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Year 4 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What substance causes acromegaly

A

Abundance of Growth Hormone -> excessive IGF-1

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2
Q

What compound supresses GH

A

Somatostatin

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3
Q

Name a chronic condition associated with acromegaly

A

T2DM

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4
Q

Symptoms of Acromgealy

A

Large hands and feet
Macroglossia
Enlarged Heart
Fatigue
Erectile Dysfunction

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5
Q

First line investigation of Acromgealy

A

Serum IGF-1 levels

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6
Q

IF serum IGF-1 levels are raised, what should be done to confirm acromgealy

A

Oral Glucose Tolerance Test

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7
Q

After diagnosing acromgealy, what should be done and why

A

MRI to check the size of the pituitary tumour (or CT if contraindictaed)

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8
Q

First line treatment of acromegaly

A

Trans-sphenoidal surgery

Second Line: Pegovisomant (GH analogue) or Radiotherapy

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9
Q

What follow-up is given to patients with acromegaly

A

ECHO for cardiomegaly and colonoscopy every 5 years

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10
Q

What is Addison’s disease

A

Lack of adrenal function (glucocorticoid deficiency)

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11
Q

What is the most common cause of Addison’s

A

Auto-immune issues

Then:
Surgical removal
Trauma
TB
WaterhouseFriderichsen Syndrome

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12
Q

What injury can cause secondary adrenal insufficiency

A

Basilar skull fracture
Radiotherapy

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13
Q

Clinical features of Addison’s

A

Hypotension
Fatigue
GI symptoms
Syncope
Pigmentation

Vitiligo

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14
Q

What test is conducted to confirm Addison’s

A

SynACTHen test

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15
Q

Renin levels in Addison’s

A

High

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16
Q

Aldosterone levels in Addison’s

A

Low

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17
Q

What initial blood tests can be done to check for Addison’s

A

U and Es

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18
Q

Na+ levels in Addison’s

A

Low

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19
Q

K+ levels in Addison’s

A

High

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20
Q

Glucose levels in Addison’s

A

Low

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21
Q

Cortisol levels in Addison’s

A

Low

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22
Q

Treatment of Addisonian crisis

A

IV Fluids and Steroids

Glucose if hypoglycaemic

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23
Q

How is Addison’s managed

A

Hydrocortisone (to replace glucorticoids)

Fludrocortisone (to replace mineralocorticoids)

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24
Q

What cardiac condition is associated iwth carcinoid tumours

A

Pulmonary stenosis

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25
Q

Investigations for Cushing’s Syndrome

A

24 hour urinary free cortisol

Dexamethasone supression test

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26
Q

What invetsigations are needed to localise the cause of Cushing’s

A

Plasma ACTH levels
High dose dexamethasone supression test
Petrosal sinus sampling
MRI of the head

CT chest and abdo

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27
Q

Surgical management of Cushing’s

A

Pituitary tumour resection

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28
Q

Medical management of Cushing’s (usually first line to reduce size)

A

Metyrapone

or Ketoconazole/mifepristone

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29
Q

What defines Diabetes Insipidus

A

Urinarting more than 3L in 24 hours + Low osmolality (< 300 mOsm/kg)

Polydipisia and polyuria

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30
Q

Causes of Cranial Diabetes Insipidus

A

Head Trauma
Sarcoidosis
Meningitis
Sickle Cell Disease
Genetics

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31
Q

What metabolic disturbances can cause nephorgenic DI

A

Hypercalcaemia
Hypokalaemia
Hyperglycaemia

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32
Q

What genetic condition can cause nephrogenic DI

A

Wolfram’s Syndrome

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33
Q

First Line Investigation of DI

A

U+Es, blood glucose (to rule out T2DM)

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34
Q

What serum osmolality is seen in DI

A

> 295

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35
Q

What urine osmolality is seen in nephrogenic DI

A

<700

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36
Q

If diagnosis remains unclear from serum and urine osmolality, what test can be done

A

Fluid deprivation test

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37
Q

Management of cranial diabetes

A

Desmopressin

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38
Q

What serum levels should be monitored during desmopressin treatment and why

A

Na+ levels, as it causes hyponatraemia

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39
Q

Drug management of Nephrogenic DI

A

Thiazide diuretic

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40
Q

What blood glucose levels indicate DKA

A

> 11.1 mmol/L

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41
Q

What blood ketones indicate DKA

A

> 3 mmol/L

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42
Q

When ar eblood cultures indicated for DKA

A

If evidence of infection

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43
Q

When are ECGs indicated in DKA

A

To check for any changes if hypokalaemia is present

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44
Q

How should a DKA be managed in a patient who is alert

A

Try oral intake + SC Insulin

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45
Q

If a patient is vomiting, confused or dehydrated, how should DKA be managed

A

IV FLuids (10mls/kg 0.9% NaCl) + SC Insulin at 0.1 units/kg/hour 1 hour after starting IV Fluids.

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46
Q

If there is evidence of shock in a patient with DKA, how does management change

A

Increase IV fluid bolus from 10mls to 20mls/kg

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47
Q

What should be the first management steps for a DKA case where there is a coma

A

ABCDE approach

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48
Q

When should IV Insulin be stopped following SC insulin

A

1 hours after

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49
Q

What is the major complication of DKA

A

Cerebral Oedema

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50
Q

What bicarbonate levels indicated DKA

A

<15 mmol/L

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51
Q

What pH levels indicated DKA

A

Less tahn 7.3

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52
Q

Once plasma levels fall below 11.1 mmol/L, what should be done

A

Add 5% dextrose alongside IV fluids + correct Hypokalaemia

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53
Q

Should SC insulin be started before or after starting IV fluids in DKA

A

After

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54
Q

What serum levels hsould be monitored hourly in a DKA

A

Glucose, ketones and ECG

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55
Q

What should be added to the fluid if k+ ions are below 5.5mmol/L

A

K+

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56
Q

After the initial hour treatment with saline, how frequently should fluid be given in a DKA

A

1L 0.9% saline + 40mmol KCL, followed by another - 2L in total at 2 hours

Then again at 4 hours

Then again at 6 hours

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57
Q

By how much should serum ketone levels drop by per hour

A

0.5mmol/L/hour

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58
Q

If insulin rate is not achieved when managing a DKA, what should be done

A

Catherisation

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59
Q

If capillary glucose falls below 14 mmol/L, what hosul dbe done

A

125ml/hr 10% glucose alongside saline

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60
Q

insulin be stopped at what blood ketone level

A

<0.3 mmol AND pH>7,3 AND HCO3- >18mmol/L

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61
Q

What endocrinological condition can cause galactorrheoa in men

A

Hypothyroidism and Liver disease

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62
Q

Name three germ cell tumours that can cause gynecomastia

A

Sertoli Cell
Leydig Cell
Germ cell

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63
Q

What endocrinological condition causes gynecomastia

A

Hyperthyroidism

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64
Q

Name two medications that can cause gynecomastia

A

Spironolactone
Ketoconazole

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65
Q

Other than PCOS, name three endocrinological causes for hirsutism

A

CAH
Cushing’s
Acromegaly
Insulin Resistance

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66
Q

Name two medications that cause hirsutism

A

Steroids
Phenytoin

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67
Q

What is Conn’s Syndrome

A

Adrenal Adenomas

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68
Q

Name some features of hyperaldosteronism

A

Polyuria
Polydipsia
Lethargy
Hypertension

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69
Q

What metabolic disturbances are seen on blood tests in hyperaldosteronism

A

Metabolic alkalosis
Hypokalaemia

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70
Q

What medication can be given to assist hyperaldosteronism

A

Spironolactone or Eplenernone

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71
Q

What causes secondary hyperparathyroidism

A

Increased secretion of PTH by parathyroid glands IN RESPONSE to low calcium ions caused by kidney, liver or bowel disease

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72
Q

What is tertiary hyperparathyroidism

A

Autonomous secretion of PTH due to CKD

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73
Q

Name some causes of secondary hyperparatyhyroidism

A

Vit D deficiency
Pancreatitis
Rhabdomyolysis
Hungry bone syndrome
Calcium malabsorption
CKD
Pseudohypothyroidism

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74
Q

Describe Calcium, phosphate, PTH and ALP levels in Vit D deficiency

A

SECONDARY Hyperparathyroidism:

Calcium - Normal
Phosphate - Low
PTH - High
ALP - High

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75
Q

Describe Calcium, phosphate, PTH and ALP levels in CKD

A

Calcium - High
Phosphate - High
PTH - High
ALP - High

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76
Q

Describe Calcium, phosphate, PTH and ALP levels in Malabsorption

A

Calcium - Low
Phosphate - Low
PTH - High
ALP - Normal

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77
Q

Describe Calcium, phosphate, PTH and ALP levels in Pseudohypoparathyroidism

A

Calcium - Low
Phosphate - High
PTH - High
ALP - Normal/High

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78
Q

What results in tertiary hyperparathyroidism

A

Prolongued secondary hyperparathyroidism

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79
Q

What is tertiary hyperparathyroidism

A

Glands produce excessive PTH even after the hypocalcaemia is corrected

Usually caused by CKD

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80
Q

Management of hyperparathyroidism

A

Cincalcet (mimics action of calclium on tissues)

Total or partial parathyoridectomy

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81
Q

What is calcium ions floating in th eblood bound to

A

Calcium Oxalate

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82
Q

What are non diffusible calcium ions bound to

A

Albumin (calclium not needed for cellular processes)

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83
Q

What is active vitamin D called and where is it activated

A

1,25 Dihydroxy Vit D

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84
Q

Two actions of PTH

A

Stimulates breakdown of bone
Kidneys stop excreting calcium + get rid of phosphate ions

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85
Q

What glands are affected in Multiple Endocrine Neoplasia

A

Parathyroid Gland
Pancreas
Pituitary

86
Q

Why do we get hyperphosphataemia in some secondary hyperparathyroidism cases

A

If there is kidney damage (e.g., CKD), phosphate cannot be filtered and stays in the blood

87
Q

What serum level indicates likely secondary hyperparathyroidism over any other types

88
Q

Whatis chovstek sign and when is it seen

A

Hypocalcaemia - twitching of muscles (as they’re eaisly excitable from lack of stimulation)

89
Q

What kind of tremour is seen in hyperthyroidism

A

Fine tremour

90
Q

What cancer can cause secondary hyperthyroidism

A

Choriocarcinoma

91
Q

What symptom rleief is given for hyperthyroidism

A

Propranolol

92
Q

What are the two medictaion sthat can be given to treat hyperthyroidism

A

Carbimazole

Propylthiouracil

93
Q

When is carbimazole contraindicated in managing hyperthyroidism

A

First trimester (can be used after)

94
Q

What is the first line managemnet in the first trimester or thyroid storm

A

Propylthiouracil

95
Q

When should radio-iodine be indicated for management of hyperthyroidism

A

Multinodular goitre or adenomas

96
Q

What condition is contraindicated for sue of radio-iodine

A

Graves eye disease

97
Q

When is thyroidectomy indicated

A

Recurrence
Obstructing otehr strutcures

98
Q

Side effect of thyroidectomy

A

Hypoparathyroidism
Hypocalcaemia

99
Q

Management of thyroid storm

A

IV propranolol
IV Digoxin

Propylthiouracil through NG tube followed by Lugol’s iodine 6 hours later

Prednisolone

100
Q

What can precipitate a thyroid storm

A

Surgery
Trauma
Infection

101
Q

What Cardiac complictaion is seen in hyperthyroidism

102
Q

Name three ways you can get hyperphosphataemia

A

Tumour Lysis Syndrome
Rhabdomyolygsis
Ingestion

103
Q

What defines hypoglycaemia

A

<4.0 mmol/L

104
Q

Name a non-diabetic drug that can cause hypoglycaemia

A

Beta blockers

105
Q

What medical emergency causes hypoglycaemia

106
Q

How can we differentiate between exogenous and endogenous causes of hypoglycaemia

A

High insulin + HIgh C-Peptide - endogenous

High insulin + low C-peptide - exogenous

107
Q

Management of hypoglycaemia (still conscious and mild symptoms)

A

ABCDE

Eat 15-25g of carbs

AVOID chocolate

108
Q

Management of severe hypoglycaemia

A

ABCDE

200ml 10% dextrose IV

1mg Glucagon IM

Treat seizure

109
Q

What defines prediabetes fasting glucose

A

6.1-7 mmol/L

110
Q

What defines an impaired fasting glucose tolerance test (pre-diabetes)

A

<7 mmol/L

2 hours: 7.8-11

111
Q

What is seen on an X-Ray for osteomalacia

A

Looser Lines (ucencies going thorugh th ebone)

112
Q

If Vit D Levels are below 25 nmol?L, what should be the appropriate management

A

High dose Vit D

113
Q

If Vit D is between 25-50 nmol/L, how should this be treated

A

Maintenance therapy alnoe

114
Q

How often should calcium levels be checked in oesteomalacia

115
Q

Risk Factors for Osteoporosis

A

SHATTERED FAMILY

Steroids
Hyperthyroidism, Hyperparathyroidism
Alchol + SMoking
Testosterone
Thin (BMI<22)
Early Menopause
Renal/Liver Failure
Erosive/Inflammatory bone disease
Diabetes

Family History

116
Q

What age is an indication to use FRAX

A

Anyone over 75

Or under 50 if:
FH
Falls History
Previous hip fracture
Low BMI
Alcohol
Steroids
Basically anyone on Shattered Family

117
Q

First Line treatment of osteoporosis

A

Bisphosphonates (weekly)

118
Q

Side effects of bisphosphonates

A

Osteonecrosis of the jaw
AF
Stress fractures (atypical)

119
Q

Second line management of osteoporosis

A

Denosumab
Raloxifene
Teriparatide
Strontium Renelate

120
Q

TSH /T3/T4 levels in primary hypothyroidism

A

TSH High

T3 Low

T4 Low

121
Q

TSH T3 T4 levels in secondary hypothyroidism

A

TSH Low
T3 Low
T4 Low

122
Q

TSH T3 T4 in primary hyperthyroidism

A

TSH Low
T3 High
T4 High

123
Q

TSH T3 T4 in secondary Hyperthyroidism

A

TSH High
T3 High
T4 High

124
Q

Where do tumours in phaechromocytoma orginiate from

A

The adrenal medulla

125
Q

Symptoms of phaeochromocytoma

A

Anxiety
Weight Loss
Palpitations
Sweating
Flushing

Hypertension
Tremour

126
Q

What can precipitate phaeochromocytoma

A

Stress
Excercise
Surgery
Beta Blockers
Opiates

127
Q

What invetsigation is used to diagnose phaeochromocytoma

A

Plasma metanephrines (FIRST LINE)

Then urinary metanephrines

128
Q

What adrenal imaging is done for phaeochromocytoma

A

CT Chest Abdomen and Pelvis (not an MRI)

129
Q

Definitive treatment of phaeochromocytoma

A

Resection of tumour

130
Q

What is Type 1 renal tubular acidosis

A

Inability to excrete hydrogen ions

131
Q

Signs of renal tubular acidosis type 1

A

Renal stones
Osteomalacia
UTIs

132
Q

What syndrome is associated with Type 2 renal tubular acidosis

A

Fanconi Syndrome

133
Q

What is Rhabdomyolysis

A

Breakdown of skeletal muscle

134
Q

What causes rhabdomyolysis

A

Immobilistaion
Crush Injuries (hyperkalaemia)
Burns
Seizures

Excercise

135
Q

Features of rhabdomyolysis

A

Muscle pain, swelling
Red/Brown Urine
AKI

136
Q

WHat investigation should be done to check for rhabdomyolysis

A

Creatinine Kinase (5 folds higher than the upper limit)

Hyperkalaemia
Hyperphosphataemia
Hyperuricaemia
Hypocalcaemia

Think tumour lysis syndrome

137
Q

What drugs can cause diabetes

A

Steroids
Phenytoin
Thiazides
Beta blockers

138
Q

Name a skin condition seen with amiodarone

A

Stevens-Johnson Syndrome

139
Q

How does amiodarone affect the colour of the skin

A

Grey discolouration

140
Q

Which anti-diabetic drug can cause weight gain

A

Sulfonylureas
Thiazolidinediones

141
Q

What HBA1c value defines diabetes

A

> 48 mmol/mol

142
Q

What fasting glucose level indicates diabetes

A

7.0 mmol/L or more

143
Q

What random plasma glucose level indicates diabetes

A

11.1 mmol/L or more

144
Q

What is MODY diabetes

A

Defects in beta-cell function that cause MILD hyperglycaemia in young people

145
Q

Name som eendocrine conditions that can cause diabetes

A

CF
Cushing’s
Acromegaly
Thyrotoxicosis
Phaeochromocytoma

146
Q

What drugs can cause diabetes

A

Steroids
Thiazides
Atypical antipsychotics

147
Q

Presentation of Type 2 diabetes

A

Polydipsia
Polyuria
Fatigue
Infections
Glucosuria

148
Q

What HBA1c defines pre-diabetes

149
Q

What fasting glucose level indicates pre-diabetes

A

6.1–6.9 mmol/L

150
Q

What glucose tolerance result indicates prediabetes

A

7.8-11.1 mmol/l

151
Q

What is the treatment target for diabetics and diabetics that have moved beyond just using metformin

A

Normal: 48

More than metformin: 53 mmol/mol

152
Q

First line management of T2DM

153
Q

Second line management of T2DM

A

Sulfonylurea
Pioglitazone
DP44-inhibitor
SGLT-2 inhibitor

154
Q

What is the third line management of T2DM

A

Triple therapy or metformin + insulin

155
Q

What does pioglitazone treat diabetes

A

Thiazolidinedione:

Increases insulin sensitivity and reduces liver productino of glucose

156
Q

Noteable side-effect for pioglitazone

A

Weight gain

157
Q

What is the most common sulfonylurea

158
Q

Side effect of glicazide

A

Hypoglycaemia
Weight Gain
Increased risk of CV disease

159
Q

How is GLP-1 delivered

160
Q

What are the role of follicular cells

A

Produce T3 (triiodothhronine)

And T4 (thyroxine)

161
Q

What is the most potent form of thyroid hormone

A

T3

So T4 -> T3 inside cells

162
Q

What are the role of C cells (parafollicular cells)

A

Produce calcitonin

163
Q

Role of calcitonin

A

Reduces Ca2+ in the blood + inhibits rebasorption of calcium ions at the kidneys

164
Q

What are differentiated thyroid carcinomas

A

Where normal and DIFFERENTIATED follicular cells divide and differentiate into cancers

165
Q

Name two types of differentiated thyroid carcinomas

A

Pappillary and follicular carcinomas

166
Q

What is the most common tpye of thyroid cancer

A

Pappillary

167
Q

Describe the spread of papillary carcinoams

A

The finger like projections (papillae) grow and block of the neighbouring lymph nodes

168
Q

What is seen under a microscope for papillary carcinomas of the thyroid

A

Orphan annie eye

Psammoma Bodies

169
Q

What is the difference in the way follicular carcinomas behave compared to papillary carcinomas

A

They can break through into blood vessels and spread haematoginously

170
Q

What thyroid cancer arise from c-cells

171
Q

What condition are medullary thyroid cancers associated with

A

MEN 2a and 2b

172
Q

Appearance of medullary thyroid carcinomas

A

Single cancer in one lobe

173
Q

What are anaplastic thyroid carcinomas

A

Where the cells of papillary or follicular cancers become unrecognisably different

174
Q

GOLD standard for thyroid cancer diagnosis

A

Fine needle aspiration

175
Q

When is a dextrose infusion indicated for DKA

A

If glucose levels fall below 14 mmol/L

176
Q

What is the benefit of SGLT-2 inhibitors (e.g., empaglafloxin)

A

Reduces risk of CV events like Mi, stroke and death

177
Q

How long before a meal should rapid acting insulin be used

A

10 minutes

178
Q

How long does novorapid and humalog (rapid acting insulin) last

179
Q

HOw long does actrapid and humulin S (short acting insulin) last for

180
Q

What antibody is found in Graves’ disease

A

Thyroid-stimulating hormone

181
Q

What autoantibody is found in Hashimoto’s thyroiditis

A

Thyroid peroxidase enzyme

182
Q

If there is failure to suppress plasma concentration in the blood with high-dose dexamethasone suppression testing, where is the source of Cushing’s

A

ectopic source of ACTH or tumour

183
Q

What is De Quervain’s thyroiditis

A

Transient hyperthyroidism from viral infections

184
Q

Describe the sequence of action in de quervain’s thyroiditis

A

Rapid hyperthyroidism followed by hypothyroidism after a few weeks

185
Q

What is a block and replace regimen in hyperthyroidism

A

Usually you give 40mg of carbimazole to block the thyroid completely

Then give levothyroxine once daily to achieve euthyroidism

186
Q

What is the criteria for radioactive iodine

A

Patient must be euthyroid

187
Q

Signs toxic mulinodular goitre

A

Usually euthyroid actually

188
Q

What is the GOLD standard diagnosis of hyperaldosteronism

A

Plasma aldosterone:renin ratio

189
Q

What is Diabetes Inspidus

A

Deficiency of vasopressin

190
Q

Should Metformin be started in people with eGFR <30?

191
Q

What is a complication of Hashimoto’s thyroiditis

A

Thyroid Lymphoma

192
Q

What condition can cause HBa1c levels to be lower than expected

A

Hereditary spherocytosis

193
Q

Management of hyponatraemia

A

Hypertonic Saline (1.8% NaCl) slowly - not more than 6 mmol//L in first 6 hours or 10mmol / 24 hours

194
Q

Management of SIADH

A

FLuid Restriction - FIRST LINE

Then Demeclocycline (blocks ADH receptors) or Tolvaptan

195
Q

Management of hypervolaemic hyponatraemia

A

Loop Diuretics

196
Q

What meabolic disorder is found with steroid crises

A

Hypokalaemic metabolic alkalosis

197
Q

Contraindications to metformin

198
Q

Contraindictation to DPP-4 (-Gliptins)

A

Hepatic and Heart failure

199
Q

COntraindications to Pioglitazone

A

HF or Bladder cancer

200
Q

Contraindications to slufonylureas

A

Hepatic and renal impairment (severe)

201
Q

Contraindication to SGLT-2 inhibitor

202
Q

Contraindication to GLP-1

A

history of pancreatitis

203
Q

What autoantibody is raised in people who have. ahigh likelihood of thyroid cancer e-occurence

A

Thyroglobulin antibodies

204
Q

What tests are needed to diagnose hyperparathyroidism

A

Serum PTH, calcium, vit D, phosphates

24 hour urinary calcium levels

205
Q

What is the first line management of diabetes T2 when renal impairment is involved

A

Gliclazide (sulfonylureas)

206
Q

When should people be offered a 6 month TRIAL of thyroxine at GP

A

If TSH remains over 10 on TWO separate occasions

207
Q

If you’re asymptomatic for Diabetes, how many times should the blood test be repeated

208
Q

Blood findings in Hyperosmolar hyperglycaemic state

A

Raised glucose with no changes in ketones

Raised osmolality

209
Q

What are the results from fluid deprivation and giving desmopressin if psychogenic polydipsia is suspected

A

High urine osmolality in both

210
Q

What is the main complication of giving too much levothyroxin e

A

Osteoporosis

Year 4 (16 decks)

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