemachromatosis? Related cancer?
-liver cirrhosis, diabetic mellitus, skin pigmentation -hepatocellular carcinoma
28
Most common cause of chronic pancreatitis?
Excessive alcohol consumption
29
Most common cause of hypothyroidism in developed countries? And worldwide?
-Hashimoto thyroiditis -worldwide: iodine deficiency
30
What is Riedel (fibrosing) thyroiditis? How does it present? What does the thyroid feel like?
-Rare disease - chronic inflammation and fibrosis of thyroid. -Presents with hypOthyroidism, and obstructive symptoms ie dyspnoea, dysphagia, and hoarseness -thyroid feels ‘hard as wood’, non tender
31
What is subacute (de Quervain) thyroiditis?
-transient inflammatory thyroid disease, characterised by PAIN & TENDERNESS of gland. Result of viral infection, usually 2-8 weeks beforehand. -presents as hypERthyroidism
32
Most frequent thyroid neoplasm? How does it present?
Papillary thyroid carcinoma Painless, hard thyroid mass, with enlargement of regional cervical lymph nodes
33
Symptoms of Cushing’s disease? What conditions may they do on to have?
Weight gain with central obesity, facial rounding, thinning of skin (striae), bruising, proximal muscle weakness -metabolic complications: diabetes mellitus, dyslipidaemia, HTN
34
4 tests you can do for Cushing’s (hypercortisolism)?
-late night salivary cortisol -1mg overnight low-dose dexamethasone suppression testing -24-hour urinary free cortisol -48-hour 2mg dexamethasone suppression testing
35
25 y/o woman. New-onset headaches, fatigue, constipation. No flushing/weight changes. Dad had kidney stones
Multiple endocrine neoplasia type 1
36
48 y/o man. 4/12 tired all the time, reduced appetite, weight loss, increased skin pigmentation including oral mucosa. Dx?
Addison’s disease. (NB haemochromatosis rarely involves mucosa!
37
Test to diagnose Addison’s?
ACTH stimulation test
38
What is congenital adrenal hyperplasia ?
Autosomal recessive metabolic disorder - most cases caused by 21-hydroxylase deficiency —> deficient cortisol and/or aldosterone. In response - increased ACTH secretion
39
Treatment for congenital adrenal hyperplasia?
Lifelong replacement of hydrocortisone. Plus salt-retaining steroid ie FLUDROCORTISONE
40
3 main symptoms of diabetes insipidus? Hallmark clinical test ?
Polyurea, polydipsia, nocturia -urine specific gravity of 1.005 or less, and urine osmolality <200
41
LH levels low or raised in eating disorders?
Low
42
Syndrome caused by Neisseria meningitidis that leads to DIC, haemorrhage into adrenal glands and shock
Waterhouse-Friderichsen syndrome
43
Older pt with weight gain, generalised weakness and bruising. Overnight dexamethasone suppression test fails to suppress cortisol levels. Plasma ACTH levels undetectable. Dx?
Primary Cushing’s (Adrenal Adenoma) -often discovered incidentally -usually presents as subclinical Cushing’s syndrome -undetectable ACTH = very likely AA
44
Difference between Cushing’s syndrome and Cushing’s disease?
Cushing’s syndrome = hormone disorder caused by high levels of cortisol ie from glucocorticoid drugs, or adrenal adenomas Cushing’s disease = PITUITARY ADENOMA, that produces large amounts of ACTH, which in turn elevates cortisol (is the most common cause of Cushing’s syndrome!)
45
40 y/o woman presents with muscle cramps, raised BP, high Na and low K. Dx?
Conn’s Syndrome
46
Symptoms of Conn’s syndrome?
-Fatigue, muscle weakness, cramps, headaches, palpitations (from HypOkalaemia) -Polydipsia/polyuria from diabetes insipidus
47
What Dx should always be considered in a patient (not on diuretics) with a hypokalaemic alkalotic hypertension?
Conn’s syndrome
48
Main symptoms of primary hyperparathyroidism?
Vague symptoms (most minimally symptomatic): general weakness, fatigue, poor concentration, depression, kidney stones
49
What is pseudoparathyroidism and how does it present?
-inherited resistance to parathyroid hormone -unusual development and skeletal defects: short stature, round face, shortened 4th metacarpals, obesity, dental hypoplasia, soft tissue calcifications
50
Complications of Haemaochromatosis?
Cardiomyopathy Hypogonadism Hypothyroidism Hepatocellular carcinoma
51
Where in bowel is most common place for colorectal cancer?
Rectum (45%)
52
FIT test cut-off (numerical value) to refer adults using urgent suspected cancer pathway?
>/= 10ug Hb/f faeces
53
What is primary sclerosing cholangitis? What disease is it strongly linked to?
Rare disease, unknown aetiology - CHRONIC INFLAMMATION & FIBROSIS OF BILE DUCT. IBD - particularly UC.
54
Symptoms of primary sclerosing cholangitis ?
Early syx: pruritis, fatigue May also present with fevers, night sweats and RUQ pain
55
What is primary biliary cirrhosis? Related diseases?
Autoimmune disease of liver with destruction of bile canaliculi. -osteoporosis, sicca syndrome
56
Presentation of primary biliary cirrhosis?
Commoner in women 30-65 y/o Fatigue, pruritis, stearorhoea, jaundice, hyperpigmentation, hepatomegaly, splenomegaly
57
Antibodies in primary biliary cirrhosis?
Antimitochondrial antibodies
58
Topical treatment for anal fissure?
If very painful- topical anaesthetic for a few days If persisting symptoms - topical GTN or diltiazem for 6-8 weeks
59
Conservative Mx of anal fissure? Other options if conservative and topical options fail?
-improve diet (high fibre, increase fluids) -sitz baths Botox toxin injections (to relax sphincter and allow fissure to heal)
60
How is campylobacter usually acquired? Symptoms? Complications
-Undercooked poultry in developed countries -Diarrhoea - can be watery/bloody, associated crampy abdo pain -reactive arthritis, Guillain-Barré syndrome
61
Yersinia enterocolitica - usual food culprit? Symptoms?
Pork meat/intestine Bloody diarrhoea, can mimic Crohn’s or appendicitis as causes colitis
62
Complications of H pylori?
-Peptic ulcer disease -Gastric MALT lymphoma -Gastric adenocarcinoma -Menetrier’s disease -Coronaritis (inflammation of coronary arteries) -Iron deficiency anaemia Note: NOT associated with oesophageal carcinoma
63
Symptoms of Glucagonoma? (Neuroendocrine tumour of pancreatic Islet cells that secrete glucagon)
‘6 Ds’ !! Diabetes Dermatosis (necrolytic migratory erythema) Deep vein thrombosis Depression Diarrhoea Decreased weight
64
How to calculate plasma osmolarity? Normal range? Number for DKA?
2Na + Urea + Glucose (2 salt, 1 waste, 1 sugar) Normal range 285-295 Should be >290 in DKA If >320 & not significant ketones, likely HHS
65
How does HHS present?
Hypovolaemia (grossly dehydrated) Marked hyperglycaemia >30 No significant hyperketonaemia Osmolality >320 (More common in elderly, present extremely unwell)
66
Thyroid enlargement in 30 y/o with facial flushing and diarrhoea. Likey Dx?
Medullary thyroid carcinoma
67
In which conditions should HbA1c not be used to screen patients for T2DM?
HIV infection (underestimates hyperglycaemia) Pregnant/up to 2m postpartum Acutely ill On corticosteroids End-stage renal disease Azure pancreatic damage
68
What is pseudohyperparathyroidism caused by and how does it present?
-resistance to parathyroid hormone -causes hypocalcaemia, hyperphosphataemia, raised PTH levels, and abnormal skeletal defects including short stature, rounded face, short metacarpals
69
What do loop diuretics and corticosteroids cause in terms of potassium?
Hypokalaemia
70
If both TSH and T4 raised, what should you be suspicious of?
A TSH-secreting pituitary adenoma
71
If both TSH and T4 raised, what should you be suspicious of?
A TSH-secreting pituitary adenoma
72
45 y/o with muscle pains, fatigue, polyuria, polydipsia. Has low potassium. Likely Dx?
CONN’S SYNDROME! -increased aldosterone secretion from adrenal glands -suppressed plasma renin activity -HTN -HypOkalaemia (causes fatigue, muscle weakness, cramping, headaches, palpitations) -may have polydipsa and polyuria from hypokalaemia-induced nephrogenic diabetes insipidus
73
How is haemachromatosis inherited?
Autosomal recessive (abnormal HFE gene)
74
40 y/o with joint pains, impotence, increased skin pigmentation. Hepatomegaly. Dx?
Haemachromatosis - 6 Hs! Hyperpigmentation Hepatomegaly Heart failure Hypogonadotrophic hypogonadism High sugar (diabetes) Harthralgia!? Joint pains
75
What is Chvostek’s sign and what is used to look for?
Tap on facial nerve - facial muscle contractions Hypocalcaemia
76
ECG changes in hypercalcaemia?
Shortened QT If severe - may see J waves
77
What electrolyte abnormalities does rhabdomyolysis cause?
Hyperphosphataemia Hyperkalaemia HypOcalcaemia Hypoalbuminaemia Hyperuricaemia
78
34 y/o with anorexia, weight loss, nausea/vomiting and intermittent abdominal pain. Grey-brown skin tinge. Likely Dx?
Addison’s disease -adrenocortical insufficiency affecting glucocorticoid and mineralocorticoid function -hyperpigmentation/ vitiligo Weakness, fatigue, poor appetite, weight loss, nausea/vomiting, myalgia, HYPOTENSION
79
How to calculate anion gap?
(na + K) - (HCO3 + Cl)
80
Young man with headaches, palpitations, diaphoresis, severe hypertension. Dx?
Phaeochromocytoma
81
3 ways to diagnose diabetes?
Fasting glucose >7 Random glucose >11.1 HbA1c >48
82
Bolus calculation for fluids for child with DKA?
10ml/kg (as bolus over 15 mins)
83
Treatment of HHS?
Fluid resuscitation (0.9%NaCl) Low dose insulin 0.05units/kg/hour (only start if no longer falling with IVF, or immediately if there is significant ketonaemia) Prophylactic anticoagulation
84
How to diagnose DKA?
-Significant ketonuria (>\=2) or blood ketone >3 -Blood glucose >11 or know DM -Bicarbonate <15 OR pH <7.3 NB usually T1DM but can occur in T2
85
What does Addison’s disease do to Na & K?
HypERkalaemia HypOnatraemia
86
What is the treatment of choice for mild-moderate SIADH or chronic hyponatraemia?
FLUID RESTRICTION
87
How does thyroid storm present?
Volume depletion Congestive heart failure Confusion N&V Extreme agitation
88
Treatment of thyroid storm?
Supportive treatment -cooling -correct volume status -Respiratory support -treatment of underlying sepsis
89
Tests to diagnose Cushings?
OVERNIGHT dexamethason suppression test Or 24H urinary free cortisol test
90
Best diagnostic investigation for acromegaly?
Insulin like growth factor-1 level
91
What conditions are anticardiolipin antibodies found in?
Antiphospholipid syndrome SLE ITP Rheumatoid arthritis Psoriatic arthritis Sjögren’s syndrome RIPASS
92
Insulin rate of infusion for HHS?
0.05units/kg/hour (should mostly fall with fluids, and don’t want to fall by more than 5mmol/L/hour
93
Triad of milk-alkali syndrome? Cause?
Hypercalcaemia Renal failure Metabolic acidosis Large amounts of calcium / antacids (absorbable alkali)

Rhi’s MSRA (13 decks)

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