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Medicine Block Year 3 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

How do you determine between Grave’s and De Quervain’s Thyroiditis?

Both are hyperthyroidism presenting with a goitre

A

Grave’s - non tender goitre

De Quervain’s - painful goitre

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1
Q

Why is exophthalmos specific to Grave’s Disease?

A

It is a consequence of TPO antibody infiltration and oedema of the periorbital tissues and muscles

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2
Q

Why is the majority of the Hydrocortisone and Fludrocortisone dose given in the earlier half of the day?

A

Steroids can cause insomnia

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3
Q

What are the biochemical features of Addisonian Crisis?

A

Hypernatraemia
Hypokalaemia
Hypoglycaemia

PMHx - of using steroids and stopping

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4
Q

What are the causes of raised prolactin levels?

A

Prolactinoma
Medications
Non-functioning pituitary adenoma
Pregnancy

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5
Q

What is the first line test for diagnosing Cushing’s Syndrome?

A

Low- dose dexamethasone suppression dose

High-dose helps distinguish the causes

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6
Q

What are the causes of primary adrenal insufficiency? ( Low cortisol, high ACTH)

A

Addison’s DIsease ( autoimmune )
Infections - TB, fungal, secondary infections to HIV
Infiltration - Amyloidosis, Sarcoidosis
Adrenal Tumours - primary and metastatic

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7
Q

What is Waterhouse-Friderichsen syndrome?

A

A complication of meningococcal infection, it is adrenal insufficiency secondary to bilateral adrenal haemorrhage

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8
Q

How does a pituitary adenoma cause hypopituitarism?

A

The compress the normal gland tissue causing it to cease functioning properly

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9
Q

What is the first line test for diagnosing Pheochromocytoma ?

A

24 hour Urinary metanephrines ( 1st ) and catecholamines
Plasma metanephrines are more specific

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10
Q

How does Carbimazole work?

A

Decreases the uptake and concentration of iodine by the thyroid. It also prevents the thyroid peroxidase enzyme (TPO) from coupling and iodinating the tyrosine residues on thyroglobulin

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11
Q

What is the first line test for Addison’s Disease?

A

9am serum cortisol ( low cortisol warrants further investigation)

Then do short SynCATHen test (cortisol levels don’t rise in response to exogenous ACTH)

Confirms primary adrenal insufficiency

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12
Q

Which drugs can cause thyrotoxicosis (high T4) ?

A

Amiodarone

Can stimulate or damage the thyroid gland ( similar to iodine )

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13
Q

What drugs can cause hypothyroidism?

A

Amiodarone
Lithium

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14
Q

What are pituitary tumours best visualised on?

A

Brain MRI

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15
Q

What is the gold standard investigation to clarify a diagnosis of hypopituitarism?

A

Insulin tolerance test

The stimulates hypoglycaemia, so it can test both ACTH and GH production , these would both increase in normal people eith hypoglycaemia

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15
Q

What are the most common types of thryoid cancer?

A

Young females - Papillary Thyroid Cancer ( popular)

Elderly female - Thyroid lymphoma ( long life )

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16
Q

How does PTH increase bone ressorbtion?

A

Binds to osteoblasts, which stimulate osteoclasts via paracrine signalling

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17
Q

What is included in MEN1?

A

pituitary tumours
parathyroid hyperplasia
pancreatic tumours

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18
Q

What is the first-line management for toxic adenoma or toxic multinodular goitre?

A

Radioiodine therapy

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19
Q

What is the treatment for patients with an Addisonian Crisis?

A

FLuid resuscitation
IV Hydrocortisone

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20
Q

How do they Dexamethasone suppression tests work?

A

Low dose - given at night time. In morning, early morning cortisol levels are not suppressed.

High dose - this will cause suppression of ACTH production by the pituitary adenoma in Cushing’s Disease. However, in ectopic production of ACTH, the cortisol will still not be suppressed as it does not work via a negative feedback cycle.

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21
Q

What is the first line test for suspected Primary Hyperaldosteronism?

A

Aldosterone/renin ratio ( Aldosterone will be high )

Then to differentiate between causes, a CT of the adrenal glands

Gold standard - s elective adrenal venous sampling can be used ( This shows if its bilateral adrenal hyperplasia because both the left and right adrenal veins will have high aldosterone)

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22
Q

What are the physiological levels of T3, T4 and TSH in the 2nd and 3rd trimester?

A

T3 and T4 low
TSH normal

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23
Q

What heart problems is hyperthyroidism associated with?

A

Tachycardia
Atrial FIbrillation

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24
Q

What is the treatment for DKA?

A

Initially give I.V NaCl Fluid bolus

Give fixed rate insulin infusion an hour later at 0.1 units/kg/hour

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25
Q

What is the treatment for Type 1 Diabetes if the patient becomes hypoglycaemic or hyperglycaemic?

A

In the community

Hypoglycaemic -
-Consume 15-20g of fast-acting carbohydrate (e.g., glucose tablets, non-diet soda, sweets, fruit juice)
-If patient can’t tolerate oral then do IM Glucagon injection

If in hospital and severe ( seizures, hospital) - Administer 200ml 10% dextrose IV

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26
Q

What are the clinical features of Klinefelter’s?

A

Delayed puberty
Gynecomastia
Microorchidism
Poor coordination
Muscle weakness

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27
Q

What is the first line treatment for type 1 diabetes?

A

Basal-Bolus insulin regime

Long acting insulin at night ( e.g Determir )
Short acting insulin 30 minutes before a meal ( e.g Novorapid)

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28
Q

What hormone is most commonly secreted by a Carcinoid Tumour?

A

Serotonin ( 5HT3)

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29
Q

What is the first line investigation for Acromegaly?

A

Serum IGF-1 = first line

Then do Oral Glucose Tolerance test to confirm
Give patient oral glucose and GH is not supressed

30
Q

What is the treatment for Acromegaly?

A

Transphenoidal resection of pituitary adenoma

Octreotide ( Somatostatin Analogue) if remission is failed with surgery

31
Q

What is MEN1 associated with?

A

Parathyroid hyperplasia/adenomas
Pancreatic tumours (gastrinomas, insulinomas)
Prolactinomas.

32
Q

What is MEN2a associated with?

A

Medullary thyroid cancer
Pheochromocytoma
Parathyroid hyperplasia/adenoma.

33
Q

What is MEN2b associated with?

A

Medullary thyroid cancer
Pheochromocytoma
Parathyroid hyperplasia/adenoma
Mucosal neuromas

34
Q

What is a complication of treating DKA?

A

Cebrebral Oedema

35
Q

What drugs are first line for diabetic neuropathy?

A

Pregabalin, Duloxetine, and Gabapentin

36
Q

How do you work out basal-bolus amounts?

A

basal bolus as 0.5units x weight = 24 hour requirement
then in 24 hours; 50% = basal and 50% = bolus.
the 50% bolus = split in 3 meals

If 100kg - 0.5x100 = 50units needed in 24 hours
Basal = 12 units , bolus = 12/3 = 4 units

37
Q

What is the add on to Metformin recommended if you have cardiovascular disease or have a new diagnosis of CVS problems during treatment for diabetes?

A

SGLT2 inhibitor

38
Q

If a patient has a HbA1c > 48mmol/L can you diagnose Diabetes?

A

Only if they are symptomatic, otherwise a confirmatory blood glucose sample should be arranged

39
Q

How is the dose of Hydrocortisone given in Addison’s disease?

A

Majority given in the first half of day and rest given in second half of day

Trying to recreate circadian levels of cortisol

40
Q

What is a myxoedema storm?

A

Myxoedema coma is a potentially fatal complication of longstanding undertreated hypothyroidism. It may be precipitated by illness, stress, and certain drugs. Apart from confusion and hypothermia, patients may have non-pitting periorbital and leg oedema, reduced respiratory drive, pericardial effusions, anaemia, seizures, and other symptoms of hypothyroidism.

41
Q

What is Pre-diabetes HbA1c?

A

42-47mmol/L

42
Q

What is the maximum dose of Metformin?

A

2g/day usually given as 1g b.d

43
Q

What are the side effects of Metformin?

A
44
Q

What are the side effects of Sulphonylureas?

A
45
Q

What are the side effects of SGLT-2 inhibitors?

A

UTIs/genital infection
normoglycemic ketoacidosis
increased risk of lower-limb amputation ( check feet)

46
Q

What is the type 1 diabetic sick day rules?

A

Stay on normal routine
Check blood sugars more frequently

47
Q

What can make the HbA1c look lower than expected?

A

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

Due do decreased RBC lifespan

48
Q

What can make the HbA1c look higher than expected?

A

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

Due to increased RBC life span

49
Q

What is the treatment for DKA?

A

500ml blus 0.9% saline
FRII ( Actrapid ) 0.1unit/kg/hour

50
Q

What is a complication of DKA ?

A

Cerebral Oedema

51
Q

What is the primary investigation for diagnosing DMT1?

A

Serum glucose

fasting glucose, random glucose or oral glucose tolerance test

52
Q

What are the thresholds for diagnosis of DMT1?

A

If symptomatic

Random blood glucose ≥ 11.1mmol/l or Fasting plasma glucose ≥ 7mmol/l
2-hour glucose tolerance ≥ 11.1mmol/l
HbA1C ≥ 48mmol/mol (6.5%)

53
Q

How should normal insulin regimes be adjusted if a patient is going on a FRII?

A

Stop short-acting insulins

Stay on long acting insulins

54
Q

What conditions are associated with Type 1 Diabetes?

A

Thyroid conditions
Coeliac’s Disease

55
Q

What are the initial investigations for DKA?

A

CBG - acidosis, low bicarb
Blood ketones >3
Blood glucose >11.1
U&Es - hypokalaemia

56
Q

How is basal-bolus insulin worked out?

A

Total insulin units per day

2/5 = basal long term
3/5 = short term, split into 3 meals

57
Q

What is the VBG finding in DKA?

A

Metabolic Acidosis with a raised ion gap

58
Q

What are some symptoms of diabetic retinopathy?

A

Floaters or dark spots in the vision
Blurred or distorted vision
Difficulty seeing at night
Sudden loss of vision

59
Q

What will be found on examination with mild retinopathy?

A

Microaneurysms
Hard exudates
Blot haemorrhages
Neo-vascularistaion

60
Q

What will be found on examination in severe diabetic retinopathy?

A

Cotton wool spots
Large blot haemorrhages

61
Q

Which diabetes drug is mainly associated with hypos?

A

Sulphonylureas e.g Gliclazide

62
Q

Is target BP different for people with Diabetes?

A

No

63
Q

What is the cause of peripheral neuropathy?

A

Microvascular

Advanced glycation end product effects on matrix metalloproteinases, this damages nerves

64
Q

What bacteria is commonly found in diabetic foot ulcer?

A

Pseudomonas aeruginosa

65
Q

What is the treatment for a diabetic foot ulcer?

A

Debridement
Use dressings while ulcer heals
Oral Flucloxacillin and Gentamicin ( Pseudomonas)

66
Q

What are some hallmarks of peripheral neuropathy?

A

Numbness
Anhidrosis
Accumulation of trauma without patient realising

67
Q

What antihyperglycemics would be stopped in end of life care?

A

Insulin
Gliclazide

Due to the risk of hypos, will affect quality of life

68
Q

When is HbA1c inaccurate?

A

Haemolytic anaemia
CKD
Chronic liver disease
Haemoglobinopathies
Steroids

69
Q

Why might a HbA1c be higher than expected?

A

Prolonged lifespan of RBCs

Splenectomy
Iron-deficiency anemia
Vitamin B12/Folic acid deficiency

70
Q

What might make the HbA1c lower than expected?

A

Due to reduced red blood cell lifespan

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

71
Q

What does Cortisol do to blood sugar levels?

A

Stimulates gluconeogenesis
Promotes glycogenolysis
Reduces glucose uptake by tissues

Increases blood sugar ( Stress, repair, fight or flight respons)

72
Q

What is the treatment for DKA?

A

1L 0.9% Saline over 1 hour
FRII 0.1units/kg/hour

Correct any hypokalemia that make occur

73
Q

What is the treatment for a thyrotoxic storm?

A

Beta blockers, propylthiouracil and hydrocortisone

Medicine Block Year 3 (12 decks)

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