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Veterinary Medicine > Clinical Endocrinology (SA) > Flashcards

Clinical Endocrinology (SA) Flashcards

1
Q

What are the MOST common signs of Cushings?

A 
PUPD
Polyphagia
Panting
Pot Belly
Alopecia
Hepatomegaly
Muscle Weakness
Hypertension
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2
Q

What is raised on Haematology with cushings?

A

Neutrophils
Thrombocytes
Erythrocytes (mild)

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3
Q

What is raised on Biochemistry with cushings?

A 
ALP
ALT
Cholesterol
Triglycerides
Glucose
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4
Q

On haematological assessment of a cushings patient, which values would you expect to be reduced?

A

Lymphocytes

Eosinophils

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5
Q

What is the value for USG in cushings?

A

<1.018-1.020

+protein

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6
Q

What is the best screening test for canine cushings?

A

LDDST - blood sample at 3 and 8h.

Don’t feed during test!

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7
Q

What is the sens/spec of UPCR for cushings?

A

High sens, V low Spec.

Repeat 2d later. If still high - both sens and spec improved.

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8
Q

How do you differentiate between PDH and ADH?

A

Measure ACTH - high indicates PDH.

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9
Q

What drug is given to dogs with cushings?

A

Trilostane

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10
Q

How can you Tx the hypertension associated with cushings? (1st and 2nd line)

A

1e: Benazepril
2e: Amlodipine

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11
Q

Following Tx for cushings, you notice improved metabolic screens but the patient is more dull. Dx/Tx?

A

Macroadenoma - hypophysectomy + RT

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12
Q

What are the causes for 1e and 2e hypoadrenocorticism?

A

1e: autoimmune destruction of adrenal cortex
2e: ACTH deficiency causing cortical atrophy

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13
Q

What are the major signs of Addisons of clinical exam?

A

Weak Pulse/inc CRT
PUPD/dehydration
Bradycardia, lethargy
V+/D+ and malaise

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14
Q

On haem/biochem of an Addisonian patient, which values would you expect to be reduced?

A

Na

Non-regen anaemia

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15
Q

On haem/biochem of an Addisonian patient, which values would you expect to be reduced?

A

Azotaemia
Lymphocytes
Eosinophils
Hyperkalaemia

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16
Q

What changes would you see on an ECG with blood K+ between 5.5 and 6.5mmol/L?

A

T wave peak

Short QR

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17
Q

What changes would you see on an ECG with blood K+ between 6.5 and 7mmol/L?

A

inc QRS duration

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18
Q

What changes would you see on an ECG with blood K+ between 7 and 8.5mmol/L?

A

Dec P wave amplitude

Long PR interval

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19
Q

What changes would you see on an ECG with blood K+ over 8.5mmol/L?

A

absent P wave

severe bradycardia

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20
Q

How can you rule out addisons as a Ddx?

A

Single cortisol test - if normal, no addisons

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21
Q

How can you confirm Addisons in a dog?

A

ACTH stim

If no change: Addisons

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22
Q

How do you Tx a dog in Addisonian Crisis?

A

0.9% NaCl @ 60-80ml/kg/hr
Saline, Insulin and Dextrose
Hydrocortisone CRI (or Dex if cortisol assay not yet performed)

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23
Q

What is the long term Tx protocol for a dog with addisons?

A

Fludrocortisone
Oral Prednisolone
DOCP

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24
Q

What are the 1st 2 tests performed to diagnose hypothyroidism? (dog)

A

Tt4 and TSH

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25
Q

What are the 2nd 2 tests performed to diagnose hypothyroidism? (dog)

A

Ft4 & TgAA

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26
Q

How is canine hypothyroidism treated?

A

Levothyroxine

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27
Q

What are the signs of feline hyperthyroidism?

A 
PUPD
Weight loss
Coat changes
Hyperactivity
Tachycardia
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28
Q

What can be seen on a blood smear of feline hyperthyroid patients?

A 
Heinz Bodies
Inc PLT size
Erythrocytosis
Macrocytosis
Leukocytosis
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29
Q

Which test diagnoses 90% of hyperthyroid cats?

A

tT4

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30
Q

What happens to a normal cats tT4 levels following a T3 suppression test with Tertroxin?

A

50% reduction

Hyperthyroid = limited change

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31
Q

Which 3 anti-thyroid drugs are available to treat hyperthyroid cats?

A

Synthesis inhibitors: Thiamazole, Methimazole, Carbimazole

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32
Q

Which anti-thyroid drug has the lower rate of adverse reactions in cats?

A

Carbimazole

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33
Q

Why do cats with concurrent CKD and hyerthyroidism have normal creatinine levels?

A

Muscle loss

Glomerular hyperfiltration of creatinine

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34
Q

Which drugs are used to control the tachycardia/pnea, hypertension, and hyper-excitability associated w/hyperthyroidism?

A

Beta Blockers - Atenolol/propanolol

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35
Q

What are the 3 Tx options for hyperthyroidism?

A

Radioiodide
Surgical Removal
Medical Therapy

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36
Q

How does the Aetiology of DM differ in dogs and cats?

A

Dogs: Loss of Islets - insulin deficiency

Cats: insulin resistance

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37
Q

What changes can be seen on haem/biochem in canine DM?

A

Hyperglycaemia
Inc ALT/ALP
Hypertrigllyceridaemia

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38
Q

What changes can be seen on urinalysis in canine DM?

A

Ketones
Glucose
Sediment
Low USG (PUPD)

39
Q

which diabetes medications are licenced for dogs and how long do they last?

A

Intermediate: Caninsulin

Long: Prozinc

40
Q

What is a normal protocol for diabetes Tx in the dog?

A

Feed 1/2 ration then administer insulin - twice daily!

41
Q

Which diet changes should be made to cats/dogs with DM?

A

Cat: low CHO, High protein

Dog: Fibre & complex CHO added

42
Q

A DM+ dog sudden presents with ataxia, collapse and seizure - what happened? Tx?

A

OVERDOSE! give sugary substance under tongue and feed.

43
Q

How should insulin dose be altered if an animal is not eating?

A

HALF DOSE - dont stop!

44
Q

how often are samples taken for a glucose curve?

A

q2h

45
Q

What is the max appropriate dose of insulin without SEs?

A

2IU/kg

46
Q

Below what nadir should insulin dose be decreased?

A

<4mmol/L

47
Q

Above what nadir should insulin dose be increased?

A

> 8-9mmol/L

48
Q

What should be done if DOA too short?

A

Switch to longer acting insulin

49
Q

What are the signs of DKA?

A 
V+
Dehydration
Weakness
Tachypnoea
Depression
50
Q

What 2 ions should be supplemented in DKA?

A

Phosphate

K+

51
Q

After stabilisation with insulin in an acute DKA episode, glucose reaches <16mmol/L - what are your next steps?

A

insulin q4-6h
Dextrose 5% infusion
Monitor q1h still!

MAINTAIN until patient eating then start lente

52
Q

What water intake classes as PUPD?

A

> 100ml/kg/day

53
Q

If you have run haem/biochem/T4/urinalysis on a PUPD patient and everything is normal, what 4 DDx are you left with?

A

HyperAC
Central DI
1e NDI
1e PD

54
Q

What is the DDAVP test used to test for?

A

Diabetes Inspidus: give dDACP q8h 1w - if SG inc and PUPD resolves - was DI.

55
Q

How is CDI treated?

A

DDAVP drops in conjuncitva SID/BID

56
Q

Which breed of dogs commonly suffer form pituitary dwarfism?

A

GSD

57
Q

Pituitary dwarfism Tx?

A

Progestagens
GH for skin
Check thyroid & supplement if needed.

58
Q

What is the cause and sequelae of acromegaly in cats?

A

Cause: pituitary tumour
Seq: Insulin resistant DM

59
Q

How is feline acromegaly tx?

A

Control DM

RT pituitary mass - or Sx

60
Q

How is 1e HyperPTH treated?

A 
IV NaCl then frusemide
Preds
Calcitonin
Bisphosphonates
Surgical Excision
61
Q

What are the signs of hyperPTH?

A

PUPD, calcification, renal damage

Hypercalcaemia
Normal/Low PO4
High PTH

62
Q

How is renal hyperPTH managed?

A

Remove cause, inc Ca, dec PO4

Phosphate binders i.e. Aluminium Hydroxide

63
Q

How is hyperfunctional thyroid tissue detected in the cat?

A

Scintigraphy (technetium 99)

64
Q

Which drugs can be used against hyperthyroidism?

A

Carbimazole (SID)

Methimazole (BID)

65
Q

What are the potential side effects of anti-thyroid medication?

A

Anorexia/V+
Facial/cervical excoriation
Bleeding eyes/nose
Hepatopathy

66
Q

Which haem/biochem changes are caused by anti-thyroid medication?

A

Dec: leukocytes, thrombocytes

Inc: lymphocytes, eosinophils

67
Q

What is the gold std Tx for feline hyperthyroidism?

A

Radioiodine therapy

68
Q

When is thyroidectomy indicated in feline hyperthyroidism?

A

Cat doesn’t tolerate meds

Radioiodide not available

69
Q

How must the patient be positioned for a thyroidectomy?

A

Extend neck - ventral midline incision

70
Q

Which 2 sets of muscles must be incised to access the thyroid glands?

A

Sternothyroideus

Sternohyoideus

71
Q

How does a thyroid adenoma differ visually from a normal gland?

A

Normal: Pale tan
Adenoma: brown/red

72
Q

Which nerves are located closely to the thyroid gland?

A

Recurrent layrngeal

Vagosympathetic Trunk

73
Q

Which blood vessels are located close to the thyroid gland?

A

Cartoid Sheath - common carotid, internal jugular vein

74
Q

How can you tell if thyroid Dz is unilateral?

A

“normal” thyroid gland will be atrophied

75
Q

What is an extracapsular thryoidectomy?

A

Thyroid removed in capsule, no attempt to preserve PT gland

76
Q

What is 1 advantage and 1 disadvantage to an extracapsular thryoidectomy?

A

Low recurrence

HypoCa

77
Q

What is an intracapsular thyroidectomy?

A

capsule left in situ to preserve cranial PT gland

78
Q

What is 1 advantage and 1 disadvantage to an intracapsular thyroidectomy?

A

Inc recurrence

Low chance of HypoCa

79
Q

What is a modified extracapsular thryoidectomy?

A

thyroid capsule incised around cranial PT gland

80
Q

What is 1 advantage and 1 disadvantage to a modified extracapsular thryoidectomy?

A

Low recurrence

Lower risk of hypoCa

81
Q

What is a modified intracapsular thyroidectomy?

A

removal of thyroid from within capsule, preserving PTH

82
Q

What is 1 advantage and 1 disadvantage to a modified intracapsular thryoidectomy?

A

Low recurrence
Lower risk of hypoCa

similar to other modified technique

83
Q

What can be done if the blood supply is interrupted to the PT gland during thyroidectomy?

A

Insert PT into sternothyroideus/ sternohyoideus - in 7-21d it will be revascularised

84
Q

How are 4 potential complications of thyroidectomy?

A

Hypocalcaemia
Recurrence of hyperT4
Laryngeal paralysis
Hypothyroidism

85
Q

What can be done to treat a cat with acute post-op hypoCa?

A

10% CaGluconate + CRI

Stable: oral vit D and Ca

86
Q

What is the best Tx for ectopic thyroid tissue?

A

I131 (radioactive iodine)

87
Q

Which breed of dog is at the greatest risk of 1e hyperPT?

A

Keeshond

88
Q

How are the cranial and caudal parathyroid glands removed?

A

Cranial: dissected from thyroid

Caudal: partial thyroidectomy; guillotine technique

89
Q

Which structures may canine thyroid carcinomas involve?

A

Jugular Vein
Carotid Artery
Vagosympathetic Trunk
Recurrent Laryngeal Nerve

90
Q

What do phaeochromocytomas secrete?

A

Catecholamines (adrenaline)

91
Q

What is the Tx of choice for a hormonally active adrenal adenoma/carcinoma?

A

Adrenalectomy

92
Q

What should your surgical approach be for an adrenalectomy?

A

Ventral Midline

93
Q

Which vascular structure may some adrenal tumours involve?

A

Caudal Vena Cava

Veterinary Medicine (68 decks)

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