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PRIYA ENDO > endo investigations > Flashcards

endo investigations Flashcards

1
Q

type 1 DM biochem diagnosis

A

HbA1c >48
Fasting G >7
OGTT >11.1
Random G >11.1

  • GAD65
  • IA-2
  • ZnT8
  • low C peptide (<200pmol/l)
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2
Q

which is more useful in T1DM, finger prick or continuous / flash monitoring? why?

A

continuous - measures intestinal glucose

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3
Q

diabetic ketoacidosis biochem diagnosis

A
  • ketonaemia >3
  • BG >11 / known DM
  • bicarbonate <15 / venous pH <7.3
  • K >5.5
  • bloods = beta hydroxybutyrate (main metabolic product in DKA)
  • urine = acetoacetate (shows ketone levels 2-4 hours previously)
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4
Q

LADA diagnosis

A
  • mild insulin resistance
  • low C peptide
  • HLA gene positive
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5
Q

T2 DM bichem diagnosis

A
  • HbA1c >48
  • fasting G >7
  • OGTT >11.1
  • random G >11.1
  • high C peptide
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6
Q

peripheral neuropahty

A

MRI to check for charcot foot

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7
Q

autonomic neuropathy

A

screen to check for raised albumin (sign of diabetic kidney failure)

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8
Q

nephropathy

A
  • measure protein : creatine levels (ACR vs PCR –> ACR <30 + PCR <50 = microalbuminuria)
  • nerve conduction studies / electromyography
  • gastric emptying studies
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9
Q

MODY

A
  • genetic testing
  • diagnosed with T1DM <30 with presence of C-peptide at 3 years duration
  • OGTT to differentiate MODY 1 + 2 ( 2 = G >7)
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10
Q

HHS

A
  • hypovolaemia
  • hyperglycaemia >30
  • mild ketonaemia <3
  • bicarbonate >15 or venous pH>7.3
  • osmolarity >320 (2xNa + urea and glucose)
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11
Q

alcohol induced keto acidosis

A
  • ketonaemia >3

- bicarbonate <15 or venous pH < 7.3

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12
Q

lactic acidosis

A
  • reduced bicarbonate
  • raised anion gap
  • raised phosphate
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13
Q

hypothyroidism

A

primary

  • TSH high (bc no negative feedback)
  • T3/4 low

secondary

  • TSH low
  • T3/4 high
  • increased MCV
  • increased CK
  • high LDL
  • hyponatraemia
  • hyperprolacinaemia
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14
Q

subclinical hypothyroidism

A

T3/4 normal

TSH high

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15
Q

hashimoto’s

A
  • T cell infiltration
  • T3/4 normal
  • TSH high
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16
Q

diffuse goitre

A

T3/4 normal

TSH high

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17
Q

multi-nodular goitre

A
  • TSH normal
  • CT (check for retrosternal extension + tracheal compression)
  • scintigraphy (focal uptake right upper pole)
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18
Q

hyperthyroidism / thyrotoxicosis

A

primary

  • T3/4 high
  • TSH low

secondary

  • T3/4 high
  • TSH high

subclinical

  • T3/4 normal
  • TSH low

investigations

  • USS FNA
  • scintigraph (1-123 or tc99m)
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19
Q

grave’s disease

A
  • TSH low
  • T3/4 high
  • hypercalcaemia + increased ALP (osteoporosis)
  • decreased WCC
  • TRAb
  • scintigraphy (homogeneous increased tracer uptake, >3% total tracer found in gland)
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20
Q

nodular thyroid disease

A
  • T3/4 high
  • TSH low
  • TRAb negative
  • scintigraphy - high uptake
  • USS
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21
Q

thyroid cancer

A
  1. US of neck
  2. TSH
  3. USS FNA
  4. laryngoscopy
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22
Q

follicular adenoma

A

TSH low (because secretes thyroid hormones / TSH independent)

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23
Q

differentiated thyroid cancer

A

USS FNA

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24
Q

papillary carcioma

A

histology

  • finger like prolongations of follicular cells
  • slow growing
  • empty nucleus
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25
Q

follicular carcinoma

A

look at invasive growth pattern

  • widely invasive = more solid architecture, less follicular architecture, more mitotic activity
  • minimally invasive = follicular architecture (well differentiated)
26
Q

medullary carcinoma

A

histology
- cerosis, many mitoses, spindle shaped cells

  • high calcitonin (forms around amyloid cells)
  • can release serotonin and VIP
27
Q

anaplastic carcinoma

A

histology

  • altered cells which appear normal
  • spindle shaped cells + pleomorphic giant cells
28
Q

thyroiditis

A

scintigraph = homogenous reduced tracer uptake

29
Q

congenital thyroid disease

A

screening = gurthie test (PKU test)

  • heel prick
  • day 5
  • capillary blood spot on dry blotting paper
  • measurement of TSH and/or T4
30
Q

hypercalcaemia

A

primary

  • raised serum Ca
  • increased urine Ca excretion

malignancy

  • raised Ca + ALK PHOS
  • xray, CT, MRI
  • isotope bone scan
31
Q

hypocalcaemia

A

prolonged QT

32
Q

hyperparathyroidism

A

primary

  • high PTH
  • high Ca
  • low PHOS

secondary

  • high PTH
  • low Ca

tertiary

  • high PTH
  • high Ca
  • sestamibi scan
33
Q

hypoparathyroidism

A
  • decreased Ca
  • decreased PTH
  • normal ALP
34
Q

pseudo-hypoparathyroidism

A
  • low Ca

- raised PTH

35
Q

pseudo-pseudo hypoparathyroidism

A
  • normal Ca
  • normal PO4
  • raised PTH
36
Q

prolactinoma

A
  • high PRL >5000
  • pituitary MRI
  • visual-field examination
37
Q

acromegaly

A
  • IGF1 (somatomedin C)
  • OGGT (normal response = GH <40 after G, acromegaly response = GH unchanged
  • visual fields
  • pituitary MRI
38
Q

cushing’s

A

diagnostic test
- low dose DST test = 2-day 2mg/day dexamethasone suppression test (normal = cortisol< <50 6 hours after last dose, abnormal = cortisol >130)

screening tests

  • overnight 1mg dexamethasone suppression test (normal = cortisol next morning <50, abnormal >100)
  • urine free cortisol - 24 hour urine collection (normal <250)

syndrome vs disease
- do high dose dexamethasone test

39
Q

hypopituitrism

A

1st line investigations

  • serum electrolytes
  • 8am cortisol and ACTH
  • TFT
  • 8am testosterone
40
Q

diapetes insipidus

A

water deprivation test

  • no water for 6-8 hours
  • check serum and urine osmolarities for 8 hours and then 4 hours after giving IM DDAVP (demopressin injection)
  • if urine/serum osmolarities >2 then it is normal (urine getting concentrated)
  • otherwise DI
  • (if it improves after DDAVP the it is due to cranial DI)
41
Q

adrenal insufficiency

A

biochem

  • decreased Na
  • increased K
  • hypoglycaemia
  • ACTH levels high
  • increased renin
  • decreased aldosterone

short synachten test

  • measure plasma cortisol before and 30 mins after each IV / IM ACTH
  • giving ACTH can let you see if adrenal cortex produces cortisol
42
Q

addison’s

A 
biochem 
- hypontraemia (due to increased ACTH)
- hyperkalaemia 
hypoglycaemia 
- increased PEL (decreased GC)
43
Q

congenital adrenal hyperplasia

A
  • basal 17-OH progesterone
44
Q

primary aldosteronism / conn’s

A
  1. confirm aldosterone excess (measure plasma aldosterone and renin and express as ratio, if >750 the do saline test) - failure of plasma aldosterone to suppress by >50% with 2L of saline confirms PA
  2. confirm subtype –> CT or PET scan to demonstrate adenoma
45
Q

adrenocortical adeoma

A

histology
- well differentiated
- small nuclei
rare mitoses

46
Q

phaeochromocytoma

A
  1. confirm catecholamine (adreanline) excess
    - urine - 2x24 hour catecholeamines / metanephrins
    - plasma at time of symptoms
  2. identify source of catecholamines excess
    - MRI scan, MIBG, PET scan
  3. biological abnormalities
    - hyperglycaemia
    - lactic acidosis in absence of shock
47
Q

SIADH

A

concentrated urine

  • Na > 200mm
  • osmolarity >500
  • hyponatraemia or plasma osmolarity <275
  • absence of hypovolaemia, oedema or diuretics
48
Q

obstructive male infertility

A
  • normal LH, FSH and testosterone
49
Q

group 1 failure

A
  • low FSH and LH
  • oestrogen deficiency (negative progesterone challenge test)
  • normal prolactin
50
Q

group 2 dysfunction

A
  • normal gonadotrophins / excess LH
  • normal oestrogen (progesterone challenge test)
  • insulin resistance
  • high free androgens (acne, hirsuitism)

score 2/3

  • chronic anovulation
  • polycystic ovaries
  • hyperandrogenism
51
Q

group 3 ovarian failure

A
  • raised FSH >30 x2 samples
  • low oestrogen
  • progesterone challenge test (positive or negative ????)
  • transvaginal US
52
Q

what is the progesterone challenge test and what do the results mean?

A
  • menstrual bleed in response to a five day course of progesterone indicates normal oestrogen levels
53
Q

premature ovarian failure

A
  • oestrogen deficiency
  • raised gonadotrophins
  • FSH >30 on 2x times, 1 month apart
54
Q

male hypogonadism

A
  • increased Ca+
  • nephrosis
  • polycythaemia
  • monitor PSA
55
Q

kleinfelter’s syndrome

A
  • low testosterone

- high LH / FSH (raised SHBG / oestradiol)

56
Q

Kallmann’s syndrome

A
  • normal MRI but no olfactory bulbs
57
Q

tubal disease

A
  1. hysterosalpinogram
  2. laparoscopy
  3. hysterectomy
  4. pelvic US
58
Q

endometriosis

A

scan may show ‘cholocate cysts”

59
Q

MEN1

A
  • presence of 1 or more MEN1 tumour types
  • high serum calcium - test of choice
  • no genetic testing
60
Q

MEN2a

A
  • RET oncogene or 2 or more tumour types
  • genetic testing

if MTC

  • screen for plasma fractionated metanphrines for phaeochromocytoma
  • serum calcium for hyperthyroidism

if not MTC

  • calcitonin
  • US of neck

PRIYA ENDO (8 decks)

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