Endo Flashcards
rings/clothes no longer fit, inc sweating, coarse facial feat, headaches, carpel tunnel, sleep apnea
acromegaly
inc pigmentation, postural HTN, loss of body hair, fatigue, wight loss, recent TB inf,
Adrenal insuf
addisons
gradual onset, painful morning stiffness, ? mark posture
ankylosing spondylitis
convulsions, arythmies, tetany, paraesthesia, trousseau, chvostek
hypocal
renal stones, bone pain, polyuria, abdo pain, depression, anxiety
hypercal
paroxysmal flushing, diarrhoea, cramping, abdo pain, wheeze, sweating,
urine - inc 5HIAA
carcinoid syndrome
centripetal obesity, fat pad on back, ankle oedema, purple striae
cushings syndro
polyuria, polydipsia, nocturia, hyponat (lethargy, irritability, confusion)
DI
polyuria, polydipsia, weight loss, tiredness
DM
N&V, kussmaul breathing, abdo pain, sweet breath
DKA
acute mono arthritis esp in 1 MTP,
joint aspirate = turbid/yelloww/ dec viscosity and inc WCC
gout
muscle weakness, VF, ECG (absent p, wide QRS, tented T)
hyperkal
muscle weakness and spasm, cardiac arrhythmia, polyuria/polydipsia
hypokal
lethargy, irritability, thirst, signs of dehydration, confusion, fits, coma
hypernat
postural HTN, dry mucous memb, tachycardia,
RF - vom, diuretics,periph oedema
hypovol hyponat
pehiph oedema, inc JVP
Hx of HF, cirrhosis, nephrotic syndro
hypervol hyponat
galactorrhea, amenorrhoea, infertility, dec libido
hyperprolactinaemia
heat intolerance, palp, tachycardia, weight loss, diarrhoea, mentrual irreg, tremor
hyperthy
cold intolerance, bradycardia, lethargy, weight gain, constipation, dry skin
hypothy
joint pain (worse at end of day), joint stiffness in morning, joint crepitus esp in weight bearing/heavily used joints
osteoarthritis
fractures, bone pain, proximal myopathy, fatigue, hypocal
osteomalacia
inc fractures, back pain, thoracic kyphosis
RF - post menopause, steroids, cushings,SLE
osteoporosis
bone pain (esp femur, pelvis and skull), sensorineural hearing loss, bone bossing, warm skin over painful area
Pagets
paroxysmal attacks of palp, headaches, episodic sweating
inc catecholamines in urine
phaecromocytoma
hirsutism, acne, oligo/amenorrhoea, weight gain
POS
HTN, symptoms of hypokal (muscle weakness, cramps, polyuria, nocturia)
hyperaldosteronism
conns
Reiter syndro - can’t see (conjunctivitis), can’t pee (urethritis), can’t climb a tree (arthritis)
2 weeks after inf (chlamydia, campylobacter, gonorrhoea, shigella)
reactive arthritis
morning joint pain and joint stiffness, joint deformities, nodules, lymphadenopathy, fever, weight loss, AoCD
rheumatoid arthritis
severe pain/swelling and dec range of movement in one joint (normally knee), fever, joint aspirate shows >90% neutrophils
septic arthritis
dec serum Na, inc urine osmo, inc urine Na
SIADH
inv for acromegaly
serum IGF-1
OGTT - failure to suppress GH after 75mg glucose load
Brain MRI to visualise tumour
Management for acromegaly
transphenoidal hypophysectomy somatostatin analogue (octreotide)
hormones def in addisons
mineralocorticoids, glucocorticoids, androgens
Inv for addisons
9am cortisol <100nmol
short synACTHen test - serum cortisol <550 @30mins
management for addisonan crisis
rapid IV fluids, dextrose, hydrocortisone, treat cause
management for chronic adrenal insuff
replace;
Glucocorticoids - hydrocortisone - inc dose in times of stress
mineralocorticoids - fludrocortisone
inv /diagnosis of amyloidosis
green bifringence under polarised light with congo red stain
where does ankylosing spondylitis mainly affect
spine + sacroiliac joints
where are the most common sites for carcinoid tumours
appendix/rectum
urine findings in carcinoid syndrome
inc 5HIAA
what is cushings disease
ACTH sec pit adenoma
most common exogenous cause of cushings syndrome
steroids
management for cushings syndro
metyrapone/ketoconazole - inhib cortisol synth
transphenoidal hypophysectomy
Inv for cushings
24 hr urinary free cortisol (diagnostic if morning cortisol >50nanomol)
low dose dexamethasone suppression - cushings -> cortisol remains high
plasma acth
management for CDI
intranasal desmopressin
management for NDI
thiazide diuretics or NSAIDs
genetic RF for DM
HLA DR3/4
inv for DM
fasting blood glucose >7
random blood glucose >11.1
xray findings in gout
rat bite erosions
ecg changes in hyperkal
absent p waves, wide QRS, tented T
management for hypokal
correct Mg
if k = 3-3.5 - oral potassium chloride and check in 48hr
if k <3 - iv potassium chloride
ECG findings in hypokal
prolonged QT interval, U wave, A/V arrhythmias
management for hypernat
replace water
management for severe hyponat and risks
giver hypertonic saline
change in [Na] must not exceed 10mmol/24hr or risk of central pontine myelinosis
management for hyperprolactinaemia
DA agonist - bromocriptine/cabergoline
surgery
what is thyroiditis
inc release of stored thyroid hormones
hyperthyroidism inv
dec TSH, inc T3/T4
exophalmos, pretibial myxoedema, everything sped up
graves
management for hypothyroidism
levothyroxine
25-200mg daily
where are tumours commonly found in MEN1
parathyroid adenoma/hyperplasia
pancreatic insulinoma/gastroma
pituitary - prolactinoma, acromegaly, adrenal/carcinoid tumour
common presentations of MEN2
100% - medullary thyroid cancer
50% - phaeocromocytoma
parathyroid hyperplasia
bloods in vit D def osteomalacia
dec Ca, dec PO4, inc PTH, dec vit D, inc ALP
bloods in CKD osteomalacia
dec Ca, inc PO4, inc PTH, inc vit D, inc ALP
management for osteomalacia
IV Ca gluconate
Vit D def -ergocalciferol
CKD -alfacalcidol
Xray findings in osteomalacia
looser frac
most common infectious cause of osteomyelitis
staph aureus
what bones are normally affected in osteomyelitis
kids = long bones adults = vertebrae
what scores do you get from a dexa scan
T score -pt comparison compared to young/healthy
Z score - age matched
-1->-2.5 = osteopenia
inv for pagets
bloods - inc ALP
Serum CTX - marker for bine resorption
serum PINP - maker for bone formation
Tec99 bone scan - hot spots =lytic areas
from where do phaecromocytomas arise
catecholamine prod chromaffin cells of adrenal medulla
-> excess adrenaline
treamtment for phaeocromocytoma
complete alpha and beta blockade
phenoxylbenzamine - non rev alpha antag
propanolol = non selective beta block
inv for POS
bloods - inc LH/testosterone/LH:FSH, decsex hormone binding globulin
what are the results of excess aldosterone
inc Na/H2O retention -> HTN
inc K loss -> hypoka
main causes for primary hyperaldosteronism and precedence
conns syndro (70%) - adrenal adenoma, young female bilat adrenal cortex hyperplasia - older guy
how do you differentiate the causes of pri hyperaldoseronism
postural test - measure aldos at 8am lying down then 4 hours after
Conns- aldos sec decreases
BACH - aldos sec inc
management for conns
adrenalectomy
management for bilat adrenal hyperplasia
aldosterone inhib - spironolactone
management for pri hyperpara
Iv fluids + biphos
transphenoidal hypophysectomy
calcium pyrophosphate crystals in joints
pseudogout
xray findings in pseudogout
white lines of chondrocalcinosis
RF for rheumatoid
HLADR4
smoking
xray findings in rheumatoid artheritis
uniform joint space narrowing, joint erosions at margins, osteopenia
causes of septic artheritis
<30 - nesseria gonorrhoea
>30 - staph aureus
management for SIADH
treat underlying cause, fluid restriction
if ineffective demeclocycline or vasopressin R antag (tolvaptan)
strong association with thyroid cancer
MEN2
