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Endocrine Flashcards

1
Q

Primary vs Secondary vs tertiary hyperparathyroidism causes and calcium levels

A

Primary - primary parathyroid adenoma. High PTH, High Ca
Secondary - low vit d or CKD. High PTH, low ca
Tertiary - prolonged untreated CKD, High PTH, High ca

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2
Q

Sx of hypoglycaemia

A

Pallor
Sweating
Restless
Tremor
Tachycardia
Anxiety
Confusion
Drowsiness

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3
Q

Rf for hypoglycaemia in hospital/ post admission

A

Change in diet during stay
Missed or delayed meals
Elderly pts
Mobilisation and physio regimes after illness
Prev ep of hypos

Medication changes
Medication errors
Comirbidities eg sepsis

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4
Q

Mild vs moderate vs severe hypoglycaemia features

A

Mild - <4, conscious, orientated, can swallow
Moderate - <4, conscious, able to swallow. Disorientated
Severe - <2.6 unconscious/agressive. Can not swallow

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5
Q

Rx of mild. If doesnt work what do you do

A

Give 5-7 dextrose tablets
Or glucojuice
Or lift juice shots

Stop any insulin in situ

Repeat x3 times, checking bm every 10-15mins. If still hypo, consider 1mg glucagon IM or 50/ml/hr of 20% iv glucose

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6
Q

Rx of moderate hypoglycaemia

A

If capable and cooperative treat like mild. If not, but can swallow, give 2 tubes of glucogel.

Max 3 times then IM glucagon or 50ml/hr 20% glucose

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7
Q

What should you do once bm rise above 4 in hypoglycaemia rx and why
What if glucagon has been administered

A

Give a long acting carbohydrate (20g) such as a slice of toast, glass of milk, 2 biscuits to replenish glycogen stores
If glucagon has been used, double the carbs (40g)

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8
Q

Presentation of DKA

A

Nausea vomiting
Sweet smelling breath
Abdo pain
Kussmaul breathing

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9
Q

What should you wait for before stopping IV insulin infusion

A

30mins after SC short acting insulin has been administered

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10
Q

Complications of HHS

A

MI, stroke, thrombosis
Seizures
Cerebral oedema
Central pontine myelinolysis

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11
Q

3 main features of HHS

A

Marked hypovolaemia/dehydration
Marked hyperglycaemia (>30)
Raised serum osmolarity >320

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12
Q

Calculate osmolarity

A

2(Na)+glucose+urea

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13
Q

Rx of HHS

A

Fluids
Insulin once glucose is no longer being reduced by fluids alone
Correct electrolyte imbalances - particularly potassium
VTE prophylaxis

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14
Q

Which diabetes drug can rarely cause mourners gangrene

A

SLGLT2 inhibitors (gliflozin)

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15
Q

ix for acromegaly

A

MRI head
Serum IGF 1 levels (GH not accurate enough as released in pulsatile manner)
OGTT - rapid increase in blood glucose should supress GH but GH levels not supressed

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16
Q

rx of acromegaly

A

transphenoidal surgery

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17
Q

what is Sheehans
rf for it

A

necrosis of pituitary after birth
PPH increases risk

18
Q

causes of hypopituitarism

A

pituitary apoplexy
sheehans
tumour
trauma
radiotherapy

19
Q

hyperprolactinaemia causes

A

anti psychotics
pituitary adenomas
prolactinomas
liver cirrhosis
pregnancy
acromegaly
Domperidone (common! used to induce lactation in breastfeeding)

20
Q

rx of hyperprolactinaemia

A

dopamine agonists eg bromocriptine, cabergoline

side effects of the dopamine is addiction! and risky behaviours

21
Q

ix results in diabetes insipidus

A

hypernatraemia
low urine osmolality
high serum osmolarity

22
Q

diagnostic ix for DI
results for craniotomy and nephrogenic

A

water deprivation test (desmopressin stimulation test)
crania low urine osmolality before and high after
nephrology low urine osmolality before but also low afterwards

23
Q

causes of nephrogenic DI

A

genetic
hypercalcaemia
lithium
pyelonephritis
sickle cell

24
Q

causes of cranial DI

A

head injury
pituitary adenoma
sarcoidosis
sheehan

25
Q

ix results in SIADH

A

dilutional hyponatraemia
high urine osmolality
low serum urine osmolality

26
Q

which lung cancer causes SIADH

A

small cell lung cancer

27
Q

causes of SIADH

A

Post-operative after major surgery
Lung infection, particularly atypical pneumonia and lung abscesses
Brain pathologies, such as a head injury, stroke, intracranial haemorrhage or meningitis
Medications (e.g., SSRIs and carbamazepine)
Malignancy, particularly small cell lung cancer
Human immunodeficiency virus (HIV)

top 3 - SSRI, small cell lung cancer, post surgery

28
Q

rx SIADH and what to monitor for

A

fluid restrict
demiclocycline
ADH antagonists

central pontine myelinisis - rx slowly, do not correct sodium levels too quickly

29
Q

rx of cranial DI

A

desmospressin

30
Q

rx of nephrogenic DI

A

thiazides and low salt diet

31
Q

features of hyperthyroidism

A

Rapid heartbeat (palpitations).
Feeling shaky and/or nervous.
Weight loss.
Increased appetite.
Diarrhea and more frequent bowel movements.
Vision changes.
Thin, warm and moist skin.
Menstrual changes.
Intolerance to heat and excessive sweating.
Sleep issues.
Swelling and enlargement of the neck from an enlarged thyroid gland (goiter).
Hair loss and change in hair texture (brittle).
Bulging of the eyes (seen with Graves’ disease).
Muscle weakness.

32
Q

antibodies in hyperthyroidism

A

TSH stimulating hormone
anti tpo

33
Q

rx of hyperthyroid

A

propanolol for adrenegeric effects
then carbimazole and thyroxine (block and replace)
radioactive iodine

34
Q

what drug not to give with methotrexate

A

trimethoprim!! risk of agranulocytosis!!

35
Q

someone come in with sore throat on carbimazole, what should you do

A

urgent FBC!!

36
Q

thyroid storm triad

A

fever, tachycardia, delirium

37
Q

what is the most common type of thyroid cancer

A

papillary

38
Q

what is AIN and features

A

hypersensitivity reaction causing inflammation of the space between the cells and the tubules of the kidney. It occurs in response to drugs (often antibiotics, including penicillin), infection (including staphylococcal infection) and systemic disease (such as systemic lupus erythematosus or systemic sclerosis). The presentation involves an allergic-type response, with an acute kidney injury (AKI) and hypertension.

rash, fever, arthralgia and aki

39
Q

what other endocrine condition should people with acromegaly be screened for

A

Diabetes mellitus due to insulin resistance

40
Q

features of acromegaly

A

frontal bossing, macroglossia, hypertension, bitemporal hemianopia, voice changes, sleep disturbance due to OSA, large hands and feet, prognathism

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