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Finals Flash Cards 🩺 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is the diagnostic test for Addison’s disease?

A

Synacthen (ACTH) stimulation test

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2
Q

Three macrovascular complications of diabetes?

A
  • CVD
  • MI
  • PAD
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3
Q

Microvascular complications of diabetes?

A
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4
Q

Name 3 neuropathic complications of T2DM?

A

Autonomic dysfunction
Peripheral neuropathy
Gastroparesis

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5
Q

Patient is started on an SGLT-2 inhibitor and is sick what should you do?

A

Stop it and be aware of of Euglycaemic ketoacidosis

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6
Q

If a patient has multiple hormone deficiencies, what would you consider?

A

Hypopituitarism

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7
Q

What is the most common cause of hypopituitarism?

A

Pituitary disorder

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8
Q

What is produced by the anterior pituitary gland?

A

LH, FSH, TSH, ACTH, GNRH, Prolactin

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9
Q

What would you see on a radioiodine uptake scan in Grave’s disease?

A

Diffuse uptake

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10
Q

What are 3 other cardiorespiratory complications of hyperthyroidism?

A
  • AF
  • High-output heart failure
  • Upper airway obstruction (large goitres)
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11
Q

Name 3 other neurological manifestations of hypothyroidism?

A
  • Slow reflexes
  • Cerebellar ataxia
  • Peripheral neuropathy
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12
Q

Name 3 causes of hypothyroidism

A
  • Hashimoto’s thyroiditis
  • Congenital hypothyroidism
  • Dietary
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13
Q

What antibodies used to investigate autoimmune hypothyroidism?

A

Anti- TPO
Anti-Thyroglobulin
Anti-TSH Receptor ABs

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14
Q

What are the symptoms of Addisonian Crisis?

A
  • Severe abdominal pain
  • Severe electrolyte imbalance
  • Hypotension
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15
Q

What does the posterior pituitary produce?

A

Oxytocin and ADH

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16
Q

What does ACTH stimulate?

A

The adrenal glands to release cortisol

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17
Q

What does Growth hormone stimulate?

A

Stimulates the release of insulin-like growth factor (IGF-1) from the liver

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18
Q

How does Aldosterone work?

A

It is a mineralocorticoid steroid hormone which works on the nephrons in the kidney to:
- Increase sodium reabsorption from the distal tubule.
- Increase potassium secretion from the distal tubule.
- Increase hydrogen secretion from the collecting ducts

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19
Q

What TFT is used for a screening test for thyroid disease?

A

Thyroid stimulating hormone. When TSH is abnormal then T3 and T4 can be measured to gain more information.

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20
Q

What can “Cold” areas (abnormally low uptake) on radioisotope scans indicate?

A

Could indicate thyroid cancer

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21
Q

What is Toxic Multinodular goitre?

A

Also known as Plummer’s disease.
It is a condition where nodules develop on the thyroid gland, which are unregulated by the thyroid axis and continuously produce excessive thyroid hormones.

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22
Q

What is Pretibial myxoedema caused by?

A

Skin condition caused by deposits of glycoaminoglycans under the skin on the anterior aspect of the leg.
Specific to Grave’s disease and is a reaction to TSH receptor antibodies

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23
Q

What is HbA1c?

A

Glycosylated haemoglobin

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24
Q

What would overestimate a blood sugar measurement?

A

Splenectomy - due to increased RBC lifespan
Also Vitamin B12/Folic Acid deficiency and Iron deficiency anaemia

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25
Q

What is the treatment of HHS?

A

Treat with fluids and need thromboprophylaxis as the blood becomes very viscous.

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26
Q

How does SGLT2 inhibitors works?

A

They increase renal glucose excretion

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27
Q

Which diabetic medication is contraindicated in heart failure?

A

Gliclazine

28
Q

How can you treat Autonomic neuropathy in T1DM?

A

Gastroparesis –> Give metoclopramide as it is a prokinetic agent and therefore increases gut motility

29
Q

What diabetic medication should you stop before sending a patient for CT scan with contrast and why?

A

Metformin as the combination of Contrast Dye and Metformin predisposes you to Lactic Acidosis

30
Q

How do you treat a myxoedemic coma?

A

Thyroxine and hydrocortisone

31
Q

How do you treat a thyrotoxic storm?

A

beta blockers, propylthiouracil and hydrocortisone

32
Q

Who might receive growth hormone therapy?

A
  • Proven growth hormone deficiency
  • Turner’s syndrome
  • Prader-Willi syndrome
  • Chronic renal insufficiency before puberty
33
Q

What is the treatment for Subacute (De Quervain’s) Thyroiditis?

A

Conservative management with ibuprofen

34
Q

What is Phase 1 of Subacute (De Quervain’s) thyroiditis?

A

Lasts 3-6 weeks: Hyperthyroidism, painful goitre, raised ESR

35
Q

What is the first line management for painrelief in diabetic neuropathy?

A

Duloxetine or amitriptyline, gabapentinn or pregabalin

36
Q

What would U&E show in Cushing’s syndrome?

A

Hypokalaemic metabolic alkalosis

37
Q

When should you add a second drug in T2DM control?

A

Only add a second drug if the HbA1c rises to 58mmol/mol

38
Q

What would a high-dose dexamethasone suppression test show with a pituitary adenoma?

A
  • Cortisol: Suppressed
  • ACTH: Suppressed
39
Q

What cancer is Hashimoto’s thyroiditis linked to?

A

MALT lymphoma

40
Q

What blood tests might you see in an adrenal crisis?

A

Hyponatraemia, hyperkalaemia and hypoglycaemia

41
Q

What are the diabetic sick days rules?

A

Stop the insulin and measure blood glucose more frequently

42
Q

What is the first-line investigation for suspected primary hyperaldosteronism?

What would the results be?

A

Aldosterone/Renin Ratio

Should show high aldosterone levels alongside low renin levels

43
Q

What are the features of primary hyperaldosteronism?

A

Hypertension
Hypokalaemia
E.g., muslce weakness
Metabolic alkalosis

44
Q

What is the pathophysiology of DKA?

A

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

45
Q

What is the definition of DKA?

A
  • pH .7.3
  • Blood ketones <0.6 mmol/L
  • Bicarbonate >15.0mmol/L
46
Q

What are the complications of DKA?

A
  • Gastric stasis
  • Thromboembolism
  • Arrhythmias secondary to hyperkalaemia
  • Iatrogenic due to incorrect fluid therapy: Cerebral oedema, hypokalaemia, hypoglycaemia
  • ARDS
  • AKi
47
Q

What should every patient being started on Insulin also receive?

A

A Glucagon kit for emergencies

48
Q

What antibodies do you get in Graves’ disease?

A

TSH Receptor antibodies

49
Q

What antibodies do you get in Hashimoto’s thyroiditis?

A

Anti thyroid peroxidase antibodies

50
Q

What electrolyte imbalance would you see in Addison’s disease?

A

Hyponatraemia, hyperkalaemia and hypoglycaemia

51
Q

What are the causes of Hypoadrenalism?

A

Primary causes:
- Tuberculosis
- Metastasis
- Meningococcal septicaemia (Waterhouse-Friderichsen syndrome)
- HIV
- Antiphospholipid syndrome

Secondary causes:
- Pituitary disorders
- Exogenous glucocorticoid therapy

52
Q

Which diabetic medications are associated with Bladder cancer?

A

Pioglitazone

53
Q

What is the HbA1c target for a patient taking drugs which may cause hypoglycaemia?

54
Q

What is the diagnostic test for diagnosis of Cushing’s syndrome?

A

Low-dose overnight dexamethasone suppression test

55
Q

How should a patient take metformin during Ramadan?

A

During Ramadan, one-third of the normal metformin dose should be taken before sunrise and two-thirds should be taken after sunset

56
Q

What is Waterhouse-Friderichsen syndrome?

A
  • Blood vessels in adrenal gland rupture leading to adrenal crisis
57
Q

What is the best test to diagnose Cushing’s disease

A

Overnight (low dose) dexamethasone suppression test

58
Q

What is the metabolic disturbance in Cushing’s syndrome?

A

Hypokalaemic metabolic alkalosis

59
Q

What is the commenest cause of Addison’s disease?

A

Autoimmune

60
Q

What lab findings would you expect in Klinefelter’s syndrome?

A

High LH and low testosterone

61
Q

What are some precipitating factors for a thyroid storm?

A
  • Thyroid or non-thyroidal surgery
  • Trauma
  • Infection
  • Acute iodine load e.g. CT contrast media
62
Q

What are some of the clinical features of thyroid storm?

A
  • fever > 38.5ºC
  • tachycardia
  • confusion and agitation
  • nausea and vomiting
  • hypertension
  • heart failure
  • abnormal liver function test - jaundice may be seen clinically
63
Q

What is the management of Thyroid Storm?

A
  • Symptomatic treatment - Paracetamol
  • Treatment of precipitating event
  • Beta-blockers: typically IV propanolol
  • Anti-thyroid drugs
  • Lugol’s iodine
  • Dexamethasone (blocks conversion of T4 to T3)
64
Q

What is the pathological basis for Cushing’s disease

A

Endogenous secretion of ACTH from a pituitary adenoma

65
Q

What is the pathophysiology of hyperosmolar hyperglycaemic state?

A

Hyperglycaemia –> Increased serum osmolality –> Osmotic diuresis –> Severe volume depletion

66
Q

What is the management of HHS?

A

fluid replacement
- fluid losses in HHS are estimated to be between 100 - 220 ml/kg
- IV 0.9% sodium chloride solution
- typically given at 0.5 - 1 L/hour depending on clinical assessment
- potassium levels should be monitored and added to fluids depending on the level
insulin - should not be given unless blood glucose stops falling while giving IV fluids
venous thromboembolism prophylaxis
patients are at risk of thrombosis due to hyperviscosity

Finals Flash Cards 🩺 (32 decks)

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