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endocrine Flashcards

1
Q

1st line for pain in diabetic neuropathy

A

duloxetine

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2
Q

Addisons electrolyte derangement

A

hyponatraemia
hyperkalaemia

+ hypoglycaemia

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3
Q

what would cause LOWER than expected levels of HbA1c

A

conditions with reduced RBC lifespan

  • sickle cell
  • G6PD deficiency
  • hereditary spherocytosis
  • haemodialysis
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4
Q

what would cause HIGHER than expected levels of HbA1c

A

conditions causing increased RBC lifespan

  • B12/ folic acid deficiency
  • iron deficiency anaemia
  • splenectomy
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5
Q

drug causes of raised prolactin (galactorrhoea) (4)

A

metoclopramide, domperidone
phenothiazines (e.g. prochlorperazine)
haloperidol
very rare: SSRIs, opioids

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6
Q

levothyroxine interactions (2)

what happens?

how to prevent this?

A

iron
calcium carbonate

levothyroxine absorption is reduced

give at least 4hrs apart

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7
Q

which T2DM medication is CI in heart failure?

why?

A

pioglitazone

causes fluid retention

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8
Q

Cushing’s syndrome blood gas results

A

hypokalaemic metabolic alkalosis

excess cortisol –> Na and water retention

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9
Q

ix for Addisons

A

short Synacthen test

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10
Q

drug causes of gynaecomastia (6)

A

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

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11
Q

which class of medications reduces hypoglycaemic awareness?

A

Beta blockers

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12
Q

sick euthyroid syndrome blood results

A

low T3/T4
normal TSH

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13
Q

levothyroxine starting dose

A

25mcg in elderly or IHD
otherwise 50mcg

1.6 microgram per kilo

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14
Q

how long after changing levothyroxine dose should thyroid bloods be re-checked?

A

8-12 weeks

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15
Q

how much should levothyroxine be changed in pregnancy?

A

25-50mcg increase

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16
Q

SE of levothyroxine: (4)

A

hyperthyroidism (due to over-rx)
reduced bone mineral density
worsening of angina
AF

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17
Q

acromegaly mgt:

A
  1. transphenoidal surgery
  2. medical rx (if inoperable or unsuccessful surgery)
  • somatostatin analogue e.g. octreotide
  • GH receptor antagonist e.g. pegvisomant
  • dopamine agonists e.g. bromocriptine
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18
Q

acromegaly cx (4)

A

HTN
DM
cardiomyopathy
colorectal cancer

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19
Q

C-petide levels in T1DM
high or low?

A

LOW

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20
Q

T2DM dx if pt sx:

A

fasting glc > or equal to 7
random glc >11 (or after OGTT)

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21
Q

T2DM dx in asx pt:

A

on 2 separate occasions:
fasting glc > or equal to 7
random glc >11 (or after OGTT)

or HbA1c 48 or more on 2 occasions

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22
Q

HbA1c cut off for dx of diabetes

A

48

(on 2 occasions if asx)

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23
Q

HbA1c suggestive of pre-diabetes

A

42-47

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24
Q

HbA1c target in:

i. diabetes
ii. diabetic on 1 drug which lowers glc
iii. diabetic already on 1 drug but HbA1c risen to 58

A

i. 48
ii. 53
iii. 53

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25
Q

HbA1c level at which to add further drug:

26
Q

impaired fasting glc definition:

A

6.1- 7.0 mmol/l

if impaired fasting glc offer OGTT to rule out DM

27
Q

impaired glc tolerance definition

A

fasting plasma glucose < 7.0 mmol/l
&
OGTT 2-hour value 7.8 - 11.1 mmol/l

28
Q

T2DM mgt

1st line

29
Q

T2DM 2nd and 3rd line mgt

30
Q

metformin

how does it work? (2)

A

increases insulin sensitivity
decreases hepatic

gluconeogenesis

31
Q

metformin SE (2)

A

lactic acidosis

GI upset

32
Q

sulphonylureas

example

A

gliclazide

33
Q

sulphonylureas

how do they work?

A

stimulate pancreatic B cells to secrete insulin

34
Q

sulphonylureas

side effects (4)

A

hypoglycaemia
increased appetite & weight gain (most common)
SIADH
cholestasis and liver dysfunction

35
Q

pioglitazone
(a thiazodinedione - the only thiazodinedione)

how does it work?

A

activates PPAR - gamma receptors in adipocytes to promote adipogenesis and increase fatty acid uptake

36
Q

pioglitazone
(a thiazodinedione - the only thiazodinedione)

side effects: (4)

A

oedema/ fluid retention
weight gain
liver dysfunction
fractures

37
Q

DPP-4 inhibitors

examples?

A

drugs ending in ________gliptin

38
Q

DPP-4 inhibitors

how do they work?

A

increase incretin levels to inhibit glucagon secretion

39
Q

DPP-4 inhibitors

SE (1)

A

pancreatitis

40
Q

SGLT-2 inhibitors

examples:

A

drugs ending in _______glifozin

41
Q

SGLT-2 inhibitors

how do they work?

A

inhibit glucose reabsorption by the kidneys

42
Q

SGLT-2 inhibitors SE: (3)

A

normoglycaemic DKA
weight loss
glucosuria (and therefore thrush/ balanitis)

43
Q

GLP-1 agonists

examples

A

drugs ending in _________tide

44
Q

GLP-1 agonists

how do they work?

A

incretin mimetic

45
Q

GLP-1 agonists SE (3)

A

weight loss
N&V
pancreatitis

46
Q

thyroid storm mgt: (4)

A
  1. beta-blockers: typically IV propranolol
  2. anti-thyroid drugs: e.g. methimazole or
    propylthiouracil
  3. Lugol’s iodine (delay 1-4 hrs from administration of anti-thyroid drugs)
  4. dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
47
Q

primary hyperparathyroidism:

i. PTH
ii. calcium
iii. phosphate

A

i. normal or raised
ii. raised
iii. low

48
Q

acromegaly ix (3)

A
  1. IGF -1

if raised:

    1. OGTT
      &
      3.serial GH measurements to confirm dx
49
Q

prolactinoma presentation in women (4)

A

amenorrhoea
infertility
galactorrhoea
osteoporosis

50
Q

prolactinoma presentation in men (3)

A

impotence
loss of libido
galactorrhoea

51
Q

macroadenoma (big prolactinoma) presentation (3)

A

headache.
visual disturbances (classically, a bitemporal hemianopia (lateral visual fields) or upper temporal quadrantanopia)
symptoms and signs of hypopituitarism

52
Q

prolactinoma

mgt:

A

benign pituitrary mass

  1. dopamine agonists
    e.g. cabergoline, bromocriptine
  2. surgery if fail to respond to medical rx
53
Q

Cushing’s most common cause

A

pituitary adenoma (80%)

54
Q

pheochromocytoma

what is it?

A

catecholamine secreting tumour of adrenal medulla

10% rule: -
bilateral in 10%
malignant in 10%
extra-adrenal in 10%

55
Q

pheochromocytoma features: (5)

A

TRIAD
1. HTN (but postural hypotension)
2. headache
3. fever

Also:
weight loss
fatigue, flushing

56
Q

pheochromocytoma ix: (3)

A
  1. plasma metanephrines followed by urinary metanephrines
  2. adrenal imaging (CT/MRI)
  3. PET scan/ MIBG for extra-adrenal
57
Q

pheochromocytoma mgt:

A
  1. alpha blocker (e.g. phenoxybenzamine) then beta blocker (e.g. propranolol)
  2. surgery (definitive)
58
Q

primary hyperaldosteronism

causes: (5)

A
  1. idiopathic bilateral adrenal hyperplasia (more common, 60-70% of cases)
  2. Conn’s syndrome (adrenal adenoma)

others:
unilateral hyperplasia
familial hyperaldosteronism
adrenal carcinoma

59
Q

primary hyperaldosteronism features:

A

HTN
hypokalaemia (e.g. muscle weakness)
metabolic alkalosis

60
Q

primary hyperaldosteronism ix:

A

aldosterone/ renin ratio

CT abdomen and AVS (adrenal venous sampling) - to distinguish between unilateral and bilateral hyperplasia

61
Q

primary hyperaldosteronism mgt:

A

if:
- adrenal adenoma: surgery (laparoscopic adrenalectomy)
- bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

MSRA (16 decks)

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