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4th Year General Medicine > Diseases of the Endocrine System > Flashcards

Diseases of the Endocrine System Flashcards

1
Q

In what age range do 90% of type 1 diabetics present?

A

<25

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2
Q

What gene group is associated with familial risk of type 1 diabetes?

A

HLA

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3
Q

What genetic disease has 20% of its patients also develop T1DM

A

Cystic fibrosis

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4
Q

Which cells in the pancreas produce insulin/are destroyed in T!DM

A

Beta cells

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5
Q

What is Kussmaul breathing?

A

Deep laboured breathing (hyperventilation) due to excessive ketones in the blood

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6
Q

An acute injury to which organ can cause hypoglycaemia in T1 diabetics

A

AKI

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7
Q

At what blood glucose do the neuroglycopenic symptoms of hypoglycaemia occur?

A

<2mmo/L

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8
Q

What is the treatment for hypoglycaemia if the patient can swallow?

A
  • 60ml Glucojuice OR
  • 4-5 Glucotabs OR
  • 150-200mls pure fruit juice (but not in renal failure)
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9
Q

What is the treatment for hypoglycaemia if the patient is drowsy or confused?

A

1.5-2 tubes of glucose gel (use patients own finger to rub it into the gums)

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10
Q

What is the treatment for hypoglycaemia if the patient is

A

IV glucose – infused over 10-15 minutes. Either 75ml of 20% glucose or 150ml of 10% glucose
+
20g of complex carb after 15 minutes if they’re better

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11
Q

What are the three criteria for DKA?

A

Ketones in the blood (or urine) + acidosis + hyperglycaemia (usually)

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12
Q

In DKA, which of the following can be raised and which can be reduced?

  • Potassium
  • Creatinine
  • Sodium
  • Lactate
  • Amylase
  • WCC
A
  • Potassium usually raised due to lack of insulin but can be low normal
  • Creatinine often raised
  • Sodium often reduced
  • Lactate often raised
  • Amylase frequently raised (this doesn’t always mean pancreatitis, can be salivary in origin)
  • White cell count can be raised
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13
Q

What is the treatment of DKA?

A

Insulin diluted with sodium chloride 0.9%
+ fluid replacement with sodium chloride (glucose falls to about 15, use dextrose as well)
+ Potassium chloride

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14
Q

How much folic acid should diabetic pregnant women take?

A

5mg

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15
Q

What is lipohypertrophy in T1DM?

A

Swelling at injection site in patients who constantly inject into the same place

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16
Q

What is the normal target HbA1c?

A

< 48 mmol/L

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17
Q

What range is considered diabetic on:

  • A fasting glucose
  • 2hr OGTT
A

Fasting = ≥ 7.0 mmol/L

OGTT = ≥11.1 mmol/L

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18
Q

What range is considered pre-diabetic on:

  • A fasting glucose
  • 2hr OGTT
A

Fasting = 6.1-6.9 mmol/L

OGTT = 7.8-11.0 mmol/L

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19
Q

What is the normal target glucose range for a T1 diabetic adult?

A

4–7mmol/L

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20
Q

What is the normal target glucose range for a T1 diabetic adult 90 minutes after meals?

A

5–9mmol/L

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21
Q

What types of insulin are Humalog, Novarapid and apidra?

A

Rapid acting - works immediately, peaks at 2 hrs and has a duration of around 4 hrs

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22
Q

What types of insulin are Humulin S, actrapid and insuman rapid?

A

Soluble insulin -peaks at around 4 hrs and has a duration of around 8. They take 30 mins to take effect so must be taken 30 minutes before eating

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23
Q

What types of insulin are insulatard, Humulin I and insuman basal?

A

Intermediate acting - duration of action of about 16 hours

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24
Q

What types of insulin are lantus and levemir?

A

Long acting analogues - duration of about 24 hours

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25
Q

What types of insulin are Humulog Mix25 / mix50, novomix30, Humulin M3, Insuman comb 12?

A

Fixed mix insulin

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26
Q

What % increase in insulin is advised if blood glucose is high?

A

10%

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27
Q

1 unit of insulin is needed per ____g of carbs

A

10

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28
Q

What equipment is used to test for peripheral neuropathy in a diabetic foot exam?

A

10g monofilament & 128 Hz tuning fork

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29
Q

What is Charcot foot?

A

A rare but serious complication of diabetes following from severe neuropathy. Bone density is reduced → joints are destroyed → gross deformity → bag of bones on x-ray

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30
Q

What reproductive issue happen to 50% of male diabetics?

A

Erectile dysfunction

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31
Q

What are the three criteria for hyperglycaemic hyperosmolar syndrome?

A

Hypovolaemia
+ hyperglycaemia
+ hyperosmolar

(without significant acidosis or ketonemia)

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32
Q

Name the main risk factors for hyperglycaemic hyperosmolar syndrome

A
  • Type 2 diabetes
  • High refined carb intake pre-event
  • Older individuals
  • Younger individuals in non-Caucasians
  • CVD events, sepsis
  • Medications eg glucocorticoids and thiazides
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33
Q

Metaformin hydrochloride is an example of what class of drug?

A

Biguanides

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34
Q

Tolbutamide, chlorpropamide, glibenclamide & gliclazide are examples of what class of drugs?

A

Sulphonylureas

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35
Q

Dapagliflozin is an example of what class of drug?

A

Sodium Glucose Lactate 2 Inhibitor

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36
Q

What is the worrying side effect of metformin to watch out for?

A

Lactic acidosis

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37
Q

Which diabetic medication is most likely to cause hypos?

A

Sulphonylureas

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38
Q

What main side effects are associated with SGL2 inhibitors?

A

Thrush/UTIs

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39
Q

What hormone is associated with diabetes insipidus?

A

ADH

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40
Q

What is the difference between cranial and nephrogenic diabetes insipidus?

A

Cranial - ADH deficiency originating in the posterior pituitary. Can be treated by replacing ADH

Nephrogenic - renal resistance to ADH. Untreatable

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41
Q

What results on a urine osmolarity and fluid deprivation tests would you expect to see in a person with diabeties insipidus?

A

Urine osmolarity - dilute urine

Fluid deprivation test - fluid output does not decrease and urine osmolarity does not go up

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42
Q

What are the three components of metabolic syndrome?

A

Obesity, diabetes, high blood pressure

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43
Q

How do you tell on examination if a lump in the neck is attached to the thyroid or not?

A

Thyroid moves up on swallowing. Anything attached to it will move up also.

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44
Q

Name the main causes of hyperthyroidism

A
  • Grave’s disease (autoimmune)
  • Toxic multinodular goitre
  • Adenoma and carcinoma
  • De Quervain’s Thyroiditis (temporary hyperthyroidism)
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45
Q

Describe the changes to T3/4 and TSH in hyperthyroidism

A

Free T3/4 high. TSH low

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46
Q

What is the serious complication of hyperthyroidism?

A

Thyroid storm

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47
Q

What are the most common triggers of thyroid storm?

A
  • Illness/infection

- Surgery

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48
Q

What antibodies are associated with Grave’s disease?

A
  • Anti-TPO antibody
  • TSH receptor antibody
  • Anti-thyroglobulin antibody
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49
Q

What two drugs are the most common treatments for hyperthyroidism?

A

Carbimazole and propylthiouracil

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50
Q

Which hyperthyroidism drug cannot be used during the 1st trimester of pregnancy?

A

Carbimazole

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51
Q

What is the most significant risk of carbimazole?

A

Agranulocytosis

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52
Q

What 2 treatments are also considered in hyperthyroid beside medication?

A
  • Radio-iodine

- Surgery

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53
Q

Does Graves disease present with a goitre?

A

Usually not

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54
Q

What auto-antibody (immunoglobulin) stimulates the release of thyroid hormones in Graves?

A

IgG

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55
Q

What is the condition of bulging eyes in Grave’s disease called?

A

Exophthalmos/proptosis

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56
Q

What lifestyle factor is exophthalmos strongly associated with?

A

Smoking

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57
Q

What is pretibial myxoedema and in what disease is it found??

A

Bilateral plaque formation on the anterior surface aspect of the lower legs in Grave’s disease. ‘Orange peel’ appearance and non-pitting

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58
Q

What bone condition is associates with Graves disease?

A

Osteoporosis

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59
Q

What is the most common cause of hyperthyroidism?

A

Graves disease

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60
Q

What is the second most common cause of hyperthyroidism?

A

Nodular thyroid disease/Toxic Multinodular Goitre (TMG)

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61
Q

How do you tell nodular thyroid disease/toxic multinodular goitre from Graves disease?

A

TMG is antibody negative

62
Q

What causes De Quervain’s thyroiditis?

A

Acute inflammatory process - usually viral

63
Q

Describe the progress of De Quervain’s thyroiditis

A

Viral infection → thyrotoxicosis/hyperthyroidism for a few weeks → hypothyroidism for a few weeks → euthyroid

64
Q

What arrhythmia drug can cause both hyper- and hypothyroidism

A

Amioderone

65
Q

What arrhythmia is most commonly associated with hyperthyroidism?

66
Q

What are the main causes of hypothyroidism?

A
  • Hashimoto’s thyroiditis
  • Iodine deficiency
  • Drug-induced
  • Secondary causes (eg loss of function of hypothalamus/pituitary)
67
Q

What is the most common cause of hypothyroidism in the UK?

A

Hashimoto’s thyroiditis

68
Q

What is the severe complication of hypothyroidism?

A

Myxoedema coma

69
Q

Who is most at risk of myxoedema coma

A

Elderly women with long standing but frequently unrecognized or untreated hypothyroidism

70
Q

Describe the changes to T3/4 and TSH in hypothyroidism

A

Decreased T4/3. Increased TSH

71
Q

What is the main antibody associated with Hashimoto’s?

A

Anti-TPO antibody positive

72
Q

What drug is used to treat hypothyroidism?

A

Levothyroxine

73
Q

What is the most common cancer of the thyroid gland

74
Q

What cancer is associated with autoimmune hypothyroidism?

A

Thyroid lymphoma

75
Q

What rare thyroid cancer secretes calcitonin?

A

Medullary thyroid cancer

76
Q

Apart from idiopathic, what is the other main cause of idiopathic thyroid cancer?

77
Q

Who is most at risk of thyroid cancer?

A

Women >15 (most common >40)

78
Q

Accidentally removing what is a risk of thyroid surgery?

A

Parathyroid glands - causing hypocalaemia

79
Q

Out of papillary and follicular thyroid cancers, which mostly spreads via lymphatics and which via haemtological spread

A 
Papillary = lymphatics 
Follicular = haematological
80
Q

What changes is TFTs are often seen in generally unwell patients in hospital?

A

TSH typically suppressed (sick euthyroid syndrome)

81
Q

What type of thyroid lump classically moves upwards when the tongue is stuck out?

A

Thyroid cyst

82
Q

What is the most common change in thyroid hormones during pregnancy?

A

14% see increased fT4

83
Q

What is the function of aldosterone?

A

Retention of sodium and loss of potassium

84
Q

What is Conn’s syndrome?

A

Aldosterone secreting tumour (usually ademona) in the zona glomerulosa causing primary aldosteronism

85
Q

What cardiac condition is caused by primary aldosteronism (Conn’s/adrenal hyperplasia)?

A

Secondary hyperplasia

86
Q

What tests are used to diagnose Conns/primary aldosteronism?

A 
Aldosterone to renin ration 
\+
Saline suppression test (aldesterone cannot be fully suppressed in Conn's)
\+ 
CT
87
Q

What are some non-congenital causes of adrenal hyperplasia (causing primary aldosteronism + secondary hypertension)

A
  • Endogenous ACTH production (eg Cushing’s disease)

- Ectopic ACTH production (eg small cell lung carcinoma)

88
Q

Congenital adrenal hyperplasia is a cause of secondary _____

A

Hypogonadism

89
Q

What hormone is in excess in Cushing’s

90
Q

If Cushing’s is caused by hypersecretion of ACTH, what else apart from glucocorticoids will be stimulated?

A

DHEA/sex hormones- produces testosterone and related symptoms (acne/amenorrhoea etc)

91
Q

What is the best test for Cushings?

A

High dose dexamethasone test

92
Q

What is Cushing’s disease?

A

ACTH secreting pituitary adenoma

93
Q

What ectopic cancers most commonly cause high circulating levels of ACTH

A

Lung, thymus and pancreas

94
Q

What are ACTH independent causes of Cushing’s?

A 
Hypersecretion of cortisol can be caused by:
•	Adrenal adenoma
•	Adrenal carcinoma
•	Nodular hyperplasia
•	High dose steroid use
95
Q

A high dose dexamethasone test shows ACTH levels of <300 and high dose dexamethasone suppression of 50%. What is the cause of the Cushings?

A

Cushing’s disease (ACTH secreting pituitary adenoma)

96
Q

A high dose dexamethasone test shows ACTH levels of >300 and high dose dexamethasone suppression of 0%. What is the cause of the Cushings?

A

Ectopic cause (likely cancer)

97
Q

A high dose dexamethasone test shows ACTH levels of <1 and high dose dexamethasone suppression of 0%. What is the cause of the Cushings?

A

Adrenal cause (eg adrenal adenoma/high dose steroids etc)

98
Q

What hormones are not produced in Addison’s disease?

A

Glucocorticoids and mineralocorticoids

aka steroid hormones

99
Q

What is the potentially fatal complication of Addison’s and what can trigger it?

A

Adrenal crisis - triggered by stress, infection, traum& surgery

100
Q

What is the best test for Addison’s?

A

Synacthen test (ACTH stimulating test) - poor rise in cortisol indicates Addison’s

101
Q

What drugs are given as a treatment for Addison’s?

A

Hydrocortisone and fludrocortisone

102
Q

What are the sick day rules for people with Addison’s?

A

MUST double up on their medication

103
Q

What is a pheochromocytoma?

A

Neuroendocrine tumour of the medulla of the adrenal glands secreting catecholamines (adrenaline and noradrenaline)

104
Q

What genetic condition is associated with bilateral pheochromocytoma?

105
Q

What is the triad of symptoms associated with pheochromocytoma?

A
  • Hypertension (50% paroxysmal)
  • Sweating
  • Headaches
106
Q

What is the first-line specific investigations into pheochromocytoma?

A

Urinary catecholamines and metabolites

107
Q

Coming off which class of drugs can cause secondary adrenal insufficiency?

A

High dose steroids - causes ACTH surpression

108
Q

Excessive use of high dose steroids can cause iatrogenic _____?

A

Cushing’s

109
Q

Secondary adrenal insufficiency causes the same symptoms as Addison’s (primary adrenal insufficency) EXCEPT what?

A

Increased tanning/skin darkening - due to secondary causing no increase in ACTH

110
Q

MEN1 and MEN2 are associated with tumors of which body system?

111
Q

What 3 major endocrine issues are associated with MEN1

A

Pituitary adenomas, parathyroid hyperplasia (hyperparathyroidism) and pancreatic tumours

112
Q

What major endocrine tumours are associated with MEN2

A

Medullary thyroid cancer, parathyroid tumors, and pheochromocytoma

113
Q

Von Hippel-Lindau (VHL) is mainly associated with tumours of which body systems?

A

Vascular (eg haemangiomas) and endocrine (eg pheochromocytomas)

114
Q

Pheochromocytomas can be associated with a genetic condition that also causes axillary freckling and Café-au-lait patches. What condition is this?

A

Neurofibromatosis type 1

115
Q

What is the main hormone raised is acromegaly?

A

Insulin growth factor 1 (IGF-1)

116
Q

What is the definitive test for acromegaly?

A

Oral glucose tolerance test - growth hormone will no be suppressed

117
Q

What medications can be used for acromegaly?

A

Dopamine agonists OR somatostatin receptor agonists OR growth hormone antagonists

118
Q

What genetic condition is associated with pituitary tumours?

119
Q

What is the most common type of functional pituitary tumour?

A

Prolactinoma

120
Q

Does a hyperprolactinaemia cause menorrhagia or amenorrhoea

A

Amenorrhoea (or period irregularity)

121
Q

What hormones are secreted by the anterior pituitary

A
  • Growth hormone (GH)
  • Adrenocorticotrophic hormone (ACTH)
  • Thyroid stimulating hormone (TSH)
  • Prolactin
  • Follicle stimulating hormone
  • Luteinising hormone (LH)
122
Q

What hormones are secreted by the posterior pituitary

A
  • Oxytocin

- Anti-diuretic hormone (ADH)

123
Q

What drugs are used in prolactinomas?

A

Dopamine agonists

124
Q

What is the most common cause of hypercalcaemia?

A

Parathyroid adenoma causing primary hyperparathyroidism

125
Q

What does groans, moans, bones and stones mean?

A

GROANS (constipation), MOANS (depression and fatigue), BONES (sore bones) AND (kidney) STONES

126
Q

What will usually happen to the phosphate levels in hypercalcaemia caused by the parathyroid glands vs hypercalcaemia caused by bony pathology?

A

Parathyroid glands = low/normal

Bony pathology = raised

127
Q

In Familial Hypocalciuric Hypocalcaemia the blood calcium is high and the urine calcium is____

128
Q

Chronic disease of what organ causes secondary hyperparathyroidism?

A

Chronic renal disease - parathyroid glands become enlarged and release too much PTH because kidneys cannot make active vitamin D (needed to absorb calcium)

129
Q

Hyperparathyroidism causes hypercalcaemia + _____

A

Osteoporosis

130
Q

In hypoparthyroidism there is hypocalcaemia and hyper_______

A

Hyperphosphatemia

131
Q

Pseudohypoparathyroidism is resistance to _____

A

Parathyroidism (PTH)

132
Q

Lack of vitamin D decreases absorption of which two minerals?

A

Ca2+ and PO4 3-

133
Q

What is the difference in PTH between hypoparathyroidism and vitamin D deficiency

A

Hypoparathyroidism = low PTH

Vitamin D deficiency = high PTH

134
Q

Do osteoblasts build or break down bone?

135
Q

Alendronate, risedronate and etidronat are examples of what class of drug?

A

Bisphosphonates

136
Q

Primary amenorrhea is defined as _____

A

Failure of menarche by the age of 16 years

137
Q

Secondary amenorrhea is defined as______

A

Cessation of periods for >6 months in an individual who has previously menstruated

138
Q

To be diagnosed with PCOS a patient must have 2 of what 3 symptoms?

A
  • Oligomenorrhoea/amenorrhoea
  • Hyperandrogenism
  • Polycystic ovaries on ultrasound
139
Q

What fertility drug is used in PCOS

A

Clomiphene citrate

140
Q

Premature ovarian failure is menopause before what age?

141
Q

Klinefelter’s syndrome (causes primary hypogonadism) is what karytope?

142
Q

Turner syndrome ( can cause premature ovarian failure) is what karytope?

143
Q

What is SIADH?

A

Syndrome of inappropriate antidiuretic hormone secretion (causes Low sodium, low sodium and low serum osmolarity while euvolemic)

144
Q

What are the 2 common causes of hypernatraemia - increased water loss/decreased water intake OR increased sodium loss/decreased sodium intake

A

Increased water loss (eg diabetes insipidus) or decreased water intake (eg dehydration)

145
Q

What is the most common cause of hyponatremia?

A

Decreased water excretion/water retention (eg SIADH)

146
Q

What is the first sign of of hyperkalaemia on an ECG?

A

Peaked T waves

147
Q

What is the treatment for hyperkalaemia?

A 
10mls 10% calcium gluconate 
\+
Actrapid 10units ) with 50mls 50% dextrose 
\+ 
Salbutamol Nebs
148
Q

Lactic acidosis does what to the anion gap?

149
Q

Is there ketonaemia in lactic acidosis?

150
Q

What happens to bicarbonate in lactic acidosis

A

It’s reduced

4th Year General Medicine (6 decks)

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