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GP FELLOWSHIP EXAM > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Dose of calcium for >50

A

1300mg daily

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2
Q

Starting dose of thyroxine

A

1.6mcg/kg
Adjust 4-8 weekly

OR
Partial treatment
25-50mcg adjust 4-8 weekly
*better for oldies and mild derrangement

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3
Q

Automatic high risk for diabetes (AND screening type and frequency)

A
  • GDM
  • Overweight and >40
  • First degree relative w diabetes
  • CVD
  • Pacific islander, indian subcontinent,ASTI
  • PCOS

FBG or HbA1c EVERY 3 YEARS

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4
Q

Starting dose for hyperthyroidism

A

Carbimazole 10-20mg in 2-3 divided doses
adjust dose 4-6 week interval

If severe (ie t3-t4 2.5 x normal) then 30-40mg

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5
Q

When to use radioidoine or thyroidectomy for graves?

A
  • Severe graves or large goitre
  • Toxic adenoma or multinodular goitre
  • When TSH receptor antibody remains elevated despite therapy
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6
Q

Signs of adrenal insufficiency

A
  • Malaise
  • Weakness
  • Anorexia
  • Weight loss
  • HYPERPIGMENTATION
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7
Q

Diagnosis of adrenal insufficiency

A
  • Morning serum cortisol
  • Urinary cortisol measurement
  • SHORT SYNACTHEN TEST
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8
Q

Cushing’s syndrome diagnosis

A
  • 24hour urinary free cortisol (measured twice)
  • 1mg overnight dexamethasone suppression test
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9
Q

Signs and symptoms of Cushing’s syndrome:

A

Features:
- Truncal obesity
- Hirsutism
- Acne
- Weakness
- Thin skin
- Bruising
- Insomnia
- Depression

Signs
- Moon facies
- Buffalo hump
- purple striae

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10
Q

Exercise restriction for diabetics (specific example/condition)

A
  • Proliferative retinopathy
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11
Q

Diabetic ideal range for BGL pre-exercise & when to check (HINT: which meds)

A

5-13.9

Insulin or sulfonylureas

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12
Q

Diabetes exercise guidelines (hint: aerobic and resistance)

A

1) 150 min mod-vigourous aerobic over at least 3 days with no more than 2 days without activity

2) 60mins resistance exercise
2-3 sessions/ week non- consecutive days

also: interrupt sitting every 30 mins

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13
Q

Minimal trauma fracture when to inititate treatment vs when to refer to specialist (hint T score cut off)

A

T score <-1.5 start treatment

if T score >-1.5 then refer for specialist review

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14
Q

Diabetes in pregnancy: pre-conception hba1c target

A

<6.5

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15
Q

Hypoglycaemia emergency management
1) able to eat
2) not able to eat

A

15g short acting carbohydrate (eg 6 jellybeans)

1mg glucagon IM

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16
Q

Frequency for diabetes screening for ATSI patients >18

A

yearly

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17
Q

Low risk individuals: how often to assess AUSDRISK? and from what age?

A

Every 3 years from 40

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18
Q

Licence restriction for severe hypoglycaemia episode (severe = not able to treat themselves)

A
  • 6 weeks
  • must see specialist
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19
Q

Incidental adrenal mass investigation next step:

A
  • 1mg dexamethasone supression test
  • 24hr urine metanephrines and catecholamines

If HTN
Then aldosterone- renin ration

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20
Q

When do we use Cabergoline?

A
  • Prolactinoma
  • Medically indicated suppression of lactation (still birth, severe mastitis)
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21
Q

Diet advice for diabetes (lifestyle)

A
  • 1.5 serves of dairy
  • 3 serves of wholegrains
22
Q

Pharmacotherapy principles for diabetic retinopathy

A
  • Optimise BGL
  • Control BP
  • Add: fenofibrate 145mg daily
  • Treat hypercholesterolaemia
23
Q

Assessment for diabetic peripheral neuropathy (clinical)

A
  • 10g monofilament pressure sensation at MTJ
  • Ankle reflex
  • Vibration sensation with 128hz fork
  • Pinprick sensation
24
Q

Neuropathic pain treatment (pharmacology) be specific

A

Amitriptyline 10mg nocte
OR
Pregabalin 75mg nocte
or
Duloxetine 30mg daily

25
Q

Addison’s crisis treatment

A

IV 100mg Hydrocortisone or prednisolone 40mg orally

IV fluid resuscitation 10-20ml/kg bolus

26
Q

Addisons (adrenal insufficiency) symptoms

A
  • Diarrhoea
  • Vomiting
  • Weight loss
  • Fatigue,
  • postural hypotension
  • HYPERpigmentation
27
Q

Cushings sydnrome tests

A

ONE OF THE FOLLOWING

  • Late night saliva cortisol
  • 24hr urinary free cortisol
  • Dexamethasone 1mg supression test
28
Q

When to order Thyroid scintigraphy

A
  • HIGH T3/T4
    HYPERthyroidism
    Looking for
  • graves
  • toxic adenoma
  • thyroiditis
29
Q

Inital dose for HYPERthyroidism

A

Carbimazole 10-20mg (mild symptoms)

Carbimazole 30-50mg (severe)

30
Q

Rare side effect of Carbimazole

A

Agranulocytosis

31
Q

3 main blood tests to distinguish T1DM from T2D

A
  • Insulin auto-antibodies (IAA)
  • Islet cell auto-antibodies (iCA)
  • GAD
  • C peptide (lower in type 1)
32
Q

GDM Cut off values (Hba1c and OGTT)

A

Hba1c 5.5
OGTT >8

33
Q

Investigation for primary aldosteronism

A
  • Change antihypertensive to verapamil SR, Prazosin, moxonidine or hydralazine.
  • Wait 6 weeks
  • Test Renin: aldosterone ratio
34
Q

Acromegaly:
Too much what ?

A

Excessive growth hormone
(pituitary adenoma)

35
Q

Acromegaly:
What test?

A

Serum insulin like growth factor-1 (IGF-1)

36
Q

Signs of Acromegaly

A
  • Frontal bossing
  • Enlargement of hands and feet
  • Oily Skin
  • Sweating
  • OSA
37
Q

Post partum raised T3 & 4 potential diagnoses

A
  • Postpartum thyroiditis
  • Graves
38
Q

Thyroid autoantibodies in Graves

A

TSH Receptor ab positive
TPO sometimes elevated

39
Q

Frequency for diabetes screening in ATSI population

A

YEARLY hba1c or FBG

40
Q

6 causes for thyrotoxicosis

A

Graves
Toxic multinodular goitre
Toxic adenoma
Painless thyroiditis
Post partum thyroiditis
Painful subacute thryoiditis

41
Q

Hypothyroidism in pregnancy dose change to thryoxine advice

A

25% increase as soon as falls pregnant (4-6 weeks)

42
Q

Hypothyroidism in pregnancy rate of testing in early pregnancy

A

4-6 weeks

43
Q

Causes for moderate hypophosphataemia

A

Vit D deficiency

Iron infusion

Primary Hyperparathyroidism

Antacid abuse

44
Q

Adrenal insufficiency/Addisons signs on exam?

A
  • HYPERpigmentation
  • Postural hypotension
  • Dehydration
  • Decreased body hair
  • Vitiligo
  • Tachycardia
45
Q

When to order thyroid scintigraphy?

A

Hyperthyroidism

46
Q

Timing pattern in Painless postpartum thyroiditis

A

1-6 months PP

Thyrotoxicosis followed by hypothyroidism (20% of the time permanent)

47
Q

Pathogenesis in painless postpartum thyroiditis

A

Autoimmune destruction of thyroid follicles causing release of stored thyroid hormone

48
Q

6 main causes of HYPERthryoidism

A
  • Graves
  • Painless post partum thyroiditis
  • Toxic adenoma/multinodular goitre
  • Exogenous thryoid hormone
  • PAINFUL subacute thyroiditis (De-Quervain’s)
  • Amiodarone
49
Q

Threshold for TSH in pregnancy to commence thyroxine (regardless of T3/4)

A

4

between 2.6-4 controversial

50
Q

What do you give to someone with Postpartum thyroiditis?

A

NO thyroid medication (transient)

–> if symptomatic then for propanolol

51
Q

Raised TSH approach (diagram given) tests and imaging

A
52
Q

Causes of hyperthyroidism

A
  • Graves disease
  • Toxic multinodular goitre
  • Toxic adenoma
  • Postpartum thryoiditis
  • Exogenous thyroid hormone
  • Painless sporadic thyroiditis
  • Painful subacute thryoiditis
  • Amiodarone induced thyroiditis

GP FELLOWSHIP EXAM (20 decks)

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