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MRCP 1 > Endo > Flashcards

Endo Flashcards

1
Q

How do SGLT-2 inhibitors work?

A

Reversibly inhibit sodium glucose co transporter in the renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion

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2
Q

Where donSGLT-2 inhibitors work?

A

Proximal convoluted tubule

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3
Q

Examples of SGLT-2 drugs

A

Canagliflozin, dapagliflozin, empagliflozin

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4
Q

Adverse effects of SGLT-2 inhibitors

A

Urinary and genital infections (glycosuria)
Fournier’s gangrene
Normoglycaemic ketoacidosis
Increased risk of lower limb amputation

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5
Q

Causes of Gynaecomastia

A

Physiological - normal in puberty
Syndromes with androgen deficiency - Kallman’s, Klinefelter’s
Testicular failure - mumps
Liver disease
Testicular cancer
Ectopic tumour secretion
Hyperthyroidism
Haemodialysis
Drugs

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6
Q

Drug causes of Gynaecomastia

A

Spironolactone - most common
Cimetidine
Digoxin
Cannabis
Finasteride
GnRH agonists - goserelin, buserelin
Oestrogens
Anabolic steroids

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7
Q

Which familial syndrome are linked to phaeochromocytosis

A

MEN2
Neurofibromatosis
Von-Hippel-Lindau

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8
Q

Symptoms of phaeochromocytoma

A

Classic triad of headache, sweating and palpitations

Anxiety
Nausea
Tremor

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9
Q

Signs of phaeochromocytoma

A

HTN
Postural hypotension
Tremor
Pallor
Reflex Bradycardia

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10
Q

Tests for phaeochromocytoma

A

24hr urinary metenephrines

24hr urinary catecholamines
Blood for plasma free metenephrines
CT imaging
Genetic testing for familial syndromes

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11
Q

Treatment for phaeochromocytoma

A

Surgery is definitive

Alpha blocker for HTN - phenoxybenzamine

Then beta blocker - propranolol or bisop

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12
Q

What is Kallmann’s syndrome

A

Delayed puberty secondary to hypogonadotrophic hypogonadism

X linked recessive

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13
Q

Features of Kallmann’s

A

Delayed puberty
Anosmia
Hypogonadism
Sex hormone levels low
LH/FSH levels low
Normal or above average height

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14
Q

Management of Kallmann’s

A

Testosterone supplement
Gonadotropin supplement layer if fertility desired

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15
Q

What are the different incontinence types

A

Overactive bladder/urge - detrusor overactivity, urge is quickly followed by uncontrollable leakage

Stress - from coughing/laughing

Mixed - both urge and stress

Overflow - bladder outlet obstruction (enlarged prostate)

Functional - comorbid physical inability to get there in time - dementia, sedation etc

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16
Q

Investigations for urinary incontinence

A

Bladder diaries - min 3 days
Vaginal exam
Urine dipstick & culture
Urodynamic studies

17
Q

Management of urge incontinence

A

Bladder retraining
Bladder stabilising drugs - antimuscarinics first - oxybutynin, tolterodine, darifenacin
- avoid oxybutynin in old ladies

Mirabegron if anticholinergic side effects

18
Q

Management of stress incontinence

A

Pelvic floor muscle training
Surgical procedures
Duloxetine if not for surgery

(Duloxetine - increased synaptic contraction within pudendal nerve = increased stimulation of urethral striated muscles)

19
Q

Causes of cranial diabetes insipidus

A

Idiopathic
Post head injury
Pituitary surgery
Craniopharyngiomas
Infiltrative - histiocytosis X, sarcoidosis
DIDMOAD - wolframs
Haemochromatosis

20
Q

What is diabetes insipidus

A

Decreased secretion of ADH or insensitivity to ADH

21
Q

Causes of nephrogenic diabetes insipidus

A

Genetic - vasopressin receptor most commonly then aquaporin2

Electrolytes - hypercalcaemia & hypokalaemia
Lithium - desensitises kidneys ability to respond to ADH in collecting ducts
Demeclocycline
Tubulo-interstitial disease - obstruction, sickle cell, pyelonephritis

22
Q

Features of diabetes insipidus

A

Polyuria
Polydipsia

23
Q

Investigations of diabetes insipidus

A

High plasma osmolality
Low urine osmolality
Water deprivation test

24
Q

Management of diabetes insipidus

A

Nephrogenic - thiazides and low salt diet

Central - desmopressin

25
Q

Inheritance pattern of familial hypercholesterolaemia

A

Autosomal dominant

26
Q

Simon Broome criteria for diagnosing familial hypercholesterolaemia

A

Total cholesterol >7.5mmol and LDL >4.9

For definite FH - tendon xanthoma in patients or 1/2 degree relatives or dna evidence

27
Q

Management of familial hypercholesterolaemia

A

Specialist referral
High dose statins
Screen relatives
Stop statins 3 months before conception in women

28
Q

What do statins do

A

HMG-CoA reductase inhibitors

MRCP 1 (14 decks)

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