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Year 5 > endocrine > Flashcards

endocrine Flashcards

1
Q

causes of hypoglycaemia

A 
DM
alcohol excess
quinine, SSRI
insulinoma
hypothyroid
hepatitis
renal dyalysis
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2
Q

what level of blood sugar should you treat for hypo?

A

<4.0mmol/L

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3
Q

hypoglycaemic and unconscious

A

10g glucose 20% through large vein

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4
Q

hypoglycaemic and conscious

A

glucogel/ oral glucose 10g

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5
Q

name some factors that would prompt critical care review in DKA

A 
ketones >6mmol/L
SBP<90
K <3.5
GCS<12
pH<7
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6
Q

3 criteria for diagnosis of DKA

A

capillary BM >11/ known DM
capillary ketones 3+mmol/L
venous bicarb <15mmol/L and/or pH <7.3

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7
Q

what insulin regime should be used in DKA

A

fixed rate IV insulin infusion- not sliding scale as inaccurate in overweight/ pregnancy

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8
Q

first bag of fluid in DKA

A

0.9% NaCl 1L over 1 hour unless hypotensive (500ml bolus-> no response call senior)

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9
Q

baseline investigations in DKA

A 
VBG hourly
CXR
ECG
urine dip
pregnancy test
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10
Q

what is the definition of resolution of DKA?

A

blood ketones <0.6 mmol/L and venous pH >7.3

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11
Q

what 2 things should you watch for when treating DKA?

A

hypoglyceamia

hypokalaemia

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12
Q

diagnostic criteria for DM

A

HbA1c >48
OR Fasting glucose > 7 mmol/L and a glucose tolerance test
OR random glucose > 11mmol/L (usually on 2 separate occasions)
Management

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13
Q

pathology of T1DM

A

T cell mediated destruction of B cells

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14
Q

what is an abnormal oral glucose tolerance test

A

give 75g anhydrous glucose, after 2 hours BM>11mmol/L

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15
Q

If DM and HTN what drug start on

A

ACEI regardless of age as also reduce risk of nephropathy and albuminurea

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16
Q

3 ways in which DM causes kidney damage

A

Glomerular damage
Ischemia caused by damage to efferent and afferent arterioles.
Ascending infection

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17
Q

what is often the first way in which diabetic nephropathy can be picked up?

A

albuminurea, note can cause episodes of nephrotic syndrome (hypoalbuminurea and oedema)

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18
Q

how might diabetic neuropathy present?

A

symmetrical mainly sensory neuropathy (stocking and glove)
acute painful neuropathy (often in shins)
mononeuropathy (carpal tunnel)
autonomic neuropathy (erectlie dysfunction, silent MI)

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19
Q

sulphonylurea (gliclazide)

A

hypo risk, low sodium, weight gain

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20
Q

DDP-4 inhibitor e.g. sitagliptin

A

risk of pancreatitis

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21
Q

at what eGFR is metformin contraindicated?

A

<30, 30-60 reduce dose

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22
Q

SGLT2 inhibitor e.g. empagliflozon

A

low hypo risk, lose weight, wee lots and UTI risk

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23
Q

side effects of metformin

A

epigastric pain, anorexia and diarrrhoea, avoid in severe liver/ kidney disease

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24
Q

complication of injecting insulin

A

lipohypertrophy of injection site, weight gain (makes you feel hungry)

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25
Q

insulin requirement

A

0.5-1 unit/kg/day

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26
Q

target BP for diabetics

A

<130/ 80

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27
Q

target cholesterol for diabetics

A

<4.5

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28
Q

2 most common causes of hyperthyroidism

A

graves

nodular thyroid disease

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29
Q

what is the pathology in Grave’s

A

TSH receptor stimulating antibodies

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30
Q

how is T3 released

A

hypothalamus releases thyrotropin releasing hormone->
anterior pituitary releases TSH->
thyroid releases T4, converted into T3 in liver/ kidneys

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31
Q

what eye changes can be seen in Grave’s? note eye changes only in Grave’s

A

exophthalmos
ophthalmoplegia
lid lag

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32
Q

name 2 other conditions that commonly occur with Grave’s

A

AI conditions: myasthenia gravis, pernicious anaemia

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33
Q

how does a thyrotoxic storm present?

A 
history of acute illness
marked fever >38.5
siezures
N+v+ diarrhoea
jaundice
death- arrhythmias
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34
Q

subclinical hyperthyroidism

A

symptoms present
TSH normal/ low
T4/ T3 normal

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35
Q

what scan is used to differentiate different causes of hyperthyroidism?

A

radionuclide scan

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36
Q

what benefit do BBs have in Grave’s?

A

symptom control

reduce peripheral conversion of T4-> T3

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37
Q

What is the side effect of carbimazole to be aware of?

A

agranulocytosis, therefore sore throat etc come for FBC

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38
Q

what is the long term complication of hyperthyroidism?

A

osteoporosis

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39
Q

Toxic Multinodular Goitre

A

older female, high dietary iodine/ amiodarone

40
Q

2 main causes of hypothyroidism

A

primary- autoimmune/ damage from radioiodine (also lithium, amiodarone, interferon)
iodine deficiency

41
Q

subclinical hypothyroidism

A

TSH high
T3/T4 normal
no symptoms

42
Q

Hashimoto’s pathology

A

T cells attack thyroid, causes firm and rubbery goitre (other causes of hypothyroid do not)

43
Q

myxoedema

A

thickened, coarse skin in hypothyroidism

44
Q

name 2 other conditions that commonly occur autoimmune hypothyroidism

A

addison’s

pernicious anaemia

45
Q

pre-tibial myxedema

A

hyperthyroidism, big fatty looking growth.

46
Q

what effect does PTH have on the kidneys?

A

increases Ca resorption and phosphate excretion

47
Q

what effect does PTH have on the intestine?

A

increases Ca absorption but requires vit D3 (25(OH)D)

48
Q

what effect does PTH have on bone?

A

increases osteoclast activity causing release of calcium

49
Q

symptoms of hypercalaemia

A

Stones (renal)
Bones (bone pain)
Groans (abdominal pain, nausea and vomiting)
Thrones (polyuria)
Psychiatric overtones (confusion and cognitive dysfunction, depression, anxiety, insomnia, coma)

50
Q

secondary hyperparathyroidism

A

PTH high
Ca low
phosphorus high
CKD-> chronic low Ca-> stimulation of PT. also due to malabsorption/ vitamin D deficiency

51
Q

tertiary hyperparathyroidism

A

PTH very high
Ca high
phosphorus high
due to long secondary hyperparathyroidism. Ca low
phosphorus high
CKD-> chronic low Ca-> stimulation of PT-> hypercalcaemia

52
Q

primary hyperparathyroidism

A

PTH high
Ca High
phophorus low

53
Q

what hormones does the adrenal cortex produce?

A
  1. mineralocorticoids- e.g. aldosterone
  2. glucocorticoids (anti-inflammatory e.g. cortisol)
  3. androgens (oestrogen/ tesetosterone)
54
Q

what is the function of aldosterone

A

raises blood sodium and lowers K by acting on distal tubule of the kidney

55
Q

how is angiotensin II produced?

A

decreased renal perfusion-> increased renin released
angiotensinogen from liver-> converted to angiotensin I by renin-> converted to angiotensin II by ACE on lung/ renal epithelium

56
Q

effects of angiotensin II

A

increased H2O and salt retention therefore increased circulating volume (1. increased sympathetic activity, 2. arteriole constriction, 3. ADH secretion from post pituitary-> H20 reabsorption 4. aldosterone secretion)

57
Q

aldosterone has what effect?

A

NaCl resorption and K excretion in kidneys

58
Q

what is ACTH?

A

adrenodorticotropic hormonr: produced by anterior pituitary, releases cortisol

59
Q

when should cortisol be measured?

A

8-9am

60
Q

which hormones make up the management of addison’s?

A

hydrocortisone- (glucocorticoid)

fludrocortisone- (mineralocorticoid)

61
Q

2 main causes of Addison’s?

A

AI disease

TB

62
Q

How would an Addisonian crisis present?

A

severe hypotension/ dehydration

give Na and aldosterone replacement in CCU

63
Q

what abnormal results may be shown on bloods in Addisons?

A 
Na low
K high
Glucose low
ACTH simulation- low rise in cortisol
08:00 cortisol low
08:00 ACTH low/ high depending on secondary/ primary
hypercalcaemia
anaemia
64
Q

when should steroid dose be increased in Addisons?

A

doubled if intercurrent illness

take more day before strenuous exercise

65
Q

hypopituitarism causing addison’s (low cortisol and low ACTH) what else should you check?

A

T4 for hypothyroid

66
Q

symptoms of cushings

A

moon face, buffalo hump, HTN, osteoporosis, striae, acne, hirstuism, amenorrhoea

67
Q

which cancer most commonly causes hypercalcaemia?

A

SCC lung (releases PTH related peptide)

68
Q

peptic ulceration, galactorrhoea, hypercalcaemia

A

multiple endocrine neoplasia 1

69
Q

hypercalcaemia, thyroid cancer and phaeochromocytoma

A

MEN 2

70
Q

hypertension
hypokalaemia (e.g. muscle weakness)
alkalosis

A

Conn’s- hyperaldosteronism

71
Q

pituitary adenoma causes what visual field loss

A

bitemporal hemianopia

72
Q

which hormones may a pituitary adenoma secrete?

A

prolactin
ACTH (causing cushings)
GH
may also be non-secreting and compress normal tissue leading to insufficiency of these

73
Q

what would a pituitary blood profile entail

A

GH, prolactin, ACTH, FH, LSH and TFTs

74
Q

reducing cholesterol by 10% gives what % reduction in CVD risk

A

20% reduction in cardiovascular disease risk after 3 years

75
Q

what factors would make you query familial hypercholeserolaemia?

A

age <30
FHx
total cholesterol >7.5

76
Q

other than lifestyle/ genetic: 3 risk factors for hyperlipidaemia

A

hypothyroid
T2DM
medications (BB, thiazides, corticosteroids, COCP, antipsychotics)

77
Q

what other bloods should you do in raised cholesterol?

A

fasting BM
U+E
LFT
TSH

78
Q

what is the target total cholesterol?

A

<4mmol/L

79
Q

side effects of statins

A

myalgia
GI upset
abnormal LFT
do LFT and CK baseline and repeat 4-8 weeks

80
Q

symptoms of hypocalcaemia

A

muscle weakness and cramp/ tetany, numb fingers, convulsions, arrhythmias, stridor

81
Q

most common causes of hypoparathyroidism

A

post-surgical, AI, radiotherapy of neck

82
Q

most common type of thyroid cancer

A

papillary, often young female, good prognosis

83
Q

single thyroid nodule

A

follicular adinoma (toxic thyroid nodule if produces hyperthyroidism)/ carcinoma

84
Q

thyroid cancer with raised calcitonin

A

medullary cancer

85
Q

illness-> hyperthyroid then hypothyroid when illness settles

A

De Quervain’s thyroiditis

86
Q

hypopituitarism may present as?

A 
GH-stunted growth
prolactin
ACTH- low BP , increased thirst/ urination
FH, LSH- irregular periods/ amenorrhoea 
TFTs- Hypothyroidism
87
Q

hypopituitarism can be caused by

A

tumours
radiation/ chemo/ surgery
TB/ meningitis
traumatic bleed

88
Q

what is a pheochromocytoma?

A

neuroendocrine tumour of chromaffin cells of adrenal medulla. often cause HTN/ hyperglycaemia. found in MEN

89
Q

congenital adrenal hyperplasia

A

excess androgen production, masculinization of women, feminization of men, or precocious sexual development in children

90
Q

hypoaldosternism

A

fluid and salt loss

hyperkalaemia

91
Q

abnormal growth of hair on a woman’s face and body.

A

hirsuitism, caused by increased androgens

92
Q

Hyperosmolar hyperglycemic nonketotic coma

A

signs of dehydration, weakness, legs cramps, vision problems, and an altered level of consciousness.

93
Q

causes of diabetes insipidus

A 
(ADH insufficiency/ insensitivity) 
head injury
pituitary surgery
idiopathic
high Ca, low K
Li
genetic
94
Q

diabetes insipidus presentation

A

polyuria/ polydipsia

95
Q

diabetes insipidus investigation

A

high plasma osmolality, low urine osmolality

96
Q

SIADH causes

A

SCC lung
stroke, subarachnoid
infection-TB
drugs- SSRI/TCA/sulfonylureas

97
Q

SIADH presentation

A

hyponatraemia secondary to the dilutional effects of excessive water retention

Year 5 (12 decks)

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