DUMS Endo Flashcards by Shubham Agwan

What is homeostasis

Physiological regulation of the body to keep processes in a stable equilibrium

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What is autocrine signalling

A response produced by a cell which acts on itself

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The retropharyngeal space lies between which two fascial layers

the pretracheal and prevertebral fascia layers

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Which fascial layer encloses all the other neck fascial compartments

Investing (deep) fascia

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Which fascial layer is the most superficial out of all the deep fascial layers

Investing fascia

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Which of the pituitary secretions is mainly controlled by inhibition and by why chemical

Prolactin is mainly controlled by the inhibitory effect of dopamine

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Asides from being inhibited by dopamine, how else is prolactin secretion controlled

Secretion caused by TRH

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what is the difference between a pituitary macroadenoma and a microadenoma

MACROadenoma = >1cm 
MICROadenoma = ≤ 1cm

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Which structure can a non-functioning macroadenoma compress and where does this structure lie

Optic chiasm

which is superior to the pituitary gland

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Which cranial nerves are at risk of being compressed by a pituitary tumour

3, 4, 6

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How can a non-functioning pituitary adenoma cause the likes of HYPO -adrenalism, -gonadism, -thyroidism

Can grow and wipe out cells that usually produce hormone – ACTH cells wiped out = hypoadrenalism etc

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How can a non-functioning pituitary adenoma cause diabetes insipidus

Grow and compress the posterior pituitary thus decreasing/ stopping the production of ADH

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Which visual field defect can a pituitary growth cause

Bitemporal Hemianopia

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What is the most common type of pituitary tumour

Prolactinoma

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What gender-specific symptoms will a prolactinoma present with

Males -> impotence

Females -> cycle irregular

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Which investigation should be carried out if you suspect a pituitary tumour…

MRI pituitary fossa

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What is the treatment for a prolactinoma and how does it work

Dopamine agonist (Cabergoline) 
Inhibits prolactin release

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How is acromegaly diagnosed

IGF1
Glucose Tolerance Test (75g Oral)
-> diagnostic if GH unchanged or > 1ug/L (normal <0.4)

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What GI symptoms can Acromegaly present with

Colon Polyps

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Which MSK hand condition can Acromegaly put you at higher risk of

Carpal tunnel syndrome

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What is the 1st line treatment for Acromegaly and what should be done after this

Pituitary surgery/ Radiotherapy to pituitary fossa

Repeat GTT

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Is surgery is unsatisfactory for Acromegaly, what drugs can be used and how do they work

Dopamine agonist (dopamine inhibits GnRH) 
Somatostatin analogue (somatostatin inhibits GH)
Pegvisomant (GH receptor antagonist)

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What do parafollicular C cells secrete

Calcitonin

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What is calcitonin involved in

Minor role in calcium regulation

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What is the major regulatory step in the HPT axis

TSH release from the anterior pituitary regulated by TRH

Which two carrier molecules are responsible for transporting thyroxine around the body

Thyroxine-binding-globulin | Transthyretin

What is a dietary cause of hypothyroidism

Lack of iodine in diet

Antibodies for Hashimoto's thyroiditis

Thyroid peroxidase antibodies (Anti-TPO)

What is the management of hypothyroidism

Levothyroxine 50-100 MICROgrams

How often should you check TSH levels for someone being treated for hypothyroidism

TSH every 2 months after any dose change 4 weeks after first starting Once stable 12-18 months

What kind of menstrual irregularities can hyperthyroidism cause

Less frequent periods

What is De Quervain's thyroid pathology and what is it caused by

Sub acute thyroiditis – viral trigger

A smooth symmetrical goitre and symptoms of hyperthyroidism should make you think of what

Grave's disease

An asymmetrical goitre and symptoms of hyperthyroidism should make you think of what

Multi-Nodular goitre | Toxic Nodule - thyroid adenoma

What drugs can be given to treat thyrotoxicosis and the symptoms of thyrotoxicosis

Beta Blockers --> for symptomatic relief | Carbimazole/ PTU --> to lower thyroxine

Which nerve is at risk from thyroid surgery and how would an injury to this structure present

Recurrent laryngeal nerve | Hoarse voice

What are the three treatments you could consider in acute hypercalcaemia

Fluids- rehydrate with 0.9% saline 4-6L in 24hours Loop diuretics once rehydrated- avoid thiazides Bisphosphonates

Which biochemical marker will be high in Paget's

ALP

What will PTH levels be like in a bone malignancy

Very low | physiological response to high Ca

What is the difference between rickets and osteomalacia

Rickets is in kids | Osteomalacia is in adults

What is the normal range of blood sugar

4-6mmol/L

What is the normal range of HbA1c for a diabetic

48-58mmol/l

What are 3 different ways to diagnose T2DM

Random blood sugar test > 11mmol/l Fasting blood sugar > 7 on 2 occasions OGTT > 11mmol/l after 2 hours

What is a rare but serious side effect of Metformin

Lactic Acidosis

After what age are TZD's not recommended and why

Over 65's due to increase in fracture risk

How are GLP-1 agonist administered

Sub-cutaneous injection

Which malignancy can GLP-1 agonists cause

Pancreatic cancer

What is the most common GLP-1 agonist

Exenatide (synthetic Exendin-4)

Which GLP-1 agonist is DPP-IV resistant

Liraglutide

What is the most commonly used DPP-IV inhibitor

Sitagliptin

What level of ketonaemia is diagnostic of DKA

>3mmol/L

What blood glucose level is diagnostic of DKA (with relevant symptoms/ history)

> 11mmol/l

What bicarbonate and pH levels diagnose DKA

Bicarbonate < 15mmol/L | pH < 7.3

What kind of breathing is specific to DKA

Kussmaul's breathing

What is Kussmaul's breathing trying to achieve in DKA

Attempt to blow off CO2 to lower pH of the blood | Attempt to compensate for the metabolic acidosis

Which condition is blood glucose typically higher in, DKA or HHS

HHS

When checking blood sugar, where should the lancet be used

Lancet against the side of the distal portion of a finger. | Don’t use the lancet on the finger pad.

What is the major regulator of aldosterone production

RAAS

When is RAAS activated

A decrease in blood pressure

How does angiotensin 2 increase blood pressure

direct (vasoconstriction) and indirect (aldosterone)

What are 4 possible causes of primary adrenal insufficiency

Addison's Congential Adrenal Hyperplasia Adrenal Tb Malignancy

What are 3 possible causes of secondary adrenal insufficiency

Lack of ACTH stimulation Iatrogenic (excess exogenous steroid) Pituitary/hypothalamic disorders

How is Addison's diagnosed

SHORT synACTHen test | Measure cortisol 30 mins after ACTH administration. Should be > 550 mmol/l

What is the management of Addison's

Hydrocortisone (Corisol mimic) | Fludrocortisone (Aldosterone mimic)

In someone with Addison's, where will they have areas of hyperpigmentation

Classically mucosal membranes, extensor surfaces and palmar creases

Why do you not give fludrocortisone in secondary adrenal insufficiency

Because the adrenal gland is functioning fine and the RAAS system will be regulating the release of Aldosterone just fine so no replacement needed

What is a common way in which an Addisonian crisis can occur

Steroid therapy stopped suddenly | Adrenal glands have 'gone to sleep'

Why is myopathy a feature of Cushing's syndrome

Glucocorticoids alter protein metabolism | Reduced protein synthesis

What are the 2 categories of causes of Cushing's

ACTH dependent | ACTH independent

Name 3 ACTH dependent causes of Cushing's

Pituitary adenoma -> most common Ectopic ACTH production Ectopic CRH

Name 3 ACTH independent causes of Cushing's

Adrenal adenoma Adrenal carcinoma Nodular hyperplasia

What is the difference between Cushing's Syndrome and Cushing's Disease

``` Syndrome = Excess Cortisol due to any cause Disease = Excess Cortisol due to pituitary pathology ```

How is Cushing's diagnosed

Overnight dexamethasone suppression test - screening | Short dexamethasone suppression test

What is the commonest cause of 2ndary hypertension

Conn's syndrome

What does renin do

Converts angiotensinogen into Ang I

What happens to angiotensin I in the RAAS

Angiotensin I converted to Ang II by ACE

Where is ACE found

Pulmonary vascular endothelium

What is the commonest cause of Conn's syndrome

Bilateral adrenal hyperplasia

How is Conn's diagnosed

Aldosterone: Renin ratio Saline suppression test (Failure to suppress aldosterone by 50% with 2L of saline is diagnostic)

What is done after Conn's is diagnosed, via a saline suppression test, to work out the treatment plan

Adrenal CT to demonstrate adenoma

What is the treatment of Conn's syndrome

Spironolactone/ eplerenone if bilateral hyperplasia | Laparoscopic Adrenalectomy if unilateral adenoma

What is the treatment of PCOS

``` Antioestrogens (Clomifene citrate or Tamoxifen) Aromatase inhibitors (Letrozole) ```

What is the normal range of HbA1c for a non-diabetic

below 41mmol/L