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F year medicine facts > Endo > Flashcards

Endo Flashcards

1
Q

MODY has what inheritence pattern

A
  • AD
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2
Q

which thyroid disease causes DM

A
  • Hyperthyroid
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3
Q

diagnostic criteria for ix of DM

A
  • Fasting glucose >7
  • random glucose > 11.1

above 2x if asymptomatic

  • HBA1C > 48 (6.5%)
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4
Q

which patients cann you not use HBA1C to diagnose DM

A
  • IDA untreated
  • Haemoglobinopathies
  • haemolytic anaemia
  • suspected gestational DM
  • Kids
  • CKD
  • Those on drugs that alter BG
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5
Q

define impaired fasting glucose

A

fasting BM b/ween 6.1-7

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6
Q

define impaired glucose tolerance

A
  • fasting BM <7, 2hr after OGTT 7.8-11.1
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7
Q

clinical significance of IFG and IGT

A
  • If IFG offer OGTT for IGT

- If <11.1 > 7.8 = Impaired glucose tolerance. if above = DM

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8
Q

types of T1DM autoantibodies

A
  • islet cell cytopalsmic
  • Glutamic acid decarboxylase
  • insulin autoantibodies
  • insulinoma associated 2 autoantibofdies
  • zinc transporter 8 autoantibodies
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9
Q

what is the course for insulin regime for T1DM called

A
  • DAFNE

- Dose adjustment for normal eating

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10
Q

during infection how much should you increase insulin dose by

A

25%

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11
Q

when do you start sliding scale preop in T2DM patients that manage with lifestyle/metformin

A

BM>12 X 2

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12
Q

T2DM rx first step if >48 hba1c

A

metformin and lifestyle

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13
Q

if > 58 hba1c T2DM rx

A

Metformin + DPP4I (gliptin) +
or
Metformin + Pioglitazone

or
Metformin + sulphonylurea

or metformin + SGL2I

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14
Q

what should you aim a patients HAB1C to be if original HBA1C = 58

A
  • 53
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15
Q

rx treatment options if triple therapy needed in T1DM

A
  • Metformin + gliptin + Sulphonylurea

or
- metformin + pioglitazone + SU

or metformin + pio/SU + SGLT2i

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16
Q

if triple therapy not tolerated, effective or CI in TDM what is next rx

A
  • if BMI >35
  • Metformin + GLP1 + SU

can be used if BMI <35 and cant have insulin

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17
Q

when can you give insulin in T2DM

A
  • HBA1C > 58 and triple therapy hasnt worked and they dotn qualify for GLP1
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18
Q

treatment pathway for T2DM in those that metformin is CI

A
  • Gliptin/ pioglitazone/SU

2ND LEVEL

  • Gliptin + pio
  • Gliptin + SU
  • Pioglit + SU

3RD
- insulin

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19
Q

MOA Metformin-

A

a biguanide

- increases insulin sensitivity and helps weight

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20
Q

DPP4i MOA

A
  • Block dpp4 which is an enzyme that destroys hormone incretin
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21
Q

glitazone MOA

A
  • Increaes insulin sensitivity
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22
Q

SU MOA-

A

Increases insulin secretion

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23
Q

how do GLP1 mimetics work

A
  • increase insulin secretion and inhibit glucagon secertion
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24
Q

what hba1c is needed for GLP1 mimetic prescription

A
  • 11mol/l reduction in HBA1C and 3% weight loss after 6 months to justify ongoign subscription
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25
Q

which nerve palsies are common in DM

A

CN 3 AND 6

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26
Q

isolated mononeuropathy in DM - what is the cause

A
  • occlusion of vasa nevorum
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27
Q

diffuse neuropathy cause in DM

A
  • peripheral nerves with fructose build up
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28
Q

types of DM neuropathy

A
  • symmetrical mainly sensory
  • diabetic amyotrophy - wasting of quads asymmetry
  • acute painful - crawling up you
  • mononeuritis - CN3 AND 6
  • autonomic
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29
Q

severe DKA criteria

A
  • tachy/brady
  • hypotensive
  • GCS 6MMOL/L
  • bicarb <12
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30
Q

DKA Dx criteria-

A

BM > 11
Ketones >3mmol/l
Acidaemia - ph <7.3 or HCO3 <15

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31
Q

rx DKA-

A
  • Slaline -.9% + 20mmol K /L. if BM <14 = 10% dexrrose
  • insulin 0.1uints/kg/hr
  • restore acid base over 24hrs

if no urine by 2hrs -chatheter
NG if drowsy or protracted vomiting
- CVP monitor if shock

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32
Q

HONK/ HSS diagnosis criteria

A

BM>33.3
No ketoacidosis
Hyperosmolality > 320

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33
Q

rx HSS

A
  • Fluids 0/9% saline
  • LMWH thromboprophylaxis
  • oral hypoglycaemia or severe = insulin
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34
Q

What GCS do you need to be in DKA/HONK for intubation

A

<12

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35
Q

why do you still need to replace k+ in DKA despite high K on bloods

A
  • as it is in the wrong place so once insulin given will shift and they get hypokalaemic
  • give extra k if >5.5
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36
Q

what is the 1,2,2,4,6 rule in DKA

A
  • 1L of fluid in 1h
  • 2nd bag over 2hrs
  • 3rd bag over 2 hrs
  • 4rth bag over 4hrs
  • 5th bag over 6hrs
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37
Q

what is HDL mainyl made of

A
  • phospholipids
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38
Q

what is LDL mainly made of

A
  • cholesterol
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39
Q

who do you screen for hyperlipidaemia

A
  • fhx of hyperlipidaemia
  • cornear arcus <50yrs
  • xanthomata or xanthalasma

and those at risk of CVD

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40
Q

types of hyperlipidaemia

A
  • common primary (70%)
  • familial primary
  • secondary
  • mixed
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41
Q

familial hyperlipidaemia types

A

1 LP, 2 LD. 3 gets V, 4 is E, 5 gets more

T1 = Deficient in LPL and apoc2

T2a and b = Deficient in LDLr and
apob100

T3= APOE

T4= VLDL overproduction

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42
Q

what builds up in the different familial hyperLD

A

1 = Cholesterol and TG AND Chylomicrons

2a = LDL, cholesterol

2b = LDL, VLDL. Cholesterol

3 = VLDL chylomicrons

4= VLDL AND TG

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43
Q

Inheritance patterns for familial hyperLD

A

1 = AR
2A and B = AD

3= AR

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44
Q

sx of familial hyperld by type

A 
1 = pancreatitis
2 = xanthomata achilles, corneal arcus
3= palmar xanthoma 
4= pancreatitis
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45
Q

which familial hyperlipdaemia type gives highest risk CHD

A
  • Type 3

- has apoe2 mutation but needs second hit such as HypoTH, DM. ETOH, OBESE,

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46
Q

special tests for hyperLD

A
  • Apolipoproteien A
    = A1 = HDL
    = B100 = VLDL, LDL
  • LIPOPROTEIN A - >300 = CVD
  • HOMOCYSTEINE = risk marker
  • apo e genotyping
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47
Q

2nd line drug fo rhigh cholesterol and MOA

A
  • Ezitimibe; stops cholesterol absorption by inhibiting
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48
Q

Primary prevention for high cholesterol is given in which patients

A
  • QRISK >10%
  • T1DM MOST
  • CKD EGFR <60

Give atorvatstatin 20mg OD

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49
Q

QRISK should not be used in which pt

A
  • T1DM
  • CKD <60 egfr
  • albuminuria
  • familial hyperlipidaemmia
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50
Q

QRISK underestimates risk in which pts

A
  • mental health
  • HIV
  • On cholesterol altering meds e.g. steroids, antipsych
  • autoimmune disorder ps
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51
Q

what total cholesterol level indicates possible familial high cholesterol

A
  • > 7.5 with fhx of premature coronary heart disease
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52
Q

who should you refer for assessment for high cholesterol possibly familial

A
  • > 7.5 Non HDL with or without fhx

- >9 TC

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53
Q

when can you increase dose in CKD for staitin

A
  • if > 40% reduction in non HDL nto achieved and egfr >30. otherwise talk to renal specialist
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54
Q

causes of hypoglycaemia in non diabetics

A
  • EXPLAIN
  • EXogenous drugs
  • Pituitary insufficiency
  • Liver failure
  • Addisons disease
  • Islet cell tumours
  • Non pancreatic neoplasma

in kids also
= nesidioblastosis; beta cell hyperplasia

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55
Q

how does alcohol cause hypoglycaemia

A
  • inhibits gluconeogenesis

- depleted glycogen stores due to starvation

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56
Q

how do BB cause hypoglycaemia

A
  • inhibition of hepatic glucose which is promoted by Symp NS
  • increase glycogenolysis in liver
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57
Q

how does aspirin cause hypoglycaemia

A
  • hepatic gluconeogenesis reduced and increase in insulin secretion , increases glucose utilization in peripheral tissues
  • also lactate high as enzyme for pyruvate conversion blocked by salicylate
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58
Q

how do Ace- i causes hypoglycaemia

A
  • increased sensitivity of peripheral tissues , block Ang II as one of the counter regulatory hormones with similar effects as adrenaline

= speeds up absoption of subcut insulin

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59
Q

how does pentamidine cause hypoglycaemia

A
  • rx for jirovecii

- surge of pancreatic cells then destruction and IDDM

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60
Q

how does quinine cause hypoglycaemia

A
  • increase insulin release in non DM patients
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61
Q

what is whipples triad of hypoglycaemia

A
  • low BG
  • symptoms of low GB
  • Resolve after sugars given
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62
Q

how to investigate fasting hypoglycaemia if symptomatic

A
  • Bloods; glucose, c peptide, insulin, ketones
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63
Q

how to investigate post prandial hypoglycaemia

A
  • OGTT ix
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64
Q

how does benign pancreatic cell tumour present

A
  • fasting hypo + whipples triad
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65
Q

how to check for insulinoma

A
  • give IV insulin and measure c peptide

- should go down but if does not then = insulinoma

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66
Q

IN PCOS what is the finding of LH:FSH ration

A

high LH:FSH

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67
Q

when to stop COCP in PCOS-

A

After 3-4 months of hirsutism stopped. why? high VTE risk

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68
Q

causes of primary hypogonadism

A
  • trauma
  • torsion
  • Chemo/RDT
  • Tumours
  • Post orchitis
  • chromosome abnormalities e.g. klinefelter 47 xxy
  • renal failure, liver failure and alcohol excess are all toxic to leydig cells
69
Q

secondary hypogonadism causes

A
  • prolactinoma
  • hypopituitarism
  • kallmans syndro me (also colour blind and anosmia)
  • systemic illness
  • laurence moon biedl/ prader willi
70
Q

what is the cause of gynaecomastia if a patients has LOW Testosterone but high LH

A
    • primary hypogonadism e.g. klinfelters
71
Q

what is the cause of gynaecomastia with low testosterone and normal LH

A
  • Piuitary/hypothalamic disease
72
Q

what is the cause of gynaecomastia with elevated testosterone with high estradiol

A
  • androgen exposure; testicular tumour
73
Q

what is the cause of gynaecomastia with elevated estradiol and elevated SBHG

A
  • oestrogen exposure, testicular/ adrenal tumour
74
Q

when do you treat low testosterone

A
  • if less than 8 on 2 morning or <15 if LH is high. and muscle bulk decrease = testogel
75
Q

who is CI to testosterone

A
  • nephrosis, high ca, polycythamiea breast, protate or lvier ca
76
Q

rx for adolescents with gynaecomastia-

A

resolves in 3yrs alone

- otherwise tamoxiffen 6months but unlciensed

77
Q

1st line rx for those that cant take sildenafil in Erectile dynfsunction

A
  • vacuum device
78
Q

what drugs cause ED

A
  • AntiHTN
  • diuretics
  • antidepressants
  • antipsychotics
  • anticonvulsants
  • hormonal treatment
  • fibrates
  • h2 blockers
79
Q

presentation of de quervains/ subacute thyroditis (hyper then hypoth)

A
  • painful goitre and raised ESR
80
Q

what is reidel thyroiditis

A
  • fibrous tissue replaces normal thyroid parencyma = painless goitre
81
Q

drugs that cause hypoTH

A
  • Lithium

- amiodarone

82
Q

what TH do Postpartum women get

A
  • Hypo
83
Q

what is the most common cause of hypoTH in developing world

A
  • iodine deficiency
84
Q

what happens to TSH and T4 in sick euthyroid

A
  • both low
85
Q

what happens to TSH and T4 in poor compliance to thyroxine

A
  • normal t4, high tsh ; lagging tsh as usually only take meds before bloods
86
Q

what situations is TBG high

A
  • pregnancy
  • high oestrogen
  • hepatitis
87
Q

TBG is low in

A
  • nephrotic syndrome and ,malnutrition
  • drugs e.g. androgens, steroids, phenytoin
  • CLD and acromegaly
88
Q

Toxic mmultinodular goitre on nuclear scintigtaphy indicates what thyroid problem

A
  • toxic multinodular goitre (secrete thyroid and compressive sx due to enlarged gland e..g sob/ dysphagia
89
Q

who should we screen for TH problem

A
  • those with af
  • those with hyperlipidaemia
  • DM annually
  • if T1DM during 1st trimester and post delivery
  • on amiodarone or lithium; 6month
  • down.turners/addisons
90
Q

rx for thyroid eye disease-

A
  1. support e.g. artificial tears
  2. fresnel prism on one spectacle
  3. methylpred
  4. surgical decompression
91
Q

what happens to neutrophiils in graves

and ca? and esr and lft?

A

neutropenia

  • high
92
Q

what are graves abs types

A

= IgG anti-TSHr

93
Q

what is the result of nuclear scintigraphy identifying hot nodule

A
  • thyroid adenoma
94
Q

rx subacute thyroiditis

A
  • NSAIDs
95
Q

rx for HyperTH

A
  • BB and titrate to help with sx
  • propylthiouracil, carbmiazole
  • use as titration block or block and replace
96
Q

when do you use propylthiouracil in HyperTH

A
  • 1st trimester or thyroid storm. otherwise not preferred due to liver injury
97
Q

radioiodine therapy and pregnancy relation

A
  • do not give it in pregnancy

- avoid pregnancy for 6 months in women and 4 months men

98
Q

when do you refer someone with subclinical hyperTH

A
  • If nodule/goitre

- if despitre rx TSH <0.1 persistently or if >65yrs or post menopausal or at risk of osteoporosis or have CVD or sx

99
Q

thyroid storm rx

A
  • propanolol
  • carbimazole/propylthio
  • lugols solution = iodine after 4hrs
  • steroids; dexa
  • avoid aspirin
100
Q

what is thyrotoxic periodic paralysis

A
  • most common in asian males
  • vigorous exercise/ high carb meal
  • flaccid ascending paralysis; proximal > distal
  • depressed/ absent DTR
101
Q

MOA thyrotoxic periodic paralysis

A
  • shift of k+ as overactive na k+ ATPase pump = low serum k+ = paralysis
102
Q

rx thyrotoxic periodic paralysis

A
  • Propanolol
  • replace k+
  • treat hyperTH

DO NOT GIVE IV GLUCOSE

103
Q

how to treat myxoedema coma

A 
ABCDE
- must do ABG 
-Thyroid hormone replacement
- correct metabolic issues; 
\: hypoventilation = intubate and ventilate

: hypona+
= water restrict

: hypoglycaemia = IV dextrose

+ hydrocortisone

104
Q

mortality predictors in myxoedema coma

A
  • age
  • temp <34
  • HR < 40
  • Large amounts of T4 IV
105
Q

subclinical hypoTH parameters

A
  • TSH >4 with normal t3 and t4 amd mo symptoms
106
Q

when do we treat subclinical hypoTH

A
  • TSH >10, hyper would be low TSH
  • +ve autoantibodies
  • past treated graves
  • other organ specific autoimmunity (T1DM, myaesthenia, pernicious anaemia etc)
107
Q

signs of myxoedema coma

A
  • looks hypothyroid
  • usually >65yrs - hypothermia
  • hyporeflexia
  • low BG
  • bradycardia
  • coma seizures
108
Q

what type of calcium do we measure on a ABG

A

= Free ionised

109
Q

what calcium do you measure on bloods

A
  • total calcium
110
Q

what happens to ca levels if ph goes down

A
  • gets displaced from albumin so h+ can bind therefore levels increase
111
Q

what is chvosteks sign

A
  • tap on fcial nerve and pt with hypoca will twitch
112
Q

what is trousseaus sign

A
  • BP cuff around arm and inflated - tetanic spasm
113
Q

what other ion is needed for pth release

A
  • mg
114
Q

which MEN syndrome is hyper PTH associated with

A

MEN1

115
Q

MEN1 syndromes

A
  • PTH hyperplasia/adenoma
  • pancreatic endocrine tumours
  • pituitary prolactinoma

= TSG

116
Q

Men 2a syndromes

A
  • thyroid - medullary thyroid ca
  • adrenal; phaeochromocytoma
  • PTH hyperlasia (less often)
117
Q

men 2b syndromes

A
  • like men 2a = + mucosal neuromas and marfanoid appearance
118
Q

what syndrome do those with severe hyperPTH get (shown on imaging)

A
  • osteitis fibrosa cystica = subpeiosteal erosions, cysts or brown tumours of phalanges +/- pepper pot skull +/- acroosteolysis
119
Q

rx for hyperpTH

A

= definitive = total parathyroidectomy

conservative only if meets criteria; 
- >50yrs age
- no end organ damage
- Ca < 0.25 ULMN
= increase fluid to prevent stones. avoid thiazides and hifh ca/vit d

calcimimetic if unsuitable for surgery

120
Q

criteria for total parathyroidectomy due to hyperPTH

A
  • <50yrs
  • ca>2.75
  • creatinine clearance - reduced by 30%
  • 24h urianry ca - >10mmol
  • Bone mineral density = t score less than -2.5SD
  • bone disease/osteoporosis/renal calculi
121
Q

signs of hypoca

A

SPASMODIC

  • Spasma
  • Perioral paraesthesia
  • anxious, irritable, irrational
  • seizures
  • muscle tone increase
  • Orientation impaired
  • dermatitis
  • impetigo herpetiformis
  • chvosteks , cataract, cardiomyopathy
122
Q

why does addisons disease cause high ca

A
  • Adrenal calcification
123
Q

which disease cause hyperca

A
  • TB
  • Toxopalsmosis
  • histopalsmosis
  • raynauds
  • muscle primaries / leiomyosarcoma
  • nephrocalcinosis
  • endocrine tumours
  • sarcoidosis
124
Q

how will hyperca show up on ECG

A
  • Reduced QT-i
125
Q

what are the two cause sof hyperca with albumin raised

A

urea raised; - dehydration

urea normal; cuffed specifmen

126
Q

what hyperca investigation results point towards malignancy

A
  • low albumin
  • low cl
  • alkalosis
  • low k
  • high PO
  • High ALP
127
Q

how to treat pt with hyperca

A
  • record weight
  • stop offendign drugs
  • saline to make euvolaemic and U O 200ml/hr
  • can need >4l in 24hrs; but careful if CCF
  • Furosemide when hypovolaemia corrected - bu tnot if malignant
  • if still high >24hrs = bisphosphonates
  • then pamidronate

if known mets = IV zolendronic acid

128
Q

rx hyperphosphotaemia

A
  • oral calcium carbonate but not if high ca

- gut phosphate binders e.g. sevelamer

129
Q

hypomg ecg changes

A
  • prolonged QT, broad/flat t waves, sometimes short ST
130
Q

what other metabolic abnormalities are cause dby hypomg

A
  • hypoca

- hypok

131
Q

rx hypomg

A
  • parenteral mg cl 50mmol in glucose if symptomatic, or with hypoca
132
Q

what happens to reflexes in hypomg

A
  • hyperreflexia
133
Q

rx hypermg

A
  • calcium gluconate
  • glucose and insulin also lowers
  • dialysis in severe CKD
134
Q

what zona produces mineralocorticoids

A
  • glomerulosa
135
Q

what muscle isssue do you get in cushings

A
  • proximal myopathy
136
Q

what result would you expect for dexamethasone suppression test for cushings disease

A
  • normal cortisol in syndrome after low dose

- low cortisol after high dose

137
Q

what is the next ix if dexa supression test comes back +Ve in both low and high dose

A
  • plasma ACTH . if ACTH undetectable then adrenal tumour
    . if detectable = extropic
  • if detectable need to differentiate between pituitary and high dose and extopic by doing high dose CRH test.
    result: dose goes s up in pituitary disease but not in ACTH production
138
Q

what is nelson syndrome

A
  • in cushings disease if oyu have bilateral adreneloctomy, this is a complication
  • increased skin pigment due to high acth from enlarging pituitary tumour as adrenelectomy removes -ve feedback

summary; pitutiatary tumour post adrenelectomy

139
Q

what drugs can you give in ectopic acth production preop or awaiting radiation

A
  • ketoconazole
  • metyrapone
  • fluconazole
  • decrease cortisol secretion
140
Q

ix for hyperaldosteronism

A
  • plasma aldosterone:renin ratio = screen
    results:
    = high aldosterone: renin = primary, high aldo and high renin = secondary
  • fludrocortisone supression test; supressed plasma renin activity = primary
141
Q

rx for bilateral adrenal hyperplasia-

A

spironolactone, elperenone

142
Q

what is conns syndrome

A
  • adenoma of the zona glomerulosa
143
Q

rx conns

A
  • lap adrenelectomy. spironolactone 4 weeks preop
144
Q

what is the other name for primary hyperaldosteronism

A
  • conns
145
Q

what is barters syndrome

A
  • AR
  • Congenital salt wasting = sodium and cl leakk in LOH due to mutated transporters
  • presents as child FTT, poyuria, polydipsia, BP normal == NA loss so voluem deplete so ADH and raas kicks in

= hyperaldosteronism secondart

146
Q

rx barters syndrome

A
  • k+ replace
  • nsaids
  • acei- i
147
Q

short synacthen test results in addisons / primary adrenal insufficiency

A
  • levels of cortisol fail to rise
148
Q

ix for addisons disease

A
  • 9am acth level = high level with low cortisol = addisons
149
Q

addisonian crisis symptoms

A
  • hyperpigment
  • low na
  • high k
  • hypoglycaemia
  • shock/low bp
150
Q

rx adissonian crisis

A
  • rehydrate with 1L 0.9% saline + bolus dexamethasone pre ACTH test

if ACTH comes back

  • then hydrocortisone IM 6hrly till stable
  • glucos eig hypoglycaemia
151
Q

what do you do to long term steroid dose if antibiotics or febrile illness

A
  • double it
152
Q

if someone on steroids vomit what should they do

A
  • emergence hydrocortisone injection and seek advice immediately
153
Q

what is waterhouse friedrickson syndrome

A
  • sepsis from menigicocaemia with associated adrenal haemorrhage;
154
Q

what MEN syndrome is phaeochromo and paraganglioma a part of

A
  • MEN2
155
Q

treatment of phaeochromocytoma-

A 
alpha block (phetolamine)
then beta block  (propranolol)
  • then op and remove.
  • then 24hr urine metanephrones 2wks post op
156
Q

what is pituitary apoplexia

A
  • acute haemorrhage or infarction of pituitary
157
Q

pituitary apoplexy sx

A
  • headache
  • vomiting
  • visual disturbances
  • ophthalmoplegia = CNIII most common
  • meningismus
  • fever
  • low consciousness
  • death
158
Q

predisposing factors for pituitary apoplexy

A
  • hypertension
  • head traum
  • cardiac surgery
  • ICP raise
  • DM
  • Acromegaly
  • cushings
  • oestrogens
  • anticoag
  • bromocriptine
  • gnrh analogies
  • RDT
159
Q

RX Pituitary apoplexy

A
  • monitor fluuids
  • replace deficient hormones
  • surfery if needed
  • ltm monitor
160
Q

indications for surgery in pituitary apoplexy

A
  • diminished level of consciousness
  • hypothalamic disturbance
  • visual impairment
161
Q

CI for insulin tolerance test

A
  • heart disease
  • epilepsys
  • adrenal failure
162
Q

microadenoma in putitary vs macro

A
  • < 1cm

- >1cm

163
Q

3 types of pituitary tumours

A
  • chromophobe; non secretory
  • acidophil; GH or PRL
  • basophil; ACTH
164
Q

rx prolactinoma

A
  • <1cm; bromocriptine = dopamine agonists

> 1cm = start with above then possible surgery if pressure symptoms

165
Q

ix for acromegaly

A
  • IGF1 and basal GH. if either or hight (GH >0.4) then OGTT. if lwoest GH after is >1mcg/l = confirmed
166
Q

rx acromegaly

A
  • surgery

- somatostatin analogyes

167
Q

diabetes insipidus rx

A
  • crania; desmopressin

- nephrogenic; treeat cause or bendroflumethiazide

168
Q

causes of diabetes insipidus (nephrogenic)

A
  • inherited
  • low k+. high ca
  • lithium, demelocycline
  • CKD
  • Post obstructive uropathy

F year medicine facts (19 decks)

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