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MedEd finals > Endo > Flashcards

Endo Flashcards

1
Q

what is the diagnosis based off these TFTs

TSH=high
T3=
T4=low

A

Hashimotos
De quervains
Atrophic thyroiditis

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2
Q

what is the diagnosis based off these TFTs

TSH= high
T3=
T4= normal

A

subclinical hypothyroidism

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3
Q

with subclinical hypo/hyperthyroidism what should you look at to figure out which one it is

A

TSH

high= hypo (due to t4 being low tsh rises)
low= hyper (due to t4 being high tsh falls)

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4
Q

what is subclinical hypo/hyperthyroidism

A

when the thyroid is under some stress but is still able to maintain t3/t4 at an appropriate level

it may progress to full blown hypo/hyperthyroidism but not there yet

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5
Q

what is the diagnosis based off these TFTs

TSH= high
T3=
T4= high

A

TSH secreting tumor

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6
Q

what is the diagnosis based off these TFTs

TSH= low
T3= high
T4= high

A

graves disease
toxic multinodular goitre
drugs

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7
Q

what is the diagnosis based off these TFTs

TSH= low
T3= normal
T4= normal

A

subclinical hyperthyrodism

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8
Q

what is the diagnosis based off these TFTs

TSH= low
T3=
T4= low

A

secondary hypothyroidism

t4 is low because tsh is low

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9
Q

what is the diagnosis based off these TFTs

TSH= low or high
T3= low
T4= low

A

sick euthyroid

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10
Q

outline the core principles of diabetes management (dont include pharmacology)

A
  1. refer to diabetes center for individualised care plan
  2. refer to support groups
  3. discuss lifestyle measures
  4. monitor HbA1c 3-6 monthly until stable on medication
  5. consider htn and lipid control
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11
Q

how is T1DM managed

A

insulin therapy
patient education on monitoring glucose and optimal targets

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12
Q

how is T2DM pharmacologically mx

A

FIRST LINE

  1. cardiovasc risk?
    yes= metformin+SGLT2 inhibitor
    no= metformin
  2. GI risk?
    yes= modified release metformin
  3. metformin contraindicated?
    cv risk= SGLT2 monotherapy
    no cv risk= DPP4 inhibitor/pioglitazone/sulfonylurea

SECOND LINE

add SGLT2/DPP4/pioglitazone/sulfonylura

THIRD LINE
add another or insulin based therapy

FOURTH LINE
switch for GLP-1 mimetic if BMI>35 or occupational limits regarding insulin therapy
switch medication

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13
Q

SLGT2 inhibitors end in

A

FLOZIN
flow like blood so good for heart

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14
Q

DDP4 inhibitors end in

A

GLIPTIN

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15
Q

GLP-1 mimetics end in

A

TIDE

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16
Q

GLP 1 mimetics moa

A

increase insulin secretion
reduce glucagon secretion

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17
Q

SGLT-2 inhibitors moa

A

reduce glucose reabsorption in kidney
increase urinary glucose excretion

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18
Q

DPP-4 inhibitors moa

A

decreases breakdown of GLP-1 in small intestine

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19
Q

what diabetes medication is good for not causing weight gain

A

DDP4 inhibitor

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20
Q

what diabetes medication helps with weight loss

A

SGLT-2 inhibitors

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21
Q

sulphonylurea moa

A

increases insulin secretion

22
Q

sulphonylurea example

A

gliclazide

23
Q

pioglitazone is a

A

thiazolidinedione

24
Q

pioglitazone moa

A

reduces peripheral insulin secretion

25
statin therapy in diabetes
if QRISK >10% start atorvastatin 20mg OD
26
BP targets in diabetes
<80= 135/85 >80= 145/85
27
what diabetes medications cause ketoacidosis as a side effect
SGLT-2 inhibitors DPP4- inhibitors sulfonylureas GLP-1 mimetics
28
what diabetes medications cause weight loss
SGLT-2 DPP4
29
what diabetes medications cause hypoglycaemia
insulin sulfonylureas
30
when is pioglitazone contraindicated in diabetes
bladder cancer visible heamaturia history of HF
31
what ix are done for suspected cushings and in what order
1. overnight dexamthasone supression test or urinary 24hr cortsiol 2. low dose or high dose dexamethasone supression test and inferior pituitary sinus sampling 3. imaging for ectopic ACTH
32
diagnosis for high dose dexamethasone test results ACTH= supressed cortisol= supressed
pituitary tumor
33
diagnosis for high dose dexamethasone test results ACTH= not supressed cortisol= not supressed
ectopic ACTH
34
diagnosis for high dose dexamethasone test results ACTH= supressed cortisol= no
adrenal adenoma
35
in the dexamethasone supression test what axis does dexamethasone act on
the pituitary axis therefore any sources of ACTH/cortisol OUTSIDE the axis will remain unsupressed eg adrenal tumor that secretes cortsiol, ectopic tumor that secretes ACTH
36
cushings disease mx
1st line trans sphenoidal resection of the pituitary 2nd line cabergoline
37
what are complications of adrenalectomy
Nelsons syndrome= due to low cortisol ACTH rises, the pituitary gland becomes really large and causes mass effect/ skin hyperpgimentation similar to Addisons sx due to no adrenal hormones- replace w steroids
38
describe how tertiary hyperparathyroidism arises
when there is long standing secondary hyperparathyroidism eg CKD the parathyroid glands become insensitive to calcium/vit D levels and autonomously produce PTH regardless of calcium/vit D levels
39
what ECG change does hypocalcaemia cause
long QT
40
mx of hypocalcaemia
IV 10ml 10% calcium gluconate consider oral calcium/ calcitriol etc w senior advice
41
what are PTH levels in primary hyperparathyroidism
high OR NORMAL they can be normal as if calcium is high PTH should be very suppressed and low, so if its not this can still be primary hyperparathyroid
42
what size is a pituitary microadenoma
<10mm
43
what size is a pituitary macroadenoma
>10mm
44
what investigations are done for suspected pituitary adenoma?
combined pituitary function test MRI brain with contrast formal visual fields assessment
45
mx of prolactinoma non functioning pituitary adenoma acromegaly
prolactinoma= replace deficient hormones, dopamine antagonist (cabergoline), 2nd line surgery non functioning pituitary adenoma= watch/wait if asymptomatic or cabergoline acromegaly=surgery, ocreotide, cabergoline
46
what happens to glucose in addisonian crisis
low
47
how is addisonian crisis managed
A-E assessment 100mg IV hydrocortisone stat fluid resus
48
how is alpha blockade for phaeo carried out
IV alpha blocker first then once stabilised long term oral alpha blocker
49
how long do you have to wait to do surgery on a phaeo
4-6 weeks of alpha blockade is needed
50
serum osmolality equation
2 x Na + urea + glucose
51
how do you differentiate secondary hyperparathyroidism and osteomalacia
in osteomalacia phosphate will be low in secondary hyperparathyroidism because its due to kidneys phosphate will be high
52

MedEd finals (2 decks)

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