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Year 6 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Which vitamin deficiency does carcinoid syndrome cause?

A

Pellagra - vitamin B3

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2
Q

Carcinoid syndrome main investigation

A

5-hydroxyindoleacetic acid

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3
Q

Carcinoid syndrome blood investigation for liver mets

A

Elevated chromogranin A

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4
Q

Carcinoid syndrome management

A

Surgical resection
Somatostatin analogues

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5
Q

Bloods in subclinical hyperthyroidism

A

Low TSH
Normal T3 and T4

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6
Q

Thyroid isotope finding in Grave’s disease

A

Diffuse uptake

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7
Q

Management of Grave’s disease in order

A

Propranolol
Carbimazole

Radioiodine if resistant
Thyroxine to prevent hypo

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8
Q

Prolactinoma presentation in women

A

Amenorrhoea
Galactorrhoae

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9
Q

Prolactinoma investigations

A

High prolactin (150-200)
Pituitary MRI
Visual field testing

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10
Q

Prolactinoma management

A

Dopamine agonists - cabergoline, bromocriptine
Trans-sphenoidal surgery

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11
Q

Gene in MEN type 1, 2, 3

A

1) MEN1
2) RET
3) RET

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12
Q

Where does MEN 1, 2 and 3 affect

A

MEN1
Pituitary
Pancreas
Parathyroid

MEN2
Parathyroid
Phaeochromocytoma
Medullary thyroid

MEN3
Phaeochromocytoma
Medullary thyroid

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13
Q

Medical treatment of obesity

A

Orlistat: pancreatic lipase inhibitor
Liraglutide: GLP-1 mimetic

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14
Q

Osteoporosis DEXA

A

Less than -2.5

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15
Q

Osteopaenia DEXA

A

-1 to -2.5

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16
Q

Osteoporosis management

A

Hip protectors
Falls risk assessment

Bisphosphonates
Calcium and vitamin D if low

HRT

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17
Q

Osteoclasts and osteoblasts in Paget’s disease

A

Excessive osteoclastic resorption
Increased osteoblastic activity (builds bone)

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18
Q

Paget’s investigations

A

Raised ALP

X-rays: osteolysis, thickened skull, lytic/sclerotic lesions
Bone scan: increased uptake in active lesions

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19
Q

Paget’s management (asymptomatic and symptomatic)

A

Asymptomatic: monitor
Symptomatic: bisphosphonates e.g. oral risedronate or IV zoledronate

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20
Q

Paget’s complications

A

Deafness
Bone sarcoma

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21
Q

Phaeochromocytoma investigations

A

24-hour urinary metanephrines

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22
Q

Phaechromocytoma management

A

Stabilise with alpha-blocker then beta-blocker

Surgery

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23
Q

Which hormones are elevated in PCOS?

A

Prolactin
Testosterone

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24
Q

Rotterdam criteria for PCOS

A

Oligo-anovulation
Clinical or biochemical hyperandrogenism
Polycystic overies or increased ovarian volume in one or both ovaries

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25
Q

PCOS management

A

Weight loss
COCP
Metformin +/- clomifene
Gonadotrophins

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26
Q

Thyroid cancer with good prognosis

A

Papillary

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27
Q

Thyroid cancer with low calcium and why

A

Medullary
Calcitonin secretion (opposite of PTH)

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28
Q

3 types of thyroid cancer

A

Papillary
Follicular
Medullary

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29
Q

TSH in thyroid cancer

A

Normal

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30
Q

Thyroid cancer investigations

A

Bloods - TFTs, FBC, LFTs
Imaging - thyroid USS, uptake if hyper/hypothyroid
Fine-needle aspiration

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31
Q

Most common cause of Conn’s

A

Bilateral adrenal hyperplasia

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32
Q

Presentation of Conn’s

A

HTN
Symptoms of hypokalaemia (muscle cramps, polyuria, polydipsia)

33
Q

Conn’s investigations

A

Bloods - raised plasma aldosterone:renin (low renin from negative feedback from high aldosterone)
Imaging - CT abdo

34
Q

Conn’s management

A

Adrenal adenoma: surgery
Adrenal hyperplasia: spironolactone

35
Q

Addison’s most common cause

A

Autoimmune (UK)
TB (worldwide)

36
Q

Addison’s symptoms

A

Salt-craving
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Hyperpigmentation

37
Q

Addison’s investigations

A

9am serum cortisol
Short synACTHen test (no rise in cortisol)

38
Q

Management for addison’s

A

Hydrocortisone
Fludrocortisone
MedicAlert bracelet
Hydrocortisone for injection in adrenal crisis

39
Q

Advice for addison’s management if intercurrent illness

A

Double dose of hydrocortisone, but keep fludrocortisone the same

40
Q

What is Cushing’s ‘disease’?

A

ACTH-producing pituitary tumour

41
Q

Cancer releasing ectopic ACTH

A

Small cell lung cancer

42
Q

Cushing’s investigations

A

Overnight dexamethasone suppression test
- suppressed: normal
- not suppressed: Cushing’s syndrome
- suppressed by high dose: pituitary
- not suppressed by high dose: ectopic (high acth) or adrenal (low acth)

Inferior pituitary petrosal sinus sampling

43
Q

Cushing’s management

A

Surgery

44
Q

Hypoparathyroidism presentation

A

Hypocalcaemia
- CATs go numb (cos they don’t have enough milk)
- Convulsions, Chvostek’s
- Arrhythmias
- Tetatny, Trousseau’s
- Numbness

45
Q

Pseudohypoparathyroidism pathophysiology and presentation

A

Enough PTH but target is insensitive

Low IQ, short stature, shortened 4th and 5th MCPs
Hyperparathyroidism biochemical picture

46
Q

Pseudopseudohypoparathyroidism difference to pseudohypoparathyroidism

A

Normal biochemical picture

47
Q

Management of severe hypocalcaemia

A

IV calcium gluconate 10ml 10% over 10mins
ECG monitoring

48
Q

Most common cause of hyperparathyroidism

A

Solitary adenoma

49
Q

Primary hyperparathyroidism presentation

A

Hypercalcaemia
Bones
Stones
Abdominal groans
Psychic moans

(it’s too much (calcium) to handle)

50
Q

Phosphate in CKD and vitamin D deficiency

A

High in CKD
Low in vitamin D deficiency

51
Q

Tertiary hyperparathyroidism PTH, calcium, phosphate

A

High PTH
High calcium
Low phosphate

(untreated CKD)

52
Q

Hypercalcaemia management

A

IV saline
Bisphosphonates

53
Q

Most common form of hypothyroidism

A

Hashimoto’s thyroiditis

54
Q

Is subacute thyroiditis hypo or hyperthyroid?

A

Hyper then hypo

55
Q

Antibodies in Hashimoto’s

A

Anti-thyroid peroxidase
Anti-thyroglobulin

56
Q

Management of hypothyroidism

A

Levothyroxine

57
Q

T1DM diagnosis

A

Random glucose >=11.1
Fastin glucose >=7.0
2-hour glucose >=11.1

58
Q

Management of T1DM

A

Basal-bolus insuline
1) Subcutaneous
2) Insulin pump (motivated, skilled, family support if child)

59
Q

Example of long-acting insulin

A

Insulin detemir (Levemir)

60
Q

Example of rapid-acting insulin

A

Insulin aspart (NovoRapid)

61
Q

T2DM investigations

A

Same as T1 but also HbA1c >=48

Need one of the above on two separate occasions if asymptomatic

62
Q

What investigation finding suggests impaired glucose tolerance?

A

Fasting glucose 6.1-7.0

63
Q

T2DM management

A

1) Conservative
2) Metformin
3) Change to DPP-4 inhibitor e.g. sitagliptin (or SGLT-2 inhibitor e.g. dapagliflozin. If CVD risk: add this if metformin is still fine, or sulfonylurea e.g. gliclazide but this has weight gain effects)

64
Q

HbA1c target if taking sulfonylurea

A

53

65
Q

Cranial diabetes inspidus causes

A

Head injury
Haemochromatosis

66
Q

Nephrogenic diabetes inspidus causes

A

Genetic
Lithium
Hypercalcaemia

67
Q

Investigation for diagnosis of diabetes inspidus

A

Serum calcium to check other differentials

Water deprivation test (8 hours - urine still diluted)

Desmopressin stimulation test
- central DI responds

68
Q

Management of central and nephrogenic diabetes inspidus

A

Central: desmopressin
Nephrogenic: manage fluid intake, sodium restriction, treat cause

69
Q

5 causes of SIADH

A

Small cell lung cancer
Subarachnoid haemorrhage
TB
SSRIs
Sulfonylureas

70
Q

Investigations for SIADH

A

High urine osmolality and sodium
Serum hypotonic hyponatraemia

71
Q

SIADH management

A

Fluid restriction
IV hypertonic saline slowly
Treat cause

72
Q

Hypokalaemia ECG

A

U waves
Small T waves
Prolonged PR interval
ST depression

73
Q

What defiency can cause hypokalaemia?

A

Magnesium deficiency

74
Q

Hypokalaemia management

A

Oral Sando-K
IV infusion if not tolerated or <2.5

75
Q

Which drugs can cause hyperkalaemia

A

Sprinolactone, amiloride
ACE inhibitors
NSAIDs
LMWH
Tacrolimus

76
Q

Hyperkalaemia ECG

A

Peaked T waves
Loss of P waves
Broad QRS
Sinusoidal
VF

77
Q

Management of hyperkalaemia and when do to this

A

> =6.5 or ECG changes

IV calcium gluconate
Insulin + dextrose infusion
Nebulised salbutamol
Calcium resonium enema (removal)
Loop diuretics (removal)

Dialysis if persistent
Treat cause

78
Q

Diabetic retinopathy stages

A

1 (mild non-proliferative) - 1+ microaneurysms
2 (moderate non-proliferative) - microaneurysms, blot haemorrhages, hard exudates, cotton wool spots
3 (severe non-proliferative) - microaneurysms and blot haemorrhages in 4 quadrants, intraretinal abnormalities in 1 quadrant

4 (proliferative) - retinal neovascularisation, fibrous tissue anterior to retinal disc

79
Q

Management of diabetic retinopathy

A

All - optimise glycaemic control, regular ophthal review

Non-proliferative - panretinal laser photocoagulation is severe

Proliferative - panretinal laser photocoagulation, intravitreal VEGF inhibitors

Year 6 (19 decks)

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