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step 2 Flashcards

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1
Q

medication used to treat gastroparesis associated with diabetes

A

metoclopramide (d2 antagonist) or erythromycin (macrolide)

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2
Q

most common cause of death in diabetic patients

A

cardiovascular disease

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3
Q

diagnostic requirement for diabetes

A

Random blood glucose > 200 + symptoms of hyperglycaemia

or 2 of the following;

  • fasting blood glucose (>8 hrs) >126
  • 2 hours post prandial (OGTT) glucose > 200
  • HbA1c > 6.5%
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4
Q

how often should patients be re-checked if they dont meet the criteria for DM but have impaired fasting glucose of OGTT

A

impaired OGTT or fasting glucose but dont meet diagnostic criteria should be checked yearly

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5
Q

how often should patients over 45 years with a HbA1c between 5.7 - 6.4% be checked

A

patients who dont meet criteria for DM but have HbA1c between 5.7-6.4% should be checked 3 yearly

if over 45 years and < 5.7 then check yearly

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6
Q

antibodies and HLA associated with type 1 diabetes

A

anti-glutamic acid dexarboxylase (GAD), anti-islet antibody, anti zinc transporter, anti insulin antibody

associated with HLA DR3 and HLA DR4

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7
Q

what diabetic patients should recieve a statin and how is the intensity of statin determined

A

all patients 40-75 years with diabetes should be started on a statin as diabetes is the highest risk factor for cardiovascular disease
use the AHA risk calculator to determine whether a moderate or high intensity statin is required

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8
Q

what vaccine should all patients with diabetes recieve

A

all patients > 19 should have the pneumococcal vaccine

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9
Q

what is the target blood pressure for patients with diabetes

A

< 130/80 mmHg

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10
Q

target HbA1c in patients with diabetes

A

< 7% (< 7.5% in children)

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11
Q

in the treatment of DKA, what should you do if the patient has a low K prior to treatment

A

if K < 3.3 then potassium infusion should be done first before insulin until it reaches > 3.3

Insulin causes K to shift intracellularly resulting in lowering K levels. K should be > 3.3 prior to treatment with insulin.

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12
Q

in the treatment of DKA, what should you do if the glucose comes down to 250 but the bicarbonate hasnt corrected

A

if glucose comes down to 250-300 or less but still acidotic then add 5% dextrose to prevent hypoglycaemia

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13
Q

patient presents with symptoms of tremor, light headed and paraesthesia shortly after she eats meals. Pt has a history of previous by pass surgery. How can you evaluate for the potential diagnosis and why?

A

patient is showing signs of hypoglycaemia shortly after eating and with history of bypass surgery this makes dumping syndrome a possibility

mixed meal testing (consumption of non-liquid meal with subsequent observation and monitoring of labs)

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14
Q

definitive treatment for hyperthyroidism

A

radio-active thyroid ablation
alternative to this is thyroidectomy

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15
Q

contraindications to radio-active ablation

A

graves exophthalmos as it can worsen
large obstructing goitre

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16
Q

what is the main stay of treatment for hyperthyroidism regardless of the underlying cause

A

betablockers to control symptoms

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17
Q

first line anti-thyroid medication and mode of action

A

anti-thyroid medication inhibit oxidation of iodine

1st line: methimazole
propythiouracil in 1st trimester pregnancy (methimazole is teratogenic)

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18
Q

black box label warning for propythiouracil

A

adverse effect includes liver failure

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19
Q

side effect associated with radio-active ablation

A

hypothyroidism
initially worsen graves ophthlamology
contraindicated in pregnancy

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20
Q

management of thyroid storm

A
  • betablockers
  • anti-thyroid medication: propylthiouracil preferred due to inhibition of peripheral conversion T3-t4
  • glucocorticoids

after initial management with the above, can also give inorganic iodine (potassium iodine) which blocks release and synthesis of thyroid hormone and bile acid sequestrants (cholestyramine) as thyroid hormone is excreted in bile

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21
Q

most common aetiology of congenital hypothyroidism

A

thyroid dysgenesis

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22
Q

what are common lab abnormaltiies found in hypothyroidism

A

elevated HDL
elevated triglycerides
hyponatraemia
elevated CK

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23
Q

when do you treat sub clinical hypothyroidism

A

if TSH > 10

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24
Q

initial treatment for myxaedema coma

A

admit to ICU
IV levothyroxine
IV hydrocortisone (unless adrenal insufficiency has already been excluded)

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25
what medication classically can cause thyroiditis
amiodarone (hyperthyroidism followed by hypothyroidism, non-tender goitre, decreased uptake on radio-active scan during hyperthyroid phase
26
treatment for thyroiditis
subacute thyroiditis is typically self resolving. NSAIDS or steroids can be given for pain control (other sub-types of thyroiditis dont typically cause painful goitre) betablockers can be given for symptomatic management during hyperthyroid phase levothyroxine can be given in hypothyroid phase if TSH > 10
27
change in thyroid levels during pregnancy
TBG increases during pregnancy which will reuslt in less free T4/T3 and TSH levels therefore if patients are on levothyroxine prior to pregnancy then this will have to be increased
28
what are features in the patients history that increase the risk of neoplastic thyroid nodule
Hx of childhood neck irradiation cold nodule (minimal uptake on radio-active iodine scan) female sex age < 20 or > 70 firm, fixed solitary nodule family history rapidly growing nodule with hoarsness
29
what are suspicious features on USS of thyroid nodule
micro-calcifications lesions that are taller than they are wider increased vascular flow
30
from what type of cells are papillary thyroid cancers derived from? How does this type of cancer spread?
papillary is derived from thyroid stimulating follicular cells lymphatic spread
31
from what type of cells are follicular thyroid cancers derived from? how does this type of cancer spread?
follicular thyroid cancer is derived from thyroid producing follicular cells haematoglogical spread with distant mets
32
what are prognostic features for medullary thyroid cancer
age and stage at time of diagnosis degree of vascular invasion
33
DEXA diagnostic value of osteoporosis vs osteopenia
osteoporosis - 2.5 SD osteopenia -1 to -2.5 SD
34
what are the medication options to treat osteoporosis
1st line: bisphosphonates i.e. alendronate, zolendronic acid Teriparatide - PTH analogue Desonumab - monoclonal Ab to RANK-L Raloxifene (selective estrogen receptor modulator)
35
signs, symptoms and complications of pagets disease
panics Pain Arthralgia Nerve compression Increased bone turnover high output Cardiac failure increased risk of osteosarComa Skull involvement / sclerotic vertebra
36
1st line treatment pagets disease
bisphosphantes (calcitonin if intolerant to bisphosphonates) calcium and vitamin D
37
treatment for acute hypercalcaemia in hyperparathyroidism
IV fluids (first line) and calcitonin
38
indications for parathyroidectomy in hyperparathyroidism
elevated calcium elevated creatinine low bone mineral density < 50 yrs
39
patients labs show elevated calcium but urinary calcium is low. ?diagnosis
familial hypocalciuric hypercalcaemia
40
describe the diagnostic investigation for suspected ACTH deficiency
Measure AM cortisol: <3 mcg/dL: Adrenal insufficiency (AI) likely, confirm with ACTH measurement 3-18 mcg/dL: ACTH stimulation test >18 mcg/dL: AI unlikely
41
how to differentiate between primary and secondary adrenal insufficiency
aldosterone is dependant on the RAAS and not ACTH so aldosterone is normal in secondary adrenal insufficency there will be no hyperpigmentation in secondary
42
cause of diabetes insipidous if urine increases in osmolality after water deprivation
psychogenic polydypsia DI would not cause increased urine osmolality with water deprivation
43
treatment for nephrogenic diabetes insipidus
salt restriction hydrochlorothiazide (thiazide like) amiloride (K sparing) low protein diet
44
treatment for central diabetes insipidus
desmopressin (ADH)
45
features of acromegaly
increased skeletal and soft tissue growth i.e. enlarged hands, feet, skull (frontal bossing, wide spaced teeth), coarsening facial features, carpal tunnel syndrome, malocclusion of the jaw organomegaly i.e. enlarged tongue degeneration of cartillage resembling osteoarthritis hyperhydrosis skin thickening, skin tags
46
complications of acromegaly
diverticulosis colon cancer OSAS cardiovascular i.e. HTN, LVH, cardiomyopathy with diastolic dysfunction (most common cause of death) T2DM
47
describe the diagnosing modality for acromegaly
serum IGF-1 if elevated --> OGTT if failed to suppress GH with oral glucose then MRI
48
best initial treatment for siADH
fluid restriction
49
treatment for chronic siADH
demeclocycline
50
medication used for severe siADH
tolvaptan, conivaptan
51
best treatment for symptomatic hyponatraemia of < 120 in siADH
IV hypertonic saline if symptomatic +/or Na < 120
52
urinary Na in siADH
urine osmolality high >100 and Na > 40 but serum osmolality low
53
what hormones are androgens, glucocorticoids and mineralocorticoids regulated by
androgens = ACTH, CRH glucocorticoids = CRH, ACTH mineralocorticoids = ACE
54
low cortisol but normal aldosterone
secondary or tertiary adenal insufficiency
55
next step in investigation of adrenal insufficiency if 8am cortisol is indeterminate
cosyntropin stimulation test within 30 mins of cortisol levels if minimal cortisol result = confirmed
56
what imaging can be used to locate extra-adrenal phaeochromocytomas
MIBGA nuclear metaiodobenzylguanidine
57
what might be present on labs if pharochromocytoma
hyperglycaemia polycythaemia (EPO production)
58
normal role of aldosterone
Na retension and K excretion
59
what might you find on labs with hyperaldosteronism
hypokalaemia hypomagnasaemia hyperaldosteronism metabolic alkalosis
60
what test is used to differentiate between adrenal mass and adrenal hyperplasia
adrenal venous sampling
61
mutation responsible for MEN1, MEN2A and MEN2B
MEN1 = MEN mutation MEN2A and 2B = gain of function of RET proto-oncogene
62
most likely diagnosis with elevated serum levels of 17-hydroxyprogesterone
21 hydroxylase deficiency (CAH)
63
what alpha blockers and beta blockers are most commonly used for phaeochromocytoma
prior to surgical resection, patients are treated with alpha blockage first and then betablockade is added alpha = phenoxybenazine or doxazocin beta = metoprolol or proranolol
64
what is ocreotide used for an a common side effect
acromegaly somatostatin anologue (reduces GH) also inhibits insulin secretin which causes a transient hyperglycaemia
65
urinary free cortisol level in cushings caused by exogenous steroids
elevated
66
side effects of PPI's
hypomagnesaemia hypocalcaemia low b12 (reduced absorption) low iron increased risk fractures / osteoporosis increased risk of pneumonia in the initial period following administration
67
what medication should be given post surgical resection of a phaochromocytoma
steroids as they are at risk of adrenal crisis hydrocotisone is first line as it contains both glucocorticoid and mineralocorticoid coverage IV fludrocotisone is only required if an alternative steroid is used such as dexamethasone or prednisolone
68
whats the most appropriate investigation if constitutional delay is suspected
constitutional delay should be expected if there is delayed puberty, short stature with a family history and no evidence of other endocrinological cause bone age assessment
69
as a consequence of parathyroidectomy, what change in thyroid hormone can be seen
transient hyperthyroidism with increased free thyroxine
70
treatment for severe hypercalcaemia
IV fluids calcitonin
71
treatment for precocious puberty
GnRh agonists to prevent premature closure of epiphyseal plates
72
what tests can be used to investigate cushings
late night salivary 24 hour urinary cortisol low dexamethasone suppression test
73
cause of rickets in a child with normal 25 OH but low 1,25 OH (hydroxycholecalciferol)
vitamin D deficiency rickets caused by 1 alpha hydroxylase deficiency will have low Ca and phosphate
74
medication used to treat symptomatic secondary cushings disease
ketaconazole or metyrapone
75
what vitamin deficiency can occur as a consequence of long term metformin use
vitamin B12
76
antithyroid medication of choice in pregnant patients
1st trimester - propythiouracil 2nd and 3rd trimester - methimazole
77
describe how primary biliary sclerosis can lead to bone pain
PBS can cause low vitamin D = low calcium = hyperparathyroidism hyperparathyroid bone disease = osteosclerosis Osteosclerosis can be seen on x-ray as an alternating sclerotic-lucent-sclerotic appearance to vertebral endplates.
78
when is calcitonin used in the management of hyperparathyroidism
if calcium levels are very high >14 or 12-14 and symptomatic if elevated but < 12 then parathyroidectomy without calcitonin
79
next step in purely cystic thyroid nodule with normal thyroid hormones
observation as risk of malignancy is low
80
OGTT levels suggestive of impaired glucose tolerence and diabetes
impaired glucose - 150-200 diabetes > 200
81
is suspected growth homrone deficiency, what blood level should you test
IGF-1 IGF-BP3 (binding protein 3)
82
patient presents with signs of thyrotoxicosis. Thyroid is non-tender and not enlarged. radio-iodine uptake scan shows no uptake. TSH low and T3 + T4 elevated. ?differentials
struma ovarii unlikely primary (graves) due to no uptake on scan unlikely secondary (pituitary tumour) due to low TSH therefore likely due to ectopic tissue --> ovary
83
when is a radionucleotide scan required for thyroid nodule
required when you suspect toxic adenoma or 'hot nodule' which would have low TSH and elevated T3/T4 levels if euthyroid on blood tests then go to FNA if suspicious
84
what is the 3 step diagnostic investigations for adrenal insufficiency
morning cortisol morning ACTH (determines primary or secondary) cosyntropin stimulation test (confirms diagnosis)
85
markers for monitoring medullary thyroid cancer recurrence after thyroidectomy
calcitonin + CEA
86
What initial blood value is K required to be added to the treatment of DKA
K < 5.3 on admission
87
how often should T2DM patients be screened for diabetic nephropathy
album: creatinine ratio every 6 months
88
how often should T2DM patients be screened for diabetic retinopathy
annually
89
how often should T2DM patients be screened for diabetic peripheral neuropathy
low risk - annually high risk - 3 monthly
90
contraindication to the use of PTH analogues such as teriparatide for osteoporosis
abnormal PTH previous radiotherapy
91
what diabetic medication can cause low B12
metformin (over long period of time)

Endocrine (3 decks)

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