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Barts Final Year > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the MOA of orlistat?

A

Inhibits gastric and pancreatic lipase to reduce the digestion of fat

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2
Q

Name 2 medications which may be used in the management of obesity

A
  • Orlistat (lipase inhibitor)
  • Liraglutide (GLP-1 mimetic)
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3
Q

What are the classes of obesity, give the BMI ranges foir each class

A
  • Class 1: 30 - 35
  • Class 2: 35 - 40
  • Class 3: >40
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4
Q

What is the infusion rate of inulin in DKA?

A

0.1 units/kg/hr

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5
Q

When should an infusion of 10% dextrose be started at 125mls/hr?

A

Once blood glucose is < 14mmol/L

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6
Q

What should happen to a patient’s usual insulin regemine in type 1 diabetics?

A

Long-acting insulin should be continued, short-acting stopped

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7
Q

What is the most dangerous complication of correcting electrolytes in DKA?
- Usually occurs after 4-12 hours

A

Cerebral oedema

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8
Q

What are the factors to define DKA resolution?

A
  • pH >7.3
  • Blood ketones <0.6mmol/L
  • Bicarbonate >15mmol/L

All 3 need to be satisfied

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9
Q

When is a K+ infusion required in DKA?

A

Below 5.5 mmol/L give 40mmol/L
- below 3.5 requires senior review

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10
Q

What is the key parameter to monitor in patients with HHS?

A

Serum osmolality

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11
Q

What are the side-effects of thyroxine?

A
  • Hyperthyroidism (over-treatment)
  • Reduced bone mineral density
  • Worsening of angina
  • AF
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12
Q

Every person treated with insulin should be given what extra kit

A

Glucagon kit

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13
Q

In Addison’s patients with an intercurrent illness what should happen to there drug dosing?

A
  • Double glucocorticoids
  • Keep fludrocortisone the same
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14
Q

1st line investigation in suspected primary hyperaldosteronism? (it is also diagnostic)

A

Aldosterone/renin ratio

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15
Q

What investigations are done after aldosterone/renin ratio?

A

CT abdo and adrenal vein sampling to differentiate between unilateral and bilateral sources of aldosterone access

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16
Q

CHild woth palpable abdo mass or unexplained enlarged abdo organ, what should you do?

A

Refer urgently (<48hrs) for specialist assessment for neuroblastoma and Wilm’s tumour

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17
Q

What is the diagnostic test for addison’s

A

Synacthen (ACTH) stimulation test

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18
Q

1ml of insulin equals how many units?

A

100 units

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19
Q

What is the treatment of an adrenal adenoma?

A

Laprascopic adrenalectomy

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20
Q

What is the treatment of bilateral adrenocortical hyperplasia?

A

Spironalactone (aldosterone antagnoist)

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21
Q

What can levothyroxine interact with to decrease absorption? (need to be given 4 hours apart)

A
  • Iron
  • Calcium
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22
Q

At what HbA1c would a second antidiabetic agent be added?

A

58 mmol/mol (unless CV disease then -> SGL2Ti)

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23
Q

When would 40 mmol/L of K+ be added to saline in DKA?

A

When potassium is between 3.5 - 5.5 mmol/L

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24
Q

Patient is on 500 mg of metformin bd anf his HbA1c is 51 mmol/L what is the best course of action in relation to his meds?

A

Increase metformin to 500 mg TDS

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25
Q

Subclinical hyperthytoidism is associated with what? (3)

A
  • AF
  • Osteoperosis
  • Dementia
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26
Q

What is the initial management of hypercalcemia?

A

1L of 0.9% NaCl over 4 hrs

27
Q

Name 3 risk factors for graves disease?

A
  • Female
  • Over 30
  • Smokers
28
Q

Patient takes long-term prednisolone and is acutely unwell, what should be doen with his steroid dose?

A

Double

29
Q

What endocrine drug can cause a neutrophilia?

A
  • Prednisolone
    (also lithium and retinoids?)
30
Q

What are the T1DM sick day rules? (5)

A
  • Do not stop insulin
  • Check blood glucose more frequently (including thru the night)
  • Consider bloor or unrine ketones checking
  • Maintain as normal a meal pattern as possible (drink juice/milk if meals not tolerated)
  • Drink 3L per day at least
31
Q

Dehydration and SGLT2is increase the risk of what?

A

Euglycemic ketoacidosis

32
Q

If a patient is on thyroxine and the TSH is high what is that likely to indicate?

A

Poor compliance

33
Q

Tender thyroid that is associated with both hyper and hypothyroidism is known as what? (2)

A
  • Subacute thyroiditis
  • AKA DeQuervain’s thyroiditis
34
Q

T2DM glucose levels?
1. Fasting
2. OGTT and random

A

7/11
- Fasting: >= 7 mmol/L or higher
- OGTT/random: >= 11.1 mmol/L

35
Q

Impaired fasting glucose and impaired glucose tolerance is defined with what blood sugar levels?

A
  • IFG: 6.1 - 7.0 (<7.0)
  • IGT 7.8 - 11.1 (<11.1)

(mmol/L)

36
Q

HbA1c for prediabetes

A

42 - 47

37
Q

How can prediabetes be defined? (2 different ways)

A
  • HbA1c: 42 - 47 mmol/L
  • Fasting glucose: 6.1 - 6.9 mmol/L

(not impaired glucose tolerance IGT)

38
Q

What kind of drug is prochorperazine?

A
  • Anti-psychotic
  • Anti-emetic
    May be used in migraines
    Similar to haloperidol, can cause incr prolactin
39
Q

If patient is starting on SGLT2i for T2DM what should be given first?

A

Metformin, titrate up

40
Q

Management options for gastrointestinal autonomic neuropathy? (3)

A
  • Metoclopramide
  • Domperidone
    (pro-kinetic, dopamine anti-emetics)
  • Erythromycin
41
Q

What should be given in hyperthyroidism thyrotoxicosis with tender thyroid (subacute thyroiditis)?

A
  • Pain management (NSAID)
  • NOT Carbimazole or PTU
42
Q

After IGF-1 what is the next investigation in order to confirm the diagnosis of Acromegaly?

A

OGTT and serial growth hormone levels

43
Q

How is thyroid strom treated? (3)

A
  • Beta blockers
  • PTU
  • Hydrocortisone
44
Q

Sick euthyroid syndrome is characterised by what?

A

Low T3/T4 and normal TSH with acute illness

45
Q

Tests to confirm Cushing’s syndrome?
(bonus points for extra tests)

A
  • Overnight (low-dose) dexamethasone suppression test

Also but less common (2 measurements required):
- 24 hr urinary free cortisol
- Bedtime salivary cortisol

46
Q

Medication prescribed in phaeochromocytoma? (pre-surgery)

A

Phenoxybenzamine then propranolol (alpha then beta)

47
Q

1st step investigation in hypercalcemia?

A

PTH level

48
Q

What thyroid conditions are just associated with hypothyroidism
(4)

A
  • Hashimotos
  • Riedel’s
  • Iodine deficiency
  • Lithium
49
Q

What conditions are just associated with hyperthyroidism?

A
  • Grave’s
  • Toxic multinodular goitre
50
Q

What conditions are associated with both hypo and hyperthyroidism?

A
  • Subacute (De Quervain’s) (Initially HYPER)
  • Postpartum thyroiditis (initially hyper)
  • Amiodarone
51
Q

If a patient has subclinical hypothyroidism what should you check for?

A

Thyroid antibodies

52
Q

What is being released in a small cell lung cancer causing a moon face and buffalo hump?

A

ACTH
- Therefore in a dex suppression test there will be both high cortisol and ACTH

53
Q

Most common complication of thyroid eye disease?

A

Exposure keratopathy (see specialist immediately if any vision changes)

54
Q

What T2DM drugs may increase ulcers and amputations?

A

SGLT2is - canagliflozin

54
Q

What neuropathic pain medication may cause urinary retention?

A

Amitriptyline

55
Q

When is PTU given and wehn is carbimazole given in pregnancy?

A
  • PTU 1st trimester
  • Carbimazole 2 -3rd trimester
56
Q

Hyperthyroidism or hypo associated with hypothermia?

A

Hypothyroidism

57
Q

What is the most common cause of hyperparathyroidism?

A

Parathyroid adenoma

58
Q

A positive low dose dexamethasone test means cortisol remains high, what does this confirm?

A

The patient has Cushing’s syndrome
- The origin cannot be asertained yet however

59
Q

High dose dexamethasone suppresion test is used to do what?

A

Differentiate between causes of Cushing’s syndrome (hypercorticolism)

60
Q

What will the results of a high dose dexamethasone suppression test produce in a pituitary tumour? (Cushing’s disease)

A
  • Low ACTH
  • Low Cortisol
61
Q

What will the results of a high dose dexamethasone suppression test produce in an adrenal tumour?

A
  • Low ACTH
  • Still High cortisol (as the tumour still secretes this)
62
Q

What will the results of a high dose dexamethasone suppression test produce in an ectopic tumour?

A
  • High ACTH (as this is what the tumour secretes)
  • High cortisol
63
Q
A

Barts Final Year (13 decks)

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