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MSRA > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Addisons has reduced output of what two hormones

A

Cortisol and aldosterone (steroid hormones)

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2
Q

What colour can skin go in addisons

A

bronze

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3
Q

electrolyte imbalances in addisons

A

low na
high k

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4
Q

test of choice for adrenal insufficiency (addisons)

A

short synacthen (synacthen is synthetic ACTH- expect cortisol to rise >double baseline in normal)

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5
Q

Cotton wool sign on XR

A

pagets

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6
Q

Addisons rx

A

Steroid replacement:
-hydrocortisone to replace cortisol as a glucocorticoid
-fludrocort to replace aldosterone as mineralocort

Double in acute illness - generally glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same

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7
Q

Addisonian crisis rx

A

IV hydrocort 100mg stat then 6 hourly

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8
Q

Phaeochromocytoma is assoc with which inherited disease

A

MEN2

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9
Q

Phaeochromocytoma Rx

A

alpha blockers eg phenoxybenzamine

beta blockers once established on alpha blockers otherwise can cause HTN crisis

Adrenalectomy is definitive but should be medically managed first to reduce risks in surgery/anaesthetic

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10
Q

Isolated ALP rise with normal ca, phos and vit D suggests what

A

Pagets disease of bone

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11
Q

Pagets Rx

A

bisphos
Calcitonin (endogenously inhibits PTH)
Surgery if symptomatic

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12
Q

Most common type of thyroid ca

A

papillary

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13
Q

Monitoring of previous thyroid ca

A

thyroglobulin levels

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14
Q

MEN1 cancers

A

parathyroid
pituitary
pancreas

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15
Q

MEN 2 gene

A

RET oncogene

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16
Q

MEN 2a cancers

A

Phaeochromocytoma
Parathyroid
Medullary thyroid ca

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17
Q

Men 2b cancers

A

Phaeochromocytoma
Medullary thyroid ca

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18
Q

What happens to testosterone, aldosterone and cortisol in congenital adrenal hyperplasia

A

Aldosterone and cortisol are low
Testosterone is high
This is because progesterone’s conversion to A and C is blocked so all the excess becomes T.

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19
Q

congenital adrenal hyperplasia mx

A

replace steroid hormones with hydrocort and fludrocort
?surgery for female genitalia

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20
Q

When to offer statin for T1dm

A

-Aged over 40 years.
-Has had diabetes for more than 10 years.
-Has established nephropathy.
-Has other CVD risk factors (such as obesity and hypertension).

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21
Q

Diabetes insipidus symptoms

A

Polyuria and polydipsia

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22
Q

2 types of diabetes insipidus

A

cranial (deficiency of ADH) and nephrogenic (insensitivity to ADH)

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23
Q

Diabetes insipidus has _____ blood and _____ urine

A

Concentrated blood
Dilute urine

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24
Q

Sodium high or low in Diabetes insipidus

A

High

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25
Q

Test for diabetes insipidus

A

Water deprivation test

Desmopressin suppression test

26
Q

Treatment for diabetes insipidus

A

Nephrogenic- thiazides, low salt/protein diet, high dose desmopressin

Cranial- desmopressin

27
Q

Tender thyroid goitre

A

De quervains

28
Q

Goitre plus thyroid eye signs, pretibial myxoedema, acropachy

A

Grave’s disease

29
Q

Increased TSH and bitemporal visual defect

A

TSHoma (pituitary)

30
Q

High TSH normal T4

A

subclinical hypothyroid

31
Q

Preceding systemic illness, low T4, TSH normal, clinically euthyroid

A

sick euthyroid

32
Q

De Quervains rx

A

supportive
can give B blockers or NSAIDs for sx

33
Q

Hyperthyroid medical management

A

Carbimazole

Propylthiouracil second line, risk hepatic reaction

Radioactive iodine

34
Q

Anti TPO antibodies are present in what

A

autoimmune thyroiditis (hashimotos) and graves

35
Q

myxoedema is in hyper or hypo thyroid

A

hypo (severe)

36
Q

Treatment for myxoedema

A

IV liothyronine

IV hydrocort until co-existing adrenal insufficiency is excluded

37
Q

What is the issue with levothyroxine in suspected adrenal insufficiency

A

can precipitate an addisonian crisis

38
Q

When do you give levothyroxine in subclinical hypothyroid?

A

Pregnancy

Serum TSH >10

Goitre

Symptomatic

High serum antithyroid peroxidase Ab

39
Q

Cushings DISEASE rather than sydrome is what

A

excess ACTH from pituitary (eg adenoma)

(stimulates adrenals to release excess cortisol)

40
Q

Cushings investigations

A

urinary free cortisol

dex suppression test (give at night then measure morning cortisol- should be low if healthy)

41
Q

What happens to potassium in cushings

A

low

42
Q

Medical management of cushings

A

metyrapone
ketoconazole
mitotane

43
Q

Fasting glucose ranges for IGT and diabetes

A

6.1-6.9 impaired
>7 diabetes

44
Q

OGTT ranges for IGT and diabetes

A

Impaired 7.8-11.1
Diabetes >11.1

45
Q

Which oral diabetes drugs have hypo risk

A

pioglitazones if used in combo
Sulfonylureas (gliclazide)

46
Q

Oral diabetes meds to be cautious in renal impairment

A

metformin
Sulphonylureas (gliclazide)

47
Q

oral diabetes meds that risk wt gain

A

pioglitazones
Sulfonylureas

48
Q

SGLT2 inhibitors example and side effect

A

flozins

wee out sugar

UTI, thrush, frequency

Euglycaemic DKA!!

49
Q

Oral diabetes med to avoid in heart failure

A

pioglitazone

50
Q

What is a drawback of gliptins (DPP-4 inhibs)

A

Often stop working

Headache,URTI and sinus infection SEs

51
Q

What diabetes med has cardiovascular benefit

A

SGLT-2 inhibitor eg dapagliflozin

52
Q

When do you start SGLT-2 inhibitors (flozins) in diabetics regardless of regime

A

If the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%)

the patient has established CVD or develops it

the patient has chronic heart failure

53
Q

can you get galactorrhoea in acromegaly

A

yes in 1/3

54
Q

drug to improve gastric paresis in diabetes

A

metoclopromide

55
Q

what is the single most important blood test to assess a patient’s response to treatment with levothyroxine for Hashimoto’s thyroiditis.

A

TSH

56
Q

HONK is characterised by

A

1.) Severe hyperglycemia
2.) Dehydration and renal failure
3.) Mild/absent ketonuria

57
Q

First line treatment for prolactinomas

A

Dopamine agonists (eg cabergoline, bromocriptine)

58
Q

What electrolyte imbalance do thiazides cause

A

hypercalcaemia

59
Q

Calcitonin is a tumour marker in what type of thyroid cancer

A

medullary thyroid cancer

60
Q

would hyper or hypoparathyroidism cause raised ALP

A

hyper

MSRA (21 decks)

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