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Year 3 Conditions > Endo > Flashcards

Endo Flashcards

1
Q

What percentage of people dont know they have T2DM

A

25%

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2
Q

What is onset of T1DM

A

Acute- present severely

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3
Q

Symtoms of T2DM

A

Lethargy and tiredness

Polyuria and polydipsia

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4
Q

Pathology of T2DM

A

Going to urinate loads so drink sugary drinks and sugar slowly rises- osmotic diuresis causes loss of water and rise in glucose and sodium- hyperosmolar

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5
Q

How does T2DM lead to stroke

A

Blood becomes like treacle

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6
Q

Microvascular complications of DM

A

Glycolysation of basement membrane proteins leading to leaky capillaries
Nephropathy
Retinopathy
Neuropathy

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7
Q

Microvascular complications of DM

A

Dyslipidaemia, HTN, hypercholesterolaemia
IHD
CVA
Peripheral gangrene

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8
Q

How does T2DM worsen MIs

A

Nerves are damaged so dont feel it then go into HF

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9
Q

What is seen under fundoscope in T2DM

A

Hard exudates

Blot haemorrhages

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10
Q

Background diabetic retinopathy

A

HARD EXUDATES
blot haemorrhages
Microaneurysm

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11
Q

Treatment for background diabetic retinopathy

A

Improve blood glucose control

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12
Q

How to treat pre-proliferative retinopathy

A

Pan retinal photocoagulation

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13
Q

Danger of preproliferative stage

A

New vessels can grow that are very thin so risk of bleeding and if they do will cause patients to go blind

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14
Q

Management of diabetic retinopathy

A

Screen regularly
Improve blood glucose control
Warn patient that danger signs are there
If preproliferative stage then needes pan retinal photocoagulation which destroys area of periphery in eye

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15
Q

Does glucose control improve symptoms T2DM

A

Yes

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16
Q

What in fundoscope indicates pre proliferative retinopathy

A

Cotton wool dots

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17
Q

When is T2DM control the most important

A

First 20 years

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18
Q

Why is early T2DM control so important

A

Legacy impact- control at the start protects you for many years as delays heart attacks

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19
Q

What cant you do with elderly T2DM patients who have had diabetes for a few years and atheromas

A

Intensively control diabetes as increases risk of sudden death

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20
Q

Management of T2DM

A 
Diet and exercise
Metformin
Sulphonylureas- glicazide
Insulin sensitisers
Insulin
Incretins
Gliptins
SGLT 2 inhibitors
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21
Q

When do you give short acting insulin

A

30 mins before meals

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22
Q

Metformin side effect

A

Diarrhoea

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23
Q

Problems with insulin T2DM

A

Cant drive HGV
Hypos common even in good control
Weigth gain as makes you hungry due to glycosuria stopping so calories saved

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24
Q

What does GLP 1 do

A

Stimulates insulin production and reduce gastric emptying

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25
Q

What is name given to GLP 1 analogues

A

Incretins

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26
Q

What do gliptins do

A

DDP4 inhibitors that reduce GLP 1 breakdown

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27
Q

Main problem of glycosuria

A

Thrush and UTIs

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28
Q

Which patients are SGLT inhibitors most effective in

A

Renal patients and HF patients

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29
Q

What happens to BP in T2DM

A

Increases

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30
Q

Kidney disease has massive impact on prognosis in T2DM

A

Yes

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31
Q

Signs of nephropathy T2DM

A

Microalbuminuria

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32
Q

Mangement of T2DM nephropathy

A

Glucose control
Bood pressure control
ARB or ACEi- Inhibition of RAS
Stop smoking

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33
Q

What is useful about ACEi

A

they prevent renal failure in patients with a lttle microalbuminuria

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34
Q

What patients cant you give ACEi to

A

Bilateral renal artery stenosis

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35
Q

Implications of renal failure

A

Acidosis
Electrolyte imabalnces
Secretory failure

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36
Q

Symptoms of renal failure

A 
Tiredness nand lethargy
SOB due to oedema
Nocturia, twitching, feeling cold
Loss of appetite, weight loss, nasty taste
Anaemia
Renal bone disease- aches and pains
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37
Q

If no renal replacement symptoms

A 
Hyperkalaemia
PO
Nausea
Malnutrition
Fits
Coma
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38
Q

What are renal replacement therapies

A

Peritoneal dialysis
Haemodialysis
Transplant

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39
Q

3 categories for hyponatraemia

A

Hypovolaemic
Euvolaemic
Hypervolaemic

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40
Q

Causes of hypovolaemic hyponatraemia

A

Vomiting
Diarrorhoea
ACEi

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41
Q

Causes of hypervolaemic hyponatraemia

A

Cardiac failure
Cirrhosis
Nephrotic syndrome

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42
Q

Causes of euvolaemic hyponatraemia

A

Hypothyroidism
Adrenal insuffiency
SIADH

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43
Q

Urinary sodium in hypovolaemia

A

Low

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44
Q

Urinary sodium in hypervolaemia

A

Low

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45
Q

Investigations euvolaemic hyponatraemia

A

TFTs

Short Synacthen test

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46
Q

Causes of SIADH

A

CNS pathology
Lung pathology
Drugs
Tumours

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47
Q

Drug causes of SIADH

A

TCA
Carbamezapines
SSRIs
PPIs

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48
Q

What in endo question does postural hypotension indicate

A

Rules out hypovolaemia

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49
Q

Ways to assess volume status

A

Look at mucous membranes

Postural hypotension

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50
Q

Urine osmolality in euvolaemic hyponatraemia

A

Increased

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51
Q

Most common causes of hyponatraemia

A

SIADH

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52
Q

What is onycholysis

A

Detatchment of nail from nail bed

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53
Q

Causes of onycholysis

A

Trauma
Thyrotoxicosis
Fungal infection
Psoriasis

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54
Q

Most appropriate investigation for DKA after CBG and ABG

A

Capillary ketones

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55
Q

When can ALP be raised

A

Liver obstruction

Bone disease

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56
Q

Bone disease that increases ALP

A

Pagets
Fracture
Malignancy

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57
Q

Blood features of primary hyperparathyroidism

A

High calcium

Low phosphate

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58
Q

Which drug has been proven to prevent diabetes

A

Metformin

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59
Q

What is most effective way to prevent diabetes

A

Diet and exercise

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60
Q

Treatment of malignancy related hypercalcaemia

A

Bisphonates IV

Rehydration

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61
Q

In thyrotoxicosis what happens to appetite

A

Increased appetite

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62
Q

Menstrual effects of thyrotoxicosis

A

Oligo-or amenorrhoea

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63
Q

What do you hear if auscultate a graves disease thyroid

A

Bruit

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64
Q

Features of thyroid in graves disease on examination

A

Smoothly enlarged

Bruit audible

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65
Q

Treatment for thyrotoxicosis

A

Carbimazole

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66
Q

Main side effect of carbimazole

A

Agranulocytosis

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67
Q

How can agranulocytosis present post carbimazole

A

Mouth ulcers
Sore throat
Fever

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68
Q

What is aim of thyroxine treatment in terms of T4

A

T4 in upper half of range

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69
Q

What can happen to T4 and TSH levels if not regularly taking medication

A

T4 normal but TSH still high as will take medication just before bloods but this is too soon to suppress TSH

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70
Q

Immediate management for phaeochromocytoma

A

Alpha blockade then beta blockade pre surgery

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71
Q

Presentation of phaeochromocytoma

A

Palpitations
Sweating
Chest tightedness
Anxiety

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72
Q

What are phaeochromocytomas normally precipitated by

A

Surgery
Anti-depressant
Stess
Alcohol and smoking

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73
Q

What is secondary hyperthyroidism caused by

A

Pituitary tumour

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74
Q

Thyrotoxicosis without hyperthyroidism can be caused by

A

Overuse of thyroxine
Post partum thyroiditis
De quervains thyroiditis
Amiodarone toxicity

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75
Q

What can be sign of acute thyroiditis

A

Painful goitre

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76
Q

Opathalmic features of all cases of thyrotoxicosis

A

Lid retraction

Lid lag

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77
Q

What are lid lag and lid retraction caused by

A

Hypersympathetic activity

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78
Q

Who is opthalmology more common amongst in thyrotoxicosis

A

Smokers

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79
Q

2 things a high TSH and T4 suggest

A

Secondary hyperthyroidism

Poor complicance with hypothyroid meds

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80
Q

2 drugs given for hyperthyroidism and how they work

A

Caribimazole and propylthiouracil

Throid peroxidase inhibitor

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81
Q

Dose of carbimazole

A

Initially 30-60mg pper day but slowly reduce down to 5-10mg according to their regular blood tests which will show when patient is euthyroid

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82
Q

What drugs are normally given alongside carbimzole and

A

Beta blockers

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83
Q

What is euthyroid

A

Normal thyroid function

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84
Q

Two types of thyroid surgery

A

Total or subthyroid surgery- subthyroid aims to remove enough tissue so that they arent hyperthyroid

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85
Q

Complications of thyroid surgery

A

Haematoma
Laryngeal nerve damage
Hypothyroidsim
Hypoparathyroidism

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86
Q

Chemical ablation of thyroid

A

Radioiodine 131

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87
Q

Complications of carbimazole

A

Maculopapular rash
Pruritis
Jaundice

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88
Q

Blood test used to analyse serum noradrenaline and adrenaline

A

Plasma metanephrines

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89
Q

Blood test to diagnose phaeochromocytoma

A

Plasma metanephrines

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90
Q

What is an MIBG scan

A

Patient given radioactive iodine and its uptake is monitored across the body

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91
Q

What are MIBG scans used to detect

A

Neuroblastomas or phaeochromocytoma

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92
Q

What is advised to all patients with primary or secondary hypoadrenalism who get a fever or flu

A

Double their hydrocortisone/prednisolone dose

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93
Q

What are Sx of adult with growth hormone deficiency

A

Low mood
General malaise
Fatigued

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94
Q

Test done on adults with suspected GH deficiency

A

AGHDA- is a quality of life questionnaire

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95
Q

What are you thinking when patient presents with abdo pain after an infection affecting any part of body

A

Thyroid storm

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96
Q

Treatment of thyroid storm

A

Anithyroid meds
B blockers
Steroids

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97
Q

Why is beta blocker use used for thyroid storms

A

Treats tachycardia and tremors

Inhibits peripheral conversion of T4-T3

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98
Q

When should you not do s thyroidectomy

A

When patient is under stress such as acutely unwell

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99
Q

What test can show uninodules on thyroid

A

Radioiodine uptake

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100
Q

When should radioiodine uptake not be checked

A

When patient very ill so only useful in later management- can precipitate a thyroid storm

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101
Q

What is most common arrythmia in thyrotoxicosis

A

AF

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102
Q

What are precipitants of thyrotoxicosis

A 
Stress such as infection, cancer and pregnancy
Thyroid surgery
MI
DKA
Any surgery
Radioiodine uptake
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103
Q

What is acromegaly

A

Excess growth hormone in adults that leads to growth of the hands face and feet

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104
Q

What is acromegaly called in children

A

Gigantism

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105
Q

When does hypothalamus release growth hormone releasing hormone

A

Every couple of hours and is affected by stresses on body

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106
Q

Stresses on body that increase growth hormone release

A 
Hungry
Exercise
Trauma
Anxiety
Low blood glucose
Increased sleep
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107
Q

How is GH release limited

A

Too much GHRH
When GH reaches its target cells they release samatomedins which inhibit GH release
GH and somatomedins inhibit GHRH release

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108
Q

GH effects in liver, bones and muscles

A

Bones- stimulates osteoblasts
Muscle- growth
Liver- release glucose

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109
Q

Insulin effects of GH

A

Xs glucose release leads to insulin resistance in cells so insulin increases in blood and become diabetic

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110
Q

What does GH stimulate release of in bones, kidneys, liver and muscle on top of somatomedin

A

ILGF 1

Which promotes cell division and stops apoptosis

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111
Q

Main cause of acromegaly

A

Pituitary adenoma

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112
Q

Rarer causes of acromegaly

A

Hypothalamic tumour

Ectopic tumours

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113
Q

Sx of acromegaly

A 
Soft tissue growths in face, hands and feet
Bony growth in feet, hands and lower jaw
Protrusion of forehead
Organomegaly
Increased sweating
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114
Q

Time course for acromegaly

A

Takes years to notice

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115
Q

Complications of acromegaly

A

HF from cardiomegaly
Carpal tunnel syndrome
Diabetes mellitus
Colon cancer from polyps

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116
Q

Diagnosis of acromegaly

A

Oral glucose tolerance test

MRI of pituitary

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117
Q

Oral glucose tolerance test in acromegaly

A

GH should be suppressed after large consumption of glucose but in acromegaly will be very high

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118
Q

Contraindicating factors that may affect oral glucose tolerance test

A

Hypothyroidism
Cushings
Poorly controlled DM

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119
Q

What is prognathism

A

Protrusion of lower jaw- seen in acromegaly

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120
Q

What is macroglossia

A

Enlarged tongue

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121
Q

Features of acromegaly

A 
Diabetes- all its consequences
Cardiomegaly
Carpal tunnel syndrome- parasthesia
Colonic polyps
Macroglossia
Prognathism
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122
Q

Treatment of acromegaly

A 
Trans-sphenoidal hypophysectomy
External beam radiation
Somatostatin analogues
GH receptor antagonists
Cabergoline
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123
Q

What is primary adrenal insufficiency

A

Can’t produce enough hormones from adrenals in particular aldosterone and cortisol

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124
Q

Where is aldosterone made

A

Zona glomerulosa

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125
Q

Role of aldosterone

A

Increase sodium réabsorption
Decrease sodium
Increase BP and volume

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126
Q

Effect of aldosterone on pH

A

Increases pH as increases H excretion

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127
Q

Where is cortisol made

A

zona fasiculata

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128
Q

What is cortisol used for

A

Physical and mental stress

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129
Q

What stimulates ACTH

A

Corticotrohin releasing hormones

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130
Q

Role of cortisol in terms of glucose

A

Increases blood glucose

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131
Q

How does cortisol increase blood glucose

A

Gluconeogenesis from liver
Causes muscle and adipose to release amino acids and free fatty acids respectively for this
Opposite to insulin

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132
Q

What are glucocorticoids

A

Cortisol

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133
Q

What are mineralocorticoids

A

Aldosterone

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134
Q

Role of adrenal in terms of sex features men

A

Produce dehydroepiandrosterone
Precursor to testosterone
Development of male reproductive organs
Development of secondary sex features such as Addams apple

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135
Q

Role of adrenal in terms of sex features women

A 
Produce dehydroepiandrosterone 
Precursor to testosterone
Growth spurt
Armpit and pubic hair
Libido
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136
Q

Chronic causes adrenal insufficiency

A 
Developing world 
Autoimmune
Metastatic cancer
Developed 
TB
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137
Q

What is chronic adrenal insufficiency called

A

Addisons

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138
Q

Acute cause of adrenal insufficiency

A

Waterhouse friederichsen syndrome

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139
Q

What is waterhouse friederichsen syndrome

A

Hypertensive crisis leads to bursting of adrenal vessels meaning it fills with blood

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140
Q

What does adrenal insufficiency suggest about the damage to adrenal

A

Majority of it is damaged- adrenal gland has high functional reserve whereby only a small proportion can churn out a lot of cells

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141
Q

ABG finding of addisons

A

Metabolic acidosis

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142
Q

Blood findings of addisons

A

Low sodium
High potassium
High urea
Low pH

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143
Q

Sx of addisons- aldosterone

A 
Craving salty foods
Nausea and vomiting
Fatigue
Dizziness when standing
Low BP
Postural hypotension
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144
Q

What do Sx of addisons depend on

A

Which layer is affected by damage

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145
Q

Sx of addisons- cortisol

A

Weak tired and disoriented in times of stress in particular
Hyperpigmentation
Weight loss

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146
Q

Why do you get hyperpigmentation in addisons

A

Reduced negative feedback on pituitary so increases POMC release which is broken down into ACTH and MSH

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147
Q

What layers are most commonly affected in addisons

A

Glomerulosa and fasiculata

Rare for reticularis to be affected

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148
Q

Sx addisons- testosterone women vs men

A

Men very few Sx as testes main source
Women loss of pubic and armpit hair
Low libido

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149
Q

Acute presentation of addisons

A 
Fever
Confused to coma
Low BP
Vomiting
Abdo pain
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150
Q

Chronic presentation of addisons

A 
Abdo pain
Weakness
Joint and muscle pain
Tired and anorexia
Weight loss
Often missed and insidious but can have addisonian crisis which is precipitated by a stressor
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151
Q

Addisonian crisis presentation

A

Low BP leading to LOC
Vomiting and diarrorhoea
Back and leg pain
Abdo pain

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152
Q

How is addisons diagnosed

A

Short synacthen test where given ACTH and monitor cortisol response

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153
Q

Treatment for addisons

A

Hydrocortisone and fludrocortisone

Must be adherent or addisonian crisis

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154
Q

What is a carcinoid tumour

A

Tumour of neuroendocrine cells that line for example the lungs and GI tract which produce large numbers od serotonin or bradykinin for example depending on where they are

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155
Q

What is carcinoid syndrome

A

Paraneoplastic syndrome that develops secondary to a carcinoid tumour that starts releasing excess hormones

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156
Q

Hormones that can be released from carcinoid tumours

A

Serotonin
Histamine
Bradyknin
Prostaglandins

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157
Q

Primary sites of carcinoid tumours

A

All gastro organs including appendix
Lungs
Ovaries

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158
Q

What is often necessary for carcinoid syndrome to develop

A

Metastase to liver meaning there is dysfunction in the breakdown of the hormone

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159
Q

What is serotonin broken down to

A

5-hydroxyindoleacetic acid which passes out in urine

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160
Q

Diagnosing phaeochromocytomas

A

Urine catecholamines
Plasma metanephrines
Abdo CT
MIBG scan

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161
Q

Most commonly affected valve in carcinoid

A

Tricuspid or pulmonary

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162
Q

Investigations for carcinoid

A

urinary 5-HIAA
CT of whole trunk
Echo

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163
Q

Carcinoid effects of increased histamine and bradykinin

A

Flushing

Itching

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164
Q

Carcinoid effects of increased serotonin

A

Fibrosis of heart valves
Bronchoconstriction- asthma
Pellagra

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165
Q

What is pellagra

A

Series of symptoms caused by a lack of niacin malabsorption

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166
Q

Sx of pellagra

A

Diarrorhoea
Dermatitis
Dementia
3ds

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167
Q

Most common sites of carcinoid

A

Distal ileum and appendix

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168
Q

Typical carcinoid syndrome

A 
Cancer of that site Sx
Diarrorhoea
Weight loss
Asthma
Flushing
Pellagra
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169
Q

What worsens carcinoid symptoms

A

Stress on body such as exercise

Alcohol

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170
Q

What is first T2DM drug given

A

Metformin if not contraindicated

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171
Q

What is initial management of T2DM

A

Monotherapy- should be metformin if not contraindicated or get diarrorhoea- and is Hb1ac is monitored after 3 months and if isnt improved or maintained then add another agent such as an incretin or basal insulin
If patient has long standing T2DM, CKD or established atherosclerotic disease then add a SGLT2 inhibitor

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172
Q

Example of SGLT 2 inhibitors

A

Empagliflozin

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173
Q

Which diabetes drug classes were shown to reduce all cause and cardiovascular mortality

A

SGLT2i

Incretins

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174
Q

Side effects of SGLT2i

A

Genital skin infections

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175
Q

Side effects of gliptins

A

Pancreatitis

Retinopathy

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176
Q

What fasting glucose is used to diagnose diabetes

A

Over 7

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177
Q

What random glucose is used to diagnose diabetes

A

Over 11.1

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178
Q

What is dose given in impaired glucose tolerance

A

75g OGTT

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179
Q

What result suggests an impaired glucose tolerance

A

7.8-11

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180
Q

How does daibetic neuropathy present

A

Glove and stocking distribution

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181
Q

O/E graves

A

Exopthalmos
Smooth goitre
Pretibial myxoedema
Tremor

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182
Q

How will technetium nuclear medicine scan show in graves

A

Diffuse increased uptake

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183
Q

Risk factors for thyroid cancer

A 
FHx
Radiation
Any goitre
Iodine deficiency
Obesity
Asian origin
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184
Q

Examination findings of thyroid cancer

A

Lymphadenopathy

Lumps in neck

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185
Q

Common met site of thyroid cancer

A

Lung

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186
Q

Investigations of thyroid cancer

A

USS

Uptake scan technetium

187
Q

How will thyroid cancer show up on Nuclear medicine uptake scan

A

Cold nodules

188
Q

Types of thyroid cancer

A

Papillary
Follicular
Medullary
Anaplastic

189
Q

Management post thyroid cancer

A

Thyroxine and radio-iodine

190
Q

What causes bitemporal hemianopia

A

Pituitary tumour

191
Q

Sx of prolactinoma

A

Bitemporal hemianopia
Amenorrhoea
Galactorrhoea
Sexual dysfunction

192
Q

What is example of dopamine agonist

A

Cabergoline

193
Q

Differentiate between macro and microprolactinoma

A

Either side of 1cm

194
Q

Treatment for prolactinomas

A

Cabergoline rather than surgery as medicines can shrink it completely

195
Q

Presentation of acromegaly

A

Headache
Sweating
Tingling in fingers
Poor sleep and snoring

196
Q

Why do you get poor sleep and snoring in acromegaly

A

Obstructive sleep apnoea

197
Q

What causes tingling in fingers in acromegaly

A

Carpal tunnel syndrome

198
Q

Initial test in suspected acromegaly

199
Q

What presents with snoring, poor sleep, sweating, tinginling in fingers and headache

A

Acromegaly

200
Q

Test used to confirm acromegaly

A

Oral glucose tolerance test

201
Q

Sx of cushings that are very general

A

Central obesity
Fatigue
Depressed

202
Q

Discriminatory cushing Sx

A 
Bruising
Thin skin
Myopathy
Striae
DM and osteoporosis at young age
203
Q

Framework for amenorrhoea/oligomenorrhoea

A 
Pregancy
Hypothalamus
Pituitary
Thyroid
Ovaries
204
Q

What can cause hypothalamic amenorrhoea/oligomenorrhoea

A

Excess exercise

Low BMI

205
Q

What can cause amenorrhoea/oligomenorrhoea related to pituitary

A

Excess prolactin

Low LH/FSH

206
Q

What does PCOS present with

A

Hirsutism

amenorrhoea/oligomenorrhoea

207
Q

Presentation of hirsutism and amenorrhoea/oligomenorrhoea

208
Q

What is blood sign of ovarian failure

209
Q

What presents with polyuria, arrythmia and weakness

A

Hypokalaemia

210
Q

What does hypokalaemia present with

A

Polyuria
Arrythmia
Weakness

211
Q

Differentials for hypokalaemia

A

Vomiting/diarrorhoea
Diuretics
Primary hyperaldosteronism

212
Q

Causes of hyperaldosteronism

A

Bilateral hyperplasia

Conns

213
Q

How to check for hyperaldosteronism

A

Aldosterone:renin ratio

214
Q

Why do hypovolaemic hyponatraemic patients have urinary low sodium

A

ADH insufficiency

215
Q

Effects of PTH on kidney

A

Reabsorb calcium
Excrete phosphate
Produce calcitriol

216
Q

Effects of calcitriol

A

GI calcium and phosphate absorption

217
Q

Effect of acidosis on calcium

A

Increases serum calcium

218
Q

Investigations for hypercalcaemia

A

PTH
Phosphate
DEXA
CT to look for potential PTH secreting tumours

219
Q

Presentation of DKA

A 
Anorexia
Lethargy
Polydipsia
Polyuria
Dehydration
Abdo pain
Vomiting
Coma
220
Q 
What presents with 
Anorexia
Lethargy
Polydipsia
Polyuria
Dehydration
Abdo pain
Vomiting
Coma
221
Q

How is DKA diagnosed

A

Raised plasma glucose or history of diabetes

Metabolic acidosis with increased anion gap

222
Q

Immediate treatment of DKA

A

IV fluid resucitation (0.9% NaCl) followed with IV bolus of insulin onsliding scale

223
Q

What is most important ion to replace in DKA

A

Potassium as is driven into cells by insulin

224
Q

Classical triad for new diabetes

A

Hyperphagia
Polydipsia/polyuria
Tiredness

225
Q

Classical cushings presentation

A 
Truncal obesity
HTN
Fatiguability and weakness
Amenorrhoea
Hirsutism
Striae
Oedema
Glycosuria
Polyuria
226
Q

Common examination test for cushings used

A

Ask patient to get up without using hands and will have no hope

227
Q

Most common cause of cushings

A

Excess glucocorticoid use

228
Q

Causes of cushings

A

Excess glucocorticoid use
Adrenal adenoma
Ectopic ACTH

229
Q

What can cause polyuria other than renal problems

A

Diabetes and DKA
Hypercalcaemia
Cushings
Hypokalaemia

230
Q

What other than DM presents with polyuria and glucosuria

231
Q

Test used to diagnose cushings

A

Overnight dexamethasone suppression

232
Q

How does overnight dexamethasone test work

A

Take dexamethasone at midnight which should suppress ACTH then measure 9am cortisol

233
Q

Presentation of hyponatraemia

A 
Confusion
Dizziness and collapse
Anorexia
Seizures
Weakness
Arrythmia
234
Q

Treatment of hyponatraemia

A

Hypertonic sodium chloride
Fluid resus
Demeclocycline

235
Q

MOA demeclocycline

A

Can be used to block ADH in renal tubule

236
Q

What causes increase in new diabetes diagnoses in february

237
Q

Which diabetes has more of a genetic component

238
Q

How young can people be to first get T2DM

A

Even in children

239
Q

What can cause T1DM

A

Viral pancreas destruction

240
Q

Differences in DKA and HHS presentation

A

DKA presents very acutely in teenagers with T1DM

HHS presents in T2DM patients with or without existing knowledge and will have insidious onset

241
Q

What can cause HHS

A

People arent hydrating properly drinking lots of lucozade and coke so hyperglycaemic

242
Q

What must always consider when patients get UTIs in older ages

A

Diabetes as glycosuria

243
Q

Differences in DKA and HHS serum glucose

A

DKA- 20

HHS- extremely high can be 99

244
Q

Differences DKA vs HHS sodium osmolality

A

DKA slighly high

HHS even higher

245
Q

Differneces in causes of confusion in DKA vs HHS

A

DKA acidosis

HHS hyperosmolar state drawing water out of brain

246
Q

Treatment for HHS

A

Normal saline with starch and then also insulin

247
Q

Difference DKA vs HHS treatment

A

DKA fluid can be given faster

248
Q

What would you think of in hepatomegaly with diarrorhoea

A

Carcinoid tumours

249
Q

Alpha blockade used in phaeochromoctoma

A

Phenoxybenzamine

250
Q

Endocrine tumours that increase BP

A

Conns

Phaeochromocytoma

251
Q

Treatment for conns

A

Spironolactone

252
Q

What drug is used to in treatment of cushings

A

Metyrapone

253
Q

Difference between cushings disease and syndrome

A

Cushings syndrome is term for too much cortisol in body but cushings disease a pituitary tumour

254
Q

Glucocorticosteroid drug replacements

A

Hydrocortisone and prednisolone

255
Q

Mineralocorticoid drug replacements

A

Fludrocortisone

256
Q

Most common form of hypothyroidism in young person

A

Hashimotos hypothyroidism- chronic autoimmune thyroiditis

257
Q

What condition are antithyroid peroxidase ABs seen in

A

Hashimotos

258
Q

What presents with low mood, body aches and polydipsia

A

Hypercalcaemia

259
Q

What happens to ALP in vit D overdose

A

Low as calcium suppresses all bone turnover

260
Q

Investigations for hyperthyroidism and their results

A

ESR- raised
Antithyroid peroxidase
TSH rarely done as expensive

261
Q

When would you always do TSH test

A

If pregnant as ABs can cross placenta and cause thyrotoxic fetus

262
Q

What would be included in yearly T2DM review

A 
Retinopathy
Foot assessment of sensation and doppler for vascular supply
U&E
Serum cholesterol
Hba1c
Weight loss
263
Q

Presentation of renal carcinoma

A

Haematuria
Weight loss
Pain in flank

264
Q

Causes of haematuria

A

Renal carcinoma

Transitional cell carcinoma

265
Q

First line investigation of haematuria

266
Q

What cant renal US pick up

A

Transitional cell carcinomas

267
Q

Management of hypovolaemic hyponatraemia

268
Q

Management of euvolaemic hyponatraemia

A

Fluid restrict

269
Q

Management of hypervolaemic hyponatraemia

A

Fluid restrict

270
Q

What does urinary sodium of less than 20mmol/L suggest

A

Hypovolaemia

271
Q

What does urinary sodium of more than 20mmol/L suggest with hyponatraemia

272
Q

Causes of SIADH

A 
SC lung cancer
CNS infections
Brain tumours
Anti-depressants
Anti-epileptic
273
Q

Causes of hypokalaemia

A 
Mouth
- Reduced dietary intake
- Vomiting
- salbutamol
Kidney area
- Conns 
- Cushings
- loop and thiazide diuretics
Anus
- diarrorhoea
274
Q

Causes of hyperkalaemia

A 
Addisons
ACEi/ARB
K+ Sparing diuretics
Renal failure
Pseudohyperkalaemia
275
Q

Example of K sparing diuretics

A

spironalactone

276
Q

What happens in pseudohyperkalaemia

A

If RBCs are haemolysed their K leaks out into sample leading to error in measurement

277
Q

When would you suspect pseudohyperkalaemia

A

K measurement doesnt fit with rest of clinical picture

278
Q

What is one organ PTH affects but calcitriol not

279
Q

Symptoms of hypercalcaemia

A 
Stones- kidney stone
Bones- fractures
Abdominal moans- dyspepsia
Thrones- polyuria, constipation
Psciatric overtones- depression, psychosis
280
Q

Management of hypercalcaemia

A

Aggressive IV fluid resus and treat cause

281
Q

What is problem of DKA

A

Acidity increases and enzymes cant function

282
Q

Complication of DKA

A

Coma and death

283
Q

Treatment for DKA

A

IV fluids
Fixed rate insulin
Monitor K+, glucose and ketones

284
Q

When patient has hyponatraemia what is first thing you should do

A

Exclude pseudohyponatraemia by looking at serum osmolality

285
Q

What happens in pseudohyponatraemia

A

The serum osmolality is normal or high and hyponatraemia is an artefact of this- sodium is main ion in blood so if that is low would expect the whole serum osmolality to be low

286
Q

What can cause pseudohyponatraemia with high osmolality

A

Hyperglycaemia
Mannitol
Glycine

287
Q

What can cause pseudohyponatraemia with normal osmolality

A

High protein

High lipids

288
Q

Signs of hypervolaemic patient

A

Raised JVP

Oedema

289
Q

What can hypovolaemic hyponatraemia be classified into

A

Whether urine sodium is low or high

If high suggests renal failure as normally kidneys should respond to low sodium by stimulating ADH

290
Q

What can cause hypovolaemic hyponatraemia with high urine sodium

A

Diuretics
Renal failure
Addisons

291
Q

What can cause hypovolaemic hyponatraemia with low sodium in urine

A

Vomiting and diarrorhoea
Third space losts
Cutaneous losses ie burns and sweating

292
Q

In euvolaemic hyponatraemia what can causes be classified into

A

High or low total urine osmolality

293
Q

What will give a high urine osmolality in euvolaemic hyponatraemia

A

SIADH as very little water will be passed out

294
Q

Causes of low urine osmolality euvolaemic hyponatraemia

A

Psychogenic polydipsia
Iatrogenic fluid overload
Severe hypothyroidism

295
Q

What is danger of correcting hyponatraemia too quickly

A

Pontine myelinolysis

296
Q

How will hypoglycaemic patient appear

A

Sweating and tachycardic as increased adrenergic activity

297
Q

Treatment of hypoglycaemia options

A

Dextrose gel in mouth
50ml of 20%insulin IV
Glucagon IM

298
Q

Why do only type 1 diabetics get DKA

A

Ketogenesis is inhibited even by a very small amount of insulin

299
Q

Overall which has a greater effect on calcium- PTH or calcitriol?

A

Calcitriol

300
Q

Overall which has a greater effect on phosphate- PTH or calcitriol?

A

PTH reducing it

Calcitriol increases it by reabsorption

301
Q

Causes of primary hyperparathyroidism

A

Parathyroid adenoma

Prathyroid hyperplasia

302
Q

Blood finding of primary hyperparathyroidism

A

High PTH
High phosphate
High calcium

303
Q

What is the name of secondary hyperparathyroidism

A

Osteomalacia

304
Q

Causes of osteomalacia

A

Vitamin D deficiency
CKD
Liver disease

305
Q

Blood findings of osteomalacia due to Vit d deficiency

A

Low calcium

Low phosphate

306
Q

Blood findings of osteomalacia due to LIVER DISEASE

A

Low calcium

Low phosphate

307
Q

Blood finding of osteomalacia due to CKD

A

Low calcium

High phosphate

308
Q

Blood finding of tertiary hyperPTH

A

High calcium

High phosphate

309
Q

What happens in tertiary hyperPTH

A

Chronic kidney disease means cant produce calcitriol so calcium level permenantly low so parathyroid continuously releases PTH as no neg feedback therefore gets autonomously released

310
Q

How to classify causes of hypercalcaemia

A

High PTH

Low PTH

311
Q

High PTH causes of hypercalcaemia

A

Pimary hyperPTH

Tertiary hyperPTH

312
Q

Low PTH causes of hypercalcaemia

A 
Bone mets
Myeloma
Paraneoplastic lung SqCC
Sarcoid
Thiazide diuretics
313
Q

How to classify causes of hypocalcaemia

A

High PTH

Low PTH

314
Q

High PTH causes of hypocaclaemia

A

Osteomalacia

315
Q

Low PTH causes of hypocalcaemia

A

Autoimmune hypoparathyroidism

316
Q

Clinical examination signs of hypocalcaemia

A

Chvostek sign- tapping facial nerve

Trousseaus sign- tight BP cuff

317
Q

What are rfx for primary hyperPTH

A

HTN

Men -1+2

318
Q

What is MEN-1

A

Multiple endocrine neoplasia 1. Pituitary tumours + pancreatic tumours+PTH gland hyperplasia

319
Q

What is MEN-2a

A

Multiple endocrine neoplasia 2. Phaeochromocytoma+ medullary thyroid cancer+PTH gland hyperplasia

320
Q

What is osteomalacia called in children

321
Q

3 ways of being vitamin d deficient

A

Poor dietary intake
Poor sunlight
Malabsorption

322
Q

Signs and symptoms of osteomalacia

A

Bone pain and fractures
Proximal myopathy
Fatigue

323
Q

Signs and symptoms of rickets

A

Bowed legs

Knock knees

324
Q

Investigations for primary hyperPTH and findings

A 
Bloods:
(FBC, CRP)
U&E
LFTs - ALP normal
Calcium up
Phosphate down
PTH up or normal
Imaging
Head x ray- pepper pot skull
Hand X ray- Subperiosteal bone resorption (radial aspects)
Acro-osteolysis
325
Q

Skull x ray finding of primary hyperPTH

A

Pepper pot skull

326
Q

Hand x ray finding of primary hyperPTH

A

Subperiosteal bone resorption

Acro-osteolysis

327
Q

What is acro-osteolysis

A

Resorption of distal phalanges

328
Q

Investigations for osteomalacia and their findings

A 
Bloods:
(FBC, CRP)
U&E- altered if due to CKD
LFTs - ALP up
Calcium down
Phosphate down or up depending on cause
PTH up
329
Q

Osteomalacia imaging findings

A

Loosers pseudofractures

Rachitic rosary

330
Q

What is rachitic rosary

A

Nodularity at costochondral junctions

331
Q

Treatment of acute primary hyperparathyroidism

A

IV fluids

Bisphosphonates if still high

332
Q

Management plan of primary hyperparathyroidism

A

Surgical total parathyroidectomy
If not healthy enough for surgery then Cinacalcet
(drug class: calcimemetic)

333
Q

What is main risk of total parathyroidectomy

A

Damage to rcurrent laryngeal nerve

334
Q

Treatment of acute osteomalacia causing hypocalcaemia

A

IV calcium gluconate

335
Q

Management of osteomalacia due to vit d deficiency

A

Inactive Vit D- ergocalciferol

Calcium

336
Q

Management of osteomalacia due to CKD

A

Calcium

Active Vit D- alfacalcidol

337
Q

What is acropachy and what do you see it in

A

Swelling of the fingers and clubbing

Associated with graves

338
Q

What is a hygroma cyst

A

Mygroma is an abnormality of the lymph system

339
Q

Where are cystic mygromas only found and what is their defining feature

A

Posterior triangle

Transilluminate

340
Q

What is a branchial cyst

A

Congenital cyst found in anterior triagnle that is from failure of branchial cleft development

341
Q

What is defining feature of branchial cyst

A

Cholesterol crystals inside

342
Q

Where are dermoid cysts in neck found

343
Q

What are dermoid cysts

A

Failures of skin development

344
Q

Where are thyroglossal cysts found

345
Q

How to tell if lump is thyroglossal cyst

A

Will move when stick tongue out

346
Q

What does goitre mean

A

Swelling of the whole thyroid gland

347
Q

Most common cause worldwide of goitre

A

Iodine deficiency

348
Q

5 causes of goitre

A 
De Quervains
Graves
Iodine deficiency
Toxic nodular goitre
Hashimotos can
349
Q

What is another name for de quervains

A

Subacture thyroiditis

350
Q

Red flags for neck lump

A 
Child
Lymphadenopathy
Radiation
Hoarseness
Fhx
Stridor
351
Q

Why do graves goitre have bruits

A

Very vascularised

352
Q

What are some possible salivary gland pathologies

A

Stones
Infection
Cancer

353
Q

How to tell neck lump is carotid aneurysm

A

Pulsatile

Bruit

354
Q

What is the name of a carotid body tumour

A

Paraganglioma

355
Q

Paraganglioma on examination of the lump

A

Pulsatile but no bruit

356
Q

How to differentiate between paraganglioma and carotid aneurysm

A

no bruit in paraganglioma

357
Q

Which thyroid tumour often presents with local lymphadenopathy

358
Q

Which thyroid cancer do you often get from iodine deficiency

A

Follicular

359
Q

What thyroid tumour do you often get in MEN 2

360
Q

What is complication of sebaceous cysts

A

Get infected

361
Q

How do sebaceous cysts appear

A

Skin coloured with punctures

Can get infected so become filled with pus

362
Q

Palpitations history for phaeochromocytoma

A

Histroy over last few weeks, of sporadic in nature lasting around 5 minutes that are associated with headaches, nausea and vomiting
Keep feeling anxious

363
Q

Examination findings of phaeochromocytoma

A

Small mass over adrenals that when palpated results in symptoms
Papilloedema

364
Q

Initial investigations for phaeochromocytoma

A

Serum metanephrines- catecholamines are less reliable as released in response to stress

365
Q

Confirmation investigations for phaeochromocytoma

A

CT/MRI/MIBG
24hr urine metanephrines
Genetic testing

366
Q

Management of phaeochromocytoma

A

ABS
Alpha blockade- phenoxybenzamine
Beta blockade- atenolol
Surgery

367
Q

Typical patient presenting with thyroid storm

A

Middle aged women with graves- peak incidence 60

368
Q

Management of thyroid storm

A

Propanolol

Then carbimazole or propylthiouracil

369
Q

What is addisons crises normally precipitated by

A

Stressors of dehydration, illness etc

370
Q

Which sex are addisonian crises more common in

371
Q

Best initial test for addisons

A

9am cortisol

372
Q

Management of addisons

A

Glucocorticosteroids
Glucose
Long term- glucocorticoids and mineralocorticoids and then increased doses during times of stress

373
Q

Common cause of waterhouse friederichsen syndrome

A

Infections such as neisseria meningitidis

374
Q

Treatment of hypovolaemic hyponatraemia

A

0.9% saline

3% hypertonic saline if unresponsive

375
Q

What is pagets disease

A

Disorder of bone remodelling

376
Q

Risk factors for pagets disease

A

Elderly

Family history

377
Q

What are 3 phases to pagets disease

A

Lytic
Mixed
Sclerotic

378
Q

What are symptoms of pagets disease

A

Fragility fractures
Insidious onset bone pain
Nerve compression

379
Q

What bones are commonly affected in pagets

A

Skull
Pelvis
Femur

380
Q

Common results of nerve compresssion in pagets

A

Sensorineural hearing loss

Sciatica

381
Q

Signs on examination of pagets

A

Bone enlargement

Warm skin over painful areas

382
Q

Bloods ordered for pagets and findngs

A 
FBC
U&E
LFTs
Clacium normal
Phosphate normal
PTH normal
Serum CTX up
Serum P1NP up
383
Q

What is of serum CTX a marker of

A

Bone resorption marker

384
Q

What is of serum P1NP a marker of

A

Bone formation marker

385
Q

Imaging for pagets

A

X ray

Tec 99- show lytic areas

386
Q

Primary causes for osteoporosis

A

Post menopausal

Elderly

387
Q

Symptoms of osteoporosis

A

Often asymptomatic
Fragility fractures
Back pain

388
Q

Secondary causes of osteoporosis

A

Drugs- steroids, thyroxine, alcohol
Endo- cushings, hyperPTH,, hyperT
GI- coeliac, IBD

389
Q

Classic osteoporosis fractures

A

Neck of femur
Wrist- colles
Lumbar spine wedge fractures
Neck of humerus

390
Q

Bloods in osteoporosis

A

All normal

391
Q

Imaging used in osteoporosis

392
Q

What is a T score

A

Bone mineral density compared to young healthy person

393
Q

What is a Z score

A

BMD compared to age matched individual

394
Q

Osteoporosis range for T score

A

Under -2.5

395
Q

Osteopenia range for T score

A

Between -1 and -2.5

396
Q

Normal T score

397
Q

Pakistani woman in bone questions

A

Osteomalacia

398
Q

Patient presents with muscle weakness and bone pain

A

Osteomalacia

399
Q

ALP in osteomalacia

400
Q

What causes HTN with elevated Na and low K

A

Conns tumour causing hyperaldosteronism

401
Q

Investigations of conns

A

24 hr BP
Aldosterone renin ration
CT scan

402
Q

What is a potent vasodilator used in phaeochromoctytoma surgery

A

Sodium nitropusside

403
Q

What is LADA

A

Latent autoimmune diabetes of adults

404
Q

How does LADA present

A

Diabetes of insidious onset that presents in older age with exact symptoms of T1DM often with a strong family history- even pancreatic islet cells antibodies present.

405
Q

What is problem of LADA

A

Often diet and medication have no impact on disease condition

406
Q

What is name of syndrome from NET producinh gastrin

A

Zollinger ellison

407
Q

What is problem of zollinger ellison syndrome

A

Lots of peptic ulcers

408
Q

What happens when have NET producing insulin

A

Hypoglycaemia

409
Q

What is name of syndrome from NET producing serotonin

410
Q

What is staining marker for NET

A

Chromogranin

411
Q

Where are gastrin NETs normally from

A

Pancreas or duodenum

412
Q

Where do NETs often originate

A 
Lungs 
Thymus
Inestines 
Rectum
Sigmoid
413
Q

Dose for short synACTHen test

414
Q

Confirmation test for addisons

A

short synACTHen

Cortisol very low still

415
Q

Causes of Addisons

A

TB
Autoimmune
Mets

416
Q

Bilateral adrenal tumours ddx

A

MEN
CAH
Primary tumour that has metastasised

417
Q

Dose of levothyroxine

A

50-100mg OD

418
Q

When cant you give propanolol with carbimazole

419
Q

If have panhypopituitarism what are main hormones that need replacing

A

Testosterone
Cortisol
Thyroxine

420
Q

What glucocorticoid is preferred in addisons

A

Prednisolone as has a longer half life meaning doesnt have to be given 3 times a day which leads to three peaks of cortisol- thus uncoupling from physiological dirurnal cycle

421
Q

Why do addisons sufferers have lower life expectancy

A

Cortisol cycle uncoupled from its physiological one

422
Q

Which drug not available for NHS is best glucorticoid replacement and its problems

A

Plenadren

Severe diarrorhoea

423
Q

For T1DM what is their insulin regime

A

Background insulin to suppress ketoacidosis

Bolus insulin before meals

424
Q

Between what range of glucose does the sympathetic nervous system get activated

425
Q

What is defined as hypoglycaemia in diabetic patient

426
Q

What is defined as hypoglycaemia in non diabetic patient

427
Q

When cant you use TSH to check levothyroxine dose

A

Panhypopituitarism

428
Q

Drugs causing hyponatraemia

A 
Loop
Thiazide
PPIs
ACEi
SSRI
Carbamezapines
Desmopressin
429
Q

What are insidious onset symptoms of T2DM

A

Tiredness
Polyuria
Polydipsia

430
Q

What are subacute onset symptoms of T2DM

A

Lethargy
Polydipsia
Polyuria
Opportunistic infections causing balanitis in men and vulvae pruritus in women

431
Q

How is T1DM diagnosed

A

Symptomatic and 1 test above 7 fasting 11 random
Or
Asymptomatic and 2 tests same as above

432
Q

Causes of hypothyroidism

A

Iodine deficiency
Hashimotos
Subacute thyroidtis
Post partum thyroiditis

433
Q

Initial tests for Cushing

A

24hr urine collection

Late night salivary cortisol

434
Q

After 24hr urine collection what is next test in Cushing diagnosis

A

Low dose dexamethasone and measure ACTH

If low will be an adrenal tumour

435
Q

After low dose dexamethasome what is next test in Cushing diagnosis

A

High dose dexa
If ACTH suppressed then pituitary tumour so Cushing diseas
If still high then ectopic ACTH

436
Q

Acromegaly typical presentation

A

Headaches
Changes in appearance
Visual problems

437
Q

Later presentation of acromegaly

A

Hirsutism
Diabetes
HTN
Growths in hands

438
Q

Test for acromegaly

A

OGTT will still see elevated GH so do MRI

439
Q

What are 3 sites graves IgG can affect and their effects

A

Eye- exophthalmos, visual disturbances
Legs- pretibial myxoedema
Fingers- acropachy and clubbing

440
Q

How does de quervains present

A

Hyperthyroid signs
Fever
Painful neck lump
Progresses to hypothyroid

441
Q

Examination and investigation findings of de quervains

A

Goitre
Tachy
Raised ESR

442
Q

What is plummers disease

A

1 nodule on thyroid that doesnt respond to antithyroid meds

443
Q

What is a simple goitre

A

Idio[athic enlargement of the thyroid associated with thyroid ABs that has no symptoms

444
Q

Goitre without symptoms of thyroid disease

A

Simple goitre

445
Q

What is riedels thyroiditis

A

Rare inflammatory condition leading fibrosis of thyroid that is asymptomatic

446
Q

Stony and wooden thyroid on percussion

A

Riedels thyroiditis

447
Q

Most common sx addisons

A

Postural hypotension
Pigmentation of scars and creases
Vitiligo
Wt loss

448
Q

What is pathognomonic for MND

A

Bulbar involvement

449
Q

Symptoms of diabetes insipidus

A

Polyuria
Polydipsia
Dehydration

450
Q

What are 3 options for causes of diabetes insipidus

A

Cranial
Nephrogenic
Psychogenic

451
Q

First test for diabetes insipidus and how they will do in test

A

Fluid deprivation
Nephrogenic and cranial urine will remain hyposmolar
Psycogenic will become concentrated

452
Q

Definitive test for diabetes insipidus

Cranial and nephrogenic results

A

Desmopressin
Cranial urine will become hyperosmolar
Nephrogenic urine will become hyposmolar

453
Q

Causes of cranial diabetes insipidus

A

Tumour
Granulomatous infiltration
Trauma

454
Q

Causes of nephrogenic diabetes insipidus

A

Lithium

Familial

455
Q

What would be cause of diabetes insipidus in psych patient

A

Psycogenic

Or lithium if bipolar

456
Q

Symptoms of hypocalcaemia

A

Tingling in fingers
Hyperrefelxia
Stridor from laryngospasm
Long QT

457
Q

What would be a thyroid cyst on examination

A

Fluctuant or soft mass

458
Q

What is a main danger of phaeos as seen in house

A

Vasoconstriction leading to tissue death

459
Q

What is general size of Conns and phaeos tumours

A

Small in conns

460
Q

If patient has statin resistance and familial hyper cholesterolaemia whatcdrug can be given

A

Evolocumab- a PCSK9i

461
Q

What is 5 AHA used for

A

Carcinoid syndrome

462
Q

Side effects of levothyroxine

A

Osteoporosis

AF

463
Q

If have panhypopituitarism what think

A

Potential GH deficiency

464
Q

In thyrotoxicosis what is preferred anti-thyroid med

Year 3 Conditions (33 decks)

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