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Phase 2a > Endo treatments > Flashcards

Endo treatments Flashcards

1
Q

Type 1 Diabetes Mellitus

Investigations
Treatment

A

Investigations

HbA1C - >48mmol/mol / 6.5%
RPG - >11.1 mmol/L
FPG >7.0
OGTT >11

Treatment
Basal bolus insulin

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2
Q

Diabetic ketoacidosis

Investigations
Treatment

A

Investigations
Serum ketone - Elevated
Capillary blood gas/ABG/VBG - Decreased pH (metabolic acidosis)
RPG >11mmol/L

Treatment
Rehydration with IV fluids (0.9% NaCl) THEN insulin infusion

  • Give potassium to replenish K+ stores (which decrease with insulin infusion)
  • Give dextrose to prevent hypoglycemia
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3
Q

Complications of T1DM

A

Microvascular - Retinopathy (glaucoma), neuropathy (diabetic foot), nephropathy (nephrotic syndrome)

Macrovascular - Myocardial infarction, ischaemic stroke

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4
Q

Type 2 diabetes mellitus

Investigations
Treatment

A

Investigations

HbA1C - >48mmol/mol / 6.5%
RPG - >11.1 mmol/L
FPG >7.0
OGTT >11

Treatment
1st line - Lifestyle modification (diet and exercise)

1st line pharmacological - METFORMIN
Others:
Sulphonylureas - Gliclazide
DPP4 inhibitors - Gliptins e.g. Sitagliptin
SGLT2 inhibitors - Gliflozin e.g. Dapagliflozin

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5
Q

Hyperosmolar hyperglycemic state

Investigations
Treatment

A

INVESTIGATIONS
- Increased serum osmolality
- RPG > 11.1
- Serum ketones will not be elevated (eliminates DKA)

TREATMENT
- Intravenous fluid replacement (saline) FIRST
Followed by intravenous insulin

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6
Q

Hypoglycemia

Investigations
Treatment

A

INVESTIGATIONS
Fingerstick measurement of glucose to confirm diagnosis (<3.9mmol/L)

TREATMENT
IV Dextrose
(If no IV access then IM glucagon)

(Sometimes patient is awake and can swallow, they can treat with 15g fast acting carbohydrates e.g. Sweets, sugary soft drinks, jellies)

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7
Q

Hyperparathyroidism

Investigations
Treatment

A

Investigations
Serum PTH, Serum calcium and Serum phosphate
Primary –> High PTH, High Calcium, low phosphate (Parathyroid pathology) (High ALP)
Secondary –> High PTH, low Calcium, high phosphate (Mostly renal pathology/something causing decreased calcium)
Tertiary –> All high (prolonged secondary and PTH secreted autonomously)

ECG - Shows short QT interval due to hypercalcemia (Primary)

Treatment
Primary –> Parathyroidectomy

Secondary/tertiary –> Treat underlying cause
- Bisphosphonates for bone resorption
- Rehydrate to prevent kidney stones

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8
Q

Hypoparathyroidism

Investigations
Treatment

A

Investigations
Serum PTH, Serum Calcium
- Low PTH, Low Calcium (high phosphate)

ECG - Long QT interval (hypocalcemia)

Treatment
Oral calcium supplements and Vitamin D3

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9
Q

Hypercalcemia

Investigations
Treatment

A

Investigations
Serum calcium - Elevated
ECG - Short QT interval

Treatment
Rehydrate with IV fluids and give IV bisphosphonates

If due to parathyroid adenoma –> Parathyroidectomy

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10
Q

Hypocalcemia

Investigations
Treatment

A

Investigations
Serum calcium - Low
ECG - Long QT interval

Treatment
Oral calcium and vitamin D3 supplements

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11
Q

Prolactinoma

Investigations
Treatment

A

Investigations
FL - Serum prolactin - Elevated
GS - Pituitary MRI - tumour/adenoma

Treatment
1st line - Dopamine agonists - Cabergoline, Bromocriptine

Definite - Transsphenoidal resection of the pituitary tumour

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12
Q

Diabetes insipidus

Investigations
Treatment

A

Investigations
1st line - Water deprivation test (for 8 hours) and desmopressin test
Cranial - Urine osmolality will increase (high after the test)
Nephrogenic - Urine osmolality will stay the same

Urine volume - MORE THAN 3L a day
Serum copeptin (fragment of precursor molecule of ADH) - decreased in Cranial, normal in nephrogenic
Serum osmolality - High
Urine osmolality - Low

Treatment
Ensure adequate water intake,
Cranial - Desmopressin
Nephrogenic - Thiazide diuretics + treat underlying cause

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13
Q

Syndrome of inappropriate anti diuretic hormone

Investigations
Treatment

A

Investigations
Urine osmolality - elevated
Serum sodium - low
(Euvolemic hyponatremia)

Short synacthen test to exclude adrenal insufficiency (another cause of hyponatremia)

Treatment
1st line - Fluid restriction (1L/day)

For chronic cases/doesn’t work –>
- Tolvaptan (Vasopressin antagonist)
- Demeclocycline (tetracycline antibiotic)

(Treat underlying cause e.g. tumour excision)

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14
Q

Acromegaly

Investigations
Treatment

A

Investigations
Serum IGF-1 (insulin like growth factor) –> Elevated

GS - OGTT (a lack of suppressed GH during an OGTT confirms the diagnosis)

Treatment
1st line- Trans-sphenoidal resection of the pituitary tumour

If not cured
Somatostatin analogue - Ocreotide
GH antagonist - Pegvisomant
Dopamine agonist - Cabergoline

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15
Q

Cushing’s syndrome

Investigations
Treatment

A

Investigations
(ensure they are not taking steroids first)
1st line - Serum cortisol

GS - Overnight dexamethasone suppression test
If low dose dexamethasone suppresses cortisol levels - ACTH independent Cushing’s syndrome –> Adrenal cause

If high dose dexamethasone suppresses cortisol - ACTH dependent - Pituitary cause

High dose dexamethasone can suppress cortisol levels in Cushing’s syndrome but not due to adrenal adenoma/ectopic causes)

MRI - pituitary/adrenal adenoma

Treatment
Cushing’s disease - Trans-sphenoidal resection of pituitary adenoma

Adrenal adenoma - Adrenalectomy of affected adrenal gland

Ectopic ACTH - surgical removal

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16
Q

Pheochromocytoma

Investigations
Treatment

A

Investigations

1st line and GS- Serum metanephrine and normetanephrine (metabolites of broken down catecholamines)

CT scan of abdomen and pelvis for tumour
24 hour urinary catecholamines

Treatment
Alpha blocker (phenoxybenzamine) THEN beta blocker (atenolol)

If benign tumour and surgical excision possible –> Excise tumour

17
Q

Complication of pheochromocytoma and what do you use to treat it

A

Hypertensive crisis –> Phentolamine

18
Q

Conn’s syndrome

Investigations
Treatment

A

Investigations
1st line
Aldosterone:Renin ratio
Primary - High
Secondary - lower (both elevated)

GS
Fludrocortisone suppression test - Serum aldosterone that is not suppressed with fludrocortisone (For primary - Conn’s syndrome)

ECG - Hypokalemia - U waves, Inverted/small T waves, Long PR and QT intervals + ST depression

Abdominal CT/MRI to determine Adrenal tumour

Treatment
Primary hyperaldosteronism –> Unilateral Adrenalectomy

Pharmacological –> Oral Spironolactone (Aldosterone antagonist)

19
Q

Adrenal insufficiency

Investigations
Treatment

A

Investigations
1st line and GS - Short synacthen test - test the cortisol producing function of the adrenal glands.

Serology for Anti 21 alpha hydroxylase antibodies (Addison’s disease)

Serum ACTH - elevated in primary, depressed in secondary

Treatment
1st line - Hydrocortisone for glucocorticoid deficiency (cortisol)
Fludrocortisone - for mineralocorticoid deficiency (aldosterone)

ENSURE PATIENTS CARRY A STEROID CARD
Doses are doubled during an acute illness, trauma, night shift work

20
Q

Addisonian crisis

Treatment

A

Treatment
IV hydrocortisone and IV saline

21
Q

Hypokalemia

Investigations
Treatment

A

Investigations
Serum potassium - low

ECG - U wave, Small/inverted T waves, long PR and QT interval, ST depression

Treatment
Oral potassium (Potassium chloride)

Drugs: Spironolactone

22
Q

Hyperkalemia

Investigations
Treatment

A

Investigations
Serum potassium - elevated

ECG - Tall tented T waves, Wide QRS complex, Absent P waves (prolonged PR interval)

Treatment
- Calcium gluconate (Patient with Cardiac issues)

Non urgent - Insulin and dextrose

23
Q

Hyperthyroidism

Investigations
Treatment

A

Investigations
Thyroid function test
Primary - High T3,T4, Low TSH (thyroid pathology)
Secondary - High T3,T4, High TSH (pituitary pathology)

GS - Serology for TSH receptor antibodies

Treatment
1st line - Carbimazole (decreases uptake of T3/T4) – Side effect of sorethroat (agranulocytosis) and also CI in pregnancy –> use PROPYLTHIOURACIL (decreases production of T3/T4)

Last resort - Surgery

24
Q

Hypothyroidism

Investigations
Treatment

A

Investigations
1st line - Thyroid function test
Primary - High TSH, Low T3,T4
Secondary - Low TSH, Low T3,T4

GS - Anti thyroid peroxidase antibodies

Treatment
1st line - Levothyroxine (synthetic T4)

25
Q

Thyroid cancer

A

Investigation
1st line - Fine needle aspiration biopsy

Thyroid ultrasound
TFTs

Treatment
Follicular/papillary –> Thyroidectomy

Anaplastic –> Palliative care

26
Q

Hypopituitarism 1st line treatment

A

First hormone replacement therapy for cortisol as its deficiency can present with addisonian crisis

27
Q

Treatment for neuropathic pain

A

Amitryptiline (TCA)

duloxetine, gabapentin, pregabalin

Phase 2a (29 decks)

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