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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
Diabetes insipidus management
Cranial: intranasal desmopressin Nephrogenic: thiazide diuretics, low salt/protein diet
26
SIADH causes
CNS: SAH, stroke, tumour, TB Pulmonary: pneumonia, Bronchiectasis Malignancy: SCLC Drugs: carbamazepine, SSRIs
27
Acromegaly signs and symptoms
Macroglossia Increased hand and feet size Prominent nose Sweating Headache Hypertension Impaired glucose tolerance
28
Acromegaly investigations
Oral glucose tolerance test: paradoxical rise in GH IGF-1
29
Acromegaly management
Transsphenoidal pituitary surgery(young) External beam irradiation(old) Somatostatin analogues(octreotide) Dopamine agonist(cabergoline)
30
Prolactinoma signs and symptoms
Hypogonadism: Male - infertility, ED Female - galactorrhoea, amenorrhoea Bitemporal hemianopia Headache
31
Prolactinoma investigations
Pituitary MRI Serum prolactin: macroprolactin, stress of venipuncture, prolactinoma
32
Prolactinoma management
Cabergoline
33
Sheehan’s syndrome signs and symptoms
Lethargy Weight loss Anorexia
34
Pituitary apoplexy signs and symptoms
Severe onset headache Bitemporal hemianopia Cavernous sinus involvement: diplopia(CN4/6), ptosis(CN3)
35
Panhypopituitarism management
Daily GH injection Levothyroxine OD Prednisolone OD Testosterone/oestrogen(infertile), progesterone to prevent endometrial cancer gonadotrophin injection(fertile)
36
Thyrotoxicosis signs and symptoms
Lid lag Tachycardia Heat intolerance Weight loss Diarrhoea Tremors Oligomenorrhoea
37
Thyrotoxicosis causes
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
Hypothyroidism signs and symptoms
Bradycardia Cold intolerance Weight gain Constipation Fatigue Depression Menorrhagia
39
Hashimoto’s thyroiditis management
Levothyroxine
40
Thyrotoxicosis management
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
1st and 2nd commonest thyroid cancer
Papillary carcinoma Follicular carcinoma
42
Thyroid cancer signs and symptoms
Palpable mass Hoarse voice Dysphagia Airway compression Haemoptysis Cervical lymphadenopathy
43
MEN1 syndrome
Parathyroid adenoma Pancreas(insulinoma/gastrinoma) Pituitary(prolactinoma/GH)
44
MEN2A syndrome
Medullary thyroid cancer Parathyroid adenoma Phaeochromocytoma
45
MEN2B syndrome
Medullary thyroid cancer Phaeochromocytoma Mucocutaneous neuroma
46
Carcinoid syndrome signs and symptoms
Flushing Diarrhoea SOB(bronchospasm) Abdo pain(usually RIF) Weight loss
47
Kallmann syndrome signs and symptoms
Anosmia Cryptorchidism Failure of testicular development Micropenis
48
Endometriosis/fibroids signs and symptoms
Menstrual pain Menstrual irregularities Infertility
49
Endometriosis management
Progesterone Laparoscopic ablation Hysterectomy Bilateral salpingo-oophorectomy
50
Fibroids management
Progesterone Continuous GnRH agonist Hysterectomy
51
Turner’s/Klinefelter’s syndrome karyotype
Turner’s(female): 45X Klinefelter’s(male): 47XXY
52
IVF process
Oocyte retrieval GnRH agonist day -7 GnRH antagonist day 6
53
Ovulation induction
Lifestyle FSH stimulation Letrozole Clomiphene
54
Hypercalcaemia signs and symptoms
Kidney stones Abdominal moans: nausea, dyspepsia, pancreatitis, anorexia Psychic groans: fatigue, depression, confusion
55
Hypocalcaemia signs and symptoms
Paresthesia Arrhythmia Convulsion Tetany(spasms) Chvostek’s sign: tap inf to zygomatic arch->twitch Trousseua’s sign: inflation of BP cuff->carpopedal spasm
56
Primary hyperPTH management
IV fluids Bisphosphonate(reduce osteoclast activity) Parathyroidectomy Shockwave lithotripsy for stones
57
Secondary hyperPTH management
Vit D replacement: Normal renal function->vit D2(ergocalciferol), vit D3(cholecalciferol) Impaired renal function->alfacalcidol
58
Hypercalcaemia investigations
Obs CXR/AXR: rule out pancreatitis/perforation Bloods: Ca2+, amylase, LFT, phosphate, PTH, vit D
59
Carcinoid syndrome investigations
Echocardiogram(tricuspid valve common) 24h urine 5-HIAA Somatostatin receptor scintigraphy CT CAP/endoscopy: metastases
60
Carcinoid syndrome management
Loperamide(antihistamine): improves itching/flushing Alpha interferon: reduce tumour size/effects Octreotide: block tumour mediators Chemo Surgical resection/ablation
61
DKA diagnosis
Raised blood glucose/known diabetes Ketonuria++ Serum bicarbonate <15mmol/L pH<7.3
62
DKA management
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
SIADH management
Mild: Fluid restrict Severe: Hypertonic 1.8% NaCl IV If resistant - demeclocylcine
64
Amenorrhoea/oligomenorrhoea causes and investigations
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
diabetic neuropathy management
amitriptyline duloxetine gabapentin/pregabalin
66
HHS diagnosis
pH > 7.3 serum osmolarity > 320 mosmol/kg blood glucose > 30mM
67
HHS management
aggressive fluid replacement IV insulin infusion 0.05 iU/kg/h

Y3 (9 decks)

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