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1
Q

What drugs can cause gynaecomastia

A

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

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2
Q

What is pheochromocytoma

A

tumour in adrenal gland causing the release of epinephrine and norepinephrine

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3
Q

What does a pheochromocytoma present with

A

palpitations, tremor and a headache

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4
Q

Investigations for pheochromocytoma

A

Raised blood pressure.
Raised levels of urinary metanephrines

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5
Q

Treatment for pheochromocytoma

A

PHenoxybenzamine before beta-blockers
10 days after blood pressure has been stabilised - surgery to remove the tumour

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6
Q

What is amlodipine

A

calcium channel blocker to reduce blood pressure

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7
Q

What is propanolol

A

Beta blocker

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8
Q

diagnostic criteria for hyperosmolar hyperglycaemic state

A

hypovolaemia
hyperglycaemia (blood sugar > 30mmol/L)
serum osmolality > 320mosmol/kg.

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9
Q

symptoms of hyperosmolar hyperglycaemic state

A

fatigue, lethargy, altered consciousness, hypotension and tachycardia, headache, blurred vision and papilloedema

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10
Q

Treatment for hyperosmolar hyperglycaemic state

A

intravenous fluid replacement and close monitoring of serum osmolality.

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11
Q

Cushing’s disease

A

excess glucocorticoids leading to raised blood glucose

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12
Q

key diagnostic features for cushing’s disease

A
  • Facial plethora
  • Supraclavicular fullness
  • Violaceous striae
  • Hypertension
  • Glucose intolerance
  • Premature osteoporosis or unexplained fractures
  • Weight gain and central obesity
  • Acne
  • Decreased libido
  • Easy bruising
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13
Q

What is facial plethora

A

swelling, puffiness, and redness in the face

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14
Q

Investigations for cushing’s

A
  • Overnight 1mg dexamethasone suppression test
    • Morning cortisol is not suppressed
  • 24h urinary free cortisol (unless renal failure)
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15
Q

How to localise cushing’s disesase

A

high dose dexamethasone test -

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16
Q

difference between cushings disease and syndrome

A

disease - pituitary adenoma (release ACTH)
syndrome - adrenal adenomas (release cortisol)

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17
Q

How to differentiate between diabetic ketoacidosis and hyperosmolar hyperglycaemic state

A

HHS has no acidosis/significant ketosis, the history is longer and the glucose is often significantly raised eg >30mmol/L

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18
Q

How is prolactin release inhibited

A

By dopamine. Cabergoline stimulates dopamine receptors in the brain causing reduced prolactin secretion

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19
Q

What is domperidone

A

dopamine receptor antagonist

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20
Q

What is pegvisomant

A

acromegaly medication -

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21
Q

What is octreotide

A

synthetic form of somatostatin

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22
Q

What is dexamethasone

A

used to diagnose cushings disease and syndrome

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23
Q

symptoms of hypercalcaemia

A

moans, groans, bones and stones

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24
Q

most common cause of hypercalcaemia

A

hyperparathyroidism

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25
features of hyperaldosteronism
hypokalaemia and hypertension
26
What is the short synacthen test
measures how well adrenal glands produce cortisol
27
What should an exacerbation of asthma be treated by
Oral prednisolone (40-50 mg for 5 days)
28
When should steroid use be tapered off
received more than 40mg prednisolone daily for more than one week received more than 3 weeks of treatment recently received repeated courses
29
What differentiates graves disease from other forms of hyperthyroidism
clubbing (acropathy)
30
Classic signs of hyperthyroidism
anxiety, excess sweating, hair thinning, palpitations and diarrhoea
31
What is graves disease
autoimmune disease causing thyroid gland to produce too much thyroid hormone
32
When is propranolol useful for hyperthyroidism
It is a non-selective beta blocker so stops adrenergic effects, is quite short term so stops symptoms rapidly
33
What is Carbimazole
anti-thyroid medication - usually more long term and given by an endocrinologist
34
What is metoprolol
selective beta blocker for beta-1 adrenergic receptors
35
What is Propylthiouracil
long term anti-thyroid medication
36
Examples of SGLT-2 inhibitor
dapagliflozin
37
Diabetes sick day rules
take insulin like normal but check blood glucose more often to check that it is not either too high or too low
38
How is weight affected by type 1 diabetes
weight is decreased
39
Risks of SGLT-2 inhibitor
necrotising fasciitis of the genitalia or perineum (Fournier's Gangrene)
40
reasons for pseudo-cushings syndrome
depression, HIV infection, excess alcohol consumption
41
What is gliclazide
sulfonylurea - diabetes medication
42
Risks of sulfonylureas
Weight gain
43
what is serum CA 19-9 useful for
blood test for pancreatic or bowel cancer or inflammation
44
highly specific tumour marker for thyroid tumours recurrence
serum calcitonin
45
How does multiple endocrine neoplasia type I present
Peptic ulceration, galactorrhoea, hypercalcaemia
46
medication change for a Addison's patient with intercurrent illness
double the glucocorticoids (higher levels of cortisol required for these times of stress), keep fludrocortisone (electrolyte balance and blood pressure does not need extra regulation) dose the same
47
What is galactorrhoea
White dense discharge from breasts
48
What medication has a side effect of galactorrhea
Metoclopromide
49
How is acromegaly diagnosed
Serum IGF-1 level
50
Typical presentation of hyperparathyroidism
Increased thirst and polyuria High calcium and a normal parathyroid hormone (which should be lower due to the fact that there is excess calcium)
51
What is primary hyperparathyroidism most likely due to
Solitary parathyroid adenoma
52
How does adrenal deficiency affect glucose levels
Adrenal deficiency leads to cortisol deficiency which has a role in stimulating gluconeogenesis, therefore by being less of it, less glucose will be formed therefore leading to hypoglycaemia
53
What is C-peptide
Byproduct of insulin production so indicative of insulin production from the body
54
How does alcohol affect glucose levels
Alcohol inhibits gluconeogenesis in the liver leading to hypoglycaemia
55
How does hypothyroidism affect periods
Leads to heavy periods
56
What is myxoedema coma
Long-standing untreated hypothyroidism
57
How does myxoedema coma present
confusion and hypothermia, patients may have non-pitting periorbital and leg oedema, reduced respiratory drive, pericardial effusions, anaemia, seizures, and other symptoms of hypothyroidism.
58
How does an addisonian crisis present
malaise, nausea and vomiting, abdominal pain, and muscle cramps and paraesthesia
59
How does a thyrotoxic storm present
Complication of hyperthyroidism that features hyperthermia, tachycardia, vomiting, and agitation.
60
What is a pepper pot skull indicative off
Primary Hyperparathyroidism
61
Side effect of gliclazide
Hypoglycaemia
62
Treatment for cushings
Predisnolone
63
Treatment for primary hyperaldosteronism
Spironolactone
64
What is secondary hyperparathyroidism
High PTH but low calcium this is due to either chronic renal failure or vitamin D efficiency Turns into tertiary when calcium becomes high
65
What is tertiary hyperparathyroidism
Continuation of secondary leading to high PTH and calcium
66
How can corticosteroids affects neutrophils
Can lead to increase
67
Symptoms of acromegaly
Galactorrhea - white discharge from nipples Increased hand and foot size Hypertension
68
Tests for acromegaly after igf-1 is higher than expected
Oral glucose tolerance test while doing serial growth hormone test If GH doesn’t drop below 1 during the test then it is positive
69
Treatment for an addisonian crisis
IV Hydrocortisone
70
What is thyroid peroxidase
Enzyme which helps produce thyroid hormones
71
What is sub clinical hypothyroidism
TSH is slightly high but T4 is normal
72
Treatment for sub clinical hypothyroidism
If TSH between 5.5 and 10 then guideline is to give a 6 month trial of levothyroxine. If TSH remains at that level on 2 separate occasions, 3 months apart then they have hypothyroidism symptoms
73
What are thionamides
Anti-thyroid medication for example it can be used for graves disease
74
What is used first in a thyroid storm? Thionamides or iodine
Thionamides
75
Side effect of pioglitazone
Weight gain
76
SGLT-2 positive side effect
Weight loss
77
How is insulin and GLP-1 administered
Via injections
78
What to do when a patient with addisons gets ill in terms of medication
Double hydrocortisone dose but keep fludrocortisone dose the same, this is because extra cortisol is required throughout the time dealing with the illness
79
Treatment for galactorrhea
Bromocriptine

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