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MSRA 2023 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Which DM meds contraindicated in HF

A

Pioglitazone

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2
Q

Factors that decrease HbA1c

A

sickle cell, GP6D Def, hereditary spherocytosis, haemodialysis

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3
Q

Factors that increase HbA1c

A

vit B12/folic acid def, IDA, splenectomy

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4
Q

sulfonylureas mechanism

A

gliclzide, glipizide, tolbutamide. bind to ATP-dependent potassium channel of pancreatic beta cells

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5
Q

Target HbA1c life style

A

48mmol/L 6.5%

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6
Q

Target HbA1c life style + metformin

A

48mmol/L 6.5%

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7
Q

target HbA1c DM control second agent OR receiving meds which may cause HYPOglycaemia

A

53mmol/L 7%

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8
Q

Dx DM2

A

Sx fasting glucose >=7mmol/L
Random glucose >=11mol/L or after 75g OGTT
HbA1c >= 48mmol/L (6.5%)

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9
Q

When to add 2nd drug T2DM

A

HbA1c rises to 58mmol/L (7.5%)

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10
Q

Aldosterone electrolyte

A

low potassium, high sodium, increase blood volume, high BP

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11
Q

Dx DKA

A

glucose >11mmol/l OR known DM; pH < 7.3 or bicarb <15mmol/l, ketones >3mmol/l OR urine dip stick ++ ketone

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12
Q

electrolyte in Conn’s

A

hyperaldosteronism
hypernatraemia
Hypokalaemia
metabolic alkalosis (proton loss)

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13
Q

when to add DPP-4 inhibitor

A

only if pt does NOT tolerate triple tx

causes WEIGHT LOSS

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14
Q

Subclinical hypothyroidism definition

A

TSH high, normal T3+T4
ASX

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15
Q

Mx subclinical hypothyroidism

A

TSH >10mU/L + T3/4 normal: offer levothyroxine if elevated 2 separate occasion taken 3months apart

TSH 5.5-10 + normal T3/4:
<65yrs offer 6month trial of levothyroxine
if >80yrs-> watch + wait

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16
Q

Pituitary cause of hypothyroidism: lab result

A

low TSH + T3+ T4

(LOW EVERYTHING)

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17
Q

Aim of levothyroxine

A

normalisation of TSH level

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18
Q

What to do with iron + levothyroxine

A

levothyroxine absorption decreases with iron-> give at least 2 hours apart

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19
Q

What is Hashimoto’s thyroiditis
What does it cause HYPER/ HYPOthyroidism?

A

Autoimmune thyroiditis

transient thyrotoxicosis in acute phase BUT later results in HYPOTHYRODISM

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20
Q

Ab in Hashimoto’s thyroiditis

A

anti TPO, anti- thyroglobulin

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21
Q

What is subacute thyroiditis
What does it cause HYPER/ HYPOthyroidism?

A

Typically occurs follwoing viral infection

De Quervain’s thyroiditis

Phase 1: hyperthyroidism, painful goitre, high ESR
2. Euthyroid
3. Hypothyroidism
4. Thyroid structure and function- normal

22
Q

Phases of subacute thyroiditis

A
  1. 3-6 weeks: hyperthyroidism, PAINFUL GOITRE, raised ESR
  2. 1-3 wks: euthyroid
  3. wks- months: hypothyroidism
  4. back to normal
23
Q

Which disease causes painful goitre

A

subacute thyroiditis/ De Quervain’s thyroiditis

24
Q

Mx subacute thyroiditis

A

self limiting
analgesia: NSAIDS, aspirin

severe: steroid

25
Q

Most common cause of thyrotoxicosis

A

Grave’s disease

26
Q

Ab found in Grave’s disease

A

TSH receptor stimulating Ab
Anti- TPO Ab

27
Q

Mx Grave’s disease

A
  1. initial sx mx: propranolol
  2. antithyroid meds: carbimazole 40mg

3, Radioidodine- relapse follow ATD OR resistant to ATD
- CI: agre, <16yrs, thyroid eye disease-> may worsen

28
Q

Mx Thyroid storm

A

1st line: BB- iv propranolol (CI: COPD, ASthma), calcium channel bl can be used
ATD: Methimazole/ Propylthiouracil PTU
Lugol’s iodine
dexamethasone

Plasma exchange

29
Q

Primary hyperaldosteronism aka, sx esp electrolyte

A

Conns disease
Hyperkalaemia, hyponatraemia, hypertension metabolic alkalosis

30
Q

Addison disease , sx, mx

A

Primary adrenal insufficiency

Low sodium, high potassium, low BP, metabolic acidosis, low BM

Give hydrocortisone, fludrocortisone.

Sick day rule, double dose of hydrocortisone

31
Q

Affects of adrenal and what disease is insufficiency

A

Increases sodium, decreases potassium, increases BP, increases BM.

Causes Addisons disease

32
Q

Normal levels of cortisol 9am

A

If cortisol >500nmol/l unlikely abonormal
If btw 100-500 will need short sync than test
If <100 then def. Abnormal

33
Q

Ix for addisons disease

A

Primary aldrenal insuffficiency

Check 9am cortisol
>00nmol/l normal
Btw 100-500nmol/l then need short sync than test
If <100nmol/l then def. Abonormal

Short synectan test take cortisol 30min before giving sync then and 30min after
Is cortisol level is still low then do of primary adrenal insufficiency as synacthen is copy of ACTH

34
Q

Ix for conns disease

A

1st line:aldosterone:renin ratio

If primary- high aldosterone:low renin
If secondary high aldosterone &renin

35
Q

Mx of conns disease\ hyperaldosteronism

A

Adrenal adenoma- lap adrenalectomy

If bilateral adrenal, hyperplasia- needs aldosterone ATG- spironolactone

36
Q

Diabetic neuropathy mx

A

1st line: amitriptyline, duloxetinem gabapentin, pregabalin

2nd line: tramadol rescue

Try others first before changing

37
Q

AutoAb found in DM1

A

Anti-glutamic acid decarboxylase, islet cell AB, insulin autoantibody , insulinoma ass 2 AutoAb.

C -peptide low

38
Q

Dx of impaired fasting glycemic

A

Fasting >6.1 but <7mmol/l
After 2hours <7.8mmol/l

39
Q

Impaired glucose tolerance dx

A

Fasting <7 mmol/l
2hour >7.8 mol/l but <11mmol/l

40
Q

Visual disturbances in prolactinoma

A

Bitemporal hemianopia or upper quadrant quadrantopia

41
Q

Mx prolactinoma

A

> 1cm macroadenoma- likely need surgery

Or medical mx
Dopamine AG- cabergoline or bromocriptine inhibit release of prolactin from pituitary gland

42
Q

Pheochromocytoma mx & dx

A

Alpha blocker- phenoxybenzamine 1st then beta blocker

Dx: 4 hr urine metanephrines 1st line or 24 hour collection of catechilamine

43
Q

Which drug can cause gynaecomastia

A

Spironolactone, anabolic steroid,

44
Q

Regulation of prolactin

Mx of hyperprolactin level

A

Dopamine inhibit release of prolactin
TRH therefore hypothyroidism stimulates prolactin release

Mx: dopamine AG: cabergoline, bromocriptin
Treat hypothyroidism

45
Q

Indication of anti thyroid drug in pregnancy

A

PTU can use in 1st trimester
Methimazole can use in 2nd trimester

Radioiodine contraindicated

46
Q

Antibodies of Graves’ disease

A

Graves’ disease - hyperthyroidism AutoAb against thyroid stimulating receptor in follicular cell

TSH-R Ab, anti-thyroid peroxidase Ab

47
Q

What needs to be taken into consideration when taking thyroxine?

A

Iron decreases absorption of thyroxine therefore taken 2 hours apart

48
Q

Causes of pri, sec, tertiary hyperparathyroidism

A

Primary: solitary adenoma of parathyroid gland
Sec: CKD, vit D deficiency-> chronically low calcium level stimulates parathyroid hormone

Tertiary: due to long term secondary parathyroidism, proliferation of parathyroid gland cells therefore produce excessive path even if level normalised

49
Q

Mx hypercalcaemia

A

1st line: ivi/ loop diuretics

Increase GI excretion- glucocorticoids
Prevent bone resorption- bisphosphonat4, calcitonin

50
Q

Causes of Conn’s disease

A

Hyperaldosteronism

Primary- adrenal adenoma, hyperplasia

Secondary: outside adrenal Renin dependent- low Bp eg HF, cirrhosis, renal artery stenosis

51
Q

Causes of hyperaldosteronism

A

Primary: adrenal axis- idiopathic hyperaldosteronism, conns syndrome- bilateral idiopathic adrenal hyperplasia

Secondary: outside adrenal low BP, cirrhosis, renal arthritis stenosis

MSRA 2023 (22 decks)

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