Conditions summary Flashcards
4 year old peeing lots v tired at preschool hungry all the time but lean hyperglycaemia low c peptide islet cell auto-antibodies present
type 1 diabetes
type 1 diabetes treatment
insulin (almost always)
v v v last line;
drugs - not SUs
surgery
28 year old male lean hyperglycaemia peeing lots hungry all the time islet cell auto-antibodies present
latent autoimmune diabetes on adulthood (LADA)
50 year old male BMI 35 family history of diabetes tired all the time (TATT) thirsty polyuria high c peptide
type 2 diabetes
type 2 diabetes treatment (4)
- lifestyle changes
- metformin
- metformin + something else (SU (gliclazide), gliptin, GLP1 (exenatide))
- metformin + SU + insulin
pregnant lady in 2nd trimester
thirsty
polyuria
hyperglycaemia
type 3 diabetes
12 week old baby that used to have diabetes but is now fine
transient neonatal diabetes
treatment of neonatal diabetes
insulin/SU (if/until it goes away)
baby <6months with hyperglycaemia that doesnt resolve
persistent neonatal diabetes
20 year old with type 2 diabetes genetic problem polyuria lean high c peptide
maturity onset diabetes of the young (MODY)
stable/non progressive hyperglycaemia
MODY2
treatment of MODY1 and MODY3
insulin + diet + SU
treatment of MODY2
diet
nothing
20 year old male hasn't been feel right so hasn't eaten all day BMI 21 addisons disease low glucose
hypoglycaemia
hypoglycaemia treatment (3)
conscious - Lucozade, glucotabs
conscious but drowsy - glucogel subbuccal
unconscious - IV glucose 12 mins or 1mg IM glucagon
check after 15 mins
forgot to take insulin this morning vomiting abdo pain kussmauls breathing (hyperventilation) pear drop breath
DKA (diabetic ketoacidosis)
DKA (diabetic ketoacidosis) treatment (4)
oxygen
IV insulin
IV fluids
IV potassium
elderly
hyperglycaemia >60
no ketoacidosis
acutely unwell
hyperosmolar hyperglycaemic state (HHS)
treatment of HHS (hyperosmolar hyperglycaemic state) (2)
diet
metformin
IV insulin
20 year old female proximal myopathy osteoporosis thin skin, easy bruising central fat distribution 'lemon on sticks' 'moon face' hirsutism acne amenorrhoea (period stops) abdominal stretch marks (striae)
cushings
cushings investigations (3)
overnight screening test - high dose dexamethasone (exogenous steroids)
then low dose diagnostic test
imaging - depending on location
low cortisol in high dose diagnostic test
high ACTH <300
ACTH secreting pituitary tumour causing cushings
high cortisol
low ACTH <1
adrenal tumour causing cushings
high cortisol in high dose diagnostic test
v high ACTH >300
ectopic ACTH production causing cushings
cushings treatment
metyrapone - to reduce ACTH production before surgery fix cause (surgery)
obese but osteoporosis
cushings
excess aldosterone from adrenal adenoma in zona glomerulosa
conns syndrome
conns syndrome treatment (2)
surgery
spironolactone
genital ambiguity
CAH
CAH treatment (kids and adults)
kids - steroids
adults - stop androgen excess
CAH pathophysiology
no steroid enzyme = increased ACTH = increased androgen precursors (testosterone)
addisonian crisis treatment
ASAP
hydrocortisone
fludrocortisone
IV saline
IV insulin
low cortisol on synacthen test nausea vomiting type 1 diabetic hyponatraemia hyperkalaemia confusion abdo pain
addisonian crisis
weight loss
buccal pigmentation
pigmentation in creases of hands
acanthosis nigrans (velvety thick lesions in axillae)
chronic addisons disease
headache palpitation constipation MEN2a (medullary thyroid cancer too) neurofibromatosis weight loss
phaeochromocytoma
phaeochromocytoma treatment (4)
alpha blocker THEN beta blocker
surgery
chemo
family screening
high BMI
bradycardia
cold constipation
heavy periods
give diagnosis and investigation findings
hypothyroidism
low T4/T3
high TSH if primary hypothyroidism, low TSH if secondary hypothyroidism
middle aged female high BMI bradycardia cold constipation puffy/closed eyes anti-TPO positive
hypothyroidism caused by hashimotos thyroiditis
hypothyroidism treatment
levothyroxine (T4)
low BMI tachycardia palpitation diarrhoea lighter periods
give diagnosis and investigation findings
hyperthyroidism
high T4/T3
low TSH if primary hyperthyroidism, high THS if secondary hyperthyroidism
middle aged female low BMI tachycardia pretibial myxoedema finger clubbing lighter periods protruding eyes symmetrical smooth goitre anti-TPO positive TSH receptor antibody positive
hyperthyroidism caused by graves disease
hyperthyroidism treatment (3)
carbimazole or propylthiouracil (PTU)
radioiodine
surgery
rough asymmetrical thyroid goitre cervical lymphadenopathy hashimotos thyroiditis histology - 'orphan annie' eyes and psammoma bodies family history radiation exposure
diagnosis and investigation
papillary thyroid carcinoma
TFTs and US guided FNA
rough asymmetrical thyroid goitre phaeochromocytoma young patient high calcitonin family history radiation exposure
diagnosis and investigation
medullary thyroid cancer (MTC)
TFTs and Us guided FNA
rough asymmetrical thyroid goitre
family history
radiation exposure
hoarse voice
diagnosis and investigation
anaplastic thyroid carcinoma (hoarse voice bc v aggressive tumour = vocal cord palsy)
TFTs and US guided FNA
treatment of benign thyroid cancer
nothing, symptomatic
treatment of malignant thyroid cancer
lobectomy/thyroidectomy
renal stones - polyuria, thirsty
abdo pain
frequent fractures
confusion
hypercalcaemia
hypercalcaemia treatment (1 symptomatic and 1 curative)
symptomatic: fluids - bc theyre
curative: bisphosphonates
other autoimmune conditions (eg rheumatoid) muscle spasms/weakness paraesthesia QT prolongation on ECG chovsteks and trousseau sign positive
autoimmune destruction of parathyroid gland = hypocalcaemia
4th metacarpal brachdactyly
learning disability
low Ca, high PTH (bc of resistance), high phosphate
pseudohypoparathyroidism
acute treatment of hypocalcaemia
IV calcium (calcium gluconate)
chronic treatment of hypocalcaemia
Ca supplements
vit D supplements
osteomalacia/rickets cause
vit D deficiency
RET gene 10q mutation (autosomal dominant)
hyperparathyroidism (parathyroid hyperplasia)
medullary thyroid carcinoma (MTC)
phaeochromocytoma (paraganglioma)
MEN2a
RET gene 10q mutation (autosomal dominant)
medullary thyroid carcinoma (MTC)
phaeochromocytoma
mucosal erosions (tongue)
MEN2b
5Ps; pituitary tumour parathyroid hyperplasia (hyperparathyroidism) pancreas tumour peptic ulcers (recurrent) prolactin high gene 11q mutation
MEN1
female oligomenorrhoea infertility galactorrhoea headaches
prolactinoma (prolactin secreting pituitary tumour)
male
headaches
bitemporal hemianopia
impotence
prolactinoma (prolactin secreting pituitary tumour)
prolactinoma (prolactin secreting pituitary tumour) treatment
cabergoline - dopamine analogue/agonist
headache bitemporal hemianopia fatigue, sleep apnoea proximal limb weakness, joint pain high IGF1 colorectal cancer
acromegaly
also has enlarged features (hands, feet, jaw etc) if you ask (wouldnt present with that
acromegaly treatment (3)
transsphenoidal surgery
radiotherapy
drugs - somatostatin analogues
short stature
obesity
menstrual irregularities/erectile dysfunction
headache
pan hypopituitarism
pan hypopituitarism treatment (5)
hydrocortisone thyroxine ADH (desmospray or desmopressin PO/IM) GH testosterone/estradiol
recent head trauma
polyuria
thirst
hypernatraemia
diabetes insipidus
diabetes insipidus treatment (2)
synthetic ADH (desmospray or desmopressin PO/IM) fluids (bc dehydrated)
v concentrated low volume urine
hyponatraemia
ADH problem
SIADH
SIADH treatment (1)
tolvaptan (ADH receptor antagonist)
PMH of addisons (autoimmune) amenorrhoea osteoporosis infertility high LH and FSH low oestradiol
POF (premature ovarian failure)
premature ovarian failure (POF) treatment
hormone replacement therapy (contraceptive pill)
girl widespread nipples horseshow kidney genetic problem primary amenorrhoea (>16 never had a period)
turners syndrome (XO)
diabetic amenorrhoea hirsutism infertility positive findings on US
polycystic ovarian syndrome (PCOS)
polycystic ovarian syndrome (PCOS) treatment (4)
weight loss (metformin if ineffective) - bc of diabetes
antioestrogens eg clomifere citrate
FSH/LH injections
surgery - drill holes to stimulate ovulation
