Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Internal Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What is the proposed mechanism for PU/PD in feline hyperthyroidism?

A

Altered renal blood flow
Electrolyte abnormalities
Thyroid hormone excess causing primary polydipsia
Concurrent renal dz?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Methimazole/carbimazole toxicity

A

Vomiting
Pruritis
Peripheral LN enlargement
Lymphocytosis, eosinophilia, leukopaenia, <5% agranulocytosis, thrombocytopaenia, IMHA
Hepatic toxicity
Increase in ANAs, acquired MG, coagulopathy with normal platelet count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Prognosis hyperthyroidism

Medical management vs I131 tx

A

MST 2 years vs 2-4 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Gold standard test for hypothyroidism

A

TSH response test

No recombinant canine TSH available so have to use human

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hypothyroidism clinical signs

A

Lethargy
Weight gain
Bradycardia, May worsen DCM
Skin/ coat changes most common (recurrent OE, malassezia, symmetrical slope is)
Reproductive problems
Neurological (diffuse neuropathy, laryngeal paralysis and megaoesophagus - often do not resolve on tx and may be assoc with more generalise myopathy/m.gravis
Dry eye
Lipidosis corneal and retina
Corneal ulceration, uveitis and 2ndary glaucoma
Assoc with Cushings, DM and Addison’s

Congenital: disproportionate growth and puppy coat. Mental retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Calcitonin actions

A

Limits post-prandial hypercalcaemia

Primarily inhibits osteoclasts activity

High doses promote urinary calcium excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Calcitriol actions

A

G-I calcium and phosphorous absorption
Tubular calcium and phosphorous reabsorption
Inhibits further calcitriol production in the kidney
Inhibits PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When to use bicarbonate in DKA cases

A

When pH is less than 7.2 and HCO3 is <12mmol/l despite aggressive fluid therapy and insulin admin
MEq = BW (kg) x 0.4 x (12-HCO3) x 0.5
Five slowly over 6h then check again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Insulin tx in DKA i/m route

A

0.2mg/kg im once
Continue with 0.1mg/kg im every hour
When bg < 15mmol/l give 0.1mg/kg im q 4 hourly in order to maintain bg stable and avoid hypos
Switch to longer acting when patient stable bright and eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Insulin for DKA I/v protocol

A

Prepare 2.2mg/kg soluble insulin in 250mls NaCl 0.9%
Discharge 50ml of this to allow insulin binding to the giving set tubing
Administer solution at 10ml/hr until until Bg <15 then 7ml/hr until bg < 12 then 2-5ml/hr to maintain stable bg

Switch to longer acting when patient stable and eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Hypoglycaemia Ddx

A 
Lab error
Insulinoma
Addison’s
Sepsis
Tumours (hepatocellular carcinoma, mammary carcinoma, haemangiosarc etc)
End stage hepatic failure
PSS
Toy breed and neonate hypoglycaemia
Glycogen storage dz
Excessive exercise
Starvation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hypoglycaemic crisis - what to do?

A

Glucose 0.5g/kg IV diluted 1:3 in saline as a slow iv bolus
Continue with CRI or 2.5-5% glucose saline
(Always start low as insulinomad retain the ability to secrete more insulin in response to glucose)
Monitor for hypoxia, cerebral oedema, hyperthermia, lung atelectasis from prolonged recumbency

If failing to respond administer dexamethasone 0.1mg/kg IV

May need sedation w diazepam/pentobarbital in severe cases

In one study a dog was treated with a glucagon CRI and signs resolved in 20mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Insulinoma medical tx

A

Prednisolone (start low and work up)
Diazoxide (benzothiazine derivative inhibits insulin secretion and gluconeogenesis) (70% success)
Ocreotide (long acting somatostatin analogue - also inhibits GH and glucagon so can worsen hypoglycaemia)
Streptozocin (nitrosurea antibiotic - toxic to pancreas and metastatic sites but highly nephrotoxic - MSTs similar to controls)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Insulinoma prognosis

A

785d surgery alone (stage I, stage II 547 and III 217d)
1316d partial pancreatectomy abd preds
12-14months with young dogs having a worse prognosis and clinical stage I having a longer dz-free interval

Stage I - just pancreas
II - pancreas plus node
iii - pancreas plus node and mets (or without node)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where do insulinomas metastasise to?

A

Mainly liver, spleen and regional LNs

Rarely lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Insulinoma diagnosis

A

Low glucose with a high or normal insulin
Need abdo ultrasound may see mass but can be nodular
CT may see pancreatic mass (MRI same as CT)
Do 3 view thoracic rads to check for mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why do we get hepatomegaly and raised liver enzymes with diabetes mellitus?

A

Hepatic lipidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Supplementation if fluids in DKA

A

Potassium
Phosphorous if low (can cause haemolysis) - half of potassium can be given as potassium phosphate
Magnesium
Possibly bicarbonate but unlikely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Treatment of acromegaly

A

Radiotherapy
Transphenoidal hypophysectomy
Ocreotide (somatostatin analogue) - moderately successful in cats
Long acting insulin with short acting insulin around meal times for insulin resistant DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Diagnosis of acromegaly

A

CT showing pituitary mass

High ilgf-1 can support a diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of central diabetes insipidus

A 
Intracranial tumours
Metastatic neoplasia
Inflammatory dz
Parasites
Pituitary surgery
Severe head trauma
Idiopathic (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Causes of acquired nephrogenic diabetes insipidus

And pathophysiology of these

A

Metabolic (hypokalaemia - downregulates aquaporin 2), hypercalcaemia)
Drugs (lithium, chemotherapy)
Urethral obstruction
Kidney failure
Paraneoplastic syndrome (only leiomyosarcoma)

Hyperthyroidism - increased blood flow to kidney
Pyelonephritis
Addison’s - sodium depleted so can’t generate concentrated renal medullary interstitium
Liver failure - reduced urea
Pyometra
Cushings - reduced release and Action of ADH
Acromegaly - DM or glomerulopathy
Hypercalcaemia - interferes with proper functioning of renal tubular cells that normally respond to ADH

23
Q

When to stop phase 2 of a water deprivation test

A

If the patient is

  • dull or clinically dehydrated
  • has lost >5% BW
  • is azotaemic
  • is hypernatraemic
  • USG >1.030

Then obtain urine, bloods, measure USG and urine osmolality

24
Q

Phase 1 of modified water deprivation test

A

Determine water intake at home
Gradually decrease water intake at home over 3-5 days until having 100mlKg/day or becoming lethargic or aggressively seeking water
Divide daily water portions into multiple small portions
Withhold food for 12 hours before phase 2

25
Q

Phase 2 of the MWDT

A

Withhold food and water, empty bladder, check USG and urine osmolality, weigh patient, check BUN/crea and electrolytes

Check clinical signs, weigh and check urine every 1-2 hours

Bloods every 2-6 hours

26
Q

Phase 3 MWDT

A

Administer exogenous ADH if Urine has not yet concentrated
IM - monitor USG every 30 mins for up to two hours
Conjunctival - monitor every 1-2 hours for 8-12 hours
SQ - every 1-2 hours for 8-12 hours

27
Q

Phase four MDWT

A

Offer small amounts of food and water every 20-30 mins for 2 hours
Monitor signs and return to free choice water when patient clinically normal

28
Q

Interpretation of MDWT

A

USG >1.030 after phase 1 or 2= primary polydipsia
<1.008 after phase 2 = complete CDI or congenital NDI
USG after phase 3 >1.015 = CDI
<1.008 after phase 3 = congenital NDI

USG 1.008-1.020 after phase 2 = acquired NDI or partial CDI progress to phase three and if osmolality increases by 10-15% = CDI

Osmolality = 36 x USG (1.010 = 360)

29
Q

Treatment of diabetes insipidus

A

One drop DDAVP in conjunctival sac

If NDI - hydrochlorthiazide and low sodium diet (reduced stimulation of thirst centre and water intake - reducing urine volume)

30
Q

DDx PUPD

A 
Central DI/ nephrogenic DI
renal failure
Cushings
Addison’s
Liver failure
Hypercalcaemia
Pyometra
Septicaemia
Hypercalcaemia
Hyperthyroidism 
Hypokalaemia
Acromegaly
Very low protein diet
Primary hyperaldosteronism
fanconis syndrome
Primary renal glycosuria
Diabetes mellitus
Post-obstructive diuresis 
Glucocorticoids
Diuretics
Phenobarbitone
High salt diet
Levothyroxine
Vitamin D
Primary polydipsia 
Renal medullary washout 
Bacterial pyelonephritis
31
Q

Osmotic diuresis causes of PUPD

A 
DM
Fanconis
Primary renal glucosuria 
Renal failure
Post obstructive diuresis
32
Q

DDx hypercalcaemia

A 
Primary hyperparathyroidism
Renal secondary hyperparathyroidism
Nutritional secondary hyperparathyroidism
Vitamin D toxicity
Malignancy (lymphoma, AGA, myeloma)
Addison’s
Young growing animal
Granulomatous dz
Non-malignant skeletal dz
Lab error
(Hyperalbuminaemia)
Hyperthyroidism 
Grape toxicity
33
Q

Treatment of primary polydipsia

A

Reduce water intake by 10% each week

Increase exercise, add another pet, increase human contact, provide a distraction eg radio

34
Q

Most common cause of feline hypercortisolism (Cushings)

A

Pituitary corticotropin secreting tumour (80%)

Rest are cortisol secreting adrenal tumours (50% malignant)

35
Q

Preferred tests for Cushings in cats

A

LDDST

UCCR

36
Q

Treatment of feline primary hyperaldosteronism

A

Adrenalectomy

Medical management:
Potassium gluconate
Spironolactone
Amlodipine

37
Q

Treatment of pituitary dwarfism

A

Porcine growth hormone injections
Medroxyprogesterone acetate to stimulate mammary GH production as well as proligestone (should spay before to prevent pyometra)

If concurrent hypothyroidism May need levothyroxine

38
Q

Hypocalcaemia clinical signs

A

Tetany, seizures, tremors, fasciculations, weakness/ataxia(less common),

Earlier signs: facial pawing, anxiety, aggression due to muscle pain,

Cataracts: immature, cortical, punctate and diffuse (characteristic of hypoparathyroidism hypocalcaemia)

39
Q

Treatment of hypoparathyroidism

A

Calcium and vitamin D supplement (needed for GI absorption Ca)
Can eventually stop calcium and only give vitamin D (calcitriol and alfacidiol as these are hydroxylated forms)

In emergency iv calcium gluconate 0.5-1.5mlKg IV over 10-30 minutes. Must monitor ECG for bradycardia, shortened QT interval. Risk for cardiac arrest. If vomiting stop or slow infusion
Maintenance 60-90mg/kg/day do not add to lactate containing fluids as it can precipitate and don’t mix calcium and bicarbonate

Can give calcium gluconate 1:1 w saline s/c q6-8 hours too after tetany has resolved and this may be easier whilst awaiting oral vitamin D to take effect

Should check magnesium levels because if low hypocalcaemia can be refractory to tx

40
Q

DDx for Na:K < 27

A 
Renal/ urinary Tract dz
Addison’s
Severe GI disease
Parasites
Hepatic failure
Effusions
Pregnancy
DM
Drug induced
Other - repercussion injury/haemolysis

If <24 highly specific for Addison’s

41
Q

Tx acute Addisonian crisis

A

Fluids 20-30ml/kg/hr saline
Give Dex if in shock
Perform ACTH stim
If not yet had dex now give dex or hydrocortisone
Once fluid balance improved give hyrocortisone sodium succinate (dex has no mineralocorticoid activity) 0.5-0.625mg/kg/h CRI

If acidotic and PH <7.2 May require bicarbonate

42
Q

Tx of hyperkalaemia in acute addisonian crisis

A

Most important tx is IV fluids
Glucose IV
0.2iu/kg soluble insulin IV and dextrose 2g/unit of insulin (always measure BG after administration)
Calcium gluconate 10% slowly IV monitoring ECG

43
Q

Prognosis of hyperaldosteronism (Conns)

A

Medical tx - 7 months - 984 days
Post-adrenalectomy - good 50% Alive one year post-op but surgical mortality is high
Protracted survival post-op if tumour is a carcinoma cf Adenoma

44
Q

Best test for discriminating PDH from ADH (cushings) in cats

A

Measure ACTH levels - very sensitive and specific but difficult to do
Better than high dose dex

45
Q

Differences between canine and feline HAC

A

Cats don’t have low urine specific gravity despite PU/PD

ALP is often low

46
Q

Clinical signs of hypercalcaemia

A 
PUPD
Anorexia
Dehydration
Lethargy
Weakness
Vomiting
Pre-renal azotaemia
Chronic renal failure (mineralisation likely if phos x tCa = > 5)
Constipation
Cardiac arrhythmia
Seizures or twitching
Death
Acute renal failure
Calcium urolithiasis
47
Q

Treatment of hypercalcaemia in an emergency

A 
Saline 3x maintenance
Furosemide once rehydrated
Calcitonin (acts for around two days)
Bisphosphonates
Glucocorticoids (once diagnosis is reached)
Bicarbonate if acidotic

If idiopathic often responds to high fibre diet +/- steroids

48
Q

Hypocalcaemia DDx

A

Parathyroid disorders:
Primary hypoparathyroidism
Or secondary to trauma/surgery

Vitamin D disorders:
Acute/chronic renal, Nutritional secondary hyperparathyroidism

Redistribution disorders:
Puerperal tetany (eclampsia)
Feline urt obstruction
Sodium phosphate enemas
Alkalinizing therapy
Massive blood transfusion (excess of citrate products)
Furosemide
Ethylene glycol intoxication
Pancreatitis

Acute renal failure - massive increase in phosphate lowering calcium

49
Q

Side effects of bisphosphonates

A 
Nausea
Vomiting
Reflux and oesophagitis
Abdominal pain
Dyspesia 
Hypocalcaemia
Hypophosphataemia
Hypomagnesaemia
Hypokalaemia
Cost and availability
50
Q

Thyroid carcinoma complications and MSTs

A

Megaoesophagus, laryngeal paralysis, haemorrhage, horners syndrome

MST 3 years if mobile and 6-12 months if fixed

51
Q

When to use chemo for thyroid carcinoma

A

Animals with documented mets or tumours greater than 27cm^3

52
Q

What level are fructosamines if there is a somogyi effect

A

They are usually high

53
Q

Complications with surgical treatment of insulinoma

A

Pancreatitis, thromboembolic dz and arrhythmias

Internal Medicine (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions