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MRCP - Passmed > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

How is a myxoedemic coma treated? How can this present?

A

Thyroxine and hydrocortisone

Eg presentation - confusion, bradycardia, hypotension

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2
Q

What happens to thyroxine dose in pregnancy?

A

Safe to take during pregnancy and breastfeeding

Increase by to 50% as early as 4-6 weeks

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3
Q

Diagnosis for insulinomas?

A

Supervised fasting with abnormally high insulin

CT pancreas

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4
Q

Treatment of thyrotoxicosis in pregnancy?

A

Propylthiouracil in 1st trimester

Carbimazole afterwards

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5
Q

When to avoid radioiodine in management of graves disease (hyperthyroidism) ?

A

When thyroid eye disease is present!

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6
Q

Investigation of acromegaly?

A

1st line - serum IGF1

Confirmed with OGTT and serial GH levels

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7
Q

Medical mx of phaeochromocytoma?

A

1st a-blocker eg PHenoxybenazmine (like PHaeo)

then B-blockers

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8
Q

When to add SGLT2 inhibitor to inital therapy in T2DM mx when on Metformin?

A

the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%)

the patient has established CVD

the patient has chronic heart failure

SGLT-2 inhibitors should also be started at any point if a patient develops CVD (e.g. is diagnosed with ischaemic heart disease), a QRISK ≥ 10% or chronic heart failure

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9
Q

Which supplement to be careful of when on levothyroxine?

A

Iron or Calcium carbonate tablets can reduce absorption of levothyroxine hence should be given 4 hours apart

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10
Q

Side effects of thyroxine therapy?

A

hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation

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11
Q

Management of thyrotoxic storm?

A

BB

Anti thyroid drugs

Steroids - prevent conversion of T4 -> T3

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12
Q

Blood gas findings in renal tubular acidosis?

A

Hyperchloraemic metabolic acidosis (normal anion gap)

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13
Q

What are the different types of RTA?

A

Type 1 RTA - Distal
Type 2 RTA - Proximal
Type 3 RTA - Mixed
Type 4 RTA - Hyperkalaemic

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14
Q
A
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15
Q
A
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16
Q

MEN 1, 2a and 2b?

A

MEN 1 (3Ps)
Parathyroid - hyper due to hyperplasia of gland
Pituitary
Pancreas
(Also adrenal and thyroid)

MEN 2a (2Ps)
Medullary thyroid cancer
Parathyroid
Phaeochromocytoma

MEN 2b (1P)
Medullary thyroid cancer
Phaeochromocytoma
Marfanoid appearance
Neuromas

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17
Q

Gene involved in MEN 1 v 2a v 2b

A

MEN 1 = MEN1 gene

MEN 2a + 2b = RET

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18
Q

Describe the hormonal responde to hypoglycaemia

A

1st - decreased insulin secretion

2nd - glucagon secretion

3rd - GH and Cortisol release

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19
Q

Describe the symathoadrenal responde to hypoglycaemia

A

Increased catecholamine-mediated (adrenergic) and acetylcholine-mediated (cholinergic) neurotransmission in PANS and CNS

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20
Q

Definitive mx of primary hyperparathyroidism?

A

Total parathyroidectomy

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21
Q

What cancer is associated with Hashimoto’s thyroiditis?

A

Thyroid lymphoma

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22
Q

Carbimazole v Propylthiouracil MoA?

A

Carbimazole + Propylthiouracil:
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

Propylthiouracil:
Also inhibits peripheral conversion of T4 to T3 via inibition of 5-deiodinase

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23
Q

Delayed puberty + hypogonadism + anosmia
LH & FSH low-normal and testosterone is low

Diagnosis?

A

Kallman’s syndrome

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24
Q

What to do in T2DM if HbA1c not controlled with triple therapy?

A

If triple therapy is not effective or tolerated consider switching one of the drugs for a GLP-1 mimetic:

BMI ≥ 35 kg/m² and specific psychological or other medical problems associated with obesity or

BMI < 35 kg/m² and for whom insulin therapy would have significant occupational implications or weight loss would benefit other significant obesity-related comorbidities

only continue if there is a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months

25
Q

Mx of infertility in PCOS?

A

Clomifene
Can also add metformin particularly if obese
Weight loss also important if appropriate

26
Q

Drug causes of Gynaecomastia?

A

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin - used in prostate ca
oestrogens, anabolic steroids

27
Q

Mx of stress incontinence?

A

Pelvic floor exercises - 8x3 daily - 3 months min

Surgical - retropubic midrethral tape procedures

Duloxetine - Offered if decline surgical procedures

28
Q

Inheritance of Familial Hypercholesteraemia?

A

Autosomally dominant

29
Q

Adverse effects of thiazolidinediones used in T2DM?

A

Weight gain

Liver impairment - monitor LFTs

Fluid retention - CI in HF (increased risk if taking insulin)

Increased # risk

Increased risk of bladder ca

30
Q

What to do to doses of long-term steroids in illness?

A

Double the dose of long-term steroids

31
Q

MoA of Sulphonureas? Can these cause weight gain and hypoglycaemia?

A

Binding of ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta

Yes causes weight gain and hypoglycaemia

32
Q

Glucocorticoid eg Pred effect on WBC?

A

Neutrophillia

33
Q

How to distinguish between renal artery stenosis v primary hyperaldosteronism?

A

Both has raised aldosterone

Renin = low in primary hyperaldosteronism as HTN -> excessive renal perfusion-> decreased renin production (negative feedback mechanism)

Renin = high in renal artery stenosis for opposing reasons

34
Q

MODY mechanism of inheritance?

A

Autosomally dominant

35
Q

Klinefelter karyotype?

A

47 XXY

36
Q

Which drugs can cause hypercalcaemia?

A

Thiazides

Ca-containing antacids

37
Q

Statins in established CVD (stroke, IHD or PVD)?S

A

High intensity (Atorvastatin 80mg)

38
Q

Gliclazide type of drug? MoA description?

A

Sulfonyureas - increase stimulation of insulin secretion by pancreatic B-cells and decrease hepatic clearance of insulin

39
Q

Blood gas findings in Cushings?

A

Hypokalaemic metabolic alkalosis

40
Q

Which HPV increases risk of cervical cancer? what are some other RFs?

A

HPV 16, 18, 33

Smoking
HIV
Earky first intercourse / multiple partners
High parity
Lower socio-economic status
COCP

41
Q

Which type of thyroid ca is associated with RET oncogene?

A

Medullary

42
Q

Which diabetic medications cause weight gain?

A

Insulin
Sulfonylureas
Thiazolidiones

43
Q

Which diabetic meds can cause hypoglycaemia?

A

Insulin
Sulfonylureas
SGLT2 inhibitors

44
Q

Medical mx of urge incontinence?

A

Muscarinic antagonist eg tolterodine, oxybutinin or solifenacin

45
Q

Target improvement when using statins?

A

NICE look for a 40% reduction in non-HDL cholesterol after 3 months

If not improving by this level to consider titrating to 80mg

46
Q

High LH, Low Testosterone

Infertile

Dx?

A

Klinefelters

47
Q

Effect of corticosteroids on WBC?

A

Neutrophilia

48
Q

How should 9am cortisol levels be interpreted?

A

> 500 nmol/l makes Addison’s very unlikely
< 100 nmol/l is definitely abnormal
100-500 nmol/l should prompt a ACTH stimulation test to be performed

49
Q

What is addisons disease?

A

Low cortisol and aldosterones

50
Q

Blood sugar targets in gestational DM?

A

fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L

51
Q

Causes of pseudohyponatraemia?

A

Hyperlipidaemia
Hyperproteinaemia
Blood taken from drip arm
Severe hyperglycaemia -> draws intracellular water into extracellular place

52
Q

Cause of Bartters syndrome?

A

defective chloride absorption at the Na+ K+ 2Cl- cotransporter (NKCC2) in the ascending loop of Henle

Note- loop diuretics work by inhibiting this so think of bartters as taking large doses of furosemide

53
Q

What is Hashimotos thyroiditis associated with?

A

MALToma

54
Q

Why should slow infusion given to younger patients with DKA?

A

cerebral oedema

55
Q

DKA insulin dose?

A

Diabetic ketoacidosis: the IV insulin infusion should be started at 0.1 unit/kg/hour

56
Q

Which antibodies in hashimotos thyroiditis

A

anti-TPO

57
Q

Important adverse effects of SGLT2 inhibitors?

A

Normoglycaemic ketoacidosis

Increased risk of lower limb amputation

Urinaru + genital infection secondary to glycosuria

58
Q
A

MRCP - Passmed (15 decks)

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