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1
Q

cushings bloods

A

hypokalaemic metabolic alkalosis

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2
Q

cushings Ix

A

1st line overnight low dose dexamthasone suppression test
= if cushings -> morning cortisol spike not suppressed
and high dose dex suppresion

2x 24hr urine free cortisol
2x bedtime salivary cortisol

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3
Q

high dose dex supression cortisol not suppressed but ACTH supressed

A

cushing syndrome due to other cuase (not pitruatry) ie adrenal adenoma

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4
Q

high dose dex supression
cortisol suppressed
ACTH supressed

A

cushings disease ie pit adenoma –>ACTH secretion

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5
Q

high dose dex supression
cortisol not suppressed
ACTH not supressed

A

ectopic ACTH syndrome

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6
Q

differentiate between cushings and pseudo cushings

A

insulin stress test

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7
Q

how to differentiate between pitruatry and ecotpic ACTh secretion

A

petrosal sinus sampling of ACTH

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8
Q

addisons acid base

A

hyperkalaemic metabolic acidosi

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9
Q

graves antibodies

A

TSH receptor

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10
Q

Anti tpo antibodies

A

hashimotos thyroiditis

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11
Q

acromegaly what is it

A

hypersectrion of GH usually from ant pit tumor

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12
Q

signs and sx of acromeg

A

bi temp hemanopia
headache
teeth spacing
frontal bossing
macro tongue
sweating

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13
Q

ddx acromegaly

A

SERUM IGF1

ogtt -> (hyperglycaemia should supress GH) but doesnt in acro

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14
Q

what else to screen for with acromegaly

A

diabetes bc GH is anti insulin = insulin resistance

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15
Q

what do acromegaly pts usually die of

A

CVD

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16
Q

acromegaly tx

A

transphenoidal resection

somatostatin analogue -octreotide
pegvisomant
bromocriptine

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17
Q

causes of hypothyroid

A

amiodarone
radiotherapy
iodine def
ca
infection
hypopitrutary

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18
Q

thyroid embryological origin

A

foramen caecum

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19
Q

hypothyroid asscoiated diseases

A

pernicous anaemia
vitiligo

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20
Q

graves tx

A

carbimazole
propythiouracil

radioidione

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21
Q

4Cs moniter DM

A

control glycaemic
competency w meds
complicatons
coping

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22
Q

kussmauls breathing

A

DKA

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23
Q

whipples triad

A

hypogycaemia

low plasma glucose <3
sx of hypo
relief w glucose

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24
Q

autonomic hypo sx

A

sweating
tremor
palp
anxiety

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25
neurogylcopenic sx hypo
confusion drowseiness seizure coma personality change fnd
26
causes of hypo
insulin,sulfonurea in prev knwon diabetic pit insuff liver failure addisons exogenous drugs
27
high insulin hypoglycaemia causes increased c peptide
sulphon
28
high insulin hypoglycaemia causes normal c pep
insulin
29
low insulin high ketones hypogly
alocohol w no food pit insuff addisons
30
low insulin now ketones hypoglycaemia cause
non pac neoplams insulin receptor abs
31
post prandial hypoglycaemia
dumping post gastric bypass
32
mc hypothyroid uk
atrophic thyroiditis
33
atrophic thyroiditis ABs goitre? associations
anti tpo anti tsh lymphocytic infiltration = no goitre pernicous anaemia vitiligo endocrinopathies
34
hashimotos abs path
anti TPO atrophy+ regen =goitre
35
myxeoedema coma
looks hypothyroid hypoglycarmia hypothyroid heart failure (brady n red BP) coma and seizures
36
causes of myxedema coma
radioiodine thyroidectomy pit surgery infection, trauma, MI, stroke
37
types of mailigant thyroid disease
papillary follicular medullary anaplastic lymphoma
38
thyroid surg sx
reactionary haematoma (remove clips and call anaesthetist) laryngeal oedma recurrent laryngel palsy hypoparathyroid
39
hyperparathyroid presentation
inc Calcium Stones bones moans and groans renal stones, polyuria and polydipsia bone pain, pathological fracture deoression abdo pain, N&V, constipation, pancreatitis, PUD (in gastrin) and in BP
40
primary hyperPTH causes and ix
solitary adenoma mc bloods- ^ca, ^/N pth, ^alp, dec PO4 ECG XR - phalyngeal erosions DEXA osteoporosis
41
primary hyperpth tx
inc fluid intake avoid diet ca and thiazides excision of adenoma
42
2ndry hyper pth causes and bloods
vit d deficiency chronic renal failure
43
2ndy hyper pth bloods
inc PTH red Ca inc po4 inc ALP red vit D
44
hypoparathyroid presentaton
Presentation: low Ca SPASMODIC Spasms (carpopedal = Trousseau's sign) Perioral paraesthesia Anxious, irritable Seizures Muscle tone inc - colic, wheeze, dysphagia Orientation impaired (confusion) Dermatitis Impetigo herpetiformis (low Ca + pustules in pregnancy) Chovsteks, cardiomyopathy (1 QTc - TdP)
45
trousseus sign chovsteks sign hypoparathyrid
HAND SPAZ ON BP CUFF touch infront ear = facial nerve twtiching
46
bloos hypopth
low ca high phosphate low pth normal ALP
47
causes of cushings syndroms that wont respond to dex supression
ACTH independant causes ie steroids or adrenal adenoma ACTH depedant ectopic ACTH from SCLC, carcinoid only cushings syndroms responds to high dose dex cause bilat adrenal hyperplasia from acth pitruit tumor
48
cushings disease tx
transphenoidal excision
49
ectopic acth
metyrapone
50
adrenal ademona/ca cushings tx
adrenalectomy
51
nelsons syndrome
rapid enlargement pit adeona post bilat adrenalectomy for cushings syndrome pt bitemp hempanp hyperpigmentation
52
primary hyper adolest path pt
excess aldoesterone independant of RAS hypokal parathesia inc BP
53
causes of 2ndry hyperaldoes and ix
due to inc renin bc renal hypoperf RAS diuretics CCF hepatuc failure nephrotic normal aldoesterone renin ratio
54
addisons bloods
low na high k low glucose low ca anaemia
55
pheochromacytoma path and causes
catecholamine producing tumor usually in adrenal medulla RULE of 10s 10% malignant 10 extra adrenal 10 bilateral 10 part of hereditory syndrome
56
hyperprolactineamia causes
exces production ie - preg, breastfeedins - prolactinoma - hypothyroi(inc TSH) dishib bc compression of pit stalk -pit edenoma - craniopharyngioma Dopamine antagonists (MC) - metoclopromide - risperdione, halopeid
57
hyperprolactinaemia tx
1st cabergoline,bromocriptine 2nd transphenoidl excision
58
acromegaly ca risk
inc risk colon polyps which may develop to colon ca
59
acromegaly tx
1st line: trans-sphenoidal excision 2nd: somatostatin analogues - octreotide 3rd line: GH antagonist - pegvisomant 4th line: radiotherapy
60
Diabetis inspid urine
exclude DI if urine: plasma osmolality >2
61
diab inspid Dx
water dep test with desmopression trial
62
causes of hirsutism
pcos cushings adrenal ca steroids
63
causes og gynacomastea
cirhossis hypogonadism hyperthyroid oest/hcg producing tumor ie testicular drugs = spiro digoxin oestrogen
64
dka path
insulin def = glucose prod in liver lipolysis also occurs -> fatty acids broken down form ketone bodies = met acidosis
65
why abdo pain in dka
polyuria 2ndry to glucose induced osmotic duiresis = dehydration
66
why k infusion in dka
insulin causes rapid uptake of k into cells
67
addisons
low na high k low glucose
68
prolactinoma sx
amenorhea infert galactorhea dec libido
69
prolactinoma tx
transphen resection radiotherapy (may cayse hypopit) dop agonst = cabergoline, bromocriptine(if want preg)
70
causes of hypophos
refeeding glucose infusion alcoholism renal tubular leak resp alkalosis of any cause
71
causes hyperphos
tumor lysis rhabdo renal fail excess vit D or phos containg med
72
vit D and ca relation
vit d needed to absorb ca in gut
73
neuropathic complications of DM
symmetric sensory poly - glove and stocking mononeuropath ie CN3/6 palsy femoral neuropathy autonomic neuropaty
74
diabetic foot signs
absent pulses ulcers painless pucnhed out charcots joint claw toe pes cavus
75
bad controlled dm starts vomiting intractibly
gastric paresis
76

finals (28 decks)

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