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MRCPI 2 Adult Med > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the relevance of oestrogen therapy when assessing thyroid fxn?

A

Oestrogen causes raised thyroxine binding globulin in the serum –> total serum thyroxine may be misleading
In that situation measure serum free thyroxine

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2
Q

Unifying diagnosis for a pt presenting with DM, deranged LFTs and hypogonadotropic hypogonadism? Initial screening test?

A

Haemochromotosis

Genetic analysis for C282Y and H63D mutations (will pick up 90% of cases in Europeans) or Serum ferritin

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3
Q

10% of patients with PCOS will also have increased prolactin. What is mechanism of this?

A

Unknown

Note: does not suppress oestradiol and LH/FSH like a prolactinoma. PCOS increased LH and normal/low FSH

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4
Q

FSH/LH findings in PCOS

A

PCOS increased LH and normal/low FSH

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5
Q

Treatment of familial hypocalciuric hypercalcaemia

A

None needed

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6
Q

In managing DM what is the pre breakfast glucose goal?

A

4-7

Note: if need to increase insulin generally it is increased in 10% increments

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7
Q

In a patient with congenital adrenal hyperplasia who requires stress dosing of there steroids the glucocorticoid is increased but the mineralocorticoid is not T/F

A

T

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8
Q

Stoping amiodarone is the management for amiodarone induced thyrotoxicosis T/F

A

F - stop amiodarone (if possible) and treat with steroids

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9
Q

What type of vision loss with craniopharygioma

A

inferior bitemporal hemianopia

Note: pit tumor typically causes superior bitemporal hemianopia

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10
Q

If free T4 and T3 are high, but TSH is normal or high, what is the next step in investigation

A

Pituitary MRI

Note: to look for a pituitary mass (TSH-secreting adenoma)

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11
Q

What is Nelson’s syndrome

A

Enlargement of an ACTH-producing tumour in the pituitary gland, following surgical removal of both adrenal glands in a patient with Cushing’s disease.

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12
Q

What testosterone and FSH/LH pattern would be expected in a male with primary vs secondary hypogonadism

A

In both decreased testosterone and sperm count

Primary: problem with testes –> increased FSH/LH as they try to stimulate the testes

Secondary: problem with either hypothalamus or pituitary gland –> decreased or inappropriately normal FSH/LH

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13
Q

In a pregnant pt with hyperthryoidism what is the treatment

A

1st trimester: PTU

2nd trimester: carbimazole

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14
Q

DeQuervain’s thyroiditis typical presentation

A

Tender goitre, weight loss and general malaise.

A markedly raised ESR (>50 and usually 100) is typical.

Initially hyperthryoid and then become hypothyroid

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15
Q

What is the relevance of sick euthyroidism being associated with hypoadrenalism

A

Hypoadrenalism which is either primary or secondary, the addition of thyroxine can precipitate acute hypoadrenalism

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16
Q

Insulin antibodies are found almost exclusively in which patient cohort?

A

Young children with type 1 diabetes.

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17
Q

What TFT pattern would be expected in over replacement with thyroxine?

A

Increased T3/T4

Suppressed TSH

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18
Q

3 criteria needed to define the resolution of DKA

A

pH >7.3
ketones <0.3 mmol/L
patient is able to eat and drink

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19
Q

When is K replacement needed in DKA mgmt

A

K up to 5.5mmol/L

Note: 3.5 - 5.5 give 40mmol in IVF L; < 3.5 seek specilaist advice for how much to give

20
Q

Which investigation most likely to differentiate between Amiodarone induced thyrotoxicosis (AIT) type 1 and type 2?

A

Colour flow Doppler

NB: appears to be superior to IL-6

21
Q

Which diabetes drugs increase levels of PTH, drive an increase in bone turnover, and are associated with increased risk of bone fracture.

A

SGLT-2 inhibitors

such as canagliflozin

22
Q

Most authorities recommended that metformin should be stopped in patients with a creatinine above ___

A

150

Note: This is not universal policy and many patients continue on metformin with creatinines much higher than 150 without any ill effect.

23
Q

Which MEN is associated with mutation in RET

A

MEN2

Note: MEN1 and 2 are both autosomal dominant

24
Q

Which MEN is associated with MENIN?

A

MEN1

25
Q

Which MEN2 has a worse prognosis?

A

MEN2B - this is because the medullary thyroid Ca is usually more aggressive.

Note: death in mid twenties can commonly occur in its who present with clinical signs of medullary thyroid Ca

26
Q

What is the most common type of thyroid Ca?

A

Papillary ( 80-85)

Note: then follicular (5-10%); rare medullary and anaplastic

27
Q

What is the typical presentation of thyroid Ca?

A

Single nodule and otherwise asymptomatic
Presents in 30s or 70s usually

Note: TFTs are normal

28
Q

Which type of thyroid Ca has worse prognosis?

A

Anaplastic

29
Q

Which type of thyroid Ca is more common in areas with low iodine?

A

Follicular

30
Q

Which type of thyroid Ca is more common in areas with high rates of thyroiditis?

A

Thyroid lymphoma

31
Q

T2 DM is association what that islet pathology

A

Islet amyloid deposition

32
Q

Most common antibodies in Hashimotos

A

Anti TPO

Note: aka anti microsomal antibodies

33
Q

Typically when reducing insulin go in increments of ___%

A

20%

34
Q

In a patient with T2DM and Hba1c significantly below 75 mmol/mol what is the insulin of choice to start?

A

Humane isophane insulin (also referred to as a Neutral Protamine Hagedorn [NPH] insulin) is the first-line recommended insulin to use in a type 2 diabetic. These are intermediate acting insulins usually used once daily at night or twice a day.

Note:
A long-acting insulin analogue might be useful in someone who struggles to inject a twice a day NPH insulin to reduce the frequency of injections to once a day (e.g. someone who requires assistance to inject from a carer or district nurse).
A biphasic ‘mixed’ preparation is recommended if an individual’s diabetic control is especially poor (HbA1c > 75 mmol/mol).

35
Q

Tx of papillary thyroid carcinoma

A

Thyroidectomy AND radioiodine-131 therapy

36
Q

Colonoscopy recommendations for pts with acromegaly?

A

Start at 40 yrs due to high risk colon Ca

If elevated IGF1 or adenomas found: repeat in 3 yrs

If not: repeat in 5 years

37
Q

In the setting of diabetes and stable renal function what test is considered the most appropriate test to detect and quantify proteinuria.

A

Albumin:creatinine ratio

38
Q

The presence of breast development in the absence of secondary sexual hair, with a history of hernias as a child is suggestive of a diagnosis of ____

A

Androgen insensitivity syndrome

39
Q

Drugs that interfere with thyroxine absorption?

A

Binding agents ( cholestyramine and sevelamer)
iron sulphate
proton pump inhibitors

40
Q

Relevance of undetectable thyroglobulin on TFTs

A

Clinches the diagnosis of factitious hyperthyroidism.
Note: thyroglobulin is the precursor of thyroid hormones, therefore if undetectable, indicates an external source of thyroid hormone has been administered.

41
Q

Goal BS in insulin dependent DM

A

Pre meal: 4-7
Pre bed: 6-8

42
Q

1st line tx of thyroid eye disease?

A

Steroids

43
Q

Compare Turners to Kallmans?

A

Both have decreased oestrogen but
Turners is a hypergonadatrophic hypogonadism (increased FSH/LH)

Kallmans hypogonadatrophic hypogonadism (normal/decreased FSH/LH). It is also assoc with central defects (eg cleft lip), colour blindness, and deafness.

44
Q

Pseudohypoparathyroidism is associated with ____

A

Short stature and shortening of the fifth metacarpal

45
Q

_____ is the best investigation for confirming subacute thyroiditis

A

Radioactive iodine uptake scan

Note: aka De Quervains. It is due to increased release of stored thyroid hormone rather than increased production therefore no role for PTU/carbimazole. Can treat symptoms with propranolol

46
Q

Metformin is known to cause what nutritional deficiency?

A

B12

47
Q

Tx of myxoedema coma?

A

IV T3 and hydrocortisone

Note: can treat clinically even before lab results

MRCPI 2 Adult Med (15 decks)

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