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Pass Med finals pack > Endo part 2 > Flashcards

Endo part 2 Flashcards

1
Q

how to thiazolidinediones work?

A
  • used in T2DM treatment
  • agonists to PPAR- gamma receptor
  • reduce peripheral insulin resistance

absolutely contraidicated in heart failure patients as cause fluid retention

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2
Q

Hypothermia, hyporeflexia, bradycardia and seizures, think …

A

myxoedemic coma

  • thin and brittle hair
  • periorbital oedema
  • more specific to hypothyroidism
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3
Q

general features of hypothyroidism

A

weight gain

lethargy

cold intolerance

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4
Q

skin features of hypothyroidism

A

dry (anhydrosis), cold, yellowish skin

non-pitting oedema (e.g. hands, face)

dry, coarse scalp hair, loss of lateral aspect of eyebrow

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5
Q

GI feature of hypothyroidism

A

constipation

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6
Q

gynae feature of hypothyroidism

A

menorrhagia

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7
Q

neurological feature of hypothyroidism

A

decreased deep tendon reflexes

carpal tunnel syndrome

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8
Q

patient with T1DM has blood glucose of 7.6mmol/L indicating his control requires improvement.

however his HbA1c level suggests good control. why might this be?

A
  • HbA1c depends on average bg concentration and RBC lifespan
  • in sickle cell anaemia, hereditary spherocytosis and G6PD deficiency there is reduced RBC lifespan
  • hence can artificially lower HbA1c levels
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9
Q

what is the incretin effect?

A
  • in normal physiology
  • an oral glucose load results in greater release of insulin
  • than if the load was given IV
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10
Q

incretin effect largely mediated by

A

GLP-1

incretin effect decreased in T2DM

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11
Q

classes of drugs for DM

A
  1. GLP-1 drugs
    - increase [GLP-1] with analogues
  2. DPP-4 inhibitors
    - inhibit breakdown
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12
Q

teritary hyperparathyroidism is characterised by…

A
  • extremely high serum PTH with moderately raised serum calcium
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13
Q

which conditions account for 90% of cases of hypercalcaemia?

A
  1. primary hyperparathyroidism (commonest cause in non-hospitalised patients)
  2. malignancy (commonest cause in hospitalised patients)
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14
Q

what occurs in Conn’s syndrome?

A
  • there is excess aldosterone production independent of RAAS
  • leads to hypertension, hypernatraemia and hypokalaemia
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15
Q

what is the underlying pathophys of DKA?

A
  • uncontrolled lipolysis
  • results in excess of free fatty acids
  • these converted to ketone bodies
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16
Q

the following features are consistent with what diagnosis:

  • abdominal pain
  • polyuria, polydipsia, dehydration
  • kussmaul respiration (deep hyperventilation)
  • acetone-smelling breath
A

diabetic ketoacidosis

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17
Q

what are sulfonylureas?

A
  • oral hypoglycaemic drugs
  • used in management of t2dm
  • increase pancreatic insulin secretion
  • only effective if functional b-cells are present
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18
Q

common adverse effects of sulfonylureas?

A
  1. hypoglycaemic episodes
  2. weight gain
Rarer adverse effects
hyponatraemia secondary to syndrome of inappropriate ADH secretion
bone marrow suppression
hepatotoxicity (typically cholestatic)
peripheral neuropathy
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19
Q

65 y/o male

  • PC, difficulty climbing stairs, worsening bruising on arms, weight gain
  • PMH , COPD, RA, polymylagia rheumatica
  • Dx, long term steroids

patients symptoms are suggestive of:

A

Cushing’s syndrome

- due to prolonged exposure to corticosteroids

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20
Q

what findings would be found on a venous blood gas of patient with Cushing’s syndrome?

hypokalaemia or hyperkalaemia

A

metabolic alkalosis

hypokalaemia

  • excess aldosterone
  • increases acid and K+ excretion
  • in kidney
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21
Q

In Addison’s disease why are patients often hyperkalaemic?

A
  • insufficiency of aldosterone
  • decreases acid secretion in kidney
  • leads to retention of potassium
22
Q

Features - ‘bones, stones, abdominal groans and psychic moans’

polydipsia, polyuria
peptic ulceration/constipation/pancreatitis
bone pain/fracture
renal stones
depression
hypertension

indicative of:

A

primary hyperparathyroidism

23
Q

what is the most common cause of primary hyperaldosteronism?

A
  • bilateral idiopathic adrenal hyperplasia
24
Q

while reviewing a 4 y/o boy with constipation you notice small mass in left lower abdomen. does not cause him distress to palpate.

previous GP had noticed this, thought it was stool due to constipation.

child is fit and well, no other concerns,

what is next appropriate step?

A
  • discuss with on-call paediatric registrar as
  • child with palpable abdominal mass or unexplained enlarged abdomen need urgent referral
  • assessment for neuroblastoma or wilm’s tumour
25
Q

48 y/o with 3 year history of HT, muscle weakness and nocturne.

blood test show:

  • low potassium
  • high aldosterone-to-renin ratio

most likely cause of this patient’s presentation?

A

primary hyperaldosteronism

26
Q

what is the most common cause of primary hyperaldosteronism?

A

bilateral idiopathic adrenal hyperplasia

27
Q

over replacement of thyroxine increases the risk for…

A

osteoporosis

28
Q

A HbA1c in what range is indicative of prediabetes.

A

of 42-47 mmol/mol

29
Q

A second drug should be added in type 2 diabetes mellitus if the HbA1c is

what should be prescribed?

A

> 58 mmol/mol

prescribe DPP-4 inhibitor

30
Q

scintigraphy showing:

diffuse enlargement of both thyroid lobes, with uniform uptake throughout.

indicative of:

A

Grave’s disease

autoimmune

31
Q

A 34-year-old woman is referred to the endocrinology clinic with symptoms of anxiety and significant weight loss. She reports feeling unusually hot all the time.

raised T4, decreased TSH

The endocrinologist arranges a nuclear scintigraphy scan which reveals patchy uptake.

indicative of:

A

toxic multi nodular goitre

32
Q

nelsons syndrome is

rare

A
  • abnormal hormone secretion
  • enlargement of pituitary
  • often post surgical removal of adrenal glands for Cushings disease
33
Q

The standard HbA1c target in type 2 diabetes mellitus

A

48 mmol/mol

34
Q

first line treatment of Grave’s disease

A

carbimazole

35
Q

an elevated TSH with normal T4 indicates

A

subclinical hypothyroidism

36
Q

32 y/p T1DM PC bloating and vomiting.

erratic blood glucose control, bloating and vomiting

indicative of:

A
  • gastroparesis

- neuropathy of vagus nerve in diabetes –> causing abnormal gut movement –> gastroparesis

37
Q

initial hyperparathyroidism, painful goitre and globally reduced uptake of iodine-131 indicative of:

A

De Quervain’s thyroiditis

38
Q

Acromegaly: if patients are not suitable for trans-sphenoidal surgery, or have residual symptoms,

what might be used?

A

octreotide

39
Q

30 y/o male T1DM, confused, drowsy. Bloods show hyperglycaemia, ketones ++ urinalysis

management

A

IV fluids

40
Q

peptic ulceration
galactorrhoea
hypercalcaemia

in a patient leads to a diagnosis of:

A

multiple endocrine neoplasia type 1

  • genetic
  • development of neoplastic lesions in pituitary gland, parathyroid gland and pancreas
41
Q

prognosis of what thyroid cancer is deemed to be excellent

A

papillary thyroid cancer

42
Q

which result established a diagnosis of diabetes mellitus?

A
  • symptomatic patient
  • random glucose 12.0 mol/L on one occasion

Diabetes diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic need two readings

43
Q

sitagliptin is an example of a …

A

DDP-4 inhibitor

dipeptidyl peptidase-4 inhibitor

reduces peripheral breakdown of incretins such as GLP-1.

44
Q

role of incretins

A

inhibit glucagon secretion

thus increases insulin secretion

hence reduces gastric emptying and blood glucose levels

45
Q

which endocrine hormones are reduced in stress response

A
  • insulin
  • testosterone
  • oestrogen
46
Q

SGLT-2 inhibitors are not linked to necrotising fasciitis of the genitalia or perineum

A

SGLT-2 inhibitors have been linked to necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)

TRUE

47
Q

what is the classical visual field defect of a pituitary adenoma?

A

bitemporal hemianopia

due to compression of the optic chiasm

48
Q

what test is best to diagnose Addison’s disease?

A

short synacthen test

The test is based on the measurement of serum cortisol before and after an injection of synthetic ACTH

49
Q

If lifestyle measures have failed to bring a patients blood pressure down they should then be offered an:

A

ACE inhibitor

50
Q

which antibodies are found in a patient with Hashimoto’s thyroiditis?

A

anti-thyroid peroxidase

Pass Med finals pack (40 decks)

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