Endo COPY Flashcards
1
Q
Causes of thyrotoxicosis
A
- Graves
- toxic nodular goitre
- acute phase of subacute (de Quervain’s) thyroiditis
- acute phase of post-partum thyroiditis
- acute phase of Hashimoto’s thyroiditis
- amiodarone therapy
2
Q
Management of papillary and follicular thyroid cancers
A
Total thyroidectomy
Followed by radioiodine I-131
Yearly thyroglobulin levels to detect recurrence
3
Q
Follow up for gestational diabetes when glucose normal after birth?
A
Fasting blood glucose check at 6-13 weeks postpartum
4
Q
Management of thyrotoxic storm:
A
Propylthiouracil (PTU) + corticosteroids + propranolol.
5
Q
MEN I cancers
A
3Ps:
Parathyroid
Pituitary
Pancreas (insulinoma, gastrinoma)
Also adrenal + thyroid
6
Q
MEN IIa cancers
A
Medullary thyroid
+ 2Ps:
Parathyroid
Phaeochromocytoma
7
Q
MEN IIb cancers
A
Medullary thyroid
+ 1P:
Phaochromocytoma
Marfanoid
Neuromas
8
Q
Genetics MEN I
A
‘MEN1 gene’
9
Q
Genetics MEN IIa
A
RET oncogene
10
Q
Genetics MEN IIb
A
RET oncogene
11
Q
Canakinumab MOA
A
Inhibits interleukin-1B receptor binding
12
Q
Canakinumab use
A
Acute gout where NSAIDs or colchicine are not tolerated or ineffective
13
Q
pH indicating severe DKA
A
pH <7
14
Q
Blood ketone, severe DKA
A
blood ketone >6 mmol/L
15
Q
Bicarbonate level, severe DKA
A
Bicarbonate < 5 mmol/L
16
Q
Normal anion gap
A
< 16 mmol/L
17
Q
Potassium level indicating severe DKA
A
Potassium < 3.5 mmol/L on admission
18
Q
Obs suggesting severe DKA
A
Tachycardia/bradycardia
Systolic BP < 90 mmHg
Sats <92% on air
GCS
19
Q
Thiazolidinedione example
A
Pioglitazone
20
Q
Anti-diabetic linked to bladder cancer
A
pioglitazone (Thiazolidinedione)
21
Q
Thiazolinedione (pioglitazone) MOA
A
Insulin sensitizer
PPAR-gamma receptor agonist
22
Q
Long-term management of diabetic gastroparesis
A
Domperidone, metoclopramide or erythromycin
23
Q
Management of myxoedema coma
A
IV thyroid replacement
IV fluid
IV corticosteroids (until coexisting adrenal insufficiency excluded)
Electrolyte replacement
Rewarming
24
Q
Myxoedema coma presentation
A
Confusion
Hypothermia
Bradycardia
Profoundly hypothyroid
25
Marker for medullary thyroid cancer
Calcitonin
26
Sulfonylurea example
Gliclazide
27
Gliptin example (DPP-4 inhibitor)
Sitagliptin
28
Thiazolidinedione example
Pioglitazone
29
SGLT-2 inhibitor examples
Dapagliflozin,
Empagliflozin
30
GLP-1 mimetic examples
Exenatide,
Liraglutide
31
Pioglitazone (Thiazolidinedione) side effects
Weight gain
Fluid retention
Liver impairment
Increased risk of fractures
Increased risk of bladder cancer
32
Management of hypertriglyceridaemia
Fibrates (fenofibrate)
Statins may be indicated if mixed hyperlipidaemia
33
Causes of primary hypothyroidism
Iodine deficiency
Iatrogenic (thyroidectomy, radioiodine, drugs)
Autoimmune (Hashimoto's, atrophic)
Thyroiditis (post-viral/DeQuervain, post-partum)
34
Carbimazole side effect
Neutropenia
Cholestasis
Rash
35
Test to diagnose thyroiditis
Thyroid scintigraphy - shows reduced uptake of iodine-131
36
Features of abetalipoproteinemia
Steatorrhoea + poor growth
Neurological dysfunciton
Visual impairment
37
Treatment of abetalipoproteinemia
Dietary fat restriction
High-dose Vitamin E
38
Deficiency in Abetalipoproteinemia
Apolipoprotein B-48 + B-100
39
QRISK2 score should not be used in:
>=85 years
Type 1 diabetics
eGFR <60 / albuminuria
FH of familial hyperlipidaemia
40
Offer statin primary prevention in T1DM if:
Older than 40,
or,
Had diabetes >10 years,
or,
Have nephropathy,
or,
Have other CVD risk factors
41
Criteria for continuing GLP-1 mimetic
Only continue if HbA1c reduced by >=11 after 6 months
42
1st line drug in MODY
Sulfonyurea (eg glipizide)
43
1st line treatment for prolactinoma (even if very large!)
Dopamine agonist (cabergoline, bromocriptine)
44
Pseudo-hypoparathyroidism Type 1a AKA
Albright's Hereditary Osteodystrophy
45
Initial insulin regime in type 1 diabetic - new diagnosis in adult
Basal-bolus using twice-daily insulin detemir
46
Findings in Gitelman's syndrome (defective NaCl transporter)
Hypokalaemia
Normotensive
Low urinary calcium
47
T1DM glucose target, on waking
5-7mmol/L
48
T1DM glucose target, before meals
4-7mmol/L
49
T1DM glucose target, 90min after eating
5-9mmol/L
50
Type 1 RTA - location + defect
Distal tubule, inability to secrete H+ into urine
51
Causes of type 1 RTA (distal)
Idiopathic
Rheumatoid arthritis, SLE, Sjogren's
Amphotericin B toxicity
NSAID nephropathy
52
Type 2 RTA (proximal) - defect
Decreased HCO3 reabsorption
53
Causes of type 2 RTA (proximal)
Idiopathic
Fanconi syndrome, Wilson's disease, Cystinosis
Carbonic anhydrase inhibitors
Outdated tetracyclines
54
Type 3 RTA - caused by
carbonic anhydrase II deficiency
55
Type 4 RTA - location + defect
proximal tubule, decreased ammonium excretion
56
Type 4 RTA - caused by
hypoaldosteronism
diabetes
(NSAIDs)
57
Type 1 RTA - metabolic effect
Hyperchloraemia
Severe metabolic acidosis,
with Hypokalaemia
58
Type 2 RTA - metabolic effect
Hyperchloraemic metabolic acidosis,
Hypokalaemia
59
Type 4 RTA - metabolic effect
hyperchloraemic metabolic acidosis,
with hypERkalaemia
60
Type 3 RTA (mixed) - metabolic effect
Hyperchloraemic metabolic acidosis
Hypokalaemia
61
Primary hyperparathyroidism - definitive management
Total parathyroidectomy
62
Primary hyperparathyroidism - conservative management considered if:
>50 yo
Calcium level less than 0.25 mmol/L over upper limit
No evidence of end-organ damage
63
Cinacalcet (calcium mimetic) is used in
Primary hyperparathyroidism, to reduce calcium levels
64
Glucagonoma features
Diabetes
VTE
Necrolytic migratory erythema
65
Management of prolactinoma
1st line: dopamine agonist (cabergoline, bromocriptine)
2nd line: surgery
66
Contraindication to pioglitazone
Congestive cardiac failure
67
Sulfonylurea (eg gliclazide) MOA
Increases glucose-independent insulin release
68
GLP-1 agonist MOA
Binds GLP-1 receptor on beta cells to increase glucose-dependent insulin secretion
69
DPP4 inhibitors (sitagliptin) MOA
Inhibit breakdown of GLP-1 to increase glucose-dependent insulin secretion
70
Metformin MOA
Biguanide: Insulin sensitizer
71
Thiazolidinediones (pioglitazone) MOA
Insulin sensitizer
72
SGLT-1 inhibitor MOA
Inhibit glucose reabsorption in kidney
73
Acromegaly - sources of raised GH
- Pituitary adenoma 95%
- Ectopic GHRH/GH (pancreatic tumour)
74
Acromegaly features
Facial features + large hands, feet, jaw, tongue
Sweating (gland hypertrophy)
Tumour: bitemporal hemianopia, hypopituitarism, raised prolactin
75
Acromegaly genetics
MEN-1 in 6%
76
Acromegaly complications
HTN
Diabetes
Cardiomyopathy
Colorectal cancer
77
Deficiency in congenital adrenal hyperplasia
21-hydroxylase deficiency (90%)
11-beta hydroxylase deficiency (5%)
17-hydroxylase deficiency (very rare)
78
Inheritance pattern of congenital adrenal hyperplasia
Autosomal recessive
79
Diagnosis of congenital adrenal hyperplasia
Raised 17-OH progesterone
80
Features of 21-hydroxylase mutation (Classic Congenital Adrenal Hyperplasia)
- Virilisation
- Salt wasting
- Hypovolemia/shock
81
Features of CAH - 11-beta hydroxylase mutation
- Hypertension
- Virilisation
82
Features of CAH - 17-alpha hydroxylase mutation
- Hypertension
- No virilisation
83
Insulin stress test cushings vs pseudo-cushings
Cushings: limited rise in cortisol
Pseudo-cushings: normal rise in cortisol
84
Tests to confirm Cushings syndrome/pseudo-cushings is present
- Overnight dexamethasone suppression test
- 24hr urinary free cortisol
85
Kallman syndrome
Hypogonadotrophic hypogonadism
Failure of migration of GnRH-releasing neurons and olfactory neurons
86
Hormone levels in Kallmann's syndrome
- Low GnRH
- Low gonadotrophs (LH, FHS)
- Low sex hormones (estrogen, progesterone, testosterone)
- Other pituitary hormones normal
87
Kallmann's syndrome - inheritance pattern
X-linked recessive
88
Kallmann's syndrome - features
Delayed puberty
Low sex hormones
Small testes
Anosmia
Tall
89
Commonest thyroid cancer
Papillary - 70%
90
Thyroid cancer which may cause pressure symptoms
Anaplastic
91
2nd commonest thyroid cancer
Follicular 20%
92
Which thyroid cancer is associated with MEN II
Medullary
93
Which cells involved in medullary thyroid cancer
Parafollicular (c) cells
94
T2DM HbA1c target - lifestyle changes alone
48 mmol/mol (6.5%)
95
T2DM HbA1c target - on metformin only
48 mmol/mol (6.5%)
96
T2DM HbA1c target - on a drug which may cause hypoglycaemia
53 mmol/mol (7.0%)
97
Which diabetes drugs may cause hypoglycaemia
Sulfonylurea (gliclazide)
Insulin
98
T2DM on 1 drug - if HbA1c rises to this level, should add a second drug
58 mmol/mol (7.5%)
99
T2DM on metformin and HbA1c rises to >58
Add gliptin / sulfonylurea / pioglitazone / SGLT-2 inhibitor
100
T2DM on metformin and 1 other drug and HbA1c >58
Triple therapy
(Or consider insulin)
101
Criteria for adding GLP-1 mimetic (exenatide)
Triple therapy not effetive/not tolerated and:
BMI >= 35
or <35 but cant use insulin due to occupation/weight loss beneficial for other comorbidities
102
Criteria for continuing GLP-1 mimetic after 6 months
HbA1c reduction of at least 11 mmol/mol
and
Lost at least 3% of initial body weight
103
Statin for primary prevention - indications
10yr CVD QRISK2) >= 10%
T1DM
CKD with eGFR <60
104
Statin for primary prevention - titration
If non-HDL not fallen by >= 40%, consider uptitrating to 80mg
105
Statin for secondary prevention - indications
Known IHD
Cerebrovascular disease
Peripheral arterial disease
106
SIADH - 1st line management
Fluid restriction
107
SIADH - management if resistant to fluid restriction
Demeclocycline
108
Demeclocycline MOA
Inhibits effect of ADH on renal tubules
109
Orlistat MOA
Inhibits pancreatic lipase
110
Orlistat criteria for starting
BMI >= 30
or
BMI >=28 with risk factors
And 3 months of dietary + lifestyle measures have failed
111
Orlistat criteria for continued use
Weight loss of 5% at 3 months
May only be used for <1 year
112
Criteria for weight loss surgery
Failure of non-surgical measures
BMI >40, or BMI 35-40 with other disease
Commits to long-term followup
113
Anti-thyroid drugs in pregnancy
Propylthiouracil in first trimester (SE hepatotoxicity)
Switch to carbimazole at start of second trimester (SE congenital abnormality)
114
Management of Addisonian crisis
Hydrocortisone 100mg IM/IV
- 6hrly until stable
IV fluids
PO steroids after 24hrs
115
Thyroid nodule, TSH is low - next investigation?
Thyroid uptake scan
- If cold/iso nodule -> FNA
- Hot nodule - no FNA
116
Thyroid nodule, TSH is normal/elevated - next investigation?
Thyroid USS
- FNA if suspicious ft on US
117
JBDS DKA criteria
glucose > 11 mmol/l (or known DM)
pH < 7.3
bicarbonate < 15 mmol/l
ketones >3, or dipstick ++
118
(JBDS) DKA - potassium replacement if K >5.5
None
119
(JBDS) DKA - potassium replacement if K 3.5 - 5.5
40 mmol/l
120
(JBDS) DKA - potassium replacement if K <3.5
Senior review
121
Screening for other disease, in known acromegaly
Regular colonoscopy, starting aged 40
122
Acromegaly 1st line management
Trans-sphenoidal surgery
123
Acromegaly 2nd line management
Best: Somatostatin analogue (octreotide) - inhibits GH release
Pegvisomant - GH receptor antagonist
Dopamine agonist (bromocriptine)
124
Drug causes of hypercalcaemia
Thiazides
Calcium-containing antacids
Lithium
125
Hypothyroidism monitoring in pregnancy
TSH each trimester, and 6-8 weeks post-partum
126
Thyroxine dose in pregnancy
Increase by 25-50% by weeks 4-6 of pregnancy.
Return to normal dose after delivery
127
Features of APS type 1 (MEDAC - multiple endocrine deficiency autoimmune candidiasis)
Need 2 out of 3:
- Addison's
- Primary hypoparathyroidism
- Chronic mucocutaneous candidiasis
128
Features of APS type 2 (Schmidt's syndrome)
Addison's plus either:
- T1DM
- Autoimmune thyroid disease
129
APS type 1 genetic mutation
AIRE1 gene on chromosome 21
130
APS type 2 HLA linkage
HLA DR3/DR4
131
Primary hyperparathyroidism monitoring
Regular renal function, bone profile + DEXA scan
132
Type 2 DM + anti-GAD
LADA
(Latent Autoimmune Diabetes of Adulthood)
133
Liddle's syndrome inheritence
AD
134
Liddle's syndrome pathophysiology
Dysfunctional sodium channels in distal tubules -> increased sodium reabsorption
135
Liddle's syndrome presentation
Hypertension
Metabolic alkalosis
Hypokalaemia
Low renin, low aldosterone
Teenager with symptomatic HTN
136
Liddle's syndrome treatment
Amiloride or triamterene
137
Simone Broome criteria for familial hypercholesterolaemia - Definite FH
TC/LDL-C over threshold, plus:
Tendon xanthoma in patient/1st/2nd degree relative
Or
DNA evidence of FH
138
Simone Broome criteria - TC and LDL-C threshold in child <16
TC >6.7 mmol/L or LDL-C >4.0 mmol/L
139
Simone Broome criteria for familial hypercholesterolaemia - Possible FH
TC/LDL-C over threshold, plus:
MI <50 in 2nd degree relative,
MI <60 in 1st degree relative, or,
FH of raised cholesterol
140
Simone Broome criteria - TC and LDL-C threshold in adult
TC >7.5 mmol/L or LDL-C >4.9 mmol/L
141
Familial hypercholesterolaemia management
Referral specialist lipid clinic
High-dose statin
Screen first-degree relatives, by age of 10 (50% chance)
142
Calculated serum osmolarity
2Na + 2K + glucose + urea
143
Normal osmolar gap
<10
144
Osmolar gap
Measured osmolarity - calculated osmolarity
145
Treatment options for Graves' disease
ATD titration (Carbimazole)
Block-and-replace (Carbimazole + thyroxine)
RAIA (radioactive ionine ablation)
Surgery
146
Definitive treatment options for Graves' disease
RAIA and surgery
147
Contraindications to RAIA in Graves'
Pregnancy/trying to get pregnant
Age <16y
Thyroid eye disease
148
Thiamine
Vitamin B1
149
Rotterdam criteria for PCOS
At least 2 of:
- Clinical/biochemical evidence of hyperandrogenism
- Oligo- or anovulation
- Polycystic ovaries on US
150
Management of infertility in PCOS
Weight loss
Clomifene (+/- metformin)
Gonadotrophins
151
Management of hirsutism in PCOS
COCP (co-cyprindiol has anti-androgen action)
Topical eflornithine
Spironolactone/finasteride/flutamide
152
Screening for gestational diabetes - with any risk factors
OGTT at 24-28 weeks
153
Screening for gestational diabetes - previous gestational diabetes
OGTT as soon as possible after booking + at 24-28weeks
154
Diagnostic threshold for gestation diabetes - fasting glucose
>= 5.6 mmol/L
155
Diagnostic threshold for gestation diabetes - 2-hour glucose
>= 7.8 mmol/L
156
Gestational diabetes, fasting glucose >= 7 at time of diagnosis
Start insulin
157
Gestational diabetes - glucose targets not met with 1-2 weeks of diet/exercise
Start metformin
158
Gestational diabetes - glucose targets not met with diet/exercise/metformin
Start insulin
159
Gestational diabetes - plasma glucose 6 - 6.9 with evidence of macrosomia/hydramnios
Offer insulin
160
Pre-existing diabetes and pregnant
Weight loss if BMI >27
Stop PO hypoglycemics, apart from metformin, start insulin
Folic acid 5mg up to 12wk
Aspirin 75mg 12wk-delivery
161
Blood sugar target diabetes in pregnancy - Fasting
5.3 mmol/l
162
Blood sugar target diabetes in pregnancy - 1 hour after meal
7.8 mmol/l
163
Blood sugar target diabetes in pregnancy - 2 hour after meal
6.4 mmol/l
164
Type 1 (distal) RTA complications
Renal stones, nephrocalcinsis
165
Features of primary hyperaldosteronism
Hypertension
Hypokalaemia
Alkalsosis
Raised aldosterone: renin ratio
166
Management of bilateral adrenal hyperplasia
Spironolactone
167
Management of adrenal adenoma
Surgery
168
Investigation of hyperaldosteronism
High-resolution CT abdomen + Adrenal Vein Sampling
169
DVLA: Diabetics on insulin can hold an HGV licence as long as
- No severe hypo in last 12m
- Have hypo awareness
- 3-month evidence of regular glucose monitoring
- Understand risks of hypose
- No debarring complications
170
DVLA: Diabetics on insulin can drive a car as long as
- Have hypo awareness
- No more than 1 hypo requiring assistance in last 12m
- No visual impairment
171
Causes of Addisonian crisis
Sepsis/surgery triggering acute exacerbation of existing insufficiency
Adrenal haemorrhage (Waterhouse-Friderichsen syndrome in meningitis)
Steroid withdrawal
172
Causes of raised prolactin
prolactinoma
pregnancy
oestrogens
stress, exercise, sleep
acromegaly
PCOS
primary hypothyroidism
173
Drug causes of raised prolactin (dopamine-blockers)
Metoclopramide, domperidone
Haloperidol
Phenothiazines (prochlorperazine)
Rare: SSRIs, opioids
174
Subacute 'De Quervains' Thyroiditis on thyroid scintigraphy
Globally reduced uptake of iodine-131
(Transient increase in hormone release, not over-production)
175
Management of subacute/De Quervains Thyroiditis initial phase
Propranolol for symptoms
NSAIDs for thyroid pain
Steroids if severe
176
SIADH criteria
Na <135
Serum osmolality <271
Urine osmolality >100
Euvolemic
177
Management of congenital adrenal hyperplasia
Reverse circadian rhythm steroids
178
Features of hyperosmolar hyperglycaemic state
High osmolality + high glucose (>30)
Dehydration, unwell
No significant ketonaemia/acidosis
179
Indications for radioiodine therapy
Differentiated thyroid cancer
Toxic multinodular goitre
Refractory Graves disease
180
Test for adult growth hormone deficiency
Insulin tolerance test - demonstrates low peak GH levels in response to hypoglycaemia
181
Test for GH deficiency when ITT contraindicated
Arginine-GHRH stimulation test
182
CI to ITT
IHD
Previous seizures
183
Risk of rapid correction of HYPOnatraemia
Central pontine myelinolysis
184
Hyponatramia correction - aim in 24hr period
Raised Na levels by 4-6mmol/l in 24 hours
185
Visible features of pseudo-hypoparathyroidism type 1a
Short 4th and 5th metacarpals
Obesity
186
Biochemical findings in pseudo-hypoparathyroidism type 1a
High PTH, with low calcium, and high phosphate
187
Imaging for phaeochromocytoma
MIBG (metaiodobenzylguanidine) scan
188
24h urinary HIAA - screens for what
Carcinoid syndrome
189
Pentagastrin stimulation test - for which cancer
Medullary thyroid cancer
190
Definition of Stage 1 hypertension
Clinic BP > 140/90
and
ABPM daytime average/HBPM average > 135/85
191
Definition of Stage 2 hypertension
Clinic BP > 160/100
and
ABPM daytime average/HBPM average > 150/95
192
Definition of Severe hypertension
Clinic systolic BP >180 or diastolic BP >120
193
Treat Stage 1 hypertension if:
<80 years old with any of:
Target organ damage,
Established CD
Renal disease
QRISK >10%
194
Management of diabetes in cystic fibrosis
High calorie diet with insulin
195
Features of carcinoid syndrome
Diarrhoea
Facial flushing
Bronchospasm
Hypotensions
Right heart valvular stenosis
196
Prolactin level seen in prolactinoma
> 5000 mU/L
197
Prolactin level seen in non-prolactin secreting pituitary tumour
600 - 3000 mU/L
198
Ferritin levels seen in haemochromatosis
> 500 ug/L
199
1st line management of hyperphosphataemia in CKD
Start with dietary phosphate restriction, add in phosphate binder (calcium acetate) if needed
200
Target BP in diabetics/CKD
Aim BP < 130/80 with ACEi
201
Management of hyperphosphataemia in CKD, when calcium is raised
Non-calcium phosphate binder (Sevelamer)
202
Features of Bartter syndrome
Hypokalamic alkalosis
Normotensive
Muscle weakness/lethargy (due to low K)
203
Verner-Morrison syndrome (VMS)
Uncontrollable watery diarrhoea causing hypokalaemia and dehydration
204
Best screening test for acromegaly
IGF-1
205
Test for growth hormone deficiency
Insulin tolerance test
206
1st line management of solitary toxic thyroid nodule
Radioactive iodine therapy
207
Solitary toxic thyroid nodule - Indications for partial thyroidectomy
Thoracic obstruction
CI to radioiodine (planned pregnancy, young children)
208
T score representing osteopenia
-1.5 to -2.5
209
T score representing osteoporosis
Below -2.5
210
Feature of pseudohypoparathyroidism
High PTH
Low calcium, high phosphate
Short 5th digit
211
Initial management of nephrogenic diabetes insipidus (after stopping lithium)
Thiazide diuretic (Hydrochlorothiazide)
212
2nd line management of nephrogenic diabetes insipidus
Add amiloride or NSAID (indomethacin)
213
Treatment of cranial diabetes insipidus
Desmopressin
214
Alternate test for acromegaly
Glucose tolerance test, with growth hormone measurement (failure to suppress GH)
215
C282Y or H63D mutations in
Haemochromatosis
216
H1069Q mutation is seen in
Wilsons disease
217
C282Y or H63D mutations in
Haemochromatosis
218
H1069Q mutation in
Wilsons
219
Diagnostic test for phaeochromocytoma
24hr urinary metanephrines
220
Use for calcitonin
Hypercalcaemia
(with rehydration +/- bisphosphonates)
