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Medicine - med school > Endo > Flashcards

Endo Flashcards

1
Q

What is the most common cause of Addison’s disease in the UK?

A

Autoimmunity

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2
Q

Dompridone - what does it NOT do (which makes it good for PD) but what is its side-effect

A

Does not cross the BBB and hence no EPS caused, but causes raised prolactin - leads to galactorrhoea

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3
Q

Addison’s disease - state what the level of morning cortisol would be & ACTH levels

A

Low morning cortisol levels

High ACTH levels

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4
Q

Secondary adrenal insufficiency (e.g. pituitary cause) - what would cortisol and ACTH levels be like?

A

Cortisol - low

ACTH - low (different to Addison’s where it is high!)

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5
Q

Lead poisoning - signs and symptoms (think of this alongside acute intermittent prophyria when there is abdo pain + neuro signs!)

A
  • Abdominal pain
  • Peripheral neuropathy (mainly motor)
  • Fatigue
  • Constipation
  • Blue lines on gum margin (~20% of adult patients, rare in children)
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6
Q

Tumour markers in:

  1. Ovarian cancer
  2. Pancreatic cancer
  3. Breast cancer
A
  1. Ca 125
  2. Ca 19-9
  3. Ca 15-3
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7
Q

Tumour markers in:

  1. Prostate ca
  2. Hepatocellular carcinoma
  3. Colorectal cancer
  4. Melanoma/schwanomma
  5. Small cell lung ca, gastric ca, neuroblastoma
A
  1. PSA
  2. AFP
  3. Carcinoembryonic antigen (CEA)
  4. S-100
  5. Bombesin
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8
Q

Cushing’s syndrome vs Cushing’s disease

A

Syndrome - increased production of ACTH due to variety of causes - exogenous causes (e.g. steroids) are more common than endogenous

Disease - Cushing’s syndrome subcategory which is specifically due to a pituitary tumour secreting ACTH = leads to adrenal hyperplasia

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9
Q

What is pseudo-Cushing’s?

A

Mimics Cushing’s syndrome;
often due to alcohol excess or severe depression
causes false positive dexamethasone suppression test or 24 hr urinary free cortisol
insulin stress test may be used to differentiate

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10
Q

Cushing’s syndrome - ACTH dependent and independent causes

A

ACTH dependent causes

  1. Cushing’s disease (80%): pituitary tumour secreting ACTH producing adrenal hyperplasia
  2. Ectopic ACTH production (5-10%): e.g. small cell lung cancer

ACTH independent causes

  1. Iatrogenic: steroids
  2. Adrenal adenoma (5-10%)
  3. Adrenal carcinoma (rare)
  4. Carney complex: syndrome including cardiac myxoma
  5. Micronodular adrenal dysplasia (very rare)
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11
Q

Best way to assess diabetic neuropathy of the feet

A

Use 10g monofilament to test sensation

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12
Q

Isolated raise in ALP alongside normal liver function tests - what does this point towards?

A

Malignancy (particular bone cancer/metastases)

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13
Q

What are the features of MEN type I?

A

3P’s

Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)

Also: adrenal and thyroid

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14
Q

MEN type II a and b

A 
Type II a:
Medullary thyroid cancer (70%) 
.. and 2 P's
Parathyroid (60%)
Phaeochromocytoma
Type II b:
2 M's - Medullary thyroid cancer and marfanoid body habitus
.. and 1 P and 1 N
Phaeochromocytoma
Neuromas
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15
Q

Conn’s syndrome (hyperaldosteronism) - what would you find in the blood gas?

A

Metabolic alkalosis that is also shows hypokalaemia (and hypernatraemia).

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16
Q

Diabetic patient - already on metformin and BMI is 35 - what is the next drug that would be suitable for him to prescribe?

A

DDP-4 inhibitors (sitagliptin)

17
Q

Infusion rate of insulin in patient with DKA

A

0.1 unit/kg/hour

18
Q

Respiratory distress syndrome (surfactant lung disease) - CXR findings

A

Ground glass shadowing and air bronchograms

19
Q

Mx of RDS in neonates

A
  1. Maternal corticosteroids if still in utero
  2. Oxygen/assisted ventilation
  3. Surfactant via ET tube is also an option
20
Q

Conjugated hyperbilirubinaemia - big dx you are trying to exclude:

A

Biliary atresia

  1. Check for jaundice, pale stools, dark urine, distended abdomen
  2. Mx: kasai hepatoportoenterostomy (if only external bile ducts involved); or liver transplant (if intra-hepatic duct involvement) - do within first 2 mos for best outcome
21
Q

Management for NEC

A
  1. NBM (rest bowel)
  2. TPN and IV antibiotics
  3. Surgery to remove necrotic bowel
22
Q

XR findings for NEC

A
  1. Pneumatosis intestinalis
  2. Pneumoperitoneum (if perforated)
  3. Dilated small bowel loops
  4. Bowel oedema
  5. Rigler sign - air inside and outside bowel
  6. Football sign
23
Q

Guthrie test - performed in 5-9 days of life; what does this test?

A 
congenital hypothyroidism
cystic fibrosis
sickle cell disease
phenylketonuria
medium chain acyl-CoA dehydrogenase deficiency (MCADD)
maple syrup urine disease (MSUD)
isovaleric acidaemia (IVA)
glutaric aciduria type 1 (GA1)
homocystinuria (pyridoxine unresponsive) (HCU)
24
Q

Management of kawasaki disease

A
  1. Steroids
  2. IV immunoglobulin
  3. Echo to screen for coronary artery aneurysms
25
Q

Management of cow’s protein allergy in formula and breast fed babies

A

Management if formula-fed:

  1. extensive hydrolysed formula (eHF) milk is the first-line replacement formula for infants with mild-moderate symptoms
  2. amino acid-based formula (AAF) in infants with severe CMPA or if no response to eHF
  3. around 10% of infants are also intolerant to soya milk

Management if breast-fed:

  1. continue breastfeeding
  2. eliminate cow’s milk protein from maternal diet
  3. use eHF milk when breastfeeding stops, until 12 months of age and at least for 6 months
26
Q

Management for pyloric stenosis

A
  1. ABCDE - keep NBM
  2. NG tube
  3. IV access - resuscitate if needed; or maintenace
  4. Carry out Ix - blood gas, U&Es, USS
  5. Surgery is the definitve Mx - Ramstedt pylorotomy
27
Q

Features of pyloric stenosis

A
  1. ‘projectile’ vomiting, typically 30 minutes after a feed
  2. constipation and dehydration may also be present
  3. a palpable mass may be present in the upper abdomen - olive-shaped mass + scaphoid abdomen
  4. hypochloraemic, hypokalaemic alkalosis due to persistent vomiting
28
Q

Haemolytic uraemic syndrome - traid of featues

A

acute renal failure
microangiopathic haemolytic anaemia
thrombocytopenia

29
Q

Management of pyloric stenosis

A
  1. ABCDE
  2. NMB ± NG?
  3. Access - get gases, bloods and resuscitate patient
  4. Imaging: USS target sign
  5. Air enema reduction or surgery
30
Q

Pepper pot skull is characteristic of which disease?

A

Hyperparathyroidism (it may also be seen in multiple myeloma)

31
Q

First-line treatment in neuropathic pain in T2DM

A

Amitrytilline, duloxatine, gabapentin or pregabalin

Tramadal - may be used for rescue therapy for exacerbations of neuropathic pain

32
Q

Cardiac abnormality associated with acromegaly

A

Cardiomyopathy

Plus HTNB, arrhythmias and left ventricular hypertrophy

33
Q

Most common cause of hypothyroidism in the developing world

A

Iodine deficiency

34
Q

Thyrotoxicosis with tender goitre points to a diagnosis of what?

A

subacute (de Quervain’s) thyroditis)

35
Q

Grave’s disease - most common autoantibodies found

A

TSH receptor stimulating antibodies (90%)

anti-thyroid peroxidase in 75%

36
Q

A 38-year-old man is noted to have a blood pressure of 175/110 on routine screening. On examination there are no physical abnormalities of note. CT scanning shows a left sided adrenal mass. Plasma metanephrines are elevated.

A

Phaeochromocytoma

Medicine - med school (10 decks)

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