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Year 6 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Classification of Pre-diabetes

A

Hb1Ac- 42-47

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2
Q

Medication for T2DM and examples

A

Thiazindine- pioglitazone
Gliptins- sitagliptin
Sulphonlyureas- glicazide, glibenclamide
SGLT2- dapaflozin

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3
Q

CI and uses of T2DM medications

A

Metformin- lactic acidosis, <GFR 30

Sulphonylureas- CI Ketoacidosis as causes hypos, caution in high BMI as causes weight gain

Thiazol- pioglitazone- weight gain, abnormal LFT, bladder cancer- CI in HF and bladder cancer

Gliptins- Good to use if overweight
Caution if GFR <45
DPP4 inhibitor- increase incretin- increase insulin

Empagliflozin- CI GFR <60 - good for HF, can help loos weight?

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4
Q

When to add medications in T2DM

A

Metformin when >48
Add another if >58

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5
Q

What medication to use if CKD 4 and T2DM

A

Sitagliptin or gliclazide

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6
Q

Signs and sx of DM

A

Fatigue, polydipsia, polyuria

Neuropathy- gastroparesis, neuropathic pain
Foot- screen annually
Nephropathy- ACR yearly, microalbuminurea first sx

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7
Q

Mx of secondary symptoms of DM

A

Gastroparesis- metoclopramide
Neuropathic pain- amitriptyline
Nephropathy- ACEi- protective in DM and CKD but toxic in AKI
if ACR >30

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8
Q

Monitoring ACEi in DM nephropathy

A

Expect a drop since dilation
If GFR drop >20% stop
If less continue

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9
Q

Diagnosis of DKA

A

DM- BM >11
Ketones >3
Acidosis- ph <7.3
Develops rapidly

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10
Q

Causes of DKA

A

Infection
Alcohol
Trauma
Insulin missed

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11
Q

Tx of DKA

A

Fluid bolus 500ml in 15 mins- then 1L/hr
Insulin- 0.1g/kg/hr
Potassium
10% dextrose when BM <14
VTE prophylaxis

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12
Q

Dx of HHS

A

pH >7.3
BM >30
Osmolarity- >320
Develops over few days

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13
Q

Tx of HHS

A

1L in first hour
then 500ml/hr for 4 hours
250ml for next 4 hours

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14
Q

When to investigate neck lump

A

> 1cm- USS +/- FNA

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15
Q

Cause of simple goitre

A

Iodine deficiency

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16
Q

Several hot nodules with thyrotoxicosis vs single hot

A

Plummers vs
Single toxic adenoma

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17
Q

Causes of diffuse goitre

A

De Quervains- painful, hx of infection- reduced uptake

Graves- exophthalmos, pretibial myxoedema

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18
Q

Mx of Graves

A

40 mg Carbimazole
Propanolol

Or radioiodine- CI with eye disease, pregnanacy

2nd- PTU

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19
Q

Causes of hypothyroid

A

Hashimotos
Iodine deficiency
Viral thyroiditis- hypo phase

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20
Q

Types of thyroid cancer and Tx

A

Papillary- common- thyroidectomy
Follicular- “
Medullary- parafollicular C cells - phaeo screen- “
Anaplastic - palliative

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21
Q

Complications of thyroid surgery

A

Early
Haematoma- obstruction- remove clips
Recurrent laryngeal nerve pasy- right side- damage to 1- hoarse voice, both- obstruction- tracheotomy
Hypoparathyroid- low calcium
Thyroid storm- propanolol and antithyroid

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22
Q

Tx of myoxedema coma

A

IV thyroxine
IV fluids
IV HC

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23
Q

Sx of Addisons

A

WT loss
N/V, abdo pain, GI
Hyperpigmentation
Postural hypotension
Vitiligo

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24
Q

Causes of Addisons

A

AI
TB
Mets
Haemorrhage- Waterhouse Friedrichson
CAH

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25
Q

Addisonian Crisis Sx

A

Shocked- high HR, cpostural drop, confused
Hypoglycaemia

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26
Q

Cause of Addisonian Crisis

A

Infection- sepsis, meningoccocoaemia- WHF
Trauma
Surgery
Stopping steroids

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27
Q

Ix for Addisons

A

SynthACTHen - measure cortisol

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28
Q

Mx of Addisonian crisis

A

IM/IV HC- 1st
IV fluid bolus - 2nd

Continue fluids and convert to PO dex

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29
Q

Main types of pituitary tumours

A

Prolactinoma> non secreting > GH secreting > ACTH secreting

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30
Q

Sx of hyperprloactinaemia

A

 Amenorrhoea
 Infertility
 Galactorrhoea
 ↓ libido
 ED

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31
Q

Sx of acromegaly

A

Coarse face
Macroglossia
Proximal weakness
Headache
DM
Increase BP

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32
Q

Ix of acromegaly

A

IGF1 then OGTT with serial GH measurements

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33
Q

Mx of acromegaly

A

Trans-sphenoidal
2nd- octretide

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34
Q

Causes of Cushings

A

Exogenous- GC therapy
Endogenous- Cushing disease- ACTH dependent pituitary
ACTH independent- adrenal adenoma

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35
Q

Ix for Cushings

A

11pm salivary cortisol- if low not Cushings
- LDDST- 1mg DM- measure cortisol before 9am
Measure ACTH too

Confirm Cushings- IPSS- determines whether pituitary or ectopic

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36
Q

Tx of Cushings

A

Pituitary adenoma- surgery
Adrenal mass- adrenalectomy + steroids replace- can cause nelson syndrome- don’t do bilateral- enlargement of pituitary- compression ++ACTH- hyperpigmentation
Ectopic- ketoconazole

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37
Q

Sx of Conns syndrome

A

Med resistant HTN
Hypokalaemia - causing muscle weakness
Paraesthesia

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38
Q

Sx of Cushings

A

Metabolic hypokalaemia alkalosis
Proximal myopathy
DM
Striae
HTN
Moon face
Fat pad

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39
Q

ECG changes with Conns

A

Flat/Inverted T waves
ST depression
U waves

Long QT and PR

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40
Q

Ix of Conns

A

Plasma aldosterone/ renin ratio - high low
Then HR-CT + adrenal vein sampling- differentiates between bilateral hyperplasia

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41
Q

Tx of Conns

A

Spironolactone then surgery

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42
Q

Causes of secondary hyperaldosteronism

A

RAS- high renin due to poor perfusion
Aldo : renin- high high

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43
Q

Cause of hypernatraemia

A

Conns syndrome
RAS- high RAS
GI loss
Diabetes insipidus

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44
Q

Signs of hyponatraemia

A

Hypovolaemia- tachycardia, low urine Na- best

Hypervolaemia- high JVP, peripheral and resp oedema

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45
Q

Causes of hyponatraemia

A

Hyper- excess water, ADH
Cardiac failure
Cirrhosis- vasodilation due to excess NO- low BP- high ADH
Renal failure

Euvolaemic- SIADH, hypovolaemia, adrenal insufficiency

Hypo- D+V, diuretics

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46
Q

Causes of SIADH

A

4 Cs
CNS pathology- stroke
Cancer- SCLC
Chest- pneumonia
Carbmazepine and SSRI, TCA, PPI
Surgery

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47
Q

Ix of euvolaemic hyponatraemia

A

TFTs
Short SynACTHen - adrenal
plasma and urine osmolatrity- SIADH

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48
Q

Causes of hyperkalaemia

A

Low GFR
NSAIDs
DM
ACEi and ARB
Addisons
Spironolactone

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49
Q

Mx of hyperkalaemia

A

10ml 10% Calcium glutinate
10U insulin
120ml 20% dextrose

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50
Q

Causes of hypokalaemia

A

GI Loss
Hyperaldosterone- RAS/Conns
Diuretics

Insulin
Alkalosis

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51
Q

Mx of hypokalaemia

A

Oral KCl- 2.5-3.5
Severe <2.5- IV KCl

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52
Q

Types of HyperPTH

A

Primary- adenoma
Secondary- CKD, vit D def
Tertiary- end stage renal

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53
Q

Types of MEN

A

1- pituitary adenoma, parathyroid, pancreatic
2A- parathyroid, medullary, phaeo
2B- marfanoid, neuroma, medullary, phaeo

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54
Q

What can cause a lower than expected HbA1c

A

Sickle
G6PD
HS
Haemodialysis

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55
Q

DM has CKD and previous MI what prescribed

A

No metformin
SGLT2

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56
Q

When to stop IV insulin to SC in DKA

A

When eating and drinking normally
Ketones <0.6
pH >7.3
Bicarbonate >15

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57
Q

If struggling to dx between T1DM and T2 what test can you use

A

C peptide

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58
Q

Primary, secondary and tertiary hyperparathyroid biochem

A

Primary
PTH high
Ca High
P Low

Secondary
PTH High
Ca Low/N
Vit D low

Tertiary
PTH V high
Ca High
P high

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59
Q

Tx of hypercalcaemia

A

Fluids 3-4L daily
Bisphosphonates ?

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60
Q

What to do If ketonaemia and acidosis and not resolved by 24 hours

A

Endocrine review

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61
Q

Sx of hypocalcaemia

A

Cramps, twitching, spasms
Trousseau sign
Chvosek

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62
Q

Mx of hypocalcaemia

A

Severe- tetany, spase, prlonged QT
IV calcium- 10ml 10% in 10 mins

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63
Q

Max rate of potassium from peripheral line

A

10mmol/hr
So 40 mmol in 4 hours

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64
Q

What electrolyte deficiency can cause abnormal calcium absorption

A

Magnesium

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65
Q

Effects of hyperthyroid on the bones

A

Osteoporosis

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66
Q

MEN 1

A

Pituitary
Parathyroid
Pancreatic- can cause Zollinger ellison- many ulcers

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67
Q

MEN 2A

A

Parathyroid
Phaeo
Medullary thyroid

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68
Q

MEN 2B

A

Medullary thyroid
Marfanoid
Phaeo

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69
Q

What requirements are there for insulin dependant DM for driving

A

Check blood sugar every 2 hours

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70
Q

Sick day rules of DM

A

Increase monitoring of glucose
Normal regime

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71
Q

Rate of fixed insulin rate in DKA

A

0.1 units/kg/hour

so if 70kg in 2hrs
14 units

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72
Q

What is acropachy and what is it associated with

A

Swelling/clubbing of fingers
Graves disease

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73
Q

Addisons treatment for those who are vomiting

A

IM HC until vomitting stops

74
Q

MOA of gliptins

A

DPP4 inhibitors- increase incretins GLP

75
Q

MOA of exanitide

A

GLP1 mimics

76
Q

If hyperkaleamia first thing you do

A

ECG
Ca gluconate with insulin and dextrose if >6.5

77
Q

Daily HC treatment of addisons

A

Majority in the first half of day
Less in evening

e.g 20mg in morning, 10 in eve

78
Q

TX of HTN in afro carribean with DM

A

ARB

79
Q

Sodium <120 tx

A

Hypertonic solution 3%

80
Q

When does a diabetic need to surrender their licence

A

If 2 hypoglycaemic episodes requiring help

81
Q

Scintigraphy of Graves vs thyroiditis

A

Uptakes is high in Graves

82
Q

Thyroid disease affecting periods

A

Hyper- oligo /ameno
Hypo- menorrhagia

83
Q

Sick day rules T1DM

A

Increase frequency of glucose monitoring
3L of fluid
If unable to eat- sugary drinks

84
Q

Patients on long term steroids on sick days

A

Double steroids

85
Q

SE of thyroxine therapy

A

OP
Angina worsen
AF

86
Q

Non functioning pituitary adenoma sx

A

Headache- pressure affects
Hypopituitism

87
Q

Medical treatment of prolactinoma

A

Carbergoline
Dopamine agonist - inhibits prolactin release

88
Q

Cushing acid imbalance

A

Hypokalaemia metabolic alkalosis
Due to K+ excretion causing H+ excretion

89
Q

Polyuria and polydyspia ix order

A

Calcium then water deprivation test

90
Q

When is hyperkalaemia treated

A

> 6.5
ECG changes

91
Q

Ix of phae

A

Urine metanephrines

92
Q

SE of metformin and what to change it to

A

Diarrhoea
Change to modified release

93
Q

Drugs that cause prolactinoma

A

Dopamine antagonist such as metoclopramide

94
Q

When is exanitide used

A

If cannot tolerate triple therapy and BMI >35

95
Q

Addison disease and ill what should you do

A

Double Hydro
Keep fludro the same

96
Q

Tx of SIADH

A

Fluid restrict
Demeclocyline

97
Q

Subclinical hypothyroidism tx

A

If 2 separate occasions 3m apart with elevated TSH 5.5-10 and symptoms
or >10

Give thyroxine for 6 months

98
Q

When to prescribe SGLT2

A

If T2DM develop CVD, high risk for CVD or CHF

Q risk >10

99
Q

What tests should men with ED get

A

Morning testosterone
Lipids

100
Q

Where should you avoid cannulating in diabetess

A

In feet due to formation of diabetic ulcer

101
Q

Main complications of fluid resuscitations in DKA

A

Cerebral oedema- seizures

102
Q

Alcoholic KA tx

A

Saline and thiamine

103
Q

How to work out how long a person should be on FRII for

A

Weight x 0.1
To give units per hour
Divide that by how many units given

104
Q

Which hormone is lost first in pituitary dysfucntion

A

GH

105
Q

Which drug can cause thyrotoxicosis

A

Amiodarone

106
Q

Hypoglycaemic unawareness mx

A

Reduce insulin
Set higher glucose targets

107
Q

If acromegaly but decline surgery mx

A

Ocretide
SomatoStatin receptor ligand

108
Q

Removal of thyroid gland and tingling

A

Hypocalcaemia

109
Q

Impaired fasting glucose and tolerance

A

6.1-7- fasting
2hr- 7.8-11.1 tolerance

110
Q

If thyrotoxicosis what order of tx do you give

A

Propanolol
Thioamine- PTU/carbimazole

Surgery only for Graves of not suitable , toxic nodules if radio iodine unsuitable

111
Q

If thyrotoxicosis what order of tx do you give

A

Propanolol
Thioamine- PTU/carbimazole

Surgery only for Graves of not suitable , toxic nodules if radio iodine unsuitable

112
Q

Main RF for eye disease in Graves

A

Smoking

113
Q

If gyna on spironolactone what should you do

A

Swap to eplerenone

114
Q

If TSH low and T4 high on levothyroxine what should you do

A

Reduce T4
Recheck in 6 weeks

115
Q

What drugs affect TSH

A

Ferrous sulphate
Reduce absorption
Raised TSH

116
Q

Acromegaly affect on prolactin

A

Raised in 1/3- galactorrhea

117
Q

Drug that mimics calcium on the sensor causing PTH to lower

A

Cinacalcet- good if not suitable for surgery

118
Q

DM with neuro pain and BPH

A

Amitrip is usually 1st but because its a TCA in BPH can cause urinary retention so should give pregabalin

119
Q

If Aldo high and CT inconclusive what next Ix

A

Adrenal venous sampling
Distinguishes between unlateral and bilateral

120
Q

Sick euthyroid results

A

Normal TSH
Low T4
During illness
No tx

121
Q

Steroid therapy TFT results

A

Low TSH normal T4

122
Q

Poor compliance With thyroxine TFT

A

High TSH
Normal T4

123
Q

Alcohol affect on electrolytes

A

Hypernatraemia- suppression of ADH

124
Q

Conns disease affect on urination frequency

A

Increased urination

125
Q

Lithium DI test results

A

Since it causes nephrogenic DI
Urine osmolality will not change after desmopressin

126
Q

RF of graves

A

Females
Smoker
30-60
Vit D deficient

127
Q

Kleinfelters blood results

A

High LH and FSH
Low test/oest

Primary hypogonadism

128
Q

DI urine osmolality levels

A

<600
Give desmo- >600 if cranial

129
Q

What drug can reduce hypoglycaemic awareness

A

BB
Since suppress adrenergic sx

130
Q

When to tx subclinical hypothyroid

A

If TSH >10- on 2 separate occasions 3m apart
or

<65 and symptomatic and TSH high 3m apart- trail of thyroxine

If >80- watch and wait

131
Q

What to screen for in t1dm

A

Coealiac

132
Q

Tx of nephrogenic DI

A

Chlorothiazide

133
Q

Where does papillary thyroid cancer spread to early

A

Cervical LN

134
Q

Where does follicular thyroid cancer spread to

A

Vascular

135
Q

Most common cause of primary hyperaldosteronism

A

Bilateral idiopathic adrenal hyperplasia

136
Q

If have foot problems in DM other than calluses what should you do

A

Refer to local diabetic foot centre

137
Q

Common complication of insulin therapy in DKA and its tx

A

Hypophosphataemia
Infusion given if severe

138
Q

Why dont you correct hypernatraemia too fast

A

As it causes cerebral oedema

139
Q

Other types of DM

A

LADA- in adulthood- perhaps other AI condition - type 1

MODY- affecting production of insulin - younger

140
Q

Rapid correction of hyper and hyponatraemia and their sx

A

Hypo correction- osmotic demyelination syndrome- spastic paresis

Hyper correction- cerebral oedema- confused

141
Q

What other sx can carcinoid cause

A

Can secrete ACTH causing Cushing sx

142
Q

If going to start SGLT2 what do you have to do first

A

Ensure metformin is titrated up
Max- 1g BD

143
Q

What should be stoped before contrast

A

Metformin

144
Q

When to refer for bariatric surgery

A

Early if
Very obese 40-40 BMI
Other conditions caused by obesity

145
Q

When are SGLT2 CI

A

GFR <60 - T2DM
GFR <30 in CVS

146
Q

How are GLP 1 delivered

A

SC

147
Q

Order of tx in phaechromocytoma

A

Alpha first- phenoxybenzamine
Beta second

148
Q

Vision problems after bilateral adrenalectomy

A

Nelson syndrome- growth of pituitary after surgery

149
Q

Thyroid cancer with high calcitonin

A

Medullary

150
Q

What can mimic Cushings

A

Alcohol

151
Q

Lytic vs sclerotic bone lesion causes

A

Sclerotic- mets

Lytic- Paget and MM

152
Q

Glucose targets for T1DM

A

5-7 mmol/l on waking and
4-7 mmol/l before meals at other times of the day

153
Q

Electrolyte risk with giving packed RBC after blood loss

A

Hyperkalaemia

154
Q

Normal anion gap and causes of raised

A

10-18
Raised- Methanol, Uraemia, DKA, Lactate, ethylene, salicylates

155
Q

Differentiating between primary and secondary adrenal failure by sx

A

Primary- hyperpigmented skin

156
Q

Units per ml of insulin

A

100

157
Q

Likely cardiac problems caused by thyrotoxicosis

A

High output cardiac failure

158
Q

Dx of T2DM

A

Symptomatic and >7 fasting or >11.1 random/OGTT

Asymptomatic- 2 abnormal HbA1c or glucose levels

159
Q

When should you test for C peptide and DM autoantibodies

A

Type 1 diabetes is suspected but the clinical presentation includes some atypical features
>age 50 years
>BMI of 25 kg/m²

160
Q

Hashimoto is associated with which cancer

A

MALT lymphoma

161
Q

When to surrender licence to DVLA if diabetic

A

If 2 or more hypos whenever

162
Q

Pioglitazone SE

A

Fluid retention

163
Q

Presents With high HR, BP, AF, purulent sputum what do you give

A

Beta blockers, propylthiouracil and hydrocortisone

There storm caused by infection

164
Q

Apart from drug induced, what else can cause hypoglycaemia

A

Liver failure
Addisons

165
Q

Pepper pot skull dx

A

Hyper parathyroid

166
Q

Tx of Paget

A

Bisphosphonates

167
Q

When to refer for Barietric surgery

A

BMI 40-50 and other co morbidities
Or >50

168
Q

Cause of gynaecomastia

A

Hyperprolactinaemia
Testicular atophy
Kleinfelters
Increased oestrogen- liver failure
Spironolactone, anti psychotics

169
Q

Cause of amenorrhoea

A

Primary- Turners, anorexia

Acromegaly AI hep
Hyperprolactinaemia
Hyperthyroid
Haemachromatosis
Sarcoid

170
Q

Cause of amenorrhoea

A

Acromegaly
Hyperprolactinaemia
AI Hep
Hyperthyroid
Haemachromatosis
Sarcoid

171
Q

High dex suppression test results

A

High dex- suppresses ACTH in Cushing disease
Adrenal adenoma- cortisol not suppressed but ACTH suppressed
Ectopic- ACTH not suppressed

172
Q

Differentiating exogenous insulin and insulinoma

A

Give insulin

If insulinoma- C peptide will not fall
Others- will fall

173
Q

Hba1c targets for T2DM

A

48

53 if on a drug that can cause hypoglycaemia
Or if above 58 and on drug

174
Q

What drug worsens glucose tolerance

A

Thiazides

175
Q

If TPO abs positive but T4 is still normal dx and tx

A

Subclinical euthyroid
If 2x with TSH >10 3 months apart or TSH 5.5-10 with symptoms- Levothyroxine 6m

176
Q

Blood tests for thyroid cancers

A

Medullary- calcitonin

Papillary- Thyroglobulin

177
Q

SE of radio iodine

A

Hypothyroid

178
Q

Causes of cranial DI

A

Haemachromatosis
Craniopharygoma

179
Q

Graves with exophthalmos tx

A

Carbimazole 12-18 months

180
Q

Amiodarone induced hypothyroid tx

A

Continue and give thyroxine

Year 6 (28 decks)

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