EXAM QS I GET WRONG Flashcards
What do you do if a patient is on 500mg metformin 3x a day and complaining of diarrhoea?
GI side effects are common with metformin and can occur in up to 20% patients.
This patient is on immediate release as he takes it 3x a day
We can switch it to the modified release variant which is usually given once daily instead
How to differentiate the causes of primary hyperaldosteronism?
Primary hyperaldosteronism =Conns syndrome
caused by adrenal adenoma secreting aldosterone, this is the most common cause
Other causes are bilateral adrenal hyperplasia
To differentiate these two causes, imaging (CT) is used- if this doesn’t produce adequate results-perform adrenal venous sampling
If the cause is bilateral hyperplasia: you’d have bilaterally increased aldosterone in adrenal veins
If it’s an adrenal adenoma- unilateral increased aldosterone in adrenal vein
Endocrine parameters reduced in stress response- which hormones are reduced during major surgery?
Insulin
Testosterone
Oestrogen
In suspected cases of Graves disease what medication can be used to manage symptoms whilst patient is waiting to see endocrinologist?
Propanalol- non-selective BB, prevents the adrenergic effects of hyperthyroid
Works quickly to help control the symptoms
What drugs do you prescribe for controlling htn in pheochromocytoma?
Alpha and beta blockers
Remember labetalol blocks both alpha and beta
Female pt with hypothyroidism, treatment during pregnancy?
Women with hypothyroidism may need to increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy
Is breast-feeding safe whilst on thyroxine?
Yes
Treatment of thyroid storm
Symptomatic- paracetamol
Treat cause
Beta blockers- IV propanolol
Anti-thyroid drugs- (thionamides)-methimazole or PTU
Lugol’s iodine
Dexamethasone- blocks conversion of T4 to T3
Role of steroids in thyrotoxic crisis
Blocks conversion T4 to T3
What is thyroid acropachy
Triad of digital clubbing, soft tissue swelling hands & feet, periosteal new bone formation
Specific to Graves’
Side effects of metaclopramide
Very common- diarrhoea, drowsy, hypotension, menstrual cycle irregularities, parkinsonism
Uncommon- arrhythmias
Rare- galactorrhoea, confusion, seizure
T1DM blood glucose targets
5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day
under 4 you hit the floor, over 7 you may go to heaven
Addison’s patient unwell- what to do about their medications?
Double the glucocorticoids (hydrocortisone)
Child with palpable abdominal mass or unexplained enlarged abdominal organ- what to do
Refer very urgently <48 hrs for specialist assessment for neuroblastoma and Wilms’ tumour
Malignancy until proven otherwise
What is primigravid
Pregnant for first time
Most common cause of primary hypothyroidism
In UK- Hashimoto’s thyroiditis
In the developing world- iodine deficiency
Hashimoto’s thyroiditis = ?
hypothyroidism + goitre + anti-TPO
What is sick euthyroid syndrome
Where TSH, thyroxine and T3 are all low
But most of the time TSH is normal
No treatment usually necessary-repeat TFTs in 6wks
What drug causes hyperCa
Thiazides- increase calcium reabsorption in DCT because they block NaCl on apical side, which reduces Na conc in DCT cells, which upregulates Na/Ca antiporter on basolat side, meaning more Na influx into the cells and calcium efflux into systemic circulation –> hyperCa and hypoNa
How to monitor recurrence in medullary thyroid cancers?
Medullary thyroid cancers often secrete calcitonin and monitoring the serum levels of this hormone is useful in detecting sub clinical recurrence.
They are a part of MEN-2
How to differentiate causes of diabetes insipidus
Water deprivation test: cranial DI
urine osmolality after fluid deprivation: low
urine osmolality after desmopressin: high
Nephrogenic DI;
Osmolality remains low
2 main causes of high calcium
malignancy and primary hyperPTH account for 90% cases
Treating thyrotoxic storm (3)
1- BB
2- PTU
3- hydrocortisone
Graves’ disease antibodies
TSH receptor stimulating antibodies
