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Y6 Senior Med > Endo 2 > Flashcards

Endo 2 Flashcards

1
Q

What are causes of low Mg

A

LOW INTAKE: TPN, alcoholic, malnutrition

RENAL LOSS: diuretics (loop, thiazide), metabolic disorders (Gitelman, Bartter), nephrotoxic drugs (amphotericin B, aminoglyocosides)

GI LOSS: diarrhoea

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2
Q

what metabolic abnormalities does hypomagnaesemia often occur with

A

low potassium

low calcium

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3
Q

when must you suspect hypomagnaesemia

A

when the patient has:

  • refractory hypokalaemia
  • unexplained hypocalcaemia
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4
Q

sx hypomagnaesemia

A 
nausea, anorexia, voomiting 
parasthhesia 
seizures 
tetany 
arrythmias
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5
Q

how do you manage hypomagnaesemia

A

> 0.4: magnesium salts, orally

<0.4: IV MgSO4 40mmol /24h

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6
Q

what causes acromegaly

A

a pituitary adenoma producing excess GH

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7
Q

sx of acromegaly

A

headachhes
soft tissue swelling (enlarged hands and feet)
prognathism (protruding jaw)
macrocossia

cx: HTN, DM

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8
Q

ix of acromegaly

A

IGF1 raised

OGTT > GH raised

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9
Q

what is normal calcium rnage

A

2.2 to 2.6

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10
Q

what causes release of PTH

A

low dietary calcium or low sunlight > cause low serum calcium

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11
Q

functions of PTH

A

increase bone calcium resoprtion
increease renal calcium resorption
produce 1alpha hydroxylae > hydroxylase vitamin D > increase calcium resorpion in intestineb

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12
Q

what does PTH do to phosphate

A

gets rid of it (PHOSPHATE TRASHING HORMONE)

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13
Q

what are the roles of activated vit D

A

increase intestinal calcium absorption
increase intestinal phosphate absorption
bone formation

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14
Q

summarise osteomalacia in one sentence

A

normal bone density

but ABNORMAL bone structure (demineralised bone)

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15
Q

what is the principal cause of osteomalacia

A

Vit D deficiency

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16
Q

what are RF / co-morbidities that lead to osteomalacia

A

RF: dark skin, lack of sunlight, dietary deficiency, malabsorption

Co-morb:

  • renal failure (as the vit D is not hydroxylased)
  • anticonvulsants (break down vit D)
  • chapati (reduce absorption)
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17
Q

what is osteomalaxia in children called

A

rickets

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18
Q

sx of osteomalacia

A

bone and muslce pain

increased fracture risk

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19
Q

sx of rickets

A 
bowel leg s
costochondral swelling 
myopathy
widened epiphysis at wrist 
looser zones on x r
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20
Q

explain what happens to hormones and electrolytes in osteomalacia (starting from the low vit D)

A

low vit D > less calcium absorbed > raised PTH > raised bone resorption (so raised ALP) > normal/ low calcium with BRITTLE bone

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21
Q

what is bone like in osteomalacia

A

weak and demineralised

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22
Q

what kind of hyperparathyroidism occurs in osteomalacia

A

SECONDARY hyperparathyroidism

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23
Q

summarise osteoporosis in one sentence

A

low bone density

normal bone structure

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24
Q

what is osteoporosis due to

A
  • age related decline
  • endocrine (cushiing’s, hyperthyroid, early menopause)
  • lifestyle (smoking, alcohol, anorexia)
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25
Q

sx of osteoporosis

A

asymptomatic

until pathological fracture occurs

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26
Q

how do you ix osteoporosis

A 
normal calcium and phosphate
DEXA Scan ( T score
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27
Q

what does a T score between -2.5 and -1 indicate

A

osteopoenia

28
Q

how do you manage osteoporosis

A

lifestyle: stop smoking, reduce alcohol, weight bearing exercise

medical: vit D / calcium
- biphosphonate ss
- teriparatide
- strontium
- HRT
- Raloxifen

29
Q

what first question must you ask when you see a HIGH calcium

A

is PTH HIGH or LOW

30
Q

Causes of HIGH calcium, HIGH PTH

A

This is INAPPROPRIATE: primary hyperparathyroidism

  1. Parathyroid adenoma
  2. Parathyroid hyperplasia
  3. Parathyroid carcinoma
31
Q

what are electrolytes like in primary hyperparathhyroidism

A

high calcium
high PTH
low phosphate

32
Q

causes of HIGH calcium, LOW PTH

A

Malignancy (SCLS, bony mets, myeloma)

Other (sarcoid, thyrotox, addisons, thiazide)

33
Q

how do you treat hypercalcaemia

A

Fluids (+ biphosphonates if cancer)

34
Q

causes of LOW CA, HIGH PTH

A

vit D deficiency
CKD
PTH resisztance

35
Q

cuases of LOW CA, LOW PTH

A

surgical (post thyroidectomy)

autoimmune

36
Q

how do you trreat low calcium

A

calcium + vit D supplements

if Ca <1.9: calcium gluconate

37
Q

mx of primary hyperparathyroidism (hihg calciumn, high PTH due to parathyroid growth)

A

TOTAL PARATHYROIDECTOMY

Cinacalcet (may be prescribed if not suitable for surgery - mimics the action of calcium on tissue, reducing PTH)

38
Q

explain the negative effects of CKD on calcium and phosphatye

A

Kidneys usually allow activation of vit D > CKD causes low calcium

Kidneys usually excrete PO > CKD causes excess PO

39
Q

how do you manage low calcium, high phosphate in CKD

A
  1. Reduce dietary PO
  2. Use phosphate binders (e.g. aluminium based binder, sevelamar)
  3. Vit D supplement (alfacalcidiol, calcitrio)
  4. consider parathyroidectomy
40
Q

what is the MAIN CAUSE of primary hyperaldosteronism

A
  1. BILATERAL ADRENAL HYPERPLASIAA (up to 70% of cases)
41
Q

what are the two causes of primary hyperaldosteronism

A
  1. bilat adrenal hyperplasia

2. adrenal adenoma (Conn’s)

42
Q

How do you distinguish between bilat adrenal hyperplasia and adrenal adenoma (Conn’s)

A

HR-CT abdo and adrenal vein sampling

43
Q

how do you manage a bilat adrenal hyperplasia

A

aldosterone antagonist (e.g. spironolactone)

44
Q

how do you manage an adrenal adenoma in Conns

A

surgery (removes the tumour but leaves some adrenal gland, so the patient does not become addisonian)

45
Q

when must levothyroxine be given if co-administered with iron / calcium supplements

A

at least 4 hours before or after

46
Q

how do you manage hypothyroidism in pregnancy

A

increase dose by up to 50% in first 4-6 weeks of pregnancy

47
Q

how do you give hydrocortisone in addisons

A

twice daily

the largesst dose in the morning, second dose after lunch

48
Q

how many units (of insulin) ae there in 1ml

A

100

49
Q

what do glucocortcoids do to WBC and neutrophil count?

A

WBC decreases

but neutrophils increase initially

50
Q

whaat is the MOA of MODY

A

Autosomal DOMINANT

51
Q

how do you manage thyroid cancer

A

THYROIDECTOMY (hemi or total) + IODINE 131 (to kill all remaining cells)

yearly followup > if positive, administer more I-131

52
Q

when can you discharge someone with thyroid cance r

A

if in remission for 7 years

53
Q

what is the effect of heparins on potassium

A

increase potassium

as they inhibit aldosterone

54
Q

what is the effect of tacrolimus on potassium

A

reduce K+ excretion> increase potassium

55
Q

what is the effect of NSAIDS on the kidney

A

they inhibit reniin release

56
Q

HYPERKALAEMIA on ECG

A 
tall tented T wave 
Broad QRS 
flat P wave 
Prolonged PRR interval 
Sine wave > cardiac arrest
57
Q

do pituitary adenomas always have to secrete hormones?

A

NO - they could be NON FUNCTING PITUITARY ADENOMAS

they would present with hypopituitarism and pressure effects

58
Q

what kind of breathing occurs in DKA

A

KUSSMAUL breathing - excess CO2 is exhaled to try to compensate for metabolic acidosis

59
Q

what diabetics need to be followed up by the local foot centre

A

ALL DIABETICS who have any foot condition other than CALLUSES

60
Q

what is thyroid acropatchy

A

TRIAD OF

  • nail clubbing
  • tissue swelling of the hands and feet
  • new bone formation
61
Q

what is Nelsons syndrome

A

removal of the adrenal glands > pituitary enlargement > hypopituitarism from compressing the stalk and RAISED ACTH (hyperpigmentation)

62
Q

What test can help distinguish between T1DM and T2DM

A

C peptide – will be LOW in T1 (because low insulin production) but RAISED in T2 (due to high insulin production, but insensitivity of cells)

63
Q

how does HYPOThyroidism affect periods

A

HYPOthyroidism causes MENORRHAGIA

64
Q

How does HYPERthyroidism affect perodos

A

causes AMENORRHHOEA

65
Q

HbA1c target for T1 DM

A

48

Y6 Senior Med (29 decks)

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