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Things I don't know, but need to know, for fourth year > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

How does Post Partum Thyroiditis present.

A

Thyrotoxic phase
Hypothyroid
Normal Thyoid phase

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2
Q

Is Post Partum Thyroiditis antibody positive?

A

90% are TPO positive

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3
Q

What is the management of post partum thyroiditis

A

Beta Blockers ( Propanolol ) then thyroxine

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4
Q

If someones fasting blood glucose is <6.1 what is I described as?

A

Normal

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5
Q

If someones fasting blood glucose is 6.1 - 6.9 what is I described as?

A

Impaired Fasting Glucose

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6
Q

In a Glucose Tolerance Test if someones Blood glucose comes back as >11.1 what is the diagnosis?

A

Diabetes Mellitus

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7
Q

In a Glucose Tolerance test someones blood glucose comes back as 7.8 - 11.1 what is the diagnosis?

A

Impaired Glucose Tolerance

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8
Q

What blood results can be used to immediately diagnose DM?

A

Fasting Glucose >7.0

Random blood glucose >11.0

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9
Q

What medication can interact with levothyroxine?

A

Iron or Calcium Carbonate if taken within four hours of the levothyroxine can reduce the uptake within the stomach.

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10
Q

Diagnoses of Hypersomolar Hyperglycaemic state

A

Hypovolaemic
Serum Osmolarity >320
Hyperglycaemic >30mmol

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11
Q

Presentation of Hypersomolar Hyperglycaemic state.

A 
Fatigue 
N+V
Pappiloedema
Thrombosis
T2DM
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12
Q

Management of HHS

A

NOT insulin

Slowly fix osmolarity - 0.9% NaCl if this doesn’t work use 0.45% Saline

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13
Q

Iron studies in Haemochromatosis

A

Increased Transferrin and Ferritin

Reduced TIBC

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14
Q

MEN type 1

A 
Three Ps
Parathyriod hyperplasia (Primary Hyperparathyroid)
Pituitary 
Pancreas (Insulinoma etc)
\+/- adrenal or thyroid glands
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15
Q

What is the commonest presenting complaint of MEN 1?

A

Hypercalcaemia

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16
Q

What gene is associated with MEN 1

A

MEN 1

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17
Q

MEN IIa

A

Medullary Thyroid cancer
Parathyroid
Phaechromocytoma

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18
Q

What gene is responsible for MEN IIa

A

RET oncogene

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19
Q

MEN IIb

A

Phaechromocytoma
Medullary Thyroid
Marfanoid and Neurofibromas

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20
Q

What gene is responsible for MEN IIb

A

RET oncogene

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21
Q

What drugs can be used in Steroid Induced Hyperglycaemia and how does it present?

A

Normal HB1Ac but high Blood glucose

Sulfonylureas - gliclazide

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22
Q

MODY

A

T2DM onset generally before 25 years old

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23
Q

What is the commonest MODY

A

MODY 3

HNF alpha gene

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24
Q

MODY 3 is associated with what?

A

Increased Hepatocellular carcinoma risk

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25
Q

What medication is extremely effective in most MODY but particularly 3.

A

Sulphonylurea

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26
Q

MODY 2

A

Glucokinase gene

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27
Q

MODY 5

A

Rarest
Renal cysts
HNF-1 beta gene

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28
Q

How do you recognised and treat a Myxoedemic Coma?

A

Hypothermia and confusion

Thyroxine + Fluids and Hydrocortisone

(once adrenal insufficiency is ruled out steroid can be stopped)

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29
Q

Klinefelters

A

47 XXY
Primary Hypogonadism
Increased FSH LH
Reduced Testosterone

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30
Q

Kallmans

A

Primary Hypogonadotrophic Hypogonadism
Anosmia
Cleft palate
Delayed puberty

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31
Q

Androgen Insensitivity

A

X linked - 46XY
Genetically Male - Phenotypically Female
No testosterone receptors
High Testosterone Low FSH LH

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32
Q

How does someone with Androgen Insensitivity Present?

A

Breast development - testosterone conversion to oestradiol
Lack of other secondary sexual characteristics
Cryptochordism - masses in groin
Amenorrhoe
Female Genitalia

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33
Q

What is congenital adrenal hyperplasia

A

Series of Autosomal Reccesive conditions characterised by.
Low Glucocorticoids
High ACTH
Increased Androgens

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34
Q

What are the three types of congenital adrenal hyperplasia?

A

21 Hydroxylase deficiency - 90%
11 Beta Hydroxylase Deficiency
17 Hydroxylase Deficiency - V.Rare

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35
Q

How does 21 hydroxylase deficiency present?

A

Virilised female genitalia
Precocious Puberty in Boys
Salt wasting crisis in first few weeks of life

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36
Q

How does 11 beta hydroxylase deficiency present?

A

Virilised female genitalia
precocious puberty in boys
Hypertension
Hyperkalaemia

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37
Q

How is androgen insensitivity diagnosed?

A

Bucal swab for chromosome observation demonstrating 46 XY - chromosomal male

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38
Q

How does 17 hydroxylase deficiency present?

A

Non Virilised females
Intersex boys
Hypertension

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39
Q

Liver Enzyme Inducers - BREAK THINGS DOWN

A 
Carbamezapine
St Johns Wart
Rifampacin
Smoking
Phenytoin
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40
Q

Liver Enzyme Inhibitors

A 
Erythromycin 
Ciprofloxacin
Isoniazid
Omeprazole
Amiodarone
SSRI
Sodium Valproate 
Allopurinol
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41
Q

Is fludrocortisone indicated in an addisonian crisis?

A

No

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42
Q

If someone with Addisons is profusely vomiting what is recommended?

A

IM hydrocortisone until settled

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43
Q

What is first line management in a Thyroid Storm?

A 
Propanolol
Treat underlying cause
Antithyroid drugs 
Lugols Iodine
Dexamethasone
44
Q

Insulin infusion rate in DKA

A

0.1 units/kg/hr

45
Q

PTH and PO4- link

A

PTH causes increased PO4 excretion

46
Q

Indications for surgery in hyperparathyroidism

A

Life threatening hypercalcaemia
Nephrolithiasis
<50 years old
T -Score

47
Q

Signs of Alcoholic Ketacidosis

A

Alcoholic with a recent history of starvation.
Low or normal blood glucose
High ketones
Acidotic ABG

48
Q

Management of a Alcoholic Ketoacidosis

A

IV saline + Thiamine

49
Q

Bone Pain + Muscle Pain
Increased ALP
Normal Ca2+, PTH, Phosphate

A

Pagets disease

- give bisphosphonates

50
Q 
Low Vitamin D
Low Calcium 
Low Phosphate
High ALP
High PTH 
Waddling gate proximal myopathy + bone pain
A

Osteomalcia

51
Q

What sign may be seen on a xray in osteomalacia ?

A

Translucent bands (Looser zone) with sclerotic bands

52
Q

What is the management of osteomalcia?

A

Vitamin D and Calcium

53
Q

In order to diagnose someone with T2DM via Hb1Ac how many abnormal tests are required?

A

2

54
Q

What can be used to permanently lower the patients K+ by removing it from the body?

A

Calcium Resonium Enema
Loop diuretics
Dialysis

55
Q

What medication should be stopped in hyperkalaemia?

A

check for ACEi

56
Q

When is hypertonic 3% saline used over 0.9% in hypovolaemic hyponatraemia?

A

If Na <120

Acute symptomatic hyponatraemia.

57
Q

Hypovolaemic Hyponatraemia causes

A

Addisons
Loop diuretics
Renal failure

58
Q

Euvolaemic Hyponatraemia cause

A

SIADH

59
Q

Hypervolaemic hypernatramia causes

A

HF
Liver failure
Nephrotic syndrome

60
Q 
Jittery 
Dehydrated
Increased muscle tone
Hyper-reflexia
Convulsions
Coma
A

Hypernatraemic Dehydration

61
Q

Management of Hypercalcaemia.

A 
Rapid fluid resus - 4/6L in 24 hours
Bisphosphonates  - 2/3 days to work
Calcitonin - works faster than bisphosphonates
Steroids - only in sarcoidosis 
Loop - if unable to tolerate fluid resus
62
Q

If a patient with T2DM is controlled with lifestyle alone +/- metformin what is their Hb1Ac target?

A

48mmol

63
Q

If a patient with T2DM is on metformin plus another drug capable of causing a hypo what is their Hb1Ac target?

A

53mmol

64
Q

What is the Hb1Ac target for adding a second drug onto metformin?

A

58mmol

65
Q

Acute onset dementia dermatitis and diarrhoea.

A 
Pellagra 
Niacin (Vitamin B3) deficiency
66
Q

Causes of SIADH

A 
SSRI
Carbamezapine
Sulfonylureas
TCA
Small Cell Lung Cancer
Post SAH
67
Q

reasons for giving growth hormone

A

Deficiency
Turners
Pader Willi
Chronic renal insufficiency

68
Q

A Hb1Ac of 42-48 is diagnostic of what? and how should it be managed?

A

Prediabetes - lifestyle and dietary changes

Metformin can be used

69
Q

When are calcimimetics used?

A

Cinacalcet is used when someone is unable to tolerate a parathyroidectomy

70
Q

If someone develops and illness and they are suffering from Addisons what are their sick day rules in regards to medication?

A

Corticosteroid dose should be doubled.

Fludrocortisone dose stays the same

71
Q

PCOS fertility management

A

Weight loss - only if appropriate
Clomifene
Clomifene + metformin
Gonadotrophins

72
Q

PCOS acne management

A 
COCP
Topical eflurnithine 
Spironolactone - specialist advice
\+
Normal acne management
73
Q

Normal Serum Osmolarity

A

275 - 295

74
Q

Differentiating SIADH from Psychogenic Polydipsia

A

Both react as expected healthy individual would to fluid deprivation and desmopressin.

Psychogenic - past history of mental health disorder
+ Urinary and Plasma osmolarity low

SIADH - Urinary osmolarity high + plasma osmolarity low

75
Q

When can bisphosphonates be stopped?

A

After 5 years if…
<75
Femoral T scan shows > -2.5
Low risk FRAX score

76
Q

What is used to monitor haemochromatosis

A

Transferrin saturation

Ferritin

77
Q

Cushings Diagnosis

A

Hypokalaemic Metabolic Alkalosis
Low dose dexamethasone ‘overnight suppression test’ - diagnostic
High dose dexamethasone - determine if cushings or ectopic ACTh
Insulin stress test - differentiate pseudocushings

78
Q

Management of Acromegaly

A

IGF-1 is screening
OGTT is diagnostic

1st line = Transphenoidal surgery
Medication - Somatostatin Analogues - Ocrtreotide
-Pegvisomant - GH receptor antagonist - reduces IGF-1 and end organ affect but doesn’t reduce size
- Dopamine Agonist - Bromocriptine - not very effective

79
Q

Indications for parathyroid surgery

A

<50
End organ disease - renal calculi bone disease
Serum calcium >2.8

80
Q

Hypoglycaemia on fasting and or exercise
Reversal of symptoms with glucose
Low blood sugars measured during symptoms

A

Insulinoma
Link with MEN1
Surgery is first line
Diazoxide and somatostatin if unfit for surgery

81
Q

BP target for a T2DM patient

A

Clinic <140/90

Home <135/85

82
Q

Complication of DKA and insulin therapy that can present with respiratory distress and weakness.

A

Hypophosphataemia

Continue insulin but add in phosphate supplements

83
Q

Decreased Caeruloplasmin
Decreased total serum copper
Increased Serum free copper
Increased urinary copper

A

Wilsons

84
Q

What is diagnostic of Wilsons?

A

Genetic testing

85
Q

Total cholesterol >7.5

A

Familial Hypercholesterolaemia

86
Q

Iron deficiency anaemia
Dysphagia
Glossitis
Oesophageal webs

A

Plumer vinson syndrome

87
Q

If semen analysis comes back ad abnormal when is it retaken?

A

3 months

88
Q

Describe Gonadotrophin Dependant or ‘central’ precocious puberty

A

FSH and LH raised
Due to premature activation of hyopothalmic pituitary gonadal axis.
Testes will be large for age

89
Q

Describe gonadotropin independent or ‘pseudo’ precocious puberty.

A

LH and FSH low
Testosterone or oestrogen high
In boys testes will be small but other secondary sexual characteristics will have developed

90
Q

What can the testicular size tell us about the cause of the precocious puberty?

A

Bilaterally large - central lesion releasing GnRH
Unilaterally large - gonadal tumour
Bilaterally small - adrenal cause. Bilateral hyperplasia or unilateral tumour.

91
Q

In someone with hyperaldosteronism if the renin is also increased what does this indicate?

A

Secondary hyperaldosteronism - renal artery stenosis causing continuous release of renin.

92
Q

If someone is on steroid for over 3 months how should they be managed?

A

Bone protection should start immediately.

Bisphosphonates.

93
Q

If someone on metformin monotherapy with well controlled T2DM develops CDV what is the management?

A

Regardless of Hb1Ac start SGLT2i unless contraindicated

94
Q

Initial insuline regime in T1DM

A

Basal Bolus + Twice daily Detemir

95
Q

Iodine uptake in De Quervians

A

Reduced uptake

96
Q

If someone is on triple therapy + inadequate Hb1Ac + >35 BMI or insulin intolerant what should be trialled?

A

Swapping one of the drugs for a GIP-1 mimetic

97
Q

In amiodarone induced hypothyroidism what is the management?

A

Add in levothyroxine - don’t alter dose of amiodarone

98
Q

When monitoring effectiveness of levothyroxine in hypothyroidism. What should be monitored?

A

TSH is indicator

99
Q

In hypocalcaemia which is resistant to Vitamin D and calcium replacement what should you check?

A

Magnesium levels as hypo magnesium is a common cause of resistant hypocalcaemia

100
Q

Metformin sick day rules

A

Withhold if D+V

101
Q

Signs associated with hypocalcaemia

A

Chvostek sign - tapping on the parotid gland triggers facial twitch
Trousseaus sign - carpal spasm on BP cuff inflation

102
Q

What is the advised glucose monitoring regime in diabetics

A

4x a day

Before each meal and before bed

103
Q

Definition of malnutrition

A

Unplanned weight loss of over 10% in 3-6 months

104
Q

If metformin is contraindicated what is first line?

A

Sitapliptin mono-therapy

or SGLT2i if CVD or Q-risk >10%

105
Q

Before adding a second drug to metformin what must happen.

A

Ensure metformin is titrated up.

106
Q

Prolactinoma - management

A

Medical is used first line even if they have neurological symptoms
Cabergoline is first line

107
Q

Before doing a water deprivation test what other electrolyte should be checked?

A

Check Calcium and PTH

Things I don't know, but need to know, for fourth year (31 decks)

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