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Year 3 MedEd > Endo1 > Flashcards

Endo1 Flashcards

Diabetes

1
Q

What is diabetes insipidus?

A

Inadequate secretion or insensitivity to vasopressin, causing hypotonic polyuria

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2
Q

What is the vasopressin pathway?

A

ADH is created in the hypothalamus
ADH is secreted in the posterior pituitary
ADH binds to the kidney and increases water reabsorption
Urine osmolality is raised
Serum osmolality is decreased

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3
Q

What are the two types of diabetes insipidus?

A

Cranial

Nephrogenic

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4
Q

What are the causes of cranial DI?

A

Posterior pituitary fails to secrete ADH

Due to: pituitary tumour, infection, sarcoidosis

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5
Q

What are the causes of nephrogenic DI?

A

Collecting ducts insensitive to ADH

High Ca, low K, lithium, inherited (AVPV2 gene), idiopathic

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6
Q

What is the presentation of DI?

A

Polyuria
Nocturia
Polydipsia
Lethargy/irritability/confusion (high Na)

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7
Q

What are the investigations for DI?

A

U+E
Glucose
Water deprivation test

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8
Q

What happens during water deprivation of a normal Pt?

A

Urine becomes concentrated

osm >600

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9
Q

What happens during water deprivation of a Pt with cranial DI?

A

Kidneys are unable to concentrate the urine

osm <400

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10
Q

What happens during water deprivation of a Pt with nephrogenic DI?

A

Kidneys are unable to concentrate the urine

osm <400

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11
Q

What do you give a Pt for the second part of the water deprivation test?

A

Desmopressin

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12
Q

What happens when you give desmopressin to a Pt with cranial DI?

A

Urine osm raises by >50% after desmopressin

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13
Q

What happens during water deprivation of a Pt with nephrogenic DI?

A

Urine osm raises by <45% after desmopressin

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14
Q

What is the management for DI?

A

Treat the cause eg.
Cranial- intranasal desmopressin
Nephrogenic- thiazide diuretic or NSAIDs

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15
Q

What is T1DM?

A

Hyperglycaemia due to a deficiency of insulin production (90% autoimmune destruction of B cells)

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16
Q

What is T2DM?

A

Hyperglycaemia due to a resistance to insulin action

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17
Q

What is the presentation of T1DM?

A

Polydipsia
Polyuria
Tired/weight loss
DKA

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18
Q

What are the clinical features of a DKA?

A

N+V
Kussmaul breathing
Ketone breath
Abdo pain

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19
Q

What is the presentation of T2DM?

A

Polydipsia

Polyuria

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20
Q

What are the risk factors for T1DM?

A

HLD DR3/4

Other autoimmune conditions

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21
Q

What are the risk factors for T2DM?

A 
Obesity
FHx
Ethnicity
Endocrine
Drugs
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22
Q

How is diabetes mellitus diagnosed?

A

Blood glucose measurement
Fasting >= 7.0mmol/L
Random > 11.1mmol.L

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23
Q

What is the management for T1DM?

A

Insulin

Patient education

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24
Q

What is the management for DKA?

A

Fluids

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25
Q

What is the management for T2DM?

A

Diet and lifestyle

Metformin/sulphonylurea/insulin

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26
Q

How can you categorise hyponatraemia?

A

Hypovolaemia
Euvolaemia
Hypervolaemia

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27
Q

What are the causes of hypovolaemic hyponatraemia?

A

Diarrhoea
Vomiting
Diuretics

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28
Q

What are the causes of euvolaemic hyponatraemia?

A

Hypothyroidism
Hypoadrenalism
SIADH (pneumonia, cancer)

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29
Q

What are the causes of hypervolaemic hyponatraemia?

A

HF
Cirrhosis
Nephrotic syndrome

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30
Q

What are the signs of hypovolaemic hyponatraemia?

A

Reduced turgor
Postural hypotension
Dry mucous membranes

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31
Q

What are the signs of hypervolaemic hyponatraemia?

A

Oedematous

High JVP

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32
Q

What are the investigations for hypovolaemic hyponatraemia?

A

Urine sample

-low Na as body tried to retain Na due to hypovolaemia

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33
Q

What are the investigations for euvolaemic hyponatraemia?

A

TFTs
synACTHen test
Drug review, breast exam, CXR, brain MRI

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34
Q

What should you do if a Pt is severely hyponatraemic?

A

Give slow hypertonic saline

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35
Q

What should you be careful for when giving a Pt hypertonic saline and why?

A

Do not exceed 10mmol/L in the first 24h

Risk of central pontine myelinosis

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36
Q

What are the complications of hyponatraemia?

A

Seizures

Decreased consciousness

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37
Q

What are the causes of hypernatraemia?

A 
Vomiting
Diarrhoea
Burns
Diabetes insipidus
Primary aldosteronism
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38
Q

What is the presentation of hypernatraemia?

A 
Lethargy
Irritability
Thirst
Signs of dehydration
Confusion
Coma
Fits
39
Q

What is the management for hypernatraemia?

A

Replace the water

40
Q

What is SIADH?

A

Too much ADH, causing too much water reabsorption
Low serum Na, high urine osm, high urine Na

NB: SIADH is not a final diagnosis

41
Q

What are the causes of SIADH?

A

CNS pathology
Lung pathology
SSRI, TCA, opiates, PPIs, carbamazepine
Tumours (eg. breast cancer)

42
Q

What is the management for SIADH?

A

Treat the underlying cause
Fluid restrict to 0.5-1L
If ineffective, give demeclocycline/tolvaptan

43
Q

What is the prolactin axis/pathway?

A

Hypothalamus -> TRH -> anterior pituitary
Anterior pituitary -> prolactin -> hypothalamus
Hypothalamus -> dopamine -> inhibits anterior pituitary

44
Q

What are the causes of hyperprolactinaemia?

A

Pituitary prolactinoma
Hypothyroidism
Metoclopramide/antipsychotics
Pregnancy, breast feeding

45
Q

What are the clinical features of female hyperprolactinaemia?

A

Galactorrhoea, amenorrhoea, infertility, loss of libido

Headache, visual field loss

46
Q

What are the clinical features of female hyperprolactinaemia?

A

Loss of libido, infertility

Headache, visual field loss

47
Q

What are the investigations for hyperprolactinaemia?

A

Prolactin
TFTs
Pituitary MRI

48
Q

What is the management for hyperprolactinaemia?

A 
DA agonist (bromocriptine/cabergoline)
Surgery
49
Q

What is the thyroid axis/pathway?

A

Hypothalamus -> TRH -> anterior pituitary
Anterior pituitary -> TSH -> thyroid gland
Thyroid gland -> hormones -/> HP/AP

50
Q

What is hyperthyroidism?

A

Excess circulating T4/3 due to:

  1. increased hormone synthesis (hyperthyroidism)
  2. increased release of stored hormones (thyroiditis)
51
Q

What are the signs and symptoms of hyperthyroidism?

A 
Heat intolerance/sweating
Palpitations, irregular pulse
Irritable
Weight loss, good appetite
Diarrhoea
Menstrual irregularity/impotence
Tremor
52
Q

What are the signs and symptoms of hypothyroidism?

A 
Cold intolerance
Bradycardia
Lethary
Weight gain
Constipation
Menstrual irregularity
Dry skin/cold hands
53
Q

What are the types of hyperthyroidism?

A

Grave’s disease (80%)
De Quervain’s thyroiditis
Toxic multinodular goitre
Adenoma

54
Q

What is Grave’s disease?

A

Antibodies to TSH receptors

55
Q

What is Grave’s triad?

A

Exophthalmos
Pretibial myxoedema
Thyroid acropachy

56
Q

What is De Quervain’s thyroiditis?

A

Post-viral inflammation
High ESR
Causes painful goitre
Self limiting, treated with NSAIDs

57
Q

What is a toxic multinodular goitre?

A

Goitre seen in the elderly/iodine deficient areas

58
Q

What is a thyroid adenoma?

A

Solitary nodule secreting T3/4

59
Q

What will you see on a radioisotope scan of Grave’s disease?

A

Diffuse increased uptake

60
Q

What will you see on a radioisotope scan of De Quervain’s thyroiditis?

A

No uptake

61
Q

What will you see on a radioisotope scan of a toxic multinodular goitre?

A

Multiple areas of increased uptake

62
Q

What will you see on a radioisotope scan of a thyroid adenoma?

A

Single area of increased uptake

63
Q

What are the causes of hypothyroidism?

A 
Autoimmune Hasimoto's thyroiditis
Iodine deficiency
Iatrogenic (post-surgery, radioiodine, amiodarone)
De Quervain's thyroiditis
Congenital thyroid dysgenesis
64
Q

What is the commonest cause of hypothyroidism in the West?

A

Autoimmune Hasimoto’s thyroiditis

65
Q

What is the commonest cause of hypothyroidism in the worldwide?

A

Iodine deficiency

66
Q

What is the management for hypothyroidism?

A

Levothyroxine 25-200 micrograms/day

67
Q

What is a myxoedema coma?

A

Severe hypothyroid state, usually seen in the elderly

68
Q

What is the presentation of a myxoedema coma?

A 
Hypothermia
Hypoventilation
Hyponatraemia
Heart failure
Confusion
Coma
69
Q

What is the treatment for a myxoedema coma?

A 
Oxygen
Rewarm
Rehydrate
IV T3/4
IV hydrocortisone
70
Q

What are the types of thyroid cancer?

A 
Papillary
Follicular
Medullary
Lymphoma
Anaplastic
71
Q

What are the characteristics of a papillary thyroid cancer?

A

Most common
Affects younger Pts
Radiation exposure is a great risk factor
Psammoma bodies and Orphan Anne nuclei seen on microscopy

72
Q

What are the characteristics of a follicular thyroid cancer?

A

Affcts middle aged women

Hurthle cells seen on microscopy

73
Q

What are the characteristics of a medullary thyroid cancer?

A

Association with MEN2

74
Q

What are the characteristics of a thyroid lymphoma?

A

Most common in females

Usually occurs after pre-existing Hashimoto’s

75
Q

What are the characteristics of a anaplastic thyroid cancer?

A

Seen in elderly females

Giant cells and pleomorphic hyerchromatic nuclei on microscopy

76
Q

What is acromegaly?

A

Hypersecretion of growth hormone in adults, usually a pituitary adenoma
GH stimulates IGF-1 causing the growth of bone and soft tissue

77
Q

What is gigantism?

A

Hypersecretion of growth hormone in children

78
Q

What is the presentation of acromegaly?

A 
Ring and shoes become tight
Increased sweating
Coarse facial features
Sleep apnoea
Weight gain
Headaches/visual disturbance
Carpal tunnel syndrome
Hypertension
Insulin resistance
79
Q

What are the investigations for acromegaly?

A

Serum IGF-1
OGTT -> failed GH supression
Pituitary MRI

80
Q

What is the treatment for acromeglay?

A

Transphenoidal hypophysectomy

Octreotide (somatostatin analogue)

81
Q

What is multiple endocrine neoplasia?

A

An autosomal dominant condition with hormone-producing tumours in multiple organs

82
Q

What is MEN1?

PPP

A

Mutation in menin gene Chr 11
Parathyroid adenoma/hyperplasia: hyperparathyroidism, high Ca
Pancreas: insulinoma, gastrinoma
Pituitary: prolactinoma, acromegaly, adrenal, carcinoid tumours

83
Q

What is MEN2A?

TAP

A

Thyroid: medullary thyroid cancer (in ALL)
Adrenal: phaeocytochroma
Parathyroid hyperplasia

84
Q

What is MEN2B?

A

Medullary thyroid carcinoma and phaeo
+mucosal neuroma: bumps on lips/cheeks/tongue/eyelids
+Marfanoid appearance
No hyperparathyroidism

85
Q

What is carcinoid syndrome?

A

Multiple symptoms from a systemic release of humoral factors from carcinoid tumours
They can produce serotonin, histamine, tachykinin, prostaglandin

86
Q

What are the common sites of carcinoid tumours?

A

Appendix

Rectum

87
Q

What is the presentation for carcinoid syndrome?

A 
Paroxysmal flushing
Diarrhoea
Crampy abdo pain
Wheeze
Sweating
Palpitations
88
Q

What are the investigations for carcinoid syndrome?

A

24h urine collection- raised 5-HIAA levels (serotonin metabolite)
CT/MRI- localise tumour

89
Q

A 49 year-old man presents with a history of difficulty sleeping. He reports feeling increasingly tired and general weakness which he attributes to his poor sleep pattern. Additionally, the patient has noticed he has gained weight and sweats more easily. On examination, the patient has coarse facial features. What is the most likely diagnosis?

A. Hyperthyroidism 
B. Cushing’s disease
C. Acromegaly 
D. Hypothyroidism
E. Diabetes
A

C. Acromegaly

90
Q

A 50 year old Asian man is referred to diabetes clinic after presenting with polyuria and polydipsia. He has a BMI of 30, a blood pressure measurement of 137/88 and a fasting plasma glucose of 7.7mmol/L. The most appropriate first-line treatment is:

A. Dietary advice and exercise 
B. Sulphonylurea 
C. Exenatide 
D. Thiazolidinediones 
E. Metformin
A

A. Dietary advice and exercise

91
Q

A 15 year old girl complains of headaches which started 6 weeks ago. The headaches initially occurred 1-2 times a week but now occur up to five times a week, they are not associated with any neurological problems, visual disturbances, nausea or vomiting. The girls also reports a white discharge from both of her nipples. She has not started menstruating. The most appropriate investigation is:

A. Lateral skull X ray 
B. CT scan
C. MRI scan
D. Thyroid function tests
E. Serum prolactin measurement
A

E. Serum prolactin measurement

92
Q

A 6 year old girl presents to A&E with severe abdominal pain, nausea and vomiting. On examination, the patient is tachypnoeic, capillary refill is 3 seconds and she has a dry tongue. While listening to the patient’s lungs you detect a sweet odour from her breath. The most likely diagnosis is:

A. Diabetic ketoacidosis 
B. Non-ketotic hyperosmolar state
C. Gastroenteritis
D. Pancreatitis
E. Adrenal crisis
A

A. Diabetic ketoacidosis

93
Q

A 58 year old woman presents with an acutely painful neck, the patient has a fever, blood pressure is 135/85, and heart rate is 102 bpm. The patient explains the pain started 2 weeks ago and has gradually become worse. She also experiences palpitations and believes she has lost weight. She presents one week later complaining of intolerance to cold temperatures. What would you see if you performed a radioisotope scan on her?

A. Single area of increased uptake 
B. Multiple areas of increased uptake 
C. Diffuse increased uptake 
D. No uptake 
E. She does not need a radioisotope scan
A

D. No uptake

94
Q

A 72 year old man is brought to A&E because his carer noticed that recently he has become increasingly lethargic, irritable and confused. On examination he has a raised JVP and bibasal crackles. He suffered from a myocardial infarction 3 years ago.
Blood results are as follows:
Na 125 mmol/L
Urea 3
K 4 mmol/L
Glucose (fasting) 6 mmol/L
What is the most likely cause of his hyponatraemia:

A. SIADH
B. Hypothyroidism 
C. Nephrotic syndrome 
D. Heart failure 
E. Diabetes
A

D. Heart failure

Year 3 MedEd (29 decks)

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