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Internal Medicine Block > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Outline how would you make Dx of diabetes

A

Fasting plasma glucose >/=7mmol/L (fasting is no colorise intake for atleast 8hours)
Or
Random glucose >/= 11.1
Or
HbA1C >/=6.5%
Or
2h PG in a 75g OGTT >/= 11.1mmol/L

In absence of any sx, test should be repeated on a diff day to confirm diagnosis

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2
Q

What tests confirms pre-diabetes states

A

Impaired fasting glucose: fasting plasma glucose 6.1-6.9
Impaired glucose tolerance: 2h post OGTT glucose 7.8-11.0 mmol/L
Other HbA1C 5.7-6.4%

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3
Q

List the macro vascular complications of diabetes

A

Ischemic Heart disease-heart attacks
CVA
Peripheral vascular disease -Poor wound healing

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4
Q

List the micro vascular complications of diabetes

A

Nephropathy
Neuropathy
Retinopathy

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5
Q

What are the 3 main diabetic emergencies

A

Diabetic ketoacidosis
Hyperosmolar non ketotic coma
Hypoglycaemia

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6
Q

What are the 7 main sx of diabetes

A

Excessive thrust
Frequent urination
Excessive hunger
Loss of weight
Fatigue
Pins and needles feeling
Blurry vision

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7
Q

What would you find in ophthalmoscope of a person with diabetic retinopathy (5)

A

Haemorrhages
Abnormal growth of vessels (Angiogenesis)
Cotton wool spots
Aneurisms
Hard exudates

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8
Q

What are people with atherosclerosis at risk of (3)

A

Heart attack
Stroke
Gangrene

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9
Q

What is the mechanism for the development of type 1 diabetes and type 2

A

Type 2: Genetic predisposition
HLA DR3/4 and DR4/4
Multiple subtypes
Then Triggers : Virus
Early Cow’s milk
Early cereals
Low vitamins (D, E)
Hygiene
Psychosocial factors
other

Type1 is Autoimmune

Anti GAD
Anti IA2
ICA
Insulin

I

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10
Q

What is the function of in region hormone in the body

A

Gut hormone released after nutrient intake and stimulate insulin secretion together with hyperglycaemia.

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11
Q

What are the prevention measures for diabetes

A

Exercise
Healthy diet

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12
Q

What causes hypoglycaemia in diabetic patients

A

Too much medication-overdosing
Too little food
Food and meds timing mismatch
Exercise
Illness

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13
Q

What are the common causes of hyperthyroidism (5)

A
  1. Graves’ disease
  2. Toxic multinodular goitre
  3. Toxic nodule
  4. Thyroiditis
  5. Iodine induced
  6. Thyrotoxicosis factitia
  7. TSH secreting pirtuitary tumour
  8. Trophoblastic disease
  9. Strums Ovarii
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14
Q

What is the commonest cause of thyroidism

A

Graves’ disease
Women 10:1 men

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15
Q

What are the clinical features of Graves’ disease 4

A

Common
Diffuse goitre with a bruit
Opthalmopathy

Uncommon
Pretibial myxodema
Thyroid acrobatic-clubbing due to thyroid disease

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16
Q

Describe the physiology of T3 and T4 (how is it made/produced)

A

Hypothalamus stimulates TRH
TRH stimulates Pituitary to release TSH
TSH stimulates thyroid gland to release T3 and T4
Only 15% T3 is from Pituitary, 85%comes from conversion of T4 to T3

17
Q

Which test do you do for someone if you suspect hyperthyroidism

A

TSH and T4, rarely T3

18
Q

Which tests would you do in someone with hyperthyroidism inorder to confirm the cause of the hyperthyroidism

A

TSH receptor antibodies - if positive it’s Graves
Thyroid reuptake scan, using radioactive isotopes if the prev test is negative

19
Q

What are the treatment options for hyperthyroidism I’m SA

A

Thionamides - Carbimazole

20
Q

What is the mechanism of action of theonamide (carbimazole)

A

Inhibits thyroid peroxidase
Latent period before therapeutic response because inhibits hormone synthesis not release

21
Q

List 4 adverse effects of Neomercazole

A

Agranulocytosis
Hepatotoxicity
Thrombocytopenia
Lupus like syndrome

22
Q

What do you do if adverse effects occur due to neomercazole therapy in hyperthyroidism

A

Stop it, treat with radioactive iodine or surgery

23
Q

How would a pt with agranulocytosis due to neomercazole present

A

Fever and sore throat

24
Q

Which other anti thyroid drugs can be used in hyperthyroidism that have a quicker onset or mechanism of action (5)

A

Logo’s iodine
Beta blockers
Lithium
Cholestyramine
Dexamethazone

25
Q

Causes of primary hypothyroidism (3)

A

Post surgery / iodine deficiency
Hashimotos disease
Anti thyroid drugs

26
Q

What is the treatment of choice of hypothyroidism

A

Levothyroxine (T4- eltroxin, euthyrox)

27
Q

Which drugs can affect absorption of thyroid hormone

A

Cholestyramine
Calcium carbonate
PPIs (Omeprazole, landoprazole)
Ciprofloxacin
Sucralfate, ferrous sukfate, aluminium hydroxide
Chromium

28
Q

What is Is osteoporosis

A

Disease of bone mineral deficiency and reduced density

29
Q

Define osteomalacia

A

Adult form of rickets in which mineral component is deficient in bone

30
Q

Outline function of osteocytes

A

Maintain nutrition of other cells

31
Q

List some of the non endocrine causes of Osteoporosis

A

Smoking! Tobacco use
Alcohol
Haematological malignancies eg multiple myeloma and breast carcinoma

32
Q

Define osteopetrosis

A

Bone is dense but brittle
Not have necessary collagen bone, posciline bone

33
Q

Outline the functions of the different cells of bone tissue

A

Osteocytes- maintains bone
Osteoblasts - forms bone matrix
Osteopenia cell- stem cell
Osteoblast - resorts bone

34
Q

What is a low impact fall

A

Forced external rotation of the lower extremity which impinges on posterior lip of the acetabulum

35
Q

Which bones fracture in osteoporosis

A

Wrist fracture
Spinal fracture
Hip fracture

36
Q

List the Causes of osteoporosis

A

Endocrine - hypogonadism, high ACH, Thyrotoxicosis, Anorexia nervousa, hyperprolactinaemia, porphyria, DM1, hyperparathyroidism, Acromegaly

Nutrition- malabsorption syndromes, malnutrition, vit D deficiency, calcium deficiency, alcoholism, gastric operations, hypercalciuria, chronic liver disease
Drugs- glucocorticoid, excess thyroid hormone, heparin, phenytoin

Disorders of collagen metabolism- osteogenesis imperfecta
Other- rheumatoid arthritis, thalassemia

37
Q

Which drug is the main cause of secondary osteoporosis

A

Glucocorticoid

38
Q

What other presentations can be similar to Cushings

A

Alcohol
Depressions

Alcohol-red checks, bruising
HBAc abnormal

39
Q

How to test for Cushings

A

1m overnight Dexamethasone suppression test
24h urinary cortisol
Midnight cortisol (salivary)

Internal Medicine Block (9 decks)

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