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Specialities > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Does Hashimoto’s cause hyper or hypothyroidism?

What type of goitre?

A

Autoimmune. Hypothyroidism (although RARELY may be 6-12 months of thyrotoxicosis in acute phase)
Firm, non-tender goitre.

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2
Q

What antibodies would you expect in Hashimoto’s?

A

Anti-thyroid peroxidase and anti-Tg antibodies.

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3
Q

What would a viral infection followed by hyperthyroidism suggest>?

A

Subacute (De Quervain’s) thyroiditis.

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4
Q

What are the 4 typical phases of De Quervain’s thyroiditis?

A

1: (3-6 weeks): Hyperthyroidism, painful goitre, raised ESR
2: (1-3 weeks) Euthyroid
3: (weeks-months) Hypothyroidism
4: Structure and function -> normal.

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5
Q

What is the Mx of De Quervain’s thyroiditis?

A

Usually self-limiting. Most patients do not require treatment.
Thyroid pain may respond to NSAIDs
Steroids used in more severe cases.

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6
Q

What glucose results are needed to diagnose T2 DM?

A

If symptomatic:

  • Fasting 7+
  • Random/after OGTT: 11.1 +

If asymptomatic: same criteria, on two occasions.

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7
Q

What is impaired fasting glucose?

A

Fasting glucose: 6.1-6.9

Offer OGTT

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8
Q

What is impaired glucose tolerance?

A

Fasting plasma glucose: <7 and OGTT 2-hour value 7.8-11

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9
Q

What HbA1c value would be diagnostic of diabetes?

A

48+mmol/mol (6.5%)

NB. Value below this doesnt exclude, its not as sensitive as fasting samples.

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10
Q

When would you not be able to use HbA1c in diabetes diagnosis?

A

Increased RBC turnover:

  • Haemoglobinopathies
  • Haemolytic anaemia
  • Untreated iron deficiency anaemia
  • Suspected gestational diabetes
  • Children
  • HIV
  • CKD
  • Meds that may cause hyperglycaemia, ie. steroids.
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11
Q

How do you adjust steroid dosage in Addison’s patient with acute illness?

A

Double hydrocortisone dose, same fludrocortisone dose

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12
Q

What is the typical drug mx of Addison’s disease?

A

Hydrocortisone (= glucocorticoid) (in 2/3 doses, majority in morning dose)
Fludrocortisone (=mineralocorticoid)

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13
Q

In the context of acute illness, what would low T3/4 and normal TSH suggest?

A

Sick euthyroid syndrome.

May also get rise in cortisol as normal stress response to infection

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14
Q

What important advice would you give a patient statin carbimazole?

A

Attend for medical review if develop any infection symptoms - check neutrophil count on FBC.
- Rare SE of drug is agranulocytosis.

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15
Q

What are the ‘sick day rules’ in DM?

A
  • Increase frequency of glucose and ketones readings to at least 4 hourly
  • Increase fluid intake, aim for >3L in 24hrs
  • If unable to eat, may need sugary drinks to maintain carb intake
  • Take medications as normal, except metformin if becoming dehydrated (renal function)
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16
Q

Which DM drug is CI if hx of bladder ca?

A

Pioglitazone

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17
Q

What are the criteria for starting a GLP1 mimetic (e.g. exenatide)?

A

BMI >35 and specific health problems associated with obesity
BMI <35 if insulin therapy would have significant occupational implications/ weight loss would benefit other obesity related comorb.

18
Q

Give 4 drugs that can lead to raised (P)rolactin?

A

Phenothiazines (-azine)
MetocloPramide
DomPeridone
HaloPeridol

19
Q

What is the first-line mx of cerebral metastases?

A

High-dose dex

20
Q

Release of which 3 hormones is reduced in the stress response?

A
  • Insulin
  • Testosterone
  • Oestrogen
21
Q

What are the features of MEN 2B?

A
  • Mucosal neuroma
  • Medullary thyroid carcinoma
  • Phaeochromocytoma
  • Marfanoid appearance
22
Q

What are the features of primary hyperaldosteronism?

A
  • HTN (refractory)
  • Hypokalaemia
  • Alkalosis
23
Q

What is the mx of prolactinomas?

A

1: Medical - dopamine agonists e.g. bromocriptine
2: Surgery - trans-sphenoidal

24
Q

What DM drugs would you use in end-stage renal failure?

A

Metformin is CI

Use a Glicazide

25
Q

What is Paget’s disease?

Features?

A

Increased, uncontrolled bone turnover.

Only 1 in 20 patients are symptomatic

  • Bone pain
  • Bowing of tibia, skull bossing
  • Raised ALP, with normal Ca and Ph.
  • Old, male.
26
Q

What are the indications for treatment in Paget’s?

Mx?

A

Ind: Bone pain, skull or long bone deformity, fracture, periarticular Paget’s.

  • Bisphosphonate (Oral Risedronate or IV Zoledronate)
27
Q

What are the causes of Addisonian crisis?

A
  • Sepsis or surgery exacerbating chronic insufficiency
  • Adrenal haemorrhage
  • Steroid withdrawal
28
Q

What blood results would you expect in an Addisonian crisis?

A

Low Na
High K
Low glucose

29
Q

What is the Mx of an Addisonian crisis?

A
  • Hydrocortisone 100mg IM/IV
  • 1L normal saline over 30-60 mins, with dextrose if hypo
  • Continue hydrocortisone 6 hourly until stable
30
Q

How do thaizolidinediones work? (-glitazones)

SE?

A

Reduce peripheral insulin resistance.

  • Weight gain
  • Liver impairment
  • Fluid retention (esp if taking insulin): CI in HF
  • Pioglitazone - Bladder ca
31
Q

What marker can you use to monitor medullary thyroid ca?

A

Serum calcitonin levels

32
Q

What is the Ix for suspected phaeochromocytoma?

A

24hr urinary metanephrines

33
Q

What are the features of phaeochromocytoma?

A
  • HTN
  • Headaches
  • Palpitations
  • Sweating
  • Anxiety
34
Q

What is the Mx of pheochromocytoma?

A

Surgery is definitive, however stabilise first:

  • Alpha blocker (Phenoxybenzamine) THEN
  • BB
35
Q

What insulin regime is used in DKA?

A

A fixed rate intravenous insulin infusion of 0.1 units/kg/hour

36
Q

In what circumstance would you not need to inform the DVLA when you are taking insulin?

A

Temporary treatment for 3 months or less

Or because of gestational diabetes up to 3 months post-partum as long as under medical supervision.

37
Q

What is the first-line mx of diabetic neuropathy?

A 
One of:
(1) Amitriptyline (Avoid in BPH)
Duloxetine
Gabapentin
Pregabalin
38
Q

What is the first-line insulin regime in newly diagnosed T1 DM?

A

Basal-bolus with twice-daily insulin detemir

39
Q

What is the diagnostic test in suspected acromegaly?

A

OGTT and serial GH measurements

Serum IGF-1 also used as screening/monitoring

40
Q

What are the two autoantibodies seen in Graves’? Which is most common?

A

TSH receptor stimulating antibodies (90%)

Anti-thyroid peroxidase antibodies (75%)

41
Q

What drug interaction must you be mindful of when prescribing ferrous sulphate for iron-deficiency anaemia?

A

Reduces the absorption of levothyroxine, must give at least 2 hours apart

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