ENDO Flashcards

1
Q

What can result in hypoglycaemia, how is it investigated?

A

Hypoglycaemia - inevitable in pt on insulin therapy

  • blood glucose level <3.5mmol/L
  • cognitive function will begin tp decline below 3mmol/L and 2.8 is considered as severe hypoglycaemia
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2
Q

What investigations are done for thyroid conditions

A
  1. TFTs
    - low T3&4 = hypothyroidism
    - high T3&4 = hyperthyroidism
    - normal T3&4 but abnormal TSH = subclinical hypo/hyperthyroidism
    - high TSH despite normal/high T3/T4 could also be indicative for TSH secreting tumour
  2. Isotope scanning
    - scan thyroid gland looking at iodine uptake
    - hot nodules - likely benign
    - cold nodules - possibly malignant
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3
Q

How is T1DM investigated?

A

T1DM Ix include:
1. Plasma glucose >11.1mol/L

  1. C-peptide and diabetes specific antibodies (often done to confirm diagnosis)
    - not routine - atypical features, suspected monogenic form and uncertain of classification
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4
Q

How us T2DM investigated?

A
  1. HbA1c levels = >persistent hyperglycaemia over 48mmol/mol
  2. Random glucose >11.1mmol/L
  3. Fasting glucose >7mmol/L

if symptomatic = can use single abnormal HbA1c/fasting glucose - but usually repeat is preferred

if asymptomatic = arrange repeat testing inital test show abnormal reading indicative of diabetes

  1. OGTT
    - used to screen pt who have a high fasting glucose but not enough to meet diabetes criterion
    - also used in screening of gestational diabetes and dx of Acromegaly
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5
Q

What are contraindications of HbA1c tests?

A
  1. acute illness
  2. pregnant or 2/12 postpartum
  3. Pancreatic injury/surgery
  4. under 18yrs
  5. HIV
  6. on meds that increase glucose
  7. 2/12 or less hx of diabetes
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6
Q

What is macrocytic anaemia investigated?
how is it investigated?
what mx plans involve?

A

low Hb and high MCV
investigated - vitB12 and folate levels (?deficient)

VitB12 Def = IM hydroxycobalamin TDS 2/52 + every 3/12

Folate Def = oral supplementation of folic acid

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7
Q

What is synacthen test used for?

A

To diagnose adrenal insufficiency aka Addison’s

Measure serum cortisol (30mins)
administer IM/IV tetracostactide - measure cortisol after

Normal ppl = cortisol increases to 500-550 after 30-60mins

adrenal insufficiency = no cortisol increase

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8
Q

what is fine needle-aspiration of a thyroid nodule?

A

in thyroid nodules - request thyroid US and FNA biopsy
U1-5 to classify the nodules
anything with U3-5 = FNA needed
FNA - diagnosis/staging

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9
Q

limitations of FNA?

A
  1. false negatives - more in nodules really large(>4cm)/small(<1cm)
  2. Suspicious FNA - not able to distinguish between benign and malignant
  3. Non-diagnostic results = DON’T ASSUME BENIGN
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10
Q

Investigations for hyperparathyroid disorders?

A
  • high serum Ca2+,
  • Low phosphate
  • PTH raised or normal
  • technetium-MIBI subtraction scan
  • pepperpot skull on X-ray and generalised osteomalacia
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11
Q

Investigations for hypoparathyroid disorders?

A
  • low calcium
  • high phosphate
  • low PTH

ECG will show Prolonged PR interval

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12
Q

What are the stages of hyperkalaemia?

A
  • mild: 5.5 - 5.9 mmol/L
  • moderate: 6.0 - 6.4 mmol/L
  • severe:≥ 6.5 mmol/L
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13
Q

What ECG changes are seen in hyperkalaemia?

A

Peaked/tall-tented T waves, loss/flattening of p waves,

broad QRS, sinosoidal wave pattern

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14
Q

What are ECG signs for hypokalaemia?

A
  • U waves
  • small/absent T waves
  • prolonged PR
  • ST depression
  • Long QT
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15
Q

Investigations for Diabetes Insipidus?

A

water deprivation test

  • high plasma osmolality and low urine osmolality
  • cannot retain water, urine osmolality >700mOsm/kg - exlcude DI
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16
Q

Investigations in SIADH?

A
  • U&Es - hyponatremia

- urine sodium & osmolality with be high

17
Q

What investigation is done in phaeochromocytoma?

A

24hr urine collection of catecholamines and metanephrines

18
Q

Prolactinoma Ix?

A
  • prolactin levels (raised)
  • clinical signs - bitemporal hemianopia, hypopituitarism
  • diagnostic - test - MRI
19
Q

Investigations in Acromegaly?

A

IGF-1 Levels done intially - if raised then do OGTT

OGTT will confirm diagnosis and thus is the diagnostic test

20
Q

Investigations done in suspected Diabetic Ketoacidosis (DKA)?

A

fingerprick BM >11.1mmol/L
high ketone levels
- 2+ in urine
- >3mmol/L in blood

identify causes - blood tests to check for infection
- CRP
- WCC
as well as CXR and urine dip

21
Q

Investigations and findings in HSS?

A

often precipitated from infection/dehydration

  • typcially blood glucose >30mmol/L
  • absent signs of ketosis - not ketones in blood or urine
22
Q

Low TSH, raised T3/4

A

overt hyperthyroidism

23
Q

Low TSH and normal T3/4

A

subclinical hyperthyroidism

24
Q

The specific Ix done in Grave’s disease?

A

TSH-receptor antibodies (TRAbs)

25
Q

Specific Ix in suspected thyroiditis?

A

Thyroid-peroxidase antibodies (TPOAbs)
- esp in postpartum thyroiditis

CRP/ESR

26
Q

TSH high, low T4

A

primary hypothyroidism

27
Q

TSH high, T4 normal

A

subclinical hypothyroidism

28
Q

TSH normal/low, T4 normal

A

secondary hypothyroidism

29
Q

When are TPOAb test indicated?

A

autoimmune thyroid disease
subclinical hypothyroidism
pregnant

30
Q

What Ix is done specifically in toxic multinodular goitre?

A

thyroid scintigraphy = patchy uptake of iodine

31
Q

What Ix is done specifically in De Quervain’s thyroiditis?

A

thyroid scintigraphy = global reduction of iodine uptake

32
Q

What Ix is done specifically in Hashimoto’s Thyroiditis?

A

Presence of TPO and Tg Abs

33
Q

What Ix is done specifically in postpartum thyroiditis?

A
TPO antibodies +ve 
thyrotoxic pattern (rpt in 8-12wks)
34
Q

What Ix is done specifically in Thyroid neoplastic Disease?

A

TFTs normal
USS - nodule characteristics,
FNA - biopsy & cytology
123I scan - cold nodule

35
Q

What Ix is done specifically in Hypercholesterolaemia?

A

total cholesterol >7.5mmol/L
LDL >4.0mmol/L

adults often 2x measurements are taken

36
Q

Criterion used in Familial Hypercholesterolemia?

A
  • In children = total cholesterol >6.7mmol/L or LDL cholesterol 4.0mmol/L (under the age of 16)
  • in adults = total cholesterol >7.5mmol/L or LDL cholesterol >4.9mmol/L with
    • tendon xanthoma
    • DNA based evidence of LDL receptor mutation - genetic component
37
Q

When can a diagnosis of hyperlipidemia be given?

A

TG>4.5mmol/L