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A - Placement > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Pseudohypoparathyroudism is what?

A

Parathyroid resistance

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2
Q

Steroid hormone is based on what? Where can it therefore act in the cell?

A
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3
Q

Hypothyroid woman falls pregnant. What do we need to ell her to do?

A

Increase levothyroxine by 25

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4
Q

Hypothyroidism affect on periods

A

Can cause infrequent heavy periods

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5
Q

Hirsuitism, weight gain and easy bruising think what

A

Hirsuitisma nd weight gain = PCOS

+ easy bruising = Cusings
+

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6
Q

Drugs that can cause hypothyroidism

A

Amiodarome - can cause hypo and hyper thyroidism
Lithium
Tyrosine kinase inhibitors
Immunotherapy - immune checkpoint inhibitors
Drugs/trratment for hyper thyroidism

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7
Q

TPO antibodies are for what?

A

Autoimmune hypothyroidism. If they have a goitre then it is hashimotos

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8
Q

When is levothyroxine best taken?

A

First thing in the morning on an empty stomach

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9
Q

Subclinical hypothyroidism treatment

A

Repeat tests in 3 months

Might revert
Check TPO antibodies.
If TSH over 10 or then treat with levothyroxine

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10
Q

Eye signs of hyperthyroidism

A

Lid lag a
Lid retraction

Graves only (due to trab antibodies)
Periorbital oedema
Proptosis
Redness
Opthalkoplagia causing Diplopoda

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11
Q

Scan to differentiate hyperthyroidism causes

A

Thyroid uptake scan (radioisotope scan)

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12
Q

What is postpartum thyroid it is and how do we treat?

A

Hyper or Hypothyroidism following giving birth

Hyper: B Blockers
Hypo: Levothyroxine

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13
Q

Hyperthyroidism typical treatment side effect and most common presentation of side effects. What do we do if they present like this?

A
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14
Q

Lump moves on sticking out tpungue vs moving on swallowing

A

Toungue = thyroglossal cyst
Swallowing = thyroid issue

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15
Q

Hard lump malignant thyroid lump do what?

A

Remove it
Then radioactive iodine (ablation)
Suppressive doses of TSH to reload thyroid

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16
Q

Micro vs macro prolactin/adinoma

A

10x10x10 or bigger is macro

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17
Q

Treatment of microprolactinoma ?

A

Carbogoline once weekly

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18
Q

Important info when starting carbergoline? How long are you in for microprolactinoma

A

Warning of disinhibition eg gambling
Periods and fertility can resume. If pregnant, stop as little evidence and following pregnancy periods resume.
Last thing at night with a snack. Might ,are drowsy/feel sick.

Microprolactinoma - 2/3 year trial and see if there is any difference

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19
Q

When should cortisol levels be done?

A

9am in the morning (will be highestish) (most likely to hit the 350 - should be above this to exclude adrenal insufficiency)

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20
Q

What is addisons ?

A

Autoimmune primary adrenal failure

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21
Q

macrotumour mildly raised prolactinoma what type of tumour

A

Stalk disconnect tumour

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22
Q

Glucocorticoid steroids or thyroxine start first when they are bo5 needed (anterior hypo pituitary is)

A

Glucocorticoid steroids first

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23
Q

Headaches, sweating, greasy skin: key symptoms of what endocrine condition?

A

Acromegaly

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24
Q

What does acromegaly mean

A

Big hands and feet

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25
acanthosis nigricans causes
Increased insulin
26
Is resistant hypertension a symptom of acromegaly?
Yes
27
Ketones over what is ska territory?
Over 3
28
Cut off for severe acidosis?
Under 7
29
How do we treat dKA?
VIP Volume 1L over 1 hour Insulin (actrapid 6 U /hour) Potassium (when by under 14, 10% dextrose with potassium added to saline bags)
30
Hyperkalaemia treatment
Insulin (drives potassium into cells )
31
Key complications of dKA
Hyper/hypokalaemia Hypoglycaemia (rebound ketones, Ute brain injury) Cerebral oedema Aspirational pneumonia AARDs
32
Arterial or venous blood gas for dKA?
Venous
33
DKA fluid of choice
Saline just be careful of hylercholaemia acidosis
34
DKA fluid of choice
Saline
35
DKA continue basal insulin
Yes
36
Lara vs type 1 diabetes
Lada: presents as type 2 then antibodies build up gradually over time and then suddenly will develop type 1like symptoms
37
What type of hormone is insulin?
Peptide
38
What type of insulin do we use in infusions for dKA?
Short acting analogue (humalin S, actarapid, insuman rapid)
39
Targets for glucose levels in t1d
40
Insulin to carb ratio
1u insulin to 10g carb
41
Time in range is within what rage for diabetes? How much of their time do we want time in range?
4-7, we want 70% Time in range
42
When do we not use hba1c?
•Suspected T1DM •Rapid onset of symptoms (T1, steroids, children, pancreatitis, pancreatic surgery) •Pregnancy •Conditions that affect RBC survival •Dialysis patients •Iron/B12 deficiency
43
Hba1c target usually
Under 53
44
Metformin side effects
GI upset
45
Sglt2 inhibitors problems
Founires gangrene (nastily genital gangrene) May see initial dip in kidney function and then it will improve long term Euglycaemic ketones acidosis
46
The gliptins are what type of drug?
Dpp4 Good as less likely to get hypos
47
Piaglitazone side effects
Fluid retention
48
What injectable agents are there? Which ones are cardio protective?
Gpp 1 - cardio protective Insulin
49
What effect does steroids have on glucose?
Increase glucose
50
How do we calculate plasma osmolality
2 x sodium +urea +glucose
51
What is hhs How do we treat
Hyperosmolar hyperglycaemic state . No BIG ketosis or acodosis. Osmolality greater than 320 Like a dKA but for type 2 diabetes Look properly unwell, very dehydrated Treatment Monitor osmolality and potassium. Fluids 1L 0.9% saline over 1h. Aiming 2-3L in 6 hours Inly if ketotic then insulin infusion. (Half what you give for dKA, so only 3u). Takes 2-3 days to return to normal levels
52
Why high blood glucose results in blurry vision?
Because glucose increases plasma osmolality and this can build up in the lense and affect the eye
53
Diabetes and hypertension, what drug do we want?
Ace inhibitors
54
Cut off for passing short synacten
Over 550
55
What turns little girls into little boys and little boys into little men and how do we test it? How to we treat ?
21 hydroxyhyperplasia tested with 17 OH hydroxy enzyme. Treat with hydrocortisone
56
What drug can we use to block cortisol production?
Metyrapone
57
Potassium. Under 2, what do we need to think?
Ectopic acth
58
Cramping is as a result of what
Hypokalaemia
59
Hypokalaemic alkalosis causes with heigh blood pressure
Liquorice Conns Cushings
60
How do we confirm high aldosterone?
Saline suppression test
61
What drug can we control conns with if we can’t do surgery
Spiralactome, eplerenone Gynaocomastia
62
Screening tests for conns
Aldosterone to rennin ratio Scan confirmed - selective adrenal vein sampling
63
Acutely illness into hospital, what do we need to consider in patient on Metformin?
Sick day rules and if they are going for angioplasty might need to stop Metformin and put onto insulin
64
Chariots difference between feet temp
More than 2 degrees
65
Chariots management
Stop using foot (non weight baring and immobilised Optimise diabetes
66
Why is frontal balding important with hand crmaping?
Myotonic dystrophy
67
hypocalcaemia symptoms
Neuro hyperexcitability Chovsteks sign, troussau sign, pins and needles,
68
do we need magnesium to secrete pth?
Yes
69
What is pseudohypoparathyroidism?
PTH resistance, allbrights clinical dystrophy, obese and round. Short 3 and 4 metararples.
70
How do you treat hypocalcaemia?
IV calcium, Bolus only lasts 2/3 hours, so needs to be put in over several hours
71
How do we try to ensure hypocalcaemia doesn't recommence?
Potent Vit D analogue (Alfacalcididol And Sandoacl 1000
72
Autoimmune polyglandular fever... Types
Type 1 and Type 2 Type 2: more commmon, adulthood, women more than men, polygenic Type 1: chronic thrus, hypoparathyroidism and adrenal insufficiency, monogenic, AIRE gene
73
Causes of Hypoglycaemia
EPLAIN Exogenous (insulin/drugs) Pituitary insufficiency (ACTH/GH) Liver Failure Addisons, Autoimmune, Alcohol Insulinoma Neoplasia (non-islet cell tumour hypoglycaemia IGF2 mediated) Multiorgan failure
74
How do we Investigate hypoglycaemia?
COnfrim using Whipples criteria - triad (symptoms, Resolution, lab glucose (under 2.2) Asses role of insulin (can do 48/72h fast to check for insulinoma)
75
What other substance is released from beta cells with endogenous insulin?
C-peptide
76
What effect does circulating insulin have on ketone production
supress
77
How can we prevent hypoglycaemia in patients getting hypos (non diabetic)
10% dextrose or NG tube overnight Diazoxide 150mg tabs Octreotide
78
LADA - gad autoantibodies Primerary hyperaldosterone high prolactin definitiosn of impaired glucose tolorence dka treatment hhs analogue insulin vs human
79
ANALOGUE insulin - modern long acting insulins
80
Gestational diabetes criteria
Fasting over 5.1 2 Hour over 8.5
80
Good drugs for gestational diabetes
Metformin, then Insulin as the placenta grows if control out of target (under 5.5 and 2h under 7)
81
A sestimibi scan is for what
Primary hyerparathyroidsim (primary prathyroidinoma) (CALCIUM)
82
What scan can we use to differenciate Graves disease and post partum thuroiditis
Thyroid isotope scan - there would be uptake, whereas there wouldn''t be for post partum
83
What is manitol used for?
REducing ICP
84
novorapid and humalog are both what type ofo insulin?
rapid analogues
85
what type of insulin is act rapid
"short" humalin insulin analogue
86
Levemir and lantus are what type of insulin?
LOng L for Long
87
Piaglitazone side effect
Fluid retnesion, weight gain - sub cut fat (turns apples into pears)
88
GLP1 how does this work?
Delays gastric emptying and makes you feel full, actually a very good weight loss drug
89
Can the patient feel a charcot foot?
Not really, bit warm, rocker bottom
90
Can't sleep at night with foot pain is what with diabetic
diabetic neuropathy
91
Prolactin level for macroprolactinoma
3 000+ Therefore if less than this and lower levels of other pituitary hormones then we want to think about a potuitary adenoma with stalk disconnect
92
somatostatin analogue is for what
GH issues
93
prolactinoma treatment
Carbergoline (dopamine agonist therapy) then pituitary surgery
94
ACromegaly investigation of choice
Oral glucose tolerance test with measurement of
95
insulin tolerance test is for what
ACTH and GH produced, so testing??
96
Hypo - give Dextrose, then give more dextrose then give more then do what?
Calll a reg
97
MIBG scan is for what?
Phaeochromocytoma
98

A - Placement (19 decks)

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