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finals > endo > Flashcards

endo Flashcards

1
Q

DPP-4 inhibitors (gliptans) MoA

A

reduce peripheral breakdown of incretins (such as GLP-1)

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2
Q

metformin moa

A

increases peripheral insulin sensitivity and reduces hepatic gluconeogenesis

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3
Q

sulfonylureas moa

A

increase pancreatic insulin secretion

hence can lead to hypoglycaemia

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4
Q

GLP mimetics, e.g. exenatide, moa

A

increase pancreatic insulin secretion
suppress glucagon release
slow gastric emptying and promote satiety

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5
Q

best diabetic med for overweight patients

A 
DPP-4 inhibitors (they do not cause weight gain, e.g. Sitagliptin)
SGLT-2 inhibitors (-flozins)
GLP1 analogues (only in BMI>35)
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6
Q

important glucocorticoid side effects

A 
osteoporosis and osteonecrosis
impaired glucose regulation
neutrophilia
immunosuppression
psychosis
avascular necrosis
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7
Q

Graves’ autoantibodies

A

TSH receptor stimulating antibodies (90%)

anti-TPO (75%)

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8
Q

features of Graves’ but not other causes of hyperthyroidism

A

eye signs - exophthalmos and ophthalmoplegia
pretibial myxoedema
digital clubbing

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9
Q

hyperthyroidism with painful goitre

A

most likely subacute (De Quervain’s) thyroiditis

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10
Q

HHS vs DKA

A

HHS does not cause hyperketonaemia and metabolic acidosis but can have much higher glucose
HHS more common in old and fat T2DM
DKA more common in young, skinny T1DM

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11
Q

mx of thyroid storm

A

beta blocker - propranolol
propylthiouracil
hydrocortisone

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12
Q

LADA vs MODY

A

LADA - no fhx, 30-50 years

MODY - <25 years, no ketones

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13
Q

Addison’s crisis mx

A

only IV hydrocortisone

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14
Q

OGTT cut offs

A

fasting ≥ 7.0 mmol/L

random or after glucose tolerance test ≥ 11.1 mmol/L

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15
Q

blood glucose targets T1DM

how often to measure

A

on waking - 5-7
before meals (except breakfast) - 4-7
measure 4 times per day

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16
Q

HbA1c target in T2DM

A

48 mmol/mol if lifestyle (+/- metformin) mx
53 mmol/mol if taking any drug that causes hypoglycaemia
at 58 mmol/mol consider adding a second agent

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17
Q

impaired fasting glucose

A

blood glucose 6.1-7.0

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18
Q

Kallman’s bloods

A

low-normal FSH and LH

low testosterone

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19
Q

hypothyroidism TFTs

A

high TSH

low T4

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20
Q

hyperthyroidism TFTs

A

low TSH

high T4

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21
Q

drug causes of gynaecomastia

A 
spironolactone
GnRH agonists (goserelin)
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22
Q

what conditions is Pioglitazone CI in

A

HF

bladder cancer

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23
Q

most common cause of Cushing’s syndrome

A

ACTH dependent causes - Cushing’s disease (pituitary tumour secreting ACTH producing adrenal hyperplasia)

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24
Q

how to interpret dexamethasone suppression testing

A

lack of cortisol suppression by low dose dexamethasone - excess glucocorticoid
high dose testing used to localise the problem
if both ACTH and cortisol are suppressed by high dose - pituitary cause
if only cortisol is suppressed by high dose - adrenal cause
if neither are suppressed - ectopic ACTH secretion

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25
Q

features of Addison’s

A

vague symptoms of lethargy, weakness, anorexia
hyperpigmentation, vitiligo
hypoglycaemia
hyponatraemia and hyperkalaemia

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26
Q

what should be done with steroid replacement for Addison’s patients with illness, e.g. gastroenteritis

A

double hydrocortisone

same fludrocortisone

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27
Q

most common cause of primary hyperaldosteronism

A

bilateral idiopathic adrenal hyperplasia

28
Q

mx of myxoedemic coma

A

thyroxine

hydrocortisone

29
Q

ix for acromegaly

A
  1. serum IGF-1 (insulin growth factor-1)

2. OGTT

30
Q

most common cause of primary hyperparathyroidism

A

solitary adenoma

31
Q

bloods in primary hyperparathyroidism

A

high PTH (can be inappropriately normal)
high Ca
low phosphate

32
Q

bloods in secondary hyperparathyroidism

A

high PTH
low/normal Ca
high phosphate
low vitamin D

33
Q

bloods in tertiary hyperparathyroidism

A 
extremely high PTH
normal/high Ca
low/normal phosphate
low/normal vitamin D
high ALP
34
Q

which thyroid cancer produces calcitonin

A

medullary

35
Q

commonest thyroid cancer

A

papillary (65%)

follicular (20%)

36
Q

mx of DKA

A

0.9% NaCl
IV 0.1 unit/kg/hr insulin infusion, once blood glucose <15 mmol/l start 5% dextrose
correct electrolyte disturbances
cont long acting insulins, stop short acting

37
Q

cause of hyperthyroidism then hypothyroidism

A

De Quervain’s thyroiditis

38
Q

results of water deprivation test in cranial DI

A

low urine osmolality after fluid deprivation

high urine osmolality after desmopressin

39
Q

results of water deprivation test in nephrogenic DI

A

low urine osmolality after both fluid deprivation and desmopressin

40
Q

electrolyte abnormality seen in Cushing’s

A

hypokalaemic metabolic alkalosis

41
Q

adverse effects of thryoxine therapy

A

hyperthyroidism due to over treatment
reduced bone mineral density
AF
worsening of angina

42
Q

which type of hyperparathyroidism in CKD

A

most likely tertiary

43
Q

causes of lower than expected HbA1c

A

anything that causes higher turnover of red cells, e.g. spherocytosis, sickle cell, G6PD deficiency

44
Q

causes of higher than expected HbA1c

A

anything that causes red cells to be held onto for longer, e.g. iron deficiency anaemia, splenectomy, vitamin B12/folate deficiency

45
Q

HbA1c that indicates prediabetes

A

42-47 mmol/mol

46
Q

ix for Addison’s

A

short synacthen (ACTH) test

47
Q

Klinefelter vs Kallmanns

A

both cause infertility
Klinefelter’s - above average height, small testes, gynaecomastia
Kallman’s - anosmia, no gyanecomastia

48
Q

mx of primary hyperaldosteronism

A

Spironolactone if bilateral adrenal hyperplasia

Surgery if adrenal adenoma

49
Q

features of MEN1

A

3 Ps
parathyroid - hyperparathyroidism
pancreas - insulinoma, gastrinoma (leading to peptic ulceration)
pituitary - prolactinoma

50
Q

insulin infusion rate in DKA

A

0.1 unit/kg/hr

51
Q

how to differentiate between causes of Cushing’s

A

dexamethasone suppression test
adrenal cause - cortisol is not suppressed by high-dose dexamethasone
pituitary cause - cortisol is suppressed by high dose dexamethasone

52
Q

mx of acromegaly

A
  1. trans-sphenoidal surgery
  2. if surgery not appropriate or unsuccessful - somatostatin analogue (Octreotide), GH receptor antagonist (Pegvisomant), dopamine agonist (Bromocriptine)
53
Q

what should be done to metformin dosing during intercurrent D&V

A

suspend during illness as it increases risk of lactic acidosis

54
Q

orlistat moa

A

pancreatic lipase inhibitor

55
Q

mx of hypoglycaemia in drowsy patient

A

IV 20% glucose is first line

if drowsy there may be risk of aspiration with gluco-gel

56
Q

best diabetic med for patients w CKD

A

Sitagliptin (DPP-4 inhibitor)

57
Q

mx of prediabetes

A

refer to Diabetes Prevention Programme

58
Q

low TSH and low T4

A

suggests secondary hypothyroidism which needs and MRI pituitary to confirm dx

59
Q

which medications may reduce absorption of levothyroxine

A

iron/calcium carbonate

60
Q

results of water deprivation test in psychogenic/primary polydipsia

A

high urine osmolality after fluid deprivation and after desmopressin

61
Q

complication of papillary thyroid cancer

A

spread to cervical lymph nodes

62
Q

mx of hypoglycaemia if person is alert and able to swallow

A

glucose tablets

63
Q

CI to testosterone therapy

A

PSA >4
hx of or active prostate/breast cancer
haematocrit >0.55

64
Q

drug cause of hyperthyroidism

A

amiodarone

65
Q

adverse effects of glitazones

A 
ELBOW
Edema fluid retention
Liver dysfunction
Bladder cancer
Osteoporosis - fractures
Weight gain
66
Q

mx of prolactinoma

A 
dopamine agonists (e.g. Cabergoline or Bromocriptine)
surgery is only performed for those who cannot tolerate/fail to respond to medical therapy

finals (25 decks)

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