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Endocrine (inc MCQBank) Flashcards

1
Q

What is HBA1c?

A

Glycosylation of N-terminal valine of B-chain haemoglobin

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2
Q

What is the equation of plasma osmolarity?

A

2Na + 2K + glucose + urea
Normal is 285-295mOsm/L

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3
Q

What is congenital adrenal hyperplasia?

A

Autosomal recessive
21-hydroxylase deficiency - results in deficient of cortisol +/- aldosterone and excess androgens

Clinical features:
- females are virilised at birth and post-pubertal amenorrhoea is common
- hyperpigmentation
- adrenal crisis
- life threatening hypoglycaemia

Tx: hydrocortisone and fludroccortisone

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4
Q

What is Chvostek sign?

A

facial muscle contraction upon tapping on the facial nerve
- associated with hypocalcaemia (causes reduced threshold for neurone to transmit a signal - hence causing hyperexcitement of nerve)

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5
Q

What is the Trousseau’s sign?

A

carpopedal spasm after compression of upper arm by blood pressure cuff

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6
Q

What is Frey’s syndrome?

A

facial sweating during meals
occurs post paratidectomy

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7
Q

Drug causes
- hypercalcaemia
- hypocalcaemia

A

HYPER: thiazide, lithium, antacids, vitamin D (>50000units per day OR 1250mcg)
HYPO: calcium chelators (citrate in blood transfusion), bone resorption inhibitors (bisphosphonate, calcitonin), drugs affecting vitamin D (phenytoin, ketonazole), foscarnet

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8
Q

Diagnosis for low calcium AND:
- raised phosphate + reduced PTH
- raised phosphate + raised PTH
- low phosphate + raised PTH

A
  • low magnesium, hypoparathyroidism, drugs (cinacalcet)
  • CKD, massive tumour lysis, early rhabdomyolysis
  • vitamin D deficiency, acute pancreatitis, drugs (bsiphosphonates)
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9
Q

What is anion gap?

A

(Na + K) - (HCO3 + Cl)

Normal is 12-17mmol/L

High anion gap: bicarb reduced due to increased acid

Low anion gap:

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10
Q

HBA1c should not be done for these patients as it would create inaccurate reading:

A

<18y/o
pregnant lady and 2months post-partum
symptoms of diabetes <2 months
acutely ill
steroids
acute pancreatic damage
ESRD
HIV

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11
Q

Sheehan VS Kallman syndrome

A

Sheehan: postpartum hypopituitarism or postpartum pituitary necrosis due to blood loss/hypovolaemic shock

Kallman: delayed puberty or absent puberty with loss of smell - hypogonadotrophic hypogonadism

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12
Q

What is milk-alkali syndrome?

A

Hypercalcaemia + renal failure + metabolic alkalosis

3rd common cause of hypercalcaemia
- due to taking calcium carbonate medication/calcium/vitamin D medications (>50000units per day)

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13
Q

What diseases are associated with hypothyroidism?

A

PBC
Turner’s syndrome (20-50%)
Down’s syndrome (10-40%)
cystic fibrosis
POEMs syndrome (polyneuropathy, organomegaly, endocrinopathy, m-protein band from plasmacytoma & skin pigmentation/tethering)

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14
Q

What cut-off values to diagnose diabetes?

A

SYMPTOMATIC
Fasting >=7
Random >=11.1
HBa1c >=48 (6.5%)

ASYMPTOMATIC
2 separate occasions of one of the above (pick & mix)

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15
Q

What are the cut-off values for:
- impaired glucose tolerance
- impaired fasting glucose
- pre-diabetes

A

IFG : fasting 6.1-6.9
IGT: fasting <7 AND 2hr post drink: 7.8-11.1
Pre-diabetes: HbA1c 6-6.4%

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16
Q

What is a thyroid storm?

A

Hyperthyroid Crisis
presents as confusion, congestive heart failure, volume depletion, n&v, extreme agitation.

Tx: intensive care with the aim to cool patient, correct volume status, respiratory support and treat underlying sepsis (if applicable for any of them). Anti-thyroid medication, corticosteroids, beta-blockers, iodine solution (Lugol’s or SSKI saturated solution of potassium iodide) should be given

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17
Q

Most common cause of subclinical hypothyroidism

A

Chronic autoimmune thyroiditis

PS: always check the TFT 3 months to confirm. If TSH>10, positive antibodies, previously tx Grave’s or other autoimmune disease, prescribe levothyroxine.

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18
Q

What is the most common cause of SIADH? And what are the other causes?

A

Idiopathic - most common cause!

Cancer: lung, pancreas, thymoma, ovary, lymphoma
Respiratoty: tumour, pneumonia, COPD, lung abscess, TB, CF
CNS: tumour, trauma, infection, stroke, subarachnoid haemorrhage, GBS, MS, delirium tremens
Drugs: NSAIDs, nicotine, diuretics, chlorpropamide, carbamezepine, TCA, SSRI, vincristine,
Surgery: post-op

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19
Q

Muscle pain, fatigue, polyuria, polydipsia. K 2.5, renin 1.0ng/ml/hr (normal is 1.9-3.7)
?diagnosis

A

Conn’s syndrome
- also 2x more common in women
- presents in 3rd to 6th decade of life

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20
Q

The most common cause of hyperaldosteronism

A

Conn’s syndrome (60%)
idiopathic OR bilateral adrenal hyperplasia (40%)

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21
Q

What tests need to be done if BM < 2.8

A

serum insulin
C-peptide
proinsulin
ethanol
beta-hydroxybutyrate
LFT
U&E
Insulin secretagogues (eg sulfonylureas)

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22
Q

Drugs that causes diabetes

A

Steroids
Thiazide

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23
Q

What drugs causes hypokalaemia?

A

Loop diuretic
steroids

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24
Q

Causes of:
- hypothyroidism
- hyperthyroidism

A

Hypo
- Hashimoto’s
- Atrophic thyroiditis
- Riedel’s thyroiditis
- Post-total thyroidectomy
- silent lymphocytic thyroiditis (occur in post-partum period)

Hyper
- Grave’s
- Toxic multinodular goitre (Plummer disease)
- Toxic adenoma
- Subacute thyroiditis

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25
Q

Diabetes + arthralgia/cirrhosis + skin pigmentation
?diagnosis

A

haemochromatosis

26
Q

Grave’s VS toxic multinodular goitre

A

Grave: has exopthalmos/opthalmopathy
radioactive iodine uptake will show diffuse uptake

Toxic multinodular goitre:
radioactive iodine uptake will show solitary or regional uptake

27
Q

What is Plummer’s disease

A

toxic multinodular goitre
second most common cause of hyperthyroidism in the west

28
Q

what other diseases are associated with phaeochromocytoma?

A

MENIIa, MENIIb, neurofibromatosis, VHL disease

29
Q

examples of short-acting insulin

A

highly purified animal sourced
- soluble insulin (hypurin)

human sequencedt
- actrapid
- humulin s
- insuman rapid

human insulin analogues
- aspart (novorapid)
- glulisine (apidra)
- lispro (humalog)

30
Q

causes of hypoglycaemia

A

EXPLAIN mnemonic

EXogenous drugs (insulin, oral hypoglycaemics, alcohol binge, aspirin, quinine, pentamidine)

Pituitary insufficiency

Liver failure

Addison’s disease

Islet cell tumours (insulinoma)

Non-pancreatic neoplasms (retroperitoneal fibrosarcomas due to IGF-1 secretion)

31
Q

treatment of idiopathic axillary hyperhidrosis

A

Topical:
- aluminium chloride hexahydrate - 1st line topical
- iontophoresis
- botulinum toxin
- topical anticholinergics

systemic: anticholinergics, calcium channel blockers/

surgical: sympathectomy, surgical excision, subcutaneous liposuction, laser

32
Q

Multiple Endocrine Neoplasia
1, 2a, 2b

A

1 (Wermer Syndrome) - high PTH, pancreatic cancer, pituitary cancer
2a (Sipple Syndrome) - HTN, high Ca, low Mg -> high PTH
2b (Wagenmann-Froboese syndrome) - medullary thyroid cancer, pheochromocytoma, medullary thyroid cancer, MARFANOID, mucosal neuromas

33
Q

what diabetic drug should not be used for patient with heart failure?

A

pioglitazone

34
Q

if HbA1c is still high and patient is on metformin, what drugs must be added on?

A

sulphonylurea (eg gliclazide)
pioglitazone
DPP-IV inhibitor

35
Q

Antibodies for:
Grave’s
Hashimoto’s thyroiditis

A

Grave: TSH-receptor, thyroid stimulating immunoglobulin (TSI), thyroid peroxidase (75%)

Hashimoto: thyroid peroxidase, thyroglobulin

36
Q

Congenital adrenal hyperplasia - what is it?

A

autosomal recessive disease

2 forms:
- classic/severe (deficient in cortisol with or without aldosterone deficiency and androgen excess) -> present as females with ambiguous genitalia or after 1-2weeks of life with acute salt-losing crisis with vomit, weight loss, hyponatraemia, hyperkalaemia

  • milder (sufficient cortisol but high androgen) -> precocious puberty if male and if female, amenorrhoea, virilisation, hirsuitism, acne, male-pattern baldness
37
Q

what thyroid problem is caused by excessive alcohol?

A

hypothyroidism caused by chronic excessive alcohol consumption

38
Q

what is the criteria for referral for parathyroid surgery?

A

any one of the following:
- adj ca >2.85
- end organ disease (renal stones, fragility fractures, osteoporosis)
- symptoms of high calcium

39
Q

what is metyrapone used for?

what is phenoxybenzamine used for?

A

diagnose and treat cushing’s syndrome
it reduces the amount of aldosterone and cortisol in the body

treat phaeochromocytoma

40
Q

what is a thyrotoxic storm?

A

fever >38.5, tachycardia, coma, delirium, vomit, diarrhoea, jaundice

41
Q

relationship between metanephrine and catecholamine

A

metanephrine is the breakdown of catecholamine

42
Q

?diagnosis - swelling adjacent to thyroid gland. no change in voice. sweating at night. weight loss. swelling in groin and left axilla.

A

Lymphoma

43
Q

? diagnosis - swelling adjacent to thyroid. euthyroid.

A

Papillary carcinoma of thyroid

44
Q

? diagnosis - swelling over lobe of thyroid. clinically euthyroid. 2 opacities over the right upper lobe of lung.

A

Follicular carcinoma of thyroid
- solitary, encapsulated, invades vein and bone
- common in areas with low iodine intake
- more likely to metastasis to lungs

45
Q

? diagnosis - woody, hard swelling in right lobe of thyroid. change of voice. swelling is enlarging.

A

Anaplastic cancer of thyroid
- most aggressive neoplasms
- more common in women and elderly
- stridor from tracheal deviation, dysphagia from oesophageal involvement and recurrent laryngeal nerve palsy are all common
- poor prognosis

46
Q

what is waterhouse-friederichsen syndrome?

A

disease of adrenal glands most commonly caused by neisseria meningitidis.
- leads to massive haemorrhage into one or both adrenal glands.
- characterised by bacterial meningococcaemia, low BP, shock, DIC with widespread purpura and adrenocortical deficiency

47
Q

calcium binding is pH dependent. explain the concentration of free calcium in alkalotic VS acidotic environment

A

alkalotic (ie less H+ and more HCO3-): calcium binds to more negative charged HCO3 & less concentration of free calcium

acidotic (ie more H+ and less HCO3-): calcium binds less & more concentration of free calcium

48
Q

what drugs can cause hypercalcaemia

A

thiazide
lithium

49
Q

Pseudohypoparathyroidism

A

PTH resistance

50
Q

TSH - T3/4 - ?what condition

raised - low - ?1
raised - normal - ?2
raised/normal - raised - ?3
low/normal - low - ?4
low - normal - ?5
low - raised - ?6

A
  1. hypothyroidism, chronic autoimmune thyroiditis, post radioiodine, post thyroidectomy, transient thyroiditis - hypothyroid phase
  2. subclinical hypothyroidism
  3. TSH-secreting pituitary tumour
  4. non-thyroidal illness, recent treatment for hyperthyroidism
  5. subclinical hyperthyroidism
  6. primary hyperthyroidism, Grave’s, multinodular goitre, toxic nodule
51
Q

most common thyroid cancer

A

papillary cancer
- women, 30-40yo & also in children
- irregular solid or cystic mass that can spread to cervical lymph nodes

52
Q

primary hyperparathyroidism
secondary hyperparathyroidism
tertiary hyperparathyroidism

A

PTH, Ca, phosphate, vit D, ALP

primary: high/N, high, low, high, N
(due to adenoma of parathyroid gland)

secondary: high, low/N, high, low, high
(in response to hypocalcaemia - seen in chronic renal failure)

tertiary: very high, high, low, low, high
(after prolonged secondary hyperPTH)

53
Q

Primary hypoparathyroidism
Secondary hypoparathyroidism
Pseudohypoparathyroidism

A

PTH, Ca, phosphate, ALP

Primary: low, low, high, N
(due to excision via surgery)

Secondary: low, high, high, N
(in response to primary process that causes hypercalcaemia)

Pseudo: high, low, high, N
(failure of ccells to respond to PTH - autosomal dominant)
- short stature, rounded face, shortened 4th metacarpal, obesity, dental hypoplasia, soft tissue calcifications/ossifications

Pseudopseudohypoparathyroidism is very rare. Morphological features of pseudohypoparathyroidism but normal biochemistry.

54
Q

CNIII palsy with pupillary sparing VS no sparing - what does it mean?

A

Pupillary sparing - due to ischaemic or diabetic aetiology

No sparing: compressive cause (ie surgical palsy)

55
Q

hypercalcaemia, renal failure and metabolic alkalosis

? diagnosis

clue: taken calcium carbonate or antacids

A

milk-alkali syndrome

56
Q

20yo catwalk with low BMI came with ‘a lot of hair’ on her body

?diagnosis

A

lanugo

(NOT hisuitism as she has low BMI, hence, likely to have lanugo hair instead)

57
Q

diarrhoea, facial flushing with enlarged nodule of the neck
? diagnosis

A

medullary thyroid cancer

58
Q

Cushing syndrome VS pseudo-cushing syndrome

A

Cushing syndrome: due to exogenous steroid administration & involves the HPA axis

Pseudo-cushing syndrome: display signs/symptoms and abnormal hormone levels like in cushing’s syndrome BUT the problem is not within the HPA axis. It is idiopathic condition in alcoholics. Signs/symptoms will disappear on alcohol abstinence.

59
Q

most common cause of subclinical hypothyroidism?

A

chronic autoimmune thyroiditis

60
Q

who normally gets subclinical hypothyroidism

A

older people
presents with tiredness and weight gain
elevated lipids (but less markied/consistent compared to full hypothyroidism)
rate of conversion to full hypothyroidism - <3% per year (more if they have positive thyroid antibodies).

DO NOT START Tx in those who are antibody negative - repeat test in 3 months!

Tx: levothyroxine

61
Q

MEN - the different types!

A

1: pituitary, pancreas, parathyroid

2a: medullary thyroid cancer, pheochromocytoma, parathyroid

2b: medullary thyroid cancer, pheochromocytoma, marfanoid, neuromas

62
Q
A

MSRA (21 decks)

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