Endocrinology Flashcards
1
Q
What is T1DM
A
Autoimmune destruction of pancreatic islet cells leading to
reduced insulin
2
Q
What is T2DM
A
Hypersecretion of insulin by depleted beta cell mass.
Increasing insulin resistance
3
Q
Main comps of diabetes
A
Retinopathy, neuropathy, nephropathy, skin infection (low immunity)
4
Q
What do alpha cells produce in pancreas?
A
glucagon
5
Q
What does insulin do to cells?
A
allows glucose to enter
6
Q
pres of t1DM
A
Polyuria, polydipsia, weight loss, lethargy,
DKA problems… (dehydration, breathing, abdo pain)…
7
Q
Initial Ix in DM
A
Urine dip, fasting glucose, random glucose, GTT, HbA1c
For comp:
Urine - protein
BP for HTN
Fasting lipid - hyperlipidaemia
8
Q
Where is neuropathy in DM
A
glove and stocking
9
Q
mx of nephropathy in DM
A
ACEi/ARB
10
Q
How can you minimise CV risk in diabetes
A
BP control + diet + smoking + statin -> QRISK
11
Q
How to reduce chest infections in DM
A
Pneumococcal vaccine and annual influenza
12
Q
What causes diabetic foot
A
Peripheral artery disease, neuropathy + infection
13
Q
How does diabetic food present?/
A
Ulcers (neuropathic painless and punched out or arterial), loss of pulses
*Charcot foot
14
Q
Name 2 things you might see in diabetic eye?
A
Microaneurysm - from physical weakness
Hard exudates - lipoproteins from leakage
Haemorrhages - rupture of weakened capillaries small dots, blots or flame (track along nerves in superficial retinal haemorrhages)
Cotton wool spots - build up of axonal debris
Neovascularisation
15
Q
How do diabetic eye present?
A
Painless, patch loss of vision
16
Q
Mx of diabetic eye
A
Optimise glycaemic control
Blood pressure control
Lipid control
Laser photocoagulation
17
Q
General non pharma mx of diabetes
A
Diabetes education
Diet and exercise - low sugar, low fat, high starchy carb
Exercise and smoking advice
Maximise glucose control - DAFNE for type 1
18
Q
Name 3 things checked annually in diabetes
A
Educate + modifiable RFs
Check BMI
Check complications: hypos, HOHS, DKA
Assess CVS: BP, pulses, bruits
Inspect injection sites - lipodystrophy
Foot check - neuropathy and pulses
Urine dip - protein, nitrites, ketones
Check eyes - acuity and ophthalmoscopy -> refer opthalmology
Ask erectile dysfunction
Bloods: HbA1c and home capillary monitoring results, random lipids
19
Q
What is the target hba1c
A
<48mmol
42-27 is pre-diabetes
20
Q
Pharma control of type 2 diabetes
A
1- metformin
if hba1c >58
2- add Gliptin or sulfonylurea or pioglitazone
if hba1c >58
3- add another
if hba1c>58
4- insulin
21
Q
how does metformin work
A
Increases insulin sensitivity (GLUT 4), decreases gluconeogenesis
22
Q
Ci to metformin
A
CKD, eGFR < 30
23
Q
common SE metformin
A
GI upset
24
Q
How does gliptin work?
A
DPP-4 inhibitors (DPP-4 destroys incretin)
Raised incretin -> produce more insulin when needed
SE: pancreatitis
25
How does sulfonylurea work?
CI?
SE?
Increase panc insulin secretion
[Suuuuuplements insulin]
Pregnancy
*Hypo, weight gain
26
how does piaglitazone work? SE? CI?
Increases insulin sensitivity
Weight gain, fluid retention and osteoporosis
Heart failure and osteoporosis
[PIG - big full of water]
27
Eg of rapid acting insulin you can take before meals
Humalog or Novorapid
28
Eg of long acting insulin
detemir
29
Mx of concious hypo?
10-20g short acting carb e.g. glass of lucozade, x3 glucose tablets, glucogel
30
Mx unconcious hypo
IM glucagon
31
Why does being unwell increase risk of DKA
Stress response to illness -> increased cortisol
Cortisol increases blood sugars and decreases insulin
32
Triggers of DKA?
pres?
Missed insulin, infection, intoxication, ischaemia, infarction
n/v, GCS, abdo pain, kussmal, dehydration
33
What is kussmal respiration?
deep hyperventilation to correct acidosis
34
ECG of hypokalaemia
PRSTTU
PR prolonged
ST depression
Flattened/inverted T wave
Prominent U wave after T
35
3 Ix in DKA ? what are you expecting to see?
Plasma glucose: high >11 or known DM
Plasma ketones: high >3mmol/l
ABG: metabolic acidosis pH < 7.3
Bicarb <15
[Urine dip: ketones (++) and glucose ]
36
Mx of DKA ?
For acidaemia?
ABCDE sats etc… + catheterise
IV NaCl
IV insulin : 0.1U/kg/hr
Correct K as it falls
Acidaemia: IV bicarbonate
DKA complications - cerebral oedema, hypoK/hyperK, hypoG/hyperG, AKI
37
Monitoring in DKA
Electrolytes and bicarb - 1-2 hours,
pH,
fluid balance hourly,
glucose hourly,
ECG
38
Characteristic features of Hyperosmolar hyperglycaemic state
T2DM
very high blood glucose >40 + v.high serum osmolality
39
Triggers of HOHG
Infection, MI, dehydration, inability to take normal meds, thiazides + loop, poor con
40
What happens in untreated HOHG
Extreme dehydration + altered mental state ± seizures ± delirium
41
Ix in HOHG
Urinalysis: glycosuria +++. Ketonuria +
Capillary glucose > 30
Serum osmolality > 320mmol/L
U+E -> AKI
ABG -> normal
Blood cultures -> rule out sepsis
42
Mx of HOHG
ABCDE
IV access, ECG, SaO2, BP
Treat cause
Safely normalise osmolality - replace fluid and electrolytes
Normalise blood glucose
IVNaCl
IV insulin
43
Complications of Mx of HOHG
Cerebral oedema, central pontine myelinosis
44
What is metabolic syndrome? 2 key criteria?
Cluster of common abnormalities including insulin resistance, impaired glucose tol, reduced HDL, elevated triglycerides and HTN
Truncal obesity
raised BP
45
name 2 medications causing obesity
Glitazone, sulfonylurea
Anticonvulsants
Antidepressants: tricyclics and mirtazapine
Lithium
Progesterone only contraception
BB
Corticosteroids
46
name 2 conditions cauing obesity
hypothyroid, PCOS, cushings, hypogonadism
47
Ix in obesity
Hormone profile: sex hormones and cortisol
TFT
48
What drug can you use for obesity? when?
Orlistat: only after diet, behaviour and exercise
49
When would you continue orlistat
Continue beyond 3/12 only if lose 5%
50
Name 2 surgeries for bariatrics
Restrictive: gastric banding
Malabsorptive: biliopancreatic diversion
Both: roux en y gastric bypass (RYGB
51
Which 2 hormones are involved in gynaecomastia
Oestrogens stimulate, androgens inhibit
52
Causes of gynaecomastia. Name 3
Low testosterone androgen resistance, Klinefelter’s, viral orchitis (mumps), renal disease
High oestrogen
neoplasms secreting HCG (e.g. seminoma) or ectopic BCG lung, RCC, adrenal tumour (oestrogen), CAH, *liver disease - increased prod androstenedione and aromatisation to oestrogen), obesity, hyperThyroid
53
Name 2 medications causing gynaecomastia
Antipsychotics, TCA (increase prolactin)
Digoxin
spironnolactone (inhibits testosterone)
54
blood Ix in gynaecomastia
Kidney function, LFT, TFT
Hormones:\
Estradiol, testosterone, prolactin, bHCG, AFP, LH
55
gynaecomastia...
LH high + test low = ?
LH low + test low = ?
LH high + test high = ?
LH high + test low = testicular failure
LH low + test low = increased oestrogens
LH high + test high = androgen resistance or neoplasm
56
When would you image gynaecomastia
Imaging: USS or mammography if suspicious or unilateral + needle core biop
57
most common cause of hypothyroid?
Presentation?
Hashimotos
Iodine deficiency is more common in developing world!
Other - thyroidectomy, radioactive iodine, lithium, Amiodarone, De Quervain;s
Bradycardia, constipation, low of concentration, menorrhagia, cold intolerance, thin skin, thin hair, depressed, fatigue, weight gain, decrease appetite, carpal tunnel
58
Hypothyroid main complication ? presentation?
myxoedema coma
hypoventilation + seizures + hypothermia + decreased consciousness
59
Mx of myxoedema coma
IV levothyroxine
+ IV hydrocortisone (after blood cortisone) - this is because primary hypothyroidism can also come with primary adrenal insufficiency. Secondary hypothyroidism can be associated with hypopituitarism leading to secondary adrenal insufficiency. Additionally, levothyroxine may cause adrenal insufficiency due to the increase in the metabolism of cortisol.
+ resp support
60
2 key antibodies in hashimotos
Anti-TPO (anti-thyroid peroxidase)
anti-Tg (antithyroglobulin)
61
How to differentiate 1 /2 hypo thyroid disease?
Primary: high TSH, low T3/T4,
secondary: low TSH, low T3/T4
62
Mx of hypothyroid ? 2 comps with mx?
Levothyroxine (T4) for life
Osteoporosis
Arrhythmia
63
Antibody in graves
Anti-TSH
64
Ix in hyperthyroid ? If orbital involvement?
TFT: TSH low, high T3/T4
AAb: anti-TSHR (99%) at Grave’s + anti thyroglobulin + anti TPO
Anti-TPO + Anti-TSH = GRAVES!
Anti-TPO + Anti-Tg = Hashimotos!
Imaging:
- USS ?cancer
Thyroid uptake scan. This uses radioisotopes and hot = overactivity, no uptake for DeQuervain’s (subacute thyroiditis - gives hyperthyroidism for a few days then hypothyroidism for a few weeks after)
Orbital -> visual field testing, CT/MRI head
65
Usual Mx of hyperthyroid
BB - propanolol
Lubricating eye drops
Carbimazole
propylthiouracil - if pregnant
66
Which antithyroid drug cant be used in pregnancy?
carbimazole -NOT IF PREG
67
what mx is often used in Relapsed Grave’s or toxic nodular ? When can this not be used
radioactive iodine
preg / breastfeeding
68
2 specific complications of thyroid surgery?
hypoparathyroidism
damage to recurrent laryngeal nerve
69
how does a thyroid storm present
Hyperpyrexia > 41
CVS: HR > 140, hypotension, AF, CHF
GI: Nausea, jaundice, vomiting, diarrhoea, abdominal pain
NEURO: Confusion, agitation, delirium
70
Ix in thyroid storm?
Sepsis screen, TFT, ECG, CXR, ABG
71
Mx of thyroid storm
ABCDE
Resus: O2, IV fluids, NG tube if vomiting
Antithyroid Rx
Oral carbimazole or propylthiouracil
IV propanolol
IV hydrocortisone (treats possible relative adrenal insufficiency)
Keep cool with tepid sponging not paracetamol
72
What causes increased PTH release
low ca
73
PTH main organs affected?
Bone - increases osteoclasts -> release Ca
Kidney
1 - increases fit D metabolism by the kidneys -> this secondarily increases Ca absorbtion in GI
2 - Increases reabs Ca, decreases reabs PO4
74
Who gets primary hyperparathyroid?
Main comps?
postmenopausal women (benign adenoma on parathyroids)
Osteoperosis + peptic ulcers, hypercalcaemia
75
Cause of secondaery hyperparathyroid?
low Ca -> PT hyperplasia. However calcium still stays low.
almost always associated with kidney, liver or bowel disease
76
Which hormone inhibits osteoclast activity?
calcitonin
Produced by para-follicular (medullary) C cells of thyroid
77
What does the excess ca absorption from bone -> in hyperparathyroid?
osteopenia and osteoporosis
(if extreme = osteitis fibrosa cystica (salt + pepper pot skull + subperiosteal resorption )
Sx of high Ca
*Bones, stones, abdominal moans, thrones, psychic overtones
78
Ix in raised Ca?
What addtional Ix might you do if you think this is longstanding?
Obvious cause: thiazide and lithium
Repeat plasma albumin adjusted calcium
Check renal function
Measure PTH - HyperPT often finding post raised Ca
Longstanding:
DEXA (annual)
Renal tract imaging USS
X-ray: skull and hand
79
mx of mild primary HPT
Surveillance
Check creatinine and Ca 6 months
DEXA yearly
Vitamin D *suppresses PTH
Avoid dehydration, thiazide diuretics -
increase fluids
80
Surgery is the definitive mx of primary HPT. Complications?
Hypothyroidism, recurrent laryngeal nerve damage
Hungry bone syndrome (due to rapid deposition of Ca in bone)
81
Medical management of low bone density in HPT
Bisphosphonates
82
Association secondary HPT
Presentation?
CKD (5)
vit D deficiency
High PTH, low Ca, Low vit D, high PO4
CKD pres with PROMINENT BONE PAIN
83
main complications of 2ndary HPT
Progress to tertiary -> high Ca -> Skeletal and cardiac calcification
84
Measure levels of what in secondary HPT? Whats high/low
High PTH,
low Ca,
PO4 high in renal disease, low in vitamin D deficiency [vit D increases PO4 absorption]
85
Mx of 2ndary HPT ?
Correct vitamin D deficiency
In CKD: Ca supp, correct vit D, phosphate binders, calcimimetics (only at end-stage kidney disease)
86
What is tertiary HPT
ongoing hyperplasia of PT glands after correction of underlying renal disorder CKD
i.e. after prolonged secondary hyperplasia of all 4 glands
87
Mx of tertiary HPT
Cinacalcet [hes a cina that cal with cet]
Total or subtotal parathyroidectomy
88
Appearance of people with pseudohypoparathyroid
Low IQ, short stature, short 4th and 5th metacarpals
89
mx of hypoparathyroid
If tetany - urgent IV Ca
Diet: rich in Ca and vit D
Calcium and vit D
90
DDx for hyperCa causes
Name 3
HPT
Malicnancy - squamous cell lung Ca, breast Ca
Endocrine - thyrotoxicosis, phaeo, primary adrenal insufficiency (Addison’s)
Drugs: thiazide diuretics, vitamin D
91
What is meant by groans, thrones, stones, and psychic overtones
Abdominal groans
Anorexia, nausea and vomiting, abdo pain, PUD, acute pancreatitis
Thrones
Polyuria, polydipsia, dehydration
Stones - if long standing
Renal colic
Psychic overtones
Depression, dementia, confusion, memory
92
Ix in hyperCa and why?
High corrected Ca (<3 = PHPT, >3 = malignancy)
Albumin - high -> with high urea = dehydration
Alk phos - normal in myeloma, raised in bony mets
Calcitonin - B cell lymphoma
PTH - high = PHPT, low = granulomatous or adrenal
*XR - bone abnormalities, cysts, pathological fractures etc
93
Mx of acute high Ca (<3.5) ?
0.9% saline - hydration and increase urinary excretion
Loop diuretic - furosemide for fluid overload
After rehydration --> IV bisphosphinates.
94
what should you give post re-hydration of acute high Ca
IV bisphosphonates
95
Causes of hypocalcaemia?
Sx of hypoCa
Causes = low PTH (surgery or radiotherapy), fit D deficiency, CKD, acute pancreatitis
Paresthesia: fingers, toes, mouth
Tetany (emergency)
Carpopedal spasm (wrist flexion and fingers drawn together)
Muscle cramps
96
QT in hypo vs hyper Ca
Hypo Prolonged QT
(shortened in hyperCa)
97
What are Chvostek’s and Trousseua’s signs?
hypoCa
Chvostek’s sign - latent tetany
Tap facial nerve -> face spasms
Trousseua’s sign - from increased neuromuscular excitability
Inflate a BP cuff above systolic - look for carpopedal spasm
98
name 3 Ix for hypoCa ? 2 more for things to exclude causes
Adjusted Ca
Serum Mg
Serum PO4
Serum PTH
Evaluate vit D metabolism
ECG
Exclude:
CKD (U+E), acute panc (amylase), rhabdo (check CK)
99
Mx of acute hypoCa (seizures / tetany) ? What to do if hypoMg
10ml 10% calcium gluconate slow IV infusion, repeat as necessary
Oral calcium
Monitor Ca
If hypomagnesaemia - correct otherwise Ca will not respond
100
Chronic mx of hypoCa
Ca
vit d
101
Hormones and basic function from ant pit
GH: stimulates liver to produce IGF-1 and counteracts insulin
Prolactin: promotes growth of mammary glands and reproductive organs
FSH: stimulates release of sex steroids
LH: stimulates release of sex steroids
ACTH: adrenocorticotropic hormone: stimulates adrenal cortex to release glucocorticoids and androgens
TSH
102
2 hormones from post pit
vasopressin
oxytocin
103
Name 2 local effects of pit ademonas
Cavernous sinus = CN 3, 4, 5a, 5b, 6
Optic chiasm
Headaches: retro-orbital and bilateral worse on waking
Visual field defect: bitemporal hemianopia
Ocular nerve palsies - squint
104
What is the key DDx of pit adenoma local effects
Craniopharyngioma
(from Rathke’s pouch, between pit and floor V3)
105
General mx of pit adenoma
Surgery: transsphenoidal
106
Key SE of pit surgery
pituitary dysfunction -> adrenal insufficiency, DI, SIADH
107
Pharma mx of prolactinoma?
bromocriptine
108
Pharma mx of GH adenoma
somatostatin
109
Effect of high prolactin pn women? men?
Women
menstrual dysfunction + galactorrhoea -> low oestrogen
(due to inhibits GNRH -> reduced gonadotropin (FSH + LH) secretion )
Men
hypogonads, decreased libido, erectile dysfunction
110
Which class of drugs causes high prolactin
antipsychotics - raise PL
Antidepressants
111
MEN1 gene associations
parathyroid tumours, prolactinoma, pancreatic islet tumour
112
Ix in raised prolactin
PRL: normal < 400, if mild el = 400-1000 - repeat before referral
> 5000 = true prolactinoma
TFT
Exclude pregnancy
Assess other pituitary function
MRI pituitary
113
medical mx of prolactinaemia
Dopamine agonist
-bromocriptine
114
Main SEs of bromocriptine
sleepiness, hypotension,
cardiac/retroperitoneal/pulmonary fibrosis - monitor
115
With pit adenoma what sreious complication are you worried about? how does it present?
pituitary apoplexy
Haemorrhage / infarction of gland
Sudden onset headache, visual symptoms
116
What two hormones involved in acromegaly
GH
IGF1
117
Name 3 features of acromegaly
Due to tumour - headaches / visual field defect
big hands / feet
thick nose, frontal bossing , macroglossia, coarse facial features
skin - thick dark oily
carpal tunne
cardiac - HTN / LVH / arrythmia
T2DM
118
Name 3 Ix for acromegaly
IGF1 - raised
GTT
GH
pit MRI
Glucose
Visual field testing
119
mx acromegaly
transsphenoidal surgery
2nd line - somatostatin analouges
3rd line - bromocriptine
120
Layers of adrenals
The deeper you get the sweeter it gets
GFR - Salt sugar sex
Zona glomerulosa - mineralocorticoids - aldosterone
Zona fasciculata - glucocorticoids - cortisol
Zona reticularis - androgens - DHEA - dehydroepiandrosterone
121
Effects of cortisol?
RIDGE
Suppression of reproduction
Suppression of immunity
Suppression of digestion
Suppression of growth
Mobilisation of energy
122
What syndrome has high cortisol
cushings
123
What are the 2 types of cushings syndrome ?
1 cause of each?
Most common cause?
ACTH dependent
Excessive ACTH pit pit (Cushing's disease),
ectopic ACTH producing tumours (due to lung cancer, small cell)
ACTH independent
Adrenal adenoma/adrenal carcinoma/excess glucocorticoids
most common is excess glucocorticoids - IATROGENIC
124
Name 3 features on presentation of cushings syndrome
buffalo hump
moon face
wiehg t gain
proximal muscle wasting
Diabetes
hypertension
osteoperosis
infection
depression
125
Ix for cushings (excluding imaging)
Treatment
Glucose - elevated
dexamethasone supression test
24hr urinary free cortisol
Tx = ketoconisole, metyrapone, SURGERY
126
What happens in addisons
Destruction of adrenal cortex and subsequent reduction in output of adrenal hormones: glucocorticoids (cortisol), and mineralocorticoids (aldosterone)
127
Causes of adrenal insufficiency
Primary
addisons (autoimmune) Surgical
Metabolic failure: CAH e.g. 21-hydroxylase deficiency
Secondary
steroids
TB
128
Noticable effect of decreased cortisol in addisons
pigmentation of skin
129
Antibody in addisons
Anti-21 hydroxylase
130
Sx of chronic addisons
thin, tanned, tired, tearful and tumbling
Fatigue and weakness
GI: Anorexia, nausea, vomiting, weight loss
Cravings for salt and salty food
Muscle cramps
Faintness due to hypotension
Mood: confusion, personality change, irritable
131
Signs of addisons
pigmental palmar crease and buccal mucosa, hypotension, postural hypotension
132
how to differentiate 1/2 addisons
ACTH levels
High = primary, low = secondary
133
Ix addisons
ACTH
Sodium - low, Potassium high
Cortisol - low
Renin (high), aldosterone (low)
CT adrenals
synacthen test
134
What is the Dx Ix for addisons
Short synacthen test:
Take cortisol level
Give 250 mcg synacthen IM (synth ACTH). In 30 mins retake cortisol
If cortisol rises then exclude Addison’s >500nmol/L
135
Electrolytes in addisons
Hyponatraemia, hyperkalaemia, hypoglycaemia, metabolic aci
136
Mx addisons
patient education
medical emergency bracelet
Glucocorticoid - hydrocortisone
mineralcorticoid - fludrocortiosone
137
What to monitor in addisons
symptoms, signs, BP, electrolytes
Annual
TFT, glucose + HbA1c, coeliac
138
Biggest Rf for addisonian crisis
long term steroids
139
Presentation of addisonian crisis ? progress to?
Malaise, fatigue, nausea/vomiting, low-grade fever, muscle cramps, confusion
Dehydration: hypotension and hypovolaemic shock
140
Mx of adisonian crisis ? monitor what?
IV/IM hydrocortisone
rehydrate
more hydrocortisone and glucose over 24 hrs
Continuous cardiac and electrolyte monitoring (ECG, reg U+E)
141
What is conns
primary hyperaldosteronism
142
What happens in conns
hypernatraemia, water retention and hypokalaemia
143
What might you think the cause is if someone presents with HTN, hypokalaemia, or alkalosis in someone not on diuretics
conns
144
presentation of conns
Oedema
Hypertension
Hypokalaemia - weakness, cramps, parasthesia
Metabolic alkalosis - secretion of H+ in exchange for K+ (more K+ in urine) in intercalated cells
Polyuria from reduced ability of kidney to concentrate urine
145
Ix in conns
U+E: hypernatraemia, hypokalaemia
BP: high
*Aldosterone: renin ratio (high ald, low renin - normal renin exludes Dx)
>800 = imaging required
ECG for arrhythmia
CT/MRI for adrenal adenoma
146
Mx of conns
medical
spronolactone - aldosterone antagonist
Laparoscopic adrenalectomy (only if unilateral)
147
give 3 causes of hyper K
Renal
AKI / CKD
Addisons
hyperkaeamia RTA
Drugs
spironolactone ACEi, ARB, NSAID, BB, Digoxin, heparin
rhabdomyolysis, burns, trauma, blood transfusion
DKA
148
Presentation of hyperK
KEVIN!!!! Kevin is in hospital for an AKI but he also has diabetes and takes loads of meds and hes tired, flaccid and depressed.
Non-specific: weakness + fatigue, flaccid paralysis, depressed tendon reflexes
Palpitations + chest pain
149
Ix in Hyper K
Medication review
U/E
ABG
ECG
150
Seen on ECG in hyper K
PPRQRST
P - loss of P
PR - prolonged - ?HB ?bradycardia
QRS - widened and sinusoidal
T - peaked T waves = first thing you see
Worry ---> can progress to VF
151
Mx of hyperK
Stop drug causing
Cardiac protection
- calcium gluconate IV
Shift potassium into cells
- Insulin infusion + glucose
If needed - nebulised salbutamol/haemodialysis
Monitor ECG
152
Usual cause of hypoK
non-K sparing diuretics / GI fluid loss (N&V)
Alkalosis or acidosis
153
HypoK presentation
Investigations?
KAREN!!!!! Karen is weak, constipated and hypotonia.
weakness, muscle pain, constipation
Severe:
neuromuscular
(ascending weakness -> resp faulure,
hypotonia)
Ix:
- U&E
- ABG
- Glucose
- Serum Mg (also goes low)
- Serum Cl
- ECG
154
Which electrolyte accompanies low K?
Mg
155
Mx of low K - How do you give it?
Mild = oral K which sandoK
Severe = IV K - Dont give as a bolus as can cause fatal arrhythmia = VF
Rate should never exceed 10mmol/hr
Cardiac monitoring
156
Classic 4 sx in phaeochromocytoma
Episodic headache + sweating + palpitations + tremor
157
o/e phaeo. 3 signs
Hypertension, postural hypotension, tremor, flushing, tachycardia
158
Ix of phaeo
24 hour urine catecholamines, metanephrines, VMA
Abdo CT/MRI
159
2 drugs given pre surgery for phaeo
alpha blocker - Phenoxybenzamine
b blocker - propanolol
160
What do you monitor after surgery for phaeo
24 hour catecholamines + VMA 2 weeks after surgery
161
What is carcinoid syndrome ? usual pres?
Tumour of enterochromaffin cell
Flushing and diarrhoea
(Wheeze, palpitations, telangiectasia, abdominal pain)
162
What is released in carcinoid syndrome?
serotonin / other vasoactive peptides
163
Ix in carcinoid syndrome? name 2
Urinary 5-HT
CT CAP - to find tumour and check liver mets
Serum chromogranin A/B
164
mx of carcinoid
Surgical resection
+ peri-operative octreotide infusion
(to prevent carcinoid crisis - continue for 48 hours post)
165
What happens in diabetes insipidus?
large amounts of dilute urine due to hyposecretion or resistance to ADH/vasopressin (same thing) and inability to concentrate urine
166
where is ADH made?
hypothalamus
167
name 2 causes of Diabetes insipidus
Cranial
Damage to hypothalamus:
tumour, surgery, granulomatous disease, infection
Inherited AD vasopressin gene
Nephrogenic causes - CKD and lithium
168
Ix in diabetes insipidus
24 urine collection
urine / serum osmolality
Desmopressin stimulation test - test urine osmolality
MRI pit/hypothalamus
water deprivation tests (can kidneys concentrate urine)
169
Mx of cranial cause of diabetes insipidus
ADH replacement
170
Mx of nephrogenic cause of diabetes insipidus
drink adequate fluid
171
If you correct SIADH too fast what could you cause \?
central pontine myelinolysis
172
most common cause of hyponatraemia
thiazine diuretics
173
Name 3 causes of SIADH
Pulmonary processes: pneumonia, lung cancer (esp small cell)
CNS disorders: infection, trauma, MS, haemorrhage, malignancy
Malignancy: lung, GI, GU, lymphoma
Drugs: SSRIs, ACE-i, chemo drugs
174
How does SIADH present
confusion, nausea, irritability, vomiting
175
Ix in SIADH
Na - low
low serum osmolalaity
High urine Na
Normal renal / adrenal
176
What happens to Na levels in SIADH with normal saline infusion
they don't respond
177
Mx SIADH
IV hypertonic saline
treat cause
furosemide if fluid overoad
178
Big old risky with very low Na
cerebral oedema
179
Risk of correcting low Na quickly in cerebral oedema
osmostic demyelination
(water moves out brain a bit fast)
180
What is the dexamethasone suppression test ?
give steroids -> should lower cortisol
If doesnt - positive test -> pit adenoma or ectopic source eg Small cell lung Ca
181
hypovolemic and hypernatraemic?
Give 5% dextrose
If really high Na just give normal saline as dont want to bring down too fast
182
Hyperkaeamia
mild >5.5
severe >6.5
183
Calcium normal range
Severe >3.5
184
Malignancies causing hyperC
breast
myeloma
SCLC
bone mets
185
signs for GRAVES
EYES - lid lag
ophthalmoplegia
exophthalmos/proptosis
pretibial myxoedema
clubbing
186
SGLT
gliflozin
SE: thrust
Work by increasing excretion of glucose from urine
187
GLT1 agonist
exenatide
