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Year 6 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

How do you diagnose diabetes?

A

symptoms + one test result

OR no symptoms + 2 test results

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2
Q

what are some complications of diabetes?

A

NEUROPATHY
Gastroparesis - feeling full quickly, ERRATIC BMS bloating, N+V
- use metoclopramide

Neuropathic pain
- amitryptiline (not in BPH) duloxetine

NEPHROPATHY
- yearly albumin creatinine ration -ACEi

DIABETIC FOOT
- PAD - absent foot impulses
- Neuropathy

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3
Q

what can cause a falsely high HbA1c

low?

A

alcohol, vit b12 def, splenomegaly, IDA

Sickle cell

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4
Q

what is the long term management of T1DM

A

measure BM 4 times a day
1 - basal bolus regimine
- rapid + long acting

if sick - continue insulin, if glucose goes up then increase insulin

  1. BD mixed regimen
    intermediate + short OR rapid acting

rapid acting - before meal
short acting - 15-30 mins before meal

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5
Q

what is the long term management plan for T2DM?

A

HbA1c 42-48 = lifestyle changes and diabetes prevention programme

> 48 diabetes
LIFESTYLE
1. Metformin
(suppresses appetite, lactic acidosis, b12 reduced absorption, GI upset )

IF CV RISK FACTORS ADD SGLT2 INHIB (FLOZINS)
DKA, infections, angioedema, gangrene

> 53
1. Metformin

+ sulphonylurea (gliclazide/glibencamide)
weight gain + hypoglycaemia)

+ DDP4 inhib GLIPTINS
good for overweight - weight loss

+SGLT2 inhib
DKA, infections, angioedema, gangrene

+pioglitazone
weight gain, LFT, bladder cancer, oestoporosis

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6
Q

how do you treat MODY?

A

sulphonylurea - flozins

autosomal dominant
early onset T2DM
no ketosis
investigation - C peptide

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7
Q

what is the diagnostic criteria for hyperosmolar hyperglycaemic syndrome?

A

osmolality >330
BM >30
pH >7.35

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8
Q

how do you manage HHS?

A
  1. fluids 3-6L over 12 hrs
  2. fixed rate insulin infusion 0.5/kg/hr
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9
Q

what do the following show?

  • low TSH, low T4
  • high TSH, normal T4
  • low TSH, normal T4
A
  • low TSH, low T4
    secondary hypo
    sick euthyroid
  • high TSH, normal T4
    subclinical hypo
    poor compliance
  • low TSH, normal T4
    steroid use
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10
Q

what investigations do you do for a thyroid lump?

A

<1mm - nothing
>1mm USS and FNA

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11
Q

what are some causes of high and low uptake on technicium scan?

A

HYPERTHYROID

high uptake
- graves
- toxic multinodular goitre
- single toxic adenoma

low
- viral thyroiditis/de quervain
- post partum thyroiditis

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12
Q

how do you manage graves disease?

A

1- propranolol
2. carbimazole
propylthoiuracil (pregnant, 6m before conceiving, pancreatitis)

titrate up and then reduce once euthyroid

  1. if meds dont work then radioiodine (not in preg)
  2. surgery - HAVE TO BE EUTHYROID
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13
Q

how do you manage myxodema coma?

A

IV thyroxine, IV hydrocortisone, Iv fluids

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14
Q

what are the sypmtoms and investigations for addisons?

A

REDUCED ALDOSTERONE AND CORISOL

hypotension
hyperkal
hyponat

9am plasma cortisol if <500
short synACTHen test
plasma cortisol 30 mins later

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15
Q

how is addisons managed?

A

IM hydrocortisone
IV fluids + glucose

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16
Q

what investigations are done for suspected acromegaly?

A

serum IGF-1
use OGTT to monitor

17
Q

how do you manage a prolactinoma?

A

cabergoline/bromocriptine

transsphenoidal hypophysectomy (THIS IS FIRST LINE FOR ACROMEGALY - followed by octreotide)

18
Q

how do you test for cushings?

A
  1. 11pm salivary cortisol (if low then NOT cushings)
  2. low dose dexa suppression test - NOT SUPPRESSED = CUSHING
  3. inferior petrosal sinus sampling - to determine cause
19
Q

how do you differentiate between primary hyperadosteronism and renal artery stenosis from A:R?

A

primary hyperadosteronism
HIGH A:R, HIGH ALDOSTERONE, LOW RENIN

RAS
NORMAL A:R, HIGH aldosterone and HIGH renin

20
Q

what are some causes of hypernatraemia?

A

increase intake - NaCl
Renal loss - diabetes insipidus
GI loss
Sweat loss
Conns
Renal artery stenosis

21
Q

what investigations should you do for hypernatraemia?

A

glucose - diabetes mellitus
serum potassium - nephrogenic DI (hypokalaemia)
serum calcium - NDI (hypercal)

plasma and urine osmolality
water deprivation test

22
Q

what are some causes of hyponatraemia?

A

hypervol
- cardiac failure, cirrhosis, renal failure

euvol
- hypothyroid, addisons, SIADH

23
Q

what are some complications of correcting hypo and hypernatraemia?

A

hypo - central pontine myelinosis
hyper - cerebral oedema

24
Q

what are some causes of hyperkalaemia?

A

addisons
low GFR/renin
ACEi/ARB
heparin
tacrolimus
aldoesterone antag
acidosis, rhabdomyolysis

25
Q

how do you treat hyperkalaemia?

A

10ml 10% CA gluconate
100ml 20% dextrose
10U insulin
nebulised salbutamol

26
Q

what are some causes of hypkalaemia?

A

GRRR

GI losses
Renal loses
- thiazide and loop diuretics
- conns, cushings
Redistribution
- insulin
- alkalosis
- beta agonist
Renal tubular acidosis

27
Q

what are the precursors for multiple myeloma?

A

MGUS
<30g/L protein
<10% plasma cells in bone marrow

Smoldering myeloma
>30g/L protein
>10% plasma cells

MM
CRAB symptoms

B cell leukaemia

Do serum and urine electropheresis

Year 6 (10 decks)

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