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Medicine Year 5 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

reference ranges for fasting glucose

A

below 6 is normal
6.1-6.9 is prediabetes
above 7 is diabetes

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2
Q

reference ranges for HbA1c

A

below 41 is normal
42-47 is prediabetes
above 48 is diabetes

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3
Q

what value on random glucose would indicate diabetes

A

11.1

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4
Q

how would you manage an asymptomatic patient with an abnormal HbA1c or fasting glucose

A

second abnormal reading is required before diagnosis

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5
Q

management of diabetes with HbA1c above 48 and 53

A

48: lifestyle and metformin
53: lifestyle and drugs which can cause hypoglycaemia

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6
Q

first line management of diabetes

A

metformin

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7
Q

management of diabetic patients with high risk of CVD/current CVD/ heart failure

A

establish metformin then add an SGLT2 inhibitor

if metformin contraindicated then monotherapy with SGLT2

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8
Q

management if metformin not tolerated

A

switch to modified release metformin

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9
Q

second line therapy of diabetes

A

continue metformin and add one of

DPP-4 inhibitor
Pioglitazone
Sulfonylurea
SGLT2 inhibitor

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10
Q

third line therapy of diabetes

A

add another drug
start insulin therapy

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11
Q

when would you add a GLP-1 mimetic

A

under specialist care if triple therapy is not tolerated or contraindicated

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12
Q

which drug reduces the peripheral breakdown of incretins

A

DPP4 inhibitor e.g. sitagliptin

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13
Q

which patients are DPP4 inhibitors useful in

A

obese patients

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14
Q

which drug is an agonist of PPAR-gamma receptors and reduces peripheral insulin resistance

A

pioglitazone
(thiazolidinediones)

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15
Q

2 contraindications for pioglitazone

A

heart failure
bladder cancer

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16
Q

give an example of a sulfonylurea

A

gliclazide

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17
Q

2 side effects of sulfonylureas

A

weight gain and hypoglycaemia

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18
Q

which drug increases urinary excretion of glucose

A

SGLT2 inhibitors e.g. dapagliflozoin

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19
Q

side effects of SGLT2 inhibitors

A

UTI, necrotising fasciitis of the genitals, increased urine output, weight loss

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20
Q

how can you distinguish between type 1 and 2 diabetes on blood tests

A

T1DM has reduced c-peptide levels and anti-GAD autoantibodies

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21
Q

first line treatment of T1 diabetes

A

basal bolus
2 daily insulin detemir

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22
Q

glucose targets in type 1 diabetes

A

5-7 on waking
4-7 before meals

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23
Q

sick day rules for people on insulin

A

continue insulin as normal but check blood sugar levels more frequently

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24
Q

everyone treated with insulin needs what

A

a glucagon kit for emergencies

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25
Q

management of DKA

A

initially 0.9% NaCl

0.1 mg/kg/hr fixed rate insulin infusion
withhold for 1 hour in children due to the risk of cerebral oedema

continue long acting insulin

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26
Q

if the ketones and acidosis have not resolved within 24 hours

A

senior endocrinology review

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27
Q

pH, ketones and bicarb levels in DKA resolution

A

pH 7.3, ketones 0.6, bicarb 15

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28
Q

presentation and monitoring for hyperosmolar hyperglycaemic state

A

similar to DKA but hyperglycaemia with no acidosis

monitor the serum osmolarity

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29
Q

management of hypoglycaemia

A

alert: oral glucose
unconscious: 200ml 20% glucose IV

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30
Q

management of diabetes induced gastroparesis

A

metoclopramide

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31
Q

inheritance and treatment for MODY

A

autosomal dominant (strong FHx)
sulfonylureas

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32
Q

HbA1c in hereditary spherocytosis

A

underestimates blood glucose levels

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33
Q

MOA of orlistat

A

inhibits gastric and pancreatic lipase to reduce fat absorption

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34
Q

what is the triad in an insulinoma

A

whipples triad

  1. hypoglycaemia with fasting/exercise
  2. reversal of sx when given glucose
  3. recorded low BMs when sx occur
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35
Q

what are the references for BMI

A

under 18.5 : underweight
18.5-25: normal
25-30: overweight
30-35: obese class 1
35-40: obese class 2
above 40: obese class 3

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36
Q

2 main causes of hyperthyroidism

A

toxic multinodular goitre
graves disease

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37
Q

toxic multinodular goitre - treatment and scan findings

A

patchy uptake on scan
give radioactive iodine

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38
Q

graves disease - treatment and scan findings

A

increased homogenous uptake

propanolol in new pts for sx control
carbimazole

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39
Q

side effect of carbimazole

A

agranulocytosis
inform immediately if sore throat, fever, malaise

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40
Q

3 findings in graves disease

A

thyroid eye disease
pretibial myxoedema
clubbing (acropachy)

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41
Q

management of thyroid eye disease

A

urgent referral

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42
Q

periods in hyper and hypo thyroid

A

hyper: oligomenorrhoea or amenorrhoea
hypo: menorrhagia

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43
Q

management of hyperthyroid in pregnancy

A

propylthiouracil as reduced risk of congenital malformations

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44
Q

risk of over replacement of thyroxine

A

graves

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45
Q

what effect can thyrotoxicosis have on the heart

A

high output cardiac failure

46
Q

3 medications to manage thyrotoxic storm

A

beta blockers
propylthiouracil
hydrocortisone

47
Q

how does hypothyroidism often present

A

brief initial hyperthyroid/thyrotoxic stage followed by hypothyroidism

48
Q

association with hashimotos

A

MALT lymphoma

49
Q

8 causes of hypothyroidism

A

hashimotos
iodine deficiency
lithium
subacute thyroiditis (de quervains)
postpartum thyroiditis
riedel’s thyroditis

50
Q

cause of subacute thyroiditis (de quervains)

A

triggered by viral infection

51
Q

thyroiditis (de quervains) - treatment and scan findings

A

reduced uptake of iodine on scan
steroids - self limiting

52
Q

amiodarone and thyroid issues

A

can be hypo or hyper

53
Q

TSH T3 and T4 in sick euthyroid

A

normal TSH
reduced T3 and T4

A/W systemic illness

54
Q

TSH and T4 in subclinical hypothyroidism

A

high TSH
normal T4

55
Q

management of subclinical hypothyroidism

A

treat if TSH above 10 on 2 separate occasions 3m apart
watch and wait in elderly

56
Q

presentation and management of myxoedema coma

A

confusion and hypothermia

IV corticosteroid and thyroid replacement (exclude adrenal insufficiency)

57
Q

which thyroid hormone does levothyroxine increase

A

TSH

58
Q

when should iron/calcium carbonate be given after levothyroxine

A

4 hours after levothyroxine

59
Q

thyroid cancer in a young female with pale empty nuclei on histology, metastases to the lymph nodes and an excellent prognosis

A

papillary thyroid cancer

60
Q

thyroid cancer with a solitary nodule

A

follicular adenoma

61
Q

thyroid cancer which is encapsulated with vascular invasion

A

follicular carcinoma

62
Q

cancer associated with hashimotos

A

lymphoma

63
Q

thyroid cancer in an elderly female with pressure symptoms requiring resection as chemotherapy is unresponsive

A

anaplastic

64
Q

cancers found in MEN I
presenting complaint is often what?

A

Parathyroid
Pituitary
Pancreas

hypercalcaemia

65
Q

cancers found in MEN II a

A

MEDULLARY THYROID CANCER
Parathyroid
Phaeochromocytoma

66
Q

cancers found in MEN II b

A

MEDULLARY THYROID CANCER
phaeochromocytoma

67
Q

which gene is associated with MEN II

A

RET oncogene

68
Q

pneumonic for hypercalcaemia

A

stones (renal)
bones (bone pain)
groans (abdo pain, N+V)
thrones (polyuria)
psychiatric overtones (confusion, depression, anxiety, insomnia, coma)

69
Q

2 common causes of hypercalcaemia

A

malignancy
primary hyperparathyroidism (pituitary adenoma)

70
Q

high calcium causes a high what

A

phosphate

71
Q

presentation and treatment of primary hypercalcaemia

A

elderly with severe thirst
total parathyroidectomy

72
Q

what mineral is needed to absorb calcium

A

magnesium

73
Q

which drug can cause hypercalcaemia

A

thiazides

74
Q

xray finding in hyperparathyroid

A

pepperpot skull

75
Q

what is trosseaus sign

A

capal spasm on inflation of bp cuff in hypercalcaemia

76
Q

the following are all causes of what:
- bilateral adrenal hyperplasia
- spironolactone
- conn’s syndrome

A

primary hyperaldosteronism

77
Q

what is conn’s syndrome

A

adrenal adenoma requiring surgery

78
Q

blood pressure, potassium level and pH in primary hyperaldosteronism

A

high bp
low potassium (causing muscle weakness)
alkalosis

79
Q

1st and 2nd line investigations for primary hyperaldosteronism

A

1st: aldosterone:renin
2nd: CT abdo / adrenal venous sampling

80
Q

autoimmune destruction of the adrenal glands which causes lethargy, weakness, anorexia, weight loss, nausea, vomiting, salt cravings, hyperpigmentation, vitiligo and hypotension

A

addisons disease

81
Q

sodium glucose and potassium in addisons

A

reduced sodium and glucose
high potassium

82
Q

shock collapse and pyrexia in addisons

A

crisis
hydrocortisone injections

83
Q

diagnosis of addisons disease

A

short synacthen test (ACTH stimulation test)

84
Q

SE of glucocorticoids

A

neutrophilia

85
Q

sick day rules in addisons

A

double the glucocorticoid
keep the fludrocortisone the same

86
Q

glucocorticoid and mineralocorticoid activity in
- fludrocortisone
- hydrocortisone
- prednisolone
- dexa/beta methasone

A
  • fludrocortisone: low GC, high MC
  • hydrocortisone: high GC, high MC
  • prednisolone: high GC, low MC
  • dexa/beta methasone: very high GC, very low MC
87
Q

ABG in cushings

A

hypokalaemic metabolic alkalosis

88
Q

difference between cushings disease and syndrome

A

cushings syndrome is low cortisol
cushings disease is pituitary adenoma - the most common endogenous cause of cushings syndrome

89
Q

how do you differentiate between cushings disease and syndrome

A

low dose dexamethasone test diagnoses cushings syndrome

high dose dexamethasone test diagnoses cushings disease
- cortisol not suppressed but ACTH suppressed if syndrome
- both suppressed if disease

90
Q

what drug can mimic cushings in excess

A

alcohol

91
Q

rapid enlargement of a pituitary corticotroph adenoma (ACTH producing) after a bilateral adrenalectomy for cushings

A

nelsons syndrome

92
Q

sweating, palpitations, headaches and severe persistent hypertension

A

phaeochromocytoma

93
Q

2 investigations for phaeochromocytoma

A

urinary metenephrins
CT TAP

94
Q

management of phaeochromocytoma

A

phenoxybenzmine then beta blockers

need alpha and beta blockage to prevent a hypertensive crisis

95
Q

adrenal haemorrhage causing profound sepsis and coagulopathy which can be fatal

A

waterhouse-friderichsen syndrome

96
Q

excess growth hormone secondary to pituitary adenoma causing spade hands, large feet and tongue, excessive sweating and frontal bossing

A

acromegaly

97
Q

headaches and bilateral hemianopia in acromegaly

A

tumour

98
Q

prolactin level in acromegaly

A

high

99
Q

diagnosis of acromegaly

A

increased IGF-1
OGTT and serial GH measurement

100
Q

management of acromegaly

A

trans sphenoidal surgery
octreotide if residual symptoms or not fit for surgery

101
Q

what genetic condition is growth hormone used in the management of

A

turners syndrome

102
Q

medical management of prolactinomas

A

dopamine agonists e.g. carbegoline/bromocriptine to inhibit dopamine release

103
Q

2 medications which can cause gynaecomastia

A

goserelin (gnrh agonist for prostate cancer)
spironolactone

104
Q

what can metoclopramide cause

A

galactorrhoea

105
Q

pregnancy, prolactinoma, PCOS, physiological, primary hypothyroidism and phenothiazine, metoclopramide and domperidone are all causes of what

A

increased prolactin

106
Q

which endocrine parameters are increased/decreased in stress response

A

decreased: insulin, testosterone and oestrogen

increased: GH, cortisol, renin, ACTH, aldosterone, prolactin, ADH, glucose

107
Q

what are the results of water deprivation tests

A

LEARN THEM

108
Q

gastrin secreting tumour causing high HCl and duodenal ulcers

A

zollinger-ellison syndrome

109
Q

delayed puberty with hypogonadism, very tall, NO SMELL, reduced LH and FSH

treated with testosterone supplementation

A

kallman syndrome

110
Q

very tall and infertile with small and firm testes, gynaecomastia and reduced LH and FSH but high testosterone

A

klinefelters syndrome

111
Q

child with a palpable abdominal mass

A

urgent 48 hour referral for wilms tumour

Medicine Year 5 (27 decks)

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