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Daisy Finals Revision > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Which autoantibodies are present in Graves’ disease?

A

TSH receptor stimulating autoantibodies

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2
Q

Which conditions are antinuclear antibodies present in?

A

Lupus, Sjorens, scleroderma, rheum conditions

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3
Q

Which antibodies are present in Hashimotos?

A

anti thyroglobulin autoantibodies

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4
Q

What conditions are anti TPO autoantibodies present in?

A

90% hashimotos and 70% graves

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5
Q

What is the first line drug therapy for T2DM?

A

No CVD risk - metformin
CVD risk - metformin then add SGLT-2 inhibitor (-gliflozins)

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6
Q

What is the 2nd line drug therapy for T2DM?

A

Add one of
1. DPP-4 inhibitor - eg gliptins
2. Pioglitazone - eg Actos
3. Sulfonylurea - eg gliclazide
4. SGLT-2 inhibitor (if NICE criteria met) - eg gliflozin

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7
Q

Adverse effects of SGLT2 inhibitors

A
  • UTI/genital infection
  • normoglycaemic ketoacidosis
  • inc risk of lower limb amputation
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8
Q

C-peptide levels in T1DM?

A

Low

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9
Q

How is insulin given in DKA in t1 diabetics?

A

FIXED rate insulin
Stop short acting insulin
Continue long-acting insulin

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10
Q

What is the INITIAL management of DKA?

A

IV fluids

Then IV insulin

Possible addition of potassium to fluids if hypokalaemic

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11
Q

Which drugs cause gynaecomastia?

A
  • spironolactone (most common)
  • cimetidine
  • digoxin
  • cannabis
  • finasteride
  • GnRH agonists
  • oestrogens, anabolic steroids
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12
Q

What visual field defect is caused by a pituitary adenoma?

A

Bitemporal hemianopia

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13
Q

What is used to investigate for acromegaly?

A

Serum IGF-1 levels
If elevated, test GH level following hyperglycaemia during oral glucose load

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14
Q

How does PTH affect calcium and phosphate?

A
  1. Increases osteoclast activity at bone -> inc ca and phos into bloodstream
  2. At kidney -> incs hydroxylation and activation of vit D.
  3. Kidney -> inc ca reabsorption (Ca ^) and inc phosphate excretion (dec phos) in raised PTH
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15
Q

pathology of cushings syndrome?

A

excessive cortisol

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16
Q

causes of cushings?

A

exogenous steroids
pituitary adenoma (inc ACTH)
adrenal adenoma
paraneoplastic

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17
Q

conditions resulting from cushings?

A

hypertension
T2DM
depression
osteoporosis

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18
Q

diagnostic test for cushings?

A

dexamethasone suppression test

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19
Q

treatment for cushings?

A

treat the cause

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20
Q

presentation in addisons?

A

fatigue
cramps
abdo pain
acute: vomiting, drowsiness and hypotension

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21
Q

what is the cause of hyperpigmentation in addisons?

A

excessive ACTH stimulates melanocytes

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22
Q

pathology of primary adrenal insufficiency?

A

= addisons
damaged adrenals, dec secretion of cortisol and aldosterone

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23
Q

pathology of secondary adrenal insufficiency?

A

dec ACTH from pituitary

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24
Q

pathology of tertiary adrenal insufficiency?

A

dec CRH from the hypothalamus

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25
key biochemical finding in addisons?
hyponatraemia
26
diagnostic test for addisons?
short synacthen test
27
treatment in addisons?
hydrocortisone to replace cortisol fludrocortisone to replace aldosterone
28
clinical feature specific to grave's dx?
exophthalmos diffuse goitre pretibial myxoedema
29
causes of raised t3 and t4?
graves toxic multinodular goitre thyroiditis (eg de quervains)
30
symptomatic tx of grave's?
propranolol
31
definitive tx options for graves?
carbimazole propylthiouracil radioactive iodine surgery
32
dx: 45 yo F with tiredness, weight gain, low mood, dry skin and constipation
hypothyroidism (hashimotos thyroiditis)
33
antibodies ass w/ hashimotos thyroiditis?
anti TPO anti thyroglobulin
34
what happens to TFTs in hashimotos thyroiditis?
TSH ^ T3/T4 - low
35
other causes of low t3/4 and high tsh?
iodine deficiency tx for hyperthyroidism medications (eg lithium)
36
tx for hypothyroidism?
levothyroxine
37
3 criteria for DKA?
hyperglycaemia ketosis acidosis
38
initial mgt of DKA?
FIG PICK Fluids Insulin Glucose Potassium Infection (treat cause) Chart fluid balance Ketone monitoring
39
which hormone is raised in acromegaly?
growth hormone
40
most common cause of acromegaly?
pituitary adenoma
41
visual field defect in acromegaly?
bitemporal hemianopia
42
initial blood test in acromegaly?
insulin-like growth factor-1
43
definitive management of pituitary adenoma?
trans-sphenoidal removal
44
options for blocking growth hormone?
GH antagonist (pegvisomant) somatostatin analogues (octreotide) dopamine agonists (bromocriptine)
45
which cancer does acromegaly increase the risk of?
colorectal
46
how does PTH increase serum calcium?
inc osteoclast activity in bones inc absorption in kidneys inc vit D activity -> inc gut absorption
47
how does hypercalcaemia present?
renal stones bone pain abdominal groans psychiatric moans
48
cause of primary hyperparathyroidism?
tumour
49
cause of secondary hyperparathyroidism?
dec vit D or CKD (most common)
50
cause of tertiary hyperparathyroidism?
hyperplasia
51
calcium in primary, secondary and tertiary hyperparathyroidism?
1 - raised 2 - low or normal 3 - high
52
which enzyme converts angiotensinogen to angiotensin I?
renin
53
most common causes of conn's?
adrenal adenoma bilateral adrenal hyperplasia
54
secondary causes of conn's?
renal artery stenosis renal artery obstruction ht failure
55
what happens to renin in primary hyperaldosteronism?
decreased
56
what happens to renin in secondary hyperaldosteronism?
inc
57
examination finding in conns?
hypertension
58
electrolyte finding in conns?
hypokalaemia
59
blood gas finding in conns?
alkalosis
60
2 examples of aldosterone antagonists?
spironolactone eplenerone
61
where is ADH secreted?
posterior pituitary
62
sodium findings in SIADH?
blood sodium LOW urine sodium HIGH
63
source of ectopic ADH?
small cell lung cancer
64
treatment of SIADH?
fluid restriction ADH receptor blockers eg tolvaptan
65
concern with rapid changes in blood sodium?
central pontine myelinolysis
66
other endocrine cause of hyponatraemia (other than SIADH)?
adrenal insufficiency
67
common meds causing hyponatraemia?
diuretics NSAIDs SSRIs carbemazepine
68
causes of a low blood and urinary sodium?
sweating diarrhoea burns vomiting
69
what is cranial DI?
lack of ADH
70
what is nephrogenic DI?
lack of response to ADH
71
what is serum osmolality in DI?
high
72
urine osmolality in DI?
low
73
test of choice in DI?
water deprivation test
74
urine osmolality after water deprivation in DI?
low
75
urine osmolality after ADH in DI?
CRANIAL - HIGH NEPHROGENIC - LOW (head is higher than kidneys)
76
medical tx for DI?
desmopressin
77
pathology of phaeochromocytoma?
adrenal tumour releasing excess of adrenaline
78
symptoms of phaeochromocytoma?
intermittent: anxiety sweating headache palpitations
79
what part of the adrenal gland is affected in phaeo?
chromaffin cells in adrenal medulla
80
genetic condition associated with phaeo?
MEN2
81
10% rule in phaeochromocytoma?
10% bilateral 10% cancerous 10% outside the adrenals
82
initial tests for phaeo?
24 hour urine catecholamines plasma free metanephrines
83
management of phaeo?
alpha blockers first (eg phenoxybenzamine) beta blockers adrenalectomy to remove tumour
84

Daisy Finals Revision (25 decks)

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