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PACES > Endo > Flashcards

Endo Flashcards

1
Q

Causes of hyperthyroidism

A

Single toxic adenoma
Toxic multinodular goitre
Grave’s disease
Viral thyroiditis - thyrotoxicosis without hyperthyroidism

Secondary Hyperthyroidism
- Pituitary tumours

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2
Q

Presentation of hyperthyroidism

A

Eye disease

Palpitations (AF)

Hands

  • Sweating
  • Tremor

Bowels/metabolism

  • Diarrhoea
  • Weight loss + increased appetite
  • Heat intolerance

Menstrual irregularities

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3
Q

Mx of hyperthyroidism

A

Medical

  • Propranolol
  • Carbimazole/PTU (either titrate to TSH, or block and replace)

Invasive

  • Radioiodine (if hyperfunctioning nodule - not if eye disease in GD)
  • Thyroidectomy (+ lifelong thyroid replacement)
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4
Q

Management of thyroid storm

A

Medical

- Propranolol + PTU + Hydrocortisone

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5
Q

Signs of hyperthyroidism

A

Graves

  • Smooth goitre (not lumpy as a multinodular goitre would be)
  • Pretibial myxoedema
  • Eye disease (exophthalmos, diplopia, gritty eyes w/ increased tear production)
  • Thyroid acropachy

General

  • Lid lag
  • Lid retraction
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6
Q

Causes of hypothyroidism

A

Autoimmune (Hashimoto’s)
Iodine deficiency
Viral thyroiditis
Post-thyroidectomy

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7
Q

Presentation of hypothyroidism

A 
Fatigue
Dry skin
Constipation
Menstrual irregularities
Weight gain + reduced appetite
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8
Q

Mx of hypothyroidism

A

Medical

- Thyroid replacement (levothyroxine, titrate to TSH, or to T4 if secondary)

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9
Q

Mx of myxoedema coma

A 
IV thyroxine
IV hydrocortisone
Fluids (with caution as possible cardiac dysfunction)
Antibiotics if infection suspected
Active warming if hypothermic
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10
Q

Differentials for thyroid lump

A 
Thyroid adenoma (asymptomatic)
Single toxic adenoma
Toxic Multinodular goitre
Thyroid malignancy
Thyroid cyst
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11
Q

Investigation of thyroid lump

A
  1. TFTs

If TSH low: Indicates probably hyperfunctioning nodule
- Thyroid scintigraphy
If high uptake, hyperfunctioning nodule: Tx with
propranolol/carbimazole/Radioactive
iodine/thyroidectomy

    If low uptake: do thyroid USS and FNA if 
    suspicious features present

If TSH high: do Thyroid USS
If suspicious features: do US-guided FNA
If no suspicious features: Monitor

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12
Q

Types of Thyroid malignancy

A

Hard irregular lump, normally non-functioning

Papillary (most common)
Medullary (associated with MEN2a - measure calcitonin)
Anaplastic
Follicular

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13
Q

MEN 1

A

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic tumour

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14
Q

MEN 2

A

Medullary thyroid carcinoma
Phaeochromocytoma
Parathyroid hyperplasia

+ for MEN2b:
Mucosal neuromas
Marfanoid body habitus

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15
Q

Cushing’s syndrome presentation

A
  • Centripetal Obesity
  • Proximal myopathy
  • Hypertension

Cosmetic

  • Moon face
  • Thin skin
  • Purple abdominal striae
  • Buffalo hump

PCOS-like

  • Amenorrhoea
  • Acne
  • Hirsutism
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16
Q

Cushing’s causes

A

ACTH-dependent
Pituitary tumour secreting ACTH (Cushing’s disease)
Ectopic ACTH

ACTH-independent
Adrenal adenoma
Steroid excess

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17
Q

Secondary causes of hypertension

A

Renal

  • RAS
  • PKD

Endocrine

  • Acromegaly
  • Cushing’s
  • Hyperaldosteronism
  • Phaeo
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18
Q

Cushing’s Ix

A

Bloods

  • HbA1c/BM
  • U&E

Screening: 9am cortisol + Low dose dexamethasone suppression test

Inferior petrosal sinus sampling
Pituitary MRI

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19
Q

Cushing’s Tx

A

Cushing’s disease

  • Medical therapy (ketoconazole, metyrapone)
  • Transphenoidal hypophysectomy (1st-line)

Ectopic ACTH
- Tumour resection +/- chemotherapy/radiotherapy

Adrenal adenoma
- Adrenalectomy + lifelong steroid replacement

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20
Q

Acromegaly Presentation

A

Compressive effects
Headaches
Disconnection hyperprolactinaemia
Bitemporal hemianopia

Hormonal effects
Enlargement of hands and feet
Coarse facial features (prognathism, supraorbital ridging)
Carpal tunnel syndrome

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21
Q

Acromegaly Ix

A

Serum IGF-1
OGTT

Pituitary screen
MRI

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22
Q

Acromegaly Mx

A

Medical
Somatostatin analogues e.g, octreotide
Dopamine agonists e.g. cabergoline

Surgery (first-line)
Pituitary surgery
Radiotherapy

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23
Q

Addison’s causes

A 
Primary adrenal insufficiency
Autoimmune (most common UK)
Adrenal malignancy
Adrenal haemorrhage
TB (most common worldwide)

Secondary adrenal insufficiency
Pituitary tumours
Pituitary surgery
Hypopituitarism

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24
Q

Anterior pituitary hormones and pathologies

A 
GH: Acromegaly
TSH: Hyperthyroidism
LH/FSH: 
Prolactin: Hyperprolactinaemia
ACTH: Cushing's
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25
Q

Addison’s presentation

A

Every non-specific symptom under the sun:

Postural hypotension
Abdominal pain
Weight loss (best way to monitor)
Dizziness
Lethargy
Weakness
Anorexia
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26
Q

Addison’s Ix

A

FBC
U&E

9am cortisol + Short Synacthen test

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27
Q

Addison’s + Addisonian crisis Mx

A

Addison’s
Hydrocortisone + Fludrocortisone replacement
(replicate diurnal variation, + sick day rules)

Addisonian crisis
IV 100mg hydrocortisone STAT + Saline 500ml bolus + Hydrocortisone infusion
Treat underlying cause

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28
Q

Phaeochromocytoma Presentation, Ix and Mx

A

PC: Episodic headaches, flushing, palpitations, dizziness

Ix: FBC, U&E, serum and urine metanephrines

Mx: Alpha blockade (phentolamine/phenoxybenzamine) + Beta blockade (for reflex tachycardia) + Surgery (open or laparoscopic adrenalectomy)

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29
Q

Carcinoid syndrome Presentation, Ix and Mx

A
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30
Q

Causes of gynaecomastia

A

Physiological

  • elderly
  • Puberty

Endocrine (more oestrogen or less testosterone)

  • Pituitary tumours e.g. prolactinoma
  • Adrenal tumours
  • Testicular tumours
  • Androgen insensitivity

Drugs

  • Spironolactone
  • Ketoconazole
  • Digoxin
31
Q

Hyperprolactinaemia causes

A

Prolactinoma
Pituitary stalk compression (disconnection hyperprolactinaemia)
Drugs (antipsychotics)

32
Q

Hyperprolactinaemia presentation

A

Headache
Visual disturbance

Gynaecomastia
Galactorrhoea
Decreased libido
Sexual dysfunction (oligomenorrhoea, erectile dysfunction) - inhibits GnRH

33
Q

Polyuria/Polydipsia differentials

A

Diabetes mellitus
Diabetes insipidus
Psychogenic polydipsia
Hypercalcaemia

34
Q

Hyperparathyroidism causes

A

Primary:

  • Parathyroid hyperplasia
  • Parathyroid adenoma (most common)

Secondary:
- Hypocalcaemia (Vit. D deficiency, CKD)

Tertiary
CKD

35
Q

How is calcium homeostasis mediated

A

PTH causes: Calcium release from bones, increased intestinal calcium absorption and intestinal phosphate excretion, increased Vit. D activation

Activated Vit. D causes: Increased calcium and phosphate reabsorption

36
Q

Polyuria/Polydipsia Ix

A

Urine dip
HbA1c
Serum/urine osmolality
Calcium + U&Es

Water deprivation test
MRI (if cranial DI suggested)

37
Q

Mx of Diabetes Insipidus

A

Cranial: Give intranasal desmopressin

Nephrogenic: Thiazide diuretics

38
Q

Hypercalcaemia Ix

A
  1. PTH

If normal or high: Suspect Primary hyperparathyroidism

If low: Likely to be hypercalcaemia of malignancy

  • Liberation of calcium from bone in bony metastases
  • PTHrp release
39
Q

Hypercalcaemia Mx

A

Loads of fluids (0.9% normal saline)

Bisphosphonates (if hypercalcaemia of malignancy)

40
Q

Hyponatraemia causes

A

Hypovolaemic

  • Diarrhoea
  • Vomiting
  • Diuretics (w/ raised urinary Na (>20)

Euvolaemic

  • SIADH
  • Hypothyroidism
  • Addison’s

Hypervolaemic

  • Cirrhosis/hypoalbuminaemia
  • HF
  • Nephrotic syndrome

-

41
Q

Assessment of hyponatraemia

A
  1. Assess fluid status, review drug chart
  2. If not hypo or hypervolaemic, rule out thyroid disease and Addison’s
  3. If TFTs and synacthen test -ve, can make diagnosis of exclusion SIADH
42
Q

Mx of hyponatraemia

A

Hypervolaemic/euvolaemic: fluid restrict + treat underlying cause

Hypovolaemic: Fluid resuscitation

43
Q

Causes of SIADH

A

CNS pathology: Trauma, SOL, stroke
Lung pathology: malignancy, pneumonia
Drugs: SSRIs, Carbamazepine
Surgery

44
Q

Mx of SIADH

A

Fluid restriction
Demeclocycline (induces nephrogenic DI)
Vaptans (V2 receptor antagonists)

45
Q

Pseudocushing’s causes

A

Depression
Obesity
Alcohol excess

46
Q

Hyperaldosteronism causes

A

Primary hyperaldosteronism

  • Bilateral adrenal hyperplasia (most common)
  • Adrenal adenoma
Secondary hyperaldosteronism ( low aldosterone:renin ratio)
- RAS
47
Q

Hyponatraemia presentation

A

Confusion
Anorexia
Muscle weakness
Seizures

Nausea

48
Q

Endo differentials for palpitations/tremor

A

Phaeo
Hyperthyroidism
Anxiety

49
Q

Presentation of thyroid storm

A

Fever
Tachycardia (possibly with AF)
Agitation/confusion

Diarrhoea, N+V, jaundice, abdo pain

50
Q

Ix for thyroid storm

A

Find underlying cause

  • Bloods (TFTs, FBC, U&E, LFTs)
  • ECG
  • CXR
  • ABG
51
Q

Complications of acromegaly (CHOD)

A

Cardiomegaly
Hypertension/Hyperprolactinaemia
OSA
Depression

52
Q

Presentation of myxoedema coma

A 
Hypothermia
Hypoglycaemia
Hyporeflexia
Bradycardia
Seizures
Coma
53
Q

RFs for phaeo

A

MEN1
VHL
NF1

54
Q

Indications for Tx of stage 1 HTN

A 
DM
Renal disease
Target organ damage
Established CVD
QRISK >10%
55
Q

Hyperaldosteronism Ix

A

Bloods (FBC, U&E, hormone profile inc. plasma aldosterone/renin ratio)
CT abdo
Adrenal venous sampling

56
Q

Levels of hyperkalaemia

A

5.5-5.9 = mild
6-6.5 = moderate
>6.5 or symptomatic/ECG changes = severe

Urgent treatment required if severe

57
Q

Hyperkalaemia ECG features

A

Flattening of P waves
PR prolongation
Wide QRS
Tented T waves

58
Q

Hyperkalaemia Mx

A

Stop offending medications
If <6.5 and asymptomatic, cardiac monitoring and repeat bloods

10mls 10% Ca gluconate
10U actrapid in 100mls 20% dextrose

Salbutamol NEB
Haemodialysis

59
Q

Paget’s disease of the bone - What is it?

what areas of the skeleton are most often affected

A

Disorder of increased, aberrant bone turnover

Skull, Spine, long bones of extremities

60
Q

Classical presentation of Paget’s

A

Older man with bone pain

Bowing of tibia, skull bossing (in untreated disease)

61
Q

Paget’s Ix

A

Isolated raised ALP (normal Ca and phosphate)

XR: Osteolysis, progressing to mixed osteolytic/osteosclerotic lesions

Bone scintigraphy: Increased uptake

62
Q

Paget’s Mx and indications for Tx

A

Bisphosphonates (oral or IV)

Indications:

  • Bone pain
  • Fracture
  • Skull/long bone deformity
  • Periarticular Paget’s
63
Q

Causes of osteomalacia

A

Vitamin D deficiency

  • Malnutrition
  • Lack of sunlight
  • CKD
  • Liver disease
  • Drugs
64
Q

Osteomalacia Presentation

A

Bone pain
Bone/muscle tenderness
Fractures

65
Q

Osteomalacia Ix

A

Bloods
Low Ca, Phosphate
High PTH and ALP

XR: Looser’s zone pseudofractures

66
Q

What are the 4 types of renal tubular acidosis

A

Type 1: Distal - unable to excrete H+
Type 2: Proximal - unable to reabsorb HCO3 (related to osteomalacia)
Type 3: Caused by carbonic anhydrase deficiency, very rare
Type 4: Related to lack of aldosterone, causing hyperkalaemic acidosis

67
Q

Assessment of risk in osteoporosis

A

FRAX assessment: For asymptomatic patients (women >65, Men >75)

DEXA scan:

  • If under 40 with major RF for osteoporosis
  • If going to be on steroids for at least 3 months and <65
  • If <75 presenting with a fragility fracture
68
Q

Complications of inappropriate correction of hyponatraemia and hypernatraemia

A

Hyponatraemia: Central pontine myelinolysis

Hypernatraemia: Cerebral oedema

69
Q

Hyperaldosteronism Mx

A

Bilat. adrenal hyperplasia: Spironolactone + SandoK
Adrenal adenoma: Surgery
Adrenal carcinoma: Surgery + radiotherapy

70
Q

Hyperkalaemia causes

A 
Release from cells (rhabdomyolysis, acidosis)
RAAS system inhibition (ACEi, ARB, spironolactone)
Low aldosterone (Addison's disease, RTA)
71
Q

Hypokalaemia causes

A 
GI loss (diarrhoea > vomiting)
Renal loss (aldosterone excess)
Redistribution into cells (insulin, beta-agonists, alkalosis)
72
Q

Hypernatraemia causes

A

Increased sodium intake

Fluid loss

73
Q

Hypokalaemia Mx

A

Mild/moderate (2.5-3.5)
Oral SandoK

Severe (<2.5) or symptomatic
IV KCl (IV saline + 40mmol KCl)
74
Q

What is pseudohyponatraemia

A

hyponatraemia with a raised serum osmolality - indicating an artefact

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