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Endocrine > Secondary care > Flashcards

Secondary care Flashcards

1
Q

What type of diabetes has a low C peptide?

A

T1DM

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2
Q

How is an overnight dexamethasone test carried out?

A

1mg dexamethasone @10pm
morning cortisol @9am

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3
Q

What extraocular muscle is affected first in ophthalmoplegia?

A

inferior rectus

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4
Q

Where are the 2 upper parathyroid glands derived from?

A

4th pharyngeal pouch

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5
Q

Where are the 2 lower parathyroid glands derived from?

A

3rd pharyngeal pouch

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6
Q

What is the PTH in hypercalcaemia of malignancy?

A

low PTH

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7
Q

How do you test for phaeochromocytoma?

A

24 hour urine metanephrines

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8
Q

Electrolyte disturbance in Conn’s syndrome

A

hypernatraemia
hypokalaemia

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9
Q

What are the zones of the adrenal cortex?

A

zona glomerulosa
zona fasciculata
zona reticularis

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10
Q

What does the zona glomerulosa of the adrenal gland produce?

A

mineralocorticoids (aldosterone)

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11
Q

What does the zona fasciculata of the adrenal gland produce?

A

glucocorticoids (cortisol)

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12
Q

What does the zona reticularis of the adrenal gland produce?

A

androgens (DHEA, androstenedione)

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13
Q

What does the adrenal medulla produce?

A

catecholamines

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14
Q

When does menopause occur?

A

when follicle supply diminishes and FSH levels rise

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15
Q

When would a non-diabetic patient be considered hypoglycaemic?

A

<2.2

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16
Q

What is the cut off for impaired fasting glucose?

A

6.1-6.9

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17
Q

What fasting triglycerides put you at risk of pancreatitis?

A

> 10

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18
Q

Which statin is particularly good at lowering triglycerides?

A

atorvastatin

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19
Q

Symptoms/signs of agranulocytosis

A

high fever
sore throat

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20
Q

PTU adverse effects

A

hepatotoxic
vasculitic rash (p-anca mediated)

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21
Q

How is toxic multinodular goitre treated?

A

radioactive iodine

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22
Q

Cons of radioactive iodine

A

no work for 5 days
cannot sleep in same bed as someone for 5 days
no contact with children or pregnant women for 3 weeks
cannot father a child within 4 months
cannot become pregnant within 6 months
can become hypothyroid

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23
Q

Drug causes of thyroiditis/thyrotoxicosis

A

amiodarone
oncology checkpoint inhibitors
lithium
interferon (alpha)

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24
Q

Who should you be more cautious giving levothyroxine?

A

older people
ischaemic heart disease

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25
Q

What is the dose of levothyroxine?

A

roughly 0.6mg/kg

26
Q

When should subclinical hypothyroidism be treated?

A

pregnant women
want to become pregnant
children

27
Q

What is raised TSH in pregnancy associated with?

A

low IQ in baby

28
Q

What is the TSH threshold for levothyroxine treatment?

A

10

29
Q

Which cancers are most likely to cause hypercalcaemia?

A

lung
myeloma
breast
kidney
lymphoma
primary bone

30
Q

Complications of primary hyperparathyroidism

A

osteoporosis
kidney stones

31
Q

Primary hyperparathyroidism treatment

A

parathyroidectomy

32
Q

Metformin advantages

A

reduction in fasting blood glucose
reduction in HbA1C
weight neutral
low risk hypoglycaemia

33
Q

When should metformin not be prescribed in the acute setting?

A

in failure states/sepsis due to the increased risk of lactic acidosis

34
Q

Sulphonylureas adverse effects

A

hypoglycaemia
weight gain

35
Q

Adverse effects of thiazolidinediones

A

fluid retention
osteoporosis
weight gain

36
Q

When are thiozolidinediones contraindicated

A

heart failure
uninvestigated macroscopic haematuria
bladder cancer

37
Q

Adverse effects of GLP1 receptor agonists

A

nausea
risk of pancreatitis

38
Q

Adverse effects of SGLT2 inhibitors

A

increased risk of genital and urinary tract infection
hypovolaemia
dizziness
eyglycaemic + hyperglycaemic DKA

39
Q

Insulin action

A

glucose uptake
suppression of hepatic glucose production
decreased lipolysis
increased lipogenesis
decreased proteolysis

40
Q

Insulin MOA

A

decreases blood glucose by increasing the glucose uptake in peripheral tissues (glucose –> glycogen)

decreasing the hepatic glucose output (decreased breakdown of glycogen and diminished gluconeogenesis)

41
Q

What does analogue insulin mean?

A

modified to be short/long acting etc

42
Q

What does novomix 30 mean?

A

30% quick-acting insulin
70% long-acting insulin

43
Q

Needing over how many units a day is classed as insulin resistance?

A

> 100 units/day

44
Q

When should metformin be given to type 1 diabetics?

A

if they are overweight as they can become insulin resistant

45
Q

Which medications should be taken at least 4 hours after levothyroxine?

A

iron
PPIs
calcium

46
Q

Which 2 drugs can affect the thyroid?

A

lithium
amiodarone

47
Q

Which group of patients generally will need higher doses of levothyroxine?

A

coeliac disease (due to malabsorption)

48
Q

What is another name for TSH receptor antibodies?

A

thyroid stimulating antibody

49
Q

What is a risk of prolonged hyperthyroidism?

A

osteoporosis due to increased bone resorption

50
Q

What is a contraindication to radioactive iodine?

A

smoking
pregnancy

51
Q

What should you consider if a diabetic patient has rapid progression of renal failure?

A

think of non-diabetic causes of nephropathy (eg. vasculitis)

52
Q

What should unilateral sensory impairment in a diabetic patient raise suspicions of?

A

raise questions of other aetiologies - diabetic neuropathies normally bilateral + symmetrical

53
Q

What is a risk of not rotating insulin injection sites?

A

lipodystrophy - will get lump, insulin not absorbed reliably in these areas

54
Q

Autoimmune polyglandular syndrome type 1 features

A

chronic candidiasis
hypoparathyroidism
autoimmune adrenal insufficiency

55
Q

Autoimmune polyglandular syndrome type 2 features

A

autoimmune adrenal insufficiency (must be present)
autoimmune thyroid disease
T1DM

56
Q

Autoimmune polyglandular syndrome type 3 features

A

autoimmune thyroid disease
other autoimmune diseases (excluding Addison’s, hypoparathyroidism and chronic candidiasis)

57
Q

Autoimmune polyglandular syndrome type 4 features

A

2 or more organ-specific autoimmune diseases which do not fall into type 1, 2 or 3

58
Q

MEN 1 features

A

pituitary adenoma
parathyroid hyperplasia
pancreatic tumours

59
Q

MEN 2A features

A

parathyroid hyperplasia
medullary thyroid carcinoma
phaeochromocytoma

60
Q

MEN 2B features

A

mucosal neuromas
marfanoid body habitus
medullary thyroid carcinoma
phaeochromocytoma

61
Q

When can lack of hypo awareness mean a person cannot drive?

A

if they cannot feel their hypos when they are below 3

62
Q
A

Endocrine (21 decks)

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