endocrinology Flashcards
risk factors for cervical cancer
-most important: smoking
-COCs must be taken long term to be a risk factor
-high parity
Most common cause of thyrotoxicosis in pregnancy?
Graves Syndrome
Thyrotoxicosis in pregnancy
-Elevated levels of Tb globulin … increases total thyroxine level not free thyroxine
-Risk for: Fetal loss, Maternal heart failure, Premature labour
Also transient gestational hyperthyroid may occur drops in 2nd and 3rd trimester
Klinefelter Syndrome
-47XXY
-Tall stature
-Small testes
-RAISED GONADOTROPHINS ,LOW TEST
Gitelman Syndrome
-Genetic disorder affecting Thiazide sensitive NA-CL transporter in -DCT-
-NORMOTENSIV
-HYPOKALEMIA ,HYPOMAGNESEMIA, HYPOCALCIURIA
-METABOLIC ALKALOSIS
Thyroid acropachy
-DIGITAL CLUBBING
-SOFT TISSUE SWELLING OF HANDS AND FEET
-PERIOSTEAL NEW BONE FORMATION
Uterine Fibroids
Associated with secondary Polycythaemia due to erythropoietin production
Kallman syndrome
CRYPTORCHIDISM
Metabolic syndrome
-Doesnt include LDL
-ELEVATED URIC ACID
-PCOS
-NON ALCOHOLIC FATTY LIVER DISEASE
SIADH drug causes?
-SSRI
-TRICYCLIC
-CARBAMAZEPINE
-SULFONYLUREA
MEN 2B
Pheochromocytoma, MTC, MARFANOID HABITUS, Oral/Intestinal neuroma
Single most useful investigation in MEN 1 ?
serum calcium
ALBUMIN CREAT RATIO IN DM1
-Less than 70 …BP Goal of less than 140/90
-More than 70….BP Goal of less than 130/80
In Gestational Diabetes if not controlled with metformin what should be added?
Insulin
glibenclamide (if met and insulin refused)
Secondary Amenorrhea with raised Gonadotrophins?
Premature Ovarian Failure
First Line of SIADH with NA<120 and neurological symptoms (Seizures) ?
Hypertonic Saline 3% with increase in NA with MAX 10mmol in 24hr or 0.5 per hour
Most IMP modifiable risk factor for thyroid eye disease?
Smoking
Contraindications for Insulin stress test?
-Ischemic Heart disease
-Epilepsy
-Adrenal insufficiency
Thyroid Tumors associated with RET
MTC
PAPILLARY
First Anti INSULIN Regulatory Hormone to be secreted in Hypoglycemia?
GLUCAGON
CORTISOL takes time
In which case would IM GLUCAGON not be appropriate in rx of hypoglycemia?
CHRONIC ALCOHOLIC LIVER DISEASE
By how much should thyroxine be increased in pregnancy?
50% As early as 4-6 weeks of pregnancy
-TSH Should be measured each trimester and 6-8 weeks postpartum
stress incontinence regimen
-Pelvic floor muscles exercises for 3 months
-Surgery
-Duloxetine
Urge incontinence regimen
-Bladder training
-Antimuscarinic drugs: Oxybutynin, tolterodine, darifenacin
-Mirabergon
PCOS Hirsutism treatement
-COCs
-EFLORNITHINE
-Spironolactone, finasteride, flutamide
Gastroparesis (Autonomic dysfunction) in DM1 Treatement?
-BLOATING, VOMITING, ERRATIC GLUCOSE
-METOCLOPROMIDE, DOMPERIDONE ,ERYTHROMYCIN
High and low HBA1C ?
HIGH:
-VIT B12/ FOLATE/ IRON DEFICIENCY
-SPLENECTOMY
LOW:
-HEMODIALYSIS
-HEMOGLIBONOPATHY
-HEMOLYSIS
Systemic glucocorticoids rash?
monomorphic papular rash without comedones or cysts
-treated by tapering steroid dose
presentation of non functioning pit. adenoma
-Mainly compression symptoms
-Hypopituitarism
when not to use antichollinergics in urge incontinence?
Old people as it may cause confusion
Closed angle glaucoma
Normal TSH FT3 FT4 BUTT HIGH TOTAL FT3 FT4?
Normal pregnancy due to increase thyroid binding globulin TBG which increases TOTAL T3 T4
MODY
-Autosomal Dominant
-Under 25 years old
- Family hx of early onset DM
-Sensitive to sulfonylurea
Side effect of RAI in hyperthyroid
HYPOTHYROIDISM
GRAVES EYE DISEASE
FAMILIAL HYPERCHOLESTEROLEMIA
50% OF FIRST DEGREE RELATIVES
HIGH INSULIN AND C-PEPTIDE
EXOGENOUS INSULIN
SULFONYLUREA
NESIDIOBLASTOSIS (IN NEONATES, FOLLOWING BARIATRIC SURGERY)
Hypercalcemia relation to pancreas
CA increases pancreatic secretions causing actue pancreatitis and gallstones
DM in Ramadan
-Doses should be split ; 2/3 befor fitar 1/3 befor suhoor
-once daily sulfonylurea after sunsuet (fitar)
-PIOGLITAZONE NO CHANGE
Hyperlipidemia and NA
-PSEUDOHYPONATREMIA
-High plasma protein or lipid content, such as hyperlipidaemia, because these substances displace water and hence sodium in the plasma, leading to a falsely low sodium reading.
Acute pancreatitis relation to calcium
causes HYPOCALCEMIA:
-SAPONIFICATION of calcium combining with fatty acids forming insoluble soaps
-CAPILLARY LEAK SYNDROME: losing calcium to extravascular space
Renal impairement in DM
DPP4 as they dont need to be adjusted for renal patients
sglt2 and glp1 avoided in renal impairement
MIRABERGON
BETA 3 AGONIST
ANTIMUSCARINIC CONTRAINDICATED IN
OLD NIBBAS
CONFUSION
HISTORY OF URINARY RETENTION
Metformin in GFR cases
GFR 45-30= dose reduction
GFR <30 STOP METFORMIN
ALCOHOL IN DM
INCREASES INSULIN PRODUCTION by inc blood flow from exocrine to endocrine
IMPAIRS THE COUNTER REGULATORY MECHANISMS TO HYPOGLYCEMIA
STRONGEST POINTER TO DIAGNOSE DM1
KETONURIA
EUGLYCEAMIC KETOACIDOSIS
-SGLT2
-INTERRUPTION OF INSULIN INFUSION PUMP
-PROLONGED FASTING
-PREGNANCY
OSMOTIC DEMYELINATION SYNDROME
-Rapid correction of hyponatremia leading to dehydration of ASTROCYTES and OLIGODENDROCYTES leading to their apoptosis
-to avoid: NA INCREASED BY 4-6 PER 24HR
-CAUSES LOCKED IN SYNDROME
Early morning weakness and diplopia with weight gain
INSULINOMA
CARBIMAZOLE
INHIBTS THYROID PEROXIDASE FROM COUPLING AND IODINATING THE TYROSINE RESIDUE
ECG IN HPER AND HPOCALCEMIA
HYPO: QT PROLONGATION
AFIB TORSADE DE POINTES]
HYPER: QT SHORTENING
OSBORN OR J WAVES
HIGHEST RISK OF FOOT AMPUTATION OUT OF SGLT2 DRUGS
CANAGLIFLOZIN NOT EMPA OR DAPA
RIEDEL THYROIDITIS
FIXED HARD NECK MASS
RETROPERITONEAL FIBROSIS
EU OR HYPOTHYROID
ELEVATED SYSTOLIC PRESSURE
URGENT OPTHALMOLOGY REFERRAL IN GRAVES
-AWARENESS IN CHANGE IN QUALITY OR INTENSITY OF COLOR VISION means optic nerve compression
-unexplained deterioration in vision
awareness of change in intensity or quality of colour vision in one or both eyes
history of eye suddenly ‘popping out’ (globe subluxation)
obvious corneal opacity
cornea still visible when the eyelids are closed
disc swelling
LITHIUM IN NEPHROGENIC DI
decreases expression of aquaporin channels
Calculation of HBA1C from glucose levels
2x HBA1C% - 4.5
PENDRED’S
-AUTOSOMAL RECESSIVE
-GOITER
-EUTHYROID
-SENSORINEURAL DEAFNESS
-VESTIBULAR BALANCE WEAKNESS
AMYTRIPTYILINE
AVOIDED IN BENIGN PROSTATIC HYPERPLASIA - CAUSES URINE RETENTION
DIABETES GENETICS
CONCORDANCE BETWEEN TWINS IS HIGHER IN TYPW 2THAN 1
TYPE 1 … DR3 , DR4 POLYGENIC
HEMOCHROMATOSIS …. EXAMPLE OF SECONDARY DM
graves antibody type
IGg
increased risk for edema with concominant administration of which medication with pioglitazone?
INSULIN
Electrolyte disturbance in Nasogastric feeding
Hypophostphatemia caused by REFEEDING SYNDROME
-ALSO BY DKA , ALCOHOL EXCESS, ACUTE LIVER FAILURE
Dynamic pituitary function test
-Give insulin, TRH, LHRH
-All hormones will rise except ADH
-Metoclopromide can be given for prolactinoma but requires a blunted response to diagnose it
Food highest in potassium
bananas, oranges, kiwi fruit, avocado, spinach, tomatoes
