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yr3 > endo SBAs > Flashcards

endo SBAs Flashcards

1
Q

Target and diagnostic HbA1c levels (3 month Hb plasma glucose average) for DM

A

> 6.5% (48mmol/mol)

There are higher levels in T2DM due to poor control

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2
Q

Conditions associated with cutaneous hyperpigmentation

A

Addison’s disease
Cushing’s syndrome
Nelson’s syndrome
Pregnancy

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3
Q

1st line therapy for pregnant T2DM

A

CCB

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4
Q

Roles of insulin

A

Increases: glycogenesis, glycolysis, glucose uptake into muscle and adipose tissue, protein synthesis, K+ uptake into cells
Decreases: gluconeogenesis, glycogenolysis, lipolysis, ketogenesis, proteolysis

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5
Q

CAH: 21-hydroxylase deficiency

A

Low aldosterone
High androgens

Hypotension, hypoNa+, hyperK+

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6
Q

CAH: 11b-hydroxylase deficiency

A

High 11-deoxycorticosterone
High androgens

Hypertension, hyperK+

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7
Q

CAH: 17a-hydroxylase deficiency

A

High aldosterone
Low androgens

Hypertension, hypoK+

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8
Q

High Ca2+
High PTH
Low phosphate

A

Primary hyperparathyroidism

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9
Q

Low Ca2+
High PTH
High/normal phosphate

A

Secondary hyperparathyroidism

Low plasma Ca2+ e.g. due to renal failure, or secondary to Vit D deficiency where phosphate would also be low.

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10
Q

Hypocalaemia

caused by hypoPTH, vit D def

A 
Convulsions
Arrythmias (prolonged QT interval)
Tetany
Stridor/spasms (hyperreflexia)
Paraesthesia/numbness

Chvostek’s and Trousseau’s sign

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11
Q

Hypercalcaemia

caused by hyperPTH, vit D toxicosis, mets

A

Bones - bone pain
Stones - kidney stones
Groans - constipation
Psychic moans - depression, fatigue, confusion
Other: abdo pain, vomit, polyuria, polydipsia, anorexia, weakness, HTN, renal failure, cardiac arrest.

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12
Q

Thyroid bruit is felt in…

A

hyperthyroisim

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13
Q

Plummer’s disease/toxic multinodular goitre

A

Goitre
Firm thyroid nodules
Overproduction of thyroid hormone
Older patients, unknown cause but usually refractory to anti-thyroid treatment

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14
Q

De Quervian’s thyroiditis/subacute granulomatous thyroiditis

A 
Fever
Pain in neck, jaw or ear
Viral in origin/preceded by URTI
Increased ESR
Females 20-50
Hyperthryoid -> hypothyroid (weeks) -> euthyroid
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15
Q

Grave’s disease

A

Toxic diffuse goitre with audible bruit

Tachycardia, tremor, fatigue, palpitations, exophthalmos, heat intolerance, acropachy, pretibial myxoedema

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16
Q

Thyroid storm/crisis

A

Rapid deterioration in hyperthyroid patients. They are often stimulated by stressors e.g. infection. Patients present with acute onset of severe tachycardia, distress + hyperpyrexia

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17
Q

Causes of metabolic acidosis with high anion gap

A

Lactate
Toxins (paracetamol, iron, metformin, ethanol)
Ketones (DKA)
Renal failure (uraemia)

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18
Q

Impaired fasting glucose tolerance values

A

6-7.0

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19
Q

Impaired glucose tolerance values

A

2 hours post glucose: 7.8-11.1

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20
Q

Carcinoid tumours commonly occur in appendix, ileum or rectum. Can result in carcinoid syndrome which is…

A

….carcinoid tumours with liver metastases.

Usually present with spontaneous facial flushing, abdominal pain, and watery diarrhoea. 50% develop cardiac abnormalities e.g. tricuspid regurg or pulmonary stenosis

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21
Q

Hyperosmolar Hyperglycemic State (HHS) in T2DM Rx

A

Correct dehydration (IV 0.9% saline slowly)
Correct hyperglycaemia (IV insulin)
Heparin (HIGH RISK OF THROMBUS. This is not prophylactic anti-coagulation.)
Replace K+

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22
Q

Acromegaly (excess GH) investigations

A
  • Oral glucose tolerance test (suppresses GH normally)

- IGF-1 levels

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23
Q

Acromegaly Rx

A

Surgical - remove tumour

Medical - SS analogues (octreotide), DA agonists (bromocriptine and cabergoline), GH antagonist (pegvisomant)

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24
Q

Addisonian crisis (hypotensive, tachycardia, pale, cold, clammy, oliguria) Rx

A

Rapid IV fluid rehydration
50% dextrose to correct hypoglycaemia
IV hydrocortisone (±fludrocortisone if adrenal problem)

Chronic: hydrocortisone to replace glucocorticoids. Increase in periods of stress

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25
Q

Replace mineralocorticoids in adrenal insufficiency with..

A

Fludrocortisone

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26
Q

Carcinoid syndrome crisis presentations

A 
Profound/paroxysmal flushing
Diarrhoea
Bronchospasm + wheeze
Tachycardia
Fluctuating BP

Diagnose by 24hr urine collection of 5-HIAA levels

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27
Q

Cushing’s syndrome Rx

A

Surgery - remove cause

Medical - inhibit cortisol synthesis with metryapone or ketoconazole. Also treat osteoporosis

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28
Q

Dopamine agonists

A

Bromocriptine

Cabergoline

29
Q

DKA treatment

A

IV 0.9% saline fluids
IV insulin continuous infusion (-> then sliding scale)
IV dextrose (replace K+)

Monitor BG, ketones, urine output
Antibiotics
Prophylactic anti-coagulant (heparin)

30
Q

Kallman’s syndrome

A

Rare genetic disease
Low GnRH
Hypogonadism, infertility, variable pubertal maturation, hypo-anosmia

31
Q

Klinefelter syndrome

A

Chr disorder
47XXY karyotype
Hypogonadism

32
Q

5-a reductase deficiency

A

Dihydrotestosterone deficiency

33
Q

Nelson’s syndrome

A

Occurs in patients who undergo bilateral adrenalectomies
Loss of -ve feedback over time causes pituitary macroadenoma
Secretion of ACTH
Presents like Addison’s

34
Q

Sheehan syndrome

A

Post-partum hypopituitarism

Agalactorrhoea, amenorrhoea and hypothyroid post-pregnancy

35
Q

How to distinguish between clinical features of acromegaly and hypothyroidism

A

Acromegaly specific features include increased sweating and coarse facial features

36
Q

Renal tubular acidosis type 1

A

Inability of kidney to excrete H+
Metabolic acidosis
Associated with rickets/ osteomalacia and increased Ca2+ i.e. nephrocalcinosis and recurrent infections

37
Q

Waterhouse-Friderichsen syndrome

A

Adrenal haemorrhage due to meningococcal infiltration
Hypoadrenalism signs
Younger patients
Fluid overloaded with high BP

38
Q

MEN type 1

the 3 p’s

A

Mutation in menin gene on Chr11

Pituitary adenomas
Parathyroid neoplasia
Pancreatic endocrine tumours

39
Q

MEN type 2a

A

Mutation in RET gene on Chr10

Parathyroid neoplasia
Medullary thyroid carcinoma
Phaeochromocytoma

40
Q

MEN type 2b

A

Mutation in RET gene on Chr10

Mucosal neuromas (lips/tongue)
Medullary thyroid carcinomas
Phaeochromocytoma

41
Q

Primary hyperparathyroidism Rx

A

Acute: IV fluids
Conservative: avoid hyperCa2+ e.g. stop thiazide diuretics. Ensure normal Ca2+ and vit D intake
Surgical: subtotal or total parathyroidectomy (total in MEN1/2a)

42
Q

Indications for parathyroidectomy in hyperPTH

A 
Age <50
Bone mineral density <2.5
Calculi
Creatine clearance decreased by 30%
Difficult to do follow-up often
Elevated Ca2+
43
Q

Secondary hyperparathyroidism Rx

A

Treat the underlying cause/renal failure

Calcium and vit D supplements

44
Q

Myxoedema coma - severe hypothyroidism crisis usually in elderly. Signs + symptoms…

A 
Hypothermia
Hypoventilation
HypoNa+
Heart failure
Confusion
Coma
45
Q

Myoxedema coma Rx

A 
Oxygen
Rewarming
IV fluids to rehydrate
IV T3(/T4)
IV hydrocortisone if it is secondary hypothyroidism
46
Q

Osteopenia defined by T-score between

A

-1.0 and -2.5

Osteoporosis

47
Q

Phaeochromocytoma rule of 10%…

A

Bilateral
Extra-adrenal (paragangliomas)
Malignant

48
Q

MEN type 2 is associated with phaeochromocytomas. Hence when phaeos are diagnosed, it is also important to consider associated MEN type 2 conditions and measure levels of….

A

Calcium
Calcitonin

(in reference to parathyroid tumours)

49
Q

Polycystic ovary syndrome (PCOS) criteria for diagnosis

frequently associated with obesity, IR, T2DM, dyslipidaemia

A

Needs 2 of the following:

  1. polycystic ovaries on USS
  2. oligo/anovulation
  3. clinical/biochemical androgen excess
50
Q

Commonest cause of infertility in women

A

PCOS

also: menstrual irregularities, uterine bleeding dysfunction, hirsuitism, acne, acanthosis nigricans

51
Q

PCOS hormone levels

A

High LH (high LH:FSH ratio)
High testosterone
High androgens
Low SHBG

52
Q

SIADH Rx

A

Treat underlying cause
Water restrict (± demeclocyline)
V2 receptor antagonists (tolvaptan)
Severe cases, give IV hypertonic saline slow infusion

53
Q

Acute hyperthyroid crisis Rx

A 
Propylthouracil
Propanolol
IV hydrocortisone
Potassium iodide/Lugol's
Rehydrate
Control temperature
54
Q

Primary hyperthyroidism Rx

A

Medical: ATDs e.g. carbimazole and propylthouracil, B-blockers e.g. propanolol
Radioactive iodine: avoid pregnancy for 4 months, pregnant women and children for 2weeks
Surgery: for large goitres etc
Opthalmopathy: corneal protection

55
Q

Hypoglycaemia (BG <3mmol/l) Rx

A

If low consciousness - IV 50% glucose or IM glucagon
If conscious - oral glucose e.g. lucozade, dextrose tablets, followed by starchy snack
Should not drive for 45mins

56
Q

DKA complications

A

Thromboembolism
Cerebral oedema
Aspiration pneumonia
Low K+, Mg2+, phosphate

57
Q

Main cause of hypoglycaemia in diabetic patients

A

Sulphonyulreas
Insulin
(increased activity, missed meal, overdose, insulinoma)

58
Q

Diagnosis of T2DM requires

A
  1. Symptomatic + 1 raised BG (fasted/random)
  2. 2 raised BG readings or OGTT 2h >11.1 if borderline
  3. 2 raised HbA1c readings
  4. 1 raised HbA1c + elevated plasma glucose
59
Q

Causes of HHS (due to insulin deficiency)

A

MI
Drugs
Intestinal infarct

60
Q

Hypopituitarism affects the hormones in what order

A 
GGPTA:
GH
Gonadotrophins (LH/FSH)
Prolactin
TSH
ACTH
61
Q

Which hyperthyroidism causes decreased isotope uptake scan results?

A

De Quervain’s thyroiditis

20% are malignant

62
Q

Which hyperthyroidism causes increased isotope uptake scan results in a pattern that is:

(i) diffuse
(ii) multiple hot nodular
(iii) single nodular

A

(i) Grave’s disease
(ii) toxic multinodular goitre (plummer’s)
(iii) solitary toxic adenoma

63
Q

First line Rx for toxic multinodular goitre

A

Radioactive iodine

64
Q

24-h urine collection to measure 5-HIAA levels
Blood plasma chromogranin A + B measurements (fasting gut hormones)
Are useful in diagnosing which syndrome…?

A

Carcinoid syndrome

65
Q

What % of MEN1 patients have carcinoid tumours

A

10%

66
Q

Diabetic patients with signs of impotence, postural hypotension and urinary retention indicate…

A

autonomic neuropathy

67
Q

HyperCa2+ post-renal transplantation is generally due to

A

Tertiary hyperparathyroidism

68
Q

Pellagra (nicotinic acid def) may present with symmetrical dermatitis on sun-exposed skin, diarrhoea and depression. Risk factors include

A

Carcinoid syndrome

Isoniazid (anti-TB) therapy

yr3 (19 decks)

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