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3B + Finals > Endocrine > Flashcards

Endocrine Flashcards

1
Q

causes of primary hyperaldosteronism

A

Adrenal adenoma
bilateral adrenal hyperplasia
familial hyperaldosteronism

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2
Q

inx for hyperaldosteronism

A

renin : aldosterone serum ratio

Both raised = secondary
Renin suppressed = primary

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3
Q

mx of hyperaldosteronism

A

aldosterone antagonist Spironolactone

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4
Q

Non-pituitary cause of acromegaly

A

GHRH secreting carcinoid tumour of pancreas or lung

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5
Q

signs/symptoms of acromegaly

A 
skin tags
big hangs, jaw, forehead and nose
L labido 
cardiac hypertrophy, raised BP
Arthralgia, back pain 
DM/glucose intolerance
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6
Q

Inx of acromegaly

A

MRI brain
glucose tolerance test - first line
serum GH

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7
Q

Patient presents with headache + nausea. Large nose and forehead and hypertension.

1) Diagnosis
2) Hormone involved
3) Initial blood tests (2). And diagnostic test
3) Potential visual feild defect
4) Sugical management
5) Medical management and MOA (2 different drugs)

A

1) Acromegaly
2) GH
3) Serum GH levels. Then glucose tolerance test. MRI brain (pituitary adenoma)
3) Bitemporal hemianopia
4) Trans sphenoidal removal of tumour
5) Somatostatin analogue (octreotide) or dopamine agonist (bromocistine). Somatostatin and dopamine both inhibit GH release.

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8
Q

Causes of secondary adrenal insufficiency

A

Low ACTH
Surgical damage
Sheehan’s syndrome (blood loss, during birth = pituitary necrosis)

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9
Q

Cause of primary adrenal insufficiency

A

Autoimmune

21-hydroxylase antibodies

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10
Q

Symptoms of Addison’s disease

A

Low Na –> abdo pain, cramps, nausea/vom
High K+ and high H+ –> metabolic acidosis
Hypovolume –> Postural hypotension

Hyperpigmentation

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11
Q

Symptoms of addisons that only affect women

A

Low androgens
Decreased sex drive
Decreased armpit and leg hair

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12
Q

Patient has hx of feeling tired, nausea/vom. and postural hypotension

1) Diagnosis
2) Cause of nausea and vomiting
3) Other electrolyte imbalance
4) Autoimmune abd
4) Gold standard inx.
5) Management

A

1) Addisons/adrenal insufficiency
2) Low Na
3) Low K+ , High H+. Metabolic acidosis
4) 21-hydroxylase antibodies
4) Short synacthen test
5) Hydrocortisone, fludrocortisone

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13
Q

Mx of Addison’s disease

A

15-25mg of hydrocortisone

50-200mcg of fludrocortisone

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14
Q

Management of addison ian crisis

A

A - should be patent, maintain
B - May be hypocapnic if acidotic. ABG.
C - BP support, 500mL of saline.
K+, do ECG. Give calcium glucoante 30mg 10% IV if needed.
D - glucose. Low cortisol could cause hypo. Give hydrocortisone 100mg IV stat
E - urine output, insert catheter if necessary. If course not clear check (pneumonia) other infection (rash)

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15
Q

How to manage Addisons patient in acute illness/operation

A

double dose of steroids.

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16
Q

Key symptoms of cushings

A 
moon face
buffalo hump 
abdominal striae 
Fat belly, skinny arms. Muscle wasting 
hypertension, cardiac hypertrophy 
depression
insomnia 
osteoporosis 
Diabetes
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17
Q

causes of cushings

A

Ectophic acth - Small cell lung carcinoma

pituitary ademona

18
Q

cushings inx

A

low dose dexamethasone suppression test, then high dose (8mg)

19
Q

1) What are the 3 common diseases that make up MEN-1

2) What are the corresponding symptoms

A

Parathyroid hyperplasia - Hypercalcaemia
Pancreatic Tumours - Insulinomas cause hypoglycaemia. Gastrinomas cause recurrent ulcers and dyspepsia.
Pituitary adenoma - Acromegaly, hyperprolactinaemia, Cushings

20
Q

Name the skin lesion associated with MEN-1.

Name the neurological condition also associated with this

A

Angiofibroma.

Tubulosclerosis

21
Q

Patient presents with recurrent peptic ulcers. Routine blood show hypercalcaemia

1) Name of syndrome (of ulcers) and genetic disease.
2) 3 possible investigations that could be done
3) Other symptoms you may expect. And other affected organs.

A

1) Zollinger-Ellison syndrome; MEN-1
2) PTH, serum calcium. Serum Prolactin. Serum GH. Serum cortisol.
3) Pituitary, pancreas, parathyroid.

Symptoms:
Boney pain, renal stones, abdominal pain. Psychosis.
Hypoglycaemia (fatigue, Low GCS, seizures)
Recurrent peptic ulcers - dyspepsia
Tunnel vision. Headaches (morning). N/V.
Large forehead. Spade hands.
Titties
All the symptoms that come with cushings.

22
Q

Patient presents with tachycardia, headache, tremors and D/V.

1) Likely diagnosis, possible related genetic condition
2) Other symptoms you might expect.
3) Cancer of what cells?
4) Investigations
5) Management (2 steps please chum)
6) Distribution of these tumours

A

1) Phaechomocytoma. MEN-2
2) Arrhythmias. AF. VT. Visual disturbance. Anxiety. Hyperactive. Confusion. Sweats and flushing
3) Sympathetic paraganglion cells
4) 24hr Catecholamines. Serum Free Metanephrines
5) Alpha blockade (phenoxybenzamine). Then B block if needed.
5) 10% Extra-adrenal. 10% bilateral. 10% Malignant. 10% Familial.

23
Q

1) Signs specific to Graves disease

2) Blood test definitive for graves disease.

A

1) Pretibial myxoedema. Exophthalmos. Ophthalmoplegia.

2) TSH receptor antibodies.

24
Q

Patient presents with secondary amenorrhoea. Morning headaches.

1) Likely diagnosis
2) Visual disturbance expected.
3) Management

A

1) Prolactinoma - pituitary adenoma
2) Bitemporal hemianopia
3) Dopamine agonists if tumour doesn’t require surgery. Bromocriptine or carbogaline

25
Q

You are bleeped to see a patient being treated for pneumonia. They are agitated, confused, they have a new AF. They have a pmh of graves disease

1) Likely diagnosis
2) Initial assessment and inx.
3) Management

A

1) Thyroid storm/thyrotoxic crisis
2) A-E assessment. TSH and free T4. FBC, U/E. Septic screen (sepsis likely cause of storm)
3) Treat infection (escalate abx) and give antipyretics. Propranolol 1mg IV over 10min for heart. Carbimazole 15-25mg/6h. Lugols solution (0.3mL/8hr) to block thyroid.
Hydrocortisone 100mcg or dex 2mg over 6 hours to prevent t4 to t3 conversion.

26
Q

Which hypoglycaemic medication is contraindicated in heart failure and why

A

Pioglitazone - causes fluid retention

27
Q

Which hypoglycaemic medication increases risk of UTIs

A

SGLT-2 transporter inhibitors

28
Q

What is seen on an FBC in cushings

A

Raised WCC

29
Q

Stepwise inx for cushings (3)

A

1) 24hr urine cortisol or serum cortisol
2) Low dose dex suppression test (1mg given at 11pm)
3) High dose dex (8mg) suppression test. (if caused by pituitary adenoma should be some negative feedback)

30
Q

Patient being treated for meningococcal sepsis has a blood result showing hyponatraemia and hyperkalaemia.

1) Likely cause of this
2) Pathophysiology

A

1) Waterhous-Friderichsen syndrom

2) bilateral haemorrhage of the adrenal gland due to meningococcal sepsis -> Addisons

31
Q

4 ECG signs of hyperkalaemia

A

Tall/peaked T waves
Flattened p waves
Broad QRS complexes
>PR interval/conduction blocks

32
Q

4 ECG signs of hypokalaemia

A

T wave inversion
U waves
ST depression
narrow QRS

33
Q

Most common cause worldwide of addisons disease

A

TB

TB infective adrenalitis

34
Q

Management of addisonian crisis

1) 3 possible causes
2) Drug and dose
3) Fluid management
4) Management of hypoglycaemia and hyperkalaemia

A

1) Post op, infection, forgot to give steroids,
2) Hydrocortisone 100mg IV
3) 500mL stat
4) Monitor glucose - give IV dextrose if need.
DO NOT give insulin for hyperkalaemia as will worsen hypos. Give IV calcium gluconate 30mg.

35
Q

Patient repeatedly attends GP with drug resistant hypertension.

1) Most common cause of secondary hypertension and pathology.
2) gold standard Investigation and results on U/Es
3) Management

A

1) hyperaldosteronism (conns). Renal artery stenosis means kidney BP < systemic BP.
2) Renin:Aldosterone ratio. Hypernatraemia and hypokalaemia
3) PC renal artery stenting

36
Q

1) Action of ADH
2) Cause of SIADH (3)
3) Drug causes of SIADH
4) Presentation
5) Management
6) Complication of SIADH

A

1) Increase aquaporin channels in distal tubule. Increases water retention
2) Stroke/SAH. Trauma. Psychosis
3) Carbamazepine, cyclophosphamide, SSRIs, MDMA.
4) Low GCS. confusion. myoclonus. lethargy
5) Desmopressin analogue. Tolvaptan
6) Central pontine myelinosis

37
Q

Cause of nephrogenic diabetes insipidus

A

AVPR2 gene malfunction. Not able to response to serum ADH.

38
Q

Gold standard inx for diabetes insipidus

A

Water deprivation test

39
Q

Drug causes of gynaecomastia (at least 6/8)

A 
Anabolic steroids 
Anti-psychotics 
Digoxin 
Spironolactone 
Goserelin 
Opiates 
Cannabis 
Alcohol
40
Q

Management of Phaeochromacytoma (in order)

A

1) Alpha blockade, phenoxybenzamine
2) Beta blockade once alpha blocked
Calcium channel blockers are alt to Alpha
Metyrosine - inhibits catecholamine production

41
Q

Management of hypercalcaemia

A

IV fluid rehydration

3B + Finals (15 decks)

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