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MRCP PART 1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are the symptoms of hypercalcaemia?

A
  • Stones
  • Abdominal groans
  • Bones
  • Psychic moans
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2
Q

What are the indications for initiating SGLT-2 inhibitors?

A
  1. Established CVD
  2. Risk of CVD
  3. Heart failure
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3
Q

What is the pharmacological management of urge incontinence?

A

Anti-muscarinics
1. Oxybutinin - caution in older patients
2. Tolterodine
3. Darifenacin
4. Solefinacin (alternative to oxybutinin)

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4
Q

What is the management of stress inocontinence?

A
  1. Bladder retraining
  2. surgery
  3. Duloxetine
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4
Q

What is the MoA of Mirabegon?

A

Beta - 3 agonist

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5
Q

What is the short term management of Charcot Arthropathy?

A
  • Immobilisation of the joint for 3-6 months
  • Consider adding Bisphosphonates
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6
Q

Which gene is mutated in MODY?

A

HNF1-alpha

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7
Q

What is the treatment of MODY?

A

Sulfonylureas

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8
Q

What is the karyotype for Turner Syndrome?

A

45XO (complete or partial absence of on X chromosome in females)

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9
Q

What is the karotype for androgen insensitivity syndrome?

A

46XY

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10
Q

What is the inheritance mode for androgen insensitivity syndrome?

A

X linked recessive

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11
Q

What are the features of AIS (androgen insensitivity syndrome)?

A
  • Primary amenorrhoea
  • scanty pubic hair
  • Groin swellings - undescended testes
  • Breast development 2ndry to overprodn of oestrogen
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12
Q

What causes a globally reduced uptake on thyroid scintigraphy?

A

Subacute (De Quervain’s) thyroiditis

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13
Q

What is the treatment of hyperparathyroidism in patient who can’t have surgery?

A

Cinacalcet - mimics the action of Ca on tissues

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14
Q

What is pseudohypoparathyroidism?

A

Insensitivity to PTH

Autosomal dominant inheritance

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15
Q

What would blood results of Pseudohypoparathyroidism show?

A
  • High PTH
  • High Phosphate
  • Low ca
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16
Q

What are the features of pseduohypoparathyroidism?

A
  • short 4th and 5th metacarpals
  • short stature
  • learning difficulties
  • obesity
  • round face
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17
Q

What would TFT results show in sick euthyroid syndrome?

A

Low TSH, T4 and T3

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18
Q

What features are specific to Graves’ disease?

A
  • pretibial myxoedema
  • thyroid acropachy (digital clubbing, swelling of hands and feet and periosteal bone formation)
  • eye signs
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19
Q

Which antibodies are specific to Graves’ disease?

A

TSH receptor stimulating antibodies

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20
Q

What does Graves’ disease show on thyroid scintigraphy?

A

diffuse, homogenous, increased uptake

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21
Q

What is the major complication of Carbimazole?

A

Agranulocytosis

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22
Q

What is the treatment of Graves’ disease for patients who relapse post ATD?

A

Radioiodine

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23
Q

Why do we use ‘block and replace’ regimen in Graves’ disease?

A

To avoid hypothyroidism

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24
Where is GLP released?
Small intestine
25
What is the MoA of GLP-1 mimetics (Exenatide)?
Increase insulin secretion and inhibit glucagon secretion
26
What is the criteria for starting/adding in GLP 1?
BMI >35 or BMI <35 but insulin cannot be used/weight loss would be beneficial
27
What are the major adverse effects of GLP-1 mimetics?
* Nausea and vomiting * Pancreatitis (Exenatide)
28
What is the MoA of DPP-4 inhibitors (gliptins)?
Prevents the peripheral breakdown of incretins
29
What are the diagnostic thresholds for gestational diabetes?
* Fasting glucose >5.6 * 2 hour glucose >7.8
30
Which type of insulin is used in gestational diabetes?
Short acting insulin
31
When should insulin be started in gestational diabetes?
* If fasting plasma glucose >7 * If fasting glucose 6-6.9 + macrosomia/hydramnios
32
Which type of insulin should be used first in T2DM?
Isophane (NPH) once or twice daily
33
What oncogene is associated with MEN type II?
RET oncogene
34
What are the features of MEN type IIa?
* Medullary thyroid cancer * Parathyroid * Phaechromocytoma
35
What is the MoA of Pegvisomant?
GH receptor antagonist
36
What is the non-surgical management of acromegaly?
* Somatostatin analogue - octreotide * GH receptor antagonist - Pegvisomant * Dopamine agonists - Bromocriptine
37
Which cells do Medullary thyroid cancer originate from?
Parafollicular (C) cells - produce calcitonin
38
What is the most common type of thyroid cancer?
Papillary carcinoma - slow growing, younger patients
39
Which antibodies are associated with Hashimoto?
Anti-TPO and Anti-thyroglobulin
40
What is the treatment for ACTH secreting adenoma?
Cortisol synthesis inhibitors - Ketoconazole/ Metyrapone
41
What is the MoA of Sulfonylurea?
Increases the stimulation of insulin secretion and decrease hepatic clearance of insulin - bind to K(ATPK+) channel
42
What are the side effects of sulfonylureas?
*Hypoglycaemia *Weight gain *Hyponatraemia - SIADH *Agranulocytosis *Hepatotixicity (Cholestatic)
43
What drugs commonly cause SIADH?
*TCAs *Sulfonylureas *Carbamazepine *SSRIs
44
What are the neurological causes of SIADH?
*Stroke *Subarachnoid haemorrhage *Subdural haemorrhage *Meningitis/encephalitis/abscess
45
What is subclinical hyperthyroidism?
* Normal T3 – T4 * ↓ TSH (usually < 0.1 mu/l)
46
What is subclinical hypothyroidism?
* Normal T3 – T4 * ↑TSH * No obvious symptoms
47
What are the side effects of Levothyroxine?
* Hyperthyroidism: due to over treatment * ↓ bone mineral density * Worsening of angina * Atrial fibrillation
48
what are the test results for poor compliance with thyroxine?
high TSH normal or high T4
49
What is the management of SIADH?
*Fluid restriction * Correction of na must be done slowly - to avoid Central Pontine Myelinolysis *Demeclocycline - reduces responsiveness to ADH *Vaptan - ADH receptor antagonists
50
Which thyroid antibodies are elevated in pregnancy?
Thyroxine binding globulin * high total thyroxine *inappropriately low TSH
51
What is the management of thyrotoxicosis in pregnancy?
* Propylthiouracil - in 1st trimester * Carbimazole from 2nd trimester keep T4 levels in upper 1/3 of normal range
52
How much should thyroxine be increased by during pregnancy?
50% at 4-6 weeks
53
What are the features of Addison's disease?
* Lethargy * N+V * Weight loss * Hyperpigmentation * Vitiligo * Hypotension * Hypoglycaemia * Hyponatraemia * Hyperkalaemia
54
What are the features of Addisonian crisis?
* Shock * Collapse * Pyrexia
55
What is the pathophysiology of HHS?
Hpyerglycaemia -->Increased serum osmolality --> increased diuresis --> increased volume depletion
56
What are the features of HHS?
* Volume loss - dehydration, polyuria, polydypsia * Neurology - altered consciousness levels, confusion * systemic - Nausea and vomiting, lethargy * Hyperviscocity - MI, stroke
57
What are the diagnostic criteria for HHS?
* Hypovolaemia * BM - >30 * Raised serum osmolality >320 (2 * Na + glucose +urea) * Ketones <3 * no signficicant acidosis
58
What is the management of HHS?
* IV fluids * Insulin - only given in BM stops falling post IV fluids * VTE prophylaxis
59
What are the clinical features of Thyroid storm?
* Confusion * Pyrexia * Tachycardia * Hypertension * Heart failure * Deranged LFTs
60
What is the management of Thyroid storm?
* Propanol - symptomatic treatmet * ATDs - Propylyuracil * Lugol's iodine * Steroids - blocks conversion of T4 to T3
61
What is the management of acne and hirsutism in PCOS?
* COC * Topical eflornithine * Sprionolactone/flutamide/finasteride (under specialist guidance)
62
How is infertility managed in PCOS?
* weight loss * clomifene - block oestrogen receptors so FSH is not inhibited * metformin * gonadotrophins
63
What lab findings would you see in Premature ovarian failure?
* High FSH/LH (Demonstrated on 2 blood samples take 4/52 apart) * Low oestrogen
64
What type of insulin resistance is impaired fasting glucose?
Hepatic insulin resistance
65
What type of insulin resistance is impaired glucose tolerance?
Muscle insulin resistance
66
What are the results of IGT?
below 11.1 mmol/l but above 7.8 mmol/l
67
What blood results are seen in Kallman syndrome?
LH & FSH low-normal and testosterone is low
68
What is the mode of inheritance in Kallman syndrome?
X-linked recessive
69
What is the pathophysiology of Kallman syndrome?
Failure of GnRH neurones to migrate to the hypothalamus
70
What are the features of Kallman Syndrome
* Delayed puberty * Low sex hormones * Hypogonadism * Cryptorchidism * Anosmia * Normal/above average height
71
What is the management of Kallman syndrome?
* Testosterone replacement * GnRH - if fertility is later desired
72
How does SGLT-2 inhibitors work?(gliflozins)
Prevents reabsorption of glucose from PCT --> glucose excretion
73
What are the side effects of SGLT-2 inhibitors?
* Weight loss * UTIs * Thrush * Genital infections * Fourniers gangrene * Normoglycaemic ketoacidosis * Increased risk of lower limb amputation
74
# (make an incision ACROSS parathyroid when) What are the indications for parathyroidectomy in hyperparathyroidism?
* Age <50 * eGFR <60 * Ca >0.25 of upper limit of normal * Renal stones * Osteoporosis/osteoporotic fracture * Symptomatic disease *
75
What cancer risk is increased with HRT + progesterone?
Breast cancer
76
What are the side effects of HRT?
* Increased risk of VTE * Increased risk of breast cancer * Increased risk of endometrial cancer (do not give women with a womb unopposed HRT) * Risk of IHD
77
77
What is the MoA of thiazolidinediones?
PPAR-gamma receptor agonist --> reducing peripheral insulin resistance, reduce hepatic gluconeogenesis
78
What are the side effects of Pioglitazone?
* Weight gain * Fluid retention - c/i in heart failure * Liver impairment - monitor LFTs * Increased risk of fractures * Bladder cancer
79
82
83
Why do uterine fibroids cause polycythaemia?
Due to autonomous production of EPO
84
What is the first line management of infertility in PCOS?
Clomifene
85
What are the sex hormone levels in Kleinfelter syndrome?
High LH and FSH Low testosterone
86
What are the Xray findings in Primary Hyperparathyroidism?
* Pepperpot skull * Osteitis fibrosa cystica
87
What tests are used in the investigation of Acromegaly?
* IGF-1 levels * OGTT and serial GH measurements for confirmation if above raised --> no suppression of GH in acromegaly
88
What is Bartters syndrome?
defective NKCC2 channel in the ascending loop of Henle
89
What is Liddles Syndrome?
Activation of epithelial sodium channels (ENaC) in the collecting duct.
90
What is Gitelman's syndrome?
* defective sodium-chloride co-transporter in the distal tubule * Autosommal recessive
91
What is the treatment for MODY associated with HFN1-a?
Low dose sulfonylurea
92
What are the features of RTA Type 1?
* inability of urine to generate H+ ions in distal tubules * Hypokalaemia
93
What are the causes of RTA 1?
* SLE * Srojren's * Rheumatoid * NSAIDs
94
What are causes RTA 2?
Reduced absorption of HCO3 in proximal tubule Causes hypokalaemia
95
What are the causes of RTA 2?
* Osteomalacia * Fanconi syndrome * Wilson's disease * Cystinosis * Carbonic anhydrase inhibitors
96
Which HPV serotypes cause cervical cancer?
HPV 16, 18 & 33
97
What will water deprivation test show in psychogenic polydypsia?
* Urine osmolality after deprivation: High * Urine osmolality after desmopression: High
98
How does Lithium cause hypothyroidism?
Inhibition of T4 release from the thyroid gland
99
How does Amiodarone cause Hyperthyroidism?
Excess iodine in Amiodarone Drug induced damage (thyroiditis)
100
What is Cushing's Syndrome?
Sustained overproduction of cortisol?
101
What are the features of Cushing's syndrome?
* Central obesity * Moon face * Osteoporosis * Recurrent infections * Hypokalaemia * Straie * Oligomenorrhoea
102
What are the causes of Cushing's syndrome?
* Adrenal tumour * Pituitary tumour (cushing's disease) * Ectopic ACTH prodn - small cell lung Ca * Ectopic CRH prodn
103
What happens to levels ACTH in Cushing's disease?
Inappropriately normal/raised
104
What happens to ACTH levels in adrenal disease?
ACTH is suppressed
105
What is the JVP wave form in cardiac tamponade?
Absent Y descent - due to limited right ventricular filling TamPaX
106
What is the JVP waveform in constrictive pericarditis?
X+Y descent
107
What are the features of Tetralogy of Fallot?
* Overriding aorta * Right ventricular hypertrophy * Right ventricular outflow tract obstruction * VSD
108
What causes persistent ST elevation post MI with no chest pain?
Left ventricular aneurysm
109
What mutation causes HOCM?
Mutation in gene encoding B myosin chain / myosin binding protein C
110
What type of cardiac dysfunction is seen in HOCM?
Diastolic dysfunction LVH --> decreased compliance --> decreased C.O
111
Which part of the aorta is involved in a Type A dissection?
Ascending Aorta BP + surgery
112
What part of the aorta is involved in a Type B dissection?
Descending aorta BP control
113
What is the treatment of Prinzmetal angina? (coronary vasospasm)
dihydropyridine calcium channel blocker Felodipine
114
Which type of pulse is seen in Left ventricular failure?
Pulsus alternans due to beat-to-beat variation in stroke volume | Heart is unable to maintain contractile force
115
Which part of the JVP wave form is associated with closure of the tricuspid valve?
C - wave
116
Which part of the JVP wave form is associated with atrial contractions?
A - wave
117
Which conditions cause large 'a' waves? (large atrial pressures)
* Tricuspid regurg * Pulmonary stenosis * Pulmonary HTN
118
What causes canon a waves?
Atrial contraction against closed tricuspid valve * complete heart block * VT * single chamber pacing * nodal rhythms
119
What causes X descent in the JVP wave form?
Fall in atrial pressure during ventricular systole
120
What are the features of papillary muscle rupture post MI?
* Mitral regurg * systolic murmur * hypotension * pulmonary oedema
121

MRCP PART 1 (9 decks)

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