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6th Year > Endo > Flashcards

Endo Flashcards

1
Q

4 Cardinal symptoms of diabetes

A

Polyuria
Polydipsia
(Lethargy
Weight loss) less common in type 2

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2
Q

What are the primary causes of Diabetes

A

1 - autoimmune desturction of beta islet cells - check anti islet and anti GAD

2 - Low exercise with obesity and high calorie and alcohol excess

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3
Q

What are the secondary causes of diabetes

A

Drugs: Steroids, Tacrolimus, HAART, atypical neuroleptics, thiazides
Pancreatic: CF, Chronic Pancreatitis, HH, Ca
Endo: Cushings, phaeo, acromegaly

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4
Q

How do you remember the management for diabetes

A 
CCCC
Control - glucose
Complications Macro and micro
Competency - can they do it right, education re injection sites
Coping - psychologivcally, work etc.
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5
Q

What are the macrovascular complications of diabetes

A

Look at monitoring pulses in limbs, blood pressure and listening to the heart.

IHD, PVD, stroke

(recurrent UTI)

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6
Q

What are the MICROvascular complications of diabetes

A

Retinopathy, neuropathy, nephropathy

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7
Q

What do you give when a diabetic is 50

A

aspirin or before if they have other risk factors and been diabetic 10 years

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8
Q

What are the contraindications for metformin?

A

GFR less than 30
Tissue hypoxia - sepsis or MI
pre GA and iodinated contrast

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9
Q

side effects of metformin

A

GI sx - Nause and vomiting, diarrhoea and abdo pain

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10
Q

Which diabetic drugs increase insulin production

A

sulphonylureas - gliclazide/ glibenclamide
meglitinides - nateglinide

DPP-4 inhibitors - sitagliptine/linagliptine
GLP-1 Agonists - exenatide/ liraglutideboth via increases in GLP-1 effects
They also reduce glucagon secretion and delay gastric emptying

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11
Q

Which diabetic drugs increase the bodies sensitivity to insulin?

A

Biguanides - metformin

thiazolodinediones - piolitazone

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12
Q

liraglutide

A

GLP1 RA

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13
Q

Sitagliptine

A

DPP-4 inhibitor

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14
Q

Exenatide

A

GLP1RA

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15
Q

pioglitazone

A

thiazolidinedione

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16
Q

gliclazide

A

sulphonylurea

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17
Q

gibenclamide

A

sulphonylurea

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18
Q

Name 2 types of insulin regime

A

Biphasic and Basal Blous

Biphasic - Twice daily (before breakfast and dinner) mixture of long and short acting insulin often used for children and those with regular daily routine.

Basal bolus - one long acting before bed plus short acting before each meal with dose adjustment depending on the meal and associated with better outcomes

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19
Q

Causes of hypoglycaemia

A 
EXPLAIN
Overuse of insulin/ sensitisers with exercise
Drugs
Pituitary insufficiency
Liver Failure
Insulinoma
Addisons
imune
non pancreatic

Measure glucose, insulin, Ketones, Cpeptide

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20
Q

What are the common symptoms in acromegaly

A 
headache,
amenhorrhoea
arthralgia
carpal tunnel
bitemporal hemianopia
 face change, 
shoes and rings dont fit
snoring
parasthesias

May have accompanying hyperprolactinaemia - loss of libido, galactorrhoea, amehorrhoea, erectile dysfunction

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21
Q

What are the causes of acromegaly

A

99% pituitary adenoma

GnRH secretion from carcinoid tumour

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22
Q

signs of acromegaly

A 
large soft tissues - wide nose big ears
prognathia
macroglossia
wide teeth
goitre with a raised JVP
myopathy - standing up
ABDO - organomegaly, acanthosis nigricans
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23
Q

How do you diagnose acromegaly

A

IGF-1 raised screenign test

OGTT with GH (fails to suppress)

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24
Q

Complications of acromegaly

A

Endocrine - impaired glucose tolerance or DM
Cardiovascular - high BP, LVH, cardiomyopaty, IHD, Stroke
Neoplasia - Colorectal cacer

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25
Q

treatment for acromegaly

A

Trans sphenoidal excision
somatostatin analogues - actreotide
GH antagonists - pegvisomant

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26
Q

What are the causes of diabetees insipidus

A 
Cranial
Idiopathic 50%
Congenital
Tumours
Trauma

Nephrogenic
Drugs: lithium, vaptans
psychological

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27
Q

Name 6 causes of acanthosis nigricans

A 
Endocrine:
Obesity and metabolic syndrome
Acromegaly
Cushings
Diabetes mellitus

Malignancy:
pancreatic
gastric

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28
Q

Name 4 causes of macroglossia

A

downs syndrome
acromegaly
hypothyroidism
amyloidosis

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29
Q

How would you complete the examination of someone with acromegaly

A 
Look at previous photos
ECG - LVH+ischemia
Urine dip glucose
Colonoscopy if older
epworth sleepiness score OSA
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30
Q

what are the complications of trans phenoidal excision of an adenoma

A

meningitis
panhypopituitarism
diabetes insipidus

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31
Q

Which hormones are released from the anterior pituitaru

A 
ACTH/MSH
TSH
LH/FSH
GH
Prolactin
32
Q

posterior pituitary hormones

A

ADH(vasopressin)

Oxytocin

33
Q

What are the causes of a bitemporal hemianopia

A 
Pituitary adenoma(compresses from below therefore loss is from the top down)
Craniopharyngeoma(compresses from top therefore loss is from the bottom up)
34
Q

Causes of a high prolactin

A

Dopamine antagonists - anti emetics and antipsychotics

35
Q

Name 3 signs of diabetes mellitus seen in the hands

A

BM pricks on fingers

Granuloma annulare - also associated with autoimmune thyroiditis and hyperlipidaemia. seen on the hands

Cheiroarthropathy - prayer sign, cannot fully extend the wrists due to thivkened skin - tight and waxy

36
Q

Name the causes of a Marcus Gunn pupil (RAPD)

A 
CAC VISION - MS and Glaucoma most common
Congenital
Alcohol - other drugs
Compresssion - Glaucoma, optic glioma, pituitary adenoma
Vascular: DM/GCA/embolic event
inflamatory - optic neuritis MS
Sarcoid
Infection - TB, herpes zoster, syphilis
Odema - papillodema
Neoplastic infiltration - lymphoma/leukaemia
37
Q

Most common causes of marcuss gunn

A

glaucoma and MS

38
Q

What type of goitre does graves disease give you?

A

diffusely enlarged with increased radioiodine uptage

39
Q

what percentage of thyrotoxicosis does graves make up?

A

60%

40
Q

What is graves associated with?

A

Type 1 diabetes
vitiligo
addisons disease

41
Q

What would you see on the technecium uptake scan in thyroiditis

A

reduced uptake

42
Q

What would you see on the uptake scan of a toxic multinodular goitre?

A

hot areas or nodules. almost always benign, however the goitre may contain other non functioning nodules which are malignant. also known as plummers disease. autonomously functioning nodules

43
Q

How do you treat thyrotoxicosis?

A

Medical - beta blockers for symptomatic reduciton
Carbimazole - inhibits TPO can titrate or block and replace
Radioactive iodine - non pregnant or lactating however they often become hypothyroid rather than euthyroid

Surgical thyroidectomy - damage to recurrent laryngeal nerve(2% risk)

44
Q

Which conditions have a thyrotoxic phase?

A

hashimotos thyroiditis
de quervains thyroiditis
subacute lymphocytic thyroiditis

45
Q

What is the most common cause of hypothyroidism in the UK?

A

atrophic thyroiditis

46
Q

What antibodies are present in atrophic thyroiditis?

A

Anti TPO and Anti TSH

47
Q

What are the primary causes of hypothyrodisism?

A 
Iodine deficiency (world comonest)
Atrophic thyroiditis (UK)
Hashimotos thyroiditis (TPO +ve)
subacute thyroiditis
de quervains
drugs: carbimazole, amiodarone, lithium
thyroid agenesis

secondary causes include: post surgery or radiotherapy/radioiodine

48
Q

What kind of goitre do you get in atrophic thyroiditis

A

no goitre - you get a lymphocytic infiltrate

49
Q

Do you get a goitre in hashimotos thyroiditis?

A

Yes due to the regeneration after atrophy

50
Q

How long does it take to see an improvement with levothyroxine treatment?

A

2 weeks

51
Q

How do you manage myxodemic coma

A 
Bloods
correct hypoglycaemia
Slowly replace t3/t4
IV hydrocortisone
manage hypothermia and heart failure
52
Q

what diseases is atrophic thyroiditis assocaited with?

A

Other autoimmune diseases namely addisons, pernicious anaemia and vitiligo.

53
Q

What kind of goitre is seen in de quervains

A

diffuse PAINFUL

often witha preceeding viral infection such as coxsackie - giant cells on histology

54
Q

What is the management for subacute lymphocytic thyroiditis?

A

self limiting

-typicaly seen post partum

55
Q

What is the most common type of thyroid carcinoma

A

Papillary 80 (young patients 20 - 40)
folliular 10
Medullary 5
anaplastic

56
Q

What are the characteristics of a malignant nodule?

A 
cold
solitary
men
young age
solid
radiation exposure
57
Q

What is the best treatment for MODY?

A

Sulphonylureas - gliclazide

very responsive

58
Q

What is the gene linked with MODY

A

HNF1A

type 2 mody is glucokinase mutation

59
Q

What is the treatment for pagets?

A

bisphosphonates

60
Q

What are the complications of pagets?

A

1% bdevelop osteosarcoma
bone thinckening
fractures
cranial nerve involvement - deafness

61
Q

What is the management in hypothyroid?

A

TFT
TPO/TSH antibodies
screen for other autoimmunity

62
Q

What are the causes of hyperparathyroidsism?

A

80% single adenoma
15% hyperplasia
4% multiple adenoma
1%carcinoma

63
Q

What is the treatment of hypercalcaemia?

A

intravenous saline - 3-4 litres per day

bisphosphonates

64
Q

Diabetic neuropathy definition?

A

occlusion of the vasa nervorum causes ischemia of myelinated and unmyelinated nerve fibres

65
Q

What is sorbitol and how does it cause a peripheral neuropathy?

A

highly hydrophilic substance which is unable to pass throught he cell membrane so becomes trapped in neuronal scwann cells, causing swelling and cell death.

66
Q

Name 5 symtpoms of an autonomic neuropathy?

A

Postural hypotension - fludrocortisone
ED - sildenafil
urinary retention
gastroparesis - early satiety/gord/bloating

67
Q

How to remember causes of a polyneuropathy?

A 
MDTVIII
Metabolic
Drugs
Toxins
Vasculitic
Inflammatory
Infectious
Inherited
68
Q

froments sign?

A

ulnar nerve palsy - require help of the median nerve to hold a piece of paper

69
Q

What should type 1 diabetics do when they are ill?

A

check blood glucose more regularly, check urinary ketones
drink lots of water?
dont stop insulin even if not eating much
keep up caloric intake where possible with sugary drinks
if they have a raised ketone at the same time as a raised sugar - they should take some insulin - daily dose /6

70
Q

which diabetic agents cause weight gain?

A

thiazoledinediones

sulphonylureas

71
Q

What are th e precipitants of an addisonian crisis?

A

stopping long term steroids
surgery
trauma
infection

72
Q

drugs that cause hypercalcaemia?

A

thiazides

73
Q

what reduces the intestinal absorption of thyroxine?

A

iron tabs

74
Q

tender vs non tender hyPER thyroid

A

tender - de quervains

non tender graves

75
Q

contraindications to metformin

A

ESRF

6th Year (19 decks)

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