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MSRA- my cards > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What are the numbers to diagnose T2DM in a symptomatic patient? (OGTT)

A

Fasting glucose >7 or Random glucose> 11 if symptomatic. If asymptomatic need to repeat on 2 separate occasions

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2
Q

What is the HBA1C to diagnose T2DM ?

A

HBA1C >48

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3
Q

How are De Quervans and Graves differentiated?

A

Both are hyperthyroid. De Quevrans presents with a tender goitre

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4
Q

What would bloods show in anorexia nervosa?

A

Most things are LOW eg hypokaemia, low FSH and LH. However the C’s and G’s are raised. Eg raised cortisol, raised glucose, growth hormone, cholesterol.

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5
Q

What HBa1c is diagnostic for pre diabetes?

A

42-47

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6
Q

What is the treatment for De Qeurvans thyroiditis? (First line)

A

First line tx is conservative with ibuprofen

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7
Q

Which diabetes medication is contraindicated in heart failure?

A

Pioglitazone as they cause fluid retention

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8
Q

What are the side effects of Pioglitazone?

A

Fluid retention, liver dysfunction, weight gain.

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9
Q

How does hypocalceamia present?

A

Muscle cramps and parathesiae

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10
Q

What are the ECG findings of hypocalceamia?

A

Isolated QT interval elongation.

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11
Q

With an OGTT test, what fasting glucose is abnormal?

A

6.1 - 7.0 implies impaired fasting glucose (IFG)

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12
Q

With an OGTT test what values are considered impaired glucose tolerance?

A

OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

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13
Q

What drug is first line in painful diabetic neuropathy?

A

Duloxetine

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14
Q

What is the first line management of T2DM (without CVS risk factors?)

A

Metformin

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15
Q

What is the first line management of T2DM (WITH CVS risk factors/ or HF)

A

Metformin + SGLT2 inhibitor

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16
Q

What is an example of an SGLT 2 inhibitor?

A

the flozins…. dapagliflozin, and empagliflozin.

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17
Q

What is the biochemical presentation of addisons?

A

Hyponatraemia/ Hyperkaemia/ low BP.

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18
Q

What test diagnoses addisons?

A

Short synachten

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19
Q

What is the blood picture in sick euthyroid?

A

Low T3/T4 and normal TSH with acute illness

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20
Q

What would the C peptide show in T1DM?

A

Low in T1DM

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21
Q

In the management of T2DM if metformin in contraindicated and the patient has CHD what drug is offered?

A

dapagliflozin. SGLT2 monotherapy

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22
Q

Primary hyperaldosteronism can be caused by which 2 processes?

A

eg CONNS.
1. adrenal adenoma (managed surgically)
2. adrenal hyperplasia (managed with Sprinolactone)

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23
Q

What is your blood picture with secondary hyperparathyroidism due to CKD?

A

Low calcium
High PTH
High Phosphate
High ALP

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24
Q

What is the HBA1C target in T1DM?

A

48

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25
Q

What are the principles of pre op T2DM oral medications?

A

Continue them all (metformin etc) apart from FLOZINS SGLT2 inhibitors.

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26
Q

What are the pre diabetes targets?

A

42-47

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27
Q

Addisions- what are the biochemical markers?

A

Hyponatraemia, hyperkaemia

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28
Q

Gliclazide is what type of drug and what are the 2 main side effects?

A

Sulphonylurea
Side effects 1. Hypoglycaemia 2. Weight gain

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29
Q

What is the Hba1c target for a type 2 diabetic being treated with metformin?

A

48

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30
Q

Sickle cell does what to the HBA1C?

A

Lower than expected!

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31
Q

What should you do with long acting insulins pre op?

A

Reduce long acting insulin dose by 20% on day of surgery.

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32
Q

What is the significance of c peptide in differentiating between T1/T2 diabetes?

A

T2 diabetes C peptide will be high!

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33
Q

What is the blood picture in Pagets?

A

All normal apart from raised ALP.

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34
Q

Primary hyperparathyroidism- what are the bloods?

A

High calcium
Low phosphate
Normal or raised PTH

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35
Q

What is HONK?

A

High blood sugar
Dehydration and renal failure
Ketonuria

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36
Q

What to do with metformin pre op?

A

Day before surgery- keep going with metformin
Day of surgery- continue. If TDS can omit lunchtime dose.

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37
Q

Oral diabetic meds- what to do day prior to surgery?

A

Continue them!

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38
Q

What are the causes of cushings syndrome?

A

ACTH dependent- eg (Cushing disease) pituitary tumour secreting ACTH
Or ACTH from another source eg small cell lung ca.

ACTH independent - STEROIDS
Adrenal adenoma, adrenal carcinoma.

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39
Q

What tests confirm cushings syndrome?

A

Low dose dexamethasone suppression test confirms cushings syndrome and then needs additional tests to localise.

40
Q

What test confirms Cushings disease?

A

High dose dexamethasone suppression test

41
Q

Primary hyperaldosteronism presents how?

A

Hypertension, low potassium, metabolic alkalosis

42
Q

Treatment of addisonian crisis?

A

Fluids and IV/IM Hydrocortisone

43
Q

What are the causes of hypothyroid?

A

Hashimotos
Subacute thyroiditis
Postpartum thyroiditis
Iodine defiency
Lithium
(Amiodarone)
Riedels

44
Q

What is the reference range for TSH and free T4?

A

TSH (0.5-5.5)
Free T4 (9-18)

45
Q

What is the presentation of Cushings syndrome?

A

(excess steroid) eg weight gain, thirst, easy bruising, hirstiusm, striae.

46
Q

Management of hypoglycaemia in unconscious patient?

A

20% dextrose

47
Q

What are the features of HONK?

A

Hyperglycaemia,
Hypovolemia,
Raised osmolality

48
Q

What is the commonest cause of hypercalcemia?

A

Primary hyperparathyroidism

49
Q

Tests to investigate acromegaly? (2)

A

iGF 1 is the firstline line
Diagnostic test- OGTT with GH levels

50
Q

What is the measurement for macro vs micro pituitary adenoma?

A

1cm! Macroadenoma >1cm

51
Q

Cushings disease - what are the 3 management options and potential problems

A
  1. remove pituitary tumour that is secreting ACTH
  2. Pituitary radiotherapy
  3. BILATERAL ADRENOLECTOMY (Problems 1. Hypoadrenal crisis needing lifelong replacement. 2. Nelson syndrome where pituitary grows ++ mass effects).
52
Q

Most common thyroid cancer?

A

Papillary is the most common

53
Q

Kallmans syndrome- how does it present?

A

Cause of delayed puberty
Usually presents with boys/ delayed puberty and anosmia

54
Q

What are the criteria for impaired fasting glucose?

A

Over 6.1 but less than 7

55
Q

What are the criteria for impaired glucose tolerance

A

2hour glucose over 7.8 but less than 11. (AND fasting less than 7)

56
Q

What are some of the clinical features of graves?

A

Thyroid acropachy (swollen hands, digital clubbing and new bone formation)
Lid lag (not specific to graves)
Eye features
Pretibial myoxodema

57
Q

What are the antibodies in Graves?

A

TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)

58
Q

What is the first line management for adults with T1DM?

A

multiple daily injection basal–bolus insulin regimens
eg: long acting insulin + novorapid PRN

59
Q

T2DM- what is the HBA1C target with metformin and when would you add in a second agent?

A

48 with metformin alone
Add in another agent at 58

60
Q

What is the first line management of T2DM?

A

Normal people= Metformin
Any CVS risk factors or CVS disease= Metformin and once established add SGLT 2 inhibitor eg Flozin

61
Q

How does hyponatraemia present?

A

N+V
Diminished reflexes

62
Q

What are the complications of Cushings syndrome?

A

HYPERtension
Left ventricular hypertrophy
Arrythmias due to hypokaemia
Atherosclerosis

63
Q

Psuedohypoparathyroidism - what are the bloods?
Other features

A

High PTH
Low calcium
High Phosphate

Short stature
Unusual skeletal defects
4th and 5th metatarsal short

64
Q

Diagnosis of Addisons - what test?

A

Short synacten

65
Q

Biochemical picture in Addisons?

A

Low Na
High K

66
Q

Biochemical picture in Primary aldosteronism (Conns)

A

Hypokaemia (LOW K)
Classic is hypertension with hypokaleamia

67
Q

How does Kleinfelters present vs Kalmanns?

A

Kalmans= delayed puberty with anosmia
Klenfelters= No secondary sex characertistics/ small testes/ taller than average/ gynaecomastia.

68
Q

What are the 3 types of hormone secreting pituitary tumours?

A

ACTH secreting adenoma - present with Cushings
GH secreting adenoma (eosinophillic)- present with acromegaly
Prolactinoma - present with galactorrhea

69
Q

Phaeochromocytoma- presentation, arises from?/ secretes ?

A

Hypertension/ flushing/ headaches
Arise from ADRENAL MEDULLA
Secrete catecholamines

70
Q

Acromegaly- cause and complications?

A

Most common cause is a GH secreting adenoma in pituitary.

  • Complications
    Hypertension
    CVS
    Diabetes
71
Q

What is Wolfram syndrome?

A

DIDMOAD is the association of
- cranial Diabetes Insipidus, Diabetes Mellitus,
- Optic Atrophy
- Deafness

72
Q

Treatment of diabetes inspidius ( cranial vs nephrogenic)

A

Cranial DI= Desmopressin
Nephrogenic= Thiazide like diuretic (benzoflumethazide)

73
Q

What are the 4 examples where the PTH is high?

A
  • Primary/ secondary and tertiary hyperparathyroidism
  • Psuedohypoparathyrodism
74
Q

What happens to PTH/ Ca2+/ Phosphate?

  • Primary/ secondary and tertiary hyperparathyroidism
  • Psuedohypoparathyrodism
A

Primary- elevated PTH, HIGH calcium and low phosphate.

Secondary. elevated PTH, low calcium and high phosphate.

Tertiary. elevated PTH. High calcium and high phosphate

Psudeohypoparathyroidism- High PTH, Low calcium and high phosphate (same as secondary)

75
Q

What are the bloods in primary hypoparathyroidism?

A

Low PTH
Low calcium
High phosphate

76
Q

What are the bloods in Osteomalacia? (Calcium/ phosphate and ALP)

A

Low calcium
Low Phopshate
Raised ALP

77
Q

Addisions - what is the biochemical picture?

A

Low NA
High K

78
Q

How do these diabetic neuropathies present?
Sensory diffuse polyneuropathy
Painful diabetic neuropathy
Mononeuropathy
Autonomic neuropathy
Mononeuritis multiplex
Diabetic amylotrophy

A

Sensory diffuse polyneuropathy - glove and stocking

Painful diabetic neuropathy - burning/ pins and needles
Mononeuropathy - Peripheral or cranial nerves. Most common 3rd cranial nerve oculomotor.
Autonomic neuropathy - Dizzyness/ postural hypotension/ sweating
Mononeuritis multiplex - subacute loss of sensory + motor loss in an individual nerve.
Diabetic amylotrophy - unilateral pain in buttocks/ thigh. Absent reflexes

79
Q

What is the first/earliest sign of diabetic retinopathy?

A

First sign is microanuerysms

80
Q

What is the diagnostic test in Conns?

A

Aldosterone/ renin Ratio

81
Q

What are the 4 features of a phaeochromocytoma? and they are a/w with what?

A

Severe Hypertension
Diaphoresis
Headaches
Palpitations

A/W: Neurofibromatosis/ MEN/ VHL

82
Q

What diabetic drug increases the risk of Bladder ca?

A

Pioglitazone

83
Q

What is a side effect of Metformin?

A

Decreased Vitamin B12

84
Q

Hashimotos has which antibodies?

A

Anti TPO/ Thyroglobin

85
Q

What is the treatment of CAH?

A

Lifelong replacement of hydrocortisone

86
Q

Presentation of CAH?

A

Autosomal recessive
Salt wasting crisis when a newborn
Hypoglycaemia with concurrent illness

87
Q

What are the principles of anti thyroid medication in pregnancy

A

PTU is used in first trimester (up to week 12) and pre pregnancy
Carbimazole thereafter

88
Q

What are these signs in hypocalcaemia
- Chvostek’s sign
-Trousseau’s sign

A

Chvostek = tapping over facial nerve causes twitching
Trousseau’s sign- blood pressure cuff causes wrist flexion and carpal spasm

89
Q

Kussmall breathing is seen in?

A

Severe Metabolic Acidosis
eg DKA

90
Q

Toxic multi nodular goitre- features

A

2nd cause of hyperthyroid after graves
Nodules can suddenly become secretory and thyrotoxicosis
AF and acute heart failure is the presentation
“Plummers disease”
Tx- radioactive iodine ablation

91
Q

What are the principles of treatment for subclinical hypothyroid?

A

If TSH if above 10 then start levothyroxine

If TSH 5-10- can repeat in 6 months if asymptomatic
- if symptomatic can consider starting levothyroxine.

92
Q

What are the blood test results in Cushings?

A

Hypokalaemia
Hyponatraemia
Hypoglycaemia

Can get a metabolic alkalosis

93
Q

What would the bloods be for a pituitary tumour secreting TSH

A

High free T4
Normal TSH

TSH isn’t inhibited due to ++secretion from pituitary tumour. May have an accompanying bitemporal hemianopia

94
Q

Diagnosis of T2DM- criteria

A

If symptomatic need 1 of the following
- Fasting >7
- Random >11.1
- HBa1c > 48

If asymptomatic single reading needs to be demonstrated twice

95
Q

What is impaired glucose tolerance?

A

Fasting less than 7 AND
2hr glucose test between 7.8 and 11.1

96
Q

What is the difference between
- low dose dexamethasone test (overnight)
-high dose dexamethasone test?

A

Low dose (overnight) to confirm cushings SYNDROME
High dose to confirm cushings DISEASE

97
Q

How do you modify patients on insulin pre op?

A

Minor surgery- reduce long acting by 20% the day before
Major surgery- put them on a variable rate infusion

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