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endocrine Flashcards

1
Q

when do pregnant hypothyroid women need to change their their thyroxine and by how much

A

increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy

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2
Q

Acromegaly CFs

A

large tongue, hands, face
XS sweating
signs of hypopituitarism- headache, bitemporal hemianopia

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3
Q

which clinical problems assiciated with acromegaly

A

HTN, Cardiomyopathy, diabetes

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4
Q

what is acromegaly caused by

A

XS GH secreted
95% caused by pit adenoma
MEN1

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5
Q

Investigations acromegaly

A

GOLD STANDARD;
Serum IGF-1 levels

If IGF-1 raised- OGTT

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6
Q

what would show on Ix for acromegaly

A

acromegaly: no supression of GH in hyperglycaemia
MRI brain - check for pit adenoma

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7
Q

first line management acromegaly and what adjunct

A

trans sphenoid surgery

ocreotide= adjunct when awaiting surgery a somatostatin analogue which is often used as an adjunct to surgery resulting in reduced growth hormone levels and reduction in tumour size.

(bromocriptide DO agonist is only for medical management alone_

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8
Q

management acromegaly:

A
  1. trans sphenoid surgery
  2. somatostatin analogue eg octreotide, directly inhibits the release of growth hormone
  3. pegvisomant——GH receptor antagonist
  4. dopamine agonists——bromocriptine (now last line)
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9
Q

what is addisons disease and what does it cause
how does it affect electrolytes

and CFs

what causes addisons

A

primary hypoadrenalism
causes reduced cortisol and reduced aldosterone

low Na
high K

loss of pubic hair

CFs
axillary hair thinning
pubic hair thinning
vitiligo
salt craving
hypotension
hypoglycaemia
addisonian crisis

caused by autoimmune destruction of adrenal glands

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10
Q

primary hypoadrenalism =????

A

addisons disease

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11
Q

eg biguanide

A

metformin

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12
Q

what type of meds are DPP4 inhibitors and their MOA

A

gliptins eg sitagliptin
DECREASE GLP 1 breakdown

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13
Q

pros of biguanides and MOA

A

eg metformin-
no risk of hypoglycaemia
works by DECREASE hepatic glucose production
and
INCREASE peripheral insulin sensitivity

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14
Q

how do gliptins work

A

DPP4 inhibitor
increase post prandial insulin

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15
Q

eg sulpohonylurea

A

glicazide, glibenclamide
work by:
increase pancreatic insulin secretion
ATPk CLOSES CHANNEL

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16
Q

which type of diabetes medicine causes weight gain

A

sulphonylurea== AVOID IN OBESE PATIENTS

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17
Q

WHAT Type of diabetes medicine can cause hypoglycaemia

A

sulphonylureas- eg gliclazide

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18
Q

eg thiazolidinediones
and MOA

A

eg pioglitazone
moa= PARRY gamma

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19
Q

TRIAD symptoms of DKA

A
  • blood glucose>11
  • capillary ketones >3 or >2+ in urine
  • pH<7.35
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20
Q

initial DKA TX

A

IV FLUIDS- and Fixed rate insulin infusion

5OU actrapid in 50ml 0.9%NaCl

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21
Q

HHS presentation and cause
CFS
Tx

A

characteristic of T2DM, severe hyperglycaemia in absense of ketosis causing hyperosmolar state

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22
Q

Tx HHS

A

agressive iV fluids
consider potassium replacement if hypokalemc

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23
Q

Treatment thyrotoxicosis

A

propylthiouracil
Propanolol
high dose steroids- dex 4mg iv
iodine
supportive measuresd

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24
Q

which medication can cause thyroidtoxicosis

A

amiodarone

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25
Q

TRAb antibody sensitive and specific for which thyroid problem?

A

Grave’s disease

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26
Q

which thyroid antibody is tested in Grave’s disease

A

TSH receptor antibody (TRAb)

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27
Q

MOA carbimazole and propylthiouracil

A

TPO

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28
Q

What does adrenal gland secrete

A

adrenaline, aldosterone, cortisol

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29
Q

electrolyte disturbance caused by addisons?

A

hyponatremia
hyperkalemia

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30
Q

Another name for sub acute thyroiditis =

A

de quervain

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31
Q

sick euthyroid is common in which patient demographic

A

hopsital inpatients

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32
Q

treatment for sick euthyroid syndrome

A

no treatment- Changes are reversible upon recovery from the systemic illness and no treatment is usually needed

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33
Q

TSH and free T3 in sick euthyroid syndrome

A

low TSH low T3

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34
Q

Sub clinical hypothyroidism TSH and T3 levels

A

High TSH,
normal T3

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35
Q

Poor compliance with thyroxinE patients: TSH and T3 levels

A

Hight TSH
normal t3

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36
Q

Polydipsia ivestigation test

A

water deprivation test

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37
Q

water deprivation test: positive for primary POLYDIPSIA:

starting plasma osmolality

urine osmolality after fluid deprivation

 -urine osmolality after desmopressin
A

starting plasma osmolality LOW

urine osmolality after fluid deprivation: HIGH

urine osmolality after desmopressin: HIGH

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38
Q

Water deprivation test: nephrogenic DI

A

urine osmolality after fluid deprivation: low
urine osmolality after desmopressin: low

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39
Q

where is ADH secreted

A

hypothalumus

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40
Q

cranial DI water deprivation test

A

starting plasma osmolality:High

urine osmolality after fluid deprivation:low

urine osmolality after desmopressin: high

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41
Q

which medication deiabetes med can cause DKA

A

Dapagliflozin/SGLT2 inhibitors

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42
Q

Klinefelter’s syndrome chromosome abnormality

CFs

A

47XXY

often taller than average
lack of secondary sexual characteristics
small, firm testes
infertile
gynaecomastia - increased incidence of breast cancer
elevated gonadotrophin levels but low testosterone HIGH LH, HIGH FHS

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43
Q

HYPOCALCAEMIA ECG

A

LONG QTC

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44
Q

Which syndrome causes LH & FSH low-normal and testosterone is low

A

Kallmans syndrome
Also, cleft palate, small testes, X LINKED recessive INHERITED

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45
Q

Sjogrens syndrome can cause ?type of renal tubular acidosis

A

type 1- distal

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46
Q

treatment for severe hyponatremia

A

3% nacl

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47
Q

Familial hypercholesterolaemia (FH) - inheritance

A

is an autosomal dominant c

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48
Q

bilateral adrenal hyperplasia causes hyper????????

A

HYPERALDOSTEROINISM

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49
Q

most common cause primary hyperparathyroidism

A

Primary hyperparathyroidism: solitary adenoma

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50
Q

in pregnancy- increase in which thyroid antibody

A

TBG- thyroxine binding globulin

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51
Q

Exenatide = MOA

A

Exenatide = Glucagon-like peptide-1 (GLP-1) mimetic

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52
Q

Deafness and hypothyroidism== what condition

A

pendred disease

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53
Q

MODY inheritance patter

A

auto dominant

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54
Q

is urinary sodium high or low in SIADH

A

high

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55
Q

which diabetes med can cause pancreatitis and severe renal impairment

A

exenatide

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56
Q

long term corticosteroid use can cause

A

avascular necrosis

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57
Q

acromegaly patients high risk for which type of cancer

A

colorectal

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58
Q

Meglitinides - moa

A

bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells

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59
Q

MEN 1, 2a and 2b associated conditions

A

see screenshot

MEN 1
PPP
Parathyroid, pituitary, pancreas

MEN 2a
PP
Parathyroid
Phaechromocytoma

MEN 2b
P
Phaeochromocytoma
Marfanoid body
medullary throid

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60
Q

hypercalcaemia is most common in which MEN type

A

MEN 1

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61
Q

acetozolamide - electrolyte hypo or hyperkalemia

A

hypokalemia

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62
Q

thiazide- electrolyte hypo or hyperkalemia

A

hypokalemia

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63
Q

sick euthyroid syndrome- TSH and T4 level

A

BOTH LOW

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64
Q

VBG of (all) renal tubular acidosis

A

hyperchloraemic metabolic acidosis
(normal anion gap)

65
Q

carbimazole MOA

A

Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin –> reducing thyroid hormone production + no action on 5’-deiodinase
carbimazole

== NO ACTION ON 5 deiodinase

66
Q

propylthiouracil moa

A

Blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin –> reducing thyroid hormone production + inhibits 5’-deiodinase which reduces peripheral conversion of T4 to T3

67
Q

incontinence in elderly—give?

A

give mirabegron
NOT oxybutynin (bc elderly == confusion)

68
Q

MOA mirabegron

A

mirabegron- beta3 agonist

69
Q

definitive mangement hyperparathyroidism

A

total parathyroidectomy

70
Q

anti thyroid medications in pregnancy
1st trimester
2nd trimester

A

1st trimester- propylthiouracil
2nd trimester onwards- switch back to carbimazole

71
Q

primary hyperparathyroidism symptoms

A

bones groans stones psychic moans
MEN 1 and 2

72
Q

electrolyes in primary hyperparathyroidism

A

high calcium
low phosphate
normal-high PTH

73
Q

In a patient with T2DM (poorly controlled) and CVD:
add metformin first
if still not helping:

add ???

A

Add SGLT2 inhibitor
eg piglitazone

74
Q

what type of anti diabetic med good for CVD

A

SGLT 2 inhibitor eg dapagliflozin

75
Q

how often check hba1c in t2dm

A

every 3-6 months until stable , then 6 monthly

76
Q

HBA1C targets in T2DM
lifestyle only
lifestyle + metformin
lifestyle +drug can cause hypos

A

lifestyle only 48
lifestyle + metformin 48
lifestyle +drug can cause hypos 52

77
Q

Causes of HTN and hypokalemia (plus mneumonic)

A

Liddle Cushing Conned 11 people
Liddle’s syndrome
Cushing’s syndrome
Conn’s syndrome (primary hyperaldosteronism)
11-beta hydroxylase deficiency

78
Q

Causes of hypokalemia WITHOUT HTN

A

diuretics
GI loss (e.g. Diarrhoea, vomiting)
renal tubular acidosis (type 1 and 2**)
Bartter’s syndrome (furosemide ascLOH)
Gitelman syndrome

79
Q

which antidiabetic med causes glycosria

A

dapagliflozin

80
Q

which antidiabetic med CI in heart failure

A

Thiazolidinediones- eg pioglitazone

81
Q

cinacalcet==? and when to give

A

in primary hyperparathyroidism
= calcium mimetic

82
Q

familial hypercholesterolaemia inheritance

A

aut dom (exception to rule)

83
Q

addisons disease investigation

A

ACTH stimulation test- synacthen test
Plasma cortisol is measured before and 30 minutes after giving Synacthen 250ug IM

if this not possible:
9am cortisol

84
Q

electrolytes in addisons

A

addisons- primary hypoaldosteronism
hyperkalaemia
hyponatraemia
hypoglycaemia
metabolic acidosis

85
Q

investigations cushing disease
confirm and localise

A

confirm:
overnight dexamethasone suppression test
IF positive for cushings disease:
NO suppression of morning cortisol

Localise:
high-dose dexamethasone suppression test

86
Q

VBG in cushings sydnrome

A

met alk and kypokalemic

87
Q

interpretation of high dose dexamethasone suppression test to localise cushings

A

Cushings syndrome (eg adrenal adenoma)
Cortisol- NOT supp
ACTH : +SUPpressed

Cushing disease (pit adenoma)
Cortisol: suppressed
ACTH: suppressed

Ectopic ACTH syndrome:
Cortisol: not suppressed
ACTH: not suppressed

88
Q

how does osteomalacia affect calcium and phosphate

A

LOW CALCIUM
and LOW PHOSPHATE

89
Q

impaired fasting glucose range

A

6.1-7.0

90
Q

impaired glucose tolerance rang

A

fasting <7.0
AND
OGTT 2 hr 7.8-11.0

91
Q

gitelmans syndrome

cause

how it affects electrolytes

A

Gitelman’s syndrome is due to a defect in the thiazide-sensitive Na+ Cl- transporter in the distal convoluted tubule.

Features
normotension
hypokalaemia
hypocalciuria
hypomagnesaemia
metabolic alkalosis

92
Q

what type of cancer ass’d with MODY

A

HCC

93
Q

what type of med is dapagliflozin, canagliflozin, GLIFLOZINS and their
MOA

A

gliflozins

MOA: SGLT2 inhibitor
Increase urinary glucose
excretion
reduce glucose reabsorption`

gliflozins can cause forniers gangrene

94
Q

in toxic multinodular goitre– nuclear scintigraphy == ?

A

patchy uptake-

95
Q

Second-line treatments T2DM:
Sulphonylureas e.g. gliclazide.

Gliptin’s e.g. sitagliptin.

Thiazolidinedione e.g. pioglitazone

Sodium/glucose cotransporter 2 (SGLT-2) inhibitors e.g. canagliflozin

A

Second-line treatments for type 2 diabetes range from:
Sulphonylureas e.g. gliclazide. Side effects include weight gain and hypoglycaemia.
Gliptin’s e.g. sitagliptin. Side effects include headaches, but are generally well tolerated.
Thiazolidinedione e.g. pioglitazone. Side effects include fluid retention and weight gain.
Sodium/glucose cotransporter 2 (SGLT-2) inhibitors e.g. canagliflozin. Side effects include urinary tract infections and increased risk of foot amputations (mainly with canagliflozin, but no evidence of a link with empagliflozin and dapagliflozin).

96
Q

What can lithium cause- cranial or nephrogenic DI

A

nephrogenic DI

97
Q

Dapagliflozin MOA and where it acts

A

SGLT-2 inhibitors reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal proximal convoluted tubule

98
Q

gestational diabetes diagnosis range

A

Diagnostic thresholds for gestational diabetes

gestational diabetes is diagnosed if either:
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

5678

99
Q

what to give in gestational diabetes if metformin not tolerated

A

glibenclamide

or give if BM targets not met on metformin but pt declines insulin

100
Q

management of pre existing diabetes in pregnancy

A

BMI <27
stop meds apart from metformin and start insulin
folic acid 5mg od

101
Q

Targets for self monitoring of pregnant women (pre-existing and gestational diabetes)

A

537864
fasting 5.3
1 hr post meal 7.8
2 hr post meal 6.4`

102
Q

what is hungry bone syndrome and how does it affect calcium levels

A

hungry bone syndrome = sudden drop in previously high parathyroid hormone levels

causes hypocalcaemia

103
Q

Bartter’s syndrome : where does it act
CFs

A

loop of henle , inhibits Na-K-2Cl

acts like furosemide

CFs
normotension
polyuria, polydipsia
hypokalemia
FTT in childhood

104
Q

Liddles syndrome
inheritance
CFs

treatment

where does it act

A

aut dominant
HTN
hypokalemia
met alkalosis
Tx= amiloride or triamtrelene

acts in distal tubules
incr sodium absorption

105
Q

graves disease- antibodies most common

A

anti TSH

106
Q

GLP 1 mimetic - egs
MOA

major pro with GLP 1 mimetics

A

eg exenatide, liraglutide
MOA= increase insulin secretion
inhibit glucagon secretion

weight lose

107
Q

Hashimotos thyroiditis associated with which type of cancer

A

thyroid lymphoma

108
Q

orlistat MOA

A

lipase inhibitor

109
Q

drug induced gynaecomastia

A

spironolactone
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

110
Q

insulin and c peptide levels

A

sulfonylurea-induced hypoglycemia: Insulin and C-peptide Rise

Insulin - Induced Hypoglycemia: Insulin Rise but C-peptide Low

111
Q

is MGUS associated with hyper or hypo calcaemia or normal calcium

A

NO HYPERCALCAEMIA

112
Q

RET oncogene thyroid cancers (2)

A

papillary and medullary

113
Q

what is monoclonal gammopathy of uncertain significance (MGUS)

A

the absence of complications such as immune paresis, hypercalcaemia and bone pain

114
Q

gestational diabetes - patient previously had in prev pregnancy- when to do OGTT in next pregnancy?

A

ASAP

115
Q

which antibody most likely to be found in hashimotos

A

anti tpo + goitre

116
Q

Gitelman = Thiazide diuretic
Bartter = Loop diuretic

A

Gitelman = Thiazide diuretic in DCT
Bartter = Loop diuretic

GITELMAN WAS A Normal man (normotension)

117
Q

tender goitre, hyperthyroidism and raised ESR. ==?

A

subacute thyroiditis

118
Q

Sick euthyroid:
T4 + T3 low, TSH normal or low

Subclinical hyperthyroidism:
T4 + T3 normal, TSH low (high if subclinical hypo)

A

Sick euthyroid:
T4 + T3 low, TSH normal or low

Subclinical hyperthyroidism:
T4 + T3 normal, TSH low (high if subclinical hypo)

119
Q

haemochromatosis
general population testing
genetic family testing

A

general population: transferrin saturation > ferritin
family members: HFE genetic testing

120
Q

Mx urge incontinence

A
  1. lifestyle
  2. if still not improved- musicarinic antagonists eg oxybutynin
    IF ELDERLY AND FRAIL
    mirabegron (a beta-3 agonist)
121
Q

androgen insensitivity syndrome

A

46XY
Features
‘primary amenorrhoea’
little or no axillary and pubic hair
undescended testes causing groin swellings
breast development may occur as a result of the conversion of testosterone to oestradiol

Management
counselling - raise the child as female
bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
oestrogen therapy

122
Q

conns anti HTN of choise

A

spironolactone

123
Q

phaeochromoctyoma Tx anti htn

A

phenoxybenzamine = non selective alpha antagonist

presents as adrenal mass

124
Q

which pit hormone is constantly under inhibition

A

prolactin

125
Q

cushings electrolyte and VBD

A

hypokalemic met alk

126
Q

causes of pseudohyponatremia

A

hyperlipidaemia
or taking blood from arm with IV in

127
Q

hyper thyroid and hypo thyroid

which cause galatorrhoea and gynaecomastia

A

Hyperthyroidism - Gynaecomastia

Hypothyroidism - Galactorrhoea
low=cry=leak

128
Q

pegvisomant moa AND WHAT IS IT used ofr

A

pegvisomant for acromegaly
GH receptor antagonist - prevents dimerization of the GH receptor

129
Q

hyponatremia–
urinary sodium <20 and >20 causes

A

Urinary sodium > 20 mmol/l

Sodium depletion, renal loss (patient often hypovolaemic)
diuretics: thiazides, loop diuretics
Addison’s disease
diuretic stage of renal failure

Patient often euvolaemic
SIADH (urine osmolality > 500 mmol/kg)
hypothyroidism
——————————————————

Urinary sodium < 20 mmol/l

Sodium depletion, extra-renal loss
diarrhoea, vomiting, sweating
burns, adenoma of rectum

Water excess (patient often hypervolaemic and oedematous)
secondary hyperaldosteronism: heart failure, liver cirrhosis
nephrotic syndrome
IV dextrose
psychogenic polydipsia

130
Q

Congenital adrenal hyperplasia
causes
cfs
tx

A

Congenital adrenal hyperplasia is most commonly due to 21-hydroxylase

autosomal recessive disorders
affect adrenal steroid biosynthesis
in response to resultant low cortisol levels the anterior pituitary secretes high levels of ACTH
ACTH stimulates the production of adrenal androgens that may virilize a female infant

Cause
21-hydroxylase deficiency (90%)
11-beta hydroxylase deficiency (5%)
17-hydroxylase deficiency (very rare)

CFs
Early puberty irregular menses, acne, hirsutism, early breast and pubic hair development, clitoromegaly and male-pattern baldness.

131
Q

which anti diabetic med causes incr flatulence

A

acarbose

132
Q

heterozygous or homozyhous familial hypercholesterolaemia

A

The presence of tendon xanthomata and cholesterol levels meet the diagnostic criteria for familial hypercholesterolaemia. Homozygous familial hypercholesterolaemia is exceedingly rare - most patients die in their teenage years from a myocardial infarction.

133
Q

liddlye syndrome inheritacne

A

aut dom

LIDL is dominant in the distant tubes

134
Q

stress incontinence tx

A

1 pelvic floor exercises
2 . duloxetine

135
Q

fibrate MOA

A
136
Q

globally decreased uptake on thyroid scan

A

deceased uptake, painful goitre= subacute de quervain thyroiditis

137
Q

sulphonylurea MOA

A

increase peripheral insulin secretion by CLOSING potassium-ATP channels on the beta cells

138
Q

most common cause of tertiatry hyperparathyroidism

A

CKD renal disease

139
Q

pendred syndrome

A

hypothyroid
painless goitre
deafness

140
Q

what causes ketone production in DKA

A

lipolysis

141
Q

what is fanconi syndrome

A

Fanconi syndrome describes a generalised reabsorptive disorder of renal tubular transport in the proximal convoluted tubule resulting in:
type 2 (proximal) renal tubular acidosis
polyuria
aminoaciduria
glycosuria
phosphaturia
osteomalacia

142
Q

insulinoma c peptide level

A

high c peptide level in insulinoma

143
Q

siadh Dx urine osmolality

A

Euvolema + urine osmolality higher than serum osmolality= SIADH

144
Q

which malignant cell secretes PTH related peptide?

A

SQUAMOUS– secreted by lung SCC

145
Q

what causes hypercalcium in sarcoidosis

A

hypercalcaemia: macrophages inside the granulomas cause an increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)

146
Q

addisons crisis mx

A

100mg hydrocortisone IV
IV 0.9 nacl

147
Q

insulin lispro =?

A

fast rapid action

148
Q

myxoedema coma CFs

A

very low fT3 T4 and high TSH

unconcious

HYPOTHERMIC
heart failure

149
Q

which pit hormone is constantly under inhibition

A

prolactin

150
Q

does wilsons or haemochromatosis cause chorea

A

WILSONS causes chorea

151
Q

difference between pit adenoma and pit apoplexy

A

pit apoplexy =
Pituitary apoplexy is commonly seen in the presence of a pituitary tumour and is caused by bleeding into or impaired blood supply of the pituitary, This generally presents with sudden onset headache, followed by symptoms of non-functioning pituitary.

152
Q

TYPES OF MODY and their gene mutations

A

most common = mody 325

MODY 3= HNF alpha
MODY 2= glucokinase
MODY 5 = HNF Beta

153
Q

how does alcohol affect BMs

A

Alcohol causes increased insulin secretion

154
Q

what type of mab is used in familial hypercholesterolaemia

A

evolucumab

155
Q

what anti htn is used in marfans

A

losartan

156
Q

Tx thyroid eye disease

A

RITUXIMAB

157
Q

cushings initial investigation

A

24hr urinary free cortisol
(not suppressed if + cushings)

158
Q

adrenal adenoma HTN treatment

A

spironolactone or eplenerone

M R C P (18 decks)

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