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Yr 3 MedEd > Endo 1 > Flashcards

Endo 1 Flashcards

1
Q

What is diabetes insipidus?

What are the two types of diabetes insipidus?

A

inadequate secretion of or insensitivity to vasopressin- causes hypotonic polyuria

  • Cranial- post. pituitary fails to secrete ADH
  • Nephrogenic: collecting ducts insensitive to ADH
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2
Q

Give 3 causes of cranial diabetes insipidus

Give 4 causes of nephrogenic diabetes insipidus

A

Cranial:
- Pituitary tumour, infection (meningitis), sarcoidosis
Nephrogenic:
- High Calcium, low potassium, lithium, inherited (AVPV2 gene), idiopathic

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3
Q

Give 3 features/ symptoms of a diabetes insipidus presentation

A
  • Polyuria- including nocturia- UO often > 3L
  • Polydipsia
  • Symptoms of hypernatraemia: lethargy, irritability, confusion.
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4
Q

What is the diagnostic investigation for diabetes insipidus?

How do the test results differ between cranial and nephrogenic diabetes insipidus?

A
  • Water deprivation test: water restricted for 8 hours, plasmas and urine osmolality measured every hour. After 8 hours give desmopressin and measure urine osmolality.
  • Cranial: Urine osmolality increase by >50% after desmopressin
  • Nephrogenic: Urine osmolality increases by <45% after desmopressin.
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5
Q

Which medication is used to treat cranial diabetes insipidus?

Which medication is used to treat nephrogenic diabetes insipidus?

A
  • Cranial: intranasal desmopressin

- Nephrogenic: Thiazide diuretic or NSAIDs: NSAIDs inhibit prostaglandin (Prostaglandin inhibits ADH).

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6
Q

How do the presentations of T1 and T2 diabetes mellitus differ?

A
  • T2 is polyuria and polydipsia.

- T1 is polyuria, polydipsia AND tiredness and weight loss, and DKA.

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7
Q

Give 4 signs of DKA.

A
  • N&V
  • Abdominal pain
  • Kussmaul breathing
  • Sweet breath
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8
Q

Give two risk factors for T1DM.

Give 4 risk factors for T2DM.

A

T1: HLA DR3/4, autoimmune conditions.
T2: Obesity, FH, ethnicity, drugs.

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9
Q

What are the fasting and random glucose measurements needed to diagnose diabetes.

A
  • Fasting >/= 7mmol/L

- Random: >11.1 mol/L

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10
Q

What is the normal range of sodium?

What is hyponatraemia caused by?

A
  • 135-145 mol/L

- Hyponatraemia caused by too much ADH- physiological or inappropriate

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11
Q

Give 3 causes of hypovolaemia with hyponatraemia.

Give 3 signs of hypovolaemia with hyponatraemia.

A
  • Diarrhoea
  • Vomiting
  • Diuretics
  • Reduced turgor
  • Postural hypotension
  • dry mucous membrane
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12
Q

Give 3 causes of hyponatraemia with euvolaemia.

Give 2 tests for a hyponatraemic patient with euvolaemia.

Give 3 further investigations if these tests were normal.

A
  • Hypothyroidism
  • Hypoadrenalism
  • SIADH- pneumonia/ cancer
  • TFTs
  • Short synACTHen: inject ACTH, cortisol will not rise in hypoadrenalism
  • Drug review, breast examination, CXR/ brain MRI
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13
Q

Give 3 causes of hypervolaemia with hyponatraemia

Give two signs of hypervolaemia with hyponatraemia

A
  • HF
  • Cirrhosis
  • Nephrotic syndrome
  • Oedema, raised JVP
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14
Q

Give 3 causes of hypernatraemia

A
  • N&V
  • Diabetes insipidus
  • primary aldosteronism- Conn’s syndrome
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15
Q

Give 5 signs of hypernatraemia.

What is the management of hypernatraemia?

A
  • Lethargy
  • Irritability
  • Thirst
  • Signs of dehydration
  • confusion
  • coma
  • fits
  • Management: replace water
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16
Q

What will the following investigations show in SIADH?

  • Serum Na
  • Urine Osm
  • Urine Na
A

Serum Na low, urine osmolality is high, urine sodium low.

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17
Q

Give 4 causes of SIADH?

A
  • CNS pathology
  • Lung pathology
  • Drugs: SSRI, TCA, Opiates, PPIs, carbamazepine
  • Tumours- don’t forget breast cancer.
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18
Q

Give 2 management steps for SIADH

A
  • Fluid restrict to 0.5-1L
  • If ineffective give demeclocycline or vasopressin receptor antagonist, e.g. tolvaptan- reduces responsiveness of collecting tubule cells to ADH.
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19
Q

Where is prolactin secreted from?

Which two hormones regulate this gland?

A
  • Prolactin secreted from anterior pituitary
  • Thyrotrophin releasing hormone (TRH) increases prolactin secretion (as well as thyroid hormone synthesis).
  • Dopamine inihibits prolactin secretion.
20
Q

Give 4 causes of hyperprolactinaemia

A
  1. Pituitary prolactinoma
  2. Hypothyroidism- increased TRH causes increased prolactin
  3. Drugs: METCLOPRAMIDE, antipsychotics (DA antagonists)
  4. Physiological; pregnancy/ breastfeeding
21
Q

Give 4 presenting features of hyperprolactinaemia in women and 2 in men.

Give 2 presenting features of tumour.

A

Women: galactorrhea, amenorrhoea, infertility, loss of libido.
Men: infertility, loss of libido
Tumour: headache, loss of visual fields.

22
Q

Give 3 investigations (2 BT, 1 imaging) for hyperprolactinaemia

A

Blood test: prolactin, TFTs

Imaging: Pituitary MRI

23
Q

Give the 1st and 2nd line management for hyperprolactinaemia

A
  1. DA agonist, e.g. bromocriptine, cabergoline

2. Surgery

24
Q

Give 7 signs of hyperthyroidism

A
  • Heat intolerance, sweating
  • Weight loss but good appetite
  • Diarrhoea
  • Irritable
  • Palpitations, irregular pules
  • tremor
  • menstrual irregularities in women, impotence in men.
25
Q

Give 7 signs of hypothyroidism

A
  • Cold intolerance
  • weight gain
  • Constipation
  • lethargy
  • bradycardia
  • Dry skin, cold hands
  • menstrual disturbance in females
26
Q

What is the difference between hyperthyroidism and thyroiditis?

A

Hyperthyroidism: increased thyroid hormone synthesis
Thyroiditis: increased release of stores thyroid hormone

27
Q

What is the aetiology of Grave’s disease.

What is Grave’s triad?

A
  • Autoantibodies to TSH receptor. Associated with other AI diseases.
  • Exopthalmos, pretibial myxoedema, thyroid acropachy (clubbing, soft tissue swelling, periosteal bone formation).
28
Q

What is the aetiology of De Quervain’s thyroiditis?
What symptoms does it cause?
What is the management?

A
  • Post viral, high ESR. Causes painful goitre and fever. Self limiting (treat with NSAIDs).
29
Q

In what 2 populations do you find toxic multinodular goitre?

A

Elderly and iodine deficient areas.

30
Q

What would you expect to be the cause of a solitary nodule producing T3/4?

A
  • Thyroid adenoma
31
Q

What radioisotope scan findings would you expect to see from the following?

  • Grave’s disease
  • De Quervain’s thyroiditis
  • Toxic multinodular goitre
  • Adenoma
A

Graves: diffuses increased uptake- smooth diffuse goitre
De Quervain’s: No uptake
Toxic MNG: Multiple areas of increased uptake
Adenoma: single area of increased uptake

32
Q

Give 5 causes of hypothyroidism

A
  • Autoimmune Hashimoto’s thyroiditis- commonest cause in West.
  • Iodine deficiency- commonest cause worldwide
  • Iatrogenic: post surgery, radioiodine, amiodarone
  • De Quervain’s thyroiditis
  • Congenital thyroid dysgenesis
33
Q

What is the management for hypothyroidism?

A
  • Levothyroxine 25-200 micrograms per day- monitor TFTs in 6 weeks.
34
Q

What are the features of the following types of thyroid cancer:

  • Papillary
  • Follicular
  • Medullary
  • Lymphoma
  • Anaplastic
A

Pap: most common, younger patients. RF: radiation exposure. Bzw: Psammoma bodies, Orphan Anne nuclei

Fol: Middle aged women. Bzw: Hurthle cells

Med: Associated with MEN2

Lym: Females, after pre-existing Hashimoto’s

Ana: Elderly females. Bzw: giant cells, pleomorphic hyper chromatic nuclei.

35
Q

What is the usual aetiology of acromegaly?

A
  • Adenoma secreting GH in pituitary.

GH stimulates release of IGF-1: causes growth of bones and soft tissue.

36
Q

Give 7 presenting features of acromegaly

A
  • Tight fitting shoes/ rings
  • Carpal tunnel syndrome
  • Coarse facial features
  • Increased sweating
  • hypertension
  • Insulin resistance
  • Sleep apnoea
37
Q

Give 1 screening test, 1 diagnostic and 1 imaging investigation for acromegaly

A
  • Screen: serum IGF-1
  • Diagnostic test: Oral glucose tolerance test: acromegalic fail to suppress GH after 75g glucose load.
  • Imaging: MRI brain to visualise pituitary tumour.

Cannot rely on GH secretion as it is pulsatile

38
Q

Give the 1st and 2nd line management for acromegaly

A

1st: transphenoidal hypophysectomy
2nd: Somatostatin analogue e.g. octreotide

39
Q

What is the inheritance pattern of MEN?

A
  • Autosomal dominant.
40
Q

Give 3 features of MEN 1

A

PPP

  • Parathyroid adenoma/ hyperplasia- hyperparathyroidism, high Ca.
  • Pancreas: insulinoma, gastrinoma
  • Pituitary: prolactinoma, acromegaly, adrenal, carcinoid tumours
41
Q

Give 3 features of MEN 2.

A

TAP

  • Thyroid: medullary thyroid cancer in all
  • Adrenal: phaeochromocytoma; in 50%
  • Parathyroid hyperplasia
42
Q

Give 3 features of MEN 3/ 2B

A
  • Med thyroid carcinoma + phaeo as in MEN 2
  • Mucosal neuromas: bumps on lips, cheeks, tongue, eyelid
  • Marfanoid appearance

No hyperparathyroidism

43
Q

What is carcinoid syndrome?

Name 4 secretory products produced.

Give 2 common sites for carcinoid tumours

A
  • Constellation of symptoms caused by systemic release of humoral factors from carcinoid tumours
  • Produce secretory products: serotonin, histamine, tachykinins, prostaglandin
  • Appendix and rectum
44
Q

Give 6 presenting features of carcinoid syndrome

A
  • Paroxysmal flushing
  • Diarrhoea
  • Crampy abdominal pain
  • wheeze
  • sweating
  • palpitations
45
Q

What is measured in urine to test for carcinoid syndrome?

What other investigation can be used?

A
  • Measure increase in 5- HIAA levels: serotonin metabolite

- CT/ MRI to localise tumour

Yr 3 MedEd (31 decks)

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