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BPT Written > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

How do you calculate the Insulin Sensitivity Factor ?

A

100/Total Daily Dose

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2
Q

What does the insulin sensitivity factor tell you?

A

The amount your BSL will drop with 1 unit Insulin

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3
Q

How do you calculate your meal ratio?

A

500/TDD

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4
Q

What does your meal (carbohydrate) ratio mean?

A

How many units of Carbs 1 unit of Insulin will cover

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5
Q

What is someone’s usual daily requirement of exogenous insulin?

A

0.5u/kg

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6
Q

What % of your daily insulin is basal vs. prandial

A

50% each

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7
Q

What cell mediates the development of T1DM?

A

T1DM is a T cell mediated process

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8
Q

What HLA types increase the risk of T1DM

A

DR3/DQ2 and DR4/DQ8

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9
Q

What is the most common Ab in T1DM?

A

Anti-GAD

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10
Q

What are the other Antibodies in T1DM?

A

IAA, IA-2A/2B, ZnT8

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11
Q

What is the risk of T1DM if you have 2 Abs?

A

60%

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12
Q

What are the 3 criteria for LADA?

A

> 30 years old, 1+ Abs, No Insulin for the first 6/12

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13
Q

Having which parent affected by T1DM gives you a higher risk of having T1DM?

A

Father >Mother

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14
Q

What HLA type protects from T1DM development?

A

HLA-DR2

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15
Q

Risk of developing T1DM if offspring of affected mother vs. affected father vs. both parents affected vs. non-twin sibling vs. monozygotic twin

A

3% vs. 6% vs. 30% vs. 5% vs. 50% life time risk

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16
Q

Ethnicities that get T1b DM

A

African and Asian

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17
Q

Drug that prevented T1DM development in those w. multiple autoAbs and IGT

A

Teplizumab

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18
Q

What is an islet cell transplant good for?

A

hypoglycaemic unawareness

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19
Q

Best bariatric surgery procedure

A

Roux-en-Y

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20
Q

Most common MODY mutation

A

HFN1a

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21
Q

Most common type of MODY

A

MODY 3

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22
Q

MODY 3 rx

A

Sulphonylurea

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23
Q

MODY 2 rx

A

Only in Pregnancy, otherwise not needed

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24
Q

In gestational diabetes what could hypoglycemia indicate?

A

failing placenta

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25
Q

Placenta effect on insulin

A

Increases insulin resistance

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26
Q

Are TSHrAbs stimulating or blocking?

A

Usually stimulating, can block/be both in same pt

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27
Q

Medication that can falsely lower TSH and elevate T4

A

Biotin

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28
Q

T1 Amiodarone thyroid dysfunction is from? U/S finding? onset? mgmt

A

Increased iodine causes hyperthyroidism (JBasedow), U/S normal or increased, usually within 3 months, anti-thyroid meds

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29
Q

T2 Amiodarone thyroid dysfunction is from? U/S finding? onset? mgmt

A

directly toxic causing thyroiditis, reduced vascularity on U/S, usually 2-3 years, steroids or surgery

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30
Q

Endocrinopathies with lithium, there are four

A

Nephrogenic DI, hypothyroidism, hyperparathyroidism, distal RTA

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31
Q

When do you treat subclinical hyperthyroidism?

A

Age >65, TSH <0.1

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32
Q

When to treat subclinical hypothyroidism?

A

TSH >10

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33
Q

Which anti-thyroid drugs to use/when in pregnancy?

A

PTU 1st trimester (less placental t/f and otherwise risk of aplasia cutis/choanal/oesophageal atresia), CBZ in 2nd/3rd (hepatitis risk from PTU late)

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34
Q

TSH levels in pregnancy

A

BHCG acts like TSH, so elevated hormones and low TSH

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35
Q

Concerning thyroid nodules

A

taller than wide, >2cm, solid, hypoechoic, irregular margins, central microcalcification, no halo

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36
Q

mgmt of thyroid follicular neoplasm undetermined significance

A

hemithyroidectomy

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37
Q

Thyroid cancer most common type

A

papillary

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38
Q

worst thyroid ca prognosis

A

anaplastic

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39
Q

thyroid ca familial links

A

medullary

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40
Q

Medullary thyroid ca marker

A

calcitonin

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41
Q

Mgmt of thyroid ca

A

thyroidectomy, thyroxine to suppress TSH, RAI

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42
Q

sick euthyroid hormone changes

A

T3 always low or normal. Others do anything

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43
Q

Adrenal anatomy outer to inner

A

Glomerulosa, fasciculata, reticularis (GFR)

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44
Q

adrenal zone hormone production outer to inner

A

Mineralocorticoid, Glucocorticoid, Androgen

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45
Q

CAH enzyme deficiency

A

21-hydroxylase

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46
Q

CAH screening test

A

17-OH progesterone

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47
Q

Ab causative for AI adrenal insufficiency

A

21-OH Ab

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48
Q

If PAI but 21-OH Ab -ve, then which further 2 tests are required? and why?

A

CT adrenals and VLCFA. Adrenoleukodystrophy and e.g. adrenal haemorrhage/infiltration/necrosis

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49
Q

Primary aldosteronism confirmatory test after ARR is?

A

Seated saline suppression test

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50
Q

drug that causes the most false +ves in Aldo:renin is…

A

Beta blockers

51
Q

Adrenal adenoma features

A

<3cm, smooth, round, homogenous, <10HU, not vascular, high washout, <1cm/year growth

52
Q

Biochemical Ix of adrenal tumour, 3 tests are:

A

1mg DST, ARR, plasma metanephrines

53
Q

rx of adrenal ca

A

mitotane

54
Q

glucocorticoid receptor antagonist drug for cushing’s

A

mifeprestone

55
Q

action of metyrapone

A

11 beta hydroxylase inhibitor, prevents steroid synthesis, use in cushing’s

56
Q

PCOS needs 2/3 of:

A

oligo/anovulation, clinical/biochem hyperandrogenism, PCOvaries on imaging

57
Q

Most important rx for PCOS

A

weight loss

58
Q

primary ovarian insufficiency w. FHx. of same or evidence of retardation/tremor/ataxia, need to test for

A

fragile X: FMR1 gene, CGG triple repeat, >55 repeats are affected

59
Q

hypogonadotrophic hypogonadism w. anosmia =

A

Kallman’s

60
Q

what does being overweight do to testosterone levels in males and why?

A

overweight -> low T because Insulin -> reduced sex HBG -> lower total T

61
Q

low anti-mullerian hormone implies…

A

reduced ovarian reserve

62
Q

What do thiazides do to ca?

A

reduce urinary ca excretion, hypercalcaemia

63
Q

FHH due to mutation in:

A

CaSR

64
Q

primary hyperpara should get surgery if…

A

<50 yrs of age, eGFR <60, Ca>2.8, T score < -2.5, previous asymptomatic vertebral fracture, nephrolithiasis/calcinosis

65
Q

tubular maximal reabsorption of phosphate is an indicator of…

A

renal responsiveness to PTH

66
Q

pseudohypoparathyroidism is due to…

A

resistance of action of PTH

67
Q

finger changes in pseudohypoparathyroidism

A

4th and 5th MCP shortening

68
Q

Ca and PO4 in pseudohypoparathyroidism…

A

Low Ca and high PO4

69
Q

Hypophosphataemic Rickets is due to…

A

mutation in FGF23 -> unable to be cleaved

70
Q

rx of hypoparathyroidism

A

ca carbonate + calcitriol. Calcium citrate if on PPI

71
Q

what location are atypical femoral #s w. bisphosphonates?

A

subtrochanteric

72
Q

define ONJ

A

exposed bone in maxfax region that doesn’t heal within 8 weeks

73
Q

MOA of Romosozumab

A

Sclerostin inhibitor

74
Q

Who to start on osteoporosis therapy if on steroids

A

Previous #, age >70, pred >7.5mg/day

75
Q

Which bone cells does PTH act on?

A

Osteoblasts -> RANKL -> osteoclassts

76
Q

Hungry bone rx

A

aggressive Ca replacement until bones are full, and vitamin D

77
Q

PTH effect on PO4 and mechanism

A

phosphaturic, impairs tubular reabsorption

78
Q

Is primary or secondary adrenal insufficiency more severe?

A

primary

79
Q

alkylating agent for aggressive pituitary tumours?

A

Temozolamide

80
Q

What is copeptin?

A

cleaves in making ADH, correlates w. ADH production

81
Q

What causes of hypopit are assoc. w. pregnancy?

A

post-partum lymphocytic hypophysitis, Sheehand’s

82
Q

Pan hypopit replacement drugs/dose

A

Glucocorticoids 10mg/m2 e.g. 20-30mg hydrocortisone/day; thyroxine; Men T gel or IM, Females COCP or HRT

83
Q

Central DI due to issues in which anatomical location in brain?

A

hypothal

84
Q

how do you confirm central vs. nephrogenic DI?

A

DDAVP response (central respond to it)

85
Q

Mgmt of DI

A

intranasal DDAVP +/- oral, titrate to serum Na

86
Q

Hyperprolactinaemia is usually due to…

A

stalk compression -> no dopamine inhibition

87
Q

Hyperprolactinaemia causes what sx?

A

galactorrhoea, hypogonadism

88
Q

mgmt of hyperprolactinaemia

A

dopamine agonists (e.g. Cabergoline), secondary might do surgery if smaller

89
Q

Best screening for acromegaly

A

IGF-1

90
Q

Usual cause of acromegaly is…

A

pituitary tumour, therefore should MRI

91
Q

Mgmt of acromegaly

A

transsphenoidal tumour resection, RTx or medical

92
Q

medical mgmt of acromegaly includes…

A

octreotide, pevisomant (GH receptor antagonist), cabergoline if hyper PRL

93
Q

Top 3 causes of cushing’s in order:

A

iatrogenic, pit adenoma, adrenal adenoma/ca

94
Q

If ACTH INdependent cushing’s, next test is…

A

CT adrenals

95
Q

If suspect pituitary or ectopic Cushing’s, you can do a…

A

high dose dex, which will suppress if pit; or do a CRH stim

96
Q

If pit cushing’s suspected, do 2 tests:

A

MRI and BIPSS (2:1 basal ACTH central:peripheral

97
Q

Mx options for Cushing’s

A

surgery, RTx, medical- ketoconazole, pasireotide (somatostatin analogue)

98
Q

If you perform a bilateral adrenalectomy, you need to…

A

irradiate the pit due to risk of Nelson’s syndrome

99
Q

5 drugs for weight loss

A

phentermine, topiramate, naltrexone/bupropion, metformin, liraglutide, SGLT2

100
Q

Denosumab must be followed up by…

A

bisphosphonate

101
Q

Denosumab mechanism:

A

RANKL inhibitor, which usually promotes osteoclast maturation; secreted by osteoblasts

102
Q

What does WNT normally do?

A

causes osteoblast proliferation

103
Q

What inhibits WNT?

A

Sclerostin

104
Q

4 meds that can cause ONJ

A

Bisphosphonates, Denosumab, Sunitinib, Bevacizumab

105
Q

Raloxifene prevents

A

vertebral # only

106
Q

teriparatide DOES NOT protect against

A

hip #

107
Q

Dumping syndrome test

A

mixed meal

108
Q

weight loss reduction surgery does not improve

A

mortality

109
Q

DPP4-I that should not be used in heart disease

A

Saxagliptin

110
Q

MOA and side effect of Pasireotide

A

high somatostatin receptor affinity as antagonist; for rx of refractory acromegaly and cushing’s disease; hyperglycaemia

111
Q

growth hormone replacement in adults is recommended in GH deficiency because of:

A

body composition, exercise capacity and bone and CV health

112
Q

cabergoline MOA and side effect

A

dopamine receptor agonist; compulsive behaviours e.g. gambling, spending

113
Q

alternative test to water deprivation test for diabetes insipidis

A

hypertonic saline stimulated plasma copeptin (precursor derived surrogate of arginine vasopressin); greater diagnostic accuracy than water deprivation test

114
Q

Drug that improves PFS in radioiodine refractory differentiated TC

A

lenvatinib (MKI against VEGFR1, 2 and 3)

115
Q

Promising/improving drug for locally advanced/ metastatic medullary thyroid ca

A

Vandetanib- TKi against RET

116
Q

Primary target cell of PTH in bone

A

Osteoblast

117
Q

What is the sequence of physiological responses to hypoglycaemia in a non-diabetic

A

reduced insulin -> increased glucagon -> adrenaline -> growth hormone and cortisol

118
Q

additional effects of glucagon

A

increases lipolysis, fatty acid oxidation and ketogenesis, satiety, thermogenesis and energy expenditure, bile acid synthesis; decreases food intake

119
Q

what effect does amiodarone have on the thyroid?

A

inhibits conversion of T4 to T3; transiently inhibits iodine transport and thyroid hormone synthesis.

120
Q

What can artificially increase serum thyroglobulin assays and seem as if there is a recurrence of cancer?

A

Anti-thyroglobulin antibodies

121
Q

Best recognised alternation in maternal thyroid physiology

A

increase in TBG in the first trimester, persisting until shortly after delivery

122
Q

increased concentration of TBG in pregnancy triggers a concomittant increase in

A

maternal thyroid synthesis, elevation of total thyroxine and T3.

123
Q

Causes of increased TBG

A

Oestrogen, methadone, heroin, tamoxifen/raloxifene, hepatitis

124
Q

Causes of low TBG

A

Cushing’s, acromegaly, androgens, nephrotic syndrome

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