Endocrine Summary Q's Flashcards
Micro and Macrovasc cimplications of diabetes
Micro - Retinop/nephrop/ neurop
Macro - PVD, Stroke, MI
treating charcots foot
Offload weight, total contact cast, Bisphosphonates
what is most important aspect of management/ risk factor control in diabetics?
BP, Chol, Coagulation, BM control
why is UTI and other infections more common in DM?
decreased function of neutrophils, basophils and eosinophils
absolute indications for amputation of diabetic foot
deep abscess, gangrene/severe ischaemia, spreading infection, septic arthritis
DM retinopathy stages
Background - Dots, Blots and Hard exudates
Pre Pro - waxy exudates and cotton wool spots
Pro - new vessel growth
Advanced - new vessel leaking and haemorrhages/micro aneurysms
treatment of proliferative stage of DM retinopathy?
stop smoking, glyc control, lower BP and LASER PHOTO COAG
what might predispose a DKA episode?
viral infection, MI, poor insulin compliance, surgery
what is significance of raised lactate?
hypoxia? acidosis?
what can cause hypogly in Non-DM?
insulinoma, iatrogenic insulin use, alcohol excess, fasting, addisons?
graves pathophys
graves IgG autoABs bind to thyroid stimulating hormone receptors and stimulate release of T3/T4.
graves specific CF, and treatment of Graves Thyrotox
goitre WITH BRUIT, opthalmoplega, exopthalmus, thyroid acropachy, pre-tib myxoedema
T / Propanolol + Carbimazole or polythiouracil
definitive = radionuclear Iodine, or subtotal thyroidectomy
risk with polythiouracil
massive risk of neutropenia
myxoedema coma - cause and CF // basic T
HYPOthyroid issue. Any definitive treatment involving thyroid (radioactive iodine)
Cold, low HR, Hypoglyc, coma, low resp rate
T/ as seen basically. Give T3 is only pre-requisite
thyrotoxic storm - cause and CF
c - MI, surgery, radioiodine, infection
seems like opposite to myxoed coma
HR up, temp up, agitated, deleirium
T / same as for hyperthyroid + hydrocort
what drugs can cause HYPOthyroid
amiodarone, iodine, lithium, any hyperthy drug - polythiour/carbimazole)
thyroid eye disease CF
Hyperthyroid condition.
Lid Lag, Exopthalmus, Opthalmoplegia, lid retraction (white of sclera visible above iris)
can result in diplopia, RAPD, pain and decreased vision.
what is malignant hyperparathyroidism?
HyperPTH caused by squamous cell CA of lung
what are the actions of PTHormone?
- Increase osteoclast action = resorption of bone causing increased CA
- decreases reabsorption of Phosphate in kidney
- increase conversion of vit D3 to calcitriol in kidney
- incresed absorption of Ca in intestine/kidney
how does dexamethasone suppression test work? Short and Long
give dexamethasone at 2300 and measure serum cortisol at 0900. if not suppressed then excess ACTH condition.
distinguish ACTH dependant by Long Dexameth test. if some suppression, then ACTH dependant (cushings) if NO suppression at all then extopic ACTH tumor.
synACTHen test details
measure serum cortisol, give synACTH then remeasure. If cortisol levels increased then NOT addisons
what treatment is given to addisons sufferers?
Hydrocortisone And fludrocortisone + medic alert bracelet
what are CF of acromegaly?
Split into Pit Tumor symp and excess GH cf’s.
Tumor: homonomous hemi, prom supra-orb ridge, hypo-pituatary
excess GH - large jaw, hands, feet, carpal tunnel, DM, pain, deep voice, SOB, large tongue
details of water deprivation test
give desmopressin, if no suppression then problem is nephrogenic
diff diag for diabetes insip
SiADH, ADH resistance in kidney (CKD)
secondary causes of DM2?
cushings, preg, chronic panc, CF
name the 3 oral hypoglycaemics
metformin, gliclazide, glitazones
what increased risk is there for MI and Stroke in diabetics?
x4 and x2
process of DM nephropathy
thickened Glom BM, (microalbuminuria) glom sclerosis, fibrosis (proteinuria)
what eye changes apaprt from retinopathy can DM cause?
cataracts, 3rd and 6th nerve palsys
management of DKA complications/side effects?
hypoglyc, hypokalaemia, pul oed/ARDS, cerebral oedema
main concerns / CF for patient with HONK?
dehydration, hyperglyc, thrombosis risk (give LMWH), AKI
how is hypo/hyper thyroid classed?
HYPO - 1,2,3
Hyper - none, either graves or tumor
treatment of Thyroid CA? (3)
Surgical removal of entire gland, radioactive I, neck lymph node dissection
CF of HYPO calc
SPASMODIC + trosseau’s + chvtoseks
how are the causes of cushings split?
ACTH dependant and independant
addisonian crisis treatment
saline and IV hydrocortsione
CONNS treatment?
SPIRO and Surg Excision
what might somatostatin be used for and why?
treatment of acromegaly as it suppresses effect of GrH meaning inhibitied release of GH
what nerves might be affected by a pituatary tumor?
2 + 3/4/6
diagnostic test for acromegaly?
OGTT and GH measurements
treatment or hyperprolactinoma?
dopamine agonist
PCOS diagnostic criteria?
US of ovaries, clinical features, menstral abnorm
causes of a metabolic acidosis?
DKA diarrhoea lactic acidosis (metformin) rhabdo toxin ingestion
