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Phase 2a mocks > Endo > Flashcards

Endo Flashcards

1
Q

Where is aldosterone produced / secreted?

A

Zona glomerulosa of the adrenal cortex

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2
Q

Where is cortisol produced / secreted ?

A

Zona fasciculata of the adrenal cortex

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3
Q

Where are androgens produced / secreted?

A

Zona reticularis of the adrenal cortex

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4
Q

In a pt with T2DM, who is already on Metformin but who’s blood glucose levels are not well managed, what is their second line treatment option?

A

Add a sulphonylurea to their metformin, eg Gliclazide

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5
Q

What is the mechanism of action of Metformin?

A
  • Reduces gluconeogenisis in the liver
  • Increases insulin sensitivity by increasing glucose uptake / use in skeletal muscle
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6
Q

What is the mechanism of action of Gliclazide?

A

A sulphonylurea
Bind to the ATP dependent K+ channels on pancreatic beta cells to promote insulin secretion

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7
Q

What is the mechanism of action of Sitagliptin?

A

DPP4 inhibitor
Increases the levels of incretins by decreasing their peripheral breakdown, therefore allowing the production of more insulin

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8
Q

What is the mechanism of action of Canagliflozin?

A

SGLT-2 inhibitor
Reversibly inhibits sodium glucose co-transporter 2 in the renal proximal convoluted tubule to reduce glucose reabsorption

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9
Q

What is the diagnostic criteria for DKA?

A

Blood glucose >11mmol/L
Plasma ketones >3mmol/L
Blood pH <7.3
Bicarbonate <15mmol/L

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10
Q

What is the most common subtype of thyroid carcinoma?

A

Papillary (70%)

Often young females, very good prognosis

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11
Q

What is the second most common type of thyroid carcinoma?

A

Follicular (20%)

Well differentiated, worse prognosis than papillary

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12
Q

Give an example of an exogenous cause of Cushing’s Syndrome

A

Prolonged glucocorticoid use, e.g. Prednisolone, Hydrocortisone

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13
Q

Give two examples of endogenous, corticotropin (ACTH) dependent cause of Cushing’s Syndrome

A
  • Pituitary adenoma
  • Small cell lung cancer causing ectopic production of cortisol
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14
Q

Give two examples of endogenous, corticotropin (ACTH) independent causes of Cushing’s Syndrome

A
  • Adrenal adenoma
  • Adrenal carcinoma
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15
Q

What TSH, T3, T4 levels are expected to diagnose Grave’s disease?

A

Low TSH
High T3/T4

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16
Q

What kind of antibody is involved in Grave’s disease?

A

IgG

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17
Q

Describe the pathology of Graves’ disease

A

Serum IgG antibodies bind to TSH receptors on the thyroid. Increased T3 and T4 production and secretion. Hyperplasia of the thyroid follicular cells. Hyperthyroidism and goitre.

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18
Q

What phrase is used to remember the symptoms of hypercalcaemia?

A

Painful bones, renal stones, psychiatric moans, abdominal groans

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19
Q

What is the gold standard diagnostic test for carcinoid syndrome?

A

Serum Chromagranin-A (raised in carcinoid syndrome)
And an octreotide scan

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20
Q

What is the gold standard investigation for Addison’s disease?

A

Synacthen test (ACTH stimulation test)

No rise in cortisol = Addison’s

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21
Q

What ECG changes are expected in hyperkalaemia?

A

Absent P waves, long PR interval, wide QRS complex, tall tented T wave

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22
Q

List 4 causes of pitting oedema

A
  • pregnancy
  • low serum albumin
  • venous insufficiency
  • cardiac failure
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23
Q

What are 3 clinical features of PCOS?

A
  • hirtuitsm
  • acne
  • oligoamenorrhoea
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24
Q

List 5 clinical features of DKA

A
  • abdo pain
  • polyuria
  • polydipsia
  • Kussmaul’s respiration
  • acetone/pear drop smell to breath
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25
Q

Describe the immediate management of DKA

A
  • fluid replacement (isotonic saline)
  • insulin
  • potassium
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26
Q

What hormones are secreted by the anterior pituitary?

A

FLAT PiG

-FSH
-LH
-ACTH
-TSH
-Prolactin
-GH

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27
Q

What is the function of glucagon?

A
  • glycogenolysis
  • gluconeogenesis
  • lipolysis
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28
Q

Describe the secretion of glucagon

A

Secreted by α cells in the islets of Langerhans in response to low blood glucose

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29
Q

Describe the action of glucagon

A
  • acts on the liver to convert glycogen to glucose
  • stimulates lipolysis and muscle breakdown -> glucose formation from lactic acid and amino acids
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30
Q

What is the function of PTH? (4)

A
  • indirect stimulation of osteoclasts / direct stimulation of osteoblasts to re absorb bone and increase serum calcium
  • increase calcium reabsorption in the kidney
  • increase calcium absorption in the small intestine via activation of vitamin D
  • decreases phosphate reabsorption in the kidney / increased phosphate loss
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31
Q

What are the contents of the spermatic cord?

A

RULE OF THREE

3 arteries:
- testicular artery
- deferential artery
- cremasteric artery

3 nerves:
- genital branch of the genitofemoral nerve
- cremasteric nerve
- sympathetic nerve fibres

3 fascias:
- external spermatic fascia
- cremasteric fascia
- internal spermatic fascia

3 others:
- ductus deferens
- processus vaginalis
- lymphatic vessels

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32
Q

What is the GS diagnostic test for Addisons?

A

Synacthen test

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33
Q

‘Lean, tanned, tired, tearful’ =?

A

Addison’s

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34
Q

What electrolyte imbalance does SIADH cause?

A

Hyponatraemia

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35
Q

What electrolyte imbalance is associated with salbutamol?

A

Hypokalaemia

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36
Q

What test is used to differentiate between cranial and nephrogenic diabetes insipidus?

A

Desmopressin test

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37
Q

What are the acromegaly investigations, in order

A
  1. IGF-1
  2. Oral glucose tolerance test
  3. Pituitary function tests
  4. MRI pituitary
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38
Q

What are the two main causes of primary hyperaldosteronism?

A

1 = bilateral idiopathic adrenal hyperplasia
2 = adrenal adenoma

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39
Q

What are the 3 main features of primary hyperaldosteronism?

A
  • hypertension
  • hypokalaemia
  • metabolic alkalosis
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40
Q

What is the first line investigation for primary hyperaldosteronism?

A

Aldosterone to renin ratio

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41
Q

What are the 4 causes of primary hyperparathyroidism?

A
  • solitary adenoma
  • hyperplasia
  • multiple adenoma
  • carcinoma
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42
Q

45F presents with hirtuism, central obesity, striae.
Low ACTH, no cortisol suppression following high dose dexamethasone suppression.
Most likely diagnosis?

A

ACTH independent cause of Cushing’s syndrome.

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43
Q

76F, presents with polyuria, polydipsia.
Bloods:
Fasting glucose = normal
Ca2+ = high
Phosphate = low
PTH = normal
ADH = normal

Most likely diagnosis?

A

Primary hyperparathyroidism

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44
Q

35M. Postural hypotension, headaches, increased sweating, palpitations.
Urine sample: high carecholamines and metanephrines.

Most likely diagnosis and GS diagnostic investigation?

A

Pheochromocytoma

Elevated plasma free metanephrine

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45
Q

What are the typical signs of Graves’ disease?

A
  • tremor
  • palpitations
  • pretibial myxoedema
  • ophthalmology
  • weight loss
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46
Q

What is the acute management of DKA, in order?

A

1 = IV fluids
2 = insulin
3 = electrolyte correction

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47
Q

Hypothyroidism symptoms?

A
  • weight gain
  • cold intolerance
  • constipation
  • menorrhagia
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48
Q

Pt forgot to take Crohn’s meds while away on holiday.
Symptoms: tired, loss of appetite, postural hypotension.

What is the cause of her symptoms?

A

Secondary adrenal insufficiency due to sudden corticosteroid withdrawal

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49
Q

List 5 cancerous causes of SIADH

A
  • small cell carcinoma
  • prostate cancer
  • pancreatic cancer
  • lymphoma
  • cancer of the thymus
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50
Q

What ECG changes are seen in hyperkalaemia?

A
  • tall tented T waves
  • absent/flat P wave
  • prolonged PR interval
  • wide QRS complex
  • bradycardia
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51
Q

State 5 signs/symptoms of hyperkalaemia

A
  • Muscle weakness/ Painful cramping / Paraesthesia
  • Neurological derangement/ irritability/ anxiety
  • Palpitations
  • Abdo cramping and diarrhoea
  • Dyspnoea
  • Hyperreflexia
52
Q

What symptoms are caused by a GH secreting pituitary adenoma?

A
  • large hands/feet
  • coarsening of facial features
  • large tongue
  • excessive sweating
53
Q

Give 3 complications of Acromegaly

A
  • obstructive sleep apnoea
  • T2DM
  • cardiomyopathy
  • hypertension
  • IHD/stroke
  • colorectal cancer
54
Q

What is the first line investigation for Acromegaly

A

Serum IGF-1
Will be raised in acromegaly

55
Q

What is the curative treatment of Acromegaly?

A

Transsphenoidal resection of the pituitary gland

56
Q

Apart from resection, what other treatments can be used in Acromegaly?

A
  • Somatostatin analogues e.g. octreotide
  • Growth hormone antagonists e.g. Pegvisomant
  • DA agonists e.g. Cabergoline
  • Stereotactic gamma knife
57
Q

Polyuria, polydipsia. DD? (6)

A
  • Diabetes mellitus
  • Diabetes insipidus
  • SIADH
  • Primary polydipsia
  • Hypercalcaemia
  • Primary hyperparathyroidism
58
Q

What is the most common cause of primary hyperparathyroidism?

A

Solitary adenoma

59
Q

Give 5 symptoms of primary hyperparathyroidism

A
  • Bone pain
  • Renal stones
  • GI upset e.g. gastric ulcer, diarrhoea
  • depression
  • polyuria
  • constipation
60
Q

What is the most common cause of Cushing’s Syndrome

A

Exogenous, corticosteroid use

61
Q

30F. Generalised fatigue, headaches, paraesthesia. Muscle cramps in legs, polyuria, polydipsia.

Give 3 DD

A
  • primary hyperaldosteronism
  • SIADH
  • DM
  • renal artery stenosis
  • DI
62
Q

What electrolyte imbalance is associated with primary hyperaldosteronism?

A

Hypokalaemia

63
Q

What is the first line investigation of hyperaldosteronism and how do you distinguish between primary and secondary?

A

Aldosterone to renin ratio

Primary = high ratio
Secondary = low ratio

64
Q

What ECG changes can be seen in hypercalcaemia?

A

Shortening of the QT interval

65
Q

Name 2 signs on clinical examination that can be seen on hypocalcaemia

A

Chvostek’s sign - tap over the facial nerve causes spasm of the facial muscles
Trousseau’s sign - inflate the BP cuff to 20mmHg above systolic for 5 mins and the hand should form a claw

66
Q

From which artery does the superior thyroid branch from?

A

External carotid artery

67
Q

Give 4 functions of parathyroid hormone

A
  • Binds to osteoblasts which signal to osteoclasts to cause resorption of bone and release calcium.
  • Active reabsorption of calcium and magnesium from the distal convoluted tubule. Decreases reabsorption of phosphate.
  • Increases activated vitamin D via calcitonin
  • increases intestinal calcium absorption via activated vitamin D
68
Q

Give 3 generalised symptoms of a pituitary adenoma

A

• Headaches
• Vision problems (double vision, vision loss)
• Nausea or vomiting
• Changes in behavior, including hostility, depression and anxiety
• Changes in the sense of smell
• Nasal drainage
• Sexual dysfunction
• Infertility
• Fatigue (extreme tiredness)
• Unexplained weight gain or loss
• Achy joints or muscle weakness

69
Q

What is carcinoid syndrome?

A

usually occurs when metastases are present in the liver and release serotonin into the systemic circulation
may also occur with lung carcinoid as mediators are not ‘cleared’ by the liver

70
Q

Give 3 signs / symptoms of carcinoid syndrome

A

flushing (often the earliest symptom)
diarrhoea
bronchospasm
hypotension
Abdominal cramps

71
Q

What drug is commonly used to reduce thyroid hormone production?

Describe its mechanism of action

A

Carbimazole

Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin
Causing decreased thyroid hormone production

72
Q

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

A

• Nausea/Vomiting
• Abdominal Pain
• Recued Conscious Levels
• Kussmauls Breathing
• Fruity Breath
• Polydipsia/Polyuria
• Hypotension
• Tachycardia

73
Q

What cells are pheochromocytomas composed of

A

Chromaffin cells

74
Q

3 symptoms of pheochromocytoma?

A

Hypertension
Tachycardia/Palpitation
Diaphoresis
Hypertensive Retinopathy
Pallor
Diabetes

75
Q

Name 2 causes of Acromegaly

A

Benign pituitary adenoma (GH secreting)
Ectopic carcinoid tumour (GH secreting) e.g. small cell lung cancer

76
Q

Give 3 signs of Acromegaly

A
  • skin darkening
  • coarsening face
  • wide node
  • large supraorbital ridge
  • interdental separation
  • deep voice
  • large tongue
  • headaches
  • excessive sweating
  • hands/feet growth
77
Q

Name 2 investigations for diagnosing Acromegaly and the result of each.

A
  • Oral glucose tolerance test: raised
  • Serum IGF-1: raised
78
Q

Why would measuring plasma growth hormone levels alone not be diagnostic of Acromegaly?

A

GH secretion is pulsatile
GH levels can also be elevated in pregnancy, stress, puberty

79
Q

Name 2 types of drug used in the treatment of Acromegaly and give examples

A
  • Somatostatin analogues e.g. IM octreotide
  • GH receptor antagonist e.g. SC Pegvisomant
  • Dopamine agonist e.g. oral cabergoline
80
Q

List the tests and diagnostic criteria for DKA (5)

A

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

81
Q

Name 3 RFs for DKA

A
  • stopped insulin
  • infection e.g. UTI
  • pancreatitis
  • undiagnosed DMT1
  • MI
  • surgery
82
Q

Name 3 potential complications of DKA

A
  • hypotension
  • coma
  • cerebral oedema
  • hypothermia
  • DVT
  • pneumonia
83
Q

What aspect on a urine dipstick would indicate DI instead of DM

A

Glucose negative in DI

84
Q

What test us used to differentiate cranial and nephrogenic DI and what result would indicate cranial?

A

IM desmopressin test

Urine becomes concentrated in cranial

85
Q

Pt found to have cranial DI. What class of medication is given and give an example

A

ADH analogue e.g. desmopressin

86
Q

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

A

Inhibits prostaglandins which stops their inhibition of ADH action

87
Q

What type of hypersensitivity reaction in Graves’ disease?

A

Type II

88
Q

What causes hyperparathyroidism in Graves?

A

Pathological stimulation of TSH receptors by IgG autoantibodies

89
Q

Why ask about vitiligo/Addisons in a Graves history?

A

Graves is associated with other autoimmune diseases

90
Q

Graves diagnosis: TSH , T3/4 levels?

A

TSH low

T3/4 raised

91
Q

If left untreated, what is a possible complication of Graves?

A

Thyroid storm

92
Q

What rare but serious adverse effect of Carbimazole needs to be monitored?

A

Agranulocytosis

93
Q

What class of meds is prescribed for bulging eyes in Graves?

A

High dose glucocorticoids

94
Q

Why would an oral glucose tolerance test help diagnose acromegaly?

A

Growth hormone is normally inhibited by glucose
Growth hormone will stay high in an OGTT
In a healthy person GH would fall in an OGTT

95
Q

What is IGF-1?

A
  • insulin like growth factor 1
  • produced by the liver
  • endocrine hormone
  • promotes growth in most cells
  • production is stimulated by GH
96
Q

Hyperkalaemia management? 1st and 2nd steps

A

1=Calcium gluconate
2=Insulin and dextrose

97
Q

What electrolyte imbalance can be caused by ectopic ACTH from small cell lung cancer?

A

Hypokalaemia

98
Q

What hormone imbalance can lithium cause?

A

elevated TSH

99
Q

Teenage Male

Headache, double vision, drowsiness, polyuria, polydipsia.

Low FT4, low 0900 cortisol, positive pregnancy test

Diagnosis?

A

Germinoma

100
Q

T1DM hypoglycaemia symptoms?

A
  • palpitations
  • poor concentration
  • shaking
  • sweating
101
Q

What is the most specific antibody to Graves’ disease?

A

TSH receptor antibody

102
Q

What blood volume and sodium levels are found in SIADH?

A

Normovolaemia
Hyponatraemia

103
Q

What drug can be used to treat the hyponatraemia in SIADH?

A

Tolvaptan

104
Q

What symptoms does phaeochromocytoma present with?

A
  • raised BP
  • raised HR
  • sweating
  • pallor
105
Q

What is phaeochromocytoma?

A

Adrenal medulla tumour that secretes chatecholamines

106
Q

What is the first line management of phaeochromocytoma?

A

Αlpha blockers e.g. Penoxybenzamine

107
Q

What is the genetic defect in Klinefelter’s syndrome?
What symptoms does it cause?
What hormones are raised?

A

47 XXY

Learning difficulties, male phenotype, small testicles

Raised LH and FSH

(Hypergonadotrophic hypogonadism)

108
Q

Central obesity, weight gain, purple striae.

Most likely diagnosis?

A

Cushing’s syndrome

109
Q

Widely spaced nipples, delayed menarche, webbed neck

Diagnosis?

A

Turner’s syndrome

110
Q

List 6 symptoms/signs of hypocalcaemia

A
  • Trousseau’s sign
  • Chvosteks sign
  • Convulsions
  • Arrhythmia
  • Tetany
  • Numbness
111
Q

First line treatment for hypocalcaemia?

A

Calcium gluconate

112
Q

What is the difference between exocrine and endocrine ?

A

exocrine glands secrete substances into a ductal system to an epithelial surface, endocrine glands secrete products directly into the bloodstream

113
Q

What blood pressure should be aimed for in diabetes mellitus?

A

130/80 mmHg

114
Q

Name a test that could be done to assess potential organ damage from hypertension in diabetes. Also say what the test would show.

A

Echo or ECG- to see left ventricular hypertrophy or past myocardial infarction

Urine analysis- shows proteinuria to check kidney function

Fundoscopy- assess hypertensive retinopathy

115
Q

What is the triad of ketoacidosis?

A
  • hyperglycaemia
  • ketonaemia
  • acidaemia
116
Q

Describe how ketoacidosis occurs

A

In absence of insulin
Unrestrained increase in hepatic gluconeogenesis/ peripheral uptake by tissues is reduced
Ketones produced as bodies require glucose in cells/ ketone bodies accumulate

117
Q

5 signs of Graves’ disease

A
  • Graves opthalmology
  • tachycardia
  • hyperreflexia
  • goitre
  • clubbing
  • AF
  • dyspnoea
118
Q

Briefly describe the pathophysiology of Graves’ disease

A
  • TSH receptor autoantibodies cause increased stimulation of the thyroid gland, causing increased T3/T4
119
Q

What is the Tx of graves?

A
  • Carbimazole
  • Radioiodine therapy
  • thyroidectomy
120
Q

What is the immediate management of hyperthyroidism?

A

Βeta blocker e.g. Propanolol

121
Q

Graves: medication used to TREAT ?

A

Thionamides e.g. Carbimazole

122
Q

Serious side effect of carbimazole ?

A

Agranulocytosis

123
Q

What is HLA B27 typically associated with?

A

Seronegative spondyloarthridities eg Ankylosing spondylitis

124
Q

What is anterior uveitis? What are some common symptoms?

A

Inflammation of the anterior portion of the eves - iris and ciliary body

Symptoms: red eye, photophobia, blurred vision, pain

125
Q

Which uncontrolled metabolic process causes DKA/

A

Uncontrolled lipolysis resulting in an excess of free fatty acids which are converted to ketone bodies

126
Q

Presenting with recurrent renal stones. Bloods tests show increased calcium and decreased phosphate.
Likely diagnosis?

A

Hyperparathyroidism - increases PTH

Phase 2a mocks (11 decks)

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