ENDOCRINE Flashcards
1
Q
infarction of macroadenoma can lead to
A
panhypopituitarism
2
Q
often cystic
A
craniopharyngioma
3
Q
most common cause of hypopituirasm
A
non function pituitary macro adenomas
4
Q
panhypopituiriasm refers to
A
deficiency of all anterior pituitary hormones
5
Q
panhypopituiriasm refers to
A
deficiency of all anterior pituitary hormones
6
Q
what does hypoadrenalism cause
A
mild hypotension, hyponatraemia and CV collapse
7
Q
what is the classical picture fo longstanding panhypopituiriasm
A
pallor with hairlessness
8
Q
what identifies pituitary adenomas
A
MRI
9
Q
difference in definitions between cranial and nephrogenic DI
A
cranial- insufficient levels of circulating ADH
nephrogenic - renal resistance to ADH
10
Q
urine/serum osmolality should be
A
> 2
11
Q
if cranial DI is diagnosed what should be done
A
CT or mRI to rule out brain tumours especially craniopharyngioma
12
Q
what can be used before surgery for acromegaly
A
somatostatin analogues eg sandostain
13
Q
what can increase risk of colon polyps or colon cancer and may be presenting feature
A
acromegaly
14
Q
drugs that reduce dopamine
A
metoclopramide, phenothiazines
15
Q
what is the main treatment for prolactinoma
A
cabergoline - v good so rarely need surgery
16
Q
symptoms of rubella syndrome in baby
A
microcephalic;y, patent ductus arterioles and cataract
17
Q
what tests for tubal patency
A
hysterosalpingiogram
18
Q
what vitamin should take before pregnancy and for first 12 weeks
A
folic acid
19
Q
what is a hydrosalpinges
A
Fallopian tube filled with water
20
Q
what detects oestrogen defieicny
A
negative progesterone challenge test
21
Q
kallamans is what class of pituitary failure
A
1 - hypothalamic pituitary failure
22
Q
turners syndrome comes into what class?
A
3 ovarian failure
23
Q
what is oligomenorrhoea
A
cycles greater than 42 days
24
Q
diffeerence between primary and secondary amenorrhoea
A
primary - never mensutrated
secondary - menstruated then stop
25
what to do if infertility but got regular periods
midluteal serum progesterone
26
what to do if got irregular cycles
hormone evaluation
27
what challenge test should introduce a period
progesterone
28
what could consider if not responding to clomifene citrate for pros in getting pregnant
methotrexate
29
what acts as a co- gonadotrophin to LH
glucose
30
what lowers SHBG that can contribute to hyperandrogegism
insulin
31
inflammatory disorder eg chlamydia, gonorrhoea can cause what
hydrosalpinx
32
what is a hydrosalpinx
Fallopian tube is blocked and fills with serous or clear fluid near the ovary
33
pelvic inflammatory disorder presents as
abdo/pelvic pain
febrile
vaginal discharge
34
uterus on US may be fixed and retroverted and may show chocolate cysts
endometriosis
35
klinefelters biochem
primary hypogonadism - low testosterone and high LH/FSH
36
kallman and prader will have what biochem
low testosterone and low fish/LH
37
if primary hypogonadism in males what tests next
karyotyping or iron studies
38
in secondary hypogonadism what do you need to exclude
medications and prolactin and pituitary hormones
39
when does testosterone peak
morning
40
most common genetic cause of hypogonadism in men
klinefelters
41
klinefelters presents
infertile and small firm testes
42
increased incidence off what in klinefelters
cryptorchidism (abscence of testes from scrotum)
43
klinefelters increase risk of what
breast cancer and non Hodgkin lymphoma
44
red green colour blindness and clip palate are associated with
kallamsn
45
there is an isolated GnRh deficiency in
Kallman
46
are men autosomal dominant or recessive
dominant
47
men 1 3 symptoms
pituitary adenoma, hyperparathyroidism and pancreatic tumour eg insulinoma
48
Ret in men 2 is a
proto oncogene
49
mutations in RET activate what
receptor tyrosine kinase
50
men 2a or b more common
2a - 90-95%
51
men 2a features
medullary thyroid cancer, phaeochromocytoma and parathyroid tumours
52
men 2b features
MTC, phaechromocytoma and marfanoid features - mucosal neuromas
53
what is typically the first presentation of MEN 2
MTC
54
von hippel Lindau is tumors where
central nervous system
55
bone lesions in NF 1
sphenoid dysplasia or thinning of long bone cortex
56
cushings, acromegaly and thyroid carcinoma
carney complex
57
mccune Albright syndrome has mutations of what
GNAS
57
mccune Albright syndrome has mutations of what
GNAS
58
what is a trophoblast tumour secretion hCG
choriocarcinoma
59
what are thyrotoxicosis not associated with hyperthyroidism
thyroiditis
60
what drug can cause drug induces thyroiditis
amiodarone
61
what does a thyroid bruit reflect
hypervascualrity of thyroid - graves
62
pretibial myxoedema is seen in graves and what else
hashimotos thyroididts
63
what scan is done if suspect graves by antibodies are negative so look for toxic nodular disease
scintiscan
64
first line for graves
carbimazoel
65
what is first line treatment for relapsed graves dn nodular thyroid disease
radioiodien
66
what is used when radio iodine is contraindicated eg in pregnancy
thyroidectomy
67
what has a painful diffuse firm goitre
de quervains
68
what often occurs after viral infection in young woman
de quervains thyroiditis
69
in dequervains there is a hyperthyroid phase followed by
hypothyroidism phase
70
drug induced thyroiditis can be caused by
amiodarone and lithium
71
what does amiodarone inhibit
DI01
72
hormone results from amiodarone
increase t4, decrease t3 and normal TSH
73
hasmimotos like de quervains can have
hyoperthyroid then hypothyroid phase
74
de quervains tends to occur in what aged females vs hashimotos
dequervains - 20-50
hashimotos- 45-60
75
hurthle cell - follicular cells with eosinophils cytoplasm can be seen in
hashimotos thyroiditis s
76
periorbital oedema is only seen in
hypothyroidism
77
in hypothyrodisims wha cardiac feature
dilated cardiomyopathy
78
obstructive sleep apnoea can occur in what thyroidism
hypo
79
congenital hypothyrodisim is called
cretinism
80
after treatment for hypothyroidism what should be checked every 12 months
TSH
81
TSH is unreliable in
secondary hypothyroidism
82
long standing complication of autoimmune hypothyroidism
B cell non Hodgkins Lymphoma in the affected gland
83
TSh elevated and normal t3/4
subclinical hypothyroidism
84
when should you always treat sublcinctal hypothyroidism
pregnancy
85
subclinical hyperthyroidism is often seen in
multi nodular goitre
86
when is treatment generally advised in subclinical hypo/hyperthyroidism
hypo: TSH >10
hyper: TSH <0.1 or osteoporosis or AF
87
can benign thyroid nodules painful/ tenderness
yes
88
most common malignant thyroid nodule
papillary thyroid carcinoma
89
difference between benign and malignant thyroid nodule?
benign is mobile and malignant is immobile
90
if a lump moves on swallowing what does this mean
it is in the thyroid invested in pretracehal fascia
91
toxic nodule may have signs of what
hypothyroidism
92
what can tell the differcen between hot and cold nodules
scintigraphy
93
are hot nodules always malignant
no -only rarely malignant
94
what mainly diagnosis thyroid nodules
US- FNA
95
what tumour in thyroid has a thin fibrous capsule
follicular adenoma
96
why is the management for follicular adenoma lobectomy with biopsy instead of FNA
FNA cannot distinguish between follicular adenoma and follicular carcinoma
97
papillary carcinoma is associated with what
hasminotos and ionising radiation
98
follicular carcinoma rates are more in
iodine deficient areas
99
what carcinoma can be multifocal, often cystic and may be calcified (psammoma bodies)
papillary
100
follicular carcinomas spread via
haemtogenosu
101
what usually confirms papillary or follicular carcinoma
us - FNA
102
what is done 3-6 months post op of thyroidectomy
whole body iodine scan
103
what are patients treated with to minimise risk of recurrence of papillary or follicular carcinoma
levothyroxine to suppress TSH
104
tumour marker for papillary and follicular carcinoma
thyroglobulin as made by thyroid follilculae epithelial cell
105
what does not respond to RAI
anapaestic carcinoma
106
what are composed of spindle or polygonal cells in nests
MTC
107
what is associated with amyloid deposition
mTC
108
diarrhoea in MTC suggests production of what
VIP
109
thyroid lymphoma often has a background of what
auto-immune hypothyroidism
110
what presents as a rapid onset mass in thyroid
lymphoma
111
a rise in what stimulates goitre
TSH
112
what nodules have an increase risk of malignant transformation
toxic
113
difference in t3/4 for multi nodular goitre if toxic
t3/4 normal in inactive
t3/4 increased in toxic
114
isotope scan can tell if
toxic or non toxic
115
how to trat toxic multomdular goitre
antithyroid drugs
116
when does hCG associated thyrotoxicosis resolve
20 weeks
117
hcg thyrotoxicos does not have
TRab antibody
118
what antibodies can cause neonatal transient hyperthyroidism
TRab
119
what is first line for hyperthyroidism with pregnancy
wait and see as often settles
120
post partum thyroididts occurs within how long of giving birth
6 months
121
25-50% of post partum thyroiditis will have what beyond 1 year
hypothyroidism
122
what is the aim for diabetes hbA1c
<53
123
diabetes in late 30s
LADA
124
viral infection that can contribute to type 1
cocksackie
125
gada and IA2 linked to
type 1 diabetes
126
what is not used in the diagnosis of type 1 but used to monitor disease after
HbA1c
127
insulin analogues reduce what
hypoglycaemia risk
128
what transports insulin to skeletal muscle
GLUT4
129
what is involves in insulin resistance in adipose tissue
TNF alpha
130
gold standard fo measuring insulin sensitivity
hyperinsulinaemiac euglycaemia clamp
131
in diabetes there is increased activity of what
tyrosine kinase activity
132
drug fro atherosclerotic cvd in diabetes
Metformin + GLP-1
133
most common mutation in MODY
transcription factor
134
what has progressive hyperglycaemia
transcription factor
135
if suspect MODY do what
oral glucose tolerance test
136
what MODY glucose will come down with oral challenge
gluokinase
137
mody is not dependent on
Insulin
138
neonatal diabetes has mutation in what mechanism
ATP sensing K channel
139
a component of the ATP sensing K channel
kir6.2
140
neonatal diabetes if under
6 months
141
treatment for neonatal diabetes
sulphonylureas
142
what is the function of insulin resistance when pregnant
divert nutrients to foetus
143
gestational diabetes can be asscociated with
polyhydramnios
144
what drugs should avoid in gestational diabetes
acei - use labetalol, nifedipine and methyldopa instead
145
gestation diabetes and all high risk pregnancies should start what at 12 weeks
aspirin
146
can stay on what during pregnancy
metformin
147
what2 things can cause osmotic damage
sorbitol and fructose
148
macular oedema if referable if hard exudate is within
1 disc diameter of the fovea
149
complication sof diabetic retinopath y
cataracts and glaucoma
150
glucose is converted to what in diabetic getting a cataract
sortibol
151
what should you do twice as false postitive readings are common
measure acr/pcr for diabetic nephropathy
152
what will not chow up on protein dipstick
microalbuminuria
153
acei / arb do what to renal arterioles
dilate afferent and efferent to reduces GFR
154
what should a diabetic with microalbuminuria be started on irrespective of HBA1c
SGLT2i
155
nsaids affect on arteriole
nsaids- constrict afferent
ace- vasoodilate efferent
156
nsaids affect on arteriole
nsaids- constrict afferent
ace- vasoodilate efferent
157
argyll rovertson pupil is highly specific to neurosyphilis but may also be a sign in
diabetic nephropahty
158
what is argylll Robertson pupil
small bilateral pupils that do not constrict when exposed to bright light but do constrict when focused on a nearby object c
159
treatment for diabtevi neuropathy
amitryptiline
160
glycopyrolate
excess sweating in diabetic
161
postural hypotension can be due to autonomic neuropathy
162
what are ketone bodies important for
heart muscle and renal cortex
163
euglycaemic DKA is a rare complication of what
SGLT2i
164
insulin effect on potassium
can cause hypokalaemia
165
amylase is often raised in
DKA
166
management for DKA
NaCL
167
what increases risk of thromboembolism in DKA
dehydration
168
what should all patients in ska receive to prevent thromboembolism
LMWH
169
2 complications of DKA?
cerebral oedema and hypokalaemia
170
what should be given after NaCl once blood glucose conc falls below 14
glucose
171
what should be given after NaCl once blood glucose conc falls below 14 in DKA
glucose
172
what are common precipitating factors of HHS
glucose rich fluids, thiazides and steriods and illness
173
in HHS there is still
small amount of insulin being secreted by the pancreas
174
in HHS there is profound hyperglycaemia and what
hyperosmolaltity
175
how to calculate osmolailtity
2x Na + glucose +urea
176
in HHS what is the ph and bicarbonate
ph >7.3 and bicarbonate >15 (no acidosis)
177
treatment fo HHS
SALINE WITHOUT INSULIN
178
what is glucose levels in alcoholic ketoacidosis
normal or low due to combined effect of alcohol and starvation
179
alcoholic has same biochemistry to DKA except
glucose is normal or may be low
180
What is IV pabrinex for
alcoholic ketoacidosis to prevent wenicke encephalopathy
181
PTH AND CALCIUM IS HIGH IN
PRIAMRY AND TERIOTARY HYPERPARATHYRROIDSM
182
what is low or normal in secondary hyperparathyroidism
calcium
183
causes of primary and tertiary hyperaprathryoidsm
primary - tumour
tertiary - hyperplasia
184
what activates osteoclasts
PTH
185
in hyperparathyroidism is Pth secretion stopped
no
186
osteoporosis, brown tumours and osteitis
fibrosa cystica
187
osteoporosis has prominent effects to which part of the bone
cortical
188
hypercalcaemia can be caused by which drugs
vit D, thiazides
189
hallmark of primary hyperparathyroidism
hypercalcaemia and hypophosphataemi with detectable or elevated intact PTH levels
190
undetectable what() with hypercalcaemia requires further investigation for malignancy
PTH
191
what is raised in hypercalcaemia of malignancy
serum alkaline phosphatase
192
how does familial hypocalciuric hypercalcaemia present
mild hypercalcaemia, reduced urine calcium excretion and PTH may be elevated
193
management of acute hypercalaemia
salien
consider loops once rehydrated
194
what diuretic to avoid in hypercalemia
thiazides
195
what is a drug for primary hyperparathyroidism if surgery not indicated
cinacalcet
196
calcium release from cells is dependent on
magnesium
197
paraesthesia suggest
hypocalcaemia
198
chovesteks sign
tapping facial nerve
199
QT prolongation is
hypocalcaemia
200
hypocalcaemia with low PTH has to be
Hypoparathyroidism
201
low calcium, high PTH and low cacidiol, low or normal phosphate
VIT D defiecjy
202
low calcium, high PTH, high phosphatee
hyperpohospahtemia or pseudohypoparathyroidism
203
low calcium with high PTH and high phosphate AND CREATINIEN
CKD
204
LOW CALCIUM , HIGH PTH AND LOW MAGNESIUM
MALABSORPTION OR ALCOHOLISM
205
management of hypocalcaemia
calcium glutinate
206
oral vit d drug
alphacalcidiol
207
injection of vit d
cholecalciferol
208
drugs that can cause low magnesium
thiazides and PPIs
209
what has dysfunction of GNAS
Pseudohyoparathyroidism
210
condition associated with resistance to the parathyroid hormone
pseudohypoparathyroidism
211
shortened 4 th finger
pseudohypoparathyroidism
212
pseudo -pseudohypoparathyroidism
no abnormaliiteis in calcium metabolism
213
acth independent or dependent that causes nodular adrenal enlargement
independent
214
what cancer can cause ectopic ACTH production
Small cell
215
what can secrete excess CRH
medullary thyroid carcinoma
216
pigmentation in cushings syndrome only occurs with
ACTH dependent causes
217
frontal balding in women
cushings
218
how should cortisol level respond to administration of deaxmethasoen
should decrease
219
what suggests ACT dependent cushings
if serum ACTH are high
220
what is last lien for cushings
bilateral adrenalectomy
221
what is a drug management that can be given if surgery fails in cushings
metyrapoen
222
what investigation if ACTH independent
CT or MRI
223
what 2 tests can tell the difference between pituitary and ectopic ACTH
high dose dexamethasone suppression or exogenous CRH
224
adrenal adenoma emerges from where
adrenal cortex
225
what in younger patients can be associated with Li- fraumeni syndrome
adrenocortical carcinoma
226
what are regulators of aldosterone
angiotensin II and potassium
227
conns syndrome is an adrenal
adenoma
228
what is the commonest secondary cause of hypertension
primary hyperaldosternoism
229
what presents with significant hypertension, hypokalaemia and alkalosis
primary hyperaldosteronism
230
what is next test you do for primary hyperaldosteronism if plasma aldosterone: rennin ratio is increased
salien suppression test
231
if plasma aldosterone doe snot suppress by how much with 2 litres of water can primary hyperaldosteronism then Bec confirmed
50%
232
what is the treatment fro bilateral adrenal hyperplasia
mineralocorticoid receptro antagonists eg spironolactone or eplerenone
233
when do renin/ aldosterone ration and get high aldosterone and high renin this indicates
secondary hyperalodsteronism
234
most cases of secondary hyperaldosternism are due to
renal artery stenosis
235
cause of secondary hyperaldosteronism in young females
fibromuscular dysplasia
236
what looks for renal artery stenosis
CT angiogram or MR angiography
237
treatment for secondary hyperaldosteronism
aldosterone antagonist eg spironolactone
238
what treats renal artery stenosis
perucataneous renal artery angioplasty
239
what involves destruction fo the entire adrenal Cortex
Addisons
240
what is the most common cause of Addisons?
autoimmune adrenalitis
241
anticoagulant treatment can cause adrenal haemorrhage which can cause
Addisons
242
as there is decreased mineralocorticoids this will result in
K retention and Na loss
243
Addisons decreases glucocorticoids causing
hypoglycaemia
244
acth contains a sequence for what within it
Melanocyte stimualting hormone
245
skin pigmentation is not seen in
hypopituitarism
246
black spots in buccal mucosa, dark palmar creases and dark finger spaces
Addisons
247
what is positive in 70% of Addisons
antibodies
248
I know not the primary investigation but what is renin: aldosterone levels like in Addisons
renin high and aldosterone decreased
249
manageement for Addisons
hydrocortisone and fludrocortisone
250
pre op in Addisons need to increase
steriod replacement
251
exogenous steriod use does what
inhibit CRH and ACTH production so gland becomes atrophied and so unable to produce cortisol even if ACTH given endogenously
252
difference in secondary and tertiary adrenal insufficiency as opposed to primary
secondary and tertiary - skin pale as no increase in ACTH and aldosterone production is intact so no hypotension
253
what is investigation for secondary/ tertiary adrenal insuffiecny
insulin tolerance test or CRH stimulation test
254
management for secondary/ tertiary adrenal insuffiency
hydrocortisone - fludrocortisone is unecessary
255
Addison crisis caused by stress in adrenal insuffiency or sudden discontinuation of steroids
256
treatment for Addisons criss
NACL
257
what tumour from the sympathetic nervous system originates from neural crest cells
neuroblastoma
258
composed of primitive appearing cells but can show maturation towards gangliod cells
neuroblastoma
259
application of what in neuroblastoma predict a poor outcome
N-myc and telomerase
260
derived from chromaffin cells
phaeochromocytoma
261
paragangliomas are typically found in the
head and neck
262
10%of phaechromocytomas are not associated with
HYPERTENSION
263
pheochromocytoma associatd with
NF 1, men 2, VHL< succinate dehydrogenase enzymes and tuberose sclerosis
264
what has a tendency for skeletal metastasis
phaechromocytoma
265
classic triad of phaeochromocytoma
hypertension, headache and sweating
266
paraoxysmal sweating
phaeochromocytoma
267
postural hypotension is seen in how many pheochromocytoma cases
50%
268
7% of phaechromocytoma had normal 24hr urianry catecholamines so
secretion is episodic so take samples when patient symptomatic
269
ideally take plasma metalephrites or catecholamines
at time of symptoms
270
hyperglycaemia, low K, mild hypercalcaemai and lactic acidosis
phaeochromocytoma
271
pre op for phaechormocytoma what do you give first
alpha blocker - phenoxybenzamine
272
defintive management for phaechromocytoma
laparoscopic surgery
273
what is congenital adrenal hyperplasia
deficiency in one of the enzymes necessary for cortisol synthesis
274
90% of CAH are due to autosomal recessive
21 alpha hydroxyls defiecny
275
21 alpha hydroxyls mutation prevents the production of what
aldosterone and cortisol
276
why does CAH have increases testosterone and dihydrotestosterone
as can't produce aldosterone or cortisol then precursors are diverted into the androgen pathway
277
how does classic cat presents
birth - genital ambiguity in females
adrenal failure- hypotension, hypoglycaemia
278
non classic CAH is partial
21 alpha hydroxyls defeicny
279
how does non classic CAH present
in adolescents with precocious puberty, hirsutism, acne , infertility
280
investigation for CAH
17- OH progesterone
281
management of CAH
glucocorticoid replacement
