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endo Flashcards

1
Q

what medication is to be prescribed prior to an adrenalectomy to stabilise BP and K+ levels?

A

spironolactone - it is a potassium sparing diuretic so will retain the K+ ions in body

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2
Q

diagnosis from raised renin and raised aldosterone?

A

secondary hyperaldosteronism - renin secreting tumour is present

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3
Q

presentations of Cushing’s syndrome?

A

abdominal striae, moon face, buffalo hump
and weight loss in extremities

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4
Q

presentations of Addison’s disease?

A

hyperpigmentation, central weight loss, hypotension

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5
Q

Loss of which feedback system results in an increase of cortisol in the body?

A

Hypothalamo-pituitary-adrenal axis

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6
Q

what test determines cranial or nephrogenic diabetes insipidus?

A

water deprivation test with desmopressin

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7
Q

what is the diagnostic criteria for DM?

A
  • Fasting plasma glucose >7mmol/L
  • HbA1c of ≥48mmol/mol
  • Symptoms
  • random plasma glucose >11mmol/L
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8
Q

hyperkalaemia ECG?

A
  • absent P waves
  • prolonged PR
  • tall T waves
  • wide QRS complex
  • bradycardia
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9
Q

what is carcinoid syndrome?

A

a paraneoplastic syndrome where a rare cancerous tumour (carcinoid tumour) secretes 5-HT
- classical triad of cardiac involvement, diarrhoea and flushing

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10
Q

how can Crohn’s disease lead to secondary adrenal insufficiency?

A
  • long term medication for Crohn’s is corticosteroids, which causes suppression/atrophy of adrenal glands
  • withdrawal from these meds can cause secondary adrenal insufficiency
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11
Q

which cancers can cause SIADH?

A

ACTH secreting; small cell carcinoma, prostate, pancreatic, thymus cancer and lymphomas

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12
Q

list some symptoms of hyperkalaemia

A
  • muscle weakness/cramping
  • paraesthesia
  • anxiety
  • palpitations
  • abdo pain
  • diarrhoea
  • dyspnoea
  • hyperreflexia
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13
Q

list 6 complications of acromegaly

A
  • T2DM
  • obstructive sleep apnoea
  • cardiomyopathy
  • hypertension
  • stroke
  • colorectal cancer
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14
Q

first line investigation for acromegaly?

A

serum IGF-1, would be raised (IGF-1 increases with GH secretion)

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15
Q

first line treatment for acromegaly?

A

transsphenoidal resection of pituitary adenoma

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16
Q

name 3 classes of drugs used to treat acromegaly and an example of each

A
  • SST analogues, e.g. octreotide
  • GH antagonist, e.g. pegvisomant
  • dopamine antagonists, e.g. cabergoline
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17
Q

give 4 differential diagnoses of polyuria and polydipsia

A

DM, DI, SIADH, primary polydipsia

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18
Q

what is the main cause of primary hyperparathyroidism?

A

solitary adenoma (80% cases)

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19
Q

list the signs and symptoms of primary hyperparathyroidism

A
  • bones: bone pain/fractures
  • stones: renal/biliary stones
  • groans: constipation, abdo pain, PUD, pancreatitis
  • psychic moans: depression
  • thrones: polyuria, polydipsia
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20
Q

definitive treatment for primary hyperparathyroidism?

A

total parathyroidectomy

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21
Q

first line investigation for Cushing’s disease?

A

overnight dexamethasone suppression test

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22
Q

most common cause of Cushing’s syndrome?

A

exogenous, e.g. excess corticosteroid use

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23
Q

main feature of a U&E for hyperaldosteronism?

A

hyperkalaemia

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24
Q

first line investigation of hyperaldosteronism?

A

aldosterone renin ratio

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25
Q

How do you distinguish between primary and secondary hyperaldosteronism?

A

High ratio = primary / low ratio = secondary

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26
Q

main finding on ECG in hypercalcaemia?

A

Shortening of the QT interval

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27
Q

2 signs for hypocalcaemia

A
  • Chvostek’s: tap over facial nerve causes spasm of facial muscles
  • Trousseau’s: inflate bp cuff to 20mmHg above systolic for 5 mins and hand should form a claw
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28
Q

where does the superior thyroid artery arise from?

A

external carotid artery

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29
Q

cause of hypercalcaemia via malignancy?

A

excessive secretion of parathyroid hormone released peptide (PTHrP)

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30
Q

list 4 functions of PTH

A
  • increases Ca2+ absorption in gut
  • increases Ca2+ reabsorbed in kidney -> less is excreted in urine
  • decreases phosphate reabsorption in kidney, increasing amount excreted
  • stimulates osteoclasts to reabsorb bone mineral, increasing bone remodelling and turnover
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31
Q

Give 5 generalised symptoms of a pituitary adenoma.

A
  • N/V,
  • headaches,
  • infertility,
  • changes in periods,
  • fatigue,
  • depression/anxiety,
  • vision problems
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32
Q

list 5 signs or symptoms would you see with increased TSH

A

heat intolerance, sweating, weight gain, palpitations, anxiety, fatigue, irregular periods

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33
Q

what symptoms would you see in carcinoid syndrome?

A

cutaneous flushing, recurrent diarrhoea, abdo cramps, asthma-like wheezing

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34
Q

what would you see on physical exam in carcinoid syndrome?

A
  • erythema
  • pellagra skin lesions
  • wheezing
  • hepatosplenomegaly from metastases
  • pulmonary systolic and diastolic heart murmur
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35
Q

What drug is commonly used to reduce thyroid hormone production?

A

carbimazole

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36
Q

outline the physiology of how carbimazole exerts its effects.

A

Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin, leading to decreased thyroid hormone production

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37
Q

Provide 4 signs and/or symptoms of a patient experiencing DKA

A

nausea, fruity breath, abdo pain, hypotension, tachycardia, reduced consciousness

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38
Q

what is a phaeochromocytoma?

A

rare tumour of the adrenal medulla

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39
Q

which cells is a phaeochromocytoma usually composed of?

A

chromaffin cells

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40
Q

give 4 symptoms of a phaeochromocytoma

A

diaphoresis, hypertension, tachycardia/palpitations, pallor, diabetes

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41
Q

which test confirms a diagnosis of Addison’s disease?

A

synacthen test - ACTH stimulation

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42
Q

which drug used in treatment of asthma may cause hypokalaemia?

A

salbutamol

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43
Q

persistent hypertension, chronic headache, muscle cramps and fatigue: suspect what?

A

primary hyperaldosteronism

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44
Q

treatment for DKA?

A

IV fluids before insulin therapy

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45
Q

what is the gold standard diagnosis for phaeochromocytoma?

A

elevated plasma free metanephrine

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46
Q

how does insulin act on cells?

A

reduces glycogenolysis

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47
Q

secondline treatment for T2DM?

A

metformin + sulfonylurea

48
Q

diagnostic criteria for DKA?

A
  • Blood Glucose >11 mmol/L
  • Plasma Ketones >3 mmol/L
  • Blood pH <7.3
  • Bicarbonate <15 mmol/L
49
Q

What is the most common subtype of Thyroid carcinoma?

A

papillary

50
Q

blood test results for Graves disease?

A

low TSH, high T3/4

51
Q

Where in the adrenal gland are catecholamines produced and secreted?

A

adrenal medulla

52
Q

Conn’s syndrome is what type of mineralocorticoid excess syndrome?

A

primary aldosteronism

53
Q

What class of immunoglobulin is involved in Graves disease?

A

IgG

54
Q

What test would be most useful to confirm your diagnosis of carcinoid syndrome?

A

chromagranin-A + octreoscan

55
Q

what would the blood test results show for primary hypothyroidism?

A

high TSH, low T4

56
Q

what U&E blood test would you expect to find in SIADH?

A

hyponatraemia

57
Q

what would the blood test results show for secondary hypothyroidism?

A

low TSH, low T3/4

58
Q

what does glucagon stimulate?

A

lipolysis

59
Q

where does fertilization occur?

A

ampulla

60
Q

The first few cellular differentiation of a zygote is called cleavage. When does cleavage occur?

A

day 2-3

61
Q

name 5 tests required for diagnosis of DKA and the results required

A

Blood glucose >= 11.1mmol/L
Plasma ketones >= 3 mmol/L
Ketonuria > 2+ on dipstick
Venous pH <7.35
HCO3- <15.0mmol/L

62
Q

name 4 risk factors for DKA

A
  • stopped insulin
  • infection
  • pancreatitis
  • undiagnosed DMT1
  • surgery
63
Q

name 3 complications of DKA

A
  • coma
  • cerebral oedema
  • pneumonia
64
Q

What aspect on a urine dipstick would indicate that the patient has diabetes insipidus (DI) instead of diabetes mellitus?

A

glucose negative

65
Q

The patient is diagnosed with diabetes insipidus, what test would be run to differentiate cranial and nephrogenic DI and what result would indicate it is cranial?

A

IM desmopressin test. Urine becomes concentrated in cranial.

66
Q

what class of medication would you give to cranial DI and name an example of this

A

ADH analogue; desmopressin

67
Q

In patients with nephrogenic DI you give them NSAIDs, what is the physiology behind this?

A

NSAIDs Inhibit prostaglandins which stops their inhibition of ADH action

68
Q

give some examples of counselling advice you should give to someone undergoing a PSA test

A
  • Raised PSA doesn’t indicate prostate cancer, at his age it will likely be raised
  • would a negative result reassure him?
  • if he does have cancer likely watch and wait
69
Q

What is the difference between benign prostatic hyperplasia and benign prostatic enlargement?

A

Hyperplasia is a histological diagnosis and enlargement is a clinical diagnosis

70
Q

What type of hypersensitivity reaction is Grave’s disease?

A

type 2

71
Q

What causes the hyperparathyroidism in grave’s disease?

A

Pathological stimulation of the TSH receptor by circulating IgG autoantibodies

72
Q

If left untreated what is a possible complication of Grave’s disease?

A

agranulocytosis

73
Q

What rare but serious adverse effect of carbimazole will require close monitoring?

A

thyroid storm

74
Q

what medication is given to control optical symptoms in Grave’s disease?

A

high dose glucocorticoids -> immunosuppress

75
Q

give 2 investigations of Grave’s disease

A

thyroid ultrasound, iodine thyroid scan

76
Q

give 3 treatments of Grave’s disease

A

carbimazole, Radioiodine therapy, Thyroidectomy

77
Q

Name 2 causes of Acromegaly

A

Benign Pituitary tumour (growth-hormone secreting), Ectopic Carcinoid tumour (growth-hormone secreting)

78
Q

What are 3 other signs of Acromegaly?

A
  • Skin darkening
  • Coarsening face
  • Wide nose
  • Big supraorbital ridge
  • Interdental separation
  • Deep voice
  • Large tongue
79
Q

Name 2 investigations for diagnosing Acromegaly

A
  • serum IGF
  • Glucose Tolerance Test (GTT)
  • MRI scan of Pituitary Gland
80
Q

What hormonal changes result in thyroid storm / crisis?

A

rapid T4 increase

81
Q

Name 2 things that a thyroid storm can progress to if not treated promptly.

A

delirium, coma, death, cerebral oedema, pneumonia

82
Q

Name 2 events which can precipitate thyroid storm.

A

stress, infection, surgery

83
Q

Name 3 drugs you would give orally to a patient in thyroid crisis.

A
  • Oral carmbimazole
  • Oral propranolol
  • Oral potassium iodide
84
Q

How does hydrocortisone work to reverse a thyroid storm?

A

inhibits peripheral conversion of T4 to T3

85
Q

Why would measuring Plasma Growth Hormone levels alone not be diagnostic of Acromegaly?

A

GH secretion is pulsatile and can be elevated due to stress / pregnancy / puberty

86
Q

what receptor antibody is specific for Grave’s disease?

A

TSH-receptor antibody

87
Q

what is the difference between an endocrine and an exocrine gland?

A

endo secretes hormones directly into bloodstream, exo secretes into a duct first

88
Q

give 3 examples of primary adrenal insufficiency

A

Addisons, surgical removal, trauma

89
Q

give 3 examples of secondary adrenal insufficiency

A

steroids, congenital, neoplasm

90
Q

give 3 appropriate investigations for Cushing’s disease

A
  • 24 hour urinary collection
  • random blood cortisol test
  • dexamethasone suppression test
91
Q

explain on a cellular level how hyperglycaemia leads to insulin secretion

A
  • increased glucose uptake by cells
  • Glucose metabolism leads to increased levels of ATP within cell
  • Increased ATP causes K+ channels to close causing depolarisation of cell membrane
  • Ca2+ channels open and Ca2+ enters cell
  • Increased Ca2+ in cell causes exocytosis of insulin-containing vesicles
  • Insulin released by Pancreatic Beta cells / cells in Islets of Langerhans
92
Q

give 2 examples of microvascular and macrovascular complications of DM

A

micro: retinopathy, neuropathy
macro: peripheral artery disease, cerebrovascular disease

93
Q

what are the thyroid autoantibodies found in graves disease?

A

thyroglobulin and anti-thyroid peroxidase antibodies

94
Q

What medication is used to treat hypothyroidism?

A

synthetic levothyroxine

95
Q

what is the gold standard test for finding the CAUSE of primary hyper-aldosteronism?

A

adrenal vein sampling

96
Q

what is Conn’s disease in simple terms?

A

primary hyperaldosteronism

97
Q

briefly describe the renin-angiotensin-aldosterone system

A
  • renin is released by juxtaglomerular cells in response to decrease in renal perfusion
  • renin increases ang 1 formation from angiotensinogen
  • ang 1 turns to ang 2 via ACE released from lungs
  • ang 2 stimulates ADH secretion from posterior pituitary
98
Q

name and give an example of 1 drug used for the medical treatment of adrenal hyperplasia

A

aldosterone antagonists e.g. spironolactone

99
Q

give 3 common presenting symptoms of hyperaldosteronism

A

HTN, weakness/fatigue, headaches, cramps, polyuria/dipsia

100
Q

what is the triad of ketoacidosis?

A

hyperglycaemia, ketonaemia, acidaemia

101
Q

pathophysiology of ketoacidosis?

A
  • in absence of insulin
  • peripheral uptake of glucose by tissues is reduced
  • ketones are produced in absence of glucose and accumulate
102
Q

blood results for secondary hyperparathyroidism?

A

high PTH, hypocalcaemia, hyperphosphataemia

103
Q

what kind of HTN does addisons cause?

A

hypotension

104
Q

name 5 complications of long term steorid use

A

DM, Immunosuppression, Osteoporosis, Proximal muscle weakness, Thinned skin

105
Q

describe relapsing remitting MS

A

most common, acute attacks followed by periods of remission

106
Q

describe primary progressive MS

A

progressive deterioration from onset

107
Q

describe secondary progressive MS

A

relapsing remitting deterioration progressing onto straight onset

108
Q

describe progressive relapsing MS

A

progressive deterioration from onset with relapsing

109
Q

give 5 signs or symptoms of Cushing’s

A
  • mood change
  • acne
  • buffalo hump
  • osteoporosis
  • moon face
  • thinning of skin
110
Q

give 2 diagnostic tests of Cushing’s

A

24hr urine cortisol, overnight dexamethasone suppression test, ACTH plasma levels, pituitary MRI

111
Q

give 2 complications that may arise from Cushing’s

A

bone fractures, depression/mood changes, hypertension, infections, diabetes

112
Q

what would the blood results be for primary hyperparathyroidism?

A

high PTH, high calcium, low phosphate

113
Q

what is the karyotype for Turner’s syndrome?

A

45, XO

114
Q

what is first line step in addisonian crisis?

A

STAT dose of 100mg hydrocortisone

115
Q

what can Conn’s syndrome cause?

A

hypokalaemia

116
Q

why does polyuria occur in diabetes mellitus?

A

increased conc of glucose in the tubule urine means it cannot all be reabsorbed in the kidneys so more water is drawn in and a larger volume of urine is produced

past questions (11 decks)

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