Endo Flashcards
(150 cards)
1
Q
What is Type 1 diabetes?
A
Autoimmune destruction of pancreatic beta cells leading to complete insulim deficiency
2
Q
At what age do symptoms occur for type 1 DM?
A
5-15
3
Q
What are the risk factors for DM1?
A
Norther European, family history HLA DR3-DQ2
4
Q
What other autoimmune disease put you at risk of DM1?
A
Autoimmune thyroid, coeliac, addisons, pernicious anaemia
5
Q
What does insulin deficiency lead to?
A
Breakdown of liver glycogen, hyperglyacaemuia and glycosuria
6
Q
What are the symptoms of DM1?
A
Polydipsia, polyuria, weight loss
7
Q
How long do symptoms for DM1 last before diagnosis?
A
A short history of severe symptoms
8
Q
The typical patient with DM1 diagnosis?
A
S&S above, young, BMI under 25, personal/fhx autoimmune, random plasma glucose >11mmol/l
9
Q
How to treat DM1?
A
Insulin. twice daily regime or insulin before meals and a baseline insulin
10
Q
What is diabetic ketoacidosis?
A
Lack of insulin leading to unrestrained increased hepatic gluconeogenesis, and hyperglycaemia
11
Q
How are ketones formed in ketoacidosis?
A
Without insulin fat is broken down, this increases fatty acids which are oxised to acetyl coa then ketones
12
Q
What are the symptoms of diabetic ketoacidosis?
A
N&V, weight loss, drowsy, confused, abdo pain, diabetes symptoms
13
Q
What are the signs of diabetic ketoacidosis?
A
Reduced tissue turgor, kussmauls breathing, breath smell of ketones, hypotension and tachycardia
14
Q
What investigations for ketoacidosis?
A
Random plasma glucose >11mmol/l, plasma ketones,, acidosis in low blood pH, glycosuria and ketonuria
15
Q
How to manage diabetic ketoacidosis?
A
ABC
fluid resuscitation, IV insulin, resotre electrolytes K+
16
Q
What are the complications of diabetic ketacidosis?
A
Coma, cerebral oedema, thromboembolism, aspiration pneumonia, death
17
Q
What is DM2?
A
Combination of peripheral insulin resistance and less severe insulin deficiency.
18
Q
Risk factors for DM2?
A
Age, men, afrocarribean, black african and south asian, obesity and hypertension
19
Q
What is the presentation of DM2?
A
Polydipsia, polyuria, glycosuria, central obesity, slower onset
20
Q
What is the HbA1c of someone with diabetes?
A
> 47mmol/mol
21
Q
Lifestyle management for DM2?
A
Diet, weight control, exercise
22
Q
1st line pharmacological for DM2
A
Metformin
23
Q
Drugs you can give alongside metformin for DM2?
A
DPP4 inhibitor, Pioglitiazone, sulfonylureas, SGLT-2i
24
Q
How does metformin work?
A
Decreased gluconeogenesis in the liver and increased cell sensitivity to insulin
25
How do sulfonureas work?
Promote insulin secresion
26
What are the side effects of sulfonylureas?
hypoglycaemia and weight gain
27
Which patients struggle with hyperosmolar hyperglycaemic state?
DM2
28
How to diagnose hyperosmolar hyperglacaeimc state?
Hyperglycaemia >11mmol/l
Heavy glycosuria
High plasma osmolality
29
What is the treatment for hyperosmolar hyperglycaemic state?
Fluid replacement with saline, LMWH to decrease risk of thromboembolism
restore electrolyte loss
30
What is cushings syndrome?
Chronic excess of cortisol hormone released by the adrenal glands
31
Which hormone stimulates ACTH release from the anterior pituitary?
Corticotropin releasing hormone
32
Which part of the adrenal cortex is cortisol released from?
Zona fasiculata
33
What is cushings disease?
Caused by an ACTH secreting pituitary adenoma
34
What are ACTH independant causes of cushings?
Adrenal adenoma, iatrogenic
35
Presentation of patients with cushings?
Central obestiy, moon face, mood change, proximal muscle weakness, purple abdominal striae, gastric ulcers, osteoporosis,
36
What drugs might cause cushings?
Oral steroids
37
First line test for cushings
Random plasma cortisol, if high do more tests
38
Gold standard test for cushings?
Overnight dexamethasone suppression test
39
What does the dexamethasone test do?
Giving dexamethasone should reduce the levels of ACTH and cortisol due to negative feedback. But in people with cushings these levels remain high.
40
How to treat cushings?
Adrenalectomy if adrenal adenoma
| Transsphenoidal surgical resection if pituitary adenoma
41
What are the complications of cushings?
Cardiovascular disease, hypertension, DM and osteoporosis
42
What is primary adrenal insufficiency?
Addisons disease, decreased production of cortisol
43
What is secondary adrenal insufficiency?
Decreased ACTH secretion, there is pituitary/hypothalamic involvement
44
What are the most common causes of addisons?
Autoimmune, can be caused by TB (developing countries)
45
Risk factors for addisons?
Female, adrenocortical antibodies, other autoimmune disease
46
Symptoms of addisons?
Fatigue, weakness, weight loss
47
Signs of addisons?
Hyper pigmentation, postural hypotension, hypoglycaemia
48
What are the sodium and potassium levels like in addisons?
Low sodium high potassium
49
Investigations for addisons?
FBC (anaemia and eosinophilia)
| Morning serum cortisol reduced, adrenal CT or MRI
50
How to manage addisons?
Treat underlying cause, glucocorticoid+mineralocorticoid replaceent
51
What is Conn's syndrome?
Autonomous aldosterone production that exceeds the body's requirements
52
What is the pathophysiology of COnn's?
Excess aldosterone
Increased Na reabsorptio and K+ excretion in the kidneys
Hypertension and potential hypokalemia
53
How do people with Conn's present?
hypertension, nocturia and polyuria, mood disturbance, difficulty concentrating excessive thirst
54
Investigations for Conns
Low potassium, high aldosterone to renin ratio
55
How to treat Conns?
SPIRONOLACTONE aldosterone antagonist, lower BP, resolve electrolyte imbalance.
56
What is the definition of hypokalaemia?
Potassium levels lower than 3.5mmol/l
57
Symptoms of hypokalaemia?
Asymptomatic, fatigue, generalised weakness, muscle cramps and pain, palpitations
58
Signs of hypokalaemia
Arrhtthmias, muscle paralysis and rhabdomyolysis
59
What are the causes of hypokalaemia?
Increased excretion, reduced intake, shift to intracellular
60
Reasons for increased excretion o potassium?
Drugs (thiazide, loop dieuretics), Renal disease, GI loss, increased aldosterone
61
Which drugs cause a shift to intracellular K?
Insulin and salbutamol
62
What ECG changes will you see in hypokalemia?
Flat T-waves, ST depression, prominent U waves, prolonged PR
63
What other investigations to diagnose hypokalaemia?
Urine osmolality, electrolytes
| bloods FBC and U&E
64
What is the definitieon of hyeprkalaemia?
greater than 5.5mmol/L
65
What are the symptoms of hyperkalaemia?
Fatigue, generalised weakness, chest pain, palpitations
66
What are the signs of hyperkalemia?
Arrhythmias, reduced power, reduced reflexs,
67
Causes of hyperkalemia?
AKI and CKD, drugs, renal tubular acidosis, metabolic acidosis
68
What are the characteristics of hyperkalemia on ECG?
Tall tented T-waves
69
How to manage hyperkalemia?
ABC assessment, consider cardiac monitoring,
protect myocardium with calcium gluconate
Drive K+ intracellulary with insulin/dextrose, salbutamol
70
What is carcinoid syndrome?
Groups of symptoms due to release of serotonin and other vasoactive peptides into the systemic circulation from a carcinoid tumour .
71
What are the symptoms of carcinoid syndroem?
diarrhoea and flushing
72
What are the signs of carcinoid syndrome?
Palpitations, abdominal cramps, RHF, bronchospasm
73
How would you investigate carcinoid?
High volumes of hydroxyindoleactic acid in the blood.
| Metabolic panel and liver ultrasound to confirm mets
74
How would you treat carcinoid?
Surgical ressection, radiofrequency ablation
75
What is hyperthyroidism?
More thyroid hormone being made or released
76
What is graves disease?
Antibodies binding to the TSH receptor causing more T3/T4 to be made
77
What is toxic multinodular goitre?
Hyperthyroidism seen often in the elderly. Thyroid enlarges with lots of little nodules which release harmful amounts of TSH
78
What are the causes of secondary hyperthyroidism?
Pituitary tumour
79
What are the risk factors for hyperthyroidism?
Young/middle aged women, smokers, stress, HLA-DR3
80
What are the symptoms of hyperthyroidism?
Hot and sweaty, diarrhoea, weight loss, anxiety/restlessness, hyperphagia.
81
What are the signs of hyperthyroidism?
Periorbital swelling, goitre, tachycardia
82
What are the investigations for hyperthyroidism?
Thyroid function tests
83
What are the results of thyroid tests for primary hyperthyroidism?
High T3/4, low TSH in primary
84
How to manage hyperthyroidism?
Propranolol for control of symptoms
Carbimazole
Surgery to remove nodules
Radioiodine
85
What are the 2 regimes of carbimazole you can try?
Block and replace.
| Titration according to TFT's
86
What is thyroid eye disease?
Eye discomfort, grittiness, photophobia, increased tear production
87
What is Hashimotos thyroiditis?
Antibodies attack the thyroid causing inflammation and dysfunction, lowering T3/4 levels
88
What are the risk factors for hypothyroidism?
Other autoimmune diseases, post partum
89
Symptoms of hypothyroidism?
Weight gain, depression, constipaion, cold intolerance, brain fog
90
What are the signs of hypothyroidism?
Bradycardia, delayed reflexes
91
Investigations for hypothyroidism?
TFT's
92
TFT results for primary hypothyroidism?
Low T3/4 high TSH
93
How to treat hypothyroidism?
Levothyroxine (T4)
94
Complications of hypothyroidism?
Heart disease, pregnancy problems, coma
95
Is there a goitre in primary atrophic hypothyroidism?
No goitre as there is atrophy of the thyroid gland
96
Is there a goitre in Hashimotos thyroiditis?
Goitre due to lymphocytic and plasma cell infiltration
97
What is the main cause of hypothyroidism worldwide?
Iodine deficiency
98
What is acromegaly?
Too much growth hormone usually from a pituitary tumour
99
What does growth hormone stimulate?
bone and muscle growth, increased protein synthesis, fat/glycogen breakdown
100
What is GH converted into in the liver?
Insulin like growth factor 1
101
Symptoms of acromegaly?
Large hands, box jaw, thick skin, arthritis, sight problems
102
Signs of acromegaly?
Hypertension, insulin resistance, bitemporal hemiopia
103
What does acromegaly cause bitemporal hemiopia?
A pituitary tumour compressing the optic chiasm
104
What investigations would you do for acromegaly?
ILGF-1 blood test, ask about changes in shoe/ring size
105
How would you manage acromegaly?
Tumour surgery, cabergoline (dopamine agonist), somatostatin analogue, GH receptor antagonist
106
What are the complications of acromegaly?
Diabetes, sleep apnoea, heart disease
107
What is a prolactinoma?
A tumour secreting prolactin
108
What are the symptoms of a prolactinoma?
Amenorrhea, galactorrhoea, gynaecomastia, low libido, possible cerebral symptoms
109
Signs of prolactinoma?
Infertility, low testosterone
110
Investigations for prolactinoma?
Prolactin levels, CT head
111
Management of a prolactinoma?
Surgery, carbergoline
112
Complications of a prolactinoma?
Infertility, sight loss, raised intracranial pressure
113
What is SIADH?
A condition where your body produces too much ADH
114
What is the result of Too much ADH?
Water is absorbed back into the blood from the collecting duct
115
What are the causes of SIADH?
Brain injury, infection, hypothyroidism, cancers, lung diseases
116
Symptoms of SIADH?
N+V, headache, lethargy, cramps, weakness, confusion
117
Signs of SIADH?
Raised JVP, oedema, ascites
118
investigations for SIADH?
ADH levels, U&E's low sodium normal potassium
119
How to manage SIADH?
Fluid restriction, treat underlying cause, increase osmolarity
120
What is diabetes insipidus?
Reduced ADH secretion causing large passage of dilute urine
121
Symptoms of DI?
Polyuria, polydipsia
122
Signs of DI?
Dry mucosa, sunken eyes, changes to skin turgidity
123
What is cranial DI?
Hypothalamus doesnt produce enough ADH
124
What is nephrogenic DI?
Kidneys do not respond to DI
125
What investigations should you do for DI?
Water deprivation test, ADH suppression test
| Urine dip for glucose
126
How does the water deprivation test differentiate between cranial and nephrogenic?
When you give desmopressin in cranial the kidneys will respond to it and the osmolaritly will increase whereas with nephrogenic the osmolality won't increase.
127
How to manage DI?
Rehydration, desmopressin, thiazide diuretics
128
What are the causes of hypocalcaemia?
Vit D deficiency, hypoparathyroidism, hypoventilation
129
What is calcium used for in the body?
Neurotransmission and muscle contraction
130
Symptoms of hypocalcaemia?
convulsions, arrhythmias, tetany and numbness
131
Signs of hypocalcaemia?
Chevostek's sign (tapping facial nerve induces spasm), BP cuff causes wrist to flex and fingers to draw together (trousseau's
132
Investigations for hypocalcaemia?
Corrected calcium levels, ECG (prolonged QT)
| Parathyroid function
133
How to treat hypocalcaemia?
10ml calcium gluconate/chloride, orla calcium and Vit D
134
complications of hypocalcaemia?
Seizure, cardiac arrest
135
Causes of hypercalcaemia ?
hyperparathyroidism, malignancy, sarcoidosis, thyrotoxicosis, drugs
136
Symptoms of hypercalcaemia?
soft weak bones, abdo pain, N+V, constipation, depression
137
Signs of hypercalcaemia?
Short QT and kidney stones
138
Investigations for hypercalcaemia>
Corrected calcium levels, ECG and look for cause
139
Management of hypercalcaemia>
treat underlying cause, increase circulation volume, increase excretion, bisphosphotes
140
what is the function of PTH?
Increased calcium through bone resorption, gut absorption, renal absorption, and activates Vit D
141
Risk factors for hyperparathyroidism?
Women 50-60 years
142
Symptoms of hyperparathyroidism?
Bones, stones, groans and psychic moans
143
Signs of hyperparathyroidism?
Hypercalcaemia
144
Investigations for hyperpaathyroidism?
PTH bone profile, high TH low calcium phosphates, DEXA scan (salt and pepper degradation of bone
145
Management of hyperparathyroidism?
Watchful waiting, surgery to remove the dodgy gland
146
Cuases of hypoparathyroidism?
Autoimmune, congenital, acquired damage
147
What does a bone profile show for hypoparathyroidism?
Low calcium, normal/high phosphate, low PTH
148
State 3 types of cancers that cause SIADH?
Prostate cancer, small cell carcinoma, pancreatic cancer
149
What is secondary adrenal insufficiency?
Caused by long term steroid therapy leading to suppression of the pituitary adrenal axis.
150
Symptoms of secondary adrenal insufficiency?
tired, tearful, weakness, anorexia, dizziness
