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Year 3 > Endocrinology Qs > Flashcards

Endocrinology Qs Flashcards

1
Q

What are the diabetes sick day rules?

A

If a patient is on insulin, they must not stop it due to the risk of diabetic ketoacidosis. They should continue their normal insulin regime but ensure that they are checking their blood sugars frequently

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2
Q

When are SGLT2 inhibitors …-flozin, given alongside metformin?

A

When a px has type 2 and cardiovascular disease e.g. hx of MI or TIA

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3
Q

What if a person with suspected DKA has high glucose, high ketones but is not acidotic?

A
  • called diabetic ketosis not DKA
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4
Q

Which diabetic drug carries the risk of hypoglycaemia e.g. after prolonged fasting or those with renal/hepatic impairment?

A

Sulfonylurea - …zide

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5
Q

What fasting glucose indicated pre-diabetes?

A

7+ = diabetes
6.1 - 7 = prediabetes

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6
Q

when is it age related macular degeneration and not diabetic retinopathy

A

Drusen seen

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7
Q

Ace inhibitors and pregnancy?

A

….pril - medications

should be potentially swapped may be tetrogenic

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8
Q

which drug may cause raised prolactin?

A

metoclopramide (dopamine receptor antagonist)

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9
Q

The Ps of raised Prolactin (6)

A

Pregnancy
Prolactinoma
Physiological
PCOS
Primary hypothyroidism
Phenothiazines, metocloPramide, domPeridone

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10
Q

What is severe hypothyroidism causing impaired mental status?

A

Myxoedema coma

tx with IV levothyroxine and liothyrnonine (T3) + IV hydrocortisone, oxygen and rehydration

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11
Q

what organisms found in infected foot ulcer on diabetic?

A

ram-positive organisms such as Staphylococcus aureus, Enterococcus, and gram-negative organisms like Pseudomonas aeruginosa, Escherichia coli, Klebsiella species, Proteus species and anaerobes.

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12
Q

cerebral oedema in DKA signs

A

More common in children

rising BP and slowing pulse
lapse in consciousness
headache
seizure

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13
Q

what type of DKA can SGLT2i cause? (dapagliflozin)

A

euglycaemic DKA (DKA features but not elevated glucose)

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14
Q

Signs on X ray of PTH disorder?

A

Pepper pot skull

(+ osteitis fibrosa cystica which is a low bone mass sign )

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15
Q

SHATTERED FAMILY?

A

Risk factors for oestoporosis

S - steroids
H - hyperparathyroid/hyperthyroid
A - Alcohol + smoking
T - Thin, BMI <22
T - Testosterone def in men
E - early menopause
R - Renal/liver disease
E - Erosive bone disease
D - Diabetes

Family hx

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16
Q

DEXA scan 1st line results for oesteoporosis?

A

T value of < - 2.5 = osteoporosis

T value -1 -> -2.5 = osteopenia

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17
Q

osteoporotic vertebral fracture investigation?

A

X ray spine

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18
Q

how to manage FRAX scan?

A

FRAX scan tells you if a person has a fracture risk in the next 10 yrs

low risk result - reassurance
intermediate - do DEXA scan
high - oral bisphosphonates

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19
Q

normal bloods but fractures?

A

osteoporosis

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20
Q

why may prolactin be high in a pituitary adenoma?

A

due to the compression of the pituitary stalk interrupting dopamine

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21
Q

pituitary tumour genetic risk factor?

A

MEN1

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22
Q

investigation - acromegaly

A

1st do serum IGF-1 levels

then do oral glucose tolerance test to confirm

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23
Q

Most common cause of secondary HTN?

A

Primary intrinsic kidney disease e.g. glomerulonephritis

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24
Q

If someone presents with HTN readings what to do next?

A

if under 180/120 offer ambulatory monitoring + assess for end organ damage + calculate QRISK score

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25
Q

Stages of HTN?

A

stage 1 - 140/90 (treat from here in under 80s if indication of end organ damage or if QRISK 10%+ )

stage 2 - 160/100 (treat all)

stage 3 - 180+ / 120 +

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26
Q

Malignant HTN?

A

severe elation resulting in end organ damage

e.g. papulloedema, retinal haemorrhage, confusion, siezure, chest pain, AKI, heart failure

if these symptoms present with 180/120+

== same day referral

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27
Q

pulmonary HTN Ix and Tx

A

ix - echocardiogram

  • CCB for vasodilation
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28
Q

Patient is taking an ACEi, a thiazide, a CCB BP still high?

A

Add spironolactone if K is <4.5

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29
Q

Lower than expected levels of HbA1c? factors affecting hba1c

A
  • due to reduced rbc lifespan:
  • sickle cell anaemia
  • GP6D
  • Hereditary spherocytosis
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30
Q

Higher than expected levels of HbA1c? factors affecting hba1c

A

increased rbc lifespan:

  • B12/folic acid deficiency
  • Iron def anaemia
  • splenectomy
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30
Q

Higher than expected levels of HbA1c? factors affecting hba1c

A

increased rbc lifespan:

  • B12/folic acid deficiency
  • Iron def anaemia
  • splenectomy
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31
Q

Metformin summary

A

Increases insulin sensitivity and reduces hepatic gluconeogenesis.

Can lead to lactic acidosis and GI side effects (eg. nausea, diarrhoea).

Weight neutral.

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32
Q

Sulfonylurea summary (gliclazide)

A

release insulin from beta cells

but can cause hypOglycaemia if too much released, can cause weight gain

best to add on in non-obese patients

Withold this drug on the morning of surgeries due to risk of hypog

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33
Q

SGLT2 i - flozin summary

A

inhibits sodium glucose transporter in renal PCT, increases glucose in urine

weight loss

naturally can cause UTI + fournier’s gangrene

if this medication is given with insulin can cause DKA

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34
Q

DPP4is - gliptins summary

A

weight neutral, does increase satiety so useful in obese patients

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35
Q

pioglitazone summary

A

Causes weight gain

contraindicated in heart failure as it causes fluid retention

liver dysfunction + fractures

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36
Q

pathophysio of diabetic neuropthy

A

glycation of axon proteins

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37
Q

Dysaesthesia?

A

In diabetes neuropathy

  • burning sensation in feet

comes with glove and stocking, worse at nihgt pain, reduced/absent ankle reflexes, painless injuries at pressure points

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38
Q

Ix for diabetic neuropathy?

A

test sensation using 10g monofilament

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39
Q

Drug mx for diabetic neuropathy

A

if painful

Try duloxetine first, but also 1st line are amitriptyline, gabapentin, pregabalin

avoid amitriptyline in px with BPH due to retention

40
Q

background vs non-proliferative retinopathy

A

microaneurysms, blot haemorrhages, hard exudates

pre = ++ cotton wool spots

41
Q

histological changes in diabetic nephropathy?

A

renal biopsy:

  • kimmelstiel-wilson nodules

Mesangial expansion GBM thickening, glomerulosclerosis

42
Q

severe life threatening hypoC due to hypoPTH?

A

ECG isolated prolonged QT interval - prediposes someone to Torsades de pointes

43
Q

hyperPTH primary vs tertiary?

A

PTH much higher markedly in tertiary
Phosphate is also higher in tertiary but low in primary

44
Q

imaging when looking for parathyroid gland adenoma?

A

US

45
Q

Drugs that inhibit PTH release?

A

Calcimimetics - cinacalcet

46
Q

hypercalcaemia of malignancy types?

A
  • humoral: tumor secretes PTHrP , SCC, Renal, bladder, breast, ovarian
  • Local osteolytic: body mets release factors that promote osteoclast function, myeloma breast cancer
  • Calcitriol mediated: 1,25 dihydroxyvitamin D release due to 1a-hydroxylase activity in tumour cells - lymphomas
47
Q

why does osteomalacia cause waddling gait?

A

Proximal myopathy - causes muscles weakness, spasms, cramps

48
Q

X-ray sign for osteomalacia?

A

Looser zones - pseudofractures

49
Q

Vitamin def treatment (osteomalacia)?

A

ergocalciferol + calcium carbonate

(vit D supplementation + calcium )

50
Q

what can cause secondary osteoporosis?

A

drugs - long term corticosteroids, anticonvulsants, anticoags, PPIs

hypogonadism
hyperthyroidism
cushings
hyperparathyroidism

51
Q

Primary osteoporosis causes

A

post menopausal

senile osteoporosis

rheumatoid arthritis

52
Q

types of malignant thyroid nodules?

A

papillary carcinoma:
- most common, best prognosis
- goes to cervical lymph nodes

follicular carcinoma:
- later in life ppt
- areas of low iodine
- goes to lungs and bones

medullary carcinoma:
- parafollicular cells cancer
- calcitonin secreted
- MEN2 (genetic link)

53
Q

1st line imaging for thyroid nodule malignancy?

A

US

54
Q

Diagnosis flowchart thyroid nodule?

A

US + TSH

TSH low –> thyroid scintigraphy –> measure T4/T3

TSH high –> FNA criteria met –> Cytology

55
Q

Thyroid eye summary

A

Graves disease

antibodies against TSHr

target the extraocular muscles = swelling behind eye == proptosis

SMOKING biggest changeable factor

+ lidlag
+ optic disc swelling
+ opthalmoplegia
+ dry eyes

if vision changes –> opthalmologist review

topical lubricants to prevent corneal inflammation
High dose IV steroids

56
Q

if statin for hyperCh/Trig is C/I (pregnancy) or interacting (erythromycin) what is 2nd line?

A

Ezetimibe

  • cholesterol absorption inhibitor
57
Q

overweight BMI?

A

25 - 29.9

58
Q

Obesity BMI according to class 1,2,3

A

Class 1 = 30-34.9

Class 2 = 35-39.9

Class 3 = 40+

59
Q

Class 1 obesity consider medication after lifestyle?

A

Orlistat (pancreatic lipase inhibitor)

60
Q

Class 2 with comorbidities or class 3 obesity mx?

A

Surgical - bariatric

61
Q

hyperthermia define?

A

40 degrees +

heat stroke = hyperthermia + CNS dysfunction

exertional heat stroke = strenous physical activity

heat exhuastion = Hot but not CNS

62
Q

How to assess hyper/hypothermia temperature?

A

Rectal temperature - best for core body temp

63
Q

mild hypothermia mx

mod hypothermia mx

severe hypothermia mx?

A

1 = passive external rewarming, blanket, warm room

2 = active external warming = warm blanker, radiate head, forced warm air

3 = IV warm crystalloid

64
Q

Hypothermia management issues?

A

rapid rewarming -> vasodilation and shock

do not put person in hot bath

do not massage their limbs

do not use heating pads

no alcohol

65
Q

Manage a heat stroke?

A

stabilisation - ABC, remove clothing

rapid active cooling = ice water bath

66
Q

Manage heat exhuastion?

A

Oral isotonic fluids

active cooling

67
Q

Addisons mx + during acute illness?

A

2/3 doses hydrocortisone
1 dose fludrocortisone

2x the hydrocortisone when sick

68
Q

Mx for Cushings?

A

Metyrapone /ketoconazole

pit adenomectomy / adrenalectomy

69
Q

If someone gets asymptomatic positive findings on fasting/random glucose?

A

Need to do it again

70
Q

long acting insulin example
short acting insulin example

A

Glargine
Lispro / aspart

71
Q

Whipples triad?

A

Hypoglcyaemia

low blood glucose concentration, hypoglycaemic symptoms & resolution of symptoms after raising blood glucose concentration to normal

72
Q

hypoglycaemia mx?

A

awake = oral 15-20g glucose + fast acting carb

asleep = IM glucagon + IV dextrose (20% glucose)

73
Q

Hyperosmolar hyperglycaemia values?

A

HyperG at 30+
Hyperosmolar at 320+
Dehydration
monitor via osmolality

74
Q

Tx of hyperosmolar hyperglycaemia?

A

IV isotonic saline +- KCL
IV insulin
5% dextrose when it falls

75
Q

When to give IV bicarbonate?

A

Severe metabolic acidosis e.g. DKA causing VBG reading <7.3, ketones 3+

76
Q

Describe diabetic neuropathy - other can the convensional peripheral pain?

gastroparesis mx ?

A

autonomic, erectile dysfunction, urinary sx

gastroparesis = metoclopramide

77
Q

What is retinal detachement?

A

painloss vision loss

shadow in the periphery

flashers + floaters

+ flashing lights

78
Q

How does viterous haemorrhage present?

A

sudden spots, floaters, blurring

79
Q

what is carcinoid syndrome?

A

NET serotonin, flushing, diarrhoea, SOB
Ix urine = serotonin

Tx = octreotide

80
Q

CATS go Numb in hypoparathyroidism?

A

Convulsions
Arrythmias
Tetany
Parasthaesia

81
Q

Hypocalcaemia signs?

A

Chvosteoks sign = cheeck

Trousseu sign = tight BP cuff

82
Q

(hypercalcaemia of malignancy) osteolytic types?

A

multiple myeloma - no ALP
or mets increased ALP

83
Q

what type of hypercalcaemia of malignancy does lymphoma lead to?

A

calcitriol mediated

84
Q

What drugs cause osteomalacia?

A

Anticonvulstants

  • look out for pseudofractures
85
Q

DEXA scan scores

what is the Z score?

A

DEXA scan gives you t score
-2.5 lower = osteoporosis
-1.0 - -2.5 = osteopenia

Z score will adjust for age, gender, ethinicity

86
Q

What is the FRAX score?

A

10 year fracture risk

87
Q

Medications for osteoporosis?

A

Give biphosphonates
1 = alendronate
2 = risedronate (to lessen Gi effects)

for post menopausal women:
-> 1 = denosumab

88
Q

What medicine not to take with levothyroxine?

A

Calcium carbonate

89
Q

carbimazole is C/

  • remember carbimazole can cause agranulocytosis
A

propylthiouracil

90
Q

how to deal with subclinical hypothyroid e.g.

TSH high, T4/T5 low

A

if patient is under 65 and have symptoms can try levothyroxine

91
Q

How to manage a thyroid storm?

A

IV propranolol
IV digoxin
propylthiouracil

then give lugols Iodine after 6 hrs

give steroids

92
Q

papillary cancer key features

follicular carcinoma features

medullary carcinoma features

A
  • lymph nodes, commonest, orphan annie cells,
  • lungs + bone mets, seen in low iodine area
  • parafolllicular cells, MEN2 link, calcitonin secretions
93
Q

J wave seen in?

A

Hypothermia

94
Q

hypothermia mild, mod, severe?

A

mild = 32-35 (shivering, HR, RR up)
mod = 28 - 32 (HR BP down)
severe - 28 (coma, arrythmia, fixed dilated pupils)

95
Q

familial hypercholesterolaemia

  • genetic link?
  • xanthomata?
  • xanthelasma?
  • eruptive?
A
  • autosomal dominant
  • lipid in skin tendons
  • yellow plaques on eyelids
  • rush, genetic, lipase def
96
Q

What does a milky white retina mean?

A

Hypertrig

97
Q

statin interactions?

A

macrolides - causes myopathy

stop statin if transaminase is 3x upper limit

Year 3 (14 decks)

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