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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
Replace mineralocorticoids in adrenal insufficiency with..
Fludrocortisone
26
Carcinoid syndrome crisis presentations
``` Profound/paroxysmal flushing Diarrhoea Bronchospasm + wheeze Tachycardia Fluctuating BP ``` Diagnose by 24hr urine collection of 5-HIAA levels
27
Cushing's syndrome Rx
Surgery - remove cause | Medical - inhibit cortisol synthesis with metryapone or ketoconazole. Also treat osteoporosis
28
Dopamine agonists
Bromocriptine | Cabergoline
29
DKA treatment
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
Kallman's syndrome
Rare genetic disease Low GnRH Hypogonadism, infertility, variable pubertal maturation, hypo-anosmia
31
Klinefelter syndrome
Chr disorder 47XXY karyotype Hypogonadism
32
5-a reductase deficiency
Dihydrotestosterone deficiency
33
Nelson's syndrome
Occurs in patients who undergo bilateral adrenalectomies Loss of -ve feedback over time causes pituitary macroadenoma Secretion of ACTH Presents like Addison's
34
Sheehan syndrome
Post-partum hypopituitarism | Agalactorrhoea, amenorrhoea and hypothyroid post-pregnancy
35
How to distinguish between clinical features of acromegaly and hypothyroidism
Acromegaly specific features include increased sweating and coarse facial features
36
Renal tubular acidosis type 1
Inability of kidney to excrete H+ Metabolic acidosis Associated with rickets/ osteomalacia and increased Ca2+ i.e. nephrocalcinosis and recurrent infections
37
Waterhouse-Friderichsen syndrome
Adrenal haemorrhage due to meningococcal infiltration Hypoadrenalism signs Younger patients Fluid overloaded with high BP
38
MEN type 1 | the 3 p's
Mutation in menin gene on Chr11 Pituitary adenomas Parathyroid neoplasia Pancreatic endocrine tumours
39
MEN type 2a
Mutation in RET gene on Chr10 Parathyroid neoplasia Medullary thyroid carcinoma Phaeochromocytoma
40
MEN type 2b
Mutation in RET gene on Chr10 Mucosal neuromas (lips/tongue) Medullary thyroid carcinomas Phaeochromocytoma
41
Primary hyperparathyroidism Rx
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
Indications for parathyroidectomy in hyperPTH
``` Age <50 Bone mineral density <2.5 Calculi Creatine clearance decreased by 30% Difficult to do follow-up often Elevated Ca2+ ```
43
Secondary hyperparathyroidism Rx
Treat the underlying cause/renal failure | Calcium and vit D supplements
44
Myxoedema coma - severe hypothyroidism crisis usually in elderly. Signs + symptoms...
``` Hypothermia Hypoventilation HypoNa+ Heart failure Confusion Coma ```
45
Myoxedema coma Rx
``` Oxygen Rewarming IV fluids to rehydrate IV T3(/T4) IV hydrocortisone if it is secondary hypothyroidism ```
46
Osteopenia defined by T-score between
-1.0 and -2.5 Osteoporosis
47
Phaeochromocytoma rule of 10%...
Bilateral Extra-adrenal (paragangliomas) Malignant
48
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....
Calcium Calcitonin (in reference to parathyroid tumours)
49
Polycystic ovary syndrome (PCOS) criteria for diagnosis | frequently associated with obesity, IR, T2DM, dyslipidaemia
Needs 2 of the following: 1. polycystic ovaries on USS 2. oligo/anovulation 3. clinical/biochemical androgen excess
50
Commonest cause of infertility in women
PCOS | also: menstrual irregularities, uterine bleeding dysfunction, hirsuitism, acne, acanthosis nigricans
51
PCOS hormone levels
High LH (high LH:FSH ratio) High testosterone High androgens Low SHBG
52
SIADH Rx
Treat underlying cause Water restrict (± demeclocyline) V2 receptor antagonists (tolvaptan) Severe cases, give IV hypertonic saline slow infusion
53
Acute hyperthyroid crisis Rx
``` Propylthouracil Propanolol IV hydrocortisone Potassium iodide/Lugol's Rehydrate Control temperature ```
54
Primary hyperthyroidism Rx
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
Hypoglycaemia (BG <3mmol/l) Rx
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
DKA complications
Thromboembolism Cerebral oedema Aspiration pneumonia Low K+, Mg2+, phosphate
57
Main cause of hypoglycaemia in diabetic patients
Sulphonyulreas Insulin (increased activity, missed meal, overdose, insulinoma)
58
Diagnosis of T2DM requires
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
Causes of HHS (due to insulin deficiency)
MI Drugs Intestinal infarct
60
Hypopituitarism affects the hormones in what order
``` GGPTA: GH Gonadotrophins (LH/FSH) Prolactin TSH ACTH ```
61
Which hyperthyroidism causes decreased isotope uptake scan results?
De Quervain's thyroiditis | 20% are malignant
62
Which hyperthyroidism causes increased isotope uptake scan results in a pattern that is: (i) diffuse (ii) multiple hot nodular (iii) single nodular
(i) Grave's disease (ii) toxic multinodular goitre (plummer's) (iii) solitary toxic adenoma
63
First line Rx for toxic multinodular goitre
Radioactive iodine
64
24-h urine collection to measure 5-HIAA levels Blood plasma chromogranin A + B measurements (fasting gut hormones) Are useful in diagnosing which syndrome...?
Carcinoid syndrome
65
What % of MEN1 patients have carcinoid tumours
10%
66
Diabetic patients with signs of impotence, postural hypotension and urinary retention indicate...
autonomic neuropathy
67
HyperCa2+ post-renal transplantation is generally due to
Tertiary hyperparathyroidism
68
Pellagra (nicotinic acid def) may present with symmetrical dermatitis on sun-exposed skin, diarrhoea and depression. Risk factors include
Carcinoid syndrome | Isoniazid (anti-TB) therapy

yr3 (19 decks)

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