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Finals passmed > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are the features of addisons disease?

A

fatigue, weakness, GI symptoms, confusion, syncope and irritability

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2
Q

How often should insulin dependant diabetics check their blood sugars when driving?

A

Before driving and every 2 hours

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3
Q

Which sign can you use to distinguish between primary and secondary adrenal insuffiency?

A

Skin hyperpigmentation - only seen in primary

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4
Q

What is kallmann syndrome?

A

A pituitary disorder - causes anosmia and hypogonadotrophic hypogonadism

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5
Q

Give an example of a sulfonylureas

A

gliclazide, glimepiride, tolbutamide

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6
Q

Which antibody is most specific for rheumatoid arthritis?

A

Anti-CCP

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7
Q

What investigation should you do in people with suspected rheumatoid?

A

X-Ray hands and feet

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8
Q

What are the blood levels in primary hyperparathyroidism?

A

high calcium
low phosphate
high ALP
high PTH

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9
Q

What are the blood levels in secondary hyperparathyroidism?

A

low calcium
high phosphate
high PTH
normal/high ALP

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10
Q

What is the management of symptomatic subclinical hypothyroidism? (raised TSH, normal T4)

A

trial Levothyroxine

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11
Q

What does exogenous mean?

A

From outside the body

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12
Q

What is the most common cause of cushing’s syndrome?

A
  • glucocorticoid therapy
  • pituitary adenomas - most common endogenous cause
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13
Q

What is the target HbA1c for diabetics?

A

48mmol/mol

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14
Q

What is the first line medical management of DMT2?

A

Metformin - titrate up slowly to avoid GI upset
if standard-release not tolerated, try modified release

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15
Q

When do you add SGLT-2 Inhibitors for T2DM management?

A
  • if CVD risk > 10%
  • if patient has established CVD
  • If patient has chronic heart failure
  • if hbA1c is > 58mmol/mol
  • metformin should be established first
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16
Q

What drugs can be given for hyperthyroidism?

A

Carbimazole - 1st line
Propylthiouracil - 2nd line
Radioactive iodine (not with thyroid eye disease)

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17
Q

What are the features of sick euthyroid syndrome (non-thyroidal illness)?

A
  • low thyroid hormones and sometimes TSH
  • no treatment needed - treat underlying cause
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18
Q

What is the most common cause of Addisons?

A

Autoimmune

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19
Q

What are the main features of addisons?

A

lethargy, weakness, anorexia, nausea & vomiting, weight loss, ‘salt-craving’ (hyperpigmentation in primary)

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20
Q

What is multiple endocrine neoplasia?

A

A group of 3 inherited endocrine disorders - autosomal dominant

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21
Q

What is MEN type 1?

A

3 Ps - parathyroid, pituitary, pancreas

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22
Q

What is MEN type 2a?

A

2Ps
Medullary thyroid cancer, parathyroid, phaechromocytoma

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23
Q

What is MEN type 2b?

A

1P. Medullary thyroid cancer, phaechromocytoma, marfanoid body habitus and neuromas

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24
Q

Name some SGLT-2 Inhibitors

A

Dapagliflozin

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25
Q

What are the actions of SGLT2 inhibitors?

A

lowers blood sugar by reabsorbing of glucose from the kidneys

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26
Q

How does pioglitazone work?

A

Lowers insulin sensitivity

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27
Q

What are the contrainidications of using pioglitazone?

A

with insulin, heart failure, bladder cancer

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28
Q

What is hashimotos thyroiditis?

A

chronic autoimmune thyroiditis, usually hypothyroid but can have acute thyrotoxicosis

29
Q

What is the difference between thyrotoxicosis and hyperthyroidism?

A

Thyrotoxicosis = high T3/T4
Hyperthyroid = type of thyrotoxicosis caused by excess endogenous thyroid hormone production

30
Q

What conditions are associated with hashimotos thyroiditis?

A

Other autoimmune conditions, MALT lymphoma

31
Q

What is the management of diabetic ketoacidosis?

A
  • fluid replacement (saline)
  • IV insulin 0.1 unit/kg/hr - once blood glucose < 14mmol/l add 10% dextrose infusion
  • correct electrolytes disturbances
32
Q

What is the HbA1c level for a pre-diabetic?

A

42-47 mmol/mol

33
Q

What is the cause of an impaired fasting glucose?

A

hepatic insulin resistance

34
Q

What is the cause of an impaired glucose tolerance?

A

muscle insulin resistance

35
Q

What is the definition of impaired glucose tolerance?

A

OGTT 2hrs, between 7.8 and 11.1mmol/l

36
Q

What are the results for an impaired fasting glucose?

A

6.1-7.0mmol/l

37
Q

What is graves disease?

A

Autoimmune thyrotoxicosis

38
Q

Which auto-antibodies are commonly seen in graves disease?

A

TSH receptor stimulating antibodies, anti-thyroid peroxidase antibodies

39
Q

Which drugs commonly cause gynaecomastia?

A

spironolactone, digoxin, cannabis, finasteride, GnRH agonists - goserelin, buserelin, oestrogens and anabolic steroids

40
Q

What is the management of a hyperosmotic hyperglycaemic state?

A
  • fluid replacement - IV NaCl - 0.5/1L per hour
  • insulin - should not be given unless glucose stops falling while giving IV fluids
  • thromboembolism prophylaxis
41
Q

What blood marker should you check in patients with subclinical hypothyroidism?

A

Thyroid autoantibodies (increased risk of progressing to overt hypothyroidism)

42
Q

What is the first line management of an afro-caribbean with type 2DM?

A

ACE-I or ARB

43
Q

What are the main features of SIADH?

A

hyponatraemia, reduced plasma osmolality and increased urine osmolality

44
Q

What is the action of ADH?

A

It causes more aquaporin utilisation in the collecting duct. causing more water to be retained, diluting electrolytes in the blood and making urine more concentrated

45
Q

Which cancers commonly cause SIADH?

A

small cell lung cancer, pancreas and prostate

46
Q

What are the most common causes of primary hyperaldosteronism?

A

bilateral idiopathic adrenal hyperplasia, then adrenal adenoma

47
Q

What are the main features of primary hyperaldosteronism?

A

hypertension, hyperkalaemia (muscle weakness), metabolic alkalosis

48
Q

What is the first line investigation for supposed hyperaldosteronism?

A

aldosterone/renin ratio
then do abdo CT and adrenal vein sampling

49
Q

Which drug is an aldosterone antagonist?

A

spironolactone

50
Q

Why is ALP raised in primary hyperparathyroidism?

A

increased bone turnover. ALP is produced by osteoblasts

51
Q

What is the action of metformin?

A

increases peripheral insulin sensitivity and gluconeogenesis

52
Q

What is the mechanism of action of gliptins?

A

reduces peripheral breakdown of incretins such as GLP-1 (glucagon-like-peptide) (glipTIN and increTIN)

53
Q

What are the features of Subacute (De Quervain’s) thyroiditis?

A

usually occurs following viral infection and presents with hyperthyroid, progresses to hypothyroid and then goes back to normal

54
Q

How do you diagnose Subacute thyroiditis?

A

thyroid scintigraphy - globally reduced uptake of iodine-131, raised ESR

55
Q

What is Conn’s syndrome?

A

primary hyperaldosteronism from an adrenal adenoma

56
Q

What are the two main signs of primary hyperaldosteronism?

A
  • hypertension
  • hypokalaemia - muscle weakness
57
Q

What is the first line investigation in suspected primary hyperaldosteronism?

A

plasma aldosterone/renin ratio (should show ^aldosterone but low renin)

58
Q

What is an incretin?

A

A hormone that causes blood glucose levels to decrease

59
Q

Name some Dipeptidl peptidase-4 inhibitors

A

Sitagliptin, Vildagliptin - reduce the peripheral breakdown of incretins - helpful in obese patients

60
Q

What are the features of De Quervain’s thyroiditis?

A
  • hyper, euthyroid, then hypo, then normal
  • following viral illness
  • reduced uptake of iodine-131
61
Q

Which diabetic medication should be used in those with CVD risk?

A

SGLT-2 inhibitor - empagliflozin

62
Q

What is a contraindication to driving with diabetes?

A
  • severe hypoglycaemic event in last 12 months
63
Q

What is the first line insulin regimen in children with DMT1?

A

Basal-bolus regimen with long acting insulin once daily, and rapid-acting insulin before meals

64
Q

What is the first line management of hypertension in a black patient with T2DM?

A

ARB

65
Q

What is the first line test for acromegaly?

A

igf-1

66
Q

What are the side effects of SGLT-2 inhibitors?

A

urinary and genital infections
normoglycaemic ketoacidosis
increased risk of lower limb amputation
weight loss

67
Q

Which type of hyperthyroidism causes a tender goitre?

A

De Quervain’s thyroiditis

68
Q

What are the features of an addisonian crisis?

A

hyperkalaemic metabolic acidosis
abdo pain, confusion, nausea and vomiting

69
Q
A

Finals passmed (23 decks)

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