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FCM > ENDO > Flashcards

ENDO Flashcards

1
Q 
weight gain 
cold intolerance 
dry coarse skin/hair 
thinning eyebrows
constipation 
menorrhagia 
lethargy
A

Hypothyroidism

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2
Q

hypothyroid symptoms with a firm, non tender goitre

A

Hashimoto’s thyroiditis

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3
Q

hypothyroid symptoms with a pain goitre and raised ESR

A

Subacute/De Quervain’s

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4
Q

lethargy, bradycardic, hypothermia

coma or seizures

A

myxoedema coma

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5
Q

management of myxoedema coma

A

emergency hospital admission

IV thyroxine and hydrocortisone

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6
Q

management of hypothyroidism

A

levothyroxine 50-100mg, start at 25mg for elderly/CVD
check TFTs every 3 months
ensure euthryoid before conceiving children/getting pregnant

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7
Q

treatment for subacute/De Quervain’s

A

usually self-limiting

mx= aspirin/NSAIDs for pain

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8
Q 
weight loss, heat intolerance 
manic/restless
palpitations 
Increased sweating 
oligomenorrhoea 
anxiety/tremor 
pretibial myxoedema = erythematous, oedematous lesions
A

Hyperthyroidism

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9
Q

hyperthyroid symptoms with exophthalmos, ophthalmoplegia and pretibial myxoedema

A

Grave’s disease

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10
Q

Hyperthyroid & Scintigraphy reveal patchy iodine uptake

A

toxic multinodular goitre

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11
Q

Hyperthyroidism treatment

A

propranolol = control thyrotoxic symptoms
carbimazole (agranulocytosis risk - check WCC) - propyluracil in pregnancy
radioiodine Tx

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12
Q

Titrate and block

A

titrate down to the lowest dose for euthyroid = maintain euthyroid

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13
Q

block and replace

A

block T4 synthesis + give levothyroxine

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14
Q 
fever >38°C
tachycardic 
confusion and agitation 
N&V
HTN, HF
jaundice and abnormal LFTs
A

thyroid storm

triggered by infection, surgery, contrast exposure/CT, trauma

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15
Q

painless enlarge thyroid nodule
hoarseness and dysphagia
fever, weight loss and night sweats

A

Thyroid cancer

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16
Q

Ix for thyroid cancer

A

TFTs, Thyroid US

I131 scan = cold nodules

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17
Q

management for thyroid cancer

A

total thyroidectomy
radioactive I131 to kill residual cells + LT4
yearly thyroglobulin levels to detect any early recurrent disease

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18
Q

main form of thyroid cancer

A

papillary

others include follicular and medullary

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19
Q 
abdominal pain 
renal stones 
depression 
bone pain 
unquenchable thirst 
may have peptic ulcers/constipation or pancreatitis

typically elderly females

A

hyperparathyroidism

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20
Q

pepperpot skull
PTH high
high calcium, low phosphate

A

hyperparathyroidism

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21
Q

management of hyperparathyroidism

A

definitive = total parathyroidectomy

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22
Q

tetany/twitching/cramps/spasms of muscle
numb, burning and paresthesia of mouth
Trousseau’s signs +ve = carpal spasm
Chvostek’s signs +ve = twitch on tapping parotid gland
prolong QT

chronic cases may present with cataracts and depression

A

hypoparathyroidism

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23
Q

low PTH
low calcium
high phosphate

A

primary hypoparathyroidism

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24
Q

low calcium
high phosphate
high PTH

A

pseudohypoparathyroidism

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25
Q

pseudohypoparathyroidism diagnosis

A

urine cAMP and PO4 after PTH infusion

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26
Q

management of hypoparathyroidism

A

alfacalcidol (vit d)

+ calcium supplements

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27
Q

> 7.5mmol/L total cholesterol

personal/family history of premature CHD (event before 60yrs)

A

familial hypercholesterolemia

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28
Q

familial hypercholesterolemia

A

high dose statins

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29
Q

primary prevention of hyperlipidemia

A

QRISK @ 40yrs = >=10%
>7.5mmol/L LDL

atorvastatin 20mg first line

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30
Q

secondary prevention of hyperlipidemia

A

80mg atorvastatin - aiming for a 40% drop in LDL

+lifestyle changes

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31
Q 
lethargy 
weight loss 
hyperpigmentation - palmar creases 
loss of pubic hair
hypotension, hypoglycaemia 
low sodium and potassium
A

Addison’s disease (corticosteroid insufficiency

32
Q

Definitive Ix for addison’s

A

Short synacthen test - cortisol <100!!

33
Q

management for addison’s

A

hydrocortisone (majority in first half of the day) and fludrocortisone

34
Q

management of addisonian crisis

extreme fatigue, lethargy, dehydration, low sodium and k+

A

IM/IV hydrocortisone

saline infusions 30-60mins with dextrose if hypoglycaemic

35
Q 
weight gain 
'central, moon faced' 
hyperglycaemia 
proximal muscle weakness 
purple striae/bruises
A

cushing’s syndrome

36
Q

Ix for cushing’s

A

overnight dexamethasone test

37
Q

management of cushings

A

if caused due to pituitary tumour = surgical resection

if not tumour = ketoconazole or metyrapone

38
Q

polydipsia and polyuria
picked up routinely on blood tests
HbA1c = >=48mmol
fasting glucose >7.0mmol or random >=11mmol

A

T2DM

39
Q

management of T2DM

A
  1. metformin - if contra = try gliptin or sulphonylurea
  2. HbA1c >58mmol/L = add another anti-diabetic agent
    gliptin/suphonylurea
  3. HbA1c >58mmol/L = triple therapy = metformin plus 2 anti-diabetic drugs
  4. HbA1c >58mmol/L = offer insulin
40
Q 
T2DM 
fatigue
lethargy 
altered consciousness 
headaches 
papilloedema 
hyperviscosity 
dehydrated, hypotension and tachycardic
A

Hyperosmolar hyperglycaemic state

hypovolemia, hyperglycaemic,>30 hyperosmotic >320

41
Q

management of HHS

A

IV 0.9NaCl first line

Insuline 0.01U/kg/hr

42
Q 
headache
palpitations
irritable 
tremor 
sweating 
tingling lips 
impaired vision

severe = loc, convulsions and coma

A

Hypoglycaemia

43
Q

manage acute hypoglycaemia episode

A

adults - 10-20g of fast acting carbohydrate/ 5 glucose tablets
recheck glucose in 10-15 mins - if inadequate repeat again after 15mins
if unable to swallow/sever condition = IM glucagon

44
Q

polydipsia
polyuria
weight loss

fasting glucose >=7.0mmol/L
random glucose >= 11.1mmol/L

A

T1DM

45
Q

management of T1DM

A

insulin SC injection

46
Q 
polydipsia
polyuria
dehydration - ketones on dipstick 
abdo pain 
kussmaul breathing/respiration 
acetone smelling/fruity breath
A

DKA (diabetic ketoacidosis)

47
Q

DKA management

A

fluid replacement using isotonic saline
Insulin via IV infusion
correct electrolyte disturbance
long-acting insulin continued, short-acting stopped.

48
Q

polyuria
polydipsia
dehydration

A

diabetes insipidus

49
Q

Ix for diabetes insipidus

A

water deprivation test

high plasma, low urine osmolarity - if osmolarity >700 = exclude DI

50
Q

management of diabetes insipidus

A

nephrogenic DI
thiazide diuretics
low salt/protein diet

Cranial DI
desmopressin

51
Q

headaches
palpitations
sweating

usually hypertensive and anxiety

A

pheochromocytoma

52
Q

Ix for pheochromocytoma

A

24hr urinary metanephrines

53
Q

management of pheochromocytoma

A

definitive = surgery

- usually stabilised with a/B-blocker first e.g. propranolol/labetalol or phenoxybenzamine

54
Q

hypertension
hypokalaemia - muscle weaknes
alkalosis

A

hyperaldosteronism/conn’s syndrome

55
Q

Ix for hyperaldosteronism/conns

A

aldosterone/renin ratio is the first-line investigation

CT abdomen and adrenal vein sampling

56
Q

Management for conns

A

adrenal adenoma: surgery

bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

57
Q

hypovolemia management

A

initiate fluid resuscitation (250-500mls over 15mins and reassess)
can give up to 2L if BP low

58
Q

hypervolemia management

A

do not administer fluids

initiate diuretics

59
Q

euvolemia management

A

calculate maintenance fluids
25-30ml/kg/day
reassess regularly

60
Q

hypernatremia management

A
  1. correct cause
  2. correct body water deficit = either oral/enteral
  3. Hypotonic solution = dextrose IV - slow pace to avoid cerebral oedema
61
Q

hyponatremia management

A
  1. fluid restriction
  2. if safe withhold contributory medication
  3. Ix for causes/insufficiency
62
Q

hyperkalemia management

A
  1. ABCDE assessment
  2. ECG change = ITU referral
  3. calcium gluconate = shift from ECM to ICM
  4. Insulin dextrose and nebulised salbutamol
  5. remove K+ using calcium resonium or RRT/loop diuretics
63
Q

hypokalaemia management

A
  1. remove causes (spironolactone)
  2. gradual replacement = oral 0.9%Nacl
  3. ECG = U waves, small/inverted T waves, prolonged QT/PR & ST depression
  4. replenish Mg2+
64
Q

presents the same as hyperparathyroidism = bone pain, renal stones, abdo pain and depression
shortened QT

A

hypercalcaemia

65
Q

management of hypercalcaemia

A

rehydrate with normal saline & bisphosphonates
calcitonin
steroid in sarcoidosis

66
Q

presents similar to hypoparathyroidism
tetany, muscle twitches
trousseau’s/Chvostek’s sign
perioral parathesia

pancreatitis presentation with alcoholic background is typical

A

hypocalcemia

67
Q

tetany, paresthesia
seizures
arrhythmias

often caused by drugs, diarrhoea or alcohol

A

hypomagnesaemia

68
Q

management of hypomagnesaemia

A

severe = IV Mg2+ replacement (<0.4)

> 0.4 oral magnesium salts = diarrhoea common side effect

69
Q 
excessive growth of hands and feet 
protruding jaw
large tongue
excessive sweating/oily skin 
galactorrhoea
A

acromegaly

70
Q

Ix for acromegaly

A

IGF-1 levels

If IGF-1 levels are raised then confirm with OGTT

OGTT confirms dx

71
Q

management for acromegaly

A

trans-sphenoidal surgery = first line

somatostatin analogue = octreotide
dopamine agonists = bromocriptine

72
Q

management of galactorrhea (non obstetric lactation)

A

Rule out serious pathology – breast cancer

Treat underlying cause

73
Q

gynaecomastia management

A

Refer if red flags (unilateral, hard/irregular tissue, fixed mass, pain, axillary LAD)

Treat underlying cause

74
Q

ingestion of lactose containing product

diarrhoea
a bloated stomach
stomach cramps and pains
stomach rumbling
feeling sick
flatulence
A

lactose intolerance

75
Q

management of lactose intolerance

A

avoid trigger/ try lactose free options

FCM (16 decks)

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