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Exams :) > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Cushing’s syndrome Ix (3)

A

-Dexamethasone suppression test (If +ve –> refer Endo, not diagnostic)
-Midnight salivary cortisol (2x readings)
-24-hour urine free cortisol (2x readings)

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2
Q

Phaeochromoctyoma triad + Ix

A

Episodic headache + sweating + tachycardia

Ix - 24 urinary metanephrines, or plasma metanephrines

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3
Q

Addison’s clinical features

A

Fatigue, LOW, nausea, LOA, depression

Postural hypotension
Skin hyperpigmentation
Salt craving

Hyperkalaemia, hyponatraemia

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4
Q

Addison’s Ix - findings

A

Low cortisol, elevated ACTH
Hyponat, hyperkalaemia
Hypoglycaemia
Hypercalcaemia

Confirm w/ short synacthen test

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5
Q

Indications for thyroid USS

A

-Structural abnormality (e.g nodule or goitre, assesses extent)
-Determine malignancy risk in known thyroid nodules
-Before neck surgery for thyroid Ca + after

–Hot nodules = low risk Ca, don’t USS
–Cold nodules = needs USS

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6
Q

Thyroxine starting dose (units per kg)

vs. Insulin starting dose (units per kg)

A

Thyroxine - 1.6mcg/kg

Insulin - 0.2 units /kg)

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7
Q

Prolactinoma causes (4)

Clinical manifestations

A

-Stress
-Nipple stimulation/lactation
-Pregnancy
-Medications (antipsychotics/anti-emetics)

Clin features:
Women - (microprolactinoma more likely) –> menstrual disturbance, galactorrhoea, infertility
Men - macroprolactinoma more likely –> visual field defects, hypopit

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8
Q

SGLT2 inhibitor RISKS (4)

A

-Euglycaemic ketoacidosis
-Mycotic genital infection - e.g Fourniere’s gangrene
-Increased UTIs
-Polyuria –> volume loss –> hypotension

(less risk of hypos)

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9
Q

Dumping syndrome - pathophys and key element of PHx

A

Pathophys - postprandial hypoglycaemia, due to rapid gastric emptying after a meal

History of gastric bypass/sleeve gastrectomy

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10
Q

Dumping syndrome clinical features

A

Dizziness/light-headedness, sweating, palpitations, hypotension, nausea, fatigue, diarrhoea

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11
Q

Screening bloods for (biocehmical) hyperandrogenism

A

-Free/total testosterone
-Free androgen index
-DHEA-S
-Androstenedione?
-LH/FSH
-Oestrogen, progesterone
-SHBG

Could also consider TSH, fasting insulin

Best done on day 3-5 of mesntrucal cycle, between 8-10am

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12
Q

Addison’s self-care action plan - aspects (4)

A

○ ↑glucocortcoid dose during illness
○ Recognise signs of adrenal crisis (N/V/hypotension/dehydration)
○ Carry injectable hydrocort when travelling
○ Wear alert necklace/bracelet/wallet card

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13
Q

Painful neck swelling DDx (7)

A

-De Quervain’s thyroiditis
-Infectious/suppurative thyroiditis
-Skin infection (cellulitis)
-Infected sebaceous cyst/thryoglossal cyst
-Traumatic thyroiditis
-Grave’s disease
-Thyroid node harbouring Cancer

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14
Q

Peripheral Neuropathy DDx (8)

A

-Diabetes
-Idiopathic
-B12 deficiency/other vit deficiencies
-Peripheral vascular disease
-Multiple myeloma
-Restless leg syndorme/periodic limb movement disorder
-Hypothyroidism
-Raynaud’s phenomenon

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15
Q

Diabetes management goals:
-how much LOW?
-Exercise?
-Fasting/post-prandial BGLs?
-Chol levels?
-BP?

A

-5-10% LOW
-150 mins + 2-3 resistance exercise sessions per week
-fasting 4-7, post-prandial 5-10
-TChol <4, HDl >1, LDL <2, TG, <2
BP <140/90 (<130/80 if a/w albuminuria)

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16
Q

AUSDRISK - how often?
What to test if high risk?
Other high risk groups?
ATSI population?

A

-Every 3 years after age .40 y.o
-fasting BGL/HbA1c every 3 years (anyone w/ impaired glucose tolerance - test annually)
-Obese people, previous CV event, gestational diabetes/PCOS, antipsychotic drugs
-Skip straight to annual bloods from age 18

17
Q

Gestational Diabetes Mellitus definition

A

Glucose intolerance beginning in pregnancy
Dx: fasting BGL >5.5 OR 2hr post-prandial >8.0

Don’t do OGTT if prev. weight loss surgery - risk of dumping syndrome

F/u w/ OGTT 6-12 weeks post-partum

18
Q

SGLT2 how long to withhold prior to surgery?

A

Withhold 3 days prior if >1 day stain in hospital, or bowel prep involved

Withhold day of if just a day procedure

19
Q

Diabaetes Cycle of care
6 monthly
12 monthly
2 yearly

A

6 mthly - BP, BMI, foot exam
12 mthly - HbA1c, lipids, urine ACR, SNAP/complication prevention
2 yearly - eye exam

20
Q

Other causes of low HbA1c (5)
Other causes of high HbA1c (3)

A

Low
-Anaemia
-Haemoglobinopathies
-Blood/iron transfusions
-Recovery from acute blood loss
-Chronic blood loss/renal failure

High
-Iron deficiency anaemia
-Splenectomy
-Alcoholism

21
Q

Which medication reduces progression of diabetic retinopathy?

A

Fenofibrate

22
Q

Driving conditions:
-T2DM on OHGs
-T2DM on insulin
-T2DM (any) & commercial licence

A

-Private licence, medical review every 5 years (unless severe hypos, end-organ complications)
-Conditional licence w/ 2 yearly review
-Conditional licence w/ specialist review

No driving after severe hypo for 6 weeks

23
Q

Hypoglycaemia “Rule of 15”
+severe management

A

15g quick-acting carb (adults)
Wait 15 mins - repeat
Long-acting carb if next meal more than 15 mins away
BSL every 1-2 hours for next 4 hours

Severe: IM/subcut glucagon 1mg

Don;t use 50% IV dextrose in kids!

24
Q

Klinefelter syndrome clin. features (7)

A

-Small testicular size
-Gynaecomastia
-Tall stature
-Reduced body hair
-Varicose veins
-Abdominal obseity
-Infertility

Other DDx small testes - mumps orchitis, vascular impairment, chemoTx

25
Q

Klinefelter syndrome Ix & findings (4)

A

-Low serum total testosterone
–Morning, fasting sample - if abnormal, repeat
-Elevated LH/FSH
-Karyotype 47XXY
-Aszoospermia on semen analysis
?TFTs

Testing not useful until post-pubertal - normal hormone levels until mid-puberty

26
Q

Klinefelter complications (8)

A

Thyroid dysfunction
T2DM
CVS - Venous thromboembolism/ischaemic heart disease/PE
Autoimmune - SLE Lupus/Hashimoto’s
Breast Ca
Osteoporosis
Tremor/Parkinson-like syndrome
Psych disorder - depression

27
Q

Indications for bariatric surgery (3)

A

BMI >40
BMI >35 + poor glycaemic control
BMI >30 + poor glycaemic control + elevated CV risk

28
Q

Puberty first signs & when they occur - girls, boys

A

Girls
-First sign = breast development, ~age 10 (normal range (8-13)
-Then growth spurt –> menarche

Boys
-First sign = testicular enlargement, ~age 11 (normal range 9-14)
-Then pubic hair, penile enlargment –> growth spurt

29
Q

Precocious puberty Ix (4)

A

-LH, FSH
-Oestradiol/testosterone
-Bone age XR
-TFTs (rare cause of central PP)

Central = high LH/FSH due to GnRH stimulation

30
Q

Medications a/w hyponatraemia

CARDISH

A

CARDISH

-ChemoTx
-Antidepressants/Antipsychotics/Anticonvulsants
-Recreational drugs (ecstasy)
-Diuretics
-Inhibitors- ACE inhibitors, SSR inhibitors
-Sulfonylureas
-Hormones/hypnotics (desmopressin, temazepam)

31
Q

Underlying causes of SIADH (5 categories)

A

-Neuro (GBS, subarach haemorrhage)
-Infective - sarcoidosis, meningitis
-Resp - pneumonia/tuberculosis/asthma
-Meds - CARDISH
-Malignancy - mesothelioma, lymphoma, sacroma,

32
Q

Hyponatraemia general DDx (conditions) (8)

A

-Hyperglycaemia
-Hypercholesterolaemia
-SIADH
-Heart failure
-Cirrhosis
-CKD
-Nephrotic syndorme
-Hypothyrpidism

33
Q

Obesity pharmacotherapy options (3)

A

Phentermine (duromine) 15mg
–C/i if b/g CVS disease, hypoerthyroidism, anxiety, eTOH/drug use, pregnancy

Orlistat 120mg TDS
–A/e’s - steatorrhoea, flatulence, faecal incontinence

Liraglutide (Saxenda) 0.6mg daily injection
–C/I severe CKD, PHx pancreatitis
–A/e’s - N/V, diarrhoea, constipation

34
Q

HHS triggers (5)
+ clinical sign (1)

A

-Infection
-AMI
-Stroke
-Pancreatitis
-Insulin non-compliance

Dehydration most clin. obvious sign

35
Q

HHS management aspects (4)

A

-Rehydration - Saline 0.9%, 3 -6L in first 12 hours (will fix BSL)
-Potassium - add to 2nd bag of IV fluids
-Insulin - only if ketones >1
-Treat underlying infection

36
Q

Diabetic foot ulcer management aspects (6)
+antibiotic choices

A

○ Antibiotics
-Mild fluclox/ceflex/clinda/augment DF, 1-2 weeks
-Mod - IV augmentin 1.2g. Severe - PipTaz
○ Debridement
○ Pressure offloading
○ Optimise glycaemic control
○ Wear shoes - protect from incidental trauma
○ Nightly-self foot check

37
Q

Androgen deficiency Ix (4)

A

○ Serum total testosterone - AM, fasting test
§ Food intake decreases testosterone
§ Always re-test an abnormal low result
○ Prolactin
○ Iron studies
○ ?Pituitary imaging if testosterone level <5.2 and low-normal gonadotrophins

Functional hypogyonadism - older men w/ chronic diseases - borderline low levels - ???modest benefit in replacement (but guidelines say don’t treat)

38
Q

Diabetic foot examination aspects (4)

A
  • Proprioception
    • Monofilament sesnation at plantar surface MTPJ
    • Ankle jerk reflexes
    • Peripheral pulses

Exams :) (20 decks)

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