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med / surg > endo > Flashcards

endo Flashcards

1
Q

acromegaly signs on examination

A 
prognathism 
macroglossia
enlarged supraorbital ridges
large hands / feet 
cardiomegaly → displaced apex beat
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2
Q

acromegaly management

A

surgical: transphenoidal resection of tumour (definitive)
medical: somatostatin analogues e.g. octreotide
GH receptor antagonists e.g. pegvisomant
radiotherapy for refractory disease

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3
Q

acromegaly investigations

A

bloods: GH, IGF1 levels + OGTT (glucose should suppress GH)
MRI → pituitary mass
visual field testing
assessment of other pituitary hormones

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4
Q

acromegaly complications

A 
cardiac: HTN, arrthythmias, IHD, cardiomyopathy
obstructive sleep apnoea
diabetes
osteoarthritis 
carpal tunnel syndrome
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5
Q

stages of diabetic retinopathy + management

A

background: hard exudates, microaneurysms, blot haemorrhages
→ optimise glucose control, pt education, annual screening
pre-proliferative: soft exudates
→ pan-retinal photocoagulation
proliferative: neovascularisation near optic disc
→ pan-retinal photocoagulation
maculopathy: exudates near macula
→ grid-laser therapy: targeted photocoagulation only at affected area

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6
Q

management DKA

A
  1. IV normal saline
    bolus 10ml/kg
    then 1L/4hrs until no longer dehydrated
    + potassium 40mmol/L but not in bolus fluid bag; infusion rate too high
  2. IV insulin (fixed rate: 0.1units/kg/hr)
    continue background insulin
  3. once plasma glucose < 12mmol/L
    change saline to 5% dextrose w 0.45% NaCl (150-250ml/hr)
  4. heparin (dehydration → risk of clotting)
  5. ABx if infection
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7
Q

management T2DM

A

cons: patient education, diet modification, exercise, weight loss, complication monitoring
med: metformin
add sulphonylurea (e.g. glibenclamide), pioglitazone, gliptin

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8
Q

causes of hyperthyroidism

A

autoimmune: Grave’s disease
toxic thyroid nodules (multiple = Plummer’s disease)
De quervain’s thyroiditis: viral / post-partum

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9
Q

causes of goitre

A

hyperthyroid: Grave’s, Plummer’s (multinodular)
De Quervain’s thyroiditis
euthyroid: non-toxic goitre, cancer, adenoma
hypothyroid: Hashimoto’s, iodine deficiency

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10
Q

causes of thyroid nodule

A

single nodule:
colloid / hyperplastic nodules, cyst, adenoma, cancer
multinodular goitre: Plummer’s disease (toxic)

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11
Q

types of thyroid cancer

A

papillary (80%): younger pts, good prognosis, assoc w radiation exposure, psamomma bodies, orphan annie eye nuclei

follicular: middle age, Hurthle cells
medullary: MEN2A+B, calcitonin-secreting
anaplastic: rare, worst prognosis

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12
Q

causes of hypothyroidism

A

central:
pituitary: adenoma, infection, radiotherapy
hypothalamic: trauma, neoplasm
primary:
autoimmune: Hashimoto’s
iodine deficiency (most common)
drugs: amiodarone, lithium, iodine
iatrogenic: post-thyroidectomy, radiotherapy, radio-iodine
infiltration: sarcoidosis, amyloidosis, haemochromatosis
post-partum / infective thyroiditis

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13
Q

management Grave’s

A

medical:
symptomatic: beta-blockers
anti-thyroid drugs (12-28mths): carbimazole, propylthiouracil
OR block + replace: high dose antithyroid then levothyroxine
radioactive iodine
surgical: thyroidectomy

orbitopathy: prisms for diplopia, lubricant eye drops / ointments
IV methylprednisolone if sight-threatening / severe

dermatopathy: short course topical corticosteroid (if severe)

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14
Q

causes of diffuse goitre

A

autoimmune: hashimoto’s, grave’s
iodine deficiency
thyroiditis: post-partum / infective

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15
Q

MEN2A

A

medullary thyroid → calcitonin
parathyroid hyperplasia → PTH → hypercalcaemia
phaeochromocytoma → catecholamines

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16
Q

MEN2B

A

marfarnoid body habitus
medullary thyroid carcinoma → calcitonin
mucosal neuromas
phaeochromocytoma → catecholamines

17
Q

MEN1

A

pituitary adenomas (prolactin, GH, ACTH, TSH)
parathyroid hyperplasia → PTH → hypercalcaemia
pancreatic tumours:
insulinoma → hypoglycaemia
zollinger ellison → gastrin → peptic ulcers

18
Q

addison’s management

A

cons: MDT approach, pt education (importance of meds, concurrent illness Tx), medical bracelets
med: glucocorticoid replacement (2-3 doses frontloaded in morning) - double in concurrent illness
mineralocorticoid replacement

19
Q

addison’s investigations

A

bloods: FBC, U&Es (↓Na, ↑K), ↓glucose
adrenal Ab (21-hydroxylase)
synACTHen test: ACTH fails to stimulate cortisol release
adrenal CT / MRI

20
Q

management hypoglycaemia

A

conscious: short-acting carb (fruit juice, lucozade) + long-acting carb (biscuit, bread)
IM glucagon / IV dextrose if no improvement
once CBG > 4mmol/L: give long-acting carb
unconscious, unco-operative, fitting, unsafe swallow: ABC, stop insulin, IV dextrose 20% 50ml
1mg IM glucagon if no improvement
once CBG > 4mmol/L and regaining consciousness: give long-acting carb

21
Q

causes of hypoglycaemia

A 
iatrogenic: insulin / sulphonylureas 
poor glylcaemic control 
heavy alcohol consumption, renal impairment
rarer causes:
insulinoma 
addison's 
factitious hypoglycaemia
22
Q

management prolonged hypoglycaemic coma (>5hrs)

A

IV mannitol + dexamethasone
constant glucose monitoring
IV glucose

23
Q

causes of diabetes insipidus

A

cranial (insufficient ADH): tumours (pituitary / craniopharygioma), trauma, vascular (aneurysms, Sheehan syn)
nephrogenic (ADH insensitivity): idiopathic, lithium, pregnancy, osmotic diuresis (diabetes)

24
Q

investigations diabetes insipidus

A

serum + urine osmolality
24hr urine collection
bloods: U&Es → hypernatraemia

fluid restriction test:
normal / psychogenic polydipsia: AVP → concentration of urine
DI: no change

DDAVP test:

cranial: concentration of urine
nephrogenic: no change

hypertonic saline (3%) test:
normal / nephrogenic: AVP release (measured)
cranial: no AVP change
25
Q

management diabetes insipidus

A

cranial: DDAVP (desmopressin)
nephrogenic: fluids, salt restriction, thiazide diuretics (bendroglumethazide)
treat underlying cause

26
Q

causes of gynaecomastia

A

increased oestrogen:androgen ratio
physiological (puberty)
androgen deficiency: Klinefelter’s, Kallman
liver disease
testicular failure: mumps
drugs: spironolactone, cimetidine, digoxin, cannabis

27
Q

management of hyperglycaemic hyperosmolar state (HHS)

A

ABCDE
slow rehydration w 0.9% saline (risk cerebral oedema)
IV insulin if glucose not falling by 5mmol/L w rehydration alone / ketonaemia
correct electrolyte imbalance
monitor urine output

28
Q

causes of hypoparathyroidism

A

primary:
genetic e.g. DiGeorge syn
acquired: anterior neck surgery, radiation
drugs: chemo / alcohol
infiltration: Wilson’s, haemochromatosis, metastases

secondary: to hypercalcaemia

29
Q

investigations cushing’s

A

24hr urinary free cortisol (1st Ix)
9am + midnight cortisol (high midnight in Cushing’s)
low dose dexamethasone suppresion test (diagnostic): fails to suppress cortisol
high dose dexamethasone: fails to suppress cortisol if ectopic ACTH (but not in cushing’s disease)

30
Q

management cushing’s

A

if iatrogenic: reduce steroid dose

medical:
steroidogenesis inhibitors: metyrapone, ketoconazole, etomidate

surgery:
removal of pituitary / adrenal tumour OR adrenalectomy
radiotherapy

31
Q

which drugs can cause hypothyroidism

A

amiodarone
lithium
iodine

32
Q

bones commonly affected in pagets

A

skull
spine
pelvis
long bones: femur, tibia

33
Q

complications of pagets

A

cardiac failure (high-output)
deafness (sensorineural: CNVIII compression)
fractures
osteosarcoma

34
Q

side effects of thiazolidinediones

A 
weight gain 
increased fracture risk 
fluid retention (contraindicated in heart failure) 
liver impairment: monitor LFTs 
bladder cancer
35
Q

pepperpot skull

A

primary hyperparathyroidism

36
Q

management SIADH

A

fluid restriction
democycline (reduces sensitivity to ADH at collecting duct)
tolvaptan (V2 antagonist)

37
Q

causes of SIADH

A

CNS: stroke, tumour
lung: small cell lung cancer, pneumonia, TB
other malignancies: pancreas, prostate
drugs: SSRIs, TCAs, carbamazpine

38
Q

investigations SIADH

A

high urine osmolality + Na
low plasma osmolality
euvolaemic hyponatraemia

med / surg (15 decks)

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