Endocrinology Flashcards
1
Q
Front
A
Back
2
Q
Treatment of Adrenal Failure (eg. 21 hydroxylase deficiency) + the amount
A
Aldosterone: Fludrocortisone, 50-100 mcg daily
Cortisol: Prednisolone 3mg daily or Hydrocortisone 10/5/2.5 daily
3
Q
Range for …
A
- Impaired fasting
6 - 7 mmol/L
- Impaired glucose tolerance
7. 8 - 11 mmol/L - Prediabetes
42-48 mmol/L
4
Q
Explain the function of theca cells and granulosa cells in ovulation.
A
- During the follicular phase, the follics (surrounding the egg) are made of theca cells and granulosa cells.
- Theca cells bind LH + Granulosa cells bind FSH
- Theca cells secrete Androdestedione which is converted to Oestrogen by Granulosa cells.
- High Oestrogen acts as NEGATIVE FEEDBACK and switches off the pituitary.
- Dominant follicle grows LH receptors on Granulosa cells
- Only dominant follicle grows and secrete oestrogen → THIS BECOMES POSITIVE FEEDBACK
- Rupture causes ovulation
5
Q
Calcium average intake
A
700 mg
6
Q
Cushing’s Syndrome: Most common screening test? Most common Diagnostic test?
A
Screening: Urine 24h
Diagnostic: Overnight dexamethasone suppression test.
7
Q
PCOS: Pathology
A
High LH levels, low FSH levels
- While the exact cause of PCOS is unknown, patients have elevated luteinizing hormone (LH) levels that often lead to theca cell hyperplasia.
- An LH:FSH ratio > 2 is typical.
- Theca cells produce excess androgens which aromatase converts to estrogens in fat cells. Abnormally high estrogen levels stimulate endometrial hyperplasia, a precursor to endometrial carcinoma.
- Hirsuitism is caused by elevated androgens.
8
Q
PCOS: 3 hormonal changes
A
- There is often a high total and free testosterone level. The free androgen index is often high. This index is calculated by 100 times total testosterone divided by sex hormone-binding globulin.
- FSH levels are normal in PCOS, whilst LH tends to rise, and hence there is a raised LH:FSH ratio
- Prolactin levels are often raised
9
Q
Why take caution when reading basal GH + thyroid + FSH/LH + cortisol?
A
Thyroid: Half life ~ 6.5 DAYS
FSH/LH: Can circulate in some woman
10
Q
Which receptors are targeted in Graves? Which antibody type targets the receptor?
A
TSH receptor: IgG activates them
11
Q
Name the eye popping and leg oedema effects in Graves.
A
Pretibial Myxoedema
Exophthalmos
12
Q
Criteria for thyroid storm
A
CHAD Jaundice
Cardiac Failure
Hyperpyrexia >41
Arrhytmia
Delirium
Jaundice
13
Q
Side effect of PTU/Carbemazole
A
Agranulocytosis/Rashes (more common)
14
Q
Length of time for hyperthyroid/hypothyroid states in Viral thyroiditis
A
1 month/3 month
15
Q
Which iodine isotope used in radioiodine
A
131 (99-Tc used in scans)
16
Q
Method of Desmopressin administration
A
Nasal
17
Q
Draw the cholesterol to aldosterone/cortisol etc pathway
18
Q
3 treatments for secondary hyperparathyroidism
A
No renal failure:
- Ergocalciferol (25 hydroxy vitamin D2)
- Cholecalciferol (25 hydroxy vitamin D3)
Renal failure:
- Alfacalcidol (1 α hydroxycholecalciferol)
19
Q
Most common cause of Addison’s in developing world
A
TB
22
Q
2 signs of hypocalcemia
A
Trosseau’s Sign: Carpopedal spasm
Chvostek’s Sign: Facial paraesthesia (gentle twictch of facial muscle when tapping on the face of hypocalcemia)
23
Q
What are the causes of infertility in women (in order of proportion of which are most common?)
24
Q
Explain tertiary hyperparathyroidism?
A
Context of chronic renal failure; prolonged calcitriol deficiency turns the parathyroid glands into OVERDRIVE.
→ Elevated PTH levels
25
What happens to calcium levels in tertiary parathyroidism? How do you differentiate from secondary hyperparathyroidism?
Tertiary: Calcium decreases then increases as PTH increases substantially
Secondary: Calcium remains low (**can progress to tertiary if result of kidney injury that becomes CKI**)
26
What’s the definition of infertility
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%203.png)
(regular intercourse = every 2-3 days)
1. Primary: no live births
1. Secondary: Live birth more than 12 months previously
27
What % of couples experience infertility at 12 + 24 months?
14% → 7%
28
What are the causes of infertility in men?
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%204.png)
Missed: vascular/toxins/immunological
29
Which drug treats hyperprolactinaemia?
Cabergoline - Dopamine Agonist
30
What’s the rough structure of an appointment for an individual with male infertility?
**MRI THE PITUITARY**
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%205.png)
31
Terms for *no sperm* and *reduced sperm*?
No sperm: Azoospermia
Reduced sperm: Oligospermia
32
What should you always check before determining female infertility?
Pregnancy or breastfeeding.
> **Women who breastfeed their children have a longer period of amenorrea and infertility following delivery than women who do not breastfeed**. The length of postpartum amenorrhea varies greatly and depends on several factors, including maternal age and parity and the duration and frequency of breastfeeding.
>
> [**The effect of lactation on ovulation and fertility - PubMed**](https://pubmed.ncbi.nlm.nih.gov/3549114/#:~:text=and%20tandem%20nursing.-,Women%20who%20breastfeed%20their%20children%20have%20a%20longer%20period%20of,duration%20and%20frequency%20of%20breastfeeding.)
33
What are the general cut-offs for the menstrual cycle, primary amenorrhea, secondary amenorrhoea and oligomenorrhea?
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%206.png)
Oligo-menorrhea also \<21 days (21
34
Most common endocrine/infertility disorder in women?
PCOS
35
What’s Turner’s Syndrome?
45XO
36
What’s the rough structure of an appointment for an individual with female infertility?
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%207.png)
37
What are the primary risks of testosterone replacement?
Increased haematocrit, prostate specific antigen levels increase
38
What’s the treatment for male factor infertility?
Initially, hCG injections, after 6 month add **FSH injections**
39
What’s the mechanism of the two main ovulation induction medications for PCOS?
**Letrozole**: Aromatase Inhibitors
**Clomiphene**: Receptor modulation (oestrogen)
40
Explain the long/short regimes for GnRH agonists in IVF?
Short term
* As you give FSH supplements, give a GnRH **antagonist** quickly to rapidly supress LH (day6)
Long term
* As you give FSH supplements, give a GnRH **agonist** ages ago, so that it becomes an antagonist by the time normally LH would cause ovulations.
* This is **desensitisation.**
41
Reason for giving LH after just trying to supress it
Supress it to stop ovulation and allow it to fully mature inside the ovary.
Giving it to convert from diploid → haploid once it’s ready.
42
What are the main ‘emergency’ contraceptives?
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Screenshot_2022-04-15_at_12.51.41.png)
43
5 main risks with HRT
1. VTE (higher risk in oral, combined)
1. Increased risk of breast cancer (higher risk in continous combined)
1. Increased risk of ovarian cancer
1. Increased risk of endometrial cancer: Provide progesterone as well!
1. CVD/stroke (higher risk in oral, combined)
44
What 3 blood levels increase as a result of taking HRT (not oestrogen)?
Increased triglycerides, CRP + SHBG
45
Which condition causes genetic absence of a vas deferens?
Cystic Fibrosis
46
What cardiological complication do individuals with Turner’s Syndrome commonly develop?
Aortic Co-arctation
47
From which cells is Ghrelin secreted?
P/D1 cells
48
From which cells is leptin secreted?
Adipose tissues
49
How do we check Vitamin D?
25 HYDROXYVITAMIN D: More stable
50
What are some associated comorbidities of obesity?
* Depression
* Sleep Apnoea
* Stroke
* Myocardial Infarction
* BMI
* Arthritis
* Hypertension
* Diabetes
* PVD
* Bowel Cancer
* Gout
51
Which bacteria is orlistat based off?
Streptomyces Toxytricini
52
What does the bacteria above do?
Inhibit gastric and pancreatic lipase
Inhibits absorption by about 30%
53
For which patients do we consider bariatric surgery?
1. BMI 40 or more
1. BMI 35-40 + other co-morbidities
1. BMI 30-34.9 + newly diagnosed T2DM
54
For which obese patients do we use **first line** bariatric surgery?
BMI 50 or more
55
What are some requirements for bariatric surgery?
**Generally fit for anaesthesia and surgery, commit to need for long-term follow up**
56
What are 3 specific types of bariatric surgeries?
**Gastric bypass: connect Small intestines to first part of stomach.**
**Gastric band: place a Band around the stomach with sensor under skin.**
**Sleeve gastrectomy: cut half the stomach away.**
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%208.png)
57
What’s the most effective form of gastric bariatric surgery?
**Gastric bypass**
58
Place the following into order of most effectiveness: Gastric Band, Vertical Gastric Banding, Gastric Bypass
1. Gastric Bypass
1. Vertical Gastric Banding
1. Gastric Banding
59
What’s LADA?
The majority of patients with autoimmune-related diabetes present younger in life. There are however a small group of patients who develop such problems later in life. These patients are often misdiagnosed as having T2DM
60
What’s MODY?
**MONOGENIC!**
A group of inherited genetic disorders affecting the production of insulin. Results in younger patients developing symptoms similar to those with T2DM, i.e. asymptomatic hyperglycaemia with progression to more severe complications such as diabetic ketoacidosis
61
Diabetes may present following pancreatic damage - true or false?
True
62
How do we measure insulin levels?
Measure C-Peptide
63
What are the stages of Type 1 Diabetes development?
1. Genetic Predisposition
1. Potential Precipitating Event
1. Immunological activation
1. Immunological response
1. Normal blood sugar
1. Abnormal blood sugar
1. **Clinical Diagnosis**
1. Antibodies made ✅
64
All people with Type 1 Diabetes have 0 insulin - true or false?
False
65
Which HLA genes pose a **significant** risk to Type 1 Diabetes?
**HLA-DR3 + HLA-DR4**
“If you buy **4 D**ia**M**onds and only pay for **3**, you get **1** for free:” DR**4** and DR**3** are associated with **D**iabetes **M**ellitus type **1**.
66
Which GWAS has the greatest association with Type 1 Diabetes?
HLA (human leukocyte antigen)
67
Name the most common environmental factor for Type 1 Diabetes and some other factors.
1. **Enteroviral infections**
1. Cow’s milk exposure/Seasonal exposures/Changes in microbiota
68
Which antibodies are detectable in Type 1 Diabetes patients?
**Insulin antibodies**
* Insulinoma-associated-2-autoantibodies
* Zinc-transporter 8
69
Which neurotransmitter enzyme is widespread in Type 1 Diabetes?
Glutamic acid decarboxylase (GADA)
70
What 2 things are a T1 Diabetes diagnosis based off?
Clinical features + Presence of ketones
71
What are the 4 T’s of Diabetes
Toilet, Thirst, Tired, Thinner
72
What do muscle cells, liver + fat cells do in the absence of insulins?
**Name the products of the fat cells’ response.**
Muscle: Proteinolysis → amino acids
Liver: Hepatic glucose output increases → glucose
Fat cells: Lipolysis → Glycerine + Non-esterified fatty acids
73
What are the 3 keto acids we make?
Acetone, 3-hydroxybutyrate + Acetoacetate
74
What molecule enters our liver to be converted to keto acids?
NEFAs
75
What are the 4 aims of treatment for T1DM?
Split into glucose/insulin/other effect/complication
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%209.png)
76
How do we describe T1DM management?
‘self-managed’
77
How many peaks do we have prandially?
2
78
What are the 2 types of insulin replacement?
**Short or quick acting with meals**
**Long acting or basal in the background**
79
What part of the abdominal wall does pump therapy inject insulin into?
**Subcutaneous fat**
80
What should ALL people with T1DM be offered?
Structured Education Programme e.g. DAFNE
81
During Islet Cell Transplantation, where do we insert the Islet Cells?
**Hepatic Portal Vein**
82
When Pancreas Transplantation, what other structure is associated with better survival if transplated as well?
**Kidneys**
83
What type of haemoglobin provides info on the last 3 months?
G**lycated** Haemoglobin (linear reaction)
84
What are some problems with using HbA1C?
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%2010.png)
85
HbA1C is measured how often?
Every 3-4 months
86
What blood level of glucose qualifies as severe hypoglycaemia?
\>3.6 mmol/L
87
HbA1C is a good marker of hypoglycaemia - true or false?
False
88
What type of medication is **prescribed to the following**?
* T1DM patient who is hypoglycaemic but alert
Sweets, Coca Cola or longer lasting sandwich
* T1DM patient who is hypoglycaemic and confused but can swallow foods
Buccal glucose, glucogel, complex carbs
* T1DM who is unconscious
* **IV, Glucose** - what percentage?
**20%**
* T1DM who is unconscious and has limited IV access
IM/Subcutaneous 1mg **Glucagon**
89
What 2 things are a T2 Diabetes diagnosis based off?
Random **glucose** + Clinical features
90
What inflammatory cells are produced in T2DM?
Adipokines
91
Name a monogenic diabetes.
MODY
92
What do adipokines do?
Drive organs to decrease insulin sensitivity
93
What’s the target HbA1C to reduce risk of microvascular complications?
**53mmol/mol**
94
Which microvascular complication is associated with the highest risk of development?
**Retinopathy \> Nephro \> Neuro \> Microalbumin**
95
What’s the mechanism behind complications of diabetes?
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%2011.png)
96
What 2 things are required to reduce risk of complications?
BP (\< 130/80) + HbA1C
97
What medication could be started for a type II diabetic under diabetic nephropathy?
SGLT2 Inhibitor
98
Which vessels are blocked in Diabetic Neuropathy?
Vasa Nervorum
99
Which complication of diabetes is a risk factor of diabetic neuropathy?
Retinopathy diabetic
100
Mechanism of diabetic nephropathy
[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Untitled%2012.png)
101
BP Cut-off when managing Cardiovascular risk?
140/80
Presence of microvascular complications: 130/80
102
Low Density Lipids + cholesterol for managing CVR in DM?
Lipids less than 2
Cholesterol less than 4
103
Explain the graph below.
* Graph[![]()](Endo%201c6507d473634c51ab6ef4cb27d564e6/Screenshot_2022-04-16_at_15.40.14.png)
* Answer
Decrease glucose disposal and increased **hepatic glucose output** contributes to
increased **fasting plasma glucose** (FPG) in diabetes mellitus.
* The diminished ability to store or oxidise glucose in muscle due to impaired
insulin activity reduces metabolic clearance rate of glucose.
* Excessive amount of glucose is converted to lactate (Anaerobic respiration).
Lactate is returned to the liver (**Cori cycling**) → Glucose → Early increase in FPG.
* A result of Cori-cycling from the previous night’s meal.
Inappropriate **glucagon secretion** induces continued glucose production by stimulating *glycogenolysis and gluconeogenesis.*
**Inadequate insulin action causes a flux of substrates – glycerol, free-fatty acids to the liver for increase gluconeogenesis.**
104
U&Es for Conn’s
**Normal sodium typically + low potassium**
