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endocrinology Flashcards

1
Q

T/F if you have 2 hypoglycaemic episodes requiring help - do you need to surrender your driving license ?

A

True

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2
Q

What medication can cause HYPERglycaemia ?

A

Corticosteroids ie prednisolone, -cortisone, -methasone

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3
Q

What would thyrotoxicosis show on liver function tests

A

TSH down
T4 and T3 up

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4
Q

What is the most common cause for thyrotoxicosis

A

Grave’s

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5
Q

What type of antibodies do you see in Hashimoto’s

A

Anti-thyroid peroxidase antibodies

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6
Q

What is Hashimoto’s thyroiditis

A

An autoimmune disorder of the thyroid gland - associated with hypothyroidism (can be transient thyrotoxicosis in the acute phase)

X10 more common in women

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7
Q

Features of Hashimoto’s ?

A

Hypothyroidism
Goitre - firm and non-tender
Anti-thyroid peroxidase and also anti-thyroglobulin antibodies

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8
Q

What disease is MALT lymphoma associated with

A

Hashimoto’s

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9
Q

What is addisons disease

A

Autoimmune destruction of the adrenal glands resulting in primary hypoadrenalism > results in reduced cortisol and aldosterone being produced

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10
Q

Symptoms of addisons

A

Lethargy, weakness, anorexia, nausea, vomiting, weight loss, ‘salt-craving’, hyperpigmentation - especially at palmar creases (appearance of being tanned) , vitiligo, loss of pubic hair in women, hypotension, hypoglycaemia

Hyponatraemia, hyperkalaemia

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11
Q

Why does addisons cause hyperpigmentation

A

The adrenocorticotropic hormone (ACTH) is produced by the pituitary to stimulate the adrenals to produce steroid hormones, has the same precursor molecule as melanocyte-stimulating hormone (MSH) so increased production of ACTH has the side effect of raising MSH levels

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12
Q

First line management for DKA

A

IV fluids

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13
Q

What causes DKA ?

A

Uncontrolled lipolysis which results in an excess of free fatty acids that are ultimately converted to ketone bodies

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14
Q

Features of DKA

A

Abdominal pain
Polyuria, polydipsia, dehydration
Kussmauls +
Acetone-smelling breath

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15
Q

What are the main principles of management of DKA

A

First: IV fluids (isotonic saline)
Second: IV infusion of insulin @ 0.1unit/kg/hour
Next: correction of electrolyte disturbance

Then : long acting insulin should be continued

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16
Q

What is the virus that can cause DMT1

A

Coxsackie B

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17
Q

what should be monitored being put on amiodarone

A

TFTs

-amiodarone can cause thyroiditis > causing both hypo and hyperthyroidism

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18
Q

Amiodarone side effects

A

Hypothyroidism
Hyperthyroidism
Corneal deposits
Steven Johnson syndrome
Grey discolouration of the skin
Liver failure

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19
Q

Define sub-clinical hypothyroidism

A

High TSH
Normal T3 and T4

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20
Q

Features specific to Graves’ disease

A

Exopthalmos/proptosis - bulging of the eyes
Lid lag
Thyroid acropachy - soft tissue swelling in the extremities, nail clubbing, new bone growth in periosteum
Pretibial myxoedema

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21
Q

What is thyrotoxicosis

A

A syndrome caused by excess of thyroid hormones in the body
Usually caused by a sudden release of large amounts of stored hormones

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22
Q

What is hyperthyroidism

A

A condition characterised by an over activity of the thyroid gland , which produces excess thyroid hormone

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23
Q

Features of hyperthyroidism

A

Fine tremor
Finger clubbing
Sweating

Pretibial myxoedema
Goitre
Thyroid bruit

Lid retraction
Lid lag

Atrial fibrillation
High output heart failure

Diarrhoea

Muscle wasting
Proximal weakness

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24
Q

Primary causes of hyperthyroidism - caused by thyroid dysfunction

A

Graves
Toxic thyroid adenoma
Multinodular goitre
Silent thyroiditis
De Quervains
Radiation

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25
Q

Secondary causes of hyperthyroidism - not caused by thyroid dysfunction

A

Amiodarone
Lithium
TSH producing pituitary adenoma
Choriocarcinoma
Gestational hyperthyroidism

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26
Q

Symptomatic relief of hyperthyroidism

A

Propranolol - bbs

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27
Q

Medical management of hyperthyroidism

A

Carbimazole
Propylthiouracil

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28
Q

Carbimazole is contraindicated with what

A

Early pregnancy

May be used in later stages

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29
Q

What is the definitive management of goitre

A

Radio-iodine

(*this is contraindicated in Graves’ disease)

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30
Q

What is thyroid storm

A

A rapid deterioration of hyperthyroidism with hyper-pyrexia, severe tachycardia, extreme restlessness, cardiac failure and liver dysfunction

Typically seen in hyperthyroid patient with an acute infection/illness and recent thyroid surgery

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31
Q

management of thyroid storm

A

High dose Carbimazole
B-blockers
Potassium iodine
Hydrocortisone
IV fluids +/- inotropes
Treat precipitating cause

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31
Q

management of thyroid storm

A

High dose Carbimazole
B-blockers
Potassium iodine
Hydrocortisone
IV fluids +/- inotropes
Treat precipitating cause

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32
Q

management of thyroid storm

A

High dose Carbimazole
B-blockers
Potassium iodine
Hydrocortisone
IV fluids +/- inotropes
Treat precipitating cause

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33
Q

What precipitates thyroid storm disease

A

Surgery, trauma, infection, pregnancy

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34
Q

drugs that causes thyroid disease

A

Lithium
Interferon
Carbimazole
Amiodarone

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35
Q

What is Cushing’s

A

An endocrine disorder of glucocorticoid excess

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36
Q

Features of Cushings

A

Proximal myopathy
Striae
Bruising
Osteoporosis
DM
Obesity
HPTN
Hypokalaemia
Moon face
Acne and hirsutism
Interscapular and supraclavicualr fat pads
Centripetal obesity
Thin limbs
Thin skin
Impotence

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37
Q

A 34-year-old man presents to the GP with a 3-month history of weight gain and lethargy. He has a past medical history of Crohn’s disease which is adequately managed with budesonide 9mg daily. On examination, you note abdominal obesity, bruising of the arms, purple abdominal striae and reduced power in the proximal muscles of the arms and legs. Which of the following is the most likely explanation for this patient’s physical findings?

A

Cushings !

Excess of budenoside !!!

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38
Q

Investigations for Cushings - cortisol excess

A

24 hour urinary free cortisol
Low dose dexamethasone suppression test

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39
Q

Investigation for Cushings - localised

A

Plasma ACTH
High dose dexamethasone suppression test
Inferior petrosal sinus sampling
MRI of pituitary
CT chest and abdomen

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40
Q

Management of cushings

A

Metyrapone - blocker of steroid synthesis pathway
Ketoconazole - adrenolytci agent/anti-fungal?
Mifepristone - glucocorticoid antagonist
Pasireotide - somatostatin receptors

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41
Q

Most serious side effect of Carbimazole use in hyperthyroidism

A

agranulocytosis

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42
Q

First line treatment for hypogonadism in men

A

Testosterone therapy

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43
Q

A middle aged woman presents with symptoms of hypothyroidism - there is a diffuse non-tender goitre on examination

TSH is raised, T4 is low, anti-TPO is positive

A

This is a classical history for Hashimoto’s

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44
Q

Middle aged woman presents with thyrotoxicosis, goitre, exopthalmos and pretibial myxoedema

Anti-TSH receptor stimulating antibodies are positive

A

Graves’ disease

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45
Q

Anti-TPO antibodies

A

Hashimotos

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46
Q

TSH receptors antibodies

A

Graves

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47
Q

How does metformin work ?

A

Works by increasing insulin sensitivity and decreasing hepatic gluconeogenesis

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48
Q

Side effects of metformin

A

Lactic acidosis
GI upset

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49
Q

How do sulfonylureas work ?

A

Work by stimulating pancreatic beta cells to secrete insulin

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50
Q

This thyroid disorder is associated with hypothyroidism, painful goitre and raised ESR

A

Subacute thyroiditis (de Quervains’)

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51
Q

Addisons is associated with what electrolyte imbalance ?

A

Hypercalcaemia

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52
Q

*globally reduced uptake on iodine - 131 scan

A

Subacute thyroiditis

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53
Q

Side effects of corticosteroids

A

Weight gain
Impaired glucose tolerance
Depression
Osteoporosis
Skin - striae, thinning, bruising
Avascular necrosis of the femoral head

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54
Q

*Nuclear scintigraphy reveals patchy uptake =

A

Toxic multinodular goitre

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55
Q

Vitamin D intoxication associated electrolyte

A

Hypercalcaemia

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56
Q

How do SGLT-2 inhibitors work

A

By stimulating pancreatic beta cells to secrete insulin

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57
Q

Sarcoidosis is associated with what type of electrolyte imbalance

A

Hypercalcaemia

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58
Q

What is sick euthyroid syndrome

A
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59
Q

What is the best investigation for Cushings

A

Overnight dexamethasone suppression test

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60
Q

Side effects of thiazolidinediones

A

Fluid retention and weight gain

(Think Pioglitazone = Pig —> weight gain)

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61
Q

Contraindication of pioglitazone

A

Heart failure

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62
Q

What is the MoA of sulfonylureas

A

Increase pancreatic insulin secretion

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63
Q

*hyperkalaemia, hyponatraemia, hypoglycaemia, hypotension, hyperpigmentation + lethargy

A

Addisons

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64
Q

Results from a high dose dexamethasone suppression test for an adrenal adenoma

A

Cortisol = not suppressed
ACTH = not suppressed

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65
Q

Results from high dose dexamethasone suppression test for pituitary adenoma

A

Cortisol = suppressed
ACTH = suppressed

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66
Q

Side effect of SGLT-2 inhibitors

A

Increased risk of UTIs

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67
Q

Which electrolyte imbalance can cause dehydration

A

Hypercalcaemia

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68
Q

What is the treatment of choice for neuropathic pain - diabetic

A

Amitriptyline , duloxetine , gabapentin , pregablin

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69
Q

What is MODY

A

A group of inherited genetic disorder affecting the production of insulin

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70
Q

What type of thyroid cancer has the best prognosis

A

Papillary thyroid cancer

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71
Q

What investigation for alopecia areata

A

TFTs

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72
Q

What medication can cause erythema nodosum

A

Sulfasalazine

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73
Q

*stuck on appearance - all brown on the head

A

Seborrheic keratosis

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74
Q

*40 year old with a history of hypertension, episodic palpatitations, excessive sweating, headaches and tremor

A

Phaechromocytoma

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75
Q

*painful goitre, raised ESR, hypothyroidism

A

Subacute thyroiditis

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76
Q

SLE makes you BALD - what is the mnemonic

A

B = butterfly rash
A = alopecia
L = livedo reticularis
D = discoid lupus

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77
Q

Adverse effect of Carbimazole

A

Myelosuppression / agranulocytosis

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78
Q

Which vascular lesions are Present from birth

A

Port wine stain + salmon patch

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79
Q

Water deprivation test results for cranial diabetes insipidus

A

Starting plasma osmolality = high
Urine osmolality after fluid deprivation = low
Urine osmolality after desmopressin = high

*if this was nephrogenic then osmolality after desmopressin would still be low (external)

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80
Q

Coeliac associated skin lesion

A

Dermatitis herpetiformis

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81
Q

Crohns associated skin lesion

A

Pyoderma gangrenosum

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82
Q

*mucosal involvement rash + new medication indicates ….

A

Steven Johnson syndrome

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83
Q

First line investigation for suspected primary hyperaldosteronism

A

Plasma aldosterone/renin ratio

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84
Q

How does glucagon oppose insulin

A

Via increased hepatic glycogenolysis

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85
Q

Abnormal metabolite in SIADH

A

Hyponatraemia

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86
Q

What is SIADH

A

Too much ADH > acts on proximal convoluted tubule > causing increased water reabsorption > dilute blood > (hyponatraemia) nausea vomiting fatigue confusion low blood pressure headaches

Severe = drowsiness
Moderate = muscle aches/weakness
Mild = nausea headaches

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87
Q

Cause of SIADH

A

Subarachnoid haemorrhage (brain injury)
Malignancy
SSRIs

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88
Q

How to differentiate between primary adrenal failure and secondary adrenal insufficiency

A

Skin pigmentation is present in primary adrenal failure

(This is due to adrenal gland not functioning properly adn secreting less cortisol —> pituitary gland releases more ACTH —> more MST = skin pigmentation

In secondary adrenal insufficiency - hypopituitarism ie not enough ACTH being secreted

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89
Q

Management of Addisons

A

Hydrocortisone (double dose)
Fludrocortisone

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90
Q

Differentiate between cushings disease and Cushing’s syndrome

A

Cushings disease = pituitary adenoma

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91
Q

Indications for losing license due to hypoglycaemia

A

Two episodes of hypo requiring help from someone else - have to declare to DVLA and not allowed to drive

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92
Q

*incidental finding of hypokalaemia and hypertension on check-up suggests

A

Primary hyperaldosteronism

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93
Q

Investigation for primary hyperaldosteronism

A

Plasma aldosterone/renin ratio

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94
Q

ABG picture seen with Cushings disease

A

Hypokalaemic metabolic alkalosis

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95
Q

What does this indicate

A

Cushings disease

  • cortisol is not suppressed by low-dose dexamethasone but is suppressed by high-dose dexamethasone
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96
Q

Causes of Cushing’s syndrome

A

-corticosteroid therapy

-ACTH - dependent (pituitary adenoma —> ACTH secretion aka Cushing disease, also ectopic ACTH secretion secondary to malignancy eg small cell lung cancer)

  • ACTH - independent (adrenal adenoma)
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97
Q

What are the 2 commonly used tests for Cushing’s syndrome

A

-overnight dexamethasone suppression test
-24 hour urinary free cortisol

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98
Q

Interpret this bitch

A
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99
Q

Other than hypoglycaemia what can sulphonylureas cause

A

Ie GLICLAZIDE

Can cause weight gain also

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100
Q

9am cortisol of
1. >500nmol/l
2. <100nmol/l
3. 100-500nmol/l

A
  1. Addisons very unlikely
  2. Definitely abnormal
  3. Should prompt a ACTH stimulation test to be performed (short synacthen test)
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101
Q

What drug that causes a flare up of gout also cause hypercalcaemia

A

Thiazide diuretics

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102
Q

Pituitary or adrenal adenoma

A

Pituitary adenoma

An adrenal adenoma would show no suppression of either (ACTH independent)

103
Q

Why is GH not a diagnostic investigation of acromegaly

A

GH levels vary throughout the day and so are not helpful

104
Q

1st line investigation for acromegaly

A

Serum IGF-1 levels

105
Q

Diagnostic investigation for acromegaly

A

OGTT

106
Q

What is the most common drug which side effect is gynaecomastia

A

Spironolactone

107
Q

If metformin not tolerated in T2DM what is next first line

A

DPP-4 inhibitor or pioglitazone or sulfonylurea

108
Q

What to do with an Addisons patients medication when they have an intercurrent illness

A

Double hydrocortisone dose but keep fludrocortisone dose the same

109
Q

When to give beta blockers in Graves’ disease

A

Help to control symptoms to new presenters

(Carbimazole is slow to effect, despite being 1st line, so patient needs symptomatic treatment with propranolol first)

110
Q

What is this ABCDE assessment suggestive of ?

(10 year old boy brought to hospital by parents due to being confused and drowsy this morning - normally fit and well)

A

DKA

GCS of 12/15 = confusion
Abdominal pain
Blood glucose unrecordable = DKA

111
Q

Cba making a question

A
112
Q

*nuclear scintigraphy reveals patchy uptake

A

Toxic multinodular goitre

113
Q

*unrelenting high BP and hypokalaemia should indicate what disease

A

Primary hyperaldosteronism

114
Q

Causes primary hyperaldosteronism

A

70% - bilateral idiopathic adrenal hyperplasia

20-30% - adrenal adenoma

115
Q

Management of primary hyperaldosteronism

A

Bilateral idiopathic hyperplasia = spironolactone
Adrenal adenoma = surgery (keyhole)

116
Q

Mxm of Addisonian crisis

A
  • hydrocortisone 100mg im or iv
  • 1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic
  • continue glucocorticoid 6 hourly until stable
  • oral replacement may begin after 24 hours
117
Q

What is Waterhouse - Friderichsen syndrome

A

Often a pre-terminal event and is associated with profound sepsis and coagulopathy

*adrenal gland showing evidence of diffuse haemorrhage

118
Q

*lipid rich core nodule of adrenal gland on CT

A

Benign incidental adenoma

Often will present with recurrent episodes of non-specific abdominal pain with normal obs.

119
Q

*urinary VMA and plasma metanephrines are elevated

A

Phaeochromocytoma

120
Q

Most common type of pituitary tumour

A

Prolactinoma (hypersecretion of prolactinoma)

121
Q

Features of prolactinoma

A

Galactorrhoea
Amenorrhea
E.D
Headache
Bitemporal hemianopia

122
Q

Investigation for suspicion of pituitary tumour

A

MRI of pituitary tumour
Blood tests

123
Q

Treatment for prolactinoma

A

Dopamine agonists - cabergoline (1st) , bromocriptine

Can also undergo trans-sphenoid surgery or radiotherapy

124
Q

Diagnosis of acromegaly

A

GH should normally be suppressed to below 0.4ug/l after OGTT but is not in acromegaly

In fact there is a paradoxical rise

125
Q

Treatment of acromegaly

A

Pituitary surgery —> retest OGTT —> still not satisfactory ?

Then —> somatostatin analogue (ocreotide) , cabergoline , pegvisomant or even radiotherapy

126
Q

Where does a craniopharyngioma derive from ?

A

Rathke’s pouch

127
Q

What are the paediatric consequeleae of craniopharyngioma

A

Can cause: hydrocephalus, growth retardation

128
Q

Which sex is more commonly seen with Cushing’s syndrome

A

Women (aged 20-40)

129
Q

Cushing’s syndrome due to pituitary adenoma is also known as

A

Cushings disease

130
Q

ACTH dependent and ACTH - independent causes of Cushing’s syndrome

A
131
Q

Which Cushing’s test do you need to repeat to confirm

A

Overnight dexamethasone

132
Q

name

A
133
Q

T/F T4 is more potent than T3

A

F - T3 is more potent than T4 and is very biologically active

134
Q

Which molecules carry T3 and T4

A

TBG and TBPA

135
Q

Most common cause worldwide of hypothyroidism

A

Lack of iodine in diet

136
Q

Management of hypothyroidism

A

Levothyroxine

137
Q

*painful goitre, viral trigger, low uptake of iodine, high ESR

A

Subacute thyroiditis / De Quervains

138
Q

Most common cause of hyperthyroidism

A

Graves

139
Q

Treatment of subacute thyroiditis

A

Usually self limiting

140
Q

*low intake of scintigraphy ,
T4 = high when early, low late, then normal
T3 = low when early, high in late, then normal

A

Subacute thyroiditis

141
Q
A

= Nodular thyroid disease

Asymmetrical uptake on scintigraphy

142
Q

Treatment of hyperthyroidism

A

Carbimazole
Propylthiouracil (better in pregnancy)

[in Graves start at a high dose]

Symptomatic = propranolol

143
Q

What is thyroid storm

A

The sudden release of hormones from the thyroid gland
Severe hyperthyroid symptoms

144
Q

Big Cockneys Hit Foreign People

A

Mnemonic to remembering how to treat thyroid storm

B = beta blockers
C = Carbimazole
H = hydrocortisone
F = fluids
P = precipitating cause

145
Q

What do you have to do after having a radioactive ablation of thyroid

A

Pretty much avoid everyone

  • avoid close contact with kids and pregnant ladies
  • dont share a bed
  • avoid pregnancy for 6 months
146
Q
A

Carbimazole causes agranulocytosis

= weakened immune system so small infections indicate vulnerable individual NEED TO BE SEEN IMMEDIATELY

Would need to do a throat swab

147
Q

*hoarseness of voice can be due to what

A

Damage to recurrent laryngeal

148
Q

*psommoma bodies and orphan Annie nuclei (big hair) histologically

A

Papillary thyroid cancer

149
Q

Most common thyroid cancer

A

Papillary

150
Q

2nd most popular thyroid cancer

A

Follicular

151
Q

3rd most ‘popular’ thyroid cancer

A

Medullary

Arises from C-cell and has amyloid deposits

Associated with MENIIa (as well as phaeochromocytoma and papillary thyroid cancer)

152
Q

Which thyroid cancer has the worst prognosis

A

Anaplastic

*is treated with chemotherapy

153
Q

Investigation of thyroid cancer

A

TFT, US guided FNA, US neck, laryngoscopy

154
Q

Mxm of thyroid cancer

A

Surgery / radioablation

Anaplastic = chemotherapy

155
Q

Which glands are involved in calcium homeostasis

A

PTH

156
Q

*thirst, dehydration, confusion, polyuria, myopathy, osteopenia, fractures, depression, abdominal pain, pancreatitis, ulcers, renal stones

A

STONES GROANS BONES PSYCHIC MOANS

Refers to all symptoms that come with hypercalcaemia

157
Q

An overactive parathyroid would proceed what blood tests

A

Raised Ca ++
Raised serum PTH (or normal)
Raised urine calcium

158
Q

Acute treatment of hypercalcaemia

A

Fluids - rehydrate with 0.9% saline

Consider loop diuretics and Biphosphonates

159
Q

cba making a question

A
160
Q

3 common causes of hypocalcaemia

A

Hypoparathyroidism
Vit D deficiency
Chronic renal failure

161
Q

Main hormones that the pancreas produces

A

Insulin and glucagon

162
Q
A
163
Q

Which cells of the pancreas release glucagon in response to low glucose levels

A

Alpha cells

164
Q

Which cells of the pancreas release insulin in response to high glucose levels

A

Beta

165
Q

Side effects of metformin

A

GI upset
Lactic acidosis

166
Q

Side effects of thiazolidinediones

A

Weight gain
Water retention (HF)
Increase in risk fractures

(Pioglitazone)

167
Q
  • tides
A

GLP-1 agonists

168
Q
  • gliptins
A

DPP-IV inhibitors

169
Q

What is produced in the zona reticularis

A

Androgens

170
Q

Where is cortisol produced

A

Zona fasciculata

171
Q

Where is aldosterone produced

A

Zona glomerulosa

172
Q

Commonest cause of primary adrenal insufficiency

A

Addisons

173
Q

Symptoms of Addisons

A

Weight loss
Fatigue
Dizziness
Low BP
Abdo pain
Vomitting
Skin pigmentation

174
Q

How to diagnose Addisons

A

Biochemistry

Short synACTHen test (measures cortisol after ACTH administration , should increase from around 250 to over 550 mol/l)

ACTH increases
Aldosterone decreases
Autoantibodies

175
Q

Management of Addisons

A

Hydrocortisone

Fludrocortisone

CANNOT STOP THESE SUDDENLY (Addisonian crisis)

176
Q

What is a phaeochromocytoma ?

A

An adrenaline secreting tumour

177
Q

Where is adrenaline produced

A

Adrenal medulla

178
Q

Prophylactic medications for phaeochromocytoma

A

Alpha block - phenoxybenzamine

Beta block - atenolol , propanolol

Fluid replacement

*before surgery to remove need alpha block of doxasozin

179
Q

MENI vs MENII

A
180
Q

Which disease fall under MENIIa

A

Phaeochromocytoma
Medullary thyroid cancer
Parathyroid hyperplasia

181
Q

What disease fall under MENIIb

A

Phaeochromocytoma

Medullary thyroid cancer

Mucosal neuroma

182
Q

How to treat PCOS

A

Metformin = 1st line

183
Q

Define infertility

A

Failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sex in a couple who have never had a child (in absence of a know reason)

184
Q

What regulates GnRH in the menstrual cycle

A

Oestrogen
Progesterone
Kisspeptin

185
Q

Which hormone is responsible for ovulation

A

LH

Also responsible for corpus luteum formation

186
Q

Hormone responsible for follicular development

A

FSH

187
Q

Where is oestrogen secreted

A

Primarily by the ovaries

Adrenal cortex as well

(And placenta)

188
Q

What is affected in primary Hypogonadism

A

Testes - high LH/FSH

“Hypergonadtrophic hypogonadism”

189
Q

What is affected in secondary hypogonadism

A

Hypothalamus/ pituitary affected, the testes are capable of normal function

Low LH/FSH

190
Q

What is Kleinfelters’

A

47 XXY

Affected men are typically infertile

Increases incidence of cryptochidism —> learning disability and pyschosocial issues

191
Q

Risks associate with klinefelters

A

Breast cancer

Non-Hodgkin lymphoma

192
Q

What is Kallman’s

A

Hypogonadism and anosmia

193
Q

Mechanism of action of DPP-4s (sitagliptin)

A

Increases levels of incretins such as GLP-1 and GIP

194
Q

MoA metformin

A

Increases cell sensitivity to insulin

195
Q

MoA pioglitazone/ glitazones / thiazolidinediones

A

Increases adipogenesis —> causing cells to become more dependent on glucose for an energy source

196
Q

MOA sulphonylureas / gliclazide

A

Increase intracellular calcium to increase insulin release

This drugs binds to ATP-sensitive potassium channels on pancreatic beta cells causing depolarisation of calcium ions into the beta cells

Granules of insulin to be released

197
Q

Which hormone is deficient in central DI and where does it act

A

-ADH
-collecting duct

198
Q

What is lipodystrophy

A

Insulin can cause small subcutaneous lumps at injection sites

199
Q

Which hormone is secreted in response to a hypo

A

Glucagon

200
Q

Where do SGLT-2 inhibitors act

A

Renal proximal convoluted tubules

201
Q

Where do sulphonylyreas act

A

Pancreatic beta cells

202
Q

Deficiency of what enzyme is a common cause of congenital adrenal hyperplasia

A

21-hydroxylase deficiency

203
Q

Mechanism of action of antidiuretic hormone

A

Promotes water re-absorption by the insertion of aquaporin-2 channels

204
Q

What does this guy have ?

A

Small cell lung cancer - with paraneoplastic syndrome (caused by antidiuretic hormone secretion)

205
Q

Function of ADH

A

Conserves body water

206
Q

Deficiency of what enzyme leads to congenital adrenal hyperplasia

A

21-hydroxylase

207
Q

Which diabetes medication causes glycosuria

A

SGLT-2s

208
Q

Klinefelters syndrome karyotype

A

47 XXY

Features = tall, lack of secondary sexual characteristics, small and firm testes, infertile

Diagnosis by chromosomal analysis

209
Q

What causes Kallman’s

A

Failure of GnRH-secreting neurons to migrate to the hypothalamus

210
Q

What is androgen insensitivity syndrome

A

X-linked recessive condition due to end organ resistance to testosterone causing genotypically male children to have a female phenotype

211
Q

What does release of ADH do ?

A

Increase blood pressure and decreases plasma osmolality

Keeps water in the blood

212
Q

What syndrome is associated with low secretion of ADH

A

Cranial DI

213
Q

What conditions are associated with hypersecretion of ADH

A

SIADH / ADH secreting tumour

214
Q

Treatment of SIADH

A

Mannitol —> for cerebral oedema / water leaking out of blood vessels bc there is not enough salt to keep it in

215
Q

What disease come under MEN IIa

A

Medullary thyroid cancer
Hypercalceamia
Phaeochromocytoma

(Hyperplastic syndromes)

216
Q

What is cortisol

A

A glucocorticoid

217
Q

How does metformin work

A

Increasing insulin sensitivity and decreasing hepatic gluconeogenesis

218
Q

What is a common drug that raises blood glucose levels

A

Glucocorticoids

219
Q

Name 2 diseases - other than DM - that can cause damage to insulin producing cells

A

Chronic pancreatitis
Haemochromatosis

220
Q

What is the hormone responsible in Cushing and what is its Main effects

A
  1. Cortisol
  2. Upregulation of alpha-1-adrenoceptors on arterioles
221
Q

You are a monkey

A
222
Q

What is Waterhouse friedrichson

A

Failure of adrenal gland secondary to adrenal haemorrhage after a severe bacterial infection

223
Q

What are the 2 obesity hormones

A

Ghrlepin and leptin

Ghrelin gains appetite
Leptin lowers appetite

224
Q

Which hormone makes you feel full

A

Leptin

225
Q

Which hormone is known as the hunger hormone

A

Ghrelin

226
Q

What are the two hypothalamic hormones which increase the secretion of prolactin

A

Prolactin releasing hormone
Gonadotropin releasing hormone

227
Q

Where is GLP-1 released

A

Ileum - this hormone release in response to oral glucose load

228
Q

When would you add exenatide (GLP-1 mimetic) to metformin + sulphonylurea

A

If:

BMI >35kg/m2 in people of European descent and there are problems associated with high weight

Or

BMI < 35kg/m2 and insulin is unacceptable because of occupational implications or weight loss would benefit other comorbidities

229
Q

Which receptors - when their stimulation is enhanced - causes palpitations and increased heart rate

A

Beta 1 receptors

230
Q

*brown bone tumours

A

Hyperparathyroidism - arise in setting of excess osteoclast activity

They appear brown because haemosiderin is deposited at the site

231
Q
A
232
Q

What is Bartter’s syndrome

A

Is a rare inherited disorder due to mutated NKCC2 channels which presents with polydipsia, polyuria and a tendency to dehydration

Results from defective NKCC2 channel in the ascending loop of Henle

233
Q

What is the first hormone secreted in response to hypoglycaemia

A

Glucagon

234
Q

Hypotestosteronism is associated with what bone condition ?

A

Osteoporosis

(Think - hypotestosteronism —> woman have less testosterone —> women get menopause —> after menopause osteoporosis big risk factor)

235
Q

Investigation for pituitary adenoma

A

MRI pituitary

236
Q

Conditions that can cause secondary hyperaldosteronism

A

Liver cirrhosis
Congestive cardiac failure
Renal artery stenosis

(Due to increased circulation renin levels)

237
Q

Which diabetes drug can cause lactic acidosis

A

Metformin (is a biguinide)

238
Q

Side effects of metformin

A

Lactic acidosis and Gi disturbance

239
Q

Side effects of sulfonylureas

A

Hypoglycaemia and weight gain

240
Q

Side effects of pioglitazone

A

Fluid retention —> worsening heart failure
Weight gain

241
Q

Side effects of SGLT-2s (flozins)

A

DKA when used with insulin

Increased risk of UTI

242
Q

Side effects of DPP-4 inhibitors

A

Hypoglycaemia and GI upset

243
Q

Side effects of GLP-1 analogues

A

Hypoglycaemia , GI upset

244
Q

Classical presentation of phaeochromocytoma ?

A

High BP
Headache
Sweating
Anxiety
Young person

245
Q

Why do you get sleep apnoea and snoring in acromegaly

A

Due to excess GH causing growth of soft tissues in pharynx

(Also excess tissue growth surround median nerve causing Carpal Tunnel syndrome)

246
Q

Management of Addisonian crisis

A

Resuscitation with IV fluids

247
Q

Sick day rules for people wit addisons

A

Double up on hydrocortisone when ill

248
Q

Adrenal insufficiency due to destruction of adrenal cortex leading to destruction of glucocorticoid production describes what disease

A

Addisons

249
Q

Metformin management of someone fasting for Ramadan

A

Continue the 3 500mg doses

Take the morning does before Suhoor (pre-sunrise meal)

Combine 2 afternoon doses at Iftar (after sunset meal)

250
Q

Management of menopause with periods every few months

A

Cyclical combined hormone replacement therapy

251
Q

*hypernatreamia, hypertension, hypokalaemia

A

Conns - primary hyperaldosteronism

252
Q

Action of aldosterone

A

Increases reabsorption of sodium , increases secretion of potassium

253
Q

What cells in the distal convoluted tubule are responsible for sensing the concentration of sodium chloride

A

Macula dense cells

254
Q

What converts T4-T3 ?

(Thyroxine to thyronine)

A

The enzyme : iodothyronine 5’deiodinase

*propylthiouracil inhibits this conversion

255
Q

What is a precursor to all steroid hormones

A

Cholesterol

256
Q

What long - term medication can predispose someone to T2DM

A

Corticosteroids - prednisolone

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