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FINALS: Passmed > Endo > Flashcards

Endo Flashcards

1
Q

Flushing, diarrhoea, bronchospasm, tricuspid stenosis, hypotension, pellagra →
Ix?
Tx?

A

CARCinoid:
- Cutaneous flushing
- Asmathic wheezing
- RHF (tricuspid valve)
- Cramping & diarrhoea

carcinoid with liver mets
urinary 5-HIAA
somatostatin analogues e.g. octreotide

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2
Q

Acromegaly is associated with which heart condition

A

cardiomyopathy

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3
Q

In type 1 diabetics, recommend monitoring blood glucose __________ (frequency)______

A

at least 4 times a day, including before each meal and before bed

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4
Q

liraglutide, exenatide are

A

GLP-1

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5
Q

___(drug)______ reduces cerebral oedema

A

dexamethasone

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6
Q

elderly man admitted to hospital with pneumonia
TSH normal, T4 reduced
what do you do?

A

nothing, sick euthyroid is common in the elderly and unwell

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7
Q

Headaches, amenorrhoea, bitemporal superior quadrantanopia–>

A

polactinoma

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8
Q

Addisonian crisis- tx?

A

IV hydrocortisone

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9
Q

how often must T1 diabetics monitor their blood glucose?

A

at least 4 times a day, including before each meal and before bed

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10
Q

tx for bilateral adrenocortical hyperplasia?

A

aldosterone antagonist e.g. spironolactone (cant do surgery as cant completely remove pts ability to produce aldosterone and cortisol)

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11
Q

Endocrine parameters reduced in stress response:

A

Insulin
Testosterone
Oestrogen

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12
Q

triad of sweating, headaches, and palpitations in association with severe hypertension - Ix?

A

Phaeochromocytoma - plasma and urinary metanephrines

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13
Q

pioglitazone is C/I in

A

HF

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14
Q

The early stages of diabetic nephropathy are associated with________, in contrast to most other causes of CKD

A

enlarged kidneys

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15
Q

what BMI does someone have to be to qualify for GLP memetic tx?

A

35

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16
Q

what can you use to differentiate between the different types of diabetes?

A
  • c-peptide levels
  • diabetic specific antibody levels (ab to glutamic acid decarboxylase or anti-GAD)
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17
Q

Thyrotoxic storm is treated with ___________________________________

A

beta blockers, propylthiouracil and hydrocortisone

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18
Q

clues that it’s secondary HTN and not primary

A
  • persistently high or malignant blood pressure
  • labile blood pressure measurements
  • young age and electrolyte abnormalities
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19
Q

what is tertiary hyperparathyoidism?

A

Tertiary hyperparathyroidism usually occurs after prolonged secondary hyperparathyroidism – the
glands become autonomous, and so produce excessive PTH even after the cause of hypocalcaemia (in this case, CKD 4) has been corrected; this then causes the hypercalcaemia that typifies tertiary hyperparathyroidism.

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20
Q

Hyperparathyroid: which disease presents with

  1. Raised PTH, raised Ca, low phosphate
  2. Raised PTH, low/normal Ca, raised Phosphate, low vitamin D
  3. Raised/normal Ca, raised PTH, low/normal phosphate, normal/low vit D, raised ALP
A

primary
secondary
tertiary

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21
Q
  1. complication of treating hyperNa
  2. complication of treating hypoNa
A
  1. cerebral oedeoma
  2. Central pontine myelinolysis
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22
Q

how to distinguish between unilateral adenoma and bilateral hyperplasia in Conn’s?

A

adrenal venous blood sampling

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23
Q

Boerhaave’s syndrome

A

transmural oesophageal perforation secondary to an episode of forceful emesis

This condition typically presents with a triad of vomiting/retching; severe retrosternal chest pain, typically radiating to the back and subcutaneous emphysema

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24
Q

what abx increases risk of cranial HTN?

A

doxycycline

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25
Q

All proximal scaphoid pole fractures require ________

A

surgical fixation

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26
Q

The PTH level in primary hyperparathyroidism may be ___________

A

normal

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27
Q

features of acromegaly

A
  • coare facial apperance
  • spade-like hands
  • increase in shoe size
  • large tongue, prognathism, interdental spaces
  • excessive sweating and oily skin
  • features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
  • galactorrhoea
28
Q

complications of acromegaly

A

hypertension
diabetes
cardiomyopathy
colorectal cancer

29
Q

Ix for acromegaly

A
  1. IGF-1 + OGTT
  2. OGTT should suppress GH but won’t
30
Q

Tx options of acromegaly

A

1st line: acromegaly
2nd line: somatostatin analgoue (octreotide), GH receptor antagonist (pegivisomant)

31
Q

causes of hyperprolactinoma

A
  • pituitary adenoma
  • hypothyroidism
  • PCOS
  • SE of haloperidol
32
Q

SGLT2 inhibitors should be given in addition to metformin if:

A
  • pt has high risk of developing CVD (QRISK>10%)/CHF
33
Q

T2DM sick-day rules with medications

A
  • don’t stop insulin
  • stop metformin/sulfonylureas
34
Q

Pathophysiology of DKA

A

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

35
Q

Hashimoto’s thyroiditis is associated with ________

A

MALT lymphoma

36
Q

endo syndromes that can cause hyperCa

A

acromegaly, thyrotoxicosis, Addison’s

37
Q

following a change in thyroxine dose thyroid function tests should be checked after

A

8-12 weeks

38
Q

what reduces the absorption of levothyroxine?

A

iron, calcium carbonate
give at least 4 hours apart

39
Q

investigation of hypopituitarism

A

insulin stress test

IV insulin given, GH and cortisol levels measured
with normal pituitary function GH and cortisol should rise

40
Q

what medications can reduce hypoglycaemic awareness?

A

beta-blockers

41
Q

3 types of MEN + inheritence pattern

A

AD

MEN1: 3Ps - hyperparathyroid, pituitary (prolactinoma), pancreas (insulinoma, gastrinoma –> peptic ulcer)

MEN2: parathyroid, phaeochromocytoma

MEN3: phaeochromocytoma

42
Q

myxoedema coma - Px and Tx?

A

Px: confusion, hypothermia
Tx: IV fluids, levothyroixine, corticosteroids [to cover for ?Addisons]

43
Q

alpha-blocker example

A

phenoxybenzamine

44
Q

Ix if you suspect a pituitary adenomna

A
  • MRI head with contrast
  • formal visual field testing
  • pituitary blood profile (incl GH, prolactin, ACTH, FSH, LH, TFTs)
45
Q

Most common cause of primary hyperaldosteronism

A

bilateral adrenal hyperplasia

46
Q

Tx for primary Conn’s?

A

spironolactone

47
Q

how does sick euthyroid syndrome present

A

TSH inappropriately normal, thyroxine and T3 low

No tx, recover when recover from systemic illness

48
Q

sublinical hyperthyroidism: Ix findings and Px? Why is it bad?

A

Ix: LOW TSH, normal free thyroxine
Px: multiondular goitre in elderly females

Bad bc AF, osteoporosis

49
Q

sublinical hypothyroidism: Ix findings and Px? Why is it bad?

A

Ix: TSH raised, T3 and T4 normal

risk of progressing to over hypothyroidism

50
Q

thyroid cancers - P-FMAL

A

Papillary (most common, young females)
Follicular
Medullary (secrete calcitonin, part of MEN2)
Anaplastic
Lymphoma (associated with Hashimoto’s thyroiditis)

51
Q

what do you replace first in secondary hypothyroidism?

A

steroids before the thyroxine

52
Q

thyrotoxic storm: in addition to beta-blockers and anti-thyroid drugs, what do you give?

A

dexamethasone

53
Q

toxic multinodular goitre - Ix and Tx

A

Ix: nuclear scintigraphy reveals patchy uptake
Tx: radioodine therapy

54
Q

________ is the key parameter to monitor in patients with hyperosmolar hyperglycaemic state

A

Serum osmolality

55
Q

causes of prolactin - all ‘Ps’

A

pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

56
Q

Patients with type I diabetes and a BMI > 25 should be considered for ______ in addition to insulin

A

metformin

57
Q

Over-replacement with thyroxine increases the risk for _________

A

osteoporosis

58
Q

Asymptomatic patients with an abnormal HbA1c or fasting glucose

A

must be confirmed with a second abnormal reading before a diagnosis of type 2 diabetes is confirmed

59
Q

_______________ is a cause of cranial diabetes insipidus

A

Hereditary haemochromatosis

60
Q

The diagnosis of type 2 diabetes mellitus (T2DM) can only be made if

A

there is one elevated glucose measurement and the presence of symptoms, or if two glucose measurements at separate time points show elevated glucose.

61
Q

Glitazones - associated with what SE

A

fractures

62
Q

_______ (diabetic drug) ____ should be stopped following a myocardial infarction

A

Metformin (risk of lactic acidosis)

63
Q

IGT itself can be defined by OGTT 2h glucose of

A

between 7.8 and 11.1mmol/L alone.

64
Q

A fasting glucose greater than or equal to_____________ implies impaired fasting glucose (IFG)

A

6.1 but less than 7.0mmol/l

65
Q
A

FINALS: Passmed (40 decks)

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