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P4 > endo > Flashcards

endo Flashcards

1
Q

inheritance pattern congential adrenal hyperplasia

pathology

which deficiency?

A

recessive

in response to low cortisol levels, the anterior pituitary secretes high levels of ACTH

  • 21-hydroxylase deficiency (90%)
  • 11-beta hydroxylase deficiency (5%)
  • 17-hydroxylase deficiency (very rare)
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2
Q

X-ray changes in hyperparathyroidism

A
  1. osteopenia (low bone density)
  2. erosion of the terminal phalyngeal tufts

pepperpot skull

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3
Q

primary / secondary / teritary hyperPTH

A

primary (oversecretion of parathyroid):
high PTH, high calcium, low phos

secondary (vit D def, CKD):
high PTH, low calcium, high phos

teritary (CKD, hyperplasia):
v high PTH, high calcium, high phos

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4
Q

where does PTH act to increase Ca levels

A

bowel
kidneys
bone

chief cels secrete PTH

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5
Q

electroylte imbalance seen in cushing

A

hypokalaemic metabolic acidosis

with impaired glucose tolerance

Ectopic AC

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6
Q

features of cushings

A 
hyperglycaemia (central obesity)
osteoporosis
muscle wasting / weakness
skin thinning / brusing / striae
ulcers
immunosuppression / infection (neutropenia)

moon face
buffalo hump

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7
Q

diagnostic tests for cushings

A
  1. 24 urinary cortisol sample
  2. dexamethasone suppression test

low (1mg) / (8mg)
serum cortisol
serum ACTH

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8
Q

c-peptide significance?

A

low in T1DM
- pancreas is not making enough insulin precursor –> which breaks down to form C-peptide + insulin)

high/normal levels in T2DM

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9
Q

how do you diagnose insulinoma?

A

whipple’s triad

  1. hypoglycaemia in mornings (before eating)
  2. reversal of symptoms with glucose/food
  3. recorded low BMs at time of symptoms

high c peptide

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10
Q

conn’s blood results

A

hypernatraemia
hypokalaemia
metabolic alkalosis

aldosterone Na/K
H ions pumped out

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11
Q

1st line conn’s investigation

A

aldosterone:renin ratio

conn’s:
high aldosterone
low renin

CT abdo/adrenal after

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12
Q

Maturity-onset diabetes of the young inheritance pattern

A

autosomal dominant

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13
Q

define fasting glucose

A

fasting glucose 6.1 to 7mmol/l

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14
Q

define impaired glucose tolerance

A

fasting glucose < 7

OGTT 2 hr 7.8 - 11mmol/L

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15
Q

mx for acute addisonian crisis

A

iv hydrocortisone

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16
Q

addision’s pt - what do you do with their steroids?

A

double hydrocortisone

same dose fludrocortisone

17
Q

gliptins / DPP-4

A

increases incretin levels
–> inhibit glucagon secretion

best for obese pt - doesn’t cause weight gain

18
Q

pioglitazone

A

reducing peripheral insulin resistance

don’t use in HF
LFT monitor
weight gain

19
Q

metformin

A

increases insulin sensitivity

GI upset
lactic acidosis
weight loss

20
Q

sulfonylurea

A

stimulate beta cells to secrete insulin

hypoglycaemia
weight gian
hyponatraemia

21
Q

SLGT

A

inhibits reabsorption of glucose in the kidney

UTI risk
thrush risk

22
Q

pt in thyrotoxic storm Mx

A

beta blocker
proplythiouracil
hydrocortisone

23
Q

features of a thyrotoxic storm

A

tachycardic
confused
hypotension
spike temp

24
Q

what is sick euthyroid syndrome?

A

norma/lowl TSH
low t3/t4

in the presence of acute illness

no treatment needed

25
Q

why is dexamethasone used for space occuping lesion in brain/raised intracranial pressure?

A

strong glucocorticoid properties - anti-inflammatory

minimal mineralcorticoid properties - fluid retaining

26
Q

which diabetic drugs are related to bladder CA?

A

thiazolidinediones
- pioglitazone

reducing peripheral insulin resistance

weight gain
liver impairment
fluid retention risk - don’t use in heart failure

27
Q

what is the fixed rate of insulin for DKA?

A

0.1 units / kg / hr

28
Q

what is the fastest you can correct potassium?

A

10mmol / hr

potassium is normally given in 40mmol
so 40mmol in 4L saline

29
Q

hyper / hypothyroidism

which gives mennorhagia / oligomenorrhagia / amenorhagia?

A

hyper - oligo / amen

hypo - menn

30
Q

Order strength of glucocorticoids (6)

A

anti-inflammatory

dexamethasone (40)
betmethasone (40)
methlyprednisolone (20)
fludrocortisone (15)
prednisolone (4)
hydrocortisone (1)
cortisone (1)
31
Q

Order strength of minercorticoids

A

fluid retention

aldosterone (400)
fludrocoritsone (150)
hydrocortisone (1)
prednisolone (0.8)

32
Q

what is Hastimoto’s?

what is the Mx & the monitoring TSH?

A
  1. autoimmune hypothyroid
  2. anti-thyroid perioxidase antibodies
  3. painless goitre

give lveothyroxine –> monitor TSH to stablise

33
Q

what is toxic multinodular goitre?

A

thyroid gland containg number of autonomously functioning thyroid nodules –> hyperthyroidism

Mx - iodine therapy

34
Q

HbA1c

what causes a increased / decrease in value?

A

increase RBC life span:

  • splenectomy
  • b12 / folate deficiency
  • iron def

Decrease RBC life span:

  • G6PD
  • hereditary spherocytosis
  • sickle cell

P4 (11 decks)

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