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MRCP > Endo > Flashcards

Endo Flashcards

1
Q

in HRT: progestogen increases the risk of …?

A

increased risk of Breast ca + VTE

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2
Q

what other medications might reduce absorption of levothyroxine?

A

iron/ calcium carbonate tablets

  • should be given 4h apart from levothyroxine
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3
Q

what 2 diabetic medication classes increases GLP-1?

A

GLP-1 analogue / DPP4 inhibitors (inhibiting its breakdown - the gliptins)

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4
Q

what are the 2 e.g.s of GLP-1 analogues/mimetics?

A

Exenatide + Liraglutide

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5
Q

Benefits of GLP-1 mimetics e.g. (Exenatide, Liraglutide)?

A

weight loss

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6
Q

Major Side effects of GLP-1 mimetics?

A

nausea + vomiting, links to severe pancreatitis.

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7
Q

When to use GLP-1 mimetic e.g. Exenatide in T2DM?

A

consider adding exenatide to metformin and sulfonylurea if:
- BMI>35
or
- BMI<35 but insulin unacceptable due to other occupational implications or weight loss would benefit other co-morbidities.

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8
Q

E.g.s of DPP-4 inhibitor?

A

Sitagliptin, Vildagliptin

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9
Q

HbA1c target if pt is on any drug which may cause hypoglycaemia?

A

53 (7%)

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10
Q

what worsens thyroid eye disease?

A

smoking + radioiodine treatment (increases the inflammatory symptoms)

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11
Q

PreDiabetes: IFG vs IGT

A
  • impaired fasting glucose (IFG): due to hepatic insulin resistance
  • impaired glucose tolerance (IGT): due to muscle insulin resistance
  • patients with IGT are more likely to develop T2DM and cardiovascular disease than patients with IFG
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12
Q

Mechanism of HPV causing cervical ca?

A

HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively.

  • E6 inhibits the p53 tumour suppressor gene
  • E7 inhibits RB suppressor gene
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13
Q

Drug causes of SIADH?

A 
sulfonylureas* (e.g. gliclazide, glimepiride, glipizide)
SSRIs, tricyclics
carbamazepine
vincristine
cyclophosphamide
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14
Q

what is the first type of insulin to start someone on according to NICE?

A
  • Neutral Protamine Hagedorn (NPH) insulin [aka isophane insulin]
    e. g. Humulin I
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15
Q

what insulin to start someone on if HbA1c is 75 mmol/mol [9.0%] or higher?

A

NPH + a short-acting insulin

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16
Q

when to consider insulin detemir or glargine as 1st line instead of NPH?

A

→ needs assistance from a carer to inject insulin and the use of insulin detemir/ glargine would reduce the frequency of injections from twice to once daily, or
→ recurrent symptomatic hypos, or
→ The person would otherwise need twice-daily NPH insulin injections in combination with oral antidiabetic drugs.

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17
Q

what type of thyroid tumour is assoc w Hashimotos?

A

thyroid lymphoma.

Hashimoto’s thyroiditis is characterised by a chronic infiltration of the thyroid gland with B-lymphocytes, which are prone to undergo clonal proliferation.

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18
Q

pegvisomant?

A
  • used in acromegaly. 2nd line.
  • GH receptor antagonist - prevents dimerization of the GH receptor
  • once daily s/c administration
  • very effective - decreases IGF-1 levels in 90% of patients to normal
  • doesn’t reduce tumour volume therefore surgery still needed if mass effect
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19
Q

bendroflumethiazide: effect on calcium?

A

causes hyperCa

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20
Q

most common cause of hyperaldosteronism?

A

Bilateral idiopathic adrenal hyperplasia

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21
Q

diabetes diagnosis cut offs?

A

fasting > 7.0, random > 11.1 - if asymptomatic need two readings

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22
Q

inheritance pattern of MODY (maturity onset diabetes of the young)

A

auto dom

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23
Q

features of MODY?

A
  • typically develops in patients < 25 years
  • a family history of early onset diabetes is often present
  • ketosis is not a feature
  • most commonly very sensitive to sulfonylureas, insulin is not usually necessary
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24
Q

MODY 3 - assoc with?

A

increased risk of HCC

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25
Q

what gene is involved in MODY 3?

A

defect in the HNF-1 alpha gene

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26
Q

what gene is involved in MODY 2?

A

glucokinase gene

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27
Q

what gene is involved in MODY 5?

A

defect in the HNF-1 beta gene

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28
Q

MODY 5- assoc w?

A

liver and renal cysts

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29
Q

e.g. of SGLT2 inhibitor?

A

canagliflozin, dapagliflozin and empagliflozin.

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30
Q

How do SGLT2 inhibitors e.g. dapagliflozin work?

A

reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal PCT -> to reduce glucose reabsorption and increase urinary glucose excretion

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31
Q

SEs of SGLT2 inhibitors e.g. dapagliflozin?

A
  • urinary and genital infection (secondary to glycosuria). – - Fournier’s gangrene
  • normoglycaemic ketoacidosis
  • increased risk of lower-limb amputation: feet should be closely monitored
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32
Q

Management of papillary and follicular thyroid cancer?

A
  • total thyroidectomy
  • followed by radioiodine (I-131) to kill residual cells
  • yearly thyroglobulin levels to detect early recurrent disease
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33
Q

what hormone is monitored to assess for recurrence of thyroid cancer?

A

thyroglobulin

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34
Q

MOA of sulphonylureas?

A

bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells.

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35
Q

Side effects of sulphonylureas?

A
  • hypoglycaemia

- weight gain

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36
Q

when should insulin be started in gestational diabetes?

A
  • fasting glucose > 7
    OR
  • fasting glucose 6-6.9 + evidence of macrosomia/ polyhydramnios
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37
Q

what medication should be considered in GDM in patients who cannot tolerate metformin or decline insulin?

A

glibenclamide

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38
Q

Foods that are high in potassium?

A

bananas, oranges, kiwi fruit, avocado, spinach, tomatoes

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39
Q

Diagnostic criteria for metabolic syndrome?

A

at least 3:

  • high waist circumference
  • high triglycerides: > 1.7 mmol/L
  • low HDL
  • high blood pressure
  • high fasting plasma glucose or T2DM
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40
Q

indications for urgent eye review in thyroid eye disease?

A
  • unexplained deterioration in vision
  • awareness of change in intensity/ quality of colour vision
  • history of eye suddenly ‘popping out’ (globe subluxation)
  • obvious corneal opacity
  • cornea still visible when the eyelids are closed
  • disc swelling
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41
Q

management options for gastroparesis?

A

metoclopramide, domperidone or erythromycin

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42
Q

associations of metabolic syndrome?

A
  • raised uric acid levels
  • non-alcoholic fatty liver disease
  • PCOS
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43
Q

What causes increased sweating in patients with acromegaly?

A

sweat gland hypertrophy

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44
Q

Complications of acromegaly?

A
  • HTN
  • diabetes (>10%)
  • cardiomyopathy
  • colorectal cancer
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45
Q

features of Kallmans syndrome?

A
  • ‘delayed puberty’
  • hypogonadism, cryptorchidism
  • anosmia
  • LOW sex hormone levels -> LH, FSH levels are inappropriately low/normal
  • normal/ tall

**Cleft lip/palate and visual/hearing defects also seen

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46
Q

what deficiency most commonly causes congenital adrenal hyperplasia?

A

21-hydroxylase deficiency

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47
Q

what electrolyte might cause nephrogenic diabetes insipidus?

A

hypercalcaemia

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48
Q

hormone levels in Klinefelter’s syndrome?

A

HIGH gonadotrophin levels, LOW testosterone

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49
Q

what is 1st line medical management of urge incontinence in frail older ladies due to increased risk of delirium, confusion and impaired function?

A

mirabegron

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50
Q

what medication to AVOID in urge incontinence for elderly frail ladies due to the risk of cognitive impairment, falls and general decline?

A

Oxybutynin

  • antimuscarinic/ anticholinergic
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51
Q

management of stress incontinence if pelvic floor exercises unhelpful + decline surgery?

A

Duloxetine

  • combined noradrenaline and serotonin reuptake inhibitor
  • MOA: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced
    contraction
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52
Q

gynaecomastia assoc w hyper or hypothyroid?

A

HYPERthyroidism

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53
Q

Management of thyroid storm?

A
  • symptomatic treatment e.g. paracetamol
  • treatment of underlying precipitating event
  • BB: typically IV propranolol
  • anti-thyroid drugs: e.g. methimazole or propylthiouracil
  • Lugol’s iodine
  • dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
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54
Q

targets for Gestational diabetes glucose control?

A
  • fasting: < 5.3mmol/L
    AND
  • 1 hour postprandial: < 7.8 mmol/L or
  • 2 hours postprandial: < 6.4 mmol/L
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55
Q

management of hyperthyroidism in pregnancy?

A

1st trimester: propylthiouracil

2nd trimester onwards: switch to carbimazole

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56
Q

Hyperthyroidim in pregnancy - what management options are contraindicated?

A
  • block-and-replace regimes should not be used

- radioiodine therapy contraindicated

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57
Q

features of complete androgen insensitivity syndrome?

A
  • ‘primary amennorhoea’
  • undescended testes causing groin swellings
  • breast development may occur as a result of conversion of testosterone to oestradiol
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58
Q

diagnosis of complete androgen insensitivity syndrome?

A

buccal smear or chromosomal analysis to reveal 46XY genotype

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59
Q

management of complete androgen insensitivity syndrome?

A
  • counselling - raise child as female
  • bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
  • oestrogen therapy
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60
Q

management of toxic multi nodular goitre?

A

radioiodine

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61
Q

Advice for patients with hypercalcaemia in malignancy?

A
  • FLUIDS 3-4L / day if no CI
  • low calcium diet NOT necessary
  • avoid vitamins/ drugs with calcium
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62
Q

Changes to make to metformin dose during fasting (Ramadan)?

A

1/3 of the normal metformin dose before sunrise and 2/3 after sunset

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63
Q

what electrolyte derangement is most likely in refeeding syndrome?

A

low phosphate

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64
Q

While investigating for Addison’s, what is the benefit of a 9am cortisol level?

A
  • > 500 nmol/l -> Addison’s very unlikely
  • < 100 nmol/l is definitely abnormal
  • 100-500 nmol/l -> should prompt a ACTH stimulation test to be performed
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65
Q

MOA of mirabegron?

A

beta-3 agonist

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66
Q

rash after use of prednisolone?

A

drug induced acne

-> manage by discontinuing the steroids

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67
Q

features of insulinoma?

A
  • hypoglycaemia
  • rapid weight gain may be seen
  • high insulin, raised proinsulin:insulin ratio
  • high C-peptide
  • assoc MEN 1
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68
Q

diagnosis of insulinoma?

A
  • supervised, prolonged fasting (up to 72 hours)

- CT pancreas

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69
Q

management of insulinoma?

A
  • surgery

- diazoxide and somatostatin if patients are not candidates for surgery

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70
Q

features of type 1 renal tubular acidosis?

A
  • inability to generate acid urine (secrete H+) in distal tubule
  • hypokalaemia
  • nephrocalcinosis and renal stones
  • normal anion gap hyperCl met acidosis
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71
Q

features of type 2 renal tubular acidosis?

A
  • decreased HCO3- reabsorption in proximal tubule
  • hypokalaemia
  • osteomalacia
  • normal anion gap hyperCl met acidosis
72
Q

features of type 3 renal tubular acidosis?

A
  • caused by carbonic anhydrase II deficiency
  • hypokalaemia
  • normal anion gap hyperCl met acidosis
73
Q

features of type 4 renal tubular acidosis?

A
  • reduction in aldosterone -> reduction in proximal tubular ammonium excretion
  • hyperkalaemia
  • normal anion gap hyperCl met acidosis
74
Q

causes of type 1 (distal) renal tubular acidosis?

A

idiopathic, rheumatoid arthritis, SLE, Sjogren’s, analgesic nephropathy,

  • drugs: amphotericin B, lithium
75
Q

causes of type 2 (proximal) renal tubular acidosis?

A
  • Fanconi Syndrome: also causes loss of phosphate, uric acid, glucose, a.as, protein in urine
  • idiopathic, Wilson’s disease, cystinosis
  • Drugs: tetracyclines, carbonic anhydrase inhibitors (acetazolamide, topiramate)
76
Q

causes of type 4 renal tubular acidosis?

A

*hyperkalaemic acidosis

  • aldosterone deficiency (Addisons) / resistance
  • diabetes
  • SLE
  • medications: amphotericin B, lithium
77
Q

what is used as adjunct to transsphenoidal surgery for acromegaly?

A

octreotide

  • a somatostatin analogue often used as an adjunct to surgery -> reduced growth hormone levels and reduction in tumour size.
78
Q

which diabetic medication may predispose to normoglycemic ketoacidosis?

A

SGLT2 inhibitors e.g. dapagliflozin

79
Q

in Hypocalcaemia, which sign is most sensitive and specific?

A

Trousseau’s sign

- carpal spasm if brachial artery occluded

80
Q

management of De quervain’s thyroiditis?

A

self limiting, if painful - aspirin/ NSAIDs.

if severe, particularly if hypothyroidism develops, steroids can be used

81
Q

Causes of Hypokalaemia with acidosis?

A
  • diarrhoea
  • renal tubular acidosis
  • acetazolamide
  • partially treated diabetic ketoacidosis
82
Q

Causes of Hypokalaemia with alkalosis?

A
  • vomiting
  • thiazide and loop diuretics
  • Cushing’s syndrome
  • Conn’s syndrome (primary hyperaldosteronism)
83
Q

features of Pendred’s syndrome?

A
  • auto recess

- bilateral sensorineural deafness + mild hypothyroidism + goitre

84
Q

diagnosis of Pendred syndrome?

A
  • genetic testing: PDS gene, chromosome 7
  • MRI imaging to look for characteristic one and a half turns in the cochlea, compared to the normal two and a half turns.
  • audiometry
85
Q

treatment of Pendred syndrome?

A

Thyroid hormone replacement + cochlear implants

86
Q

MOA of pegvisomant?

A

GH receptor antagonist

  • very effective, decreases IGF-1 levels in 90% of patients to normal
  • no effect on tumour volume
87
Q

what diabetic medication may cause euglycaemic DKA?

A

SGLT2 inhibitor: e.g. canagliflozin, dapaglifozin, empa-

  • raised anion gap acidosis + normal blood sugar
88
Q

Where in the kidney do SGLT-2 inhibitors work on?

A

proximal convoluted tubule: inhibits SGLT-2

to reduce glucose reabsorption and increase urinary glucose excretion

89
Q

complications of acromegaly?

A
  • hypertension
  • diabetes (>10%)
  • cardiomyopathy
  • colorectal cancer
90
Q

features of Type 1 Autoimmune polyendocrine syndrome?

A

2 out of 3 needed:

  • Addisons disease
  • primary HYPOparathyroidisim
  • chronic mucocutaneous candidiasis (typically the 1st feature)
91
Q

Genetics of Type 1 Autoimmune polyendocrine syndrome?

A

autosomal recessive, mutation of AIRE1 gene on chromosome 21

92
Q

what is usually the first presenting feature of Type 1 Autoimmune polyendocrine syndrome?

A

chronic mucocutaneous candidiasis

93
Q

features of Type 2 Autoimmune polyendocrine syndrome?

A
  • Addisons
    +
  • T1DM OR Autoimmune thyroid disease
94
Q

genetics of type 2 Autoimmune polyendocrine syndrome?

A

polygenic inheritance, linked to HLA-DR3/4

95
Q

development of type 2 diabetes mellitus in patients < 25 years old. typically inherited as an autosomal dominant condition.

A

MODY (Maturity onset diabetes of the young)

96
Q

features of MODY?

A
  • typically <25yo
  • family hx of early onset diabetes
  • ketosis not a feature
  • most common form: v sensitive to sulfonylureas, insulin not usually necessary
97
Q

Most common form of MODY?

A

MODY 3: 60%

  • defect of HNF-1 alpha gene
  • assoc w increased risk of HCC
98
Q

defect in glucokinase gene?

A

MODY 2 - 20% of cases

99
Q

defect in HNF-1 beta gene?

A

rare, MODY 5.

- assoc w liver + renal cysts

100
Q

what type of cancer is of increased risk in patients with MODY? (most commonly- MODY 3)

A

HCC

101
Q

which diabetic medication is assoc with excessive flatulence?

A

acarbose

  • inhibitor of intestinal alpha glucosidases -> decreased absorption of starch and sucrose
102
Q

MOA of meglitinides?

A

increase pancreatic insulin secretion

  • like sulfonylureas, they bind to ATP-dependent K+ channels on the cell membranes of pancreatic beta cells
103
Q

Very high glucocorticoid activity, minimal mineralocorticoid activity

A

Dexamethasone, Betmethasone

104
Q

Predominant glucocorticoid activity, low mineralocorticoid activity

A

prednisolone

105
Q

Glucocorticoid activity, high mineralocorticoid activity,

A

hydrocortisone

106
Q

Minimal glucocorticoid activity, very high mineralocorticoid activity,

A

fludrocortisone

107
Q

1st line treatment of Graves disease?

A
  • propranolol for symptom control

- carbimazole (for approx 12-18 months)

108
Q

Treatment of Graves disease: block and replace regime vs titration regime?

A

Titration regime:
carbimazole 40mg and reduced gradually to maintain euthyroidism, typically 12-18 months.

  • fewer side effects but longer.

Block and replace:
- carbimazole 40mg, thyroxine added when pt euthyroid.
typically 6-9 months.

109
Q

Ix of pseudohypoparathyroidism?

A

infusion of PTH followed by measurement of urinary phosphate and cAMP measurement - helps differentiate between type I (neither phosphate or cAMP levels rise) and II (cAMP rises but phosphate levels do not change)

110
Q

cause of low libido/ loss of pubic hair in Addisons disease?

A

DHEA (dehydroepiandrosterone) deficiency

  • adrenal glands are main source of DHEA in females.
111
Q

what test can help to differentiate between true Cushings and pseudo-Cushing’s?

A

insulin stress test

*can also do midnight cortisol (this will be high in true Cushings syndrome)

112
Q

What tests can be used to differentiate between pituitary and ectopic ACTH secretion?

A
  1. high dose dexamethasone suppression test:
    - Cortisol and ACTH suppressed if Cushing’s disease,
    neither suppressed if ectopic
  2. CRH stimulation: if pituitary source, cortisol rises, if ectopic/ adrenal: no change
  3. Petrosal sinus sampling of ACTH
113
Q

Management of acute severe hypocalcaemia?

A

IV Calcium gluconate 10% 10mL over 10 mins

- not calcium chloride

114
Q

genetic inheritance of MODY

A

auto dominant

115
Q

MOA of carbimazole?

A

blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

116
Q

cryptorchidism suggests which genetic condition?

A

kallmans

- X linked recessive, delayed puberty secondary to hypogondatrophic hypogonadism

117
Q

diagnosis of insulinoma?

A
  • supervised, prolonged fasting (up to 72h)

- CT pancreas

118
Q

management of insulinoma?

A

surgery.

- diazoxide and somatostatin if not suitable for surgery

119
Q

most common cause of primary hyperaldosteronism?

A

Bilateral idiopathic adrenal hyperplasia
- in up to 70%

(prev thought to be adrenal adenoma)

120
Q

Criteria for GLP1 mimetic e.g. exenatide?

A
  • if triple therapy not effective/ CI/ not tolerated
    -> then consider metformin, sulfonylurea + GLP1 mimetic if:
    1. BMI>/=35 + obesity related comorbidities
    or
    2. BM <35 and insulin unacceptable
121
Q

Fibrates MOA? e.g. fenofibrate

A

activating PPAR alpha receptors -> increase in LPL activity and reducing triglyceride levels

122
Q

Side effects of fibrates?

A

GI side effects,

Increased VTE Risk

123
Q

first line management of remnant hyperlipidaemia?

A

Fibrates

124
Q

causes of tunnel vision?

A
  • papilloedema
  • glaucoma
  • retinitis pigmentosa
  • choroidoretinitis
  • optic atrophy secondary to tabes dorsalis
  • hysteria
125
Q

Features of bartters syndrome?

A
  • autosomal recessive, typically neonates
  • like too much furosemide
  • hypoCl, hypoK alkalosis
  • high renin aldosterone ratio
  • hypercalciuria
  • normal or low BP
126
Q

Features of gitelman syndrome?

A

Like too much thiazide diuretics

  • normotension
  • hypokalaemia, hypoMg
  • hypocalciuria
  • metabolic alkalosis
127
Q

Causes of sub clinical hyperthyroidism?

A
  • multinodular goitre, particularly in elderly females

- excessive thyroxine may give a similar biochemical picture

128
Q

Causes of sub clinical hyperthyroidism?

A
  • multinodular goitre, particularly in elderly females

- excessive thyroxine may give a similar biochemical picture

129
Q

Risks of subclinical hyperthyroidism?

A

increased risk of atrial fibrillation and hip fractures

130
Q

When would you treat sub clinical hyperthyroidism?

A

if older than 65 years or are at risk of osteoporosis or heart disease.

131
Q

Management of subclinical hyperthyroidism if TSH levels do stay persistently low?

A

therapeutic trial of low-dose antithyroid agents for approximately 6 months in an effort to induce a remission

132
Q

What diagnostic test can be used to test for Growth hormone deficiency, if oral glucose tolerance test is contraindicated (ie pts with IHD or seizures)?

A

arginine-GHRH stimulation test

133
Q

Pathophysiology of familial hypocalciuric hypercalcaemia?

A

calcium-sensing receptors of the parathyroid and thyroid experience a loss of function

  • > PTH continues being released despite appropriate calcium levels. (Not suppressed bc of decreased sensitivity to increases in extracellular Ca)
  • > Ca reabsorption in the kidney is not inhibited despite increased serum Ca and thus Ca is reabsorbed from the urine leading to hypocalciuria
134
Q

Features of familial hypocalcuric hypercalcaemia?

A

Hypercalcaemia
normal phosphate + PTH
+ low urinary calcium

135
Q

What is used to differentiate between true Cushing’s and pseudo-Cushing’s (ie 2’ alcohol use)?

A

insulin stress test

136
Q

When to consider thyroidectomy instead of thyroid lobectomy in thyroid cancers?

A

any lump greater than 1cm in size or has any signs of metastatic spread to LNs

137
Q

Which patients with thyroid cancer should have radioiodine ablation after?

A
  1. thyroid lumps > 4cm regardless of extrathyroid disease;
  2. lumps 1 - 4cm + extra-thyroid disease
  3. high-risk histology such as aggressive histological subtypes
138
Q

Causes of excessive endogenous insulin secretion?

Ie both insulin + c peptide high

A

insulinoma and sulphonylurea overdose

139
Q

Mx of sulphonylurea OD?

A

if remains hypoglycaemic despite the infusion of sufficient glucose, consider administration of octreotide* IM

  • somatostatin analogue that inhibits insulin release from pancreatic beta-islet cells.
140
Q

11-beta hydroxylase deficiency features

A

virilisation of female genitalia
precocious puberty in males
Like excess aldosterone: hypertension +
hypokalaemia

141
Q

why does osteomalacia develop in type 2 renal tubular acidosis?

A

failure of conversion of 25(OH)-cholecalciferol to 1,25 (OH)2 cholecalciferol in the proximal tubule

142
Q

what medication can you use in SIADH resistant to fluid restriction?

A

demeclocycline:

reduces the responsiveness of the collecting tubule cells to ADH

143
Q

what monoclonal antibody could you use in treatment of acute gout in patients intolerant to steroids/ nsaids/ colchicine?

A

Canakinumab: selectively inhibits IL-1 beta Receptor binding

144
Q

management of hypertriglyceridaemia?

A

1st line: fibrates e.g. fenofibrate

2nd: statins have a role in mixed hyperlipidaemia

145
Q

what tumour marker can you monitor for Medullary thyroid carcinoma in MEN type II ?

A

calcitonin

- yearly monitoring

146
Q

what is the most common initial manifestation of MEN1 syndrome?

A

hyperparathyroidism is by far the most common initial manifestation and will eventually develop in 90% of MEN1 patients

147
Q

Mx of Refractory hypercalcaemia of malignancy if therapy with fluids and pamidronate fails?

A

S/c calcitonin

  • Calcitonin acts by increasing the excretion of renal calcium and decreasing bone resorption.
148
Q

Denosumab in malignancy related hypercalcaemia?

A

Denosumab can be repeated weekly

149
Q

Management of medications in Addison’s disease if undertaking significant strenuous activity e.g. marathon?

A

double the dose of both glucocorticoid and mineralocorticoids

150
Q

what is the most common electrolyte abnormality in alcohol withdrawal and may often cause seizures?

A

hypophosphataemia

151
Q

Long synacthen test differentiates between?

A

primary and secondary adrenal insufficiency

Long synacthen test: rise of cortisol in SECONDARY adrenal insufficiency

  • chronic low lvls of ACTH > atrophy of adrenals
  • Prolonged stimulation by ACTH in the long synacthen test > significant rise on cortisol as there is a degree of recovery by adrenals
152
Q

thyroid storm post CT scan?

A

Iodine in CT contrast media can precipitate thyrotoxicosis or thyroid storm

153
Q

first line medical management for mixed urinary incontinence?

A

tolterodine, oxybutynin or darifenacin

153
Q

first line medical management for mixed urinary incontinence?

A

tolterodine, oxybutynin or darifenacin

154
Q

diabetes mellitus, venous thrombo-embolism and the classical rash of necrolytic migratory erythema - a red, blistering rash?

A

Glucagonoma

155
Q

Mx of glucagonoma?

A

Surgical resection and octreotide

156
Q

struma ovarii?

A

Ovarian teratomas that can produce exogenous TSH

156
Q

struma ovarii?

A

Ovarian teratomas that can produce exogenous TSH

157
Q

Liddle syndrome?

A

hypertension and hypokalaemic alkalosis

suppressed renin and aldosterone levels

caused by disordered Na channels in the distal tubules leading to increased reabsorption of Na

158
Q

Management of Liddle syndrome?

A

amiloride or triamterene

  • amiloride acts directly on the sodium channel
159
Q

When will you treat subclinical hypothyroidism?

A

If pt <70 and TSH> 10 even if asymptomatic

160
Q

Which anti thyroid drug do you typically give first in a thyroid storm?

A

Propylthiouracil

  • more rapid onset of action
  • can inhibit peripheral conversion of T4 to T3
161
Q

Rate of fluid replacement in HHS?

A

replace approximately 50% of estimated fluid loss within the first 12 hours and the remainder in the following 12 hours

162
Q

Safe rate of glucose reduction in HHS?

A

fall of plasma glucose of between 4 and 6 mmol/hr

163
Q

Safe rate of decrease in sodium in HHS?

A

should not exceed 10 mmol/L in 24 hours

164
Q

When to start insulin infusion in HHS?

A

If BOHB >1 mmol/L: indicates relative hypoinsulinaemia and insulin should be started (e.g. mixed DKA / HHS picture)

-> fixed rate IV insulin infusion at 0.05 units/ kg/ h.

165
Q

What common drug to stop in acute thyrotoxicosis?

A

Aspirin

Aspirin binds to thyroxine-binding globulin and displaces bound T4, thereby increasing the levels of free T4.

166
Q

What is abnormally raised in 11-beta hydroxylase deficiency?

A

11-deoxycortisol

167
Q

Abetalipoproteinaemia: features of?

A 
failure to thrive + developmental delay
steatorrhoea
retinitis pigmentosa
cerebellar signs
deep tendon reflexes are absent
acanthocytosis
hypocholesterolaemia
168
Q

Abetalipoproteinaemia: management?

A

dietary restriction of fats, and high-dose vitamin E therapy.

169
Q

Abetalipoproteinaemia: pathophysiology?

A
  • mutation in the microsomal triglyceride transfer protein -> deficiencies in apolipoproteins
  • Apolipoproteins are essential in the synthesis and exportation of chylomicrons and VLDL.
  • > malabsorption of dietary fats, cholesterol, and fat soluble vitamin (e.g. vitamins K, A, D and E).
170
Q

How long after a CT scan do you have to wait before giving radioiodine therapy?

A

8 weeks

171
Q

Which diabetic medication increases risk of bladder cancer?

A

Pioglitazone

172
Q

Conn’s adenoma vs adrenal hyperplasia: how to differentiate using aldosterone levels on standing?

A

Adrenal hyperplasia: aldosterone increases on prolonged standing,

Conn’s adenoma: aldosterone same/ drops on standing.

173
Q

what are the glucose targets for T1DM 90 minutes after eating?

A

5-9 mmol/L

174
Q

Follow up of gestational diabetes following delivery of baby?

A

fasting blood glucose test 6-13 wks postpartum

MRCP (21 decks)

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