ENDO Flashcards
weight gain cold intolerance dry coarse skin/hair thinning eyebrows constipation menorrhagia lethargy
Hypothyroidism
hypothyroid symptoms with a firm, non tender goitre
Hashimoto’s thyroiditis
hypothyroid symptoms with a pain goitre and raised ESR
Subacute/De Quervain’s
lethargy, bradycardic, hypothermia
coma or seizures
myxoedema coma
management of myxoedema coma
emergency hospital admission
IV thyroxine and hydrocortisone
management of hypothyroidism
levothyroxine 50-100mg, start at 25mg for elderly/CVD
check TFTs every 3 months
ensure euthryoid before conceiving children/getting pregnant
treatment for subacute/De Quervain’s
thyroid scintigraphy = lowered iodine uptake
mx= aspirin/NSAIDs for pain
weight loss, heat intolerance manic/restless palpitations Increased sweating oligomenorrhoea anxiety/tremor pretibial myxoedema = erythematous, oedematous lesions
Hyperthyroidism
hyperthyroid symptoms with exophthalmos, ophthalmoplegia and pretibial myxoedema
Grave’s disease
Hyperthyroid & Scintigraphy reveal patchy iodine uptake
toxic multinodular goitre
Hyperthyroidism treatment
propranolol = control thyrotoxic symptoms
carbimazole (agranulocytosis risk - check WCC) - propyluracil in pregnancy
radioiodine Tx
Titrate and block
titrate down to the lowest dose for euthyroid = maintain euthyroid
block and replace
block T4 synthesis + give levothyroxine
fever >38°C tachycardic confusion and agitation N&V HTN, HF jaundice and abnormal LFTs
thyroid storm
triggered by infection, surgery, contrast exposure/CT, trauma
painless enlarge thyroid nodule
hoarseness and dysphagia
fever, weight loss and night sweats
Thyroid cancer
Ix for thyroid cancer
TFTs, Thyroid US
I131 scan = cold nodules
management for thyroid cancer
total thyroidectomy
radioactive I131 to kill residual cells + LT4
yearly thyroglobulin levels to detect any early recurrent disease
main form of thyroid cancer
papillary
others include follicular and medullary
abdominal pain renal stones depression bone pain unquenchable thirst may have peptic ulcers/constipation or pancreatitis
typically elderly females
hyperparathyroidism
pepperpot skull
PTH high
high calcium, low phosphate
hyperparathyroidism
management of hyperparathyroidism
definitive = total parathyroidectomy
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
hypoparathyroidism
low PTH
low calcium
high phosphate
primary hypoparathyroidism
low calcium
high phosphate
high PTH
pseudohypoparathyroidism
pseudohypoparathyroidism diagnosis
urine cAMP and PO4 after PTH infusion
management of hypoparathyroidism
alfacalcidol (vit d)
+ calcium supplements
> 7.5mmol/L total cholesterol
personal/family history of premature CHD (event before 60yrs)
familial hypercholesterolemia
familial hypercholesterolemia
high dose statins
primary prevention of hyperlipidemia
QRISK @ 40yrs = >=10%
>7.5mmol/L LDL
atorvastatin 20mg first line
secondary prevention of hyperlipidemia
80mg atorvastatin - aiming for a 40% drop in LDL
+lifestyle changes
lethargy weight loss hyperpigmentation - palmar creases loss of pubic hair hypotension, hypoglycaemia low sodium and potassium
Addison’s disease (corticosteroid insufficiency
Definitive Ix for addison’s
Short synacthen test - cortisol <100!!
management for addison’s
hydrocortisone (majority in first half of the day) and fludrocortisone
management of addisonian crisis
extreme fatigue, lethargy, dehydration, low sodium and k+
IM/IV hydrocortisone
saline infusions 30-60mins with dextrose if hypoglycaemic
weight gain 'central, moon faced' hyperglycaemia proximal muscle weakness purple striae/bruises
cushing’s syndrome
Ix for cushing’s
overnight dexamethasone test
management of cushings
if caused due to pituitary tumour = surgical resection
if not tumour = ketoconazole or metyrapone
polydipsia and polyuria
picked up routinely on blood tests
HbA1c = >=48mmol
fasting glucose >7.0mmol or random >=11mmol
T2DM
management of T2DM
- metformin - if contra = try gliptin or sulphonylurea
- HbA1c >58mmol/L = add another anti-diabetic agent
gliptin/suphonylurea - HbA1c >58mmol/L = triple therapy = metformin plus 2 anti-diabetic drugs
- HbA1c >58mmol/L = offer insulin
T2DM fatigue lethargy altered consciousness headaches papilloedema hyperviscosity dehydrated, hypotension and tachycardic
Hyperosmolar hyperglycaemic state
hypovolemia, hyperglycaemic,>30 hyperosmotic >320
management of HHS
IV 0.9NaCl first line
headache palpitations irritable tremor sweating tingling lips impaired vision
severe = loc, convulsions and coma
Hypoglycaemia
manage acute hypoglycaemia episode
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
polydipsia
polyuria
weight loss
fasting glucose >=7.0mmol/L
random glucose >= 11.1mmol/L
T1DM
management of T1DM
insulin SC injection
polydipsia polyuria dehydration - ketones on dipstick abdo pain kussmaul breathing/respiration acetone smelling/fruity breath
DKA (diabetic ketoacidosis)
DKA management
fluid replacement using isotonic saline
Insulin via IV infusion
correct electrolyte disturbance
long-acting insulin continued, short-acting stopped.
polyuria
polydipsia
dehydration
diabetes insipidus
Ix for diabetes insipidus
water deprivation test
high plasma, low urine osmolarity - if osmolarity >700 = exclude DI
management of diabetes insipidus
nephrogenic DI
thiazide diuretics
low salt/protein diet
Cranial DI
desmopressin
headaches
palpitations
sweating
usually hypertensive and anxiety
pheochromocytoma
Ix for pheochromocytoma
24hr urinary catecholamines
management of pheochromocytoma
definitive = surgery
- usually stabilised with a/B-blocker first e.g. propranolol/labetalol or phenoxybenzamine
hypertension
hypokalaemia - muscle weaknes
alkalosis
hyperaldosteronism/conn’s syndrome
Ix for hyperaldosteronism/conns
aldosterone/renin ratio is the first-line investigation
CT abdomen and adrenal vein sampling
Management for conns
adrenal adenoma: surgery
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone
hypovolemia management
initiate fluid resuscitation (250-500mls over 15mins and reassess)
can give up to 2L if BP low
hypervolemia management
do not administer fluids
initiate diuretics
euvolemia management
calculate maintenance fluids
25-30ml/kg/day
reassess regularly
hypernatremia management
- correct cause
- correct body water deficit = either oral/enteral
- Hypotonic solution = dextrose IV - slow pace to avoid cerebral oedema
hyponatremia management
- fluid restriction
- if safe withhold contributory medication
- Ix for causes/insufficiency
hyperkalemia management
- ABCDE assessment
- ECG change = ITU referral
- calcium gluconate = shift from ECM to ICM
- Insulin dextrose and nebulised salbutamol
- remove K+ using calcium resonium or RRT/loop diuretics
hypokalaemia management
- remove causes (spironolactone)
- gradual replacement = oral 0.9%Nacl
- ECG = U waves, small/inverted T waves, prolonged QT/PR & ST depression
- replenish Mg2+
presents the same as hyperparathyroidism = bone pain, renal stones, abdo pain and depression
shortened QT
hypercalcaemia
management of hypercalcaemia
rehydrate with normal saline & bisphosphonates
calcitonin
steroid in sarcoidosis
presents similar to hypoparathyroidism
tetany, muscle twitches
trousseau’s/Chvostek’s sign
perioral parathesia
pancreatitis presentation with alcoholic background is typical
hypocalcemia
tetany, paresthesia
seizures
arrhythmias
often caused by drugs, diarrhoea or alcohol
hypomagnesaemia
management of hypomagnesaemia
severe = IV Mg2+ replacement (<0.4)
> 0.4 oral magnesium salts = diarrhoea common side effect
excessive growth of hands and feet protruding jaw large tongue excessive sweating/oily skin galactorrhoea
acromegaly
Ix for acromegaly
OGTT
serum IGF-I levels and MRI pituitary
management for acromegaly
trans-sphenoidal surgery = first line
somatostatin analogue = octreotide
dopamine agonists = bromocriptine
galactorrhea (non obstetric lactation)
Rule out serious pathology – breast cancer
Treat underlying cause
gynaecomastia management
Refer if red flags (unilateral, hard/irregular tissue, fixed mass, pain, axillary LAD)
Treat underlying cause
ingestion of lactose containing product
diarrhoea a bloated stomach stomach cramps and pains stomach rumbling feeling sick flatulence
lactose intolerance
management
avoid trigger/ try lactose free options
