Endo Flashcards

Question

Hyperosmolar vs DKA

Answer 1

SGLT-2 inhibitors are increasingly being recommended. Older patients often have a QRISK score above 10%, making them fall into the “high risk” category for cardiovascular disease. NICE suggests considering SGLT-2 inhibitors alongside metformin as part of the first-line treatment in type 2 diabetics at high risk of cardiovascular disease. SGLT-2 inhibitors are recommended second-line as part of dual therapy in these patients. The significant potential side effect to remember is diabetic ketoacidosis. increased frequency of urinary tract infections and genital thrush due to lots of sugar passing through the urinary tract. Secondly, diabetic ketoacidosis. Patients starting SGLT-2 inhibitors are counselled about the features of DKA and when to seek emergency medical input.

Answer 2

where nodules develop on the thyroid gland, which are unregulated by the thyroid axis and continuously produce excessive thyroid hormones. It is most common in patients over 50 years.

Answer 3

the risk of acute pancreatitis in patients taking carbimazole. In your exams, look out for a patient on carbimazole presenting with symptoms of pancreatitis (e.g., severe epigastric pain radiating to the back).

Answer 4

Both carbimazole and propylthiouracil can cause agranulocytosis, with a dangerously low white blood cell counts. Agranulocytosis makes patients vulnerable to severe infections. A sore throat is a key presenting feature of agranulocytosis. In your exams, if you see a patient with a sore throat on carbimazole or propylthiouracil, the cause is likely agranulocytosis. They need an urgent full blood count and aggressive treatment of any infections.

Answer 5

newborn blood spot screening test.

Answer 6

Hyperaldosteronism is worth remembering as the most common cause of secondary hypertension.

Answer 7

Multiple endocrine neoplasia type 2 (MEN 2) Neurofibromatosis type 1 Von Hippel-Lindau disease

Answer 8

Anti-TTG and anti-EMA antibodies are IgA. Some patients have an IgA deficiency. When you test for these antibodies, it is important to test for total Immunoglobulin A levels because if total IgA is low because they have an IgA deficiency then the coeliac test will be negative even when they have coeliacs. In this circumstance, you can test for the IgG version of anti-TTG or anti-EMA antibodies or simply do an endoscopy with biopsies.

Answer 9

Remember, “Distend Him” said the obstructed bowel Diverticulitis IBD (**CD** & UC), I**schaemic Bowel disease Surgery (adhesions) Tumours Endometriosis** Neonanatal Hirschsprung’s **Duodenal gallstones ** **Hernias Intussusception Malrotation**

Answer 10

Ivor- Lewis procedure

Answer 11

The reason urea rises in upper GI bleeds is that the blood in the GI tract gets broken down by the acid and digestive enzymes. One of the breakdown products is urea and this urea is then absorbed in the intestines.

Answer 12

Can be used clinically to predict the trajectory of a fistula tract, depending on the location of the external opening .

Answer 13

A staghorn calculus is where the stone forms in the shape of the renal pelvis, giving it a similar appearance to the antlers of a deer stag. The body sits in the renal pelvis with horns extending into the renal calyces. They may be seen on plain X-ray films. Most commonly, this occurs with stones made of struvite. In recurrent upper urinary tract infections, the bacteria can hydrolyse the urea in urine to ammonia, creating the solid struvite.

Answer 14

Rise in creatinine of ≥ 25 micromol/L in 48 hours Rise in creatinine of ≥ 50% in 7 days Urine output of < 0.5ml/kg/hour for > 6 hours

Answer 15

Goodpasture syndrome and granulomatosis with polyangiitis (AKA Wegener’s granulomatosis). Goodpasture syndrome is associated with anti-GBM antibodies, whereas Wegener’s granulomatosis is a type of vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA). Patients with Wegener’s granulomatosis may also have a wheeze, sinusitis and a saddle-shaped nose.

Answer 16

postural hypotension. If an older man presents with lightheadedness on standing or falls, check whether they are on tamsulosin and check their lying and standing blood pressure. The most common side effect of finasteride is sexual dysfunction (due to reduced testosterone).

Answer 17

The right testicular vein drains directly into the inferior vena cava. The left testicular vein drains into the left renal vein. Most varicoceles (90%) occur on the left due to increased resistance in the left testicular vein. A left-sided varicocele can indicate an obstruction of the left testicular vein caused by a renal cell carcinoma.

Answer 18

transilluminated

Answer 19

Nitrofurantoin needs to be avoided in the third trimester as there is a risk of neonatal haemolysis (destruction of the neonatal red blood cells). Trimethoprim needs to be avoided in the first trimester as it works as a folate antagonist. Folate is essential in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (e.g., spina bifida). It is not known to be harmful later in pregnancy but is generally avoided unless necessary.

Answer 20

gram-negative, anaerobic, rod-shaped bacteria

Answer 21

Features of Wernicke’s encephalopathy Confusion Oculomotor disturbances (disturbances of eye movements) Ataxia (difficulties with coordinated movements) Features of Korsakoffs syndrome Memory impairment (retrograde and anterograde) Behavioural changes

Answer 22

Type 1 Autoantibodies: Anti-nuclear antibodies (ANA) Anti-smooth muscle antibodies (anti-actin) Anti-soluble liver antigen (anti-SLA/LP) Type 2 Autoantibodies: Anti-liver kidney microsomes-1 (anti-LKM1) Anti-liver cytosol antigen type 1 (anti-LC1)

Answer 23

Kernicterus is a type of brain damage caused by excessive bilirubin levels

Answer 24

Fat entering the digestive system causes cholecystokinin (CCK) secretion from the duodenum. CCK triggers contraction of the gallbladder, which leads to biliary colic. Patients with gallstones and biliary colic are advised to avoid fatty foods to prevent CCK release and gallbladder contraction.

Answer 25

P – Pa02 < 8 KPa A – Age > 55 N – Neutrophils (WBC > 15) C – Calcium < 2 R – uRea >16 E – Enzymes (LDH > 600 or AST/ALT >200) A – Albumin < 32 S – Sugar (Glucose >10)

Answer 26

Ascites is basically fluid in the peritoneal cavity. The increased pressure in the portal system causes fluid to leak out of the capillaries in the liver and bowel and in to the peritoneal cavity. The drop in circulating volume caused by fluid loss into the peritoneal space causes a reduction in blood pressure entering the kidneys. The kidneys sense this lower pressure and release renin, which leads to increased aldosterone secretion (via the renin-angiotensin-aldosterone system) and reabsorption of fluid and sodium in the kidneys. Cirrhosis causes a transudative, meaning low protein content, ascites.

Answer 27

Confusion Asterixis: 'liver flap', arrhythmic negative myoclonus with a frequency of 3-5 Hz Constructional apraxia: inability to draw a 5-pointed star Triphasic slow waves on EEG

Answer 28

It is worth noting that a new onset of diabetes, or a rapid worsening of glycaemic control type 2 diabetes, can be a sign of pancreatic cancer. Keep pancreatic cancer in mind if a patient in your exams or practice has worsening glycaemic control despite good lifestyle measures and medication.

Answer 29

First line is monotherapy with methotrexate, leflunomide or sulfasalazine. Hydroxychloroquine can be considered in mild disease and is considered the “mildest” anti rheumatic drug. Second line is 2 of these used in combination. Third line is methotrexate plus a biological therapy, usually a TNF inhibitor. Fourth line is methotrexate plus rituximab

Answer 30

The most important biologics to remember are the TNF inhibitors adalimumab, infliximab and etanercept and it is also worth remembering rituximab. The others are very unlikely to come up in your exams but are worth being aware of. Just remember they all lead to immunosuppression so patients are prone to serious infections. They can also lead to reactivation of dormant infections such as TB and hepatitis B.

Answer 31

Methotrexate: Bone marrow suppression and leukopenia and highly teratogenic Leflunomide: Hypertension and peripheral neuropathy Sulfasalazine: Male infertility (reduces sperm count) Hydroxychloroquine: Nightmares and reduced visual acuity Anti-TNF medications: Reactivation of TB or hepatitis B Rituximab: Night sweats and thrombocytopenia

Answer 32

In a young patient presenting with a single acutely swollen joint always think of gonococcus septic arthritis until proven otherwise. Gonorrhoea infection is common and delaying treatment puts the joint in danger. In your exams it might say the gram stain revealed a “gram-negative diplococcus”. The patient may have urinary or genital symptoms to trick you into thinking of reactive arthritis but remember that it is important to exclude gonococcal septic arthritis first as this is the more serious condition.

Answer 33

Flucloxacillin plus rifampicin is often first line

Answer 34

DKA is caused by uncontrolled lipolysis which results in an excess of free fatty acids that are ultimately converted to ketone bodies

Answer 35

* pH >7.3 and * blood ketones < 0.6 mmol/L and * bicarbonate > 15.0mmol/L

Answer 36

hyperglycaemia → ↑ serum osmolality → osmotic diuresis → severe volume depletion