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Endocrine 2 Flashcards

1
Q

side effects of metaformin

A 
rash
GI - subside 
can interfere with b12 and folate defic
lactic acidosis - rare
discontinue if liver failure or cirrhosis 
renal failure stop if gfr <30 or creat >150
half if EGFR 30-45
temp withhold if IV contrast
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2
Q

SU SEs

A 
hypos in elderly, alcohol abuse, liver disease
weight gain 
GI upset, headaches
h/s
avoid in renal and liver failure
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3
Q

TZDs

A

weight gain
heart failure
fractures

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4
Q

DPP-IV inhibitors

A

pancreatitis

pancreatic cancer

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5
Q

SGLT inhibitors

A

thrush

UTIs

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6
Q

GnRH synthesised where
released how
simulates synthesis and release of what

A

by neurones in hypothalamus
pulsatile release
low pulses for FSH and high for LH

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7
Q

FSH secreted by what

does what

A

ant pit

stimulates follicular development and thickens endometrium

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8
Q

LH secreted by what

does what

A

ant pit
peak stimulates ovulation
stimulates CL development
thickens endometrium

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9
Q

what peaks before ovulation

A

oestrogen

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10
Q

what peaks following ovulation

A

progesterone

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11
Q

oestrogen secreted by what
stimulates what
blocks what and stimulates what

A

secreted by ovaries (follicles), adrenal cortex and placenta in pregnancy
stimulates thickening of endometrium
responsible for fertile cervical mucus
high oestrogen concentration inhibits prolactin and FSH and stimulates secretion of LH

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12
Q

progesterone does what

A

decorated by CL to maintain pregnancy
inhibits LH
responsible for thick cervical infertile mucus
maintains thickness of endometrium
has thermogenic effect (increased basal temp)
relaxes smooth muscles

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13
Q

hypothalamic hormones

A

GnRH
PRH
TRH
CRH
Somatostain - inhibits release of GH from a ant pit
Dopamine - inhibits prolactin release from ant pit

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14
Q

Ant pit hormones

A 
LH
FSH
PRL
TSH
ACTH
GH - stimulates IGF-1 from liver
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15
Q

post pit hormones

A

oxytocin - stimulates milk secretion/utrine contraction

ADH

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16
Q 
addisons is what 
ABs
signs
ix
rx
A

AI primary adrenal insufficiency - decreased cortisol and/or aldosterone

ABs produced against adrenal cortex or an enzyme called 21 hydroxylase

hyper pigmentation. hypotension

ACTH synacthin test - cortisol doesn’t rise in addisons

hydrocortisone and fludrocortisone

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17
Q

addiosns crisis treatment

A

0.9% saline
IV/IM hydrocortisone
glucose if hypoglycaemic

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18
Q

cushings is what
causes
test
rx

A 
increased cortisol 
pit (cushings dx) - adenoma 
adrenal (cushings syndrome) - adenoma/hyperplasia 
ectopic - SCLC
prolonged exposure to steroids

dexa supression test

if cause not found - bilateral adenectomy to prevent nelsons syndrome - lifelong hydro

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19
Q

pseudocushings

A

fails to be suppressed by dexa

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20
Q

conns is what
test
rx

A

increased aldosterone
saline suppression test
adrenelectomy - definitive. spironolactone/amiloride

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21
Q 
phaemocromocytoma is a what 
secretes what 
signs/symp 
what disease can be linked to them 
treatment
A

adrenal medullary tumour
catecholamines
headache, tremor, hypertension, fever, palpitations
MEN2
alpha blocker phenoxybenzine
BBs - propanolol, atenolol, metoprolol. surgical

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22
Q

10% tumour

A

extra renal
biologically malignant
bilateral
not assoc with hypertension

25% familial (bilateral, young)

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23
Q

hyperthyroidism TFTS

rx

A

decreased TSH increased T4T3

carbimazole BBs for symptoms

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24
Q

graves antibodies
goitre
scintogrophy
treatment

A 
anti TPO, TSH receptor ABs
smooth symm goitre 
high uptake 
@18m 50% will relapse and 50% will resolve
carb decrease dose over 12-18m then stop
25
Q

primary hyperparathyroidism

A

increased Ca, increased PTH, low phosphate

adenoma

26
Q

secondary hyperparathyroidism

A

increased PTH, decreased Ca
increased phosphate in renal disease
decreased in vit D deficiency

27
Q

tertiary hyperparathyroidism

A

increased PTH, increased calcium, increased phosphate

28
Q

parathyrectomy indications

A

<50
end organ damage present
increased calcium
GFR <60

29
Q 
De Quiuervincs
presentation 
TFTs
scintogrophy 
treatment
A 
painful 
following viral infection 
hyper first then become hypo 
low uptake 
self limiting
30
Q

hypothyroidimg
goitrous
non goitrous
treatment

A

increased TSH, low T4T3
goitrous - hashimotos, drug induced
non goitrous - congenital, atrophic, post radio/ablastive
thyroxine (increase during pregnancy)

31
Q

hasimotos goitre

antibodies

A

painless with rubber consistency and irregular surface

Anti tPO and anti thyroglobin ABs

32
Q

hypoparathyroidism
signs
rx

A

low calcium
increased phosphate
decreased/normal PTH

chovesteks - tapping the facial nerve causes facial muscles to contact
trousu - occluding the arm circulation for 3m causes carpopedal spasm

calcium and vit D supplement
IV calcium if severe

33
Q

subclinical hypothyroidism

A

increased TSH normal T4/T3

34
Q

secondary hypothyroidism

A

normal TSH decreased T3/T4

35
Q

subclinical hyperthyroidism

A

low TSH normal T3T4

36
Q

transcription factor MODY

A

adolescent/young adult
progressive hyperglycaemia
1/3 diet 1/3 OHD 1/3 insulin
cx frequent

37
Q

glucokinase MODY

A

onset at birth
stable hyper glycaemia
diet control
cx rare

38
Q

DKA biochem dx

DKA cx

A

ketonuria >3 or >2 on dip
BG >11 or known DM
bicarb <15 or ph<7.3

children - cerebral oedema
adults get - aspiration pneumonia, ARDS, hypokalaemia

39
Q

treatment for DKA

A

0.9 NaCl when glucose falls to 15 switch to dextrose
insulin
potassium

40
Q

HHS who

A 
type 2 DM
elderly 
osmolarity 400
high glucose 60
increased sodium
41
Q

peripheral neuropathy treatment

A

analgesia

amitriptyline, gabapentin, prcegablin

42
Q

neuropathy treatment

A

ACEI/ARB

43
Q

retinopathy stages and treatment

A

mild non prolif - haemorrhages and microaneurysms
mod non porlfi - haem, MA, hard exudates
severe non prolif - haem, venous beading
prolif - new vessel formation

laser, vitrectomy, anti VEGF

44
Q

Diabetes insipidus types
symp
ix
rx

A 
cranial - decreased secretion of ADH
nephrogenic - renal resistance to ADH
polyuria, polydipsia, nocturia 
water deprivation test 
desmopressin
45
Q 
hypogonadotrophic hypogonadism 
causes
symp
ix
rx
A

stress, eating disorders, trauma, kallmasn, drugs

amen

decreased FSH/LH, oestrogen defic

stabilise weight, pulsatile GnRH, injections (USS monitoring of response)

46
Q

PCOS symp
dx
treatment

A

10-20% amen 80% oligo
50-80% have insulin resistance

oligo/amen
polycystic ovaries
acne/hirsutism

clomifene citrate (+ metaformin)
injections 
laparoscopic ovarian diathermy
47
Q

complications of ovulation induction

A

hyprsitmualtion
multiple preg
ovarian cancer

48
Q

what is linked to ovulation induction

A

hyperprolactinoma

treatment dopamine agonist

49
Q

what test confirm normal regular cycles

A

mid luteal day 21 progesterone test

>30 on 2 samples confirms regular cycles

50
Q

hirsutism causes

A

PCOS, familial, idiopathic, CAH

adrenal or ovarian tumour - high testosterone and signs of vitalisation

51
Q

treatment for hirsutism

A

PCOS - OCP, anti androgens

Late onset CAH - low dose glucocorticoid to suppress ACTH drive

52
Q

pseudohypoparathyroidism

A

decreased calcium

increased PTH

53
Q

psedopseduohypoparathyroidim

A

normal calcium and PTH

54
Q

acute hypocalcaemia

A

IV calcium gluconate 10ml 10% over 10 mins in 50mls saline or dextrose

55
Q

acute hypercalcaemia

A

0.9% saline 46L in 12 hours
loop diuretics once rehydrated
bisphosphonates

56
Q

osteoporosis common fractures

A

neck of femur
vertebral body
distal radius
humeral neck

57
Q

osteopenia
osteoporosis
severe osteoporosis

A

> 1 SD below
=2.5 below
= 2.5 and a fragility fracture

58
Q

pagets treatment

A

analgesia

if still in pain then bisphosphonates

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