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1. 4th year > Endocrine - investigations and treatments > Flashcards

Endocrine - investigations and treatments Flashcards

1
Q

main antibody in graves

A

anti-TSH

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2
Q

symptomatic control of hyperthyroid

A

propranolol

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3
Q

main treatment of hyperthyroid

A

carbimazole

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4
Q

main risk of carbimazole use

A

agranulocytosis

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5
Q

tx hyperthyroid in 1st trimester of pregnancy

A

propylthiouracil

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6
Q

tx hyperthyroid in 2nd and 3rd trimester pregnancy

A

carbimazole

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7
Q

usual regime of carbimazole

A

started at 40mg then reduced gradually, continued for 12-18 months

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8
Q

tx thyroid storm

A

Iv propranolol
IV dexamethasone
carbimazole or PTU

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9
Q

antibody in hashimotos

A

anti-TPO

anti-Tg

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10
Q

tx hypothyroidism

A

levothyroxine
young - 50-100mcg
older - 25-50mcg

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11
Q

when should thyroid hormones be checked following a change in thyroxine

A

after 8-12 weeks

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12
Q

how much should levothyroxine be increased in pregnancy

A

by 25-50 mcg

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13
Q

advice for patient if taking levothyroxine with iron or calcium

A

take at least 4 hours apart

levothyroxine must also be taken 30 mins before food

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14
Q

tx myxoedema coma

A

IV levothyroxine
IV fluids
IV steroids (due to possibility of co-existing adrenal insufficiency)

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15
Q

TSH and T4 seen in

primary hyperthyroidism

A

high T4

low TSH

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16
Q

TSH and T4 seen in

secondary hyperthyroidism

A

high T4

high TSH

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17
Q

TSH and T4 seen in

subacute hyperthyroidism

A

low TSH

normal T4

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18
Q

scintigraphy uptake seen in toxic adenoma

A

single nodule of high uptake

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19
Q

scintigraphy uptake seen in de quervians

A

globally reduced uptake

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20
Q

scintigraphy uptake seen in graves

A

diffuse increased uptake

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21
Q

scintigraphy uptake seen in toxic multinodular

A

high patchy uptake in multiple locations

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22
Q

phases of de quervians

A

phase 1 - hyperthyroid- 3-6 weeks
phase 2 euthyroid 1-3 weeks
phase 3 hypothyroid (weeks - months)
phase 4 normal

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23
Q

tx de quervians

A

self limiting

NSAID if painful goiture

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24
Q

TSH and T4 in primary hypothyroid

A

t4 low

tsh high

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25
Q

TSH and T4 in secondary hypothyroid

A

low TSH

low t4

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26
Q

TSH and T4 in subclinical hypothyroid

A

normal T4

high TSH

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27
Q

TSH and T4 in sick euthyroid

A

low TSH

low T4

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28
Q

TSH and T4 in poor compliance with thyroxine

A

high TSH

high T4

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29
Q

phases of post-partum thyroiditis

A

thyrotoxicosis
hypothyroid
normal

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30
Q

treatment of post-partum thyroiditis

A

thyrotixic phase- propranolol

hypothyroid phase - thyroxine

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31
Q

gold standard investigation for thyroid cancer

A

US guided FNA

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32
Q

tx thyroid cancer

A

thyroidectomy + radio-ablation

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33
Q

tx thyroid cancer if low risk, < 50 < 4cm

A

lobectomy

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34
Q

what monitoring is required in thyroid cancer

A

yearly thyroglobulin

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35
Q

grading of thyroid cancer from USS

A

U2 - benign
U3 - atypical
U4 - probably malignant
U5 - malignant

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36
Q

grading of thyroid cancer from FNA

A 
Thy1 - inadequate
Thy2 - benign
Thy3 - atypical
Thy 4 - probably malignant
Thy 5 - malignant
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37
Q

dx of osteoporosis

A

DEXA scan < -2.5

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38
Q

DEXA scan osteopenia

A

-1 to -2.5

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39
Q

normal BMD on DEXA

A

above -1

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40
Q

1st line tx osteoporosis

A

bisphosphonates - alendronate, risedronate

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41
Q

when are bisphosphonates taken

A

once a week with large glass of water and sitting up for at least 30 minutes

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42
Q

tx osteoporosis if cant tolerate bisphosphonates

A

if cant tolerate alendronate due to GI symptoms try another bisphosphonate
if cant tolerate any bisphosphonates - strontium ranelate

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43
Q

tx osteoporosis if no response to bisphosphonate or strontium

A

SC teriparatide

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44
Q

as well as bisphosphonates what should osteoporosis management include

A

vitamin D and calcium supplements

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45
Q

bloods of pagets disease of the bone

ALP, ca, phos

A

increase ALP

normal calcium and phosphate

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46
Q

tx pagets

A

analgesia

bisphosphonates

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47
Q

lack of vitamin D leads to what bone problem in

  • children
  • adults
A

rickets

osteomalacia

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48
Q

pathophysiology in renal bone disease

A

damaged kidneys excrete less phosphate –> hyperphosphataemia and hypocalcaemia

reduced vit D activation by kidneys also leads to hypocalcaemia

hypocalcaemia leads to secondary hyperparathyroidism –> high PTH

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49
Q

bloods of osteomalacia caused by vitamin D deficiecny

A 
hypocalcaemia
hypophosphataemia
low vitamin D
high ALP
high PTH
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50
Q

blood of osteomalacia caused by renal bone disease

A

hypocalcaemia

hyperphosphataemia
high ALP
high PTH

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51
Q

differentiating feature of osteomalacia caused by RBD and low vit D

A

RBD - high phosphate

vit D deficiency - low phosphate

52
Q

tx osteomalacia cause by vitamin D deficiency

A

calcium / Vitamin D supplements- calcium D3

53
Q

1st line treatment osteomalacia by RBD

A

reduce dietary intake of phosphate

54
Q

2nd line treatment of osteomalacia by RBD

A

phosphate binders - sevelamer

vitamin D - alfacalcidol, calcitrol

55
Q

ix primary hyperparathyroidism

A

24 hour urinary calcium - high

56
Q

bloods of primary hyperparathyroidism

A

PTH raised or inappropriately normal (should be low given high Ca)

hypercalcaemia

hypophosphataemia

57
Q

definitive tx primary hyperparathyroidism

A

total parathyroidectomy

not definitive - but watchful waiting if no evidence of organ damage/Ca not too high

58
Q

tx primary hyperparathyroidism if not suitable for surgery

A

cinacalcet ( calcium mimetic)

59
Q

bloods of secondary hyperparathyroidism

A

low Ca
high PTH
high phosphate

normal response of parathyroid gland to low calcium

60
Q

bloods of tertiary hyperparathyroidism

A

high calcium
high PTH

prolonged hypocalcaemia leads to parathyroid hyperplasia

61
Q

what cancers can release PTHrp

A

squamous cell lung
renal
breast

62
Q

bloods of paraneoplastic PTHrp

A

high Ca

low PTH

63
Q

bloods of primary hypoparathyroidism

A

low ca
low PTH
high Phosphate

64
Q

tx primary hypoparathyroidism

A

alfacalcidol

65
Q

bloods of pseudo-hypoparathyroidism

A

low Ca
high phosphate
high PTH

66
Q

dx of hypoparathyroidism

A

measure urinary cAMP and phosphate after infusion of PTH

primary hypoparathyroidism - increase in both

pseudo type 1 - neither increases

pseudo type 2 - only cAMP rises

67
Q

what is pseudo pseudo hypoparathyroidism

A

morphological features of pseudo hypoparathyroidism but bloods normal

68
Q

tx pseudo and pseudopseudo hypoparathyroidism

A

calcium and vit D supplemetns

69
Q

ix of familial hypocalciuric hypercalcaemia

A

urine calcium:creatinine clearance ratio

70
Q

tx acute hypercalcaemia

A 
IV fluids - normal saline 
following rehydration IV bisphosphonates 
calcitonin - quicker than bisphos
steroids
loop diuretics
71
Q

tx hypocalcaemia acute

A

IV calcium gluconate 10ml 10% over 10 minutes

72
Q

tx hypocalcacemia mild

A

calcium and vit D supplements

73
Q

features of MEN 1

A

parathyroid hyperplasia
pituitary adenoma
pancreatic tumour

74
Q

features of MEN 2a

A

medullary thyroid carcinoma
phaeochromocytoma
parathyroid hyperplasia

75
Q

features of MEN 2b

A

medullary thyroid carcinoma
phaeochromocytoma
neuromas
marfanoid appearance

76
Q

ix hypopituitarism

A

measure all pituitary hormones

insulin tolerance/stress test (gold standard)
- if CI e.g. IHD or epilepsy, can do glucagon stimulation test

77
Q

test for ACTH deficiency

A

short synacthen test

78
Q

imaging in pituitary disease

A

MRI

79
Q

what does craniopharyngioma usually cause hormone wise

A

diabetes insipidus

80
Q

1st line tx hyperprolactinaemia

A

cabergoline, bromocriptine

81
Q

2nd line treatment hyperprolactinaemia

A

surgical excision if no success with medical treatment

82
Q

1st line ix for acromegaly

A

serum IGF-1 levels

83
Q

gold standard in confirming acromegaly

A

glucose tolerance test

84
Q

1st line treatment acromegaly

A

transphenoidal surgery

85
Q

2nd line treatment acromegaly

A

octreatide, sandostatin

or pegvisomant - doesnt shrink tumour, still need surgery if mass effect, once SC administration

86
Q

1st line ix of DI

A

plasma and urine osmolalities

urine osmolality > 700 excludes DI

87
Q

osmolality of Diabetes insipidus

A

low urine osmolality
high serum osmolality

peeing out all water

88
Q

gold standard investigation for DI

A

water deprivation test

89
Q

how do you differentiate nephrogenic and central DI

A

after water deprivation give ADH

  • nephrogenic - no rise in urine osmolality
  • central - rise in urine osmolality
90
Q

tx central DI

A

desmopressin

91
Q

tx nephrogenic DI

A

thiazide diuretic

92
Q

sodium potassium and glucose levels in Addisons

A

low sodium
high K
low glucose

93
Q

diagnostic test for addisons

A

short synacthen test

94
Q

results of short synacthen test in addisons

A

no rise in cortisol after giving synthetic ACTH

95
Q

test for addisons if short synacthen test not available

A

9am cortisol level - will be low

96
Q

tx addisons

A

fludrocortison + hydrocortisone

97
Q

how is addisons treatment given

A

divided dose, in first part of day

98
Q

what should patients be told about their steroid doses in sickness

A

double hydrocortisone for a week
fludrocortisone stays same
if vomiting replace with IM

99
Q

tx addisonian crisis

A

fluid resus - saline or dextrose if hypoglycaemia

IV hydrocortisone STAT

100
Q

what acid base problem dose addisons causes

A

hyperkalaemic metabolic acidosis

101
Q

aldosterone
cortisol
androgen

levels in addisons vs bilateral adrenal hyperplasia

A

addisons - all low

bilateral adrenal hyperplasia - increased androgen, reduced aldosterone, reduced cortisol

102
Q

addison features but no hyperpigmentation think…

A

secondary adrenal insufficency e.g. pituitary or LT steroid - no build up of ACTH

103
Q

1st line ix for hyperaldosteronism (primary = conns)

A

plasma aldosterone:renin ratio (high)

104
Q

sodium and potassium in hyperaldosteronism

A

high sodium

low potassium

105
Q

ix of hyperaldosteronism if confirmed with plasma aldosteronism:renin ratio

A

CT abdomen and adrenal vein sampling

106
Q

saline suppression test results of aldosteronism

A

failure to suppress aldosterone by 50% following consumption of water

107
Q

tx hyperaldosteronism

A

spironolactone

108
Q

tx conns

A

spironolactone

removal of adenoma

109
Q

ix of cushings if pituitary problem

A

MRI

110
Q

ix of cushings if adrenal problem

A

CT

111
Q

what acid base problem does cushing cause

A

hypokalaemic metabolic alkalosis

+ hyperglycaemia

112
Q

1st line ix to confirm cushings

A

overnight dexamethasone suppression test

113
Q

1st line ix to localise cushings

A

plasma ACTH and cortisol at 9am and midnight

114
Q

results of plasma ACTH and cortisol at 9am and midnight in ACTH dependent cause

A

elevated ACTH and cortisol

115
Q

results of plasma ACTH and cortisol at 9am and midnight in ACTH independent cause

A

undetectable ACTH with raised cortisol

116
Q

example of ACTH independent causes of cushings

A

adrenal adenoma / carcinoma

steroids

117
Q

examples of ACTH dependent causes of cushings

A

pituitary adenoma

ectopic from small celll lung cancer

118
Q

diagnostic test for cushings

A

48 hour high dose dexamethasone suppression test

119
Q

results of 48 hour high dose dexamethasone suppression test in cushings disease i.e. pituitary adenoma

A

cortisol suppressed

ACTH suppressed

120
Q

results of 48 hour high dose dexamethasone suppression test in ACTH independent cause i.e. adrenal adenoma

A

cortisol not suppressed

ACTH suppressed

121
Q

results of 48 hour high dose dexamethasone suppression test in ectopic ACTH

A

neither cortisol or ACTH suppressed

122
Q

ix if ectopic cause

A

CT CAP

123
Q

tx of cushings disease

A

trans sphenoidal surgical excision of pituitary adenoma

124
Q

tx cushings by adrenal adenoma

A

adrenectomy

125
Q

ix pheochromocytoma

- 1st line and type of scan

A

24 hour urine metanephrines

MIBG scan

126
Q

tx phaeochromocytome

A

alpha blockade - phenoxybenzamine
then beta blockade - propanolol

then
surgical excision of tumour

127
Q

tx hypertensive crisis in phaeochromocytoma

A

labetolol

1. 4th year (23 decks)

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