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4th year passmed > Endo > Flashcards

Endo Flashcards

1
Q

What is the classical presentation of Waterhouse Friderichsen sydrome

A

Profound sepsis and coagulopathy - it is a pre-terminal event

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2
Q

What are the structural characteristics of a benign adenoma?

A

Well defined and often wiht a rich lipid core

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3
Q

What causes thyrotoxicosis with a tender goitre?

A

De Quervain’s thyroiditis

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4
Q

What is the time course of DeQuervain’s thyroiditis?

A

Hyper - 5 weeks
Eu - 2 weeks
Hypo - weeks to months
Normality resumed

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5
Q

What is seen on 131 scans in Thyroiditis?

A

Globally reduced uptake

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6
Q

What are the side effects of pioglitazone?

A 
Weight gain
Liver impairment
Fluid retention
Fractures 
Bladdercancer
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7
Q

What are Trosseau’s and Chvoitek’s signs?

A

Trosseau’s - Carpal spasm on BP cuff inflation

Chvostek’s - tapping parotid causes facial twitching

Both seen in hypOcalcaemia

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8
Q

At what stage should another anti-diabetic drug be added?

A

If HbA1c is above58/7.5%

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9
Q

What are the differences between HHS and DKA?

A

No hyperketonuria
No metabolic acidosis
Higher blood glucose
Normal pH

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10
Q

Do DDP4 inhibitors e.g. Sitagliptin cause weight gain?

A

No, nor do they cause hypos

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11
Q

Which element is required for PTH secretion and action other than Ca?

A

Mg

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12
Q

What endocrine abnormality can quinines precipitate?

A

Hypogylcaemia

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13
Q

What is the TFT profile seen in subclinical hypothyroidism?

A

Elevated TSH with normal T4

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14
Q

Which diabetes medication is contraindicated in patients with recurrent thrush?

A

SGLT2 inhibitors

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15
Q

What are the various DM diagnostic criteria for a symptomatic patient?

A

Fasting glucose >=7
Random glucose>=11.1
2Hr 75g OGTT>= 11.1
HbA1C>=48/6,5%

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16
Q

What criteria must be met for an asymptomatic patient to be diagnosed with DM?

A

Same numbers as for a symptomatic patient but mutst be met twice

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17
Q

Hyponatraemia and hyperkalaemia in a patient with lethargy most likely indicates…..? And what diagnostic test should be done?

A

Addison’s disease

Short SynACTHen test

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18
Q

What is the single most important measure to prevent gangrene development in diabetic foot patients/

A

Education about foot care and appointment with diabetic foot clinic

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19
Q

True or false - long term steroid use causes osteomalacia?

A

False - it causes osteopaenia and osteoporosis but not osteomalacia

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20
Q

What should be done for all patients with pituitary masses?

A

Hormonal profiling

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21
Q

Which diabetic meds are contraindicated in heart failure?

A

Thiazolinediones (pioglitazone)

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22
Q

What should be done for patients with Addison’s taking hydro and fludrocortisone who are unwell?

A

Double the hydrocortisone ONLY

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23
Q

Men 1, 11a, 11b?

A

1 - 3Ps - Parathyroid, pituitary, pancreas

2a - 2Ps - Parathyroid, phaeo, thyroid

2b - 1P - Phaeos, thyroid, Marfans

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24
Q

What is the commonest side effect of radio thyroid treatment?

A

Hypothyroidism

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25
Q

What is the commonest complication - and thus CIs- of carbimazole (ATD)?

A

Agranulocytosis

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26
Q

What is the commonest type of thyroid cancer, and how does it spread?

A

Papillary carcinoma

Lymphatic spread

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27
Q

Which thyroid cancer typically has a hereditary historyt to it?

A

Medullary - as part of MEN2A

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28
Q

what causes impaired hypoglycaemic awareness in diabetics?

A

ANS Neuropathy

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29
Q

What is the first line investigation for acromegaly?

A

Serum IGF1

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30
Q

What is Nelson’s syndrome?

A

Rapid enlargement of an ACTH producing pituitary adenoma following a bilateral adrenalectomy for Cushings

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31
Q

What is the inheritance pattern of MODY

A

AD

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32
Q

Thiazides cause hyper or hypocalcaemia?

A

Hypercalcaemia

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33
Q

Whatis the difference between Hashimoto’s and De Quervain’s thyroiditis?

A

Time frame - the former is over 6-12 months whereas the latter over a matter of weeks

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34
Q

What does ‘unrecoreable’ blood glucose mean?

A

Too HIGH rather than low

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35
Q

Wht is the HbA1C definition of Prediabetes?

A

42-47/6-6.4%

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36
Q

What are the drug causes of gynaecomastia?

A

Spiro - commonest
Cimetidine
Digoxin
Goserelin

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37
Q

Which antibodies are seen in Hashimotos?

A

anti-TPO

38
Q

What is the first line management of prolactinomas?

A

Da agonists e.g. cabergoline or bromocriptine

39
Q

What effect does iron have on thyroid function?

A

Iron reduces thyroxine absorption, therefore causing a hypothyroidism

40
Q

What are the drug causes of gynaecomastia?

A

Spiro - commonest
Cimetidine
Digoxin
Goserelin

41
Q

Which antibodies are seen in Hashimotos?

A

anti-TPO

42
Q

What is the first line management of prolactinomas?

A

Da agonists e.g. cabergoline or bromocriptine

43
Q

What effect does iron have on thyroid function?

A

Iron reduces thyroxine absorption, therefore causing a hypothyroidism

44
Q

What insulin regiment should DKA patients be on?

A

Fixed rate

COntinue regular LA injectables but stop short acting insulin

45
Q

What may cause a diabetiv with poor glucose control to experience bloating and vomiting?

A

Gastroparesis due to vagal neuropathy

46
Q

Which diabetic med is contraindicated in bladder cancer and causes weight gain?

A

Pioglitazone (thiazolidinediones)

47
Q

What is the mechanism of sitagliptin?

A

DDP4 inhibitor

48
Q

What are the blood glucose targets for T1DM?

A

5-7 on waking

4-7 before other meals of the day

49
Q

Chronic alcohol abuse may mimic which endocrine syndrome?

A

Cushing’s

50
Q

What is the first line treatkent for cerebral metastases?

A

Dexamethasone

51
Q

What is the most important modifiable risk factor for the development of thyroid eye disease?

A

Smoking cessation

52
Q

When should a second diabetic agent be added?

A

when HbA1c is above 58 or 7.5%

53
Q

What is the management of a post menopausal woman with a fracture?

A

Bisphosphonates and calcium supplementation - there is no need for a DEXA scan

54
Q

What is the most common cardiac complication of thyrotoxicosis?

A

High output cardiac failure

55
Q

What is the management of hypoglycaemia with impaired GCS?

A

IV 100ml 20% dextrose STAT if access

IM glucagon 1mg IV STAT if not

56
Q

What are the common side effects of sulphonylureas (and name one)

A

Gliclazide
Hypos
Weight gain

57
Q

What is the HbA1c targetin T1DM?

A

48/6.5%

58
Q

What is the biochemical marker of response to levothyroxine?

A

TSH normalisation

59
Q

What complication should be monitored while fluid resuscitating young DKA patients?

A

Cerebral oedema

60
Q

What are the features and management of a thyroid storm?

A

Fx
Fever, tachy, confusion, N&V, HTN, HF, jaundice

Rx
Treat the precipitant
IV propranolol
Anti thyroids e.g. propylthiouracel
Lugols iodine
Dexamethasone - blocks T4-=>T3 convesion
61
Q

What is the acid base balance in Cushings?

A

Hypokalaemic metabolic alkalosis due to potassium excretion and primary HCO3 loss

62
Q

What are the characteristic features of an insulinoma?

A

Whipples triad

Hyooglycaemia with fasting or exercise
Reversal of symptoms with glucose
Recorded hypose at time of symptoms

63
Q

Which one of the following drugs is not a cause of galactorrhoea?

Metoclopramide
Bromocriptiner
Chlorpromazine
Haloperidol
DOmperidone
A

Bromocriptine is a treatment for galactorrhoea rather than a cause

64
Q

Subacute thyroiditis shows what picture on 131-I scintigraphy?

A

Globally reduced uptake

65
Q

What are the features of a myxoedema coma?

A

Hypothermia
Hyporefleia
Bradycardia
Seizures

66
Q

Which drugs cause galactorrhoea?

A

Metoclopromide
Domperidone
CHlorpromazine
Haloperidol

67
Q

Treatment with which hormone is recommended in Turner’s patients?

A

GH

68
Q

Which steroids have the following profiles:

i) Minimal glucocorticoid but high mineralocorticoid activity
ii) Glucocorticoid activity with high minteralocorticoid activity
iii) Predominant glucocorticoid activity with low mineralocorticoid activity

A

i) Fludrocortisone
ii) Hydrocortisone
iii) Prednisolone

69
Q

Which hormone is reduced in surgery?

A

Insulin

70
Q

What is the mechanism of action of orlistat?

A

Pancreatic lipase inhibitor which therefore reduces fat digestion

71
Q

What is the primary cardiac manifestation of acromegaly?

A

Agromegalic cardiomyopathy

72
Q

Every person on insulin should also receive what?

A

Glucagon kit

73
Q

What should be the next step in the management with a palpable abdo mass or unexplained organomegaly?

A

V urgent refurral (<48hrs) for ?neuroblastoma and Wilm’s tumour

74
Q

Cortisol not suppressed by low dose dex but is suppressed by high dose dex?

A

Cushing’s disease

75
Q

Ehat asre the casuses of hyopoglycaemia?

A

Explain

Exogenous drugs
Pit insufficiency
Liver failure
Addison's
Insulinomas
Non pancreatic neoplasia
76
Q

Which diabetes drugs increase risk of osteoporosis?

A

Thiazolidinediones (pioglitazone)

77
Q

What are the key features of latent autimmune diabetes of adulthood?

A

Basically T1DM but presents later

78
Q

What might causea falsely low HbA1C?

A

Sickle cell and other Hbopathies due to decreased red cell lifespan

79
Q

What is the management of amyxoedema coma?

A

Hydrocortisone

Levothyroxine

80
Q

What is the bvest treatment for a toxic multinodular goitre?

A

Radioactive iodine

81
Q

Can HbA1c be used to rule out diabetes?

A

No - needs a fasting glucose test

82
Q

What is the management of an addisonisn crisis?

A

Hydrocortisone 100mg IV
Saline +-dextrose

NO Fludrocortisone needed

83
Q

What is the first line for pituitary tumours causing acromegaly?

A

Trans-sphenoidal surgery

Otreotide if this fails

84
Q

What are the gynae manifestations of thyroid disease?

A

Hyper -> oligo/amenorrhoea

Hypo -> menorrhagia

85
Q

What is a good screening test for medullary thyroid carcinoma?

A

Calcitonin

86
Q

What is the management of primary hyperaldosteronism?

A

Spironolactone

87
Q

What is the first line insulin regimen for newly diagnosed T1DM?

A

Basal bolus with twice daily detemir

88
Q

How many units of insulin are there in 1ml?

A

100U

89
Q

What is a good diabetes med to give someone who is obese?

A

Sitabliptin (DDP4 inh)

90
Q

What does a gliclazide OD cause?

A

Hyperinsulinaemia with high C-peptide levels

91
Q

What should be given first to a phaeo patient/

A

Phenoxybenzamine (alpha before beta)

4th year passmed (28 decks)

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