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FINALS: PASSMED/QUESMED > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are features of Kallman syndrome?

A
  • Delayed pubtery
  • Hypogonadism
  • Loss of smell
  • Low sex hormones
  • Normal/above average height
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2
Q

How is Kallman syndrome managed?

A
  • Testosterone supplementation
  • Sex hormones supplementation for fertility
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3
Q

What is vitamin D deficiency associated with?

A

Hypocalcaemia

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4
Q

Patients with high calcium, low PTH with cancer risk factors?

A

Think malignancy

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5
Q

What is the management of hypoglycaemia with impaired GCS?

A

IV Glucose if access

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6
Q

What characterises tertiary hyperparathyroidism?

A
  • extremely high PTH
  • moderately raised calcium
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7
Q

What is the management of new onset graves disease to control symptoms?

A
  • Propranolol
  • Carbimazole used to induce remission
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8
Q

Any change in vision for someone with thyroid eye disease needs what?

A

Urgent review by specialist

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9
Q

What is the target HBa1c for those on hypoglycaemic medications for T2DM?

A

53

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10
Q

What conditions make up MEN Type 2?

A

Medullary thyroid cancer, hypercalcaemia - parathyroid hyperplasia, phaeochromocytoma

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11
Q

What would you see on blood test results for hypercalcaemia secondary to malignancy?

A
  • Raised calcium
  • low PTH
  • low phosphate
  • raised PTHrP
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12
Q

What is the mode of action of orlistat?

A

inhibiting gastric and pancreatic lipase to reduce the digestion of fat

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13
Q

What should patients on long-term steroids do during intercurrent illness?

A

Double steroid doses

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14
Q

What adjunct can be used alongside orlistat for obese patients with one weight related co-mobidity?

A

Liraglutide

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15
Q

Subclinical hyperthyroidism is associated with what?

A

atrial fibrillation, osteoporosis and possibly dementia

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16
Q

What should be monitored to detect recurrence of medullary thyroid cancer?

A

Serum calcitonin

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17
Q

What is definitive management of primary hyperparathyroidism?

A

Total parathyroidectomy

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18
Q

Confusion, hypothermia, hyporeflexia, bradycardia, seizures and signs of hypothyroidism?

A

Myoxedema coma

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19
Q

Patients with type I diabetes and a BMI > 25 should be considered for what?

A

Metformin alongside insulin

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20
Q

Asymptomatic patients with abnormal HbA1c/fasting glucose need what?

A

Second abnormal reading

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21
Q

hypothyroidism + goitre + anti-TPO triad suggests what?

A

Hashimotos thyroiditis

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22
Q

Thyrotoxicosis with tender goitre?

A

Subacute thyroiditis / De Quervains

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23
Q

What are sick day rules for T1DM?

A
  • Insulin should not be stopped
  • Increased frequency of checking blood sugars
  • Drink atleast 3L fluids
  • Replace meals with carbohydrate drinks if appetite is reduced
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24
Q

What are sick day rules for T2DM?

A
  • Stop oral hypoglycaemics and restart once eating and drinking is back to normal for 24-24 hours
  • Do not stop insulin if using
  • Monitor blood glucose more frequently as needed
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25
Q

Which drugs can cause galactorrhoea?

A
  • Metoclopramide, domperidone
  • Haloperidol
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26
Q

Who should diabetic foot problems be referred to?

A

Local diabetic foot centre

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27
Q

What does a patchy uptake on nuclear scintigraphy suggest?

A

Toxic multinodular goitre

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28
Q

Long term steroid use can lead to what?

A

Avascular necrosis

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29
Q

Steroids can cause what in the muscles?

A

Proximal myopathy

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30
Q

Which hormones are decreased in response to stress?

A
  • Insulin
  • Testosterone
  • Oestrogen
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31
Q

What are the features of sick euthyroid syndrome?

A

Low T3/T4 with normal TSH during acute illness

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32
Q

What imaging should be done for those with suspected Cushings syndrome?

A

CT adrenal glands

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33
Q

2nd line medication for obese patient with T2DM?

A

DPP-4 inhibitors as least likely to cause weight gain

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34
Q

What would be seen on thyroid scintigraphy for someone with De Quervains thyroiditis?

A

Reduced iodine uptake

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35
Q

Peptic ulceration, galactorrhoea, hypercalcaemia all suggest what?

A

MEN type 1(pancreas, parathyroid, pituitary)

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36
Q

Glucocorticoid therapy can induce what?

A

Neutrophilia

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37
Q

What would be the urine osmolality for someone with primary polydipsia?

A

-Initially low
- After fluid deprivation: High

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38
Q

What features would be atypical for suspected T1DM?

A
  • Age > 50
  • BMI > 25
  • Slow progression of hyperglycaemia
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39
Q

What tests should patients undergo if atypical presentation of T1DM?

A
  • C peptide and diabetic autoantibodies
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40
Q

What is the treatment of a thyrotoxic storm?

A
  • Beta blockers, IV fluids, propylthiouracil and steroids
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41
Q

What should women with hypothyroidism do when they are pregnant?

A

Increase thyroid hormone replacement by upto 50%

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42
Q

Presentation of HHS

A

1) Hypovolaemia
2) Hyperglycaemia
3) Significantly raised serum osmolarity
4) Absence of ketoacidosis.

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43
Q

What blood sugars suggest impaired fasting glycaemia?

A

Between 6.1 and 6.9

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44
Q

What are the target blood sugars for T1DM?

A

Waking - 5-7
Other times: 4-7

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45
Q

What can worsen thyroid eye disease in patients with Graves?

A

Radioiodine treatment

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46
Q

What does a raised C-peptide help to distinguish?

A

Raised - T2DM
Low = T1DM

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47
Q

Management of subclinical hypothyroidism?

A

Check TPO antibodies

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48
Q

If 3 diabetic drugs are not helping, what should be done?

A

Switch one of them for a GLP-1 e.g. exenatide

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49
Q

Side effect of piogliotazone

A

Peripheral oedema

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50
Q

Patient who have 2 hypoglycaemic episodes need what?

A

Surrender driving licence

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51
Q

How should steroid doses be altered during illness with Addisons?

A

Glucocorticoid e.g. hydrocortisone -> doubled
Fludrocortisone -> kept the same

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52
Q

What are the diabetic specific autoantibodies?

A

anti-GAD

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53
Q

Which diabetes med increases risk of bladder cancer?

A

Thiazolidinedione e.g Pioglitazone

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54
Q

Over replacement with thyroxine increases the risk of what?

A

Osteoporosis

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55
Q

Fluids resuscitation in DKA?

A

1L of IV 0.9% NaCl over 1 hour - if systemic BP >90
500ml of IV 0.9% NaCl over 5 mins if systemic BP <90

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56
Q

What would be the expected metabolite results in Cushings?

A

Hypokalaemia with metabolic alkalosis

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57
Q

Erratic blood glucose control, bloating and vomiting

A

Gastroparesis

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58
Q

What should every person with insulin be given for emergencies?

A

Glucagon kit

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59
Q

Headaches, amenorrhoea, visual field defects suggests what?

A

Prolactinoma

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60
Q

Thyrotoxicosis with tender goitre?

A

De Quervains thyroiditis

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61
Q

Elevated prolactin with secondary hypothyroidism and hypogonadism?

A

Non-functioning pituitary adenoma

62
Q

increased TSH levels and normal T4 suggests what?

A

Poor compliance with thyroxine

63
Q

What can mimic Cushings disease?

A

Excess alcohol consumption

64
Q

Increased plasma 17-hydroxyprogesterone levels is suggestive of what?

A

Congenital adrenal hyperplasia

65
Q

Primary vs secondary hyperaldosteronism?

A

If renin is high, secondary cause is likely i.e. renal artery stenosis

66
Q

hyponatraemia, reduced plasma osmolality and increased urine osmolality suggests what?

A

SIADH

67
Q

Symptoms of acromegaly?

A
  • Spade like hands and feet
  • Frontal bossing
  • Macroglossia
  • Headaches
  • Bitemporal hemianopia
  • Sleep disturbances
  • Carpal tunnel
  • HTN
68
Q

What is the main cause of death in patients with acromegaly?

A

CVD

69
Q

What are some signs of hypothyroidism?

A
  • Dry hair/skin
  • Goitre
  • Mental slowness
  • Ataxia
  • Peripheral neuropathy
  • Slow/relaxing reflexes
70
Q

What are some signs of hyperthyroidism?

A
  • Tachycardia
  • AF
  • Goitre
  • Palmar erythema
  • Brisk reflexes
71
Q

Hashimotos vs Graves antibodies

A

Graves - anti TSH reception antibodies
Hashimotos - anti TPO antibodies

72
Q

Where does thyroid gland originate from embryologically?

A

Foramen caecum

73
Q

What are symptoms of neuroglycopenia?

A
  • Coma
  • Seizures
  • Drowsiness
  • Confusion
74
Q

What are causes of hypoglycaemia in non-diabetic patients?

A
  • Liver failure
  • Addisons
  • Alcohol binging
  • Pituitary insufficiency
  • Insulin secreting tumour
75
Q

What happens to periods with hypo and hyperthyroidism?

A

Hypo - heavy periods
Hyper - irregular/no periods

76
Q

Low serum calcium, low serum phosphate, raised ALP and raised PTH

A

Osteomalacia

77
Q

What is latent autoimmune diabetes of adulthood and maturity onset diabetes of the young?

A

LADA - Late onset T1DM - usually aged 30-50
MODY - earl onset T2DM - usually under 25

78
Q

What cardiac manifestations can occur with carcinoid syndrome?

A
  • Pulmonary stenosis and tricuspid insufficiency
79
Q

Management of an incidental pituitary mass?

A

Lab investigations to assess hormone hypersecretion/hypopituitarism

80
Q

What is alcoholic ketoacidosis?

A

A euglycemic form of ketoacidosis occurring in alcoholics
- When they don’t eat and they become malnourished, they start breaking down ketones
- Presents with metabolic acidosis, elevated ketones and normal/low glucose
- Tx with IV saline and thiamine

81
Q

Depression, nausea, constipation, bone pain

A

Primary hyperparathyroidism

82
Q

What is an important complication of fluid resus in DKA in children?

A

Cerebral oedema

83
Q

When to start dextrose infusion in DKA?

A

When blood glucose is <14

84
Q

Vit D deficiency vs CKD as cause of hyperparathyroidism

A

Vit d - low calcium and phosphate
CKD - low calcium but raised phosphate

85
Q

What differentials for SIADH must be considered

A

Severe hypothyroidism + adrenal insufficiency

86
Q

What is Klinefelters syndrome?

A
  • 47 XXY
  • Tall and slender male with small testes and gynaecomastia
  • Low testosterone with raised FSH:LH
  • Managed with HRT + regular monitoring for polycythaemia and DEXA scans for bone mineral density
87
Q

Microvascular vs macrovascular complications of diabetes?

A

Micro - nephropathy, neuropathy, retinopathy
Macro - CVD/Stroke, MI, PVD

88
Q

What is the pathophysiology of DKA?

A

Insulin deficiency produces glucose production in the liver;
lipolysis also occurs; fatty acids are broken done to form ketone
bodies which produce a metabolic acidosis

89
Q

What should patients taking steroids be made aware of?

A
  • carry steroid card
  • medic alert bracelet
  • know how to change dose for sick days
  • carry emergency IM hydrocortisone
90
Q

What sensation will be affected first in diabetic neuropathy?

A

Vibration

91
Q

What findings may be present with diabetic neuropathy on feet?

A
  • Joint deformity
  • Painless ulcer
  • Diminished reflexes
92
Q

Vomiting in poorly controlled diabetic patient?

A

Think gastroparesis

93
Q

carpal tunnel syndrome can be associated with what?

A

Acromegaly

94
Q

What is the most common complication of thyroid eye disease?

A

Exposure keratopathy

95
Q

What is the management of de Quervains thyroitidits?

A

Conservative with analgesia

96
Q

What is the most common cause of Cushings syndrome?

A

Pituitary tumour secreting ACTH (Cushings disease)

97
Q

What can cause low HbA1c?

A

Sickle cell/G6PD
Hereditary spherocytosis
Haemodialysis

98
Q

Splenectomy can cause what?

A

Raised Hba1c

99
Q

What is the key parameter to monitor in HHS?

A

Serum osmolality

100
Q

How to differentiate between unilateral and bilateral sources of aldosterone excess?

A

High res CT
If normal, adrenal venous sampling

101
Q

Moderate-severe aortic stenosis is a C/I to what?

A

ACE inhibitors

102
Q

hypertension, hypokalaemia, and metabolic alkalosis

A

Conn’s syndrome

103
Q

Management of myoxedemic coma?

A

Thyroxine + Hydrocortisone

104
Q

Management of thyroid storm?

A

Beta blockers, propylthiouracil and hydrocortisone

105
Q

How should HHS fluids be given?

A

Slow infusion

106
Q

What are signs of hypercalcaemia on ECG?

A

Short QT, J waves

107
Q

Which diabetic medication is approved in CKD?

A

DPP inhibitors

108
Q

What is the medical management for acromegaly?

A
  • Somatostatin analogues e.g ocreotide
109
Q

What is the diagnostic test for acromegaly?

A

Oral glucose tolerance test

110
Q

What enzyme is deficient in congenital adrenal hyperplasia?

A

21-hydroxylase

111
Q

What serum marker is raised in CAH?

A

17-OH progesterone

112
Q

How does CAH present?

A
  • Ambiguous genitalia
  • Acne
  • Hirsutism
  • Delayed puberty
113
Q

How is CAH managed?

A
  • Glucocorticoid (hydrocortisone) and mineralocorticoid (fludrocortisone) replacement
114
Q

If patients are asymptomatic for DM, what do you need?

A

2 abnormal readings

115
Q

What are side effects of gliotazones?

A
  • Weight gain
  • Increased risk of fractures
  • Fluid retention
116
Q

Iron tablets/calcium carbonate tablets can have what effect?

A

Reduced absorption of levothyroxine -> give 4 hours apart

117
Q

How does Cushing’s disease present on dex suppression test?

A

ACTH and cortisol suppressed

118
Q

What time gap should be kept when titrating metformin doses?

A

1 week

119
Q

Which cancer is Hashimotos thyroiditis associated with?

A

MALT lymphoma

120
Q

Thyrotoxicosis can lead to what?

A

high output cardiac failure

121
Q

When should treatment with statins be discontinued?

A

If serum transaminase concentrations rise to 3 times the upper limit of reference ranges

122
Q

Why does Cushing’s cause tanned appearance?

A

ACTH has a stimulatory effect on the melanocytes due to affinity for the MSH receptor

123
Q

Why does impaired hypoglycaemia awareness occur?

A

neuropathy of parts of the autonomous nervous system

124
Q

Management of subclinical hypothyroidism

A

TSH > 10 - Consider thyroxine if this is present on 2 separate occasions atleast 3 months apart
TSH 5.5-10 - Consider 6 months of thyroxine if <65 and there are symptoms of hypothyroidism
If asymptomatic/older - watch and wait

125
Q

What do each of the zones of the adrenals produce?

A

Zona glomerulosa - Mineralocorticoids - Aldosterone
Zona fasciculata - Glucocorticoids - Cortisol
Zona reticularis - Androgens
Medulla - Adrenaline/Noradrenaline

126
Q

hyperkalaemic, hyponatraemic, hypoglycaemic metabolic acidosis

A

Adrenal Crisis - Addisons

127
Q

How quickly should ketones fall in DKA?

A

Atleast 0.5 per hour

128
Q

What are primary causes of hypogonadism?

A
  • Trauma
  • Mumps
  • Iatrogenic
  • Klinefelter’s syndrome
129
Q

What is the most common thyroid cancer?

A
  • Papillary
130
Q

What is the management of non adrenal adenoma hyperaldosteronism?

A

Spironolactone

131
Q

Which cells of pancreas are affected in diabetes?

A

Beta pancreatic islet cells

132
Q

What genetic mutations might T1DM have?

A

HLA-DR3/4

133
Q

What time should serum cortisol be taken?

A

9am

134
Q

Treatment of choice for toxic multinodular goitre?

A

Radioactive iodine

135
Q

Osteoporosis in a man?

A

Check testosterone

136
Q

What is the management of Addisonian crisis?

A
  • Hydrocortisone
  • 1L Saline
137
Q

How do DPP-4 inhibitors work?

A

Increase incretin levels by reducing their peripheral breakdown

138
Q

How should the dose of hydrocortisone be taken in someone with Addisons?

A

Majority in first half of the day

139
Q

What should be corrected before giving bisphosphonates?

A

Hypocalcaemia
Vit D deficiency

140
Q

Patient >75 with fragility fracture?

A

Start bisphosphonate without needing to do DEXA

141
Q

What dose of glucose gel should be given to a patient with a low blood sugar?

A

10-20g

142
Q

Which HTN drug an cause sexual dysfunction?

A

Thiazide-like diuretics e.g indapamide

143
Q

How long should metformin be discontinued for after CT with contrast?

A

48 hours

144
Q

In primary prevention of CVD, what should the non-HDL cholesterol reduce by?

A

> 40% within the first 3 months

145
Q

What should be done after treatment with bisphosphonates for 5 years?

A

Repeat DEXA and FRAX and stop if score <-2.5

146
Q

Which diabetes medication is linked to Fournier’s gangrene (necrotising fasciitis of the genitals)?

A

SGLT-2 inhibitors

147
Q

What is the investigation of choice for suspected insulinoma?

A

72 hour fast

148
Q

Ferrous sulphate can interact with what?

A

Levothyroxine

149
Q

Management of hyperglycaemia in someone who has started enteral feeding?

A

Insulin

150
Q

Management of steroid induced diabetes?

A

Sulfonylureas e.g. gliclazide

151
Q
A

FINALS: PASSMED/QUESMED (22 decks)

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