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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
Q

acanthosis nigricans causes

A

Increased insulin

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26
Q

Is resistant hypertension a symptom of acromegaly?

A

Yes

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27
Q

Ketones over what is ska territory?

A

Over 3

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28
Q

Cut off for severe acidosis?

A

Under 7

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29
Q

How do we treat dKA?

A

VIP
Volume 1L over 1 hour
Insulin (actrapid 6 U /hour)
Potassium (when by under 14, 10% dextrose with potassium added to saline bags)

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30
Q

Hyperkalaemia treatment

A

Insulin (drives potassium into cells )

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31
Q

Key complications of dKA

A

Hyper/hypokalaemia
Hypoglycaemia (rebound ketones, Ute brain injury)
Cerebral oedema
Aspirational pneumonia
AARDs

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32
Q

Arterial or venous blood gas for dKA?

A

Venous

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33
Q

DKA fluid of choice

A

Saline just be careful of hylercholaemia acidosis

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34
Q

DKA fluid of choice

A

Saline

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35
Q

DKA continue basal insulin

A

Yes

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36
Q

Lara vs type 1 diabetes

A

Lada: presents as type 2 then antibodies build up gradually over time and then suddenly will develop type 1like symptoms

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37
Q

What type of hormone is insulin?

A

Peptide

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38
Q

What type of insulin do we use in infusions for dKA?

A

Short acting analogue (humalin S, actarapid, insuman rapid)

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39
Q

Targets for glucose levels in t1d

A
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40
Q

Insulin to carb ratio

A

1u insulin to 10g carb

41
Q

Time in range is within what rage for diabetes? How much of their time do we want time in range?

A

4-7, we want 70% Time in range

42
Q

When do we not use hba1c?

A

•Suspected T1DM
•Rapid onset of symptoms (T1, steroids, children, pancreatitis, pancreatic surgery)
•Pregnancy
•Conditions that affect RBC survival
•Dialysis patients
•Iron/B12 deficiency

43
Q

Hba1c target usually

A

Under 53

44
Q

Metformin side effects

A

GI upset

45
Q

Sglt2 inhibitors problems

A

Founires gangrene (nastily genital gangrene)
May see initial dip in kidney function and then it will improve long term
Euglycaemic ketones acidosis

46
Q

The gliptins are what type of drug?

A

Dpp4

Good as less likely to get hypos

47
Q

Piaglitazone side effects

A

Fluid retention

48
Q

What injectable agents are there? Which ones are cardio protective?

A

Gpp 1 - cardio protective
Insulin

49
Q

What effect does steroids have on glucose?

A

Increase glucose

50
Q

How do we calculate plasma osmolality

A

2 x sodium
+urea
+glucose

51
Q

What is hhs
How do we treat

A

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
Q

Why high blood glucose results in blurry vision?

A

Because glucose increases plasma osmolality and this can build up in the lense and affect the eye

53
Q

Diabetes and hypertension, what drug do we want?

A

Ace inhibitors

54
Q

Cut off for passing short synacten

A

Over 550

55
Q

What turns little girls into little boys and little boys into little men and how do we test it? How to we treat ?

A

21 hydroxyhyperplasia tested with 17 OH hydroxy enzyme.

Treat with hydrocortisone

56
Q

What drug can we use to block cortisol production?

A

Metyrapone

57
Q

Potassium. Under 2, what do we need to think?

A

Ectopic acth

58
Q

Cramping is as a result of what

A

Hypokalaemia

59
Q

Hypokalaemic alkalosis causes with heigh blood pressure

A

Liquorice
Conns
Cushings

60
Q

How do we confirm high aldosterone?

A

Saline suppression test

61
Q

What drug can we control conns with if we can’t do surgery

A

Spiralactome, eplerenone

Gynaocomastia

62
Q

Screening tests for conns

A

Aldosterone to rennin ratio

Scan confirmed - selective adrenal vein sampling

63
Q

Acutely illness into hospital, what do we need to consider in patient on Metformin?

A

Sick day rules and if they are going for angioplasty might need to stop Metformin and put onto insulin

64
Q

Chariots difference between feet temp

A

More than 2 degrees

65
Q

Chariots management

A

Stop using foot (non weight baring and immobilised
Optimise diabetes

66
Q

Why is frontal balding important with hand crmaping?

A

Myotonic dystrophy

67
Q

hypocalcaemia symptoms

A

Neuro hyperexcitability Chovsteks sign, troussau sign, pins and needles,

68
Q

do we need magnesium to secrete pth?

A

Yes

69
Q

What is pseudohypoparathyroidism?

A

PTH resistance,

allbrights clinical dystrophy, obese and round. Short 3 and 4 metararples.

70
Q

How do you treat hypocalcaemia?

A

IV calcium,
Bolus only lasts 2/3 hours, so needs to be put in over several hours

71
Q

How do we try to ensure hypocalcaemia doesn’t recommence?

A

Potent Vit D analogue (Alfacalcididol
And Sandoacl 1000

72
Q

Autoimmune polyglandular fever… Types

A

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
Q

Causes of Hypoglycaemia

A

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
Q

How do we Investigate hypoglycaemia?

A

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
Q

What other substance is released from beta cells with endogenous insulin?

A

C-peptide

76
Q

What effect does circulating insulin have on ketone production

A

supress

77
Q

How can we prevent hypoglycaemia in patients getting hypos (non diabetic)

A

10% dextrose or NG tube overnight
Diazoxide 150mg tabs
Octreotide

78
Q

LADA - gad autoantibodies
Primerary hyperaldosterone
high prolactin
definitiosn of impaired glucose tolorence
dka treatment
hhs
analogue insulin vs human

A
79
Q

ANALOGUE insulin - modern long acting insulins

A
80
Q

Gestational diabetes criteria

A

Fasting over 5.1
2 Hour over 8.5

80
Q

Good drugs for gestational diabetes

A

Metformin, then Insulin as the placenta grows if control out of target (under 5.5 and 2h under 7)

81
Q

A sestimibi scan is for what

A

Primary hyerparathyroidsim (primary prathyroidinoma) (CALCIUM)

82
Q

What scan can we use to differenciate Graves disease and post partum thuroiditis

A

Thyroid isotope scan - there would be uptake, whereas there wouldn’‘t be for post partum

83
Q

What is manitol used for?

A

REducing ICP

84
Q

novorapid and humalog are both what type ofo insulin?

A

rapid analogues

85
Q

what type of insulin is act rapid

A

“short” humalin insulin analogue

86
Q

Levemir and lantus are what type of insulin?

A

LOng L for Long

87
Q

Piaglitazone side effect

A

Fluid retnesion, weight gain - sub cut fat (turns apples into pears)

88
Q

GLP1 how does this work?

A

Delays gastric emptying and makes you feel full, actually a very good weight loss drug

89
Q

Can the patient feel a charcot foot?

A

Not really, bit warm, rocker bottom

90
Q

Can’t sleep at night with foot pain is what with diabetic

A

diabetic neuropathy

91
Q

Prolactin level for macroprolactinoma

A

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
Q

somatostatin analogue is for what

A

GH issues

93
Q

prolactinoma treatment

A

Carbergoline (dopamine agonist therapy) then pituitary surgery

94
Q

ACromegaly investigation of choice

A

Oral glucose tolerance test with measurement of

95
Q

insulin tolerance test is for what

A

ACTH and GH produced, so testing??

96
Q

Hypo - give Dextrose, then give more dextrose then give more then do what?

A

Calll a reg

97
Q

MIBG scan is for what?

A

Phaeochromocytoma

98
Q
A

A - Placement (16 decks)

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