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Finals > Endocrine Guidelines > Flashcards

Endocrine Guidelines Flashcards

1
Q

Fasting glucose threshold diabetes

A

<6 is normal

>7 is diabetes

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2
Q

Random glucose threshold diabetes

A

> 11.1 is diabetes

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3
Q

OGTT threshold diabetes

A

> 11.1 is diabetes

<7.8 is normal

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4
Q

HBa1C threshold diabetes

A

48+ is diabetes

<42 is normal

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5
Q

how often should you self monitor for diabetes

A

4x per day

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6
Q

Daily glucose targets T1DM

A

4-7

5-7 when waking up

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7
Q

HTN in diabetic black person 1st line

A

ACEi and CCB

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8
Q

DKA diagnosis

A

pH <7.3
bicarb <15
ketones ++ or >3
glucose >11 or known diabetes

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9
Q

DKA management

A

Need fluids: 1 2 2 4 4 6 = litre saline 0.9%
Need potassium replacement = add 40mmol if 3.5-5.5, call senior if below that.
0.1U/kg/hr insulin. Dextrose when <15

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10
Q

T2DM first line

A

metformin + lifestyle

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11
Q

hba1c target with T2DM

A

48 (53 on gliclazide)

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12
Q

When do you add a second drug in T2DM

A

hba1c >58

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13
Q

when do you use GLP1

A

If triple therapy has not worked (i.e. it is fourth line) and BMI >35 with problem associated with obesity or BMI <35 but insulin would affect their work badly.

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14
Q

HHS management

What do you check doing management

A

Fluid loss = 10=20% of body weight
Give fluid back (half in 12 hours, half in next 12 hours)

Must check that osmolality is going down (2Na + urea + glucose) so plot it on graph:

  • glucose should fall by 5/hr
  • sodium should not fall by more than 10 in 24 hour§
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15
Q

Graves disease Mx

A

18 months of carbimazole or block and replace

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16
Q

TMG Mx

A

radioidine or lifetime carbimazole

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17
Q

Toxic adenoma Mx

A

Radioiodinde

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18
Q

Thyroid storm Mx

A

IV propranolol, Lugol’s iodine, anti-thyroid drugs

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19
Q

When should you start at a lower dose with levothyroxine

A

Elderly or heart disease (start at 25 instead of 50 ug)

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20
Q

When do you check TFTs after starting Tx for hypothyroidism and what do you aim for

A

Normal TSH after 6-8w

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21
Q

Levothyroxine dose in pregnancy

A

Increase by 25-50microgram

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22
Q

levothyroxine dose alongside iron?

A

No, leave 2 hours in between as iron reduces levothyroxine absorption

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23
Q

Do you treat subclinical hypothyroidism

A

Depends
If >80, no
If <80 + TSH >10, yes
If TSH only a bit raised (4-10), treat if <65

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24
Q

de quervains thyroiditis Mx

A

self limiting

steroids may help hypothyroid phase

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25
Q

post-partum thyroiditis

A

propranolol in hyperthyroid phase

levothyroxine in hypothyroid phase

26
Q

primary hyperPTH Mx

A

Parathyroidectomy

27
Q

Can you ever not treat primary hyperPTH

A

Yes, if >50, Ca raised by <0.25, no end organ damage

28
Q

Secondary hyperPTH

A

calcium and vit D supplementation

29
Q

Tertiary hyperPTH

- what about if just had a renal transplant

A

Excision of culprit gland

Wait 12m after a renal transplant as many resolve

30
Q

how to differentiate between pseudo and real cushings

A

Best = low dose dex suppression test

Also used = insulin stress test

31
Q

best test for cushings

A

overnight dex suppression test - give dex, and cortisol should be reduced the next morning.
First do low dose then do high dose.

32
Q

Addison’s best test

A

spank the adrenals with SYnACTHen to see if they work.

measure cortisol before and 30 min after ACTH given.

33
Q

Addisons ABG

A

hypoglycaemia, hyponatraemia, hyperkalaemia, metabolic acidosis

34
Q

Mx of Addisons

A

hydrocortisone TDS with biggest dose in the morning + fludrocortisone

35
Q

Addisons crisis management

A

IV hydrocortisone 100mg (big dose) only

saline + dextrose if needed

36
Q

prolactinoma 1st and 2nd/definitve

A 
1st = bromocriptine/cabergoline
2nd = surgery
37
Q

hypoglycaemia

A

depends on access

  • conscious = oral
  • unconscious no IV = IM glucagon
  • unconscious with IV = dextrose
38
Q

diabetic foot - who gets followed up

A

anyone with anything more than a simple callous (so moderate or severe as opposed to mild)

39
Q

hyponatraemia investigation: what do you do first

A

exclude pseudohypoNa (test lipid and protein) and exclude compensatory (test glucose)

40
Q

Steps 1 to 3 for investigating hypoNa

  • addisons/diuretic
  • vomiting/diarrhoea
  • SIADH/hypothyroid
  • nephrotic syndrome, CCF, cirrhosis
A

Step 1 = depleted euvolaemic, overloaded
Step 2 = urinary sodium >20 or <20
Step 3 = imagine the flow diagram and figure out what it is

  • addisons/diuretic = dehydrated + UNa >20
  • vomiting/diarhoea = dehydrated + UNa <20
  • SIADH/hypothyroid = euvolaemic + UNa >20
  • failures = overloaded + UNa <20
41
Q

Treatment of hypoNa

  • rate of Na correction
  • use of hypotonic saline?
A

normal saline 0.9% for F1 always

  • no more than 10mmol/24 hours
  • only in cerebral oedema under senior supervision
42
Q

severe hypoCa management

A

10ml calcium glutinate 10% with ECG monitoring

43
Q

hyperPTH : Ca, PO4, PTH, ALP

A

high Ca, low PO4, high PTH (or inappropriately normal), high ALP

44
Q

malignancy with bone met: Ca, PO4, PTH, ALP

A

High Ca, high PO4, low PTH, high ALP

45
Q

Mx of hypercalcaenia

  • first
  • ongoing helper management
A

3-4L per day of normal saline

Bisphosphonates can be used too but these take 2-3 ays to work with maximal effect at 7d

46
Q

recurrence of thyroid cancer

A

yearly check of thyroglobulin antibodies

47
Q

HypoPTH: PTH, PO4, Ca

hypoPTH vs pseudohypoPTH vs psuedopseudohypoPTH

Best way to diagnose pseudohypoPTH

A

Low PTH, high PO4, low Ca

pseudo = high PTH, high PO4, low Ca (target cells insensitive to PTH)

pseudopseudo = normal everything but physically looks like pseudo )low IQ, short 4/5th metacarpal, short

BUT

best way to diagnose pseudohypoPTH is by measuring urinary cAMP/PO4 after PTH infusion (stays same in pseudo as not responsive)

48
Q

Mx of true hypoPTH

A

alfacalcidol to boost the low calcium

49
Q

Conn’s syndrome best Ix

A

aldosterone:renin will be HIGH

50
Q

ABG in Conn’s

A

high Na, low K, metabolic alkalosis

51
Q

Once Conn’s diagnosed, what test do you then do

A

Need to find out the cause:

Do high resolution CT scan and adrenal vein sampling. helps distinguish between adenoma or hyperplasia

52
Q

Mx of Conn’s

  • adenoma
  • hyperplasia
A

surgery

spironolactone

53
Q

Pheochromocytoma Ix

A

metanephrine/VMA in urine (NOT SERUM)

54
Q

Phaeo Mx

A

surgery, but give alpha (phenoxybenzamine) then beta blockage in meantime

55
Q

Acromegaly Ix
FIRST
BEST

A

first = Serum IGF1

Best (to confirm) = OGTT (to try and suppress axis. in acromegaly GH doesn’t suppress after glucose)

56
Q

Acromegaly 1st line

other Tx?

A

surgery
medical Tx includes octreotide (somatostatin analogue) or dopamine agonist (cabergoline/bromocriptine)
GH receptor antagonist (pegvisomant - prevents dimerisation of the receptor)

57
Q

Diabetes insipidus Ix to confirm

to detect type

A

Check serum and urine osmolality to confirm

Do desmopressin test to check which

58
Q

Check for primary polydipsia as cause of polyuria (Ddx for diabetes insipidus)

A

Water deprivation test (urine conc will eventually go up in primary polydipsia)

59
Q

Neprhogenic vs cranial DI Mx

A 
Cranial = desmopressin
Nephrogenic = thiazides and low salt/protein diet§
60
Q

What do you do if metformin isn’t tolerated due to GI SEs

A

You try metformin MR before going to second line treatment

61
Q

Thyroid eye disease management

A

topical lubricants
ORAL not injection steroids
radiotherapy
surgery

Finals (13 decks)

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