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MSRA 2023 > Endo > Flashcards

Endo Flashcards

1
Q

Most aggressive subtype of thyroid ca which is often diagnosed late?

A

Anaplastic

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2
Q

Type of thyroid ca: typically upper lobe ca, typically facial flushing and diarrhoea
- what syndrome is is associated with?

A

Medullary thyroid ca
- flushing and diarrhoea due to calcitonin secretion

  • MEN2!
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3
Q

Most common type of thyroid ca?
Common iatrogenic cause

A

Papillary (popullary haha)
- caused by radiation to head and neck often, seen in children ++

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4
Q

Top 3 causes of high prolactin

A

Prolactinoma
Hypothyroidism (TRF stimulates both TSH and prolactin)
Drugs - dopamine antagonists

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5
Q

HbA1c targets in T2DM

A

For lifestyle only or + drug which doesn’t cause hypoglycaemia - aim 48

If on sulfonylurea/other hypoglycaemic drug - aim 53

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6
Q

State the indications for commencing SGLT2 inhibitors in T2DM at time of diagnosis

A

1st establish metformin therapy.
Then add sglt2 if:
Established CVD
Heart failure
QRISK >10%

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7
Q

TFT levels in sick euthyroid syndrome?

A

Low T4/T3
Normal TSH
- no sx of clinical hypothyroidism

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8
Q

TFT levels in sick euthyroid syndrome?

A

Low T4/T3
Normal TSH
- no sx of clinical hypothyroidism

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9
Q

Cause of primary haemochromatosis

A

HFE gene mutation (auto recessive)

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10
Q

Diabetes mellitus
Skin pigmentation
Liver cirrhosis

Diagnosis?

A

Haemochromatosis

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11
Q

Diabetes mellitus
Skin pigmentation
Liver cirrhosis

Diagnosis?

A

Haemochromatosis

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12
Q

Liver disease
+ psychiatric disorder

Diagnosis?

A

Wilson’s disease

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13
Q

What is cushings disease

A

Pituitary ACTH secreting tumour

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14
Q

Most common cause of Cushing’s syndrome?

A

Pituitary Adenoma (Cushings disease)

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15
Q

Dexamethasone suppression test
- if low dose is given, what is the result in:

  • adrenal adenoma
  • ectopic ACTH secreting tumour
  • pituitary tumour
A

No suppression of cortisol in any of them

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16
Q

High dose dexamethasone suppression test - what is the cortisol level in each scenario

  • adrenal adenoma
  • ectopic ACTH (aka secreting tumour)
  • pituitary adenoma
A

A high dose of Dex would ordinarily exert negative feedback on PITUITARY ACTH production, and subsequent cortisol release would decrease

  • adrenal adenoma: no suppression
  • ectopic ACTH: no suppression
  • pituitary adenoma: suppression of cortisol release
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17
Q

Biochemistry abnormality in Wilson’s disease

A

Low caeruloplasmin

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18
Q

What is pseudohypoparathyroidism

A

Low Ca and high PTH

Caused by an inherited resistance to PTH

19
Q

impaired fasting glucose

A

6-7

20
Q

impaired glucose tollerance

A

7.8 - 11 for 2 hour OGTT

21
Q

best blood test in suspected acromegaly?

A

IGF1

22
Q

best blood test in suspected addisons?

A

short synacthen test

23
Q

Cushings disease vs syndrome?

A

disease = pituitary tumour secreting ACTH

24
Q

1st line test in suspected cushings syndrome

A

overnight dexamethasone suppression
- Cortisol will be high the following morning in Cushings

25
Q

Fibrosis of the thyroid - rock hard neck lump

A

Riedels thyroiditis

26
Q

most common type of thyroid malignancy?

A

Papillary

27
Q

2 drugs which can cause DM

A

steroids
thiazides

28
Q

milk alkali syndrome
- triad of features

A

hypercalcemia
metabolic alkalosis
renal failure

29
Q

secondary hyperparathyroidism

Ca, phosphate, PTH levels?

A

CKD –> low calcitriol + kidneys unable to excrete phosphate

  • low Ca
  • high phosphate (and this binds to Ca and uses it all up!!)
  • high PTH
30
Q

ECG changes in hyper and hypocalcemia

A

hypercalcemia - osborn wave
hypocalcemia - QT prolongation

31
Q

vitamin D deficiency

Ca, phosphate, PTH levels?

A

unable to synthesise calcitriol

  • low Ca
  • low PTH
  • high PTH
32
Q

secondary vs tertiary hyperparathyroidism

A

secondary is due to CKD –> lowcalcitriol and low Ca–> high PTH in response

tertiary is due to prolonged secondary hyper PTH –> autonomous PTH secretion . therefore high ca and low PO4

33
Q

what is pseudohypoparathyroidism

A

resistance to PTH hormone.

34
Q

how to calculate anion gap

A

(Na+K)-bicarb - chloride

35
Q

most common cause worldwide of non toxic goitre

A

iodine deficiency

36
Q

3 top causes of high prolactin

A
  1. prolactinoma
  2. hypothyroidism
  3. dopamine antagonist = domperidone, metoclopramide
37
Q

De Quervains thyroiditis
what is it

A

Hyperthyroidism and fever

followed by hypothyroidism (TSH suppressed and T4 supplies run out)

38
Q

Most common neurological manifestation of diabetes?
Most serious neuro manifestation ?

A

Gustatory sweating

most serious - postural hypotension

39
Q

pt is tired
TSH high, T4 normal. has no thyroid autoantibodies. what do you do next?

A

i.e. subclinical hypothyroidism

  • repeat tests in 3 months
40
Q

congenital adrenal hyperplasia
-how does it present in girls vs boys
- key blood tests x2

A

girls: typically with ambiguous genitalia at birth
boys: normal genitalia therefore present at 1 week old with salt losing crisis

17 hydroxyprogesterone - high if 21-a-hydroxylase deficiency

short synACTHen test - will result in low cortisol if the non-salt losing form

41
Q

adrenocortical insufficiency in pt with meningitis - diagnosis

A

Waterhouse Friederichsen

42
Q

Features of MEN1

A

3Ps
- PTH high
- Pituitary tumour
- Pancreatic islet cell tumour

43
Q

Features of MEN2a vs 2b

A

Both MEN2s have:
- Medullary THYROID ca
- Phaeochromocytoma

2a) - high PTH
2b) - Marfanoid

MSRA 2023 (14 decks)

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