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Y3 > Endo > Flashcards

Endo Flashcards

1
Q

Cushing’s syndrome signs and symptoms

A

Hypertension
Menstrual irregularity
Glucose intolerance
Recurrent infections

Moon face
Red cheeks
Easy bruising
Thin skin
Centripetal obesity

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2
Q

Cushing’s syndrome causes

A

Pituitary adenoma
Ectopic ACTH(SCLC)
Exogenous steroids(iatrogenic)
Adrenal adenoma

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3
Q

Cushing’s syndrome investigations

A

Exclude exogenous steroids
24h urinary free cortisol
Low dose dexamethasone suppression test
inferior petrosal sinus sampling
MRI pituitary

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4
Q

Cushing’s syndrome management

A

Pituitary adenoma: surgery/radiotherapy
ectopic(SCLC): radio/chemo/surgery
Adrenal adenoma: surgery

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5
Q

Addison’s disease signs and symptoms

A

Nausea+vomiting
Lethargy
Anorexia
Weight loss

Primary: pigmentation, hypoNa+, hyperK+

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6
Q

Addison’s disease investigations

A

9am cortisol: <500nmol/L
SynACTHen test(diagnostic)
TB screening
Adrenal imaging
Pituitary imaging

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7
Q

Addison’s disease management

A

Crisis:
Normal saline
IV dextrose
IV hydrocortisone 100mg

Hydrocortisone/prednisolone(3mgOD)
Fludrocortisone(mineralcorticoid)

Sick day rules; double hydrocortisone during infection

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8
Q

Conn’s syndrome signs and symptoms

A

Hypertension
Hypokalaemia - muscle cramps, polyuria, polydipsia

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9
Q

Conn’s syndrome investigations

A

Exclude secondary(RAAS) by suppressing angiotensin
Blood pressure
Bloods: Na, K
Aldosterone:renin ratio
Adrenal imaging

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10
Q

Conn’s syndrome management

A

Spironolactone(metabolised in liver) - menstrual irregularities, gynaecomastia
Epleronone - mild side effects

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11
Q

PCOS signs and symptoms

A

Irregular periods
Weight gain
Fatigue
Pelvic pain
Hair loss
Acne
Growth of unwanted hair

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12
Q

PCOS investigations

A

Rotterdam criteria(2 of 3):
Oligo/amenorrhoea
Hyperandrogenism
Polycystic morphology on USS

Bloods: FSH, LH, testosterone, prolactin, TSH
TV USS: >11 follicles in 1 ovary

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13
Q

PCOS management

A

Diet and lifestyle and metformin(prevent gestational DM)
OCP and metformin(prevent irregular periods)
Anti-androgen(prevent hirsutism)
Progesterone courses(prevent endometrial cancer)

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14
Q

Phaeochromocytoma signs and symptoms

A

Hypertension
Palpitation
Sweating
Anxiety

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15
Q

Phaeochromocytoma investigations

A

Blood pressure: >200 systolic
24h urinary metanephrines
MIBG scan: PCC or neuroblastoma

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16
Q

Phaechromocytoma management

A

1st: Alpha blockers(noradrenaline): lower bp
2nd: Beta blockers(adrenaline): lower bp and pulse

Surgery

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17
Q

T1DM signs and symptoms

A

Polydipsia
Polyuria
Weight loss
Fatigue
DKA signs: N+V, abdo pain, kussmaul breathing, sweet smelling breath

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18
Q

Diabetes mellitus investigations

A

HbA1c: >=48mmol/mol
Fasting glucose: >7mol/L

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19
Q

T1DM management

A

Long acting insulin OD
Fast acting insulin pre meal

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20
Q

T2DM management

A

Lifestyle
Metformin
DPP4i: sitagliptin
Sulphonylurea: gliclazide
SGLT2i: dapaglifozin

Check renal function and B12

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21
Q

Diabetic retinopathy management

A

Background retinopathy (blot and dot haemorrhages/hard exudates)
->glycaemic control

Pre proliferative retinopathy (background + cotton wool spots)
->pan retinal laser coagulation

Proliferative retinopathy (non-proliferative + new vessels on disk)
->pan retinal laser coagulation

Maculopathy (hard exudates happen to be near macula)
->intra vitreal VEGF inhibitors

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22
Q

Diabetic nephropathy investigations

A

Urinalysis: ACR -> microalbuminuria

Renal biopsy: kimmelstiel-Wilson nodules

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23
Q

Diabetic nephropathy management

A

ACEi/ARBs(Reno-protective)
Glycaemic control

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24
Q

Diabetes insipidus investigations

A

Water deprivation test: low urine osmolality
Give desmopressin: if urine osmolality rises->cranial DI, if not then nephrogenic DI

Bloods: U&E, glucose

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25
Q

Diabetes insipidus management

A

Cranial: intranasal desmopressin

Nephrogenic: thiazide diuretics, low salt/protein diet

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26
Q

SIADH causes

A

CNS: SAH, stroke, tumour, TB
Pulmonary: pneumonia, Bronchiectasis
Malignancy: SCLC
Drugs: carbamazepine, SSRIs

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27
Q

Acromegaly signs and symptoms

A

Macroglossia
Increased hand and feet size
Prominent nose

Sweating
Headache
Hypertension
Impaired glucose tolerance

28
Q

Acromegaly investigations

A

Oral glucose tolerance test: paradoxical rise in GH

IGF-1

29
Q

Acromegaly management

A

Transsphenoidal pituitary surgery(young)
External beam irradiation(old)

Somatostatin analogues(octreotide)
Dopamine agonist(cabergoline)

30
Q

Prolactinoma signs and symptoms

A

Hypogonadism:
Male - infertility, ED
Female - galactorrhoea, amenorrhoea

Bitemporal hemianopia
Headache

31
Q

Prolactinoma investigations

A

Pituitary MRI
Serum prolactin: macroprolactin, stress of venipuncture, prolactinoma

32
Q

Prolactinoma management

A

Cabergoline

33
Q

Sheehan’s syndrome signs and symptoms

A

Lethargy
Weight loss
Anorexia

34
Q

Pituitary apoplexy signs and symptoms

A

Severe onset headache
Bitemporal hemianopia
Cavernous sinus involvement: diplopia(CN4/6), ptosis(CN3)

35
Q

Panhypopituitarism management

A

Daily GH injection
Levothyroxine OD
Prednisolone OD
Testosterone/oestrogen(infertile), progesterone to prevent endometrial cancer
gonadotrophin injection(fertile)

36
Q

Thyrotoxicosis signs and symptoms

A

Lid lag
Tachycardia
Heat intolerance
Weight loss
Diarrhoea
Tremors
Oligomenorrhoea

37
Q

Thyrotoxicosis causes

A

Grave’s disease:
Smooth goitre
Bilateral exophthalmos
Pretibial myxoedema

Toxic multinodular goitre(Plummer’s):
Lumpy goitre

De Quervain’s thyroiditis:
Fever
Dysphagia
Hyperthyroid then hypothyroid

38
Q

Hypothyroidism signs and symptoms

A

Bradycardia
Cold intolerance
Weight gain
Constipation
Fatigue
Depression
Menorrhagia

39
Q

Hashimoto’s thyroiditis management

A

Levothyroxine

40
Q

Thyrotoxicosis management

A

Thionamides: propylthiouracil(agranulocytosis/rash), carbimazole
CBZ- 30-60mg per day, reduce to 5-10mg
PTU can cause nephritis

Potassium iodide(pre-surgery)

Beta blockers(propranolol)

Thyroidectomy

Radioiodine

41
Q

1st and 2nd commonest thyroid cancer

A

Papillary carcinoma
Follicular carcinoma

42
Q

Thyroid cancer signs and symptoms

A

Palpable mass
Hoarse voice
Dysphagia
Airway compression
Haemoptysis
Cervical lymphadenopathy

43
Q

MEN1 syndrome

A

Parathyroid adenoma
Pancreas(insulinoma/gastrinoma)
Pituitary(prolactinoma/GH)

44
Q

MEN2A syndrome

A

Medullary thyroid cancer
Parathyroid adenoma
Phaeochromocytoma

45
Q

MEN2B syndrome

A

Medullary thyroid cancer
Phaeochromocytoma
Mucocutaneous neuroma

46
Q

Carcinoid syndrome signs and symptoms

A

Flushing

Diarrhoea
SOB(bronchospasm)
Abdo pain(usually RIF)
Weight loss

47
Q

Kallmann syndrome signs and symptoms

A

Anosmia
Cryptorchidism
Failure of testicular development
Micropenis

48
Q

Endometriosis/fibroids signs and symptoms

A

Menstrual pain
Menstrual irregularities
Infertility

49
Q

Endometriosis management

A

Progesterone
Laparoscopic ablation
Hysterectomy
Bilateral salpingo-oophorectomy

50
Q

Fibroids management

A

Progesterone
Continuous GnRH agonist
Hysterectomy

51
Q

Turner’s/Klinefelter’s syndrome karyotype

A

Turner’s(female): 45X
Klinefelter’s(male): 47XXY

52
Q

IVF process

A

Oocyte retrieval
GnRH agonist day -7
GnRH antagonist day 6

53
Q

Ovulation induction

A

Lifestyle
FSH stimulation
Letrozole
Clomiphene

54
Q

Hypercalcaemia signs and symptoms

A

Kidney stones
Abdominal moans: nausea, dyspepsia, pancreatitis, anorexia
Psychic groans: fatigue, depression, confusion

55
Q

Hypocalcaemia signs and symptoms

A

Paresthesia
Arrhythmia
Convulsion
Tetany(spasms)

Chvostek’s sign: tap inf to zygomatic arch->twitch
Trousseua’s sign: inflation of BP cuff->carpopedal spasm

56
Q

Primary hyperPTH management

A

IV fluids
Bisphosphonate(reduce osteoclast activity)
Parathyroidectomy
Shockwave lithotripsy for stones

57
Q

Secondary hyperPTH management

A

Vit D replacement:
Normal renal function->vit D2(ergocalciferol), vit D3(cholecalciferol)
Impaired renal function->alfacalcidol

58
Q

Hypercalcaemia investigations

A

Obs
CXR/AXR: rule out pancreatitis/perforation
Bloods: Ca2+, amylase, LFT, phosphate, PTH, vit D

59
Q

Carcinoid syndrome investigations

A

Echocardiogram(tricuspid valve common)
24h urine 5-HIAA
Somatostatin receptor scintigraphy
CT CAP/endoscopy: metastases

60
Q

Carcinoid syndrome management

A

Loperamide(antihistamine): improves itching/flushing
Alpha interferon: reduce tumour size/effects
Octreotide: block tumour mediators
Chemo
Surgical resection/ablation

61
Q

DKA diagnosis

A

Raised blood glucose/known diabetes
Ketonuria++
Serum bicarbonate <15mmol/L
pH<7.3

62
Q

DKA management

A

1L 0.9% NaCl bolus
10 unit IM insulin

Urinary catheter
Then give 0.9% NaCl with 40mmol K+
When glucose<14, give 10% dextrose

63
Q

SIADH management

A

Mild:
Fluid restrict

Severe:
Hypertonic 1.8% NaCl IV
If resistant - demeclocylcine

64
Q

Amenorrhoea/oligomenorrhoea causes and investigations

A

Pregnancy: urine bHCG
Hypothalamus: excessive exercise/low BMI
Pituitary: high PRL or low LH/FSH
Thyroid: TFT
PCOS: hirsutism/excess androgens
Ovarian insufficiency: high FSH

65
Q

diabetic neuropathy management

A

amitriptyline
duloxetine
gabapentin/pregabalin

66
Q

HHS diagnosis

A

pH > 7.3
serum osmolarity > 320 mosmol/kg
blood glucose > 30mM

67
Q

HHS management

A

aggressive fluid replacement
IV insulin infusion 0.05 iU/kg/h

Y3 (9 decks)

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