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Medicine Finals: HARD STUFF ONLY > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is Chvostek’s sign and when is it seen?

A

Twitch of the facial muscles that occurs when gently tapping the parotid

Hypocalcaemia

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2
Q

What is Trousseau’s sign and when is it seen?

A

Carpopedal spasm of the hand and wrist occurs after an individual wears a blood pressure cuff inflated over their systolic blood pressure for 2 to 3 minutes

Hypocalcaemia

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3
Q

How is hypocalcaemia treated?

A

Calcium gluconate

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4
Q

What lab results are seen in Cushing’s syndrome?

A 
Hypokalaemic metabolic alkalosis
Hyperglycaemia
Hypertension
Hypernatraemia
Hypokalaemia
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5
Q

What are the different types of results you can get for 8mg Dexamethasone suppression test and what do they mean?

A

ACTH + Cortisol suppressed = Cushing’s disease
ACTH suppressed, cortisol not suppressed = ACTH independent e.g. adrenal adenoma
ACTH and cortisol not suppressed = Ectopic ACTH production (e.g. small cell lung cancer)

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6
Q

What are features of adrenal insufficiency?

A

Lethargy
Weakness
Weight loss
Salt craving

in Addison’s - palmar crease hyperpigmentation

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7
Q

What lab results are seen in adrenal insufficiency?

A

Hyperkalaemia
Hyponatraemia
Hypotension
Hypoglycaemia

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8
Q

How does an Addisonian crisis present?

A

Reduced consciousness + Same labs you see in Addison’s

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9
Q

How is an Addisonian crisis managed?

A

IV Hydrocortisone

Treatment of hypoglycaemia

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10
Q

What autoantibodies are seen in T1DM?

A

Insulin antibodies
Islet cell antibodies
Anti-GAD antibodies

Also low C-peptide levels

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11
Q

What are symptoms and signs of a DKA?

A

Symptoms:
Abdominal pain
Nausea/vomiting
Polyuria+polydipsia

Signs:
Fruity ketone smelling breath
Kussmaul breathing
Dehydration

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12
Q

What are side effects and CIs to Metformin

A

Side effects=
Diarrhoea
Lactic acidosis

CI=
Recent MI
CKD

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13
Q

What are side effects and CIs to a DPP4 Inhibitor?

A

Side effects=
URTI
GI system upset
Pancreatitis

Not that effective

-gliptin

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14
Q

What are side effects and CIs to Pioglitazone?

A 
Side effects=
Weight gain
Fluid retention
Anaemia
Heart failure
Increased risk of bladder cancer
Increased risk of fractures

CI=
Heart failure
History of bladder cancer

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15
Q

What are side effects and CIs to Gliclazide?

A

Side effects=
Weight gain
Hypoglycaemia

CI=
People who drive for their job

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16
Q

What are side effects and CIs to SGLT2 inhibitors?

A 
Side effects=
Euglycaemic DKA
Fouriers gangrene
Increased risk of UTIs
Weight LOSS
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17
Q

Which autoantibodies are seen in Hashimoto’s?

A

Anti-TPO

Anti-thyroglobulin

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18
Q

Which autoantibodies are seen in Graves’ disease?

A

TSH receptor stimulating antibodies

Anti-TPO

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19
Q

How does a thyroid storm present?

A 
Thyroid storm
Tachycardia
Reduced consciousness
Fever
Confusion
Nausea+vomiting
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20
Q

How is a thyroid storm managed?

A

Hydrocortisone/Dexamethasone + Propranolol + Propylthiouracil

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21
Q

Which diabetes drugs cause weight gain?

A

Gliclazide

Pioglitazone

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22
Q

Which diabetes drugs cause weight loss?

A

SGLT2 inhibitors
GLP1 memetic
Metformin

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23
Q

How is a prolactinoma managed?

A
  1. Cabergoline/Bromocriptine

2. Trans-sphenoidal surgery if medical management has not been successful

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24
Q

How does acromegaly present?

A 
Large tongue
Large hands and feet
Protruding jaw
Large forehead
Increased sweating
Symptoms of the tumour
25
How is acromegaly investigated? How is it managed?
1. Insulin like growth factor 2. Oral glucose tolerance test + serial growth hormone levels 3. MRI Pituitary Management 1. Trans-sphenoidal surgery 2. Octreotide if surgery not suitable
26
How is SIADH treated?
Tolvaptan
27
How does carcinoid syndrome present?
``` Abdominal pain Flushing Bronchospasm Diarrhoea Hypotension ```
28
How is carcinoid syndrome diagnosed?
Raised urinary 5HIAA
29
How is carcinoid syndrome managed?
Octreotide
30
What is a pheochromocytoma and how does it present?
Adrenal adenoma secreting catecholamines (adrenaline and noradrelinane) ``` Hypertension Headaches Palpitations Sweating Anxiety ```
31
How is pheochromocytoma diagnosed?
24 hour urinary collection of metanephrines
32
How is phaechromocytoma managed?
First stabilise with Alpha blocker (Phenoxybenzamine) | then beta blocker (propranolol/labetalol)
33
How does a myxoedema coma present?
Bradycardia Hypothermia Hyporeflexia Confusion
34
What is MEN I?
3 P's Parathyroid (hyper) Pituitary Pancreas Hypercalaemia
35
What is MEN IIa?
2 P's Parathyroid Phaechromocytoma Associated with medullary thyroid cancer
36
What is MEN IIb?
1 P | Phaechromocytoma
37
What is seen on XR in hyperparathyroidism?
x
38
Is kallman's or Klinefelter's associated with anosmia?
Kallmann's
39
How is Graves disease seen on thyroid scintigraphy?
Diffuse, homogenous increased uptake
40
How is toxic multi nodular goitre seen on thyroid scintigraphy?
Patchy uptake
41
How is subacute thyroiditis seen on thyroid scintigraphy?
Globally reduced uptake
42
What is the first line imaging for thyroid nodules?
Ultrasonography
43
How to manage a new change in vision in someone with a history of hyperthyroidism?
Urgent ophthalmology referral
44
How often should T1DM patients check glucose whilst driving?
Every 2 hrs
45
What is the first line insulin regime in a newly diagnosed T1 diabetic?
Basal bolus + twice daily insulin detemir
46
What can cause a lower than expected HbA1c?
Sickle cell anaemia G6PD Hereditary spherocytosis
47
What can cause a higher than expected HbA1c?
Splenomegaly Vitamin B12/folate deficiency Iron deficiency anaemia
48
What should capillary glucose targets be for a T1 diabetic?
On waking = 5-7 | Before meals = 4-7
49
How is T2DM diagnosed?
Fasting glucose >7 Random glucose >11 HbA1c >48 If patient is asymptomatic - this must be demonstrated on two occasions If patient is symptomatic - one reading is sufficient
50
What is impaired fasting glucose and impaired glucose tolerance?
Impaired glucose tolerance = 2 hour oral glucose tolerance is between 7.8 and 11.1 Impaired fasting glucose = fasting glucose is between 6.1 and 7
51
Which autoantibodies are most common in Graves disease?
TSH receptor stimulating autoantibodies
52
What are side effects of corticosteroids?
Endocrine = impaired glucose regulation in diabetics, increased appetite and weight gain, hirsutism Cushing's = moon face, buffalo hump, striae Musculoskeletal = osteoporosis + proximal myopathy Psychiatric = insomnia, mania, psychosis, depression Immunosuppression Peptic ulcers Growth suppression in children Neutrophilia IIH
53
How does Kallman's present?
``` Hypogonadotropic hypogonadism Delayed puberty Hypogonadism (small testes) Anosmia Low FSH and low LH ```
54
How does Klinefelter's present?
``` Tall Lack of secondary sexual characteristics Infertile Gynaeocmastia Low testosterone High FSH and LH ```
55
What is androgen insensitivity syndrome?
X-linked recessive condition End organ resistance to testosterone - genotypical male child which presents with a female phenotype Primary amenorrhoea Groin swellings due to undescended testes
56
How can you grade the severity of Graves eye disease?
``` NOSPECS No signs/symptoms Only signs (upper lid retraction) Signs and symptoms Proptosis Extra-ocular muscle involvement Corneal involvement Sight loss ```
57
What signs are specific to Graves disease and not other types of hyperthyroidism?
Exophthalmos Ophthalmoplegia Pretibial myxoedema Digital clubbing
58
DKA guidelines- fluids
If systolic BP <90 - fluid bolus | If systolic BP >90 - can just give 1L over 1 hour
59
What is the most common cause of primary hyperparathyroidism?
Solitary parathyroid adenoma

Medicine Finals: HARD STUFF ONLY (23 decks)

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