Endo Flashcards
What is the classical presentation of Waterhouse Friderichsen sydrome
Profound sepsis and coagulopathy - it is a pre-terminal event
What are the structural characteristics of a benign adenoma?
Well defined and often wiht a rich lipid core
What causes thyrotoxicosis with a tender goitre?
De Quervain’s thyroiditis
What is the time course of DeQuervain’s thyroiditis?
Hyper - 5 weeks
Eu - 2 weeks
Hypo - weeks to months
Normality resumed
What is seen on 131 scans in Thyroiditis?
Globally reduced uptake
What are the side effects of pioglitazone?
Weight gain Liver impairment Fluid retention Fractures Bladdercancer
What are Trosseau’s and Chvoitek’s signs?
Trosseau’s - Carpal spasm on BP cuff inflation
Chvostek’s - tapping parotid causes facial twitching
Both seen in hypOcalcaemia
At what stage should another anti-diabetic drug be added?
If HbA1c is above58/7.5%
What are the differences between HHS and DKA?
No hyperketonuria
No metabolic acidosis
Higher blood glucose
Normal pH
Do DDP4 inhibitors e.g. Sitagliptin cause weight gain?
No, nor do they cause hypos
Which element is required for PTH secretion and action other than Ca?
Mg
What endocrine abnormality can quinines precipitate?
Hypogylcaemia
What is the TFT profile seen in subclinical hypothyroidism?
Elevated TSH with normal T4
Which diabetes medication is contraindicated in patients with recurrent thrush?
SGLT2 inhibitors
What are the various DM diagnostic criteria for a symptomatic patient?
Fasting glucose >=7
Random glucose>=11.1
2Hr 75g OGTT>= 11.1
HbA1C>=48/6,5%
What criteria must be met for an asymptomatic patient to be diagnosed with DM?
Same numbers as for a symptomatic patient but mutst be met twice
Hyponatraemia and hyperkalaemia in a patient with lethargy most likely indicates…..? And what diagnostic test should be done?
Addison’s disease
Short SynACTHen test
What is the single most important measure to prevent gangrene development in diabetic foot patients/
Education about foot care and appointment with diabetic foot clinic
True or false - long term steroid use causes osteomalacia?
False - it causes osteopaenia and osteoporosis but not osteomalacia
What should be done for all patients with pituitary masses?
Hormonal profiling
Which diabetic meds are contraindicated in heart failure?
Thiazolinediones (pioglitazone)
What should be done for patients with Addison’s taking hydro and fludrocortisone who are unwell?
Double the hydrocortisone ONLY
Men 1, 11a, 11b?
1 - 3Ps - Parathyroid, pituitary, pancreas
2a - 2Ps - Parathyroid, phaeo, thyroid
2b - 1P - Phaeos, thyroid, Marfans
What is the commonest side effect of radio thyroid treatment?
Hypothyroidism
What is the commonest complication - and thus CIs- of carbimazole (ATD)?
Agranulocytosis
What is the commonest type of thyroid cancer, and how does it spread?
Papillary carcinoma
Lymphatic spread
Which thyroid cancer typically has a hereditary historyt to it?
Medullary - as part of MEN2A
what causes impaired hypoglycaemic awareness in diabetics?
ANS Neuropathy
What is the first line investigation for acromegaly?
Serum IGF1
What is Nelson’s syndrome?
Rapid enlargement of an ACTH producing pituitary adenoma following a bilateral adrenalectomy for Cushings
What is the inheritance pattern of MODY
AD
Thiazides cause hyper or hypocalcaemia?
Hypercalcaemia
Whatis the difference between Hashimoto’s and De Quervain’s thyroiditis?
Time frame - the former is over 6-12 months whereas the latter over a matter of weeks
What does ‘unrecoreable’ blood glucose mean?
Too HIGH rather than low
Wht is the HbA1C definition of Prediabetes?
42-47/6-6.4%
What are the drug causes of gynaecomastia?
Spiro - commonest
Cimetidine
Digoxin
Goserelin
Which antibodies are seen in Hashimotos?
anti-TPO
What is the first line management of prolactinomas?
Da agonists e.g. cabergoline or bromocriptine
What effect does iron have on thyroid function?
Iron reduces thyroxine absorption, therefore causing a hypothyroidism
What are the drug causes of gynaecomastia?
Spiro - commonest
Cimetidine
Digoxin
Goserelin
Which antibodies are seen in Hashimotos?
anti-TPO
What is the first line management of prolactinomas?
Da agonists e.g. cabergoline or bromocriptine
What effect does iron have on thyroid function?
Iron reduces thyroxine absorption, therefore causing a hypothyroidism
What insulin regiment should DKA patients be on?
Fixed rate
COntinue regular LA injectables but stop short acting insulin
What may cause a diabetiv with poor glucose control to experience bloating and vomiting?
Gastroparesis due to vagal neuropathy
Which diabetic med is contraindicated in bladder cancer and causes weight gain?
Pioglitazone (thiazolidinediones)
What is the mechanism of sitagliptin?
DDP4 inhibitor
What are the blood glucose targets for T1DM?
5-7 on waking
4-7 before other meals of the day
Chronic alcohol abuse may mimic which endocrine syndrome?
Cushing’s
What is the first line treatkent for cerebral metastases?
Dexamethasone
What is the most important modifiable risk factor for the development of thyroid eye disease?
Smoking cessation
When should a second diabetic agent be added?
when HbA1c is above 58 or 7.5%
What is the management of a post menopausal woman with a fracture?
Bisphosphonates and calcium supplementation - there is no need for a DEXA scan
What is the most common cardiac complication of thyrotoxicosis?
High output cardiac failure
What is the management of hypoglycaemia with impaired GCS?
IV 100ml 20% dextrose STAT if access
IM glucagon 1mg IV STAT if not
What are the common side effects of sulphonylureas (and name one)
Gliclazide
Hypos
Weight gain
What is the HbA1c targetin T1DM?
48/6.5%
What is the biochemical marker of response to levothyroxine?
TSH normalisation
What complication should be monitored while fluid resuscitating young DKA patients?
Cerebral oedema
What are the features and management of a thyroid storm?
Fx
Fever, tachy, confusion, N&V, HTN, HF, jaundice
Rx Treat the precipitant IV propranolol Anti thyroids e.g. propylthiouracel Lugols iodine Dexamethasone - blocks T4-=>T3 convesion
What is the acid base balance in Cushings?
Hypokalaemic metabolic alkalosis due to potassium excretion and primary HCO3 loss
What are the characteristic features of an insulinoma?
Whipples triad
Hyooglycaemia with fasting or exercise
Reversal of symptoms with glucose
Recorded hypose at time of symptoms
Which one of the following drugs is not a cause of galactorrhoea?
Metoclopramide Bromocriptiner Chlorpromazine Haloperidol DOmperidone
Bromocriptine is a treatment for galactorrhoea rather than a cause
Subacute thyroiditis shows what picture on 131-I scintigraphy?
Globally reduced uptake
What are the features of a myxoedema coma?
Hypothermia
Hyporefleia
Bradycardia
Seizures
Which drugs cause galactorrhoea?
Metoclopromide
Domperidone
CHlorpromazine
Haloperidol
Treatment with which hormone is recommended in Turner’s patients?
GH
Which steroids have the following profiles:
i) Minimal glucocorticoid but high mineralocorticoid activity
ii) Glucocorticoid activity with high minteralocorticoid activity
iii) Predominant glucocorticoid activity with low mineralocorticoid activity
i) Fludrocortisone
ii) Hydrocortisone
iii) Prednisolone
Which hormone is reduced in surgery?
Insulin
What is the mechanism of action of orlistat?
Pancreatic lipase inhibitor which therefore reduces fat digestion
What is the primary cardiac manifestation of acromegaly?
Agromegalic cardiomyopathy
Every person on insulin should also receive what?
Glucagon kit
What should be the next step in the management with a palpable abdo mass or unexplained organomegaly?
V urgent refurral (<48hrs) for ?neuroblastoma and Wilm’s tumour
Cortisol not suppressed by low dose dex but is suppressed by high dose dex?
Cushing’s disease
Ehat asre the casuses of hyopoglycaemia?
Explain
Exogenous drugs Pit insufficiency Liver failure Addison's Insulinomas Non pancreatic neoplasia
Which diabetes drugs increase risk of osteoporosis?
Thiazolidinediones (pioglitazone)
What are the key features of latent autimmune diabetes of adulthood?
Basically T1DM but presents later
What might causea falsely low HbA1C?
Sickle cell and other Hbopathies due to decreased red cell lifespan
What is the management of amyxoedema coma?
Hydrocortisone
Levothyroxine
What is the bvest treatment for a toxic multinodular goitre?
Radioactive iodine
Can HbA1c be used to rule out diabetes?
No - needs a fasting glucose test
What is the management of an addisonisn crisis?
Hydrocortisone 100mg IV
Saline +-dextrose
NO Fludrocortisone needed
What is the first line for pituitary tumours causing acromegaly?
Trans-sphenoidal surgery
Otreotide if this fails
What are the gynae manifestations of thyroid disease?
Hyper -> oligo/amenorrhoea
Hypo -> menorrhagia
What is a good screening test for medullary thyroid carcinoma?
Calcitonin
What is the management of primary hyperaldosteronism?
Spironolactone
What is the first line insulin regimen for newly diagnosed T1DM?
Basal bolus with twice daily detemir
How many units of insulin are there in 1ml?
100U
What is a good diabetes med to give someone who is obese?
Sitabliptin (DDP4 inh)
What does a gliclazide OD cause?
Hyperinsulinaemia with high C-peptide levels
What should be given first to a phaeo patient/
Phenoxybenzamine (alpha before beta)
