Endocrinology Flashcards
1
Q
reference ranges for fasting glucose
A
below 6 is normal
6.1-6.9 is prediabetes
above 7 is diabetes
2
Q
reference ranges for HbA1c
A
below 41 is normal
42-47 is prediabetes
above 48 is diabetes
3
Q
what value on random glucose would indicate diabetes
A
11.1
4
Q
how would you manage an asymptomatic patient with an abnormal HbA1c or fasting glucose
A
second abnormal reading is required before diagnosis
5
Q
management of diabetes with HbA1c above 48 and 53
A
48: lifestyle and metformin
53: lifestyle and drugs which can cause hypoglycaemia
6
Q
first line management of diabetes
A
metformin
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
8
Q
management if metformin not tolerated
A
switch to modified release metformin
9
Q
second line therapy of diabetes
A
continue metformin and add one of
DPP-4 inhibitor
Pioglitazone
Sulfonylurea
SGLT2 inhibitor
10
Q
third line therapy of diabetes
A
add another drug
start insulin therapy
11
Q
when would you add a GLP-1 mimetic
A
under specialist care if triple therapy is not tolerated or contraindicated
12
Q
which drug reduces the peripheral breakdown of incretins
A
DPP4 inhibitor e.g. sitagliptin
13
Q
which patients are DPP4 inhibitors useful in
A
obese patients
14
Q
which drug is an agonist of PPAR-gamma receptors and reduces peripheral insulin resistance
A
pioglitazone
(thiazolidinediones)
15
Q
2 contraindications for pioglitazone
A
heart failure
bladder cancer
16
Q
give an example of a sulfonylurea
A
gliclazide
17
Q
2 side effects of sulfonylureas
A
weight gain and hypoglycaemia
18
Q
which drug increases urinary excretion of glucose
A
SGLT2 inhibitors e.g. dapagliflozoin
19
Q
side effects of SGLT2 inhibitors
A
UTI, necrotising fasciitis of the genitals, increased urine output, weight loss
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
21
Q
first line treatment of T1 diabetes
A
basal bolus
2 daily insulin detemir
22
Q
glucose targets in type 1 diabetes
A
5-7 on waking
4-7 before meals
23
Q
sick day rules for people on insulin
A
continue insulin as normal but check blood sugar levels more frequently
24
Q
everyone treated with insulin needs what
A
a glucagon kit for emergencies
25
management of DKA
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
26
if the ketones and acidosis have not resolved within 24 hours
senior endocrinology review
27
pH, ketones and bicarb levels in DKA resolution
pH 7.3, ketones 0.6, bicarb 15
28
presentation and monitoring for hyperosmolar hyperglycaemic state
similar to DKA but hyperglycaemia with no acidosis
monitor the serum osmolarity
29
management of hypoglycaemia
alert: oral glucose
unconscious: 200ml 20% glucose IV
30
management of diabetes induced gastroparesis
metoclopramide
31
inheritance and treatment for MODY
autosomal dominant (strong FHx)
sulfonylureas
32
HbA1c in hereditary spherocytosis
underestimates blood glucose levels
33
MOA of orlistat
inhibits gastric and pancreatic lipase to reduce fat absorption
34
what is the triad in an insulinoma
whipples triad
1. hypoglycaemia with fasting/exercise
2. reversal of sx when given glucose
3. recorded low BMs when sx occur
35
what are the references for BMI
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
36
2 main causes of hyperthyroidism
toxic multinodular goitre
graves disease
37
toxic multinodular goitre - treatment and scan findings
patchy uptake on scan
give radioactive iodine
38
graves disease - treatment and scan findings
increased homogenous uptake
propanolol in new pts for sx control
carbimazole
39
side effect of carbimazole
agranulocytosis
inform immediately if sore throat, fever, malaise
40
3 findings in graves disease
thyroid eye disease
pretibial myxoedema
clubbing (acropachy)
41
management of thyroid eye disease
urgent referral
42
periods in hyper and hypo thyroid
hyper: oligomenorrhoea or amenorrhoea
hypo: menorrhagia
43
management of hyperthyroid in pregnancy
propylthiouracil as reduced risk of congenital malformations
44
risk of over replacement of thyroxine
graves
45
what effect can thyrotoxicosis have on the heart
high output cardiac failure
46
3 medications to manage thyrotoxic storm
beta blockers
propylthiouracil
hydrocortisone
47
how does hypothyroidism often present
brief initial hyperthyroid/thyrotoxic stage followed by hypothyroidism
48
association with hashimotos
MALT lymphoma
49
8 causes of hypothyroidism
hashimotos
iodine deficiency
lithium
subacute thyroiditis (de quervains)
postpartum thyroiditis
riedel's thyroditis
50
cause of subacute thyroiditis (de quervains)
triggered by viral infection
51
thyroiditis (de quervains) - treatment and scan findings
reduced uptake of iodine on scan
steroids - self limiting
52
amiodarone and thyroid issues
can be hypo or hyper
53
TSH T3 and T4 in sick euthyroid
normal TSH
reduced T3 and T4
A/W systemic illness
54
TSH and T4 in subclinical hypothyroidism
high TSH
normal T4
55
management of subclinical hypothyroidism
treat if TSH above 10 on 2 separate occasions 3m apart
watch and wait in elderly
56
presentation and management of myxoedema coma
confusion and hypothermia
IV corticosteroid and thyroid replacement (exclude adrenal insufficiency)
57
which thyroid hormone does levothyroxine increase
TSH
58
when should iron/calcium carbonate be given after levothyroxine
4 hours after levothyroxine
59
thyroid cancer in a young female with pale empty nuclei on histology, metastases to the lymph nodes and an excellent prognosis
papillary thyroid cancer
60
thyroid cancer with a solitary nodule
follicular adenoma
61
thyroid cancer which is encapsulated with vascular invasion
follicular carcinoma
62
cancer associated with hashimotos
lymphoma
63
thyroid cancer in an elderly female with pressure symptoms requiring resection as chemotherapy is unresponsive
anaplastic
64
cancers found in MEN I
presenting complaint is often what?
Parathyroid
Pituitary
Pancreas
hypercalcaemia
65
cancers found in MEN II a
MEDULLARY THYROID CANCER
Parathyroid
Phaeochromocytoma
66
cancers found in MEN II b
MEDULLARY THYROID CANCER
phaeochromocytoma
67
which gene is associated with MEN II
RET oncogene
68
pneumonic for hypercalcaemia
stones (renal)
bones (bone pain)
groans (abdo pain, N+V)
thrones (polyuria)
psychiatric overtones (confusion, depression, anxiety, insomnia, coma)
69
2 common causes of hypercalcaemia
malignancy
primary hyperparathyroidism (pituitary adenoma)
70
high calcium causes a high what
phosphate
71
presentation and treatment of primary hypercalcaemia
elderly with severe thirst
total parathyroidectomy
72
what mineral is needed to absorb calcium
magnesium
73
which drug can cause hypercalcaemia
thiazides
74
xray finding in hyperparathyroid
pepperpot skull
75
what is trosseaus sign
capal spasm on inflation of bp cuff in hypercalcaemia
76
the following are all causes of what:
- bilateral adrenal hyperplasia
- spironolactone
- conn's syndrome
primary hyperaldosteronism
77
what is conn's syndrome
adrenal adenoma requiring surgery
78
blood pressure, potassium level and pH in primary hyperaldosteronism
high bp
low potassium (causing muscle weakness)
alkalosis
79
1st and 2nd line investigations for primary hyperaldosteronism
1st: aldosterone:renin
2nd: CT abdo / adrenal venous sampling
80
autoimmune destruction of the adrenal glands which causes lethargy, weakness, anorexia, weight loss, nausea, vomiting, salt cravings, hyperpigmentation, vitiligo and hypotension
addisons disease
81
sodium glucose and potassium in addisons
reduced sodium and glucose
high potassium
82
shock collapse and pyrexia in addisons
crisis
hydrocortisone injections
83
diagnosis of addisons disease
short synacthen test (ACTH stimulation test)
84
SE of glucocorticoids
neutrophilia
85
sick day rules in addisons
double the glucocorticoid
keep the fludrocortisone the same
86
glucocorticoid and mineralocorticoid activity in
- fludrocortisone
- hydrocortisone
- prednisolone
- dexa/beta methasone
- 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
ABG in cushings
hypokalaemic metabolic alkalosis
88
difference between cushings disease and syndrome
cushings syndrome is low cortisol
cushings disease is pituitary adenoma - the most common endogenous cause of cushings syndrome
89
how do you differentiate between cushings disease and syndrome
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
what drug can mimic cushings in excess
alcohol
91
rapid enlargement of a pituitary corticotroph adenoma (ACTH producing) after a bilateral adrenalectomy for cushings
nelsons syndrome
92
sweating, palpitations, headaches and severe persistent hypertension
phaeochromocytoma
93
2 investigations for phaeochromocytoma
urinary metenephrins
CT TAP
94
management of phaeochromocytoma
phenoxybenzmine then beta blockers
need alpha and beta blockage to prevent a hypertensive crisis
95
adrenal haemorrhage causing profound sepsis and coagulopathy which can be fatal
waterhouse-friderichsen syndrome
96
excess growth hormone secondary to pituitary adenoma causing spade hands, large feet and tongue, excessive sweating and frontal bossing
acromegaly
97
headaches and bilateral hemianopia in acromegaly
tumour
98
prolactin level in acromegaly
high
99
diagnosis of acromegaly
increased IGF-1
OGTT and serial GH measurement
100
management of acromegaly
trans sphenoidal surgery
octreotide if residual symptoms or not fit for surgery
101
what genetic condition is growth hormone used in the management of
turners syndrome
102
medical management of prolactinomas
dopamine agonists e.g. carbegoline/bromocriptine to inhibit dopamine release
103
2 medications which can cause gynaecomastia
goserelin (gnrh agonist for prostate cancer)
spironolactone
104
what can metoclopramide cause
galactorrhoea
105
pregnancy, prolactinoma, PCOS, physiological, primary hypothyroidism and phenothiazine, metoclopramide and domperidone are all causes of what
increased prolactin
106
which endocrine parameters are increased/decreased in stress response
decreased: insulin, testosterone and oestrogen
increased: GH, cortisol, renin, ACTH, aldosterone, prolactin, ADH, glucose
107
what are the results of water deprivation tests
LEARN THEM
108
gastrin secreting tumour causing high HCl and duodenal ulcers
zollinger-ellison syndrome
109
delayed puberty with hypogonadism, very tall, NO SMELL, reduced LH and FSH
treated with testosterone supplementation
kallman syndrome
110
very tall and infertile with small and firm testes, gynaecomastia and reduced LH and FSH but high testosterone
klinefelters syndrome
111
child with a palpable abdominal mass
urgent 48 hour referral for wilms tumour
