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MSRA > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Test for phaechromocytoma

A

24 hour urinary collection for metanephrines

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2
Q

Management of phaeochromocytoma

A

Surgery - Stabilisation required first:
1. Alpha blocker (phenoxybenzamine) and then
2. Beta blocker

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3
Q

Mechanism of action of GLP 1 mimetics (eg exenatide)

A

Increase insulin secretion and inhibit glucagon secretion

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4
Q

Mechanism of action of DPP 4 inhibitors eg vildagliptin

A

Increase levels f incretins (GLP 1 and GIP) by decreasing their peripheral breakdown

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5
Q

ECG abnormality associated with hypercalcaemia

A

Shortened QT interval

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6
Q

ECG abnormalities associated with hypokalaemia

A

U waves
Small or absent T waves
Prolonged PR interval
ST depression
Long QT

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7
Q

Antibodies seen in hashimotos thyroiditis

A

Anti TPO
Ati Tg antibodies

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8
Q

What can cause HBA1c to be lower than expected

A

Sickle cell anemia
G6PD deficiency
Heriditary spherocytosis
Haemodylasis

Due to reduced red blood cell lifespan

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9
Q

What can cause higher than expected levels of HbA1c?

A

Vitamin B12/Folate deficiency
Iron deficiency anaemia
Splenectomy

Due to increased red blood cell lifespan

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10
Q

Definition of impaired fasting glucose

A

Fasting glucose greater than or equal to 6.1 but less than 7

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11
Q

Definition of impaired glucose tolerance

A

Fasting glucose less than 7 and OGTT 2 hour value greater than or equal to 7.8 but less than 11.1

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12
Q

Treatment for acromegaly

A

Trans sphenoidal surgery
If inoperable then:
1. Somatostatin analogue eg octreotide
2. Pegvisomant (GH receptor antagonist)
3.Dopamine agonist eg bromocriptine only effective in a minority.

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13
Q

Treatment for a prolocatinoma?

A

Dopamine agonist eg cabergoline or bromocriptine
Surgery if this fails

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14
Q

How often should HBA1c be checked?

A

Every 3 - 6 months until stable and then 6 monthly.

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15
Q

What is the 10% rule in phaechromocytoma?

A

10% are bilateral
10% are malignant
10% are extra adrenal

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16
Q

Adverse affects of pioglitazone

A

Weight gain
Liver impairment
Fluid retention
Increased risk of fractures
Increased risk of bladder cancer

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17
Q

What is the starting rate of IV insulin for DKA

A

0.1 units/kg/hour

18
Q

What are the causes of primary hyperaldosteronism?

A
  1. Bilateral idiopathic adrenal hyperplasia (60 - 70% of cases)
  2. Adrenal adenoma (20 - 30% of cases)
  3. Unilateral hyperplasia
  4. Familial hyperaldosteronism
  5. Adrenal carcinoma
19
Q

Who should be screened for primary hyperaldosteronism?

A
  1. Hypertension with hypokalaemia
  2. Treatment resistant hypertension
20
Q

What is the first line investigation for primary hyperaldosteronism?

A

Aldosterone/renin ratio

21
Q

What will the renin aldosterone ratio show is patients with primary hyperaldosteronism?

A

High aldosterone and low renin

22
Q

What is the management for bilateral adrenocorticol hyperplasia?

A

Aldosterone antagonist (spironolactone)

23
Q

Treatment for toxic multinodular goitre

A

Radioiodine therapy

24
Q

Nuclear scintigraphy results in toxic multinodular goitre

A

Patchy uptake

25
Q

Nuclear scintigraphy results in graves disease

A

Diffuse enlargment of both thyroid lobes

26
Q

Blood gas result in cushings syndrome

A

Hypokalaemic metabolic alkalosis

27
Q

First line test to confirm cushings syndrome

A

Overnight (low dose) dexamethasone suppression test
- Most sensitive test. Patients with cushings - no supression of morning cortisol

28
Q

What tests allows you to localise the pathology resulting in cushings syndrome

A
  1. 9am and midnight ACTH + cortisol levels. If ACTH supressed then a non ACTH dependant cause is likely (eg adrenal adenoma)
  2. High dose dexamethasone supression test
29
Q

Antibodies in graves disease

A

Anti TPO
TSH receptor stimulating antibodies

30
Q

What medication interacts with levothyroxine

A

Iron

31
Q

What is the optimal management of thyrotoxicosis in patients who are pregnant or planning a pregnancy?

A

Thyroidectomy then thyroxine replacment

32
Q

Blood gas results in an addisonian crisis

A

Metabolic acidosis with low sodium and raised pottasium

33
Q

Triad of MEN 2A

A

Medullary thyroid cancer
Primary hyperparathyroidism
Phaeochromocytoma

34
Q

Triad of MEN1

A

Hyperparathyroidism
Pituitary adenoma (usually prolactinoma)
Pancreatic islet cell tumour

35
Q

Diagnosis of adrenal failure

A

short synacthen test. In adrenal failure plasma cortisol will not rise to above 550

36
Q

What is the mechanism of action of sulfonlyureas

A

Stimulated insulin secretion for the beta cells of the islets of langerhans

37
Q

What is the mechanism of action for DPP4 inhibitors such as sitagliptin

A

Inhibit DPP4 which destroys incretics. Allsos increase in incretins which stimulate the release of insulin and inhibit the release of glucagon.

38
Q

What are the results of FSH, LH and testosterone in kallmans syndrome

A

Low LH, FSH and low Testosterone

39
Q

Management of a thyroid strom

A

IV Propanolol
Anti thyroid durgs et Methimazole or propylthiouracil
Lugols iodine
Dexamthasone

40
Q

Treatment for myxodema coma

A

IV thyroid replacement
IV fluids
IV corticosteroids

MSRA (23 decks)

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