Endocrinology Flashcards
What are two hand/nail signs of hyperthyroidsim?
Acropachy and onycholysis
When is insulin taken and glucose checked?
Before meals
What is the blood glucose target for someone taking insulin upon waking/ pre breakfast?
5-7 mmol/L
What is the blood glucose target for someone taking insulin 90 minutes after a meal?
5-9 mmol/L
What is the blood glucose target for someone taking insulin pre lunch/ dinner?
4-7 mmol/L
How would you change the dose of insulin if a patient had a lower/ higher blood glucose before a meal?
Hypoglycaemia has a bigger threat than hyperglycaemia so reduce the insulin dose
A housebound patient has a tender rib cage on patient. What does this suggest?
Osteomalacia
What is an example of peripheral neuropathy vs autonomic neuropathy in diabetics?
Peripheral neuropathy: glove and stocking
Autonomic neuropathy: gastroparesis
In a DKA patient with a potassium <5.5 what is the first line treatment?
IV 0.9% saline and KCl
What are four ECG changes in hyperkalaemia?
- tall, tented T waves
2 wide QRS complexes - no p waves
4 sinusodial waves
What is the first investigation for a patient with symptoms of hypercalcaemia?
Fasting serum calcium
A patient with palpitations and hypertension with a history of total thyroidectomy. What investigation is indicated?
24 hour urinary metanephrines (vanillylmendelic acid)
for phaeocytochroma (MEN2A)
What breathing is seen in DKA patients?
Kussmaul breathing
deep and laboured to blow off the CO2
How does hypothyroidism lead to hyperprolactinaemia?
By stimulating increased TRH which increases prolactin production
What syndrome describes cushingoid features, patchy skin, bone abdormalities and hypophosphataemia?
Mccume-Albright syndrome
What is measured first in hypo or hyperthyroidism?
TSH levels
Describe Nelson syndrome
Adrenelectomy causes an increase in ACTH levels leading to headache, bitemporal haemanopia, and increased pigmentation of skin
What is the visual field defect in pituitary apoplexy?
Bitemporal superior quandrantopia
A patient is oedematous, shaking and has rust coloured sputum. What are they experiencing?
Myxoedema coma
What is secondary adrenal failure caused by and what are the ACTH levels like?
Steroid abuse leading to low ACTH Addisons disease
What can be given to slow the rate of sodium correction?
5% dextrose
What does an increased T4 but an even higher TSH indicate in someone taking levothyroxine?
Non-compliance to medication
How does panhypopituitarism affect prolactin levels?
Increased as non functioning pituitary adenoma can have a negative effect on dopaminergic neryones
What is the first line treatment for pituitary apoplexy?
IM bolus 100ml hydrocortisone
What medication can be given to treat primary parahyperparathyroidism after IV fluids are given?
Cinacalcet
decreases PTH secretion from parathyroid gland
What scan can look at parathyroid function?
Sestamibi nuclear scan
How much fluids should be given over 6 hours in HHS?
3L NaCl over 6 hours
1 litre for:
1hr, 2hr, 2hr, 4hr, 4hr
What causes hypovolaemic hyponatraemia with a high urinary sodium?
Furosemide use
How does Riedel’s thyroiditis affect thyroxine leveles?
Fibrosis of the thyroid gland leads to hypothyroidism
How does Hashimoto’s affect prolactin levels
Increases TRH which can increase prolactin levels
When investigating polyuria and polydipsia what must be ruled out before doing a water deprivation test?
Hypercalcaemia
If the patient is alert enough to swallow what mode of glucose should the patient receive?
Glucose tablets not gel
How is serum osmolality measured?
2*Na + urea + glucose
What medication is approved to treat diabetes in CKD patients?
Sitagliptins
What is the triad for IgA vascultis / Henoch Schonlein purpura?
Rash
Abdo pain
Arthralgia
In nephrotic syndrome what medication should be started to reduce swelling?
Furosemide
