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FRACP HANNAH 2022 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Which genetic defect is associated with MODY 3?

A

Hepatocute nuclear factor-1-alpha

Most common form of MODY

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2
Q

Which forms of MODY are highly sensitive to sulfonylureas?

Which genetic defects are they associated with

A

MODY 1 and MODY 3

Associated with defect in hepatocyte nuclear factor 4a (MODY 1) and Hepatocyte nuclear factor 1a (MODY 3)

MODY 3 is most common

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3
Q

Which of the following is not a criteria for ordering auto-antibodies in diabetes?

A. Personal or family history of autoimmune disease
B. BMI <30
C. Age <50
D. Acute symptoms

A

B. BMI <25

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4
Q 
Which of the following patients would be most likely to respond to a CRH stimulation test?
A. Psuedo cushings
B. Cushings disease
C. Adrenal adenoma
D. Phaeochromocytoma
A

B. Cushings disease

Corticotroph tumors respond to CRH, ectopic (i.e. non pituitary) ACTH producing tumors do not

Positive result - ACTH rise >40% within 15-30 mins and cortisol rise >20% within 45-60 mins

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5
Q

Which form of MODY is not associated with microvascular complications? Genetic defect?

A

MODY 2 - mild fasting hyperglycemia, genetic defect in glucokinase gene, not typically associated with microvascular disease

Managed with diet only

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6
Q

Which forms of MODY need insulin?

A

Mody 5 and 6, defect in hepatocyte nuclear factor 1a (MODY 5) and neurogenic diffferentiation factor-1 (MODY 6)

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7
Q

Which patients should be screened for OP on steroids?

A

Steroids for 3 months at >7.5mg/day

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8
Q

How does hyperthyroidism occur in pregnancy? What is it associated with?

A

BHCG stimulates TSH receptor –> TSH supression with associated high fT3 + fT4

Associated with hyperemesis gravidum due to high BHCG

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9
Q

Drugs causing hyperthyroidism?

A

Iodine
Amiodarone
Interleukin 2
Interferon alpha

Lithium can cause thyroiditis and hyperthyroidism before hypothyroidism

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10
Q

Immunotherapy associated with hypothyroidism

A

Anti-CTLA4 - ipilimumab, trepilimumab

Anti-PD1 - nivolumab, prembrolizumab

TKI

Bexarotene

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11
Q

Factors that increase TBG?

Drugs that decrease TBG?

A

Increase:

  • estrogen/pregnancy
  • hepatitis
  • drugs (opioids, fluorouracil, perphenazine)
  • acute intermittent porphyria

Decrease:

  • high dose androgens
  • cortisol/cushings syndrome
  • acromegaly
  • neprhotic syndrome (loss of TBG)
  • danazol
  • niacin
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12
Q

Features of MEN 1,

A

MEN1

Triple Ps - Parathyroid adenomas
Pancreatic tumors
Pituitary adenomas

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13
Q

Features of MEN2a vs MEN2b

A

MEN2 = PARATHYROID

MEN2a
Medullary thyroid carcinoma
Pheochromocytomas
Parathyroid adenomas

MEN2b (rare skinny men with weird tongues)

Medullary thyroid carcinoma
Pheochromocytomas
Mucosal neuromas
Marfanoid habitus

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14
Q

Which diabetic drugs are contraindicated with a past history of pancreatitis?

A

DDP4 inhibitors (-gliptins, i.e. linagliptin) + GLP1 agonists (-tides, i.e. exenatide)

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15
Q

Which diabetic drugs are associated with weight loss?

A

Metformin
SGLT2 inhibitiors
GLP1 agonists

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16
Q

Mechanism of action and effects of GLP1 agonists?

A

Mimics effects of GLP1 by effects on GLP1 receptor –> increased insulin secretion, decreased glucagon secreation, delayed gastric emptying (inhibits peristalsis of the stomach while increasing tonic contraction of the pyloric region.

Results in reduced appetite, weight loss

17
Q

Mechanism of action of acarbose?

A

Alpha-glucosidase inhibitor - a-glucosidase normally converts CHO to monosaccharides, inhibition leads to reduced GI glucose absorption and reduced postprandial BSLs

18
Q

Most common cause of asymptomatic hyperprolactinemia

A

Macroprolactin - ask lab to pre-treat samplex with polyethylene glycol

19
Q

4 causes of increased thyroid uptake on technetium scan

A

TSHoma
HCG secreting tumor
Graves disease
Toxic multinodular goitre or adenoma

20
Q

Treatment of hyperthyroidism in trimester 1?

Treatment in trimester 2 and beyond?

A

Trimester 1 - propylthiouracil
Trimester 2 - carbimazole

1p2c

21
Q

3 hormones that inhibit food intake

A

Leptin
CCK
Adiponectin

22
Q

3 hormones that stimulate food intake

A

Grehlin
Neuropeptide Y
Agouty-related peptide

23
Q

Most common genetic cause of obesity

A

MC4R mutations

24
Q

Which hormones are deficient in congenital adrenal hyperplasia? Which are in excess?

A

Deficient - aldosterone, cortisol
Excess - androgens (hirsuitism and amibuous genitalia in women)

Due to alpha-21 dyhydroxylase deficiency

25
Q

Hormone released from the zona glomerulosa

A

Aldosterone

26
Q

Hormone released from the zona fasciulata

A

cortisol

27
Q

Hormones released from the zona reticularis

A

Androgen precursors - DHEAS, androstenedione

28
Q

Hormones released from the medulla

A

Adrenaline/norad, dopamine

29
Q

Romosuzumab mechanisms of action

A

Inhibits sclerostin –> enhances Wnt signalling –> increased osteoblast matuation

30
Q

Which steroid is innappropriate for treatment of Addisons?

A

Dexamethasone, betamethasone - no mineralocorticoird activity (need to prescribe fludrocortisone with it)

31
Q

PBS criteria for anabolic agents

A

high fracture risk
BMD -3.0
2 or more minimal trauma fractures
1 symptomatic fracture 12 months after treatment with an antiresorptive

+ no romosuzumab treatment previously

32
Q

Type 1 amiodarone induced thyrotoxicosis - what is it and treatment

A

Increased synthesis of T4 and T3
More common in unerlying Graves
Treat with thionamides (methimazole)

33
Q

Type 2 amiodarone induced thyrotoxicosis - what is it and treatment

A

Increased release of T4 and T3 due to toxic effect of amiodarone on thyroid epithelial cells
More common in euthyroid people
Treat with preed

34
Q

Markers of bone formation and resorption

A 
Osteocalcin = formation
C-telopeptide = resorption
35
Q

BSL targets during pregnancy (pre-exisitn diabetes)

A

HbA1c <6.5 T1, <6.0 T2 - check once per trimester

Pre prandial BSL 4.0 - 5.3
1hr post prandial 5.5 - 7.8
2hr post prandial 5.0 - 6.7

36
Q

Factors that increase FGF-23

Action of FGF-23

A

Secreted by osteocytes

Factors that increase it:

  • PTH
  • Phosphate
  • calcium
  • calcitriol (activated vitamin D)

Actions:

  • increase phosphate excretion by reducing reabsorption
  • inhibit vitamin D activation - reduced calcium _ hosphate gut/renal reabsorption
  • inhibit PTH
37
Q

Co-factor of FGF23

A

Klotho

38
Q

Sick euthryoid TFTs

A

Normal TSH
Low T3
Normal T4

39
Q

Antibodies in type 1 diabetes

Which is specific for beta cells?

A

Anti-GAD65
ZnT8
IA21
Insulin auto-antibodies (IAA)

Insulin antibodies = specific for beta cells
?maybe islet cell antiboides also

FRACP HANNAH 2022 (16 decks)

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