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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
sx of osteoporosis
asymptomatic | until pathological fracture occurs
26
how do you ix osteoporosis
``` normal calcium and phosphate DEXA Scan ( T score ```
27
what does a T score between -2.5 and -1 indicate
osteopoenia
28
how do you manage osteoporosis
lifestyle: stop smoking, reduce alcohol, weight bearing exercise medical: vit D / calcium - biphosphonate ss - teriparatide - strontium - HRT - Raloxifen
29
what first question must you ask when you see a HIGH calcium
is PTH HIGH or LOW
30
Causes of HIGH calcium, HIGH PTH
This is INAPPROPRIATE: primary hyperparathyroidism 1. Parathyroid adenoma 2. Parathyroid hyperplasia 3. Parathyroid carcinoma
31
what are electrolytes like in primary hyperparathhyroidism
high calcium high PTH low phosphate
32
causes of HIGH calcium, LOW PTH
Malignancy (SCLS, bony mets, myeloma) | Other (sarcoid, thyrotox, addisons, thiazide)
33
how do you treat hypercalcaemia
Fluids (+ biphosphonates if cancer)
34
causes of LOW CA, HIGH PTH
vit D deficiency CKD PTH resisztance
35
cuases of LOW CA, LOW PTH
surgical (post thyroidectomy) | autoimmune
36
how do you trreat low calcium
calcium + vit D supplements if Ca <1.9: calcium gluconate
37
mx of primary hyperparathyroidism (hihg calciumn, high PTH due to parathyroid growth)
TOTAL PARATHYROIDECTOMY Cinacalcet (may be prescribed if not suitable for surgery - mimics the action of calcium on tissue, reducing PTH)
38
explain the negative effects of CKD on calcium and phosphatye
Kidneys usually allow activation of vit D > CKD causes low calcium Kidneys usually excrete PO > CKD causes excess PO
39
how do you manage low calcium, high phosphate in CKD
1. Reduce dietary PO 2. Use phosphate binders (e.g. aluminium based binder, sevelamar) 3. Vit D supplement (alfacalcidiol, calcitrio) 4. consider parathyroidectomy
40
what is the MAIN CAUSE of primary hyperaldosteronism
1. BILATERAL ADRENAL HYPERPLASIAA (up to 70% of cases)
41
what are the two causes of primary hyperaldosteronism
1. bilat adrenal hyperplasia | 2. adrenal adenoma (Conn's)
42
How do you distinguish between bilat adrenal hyperplasia and adrenal adenoma (Conn's)
HR-CT abdo and adrenal vein sampling
43
how do you manage a bilat adrenal hyperplasia
aldosterone antagonist (e.g. spironolactone)
44
how do you manage an adrenal adenoma in Conns
surgery (removes the tumour but leaves some adrenal gland, so the patient does not become addisonian)
45
when must levothyroxine be given if co-administered with iron / calcium supplements
at least 4 hours before or after
46
how do you manage hypothyroidism in pregnancy
increase dose by up to 50% in first 4-6 weeks of pregnancy
47
how do you give hydrocortisone in addisons
twice daily | the largesst dose in the morning, second dose after lunch
48
how many units (of insulin) ae there in 1ml
100
49
what do glucocortcoids do to WBC and neutrophil count?
WBC decreases | but neutrophils increase initially
50
whaat is the MOA of MODY
Autosomal DOMINANT
51
how do you manage thyroid cancer
THYROIDECTOMY (hemi or total) + IODINE 131 (to kill all remaining cells) yearly followup > if positive, administer more I-131
52
when can you discharge someone with thyroid cance r
if in remission for 7 years
53
what is the effect of heparins on potassium
increase potassium as they inhibit aldosterone
54
what is the effect of tacrolimus on potassium
reduce K+ excretion> increase potassium
55
what is the effect of NSAIDS on the kidney
they inhibit reniin release
56
HYPERKALAEMIA on ECG
``` tall tented T wave Broad QRS flat P wave Prolonged PRR interval Sine wave > cardiac arrest ```
57
do pituitary adenomas always have to secrete hormones?
NO - they could be NON FUNCTING PITUITARY ADENOMAS they would present with hypopituitarism and pressure effects
58
what kind of breathing occurs in DKA
KUSSMAUL breathing - excess CO2 is exhaled to try to compensate for metabolic acidosis
59
what diabetics need to be followed up by the local foot centre
ALL DIABETICS who have any foot condition other than CALLUSES
60
what is thyroid acropatchy
TRIAD OF - nail clubbing - tissue swelling of the hands and feet - new bone formation
61
what is Nelsons syndrome
removal of the adrenal glands > pituitary enlargement > hypopituitarism from compressing the stalk and RAISED ACTH (hyperpigmentation)
62
What test can help distinguish between T1DM and T2DM
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
how does HYPOThyroidism affect periods
HYPOthyroidism causes MENORRHAGIA
64
How does HYPERthyroidism affect perodos
causes AMENORRHHOEA
65
HbA1c target for T1 DM
48

Y6 Senior Med (29 decks)

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