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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
Q

Where is GLP released?

A

Small intestine

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25
Q

What is the MoA of GLP-1 mimetics (Exenatide)?

A

Increase insulin secretion and inhibit glucagon secretion

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26
Q

What is the criteria for starting/adding in GLP 1?

A

BMI >35 or BMI <35 but insulin cannot be used/weight loss would be beneficial

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27
Q

What are the major adverse effects of GLP-1 mimetics?

A
  • Nausea and vomiting
  • Pancreatitis (Exenatide)
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28
Q

What is the MoA of DPP-4 inhibitors (gliptins)?

A

Prevents the peripheral breakdown of incretins

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29
Q

What are the diagnostic thresholds for gestational diabetes?

A
  • Fasting glucose >5.6
  • 2 hour glucose >7.8
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30
Q

Which type of insulin is used in gestational diabetes?

A

Short acting insulin

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31
Q

When should insulin be started in gestational diabetes?

A
  • If fasting plasma glucose >7
  • If fasting glucose 6-6.9 + macrosomia/hydramnios
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32
Q

Which type of insulin should be used first in T2DM?

A

Isophane (NPH) once or twice daily

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33
Q

What oncogene is associated with MEN type II?

A

RET oncogene

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34
Q

What are the features of MEN type IIa?

A
  • Medullary thyroid cancer
  • Parathyroid
  • Phaechromocytoma
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35
Q

What is the MoA of Pegvisomant?

A

GH receptor antagonist

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36
Q

What is the non-surgical management of acromegaly?

A
  • Somatostatin analogue - octreotide
  • GH receptor antagonist - Pegvisomant
  • Dopamine agonists - Bromocriptine
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37
Q

Which cells do Medullary thyroid cancer originate from?

A

Parafollicular (C) cells - produce calcitonin

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38
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma - slow growing, younger patients

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39
Q

Which antibodies are associated with Hashimoto?

A

Anti-TPO and Anti-thyroglobulin

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40
Q

What is the treatment for ACTH secreting adenoma?

A

Cortisol synthesis inhibitors - Ketoconazole/ Metyrapone

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41
Q

What is the MoA of Sulfonylurea?

A

Increases the stimulation of insulin secretion and decrease hepatic clearance of insulin - bind to K(ATPK+) channel

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42
Q

What are the side effects of sulfonylureas?

A

*Hypoglycaemia
*Weight gain
*Hyponatraemia - SIADH
*Agranulocytosis
*Hepatotixicity (Cholestatic)

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43
Q

What drugs commonly cause SIADH?

A

*TCAs
*Sulfonylureas
*Carbamazepine
*SSRIs

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44
Q

What are the neurological causes of SIADH?

A

*Stroke
*Subarachnoid haemorrhage
*Subdural haemorrhage
*Meningitis/encephalitis/abscess

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45
Q

What is subclinical hyperthyroidism?

A
  • Normal T3 – T4
  • ↓ TSH (usually < 0.1 mu/l)
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46
Q

What is subclinical hypothyroidism?

A
  • Normal T3 – T4
  • ↑TSH
  • No obvious symptoms
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47
Q

What are the side effects of Levothyroxine?

A
  • Hyperthyroidism: due to over treatment
  • ↓ bone mineral density
  • Worsening of angina
  • Atrial fibrillation
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48
Q

what are the test results for poor compliance with thyroxine?

A

high TSH
normal or high T4

49
Q

What is the management of SIADH?

A

*Fluid restriction
* Correction of na must be done slowly - to avoid Central Pontine Myelinolysis
*Demeclocycline - reduces responsiveness to ADH
*Vaptan - ADH receptor antagonists

50
Q

Which thyroid antibodies are elevated in pregnancy?

A

Thyroxine binding globulin
* high total thyroxine
*inappropriately low TSH

51
Q

What is the management of thyrotoxicosis in pregnancy?

A
  • Propylthiouracil - in 1st trimester
  • Carbimazole from 2nd trimester
    keep T4 levels in upper 1/3 of normal range
52
Q

How much should thyroxine be increased by during pregnancy?

A

50% at 4-6 weeks

53
Q

What are the features of Addison’s disease?

A
  • Lethargy
  • N+V
  • Weight loss
  • Hyperpigmentation
  • Vitiligo
  • Hypotension
  • Hypoglycaemia
  • Hyponatraemia
  • Hyperkalaemia
54
Q

What are the features of Addisonian crisis?

A
  • Shock
  • Collapse
  • Pyrexia
55
Q

What is the pathophysiology of HHS?

A

Hpyerglycaemia –>Increased serum osmolality –> increased diuresis –> increased volume depletion

56
Q

What are the features of HHS?

A
  • Volume loss - dehydration, polyuria, polydypsia
  • Neurology - altered consciousness levels, confusion
  • systemic - Nausea and vomiting, lethargy
  • Hyperviscocity - MI, stroke
57
Q

What are the diagnostic criteria for HHS?

A
  • Hypovolaemia
  • BM - >30
  • Raised serum osmolality >320 (2 * Na + glucose +urea)
  • Ketones <3
  • no signficicant acidosis
58
Q

What is the management of HHS?

A
  • IV fluids
  • Insulin - only given in BM stops falling post IV fluids
  • VTE prophylaxis
59
Q

What are the clinical features of Thyroid storm?

A
  • Confusion
  • Pyrexia
  • Tachycardia
  • Hypertension
  • Heart failure
  • Deranged LFTs
60
Q

What is the management of Thyroid storm?

A
  • Propanol - symptomatic treatmet
  • ATDs - Propylyuracil
  • Lugol’s iodine
  • Steroids - blocks conversion of T4 to T3
61
Q

What is the management of acne and hirsutism in PCOS?

A
  • COC
  • Topical eflornithine
  • Sprionolactone/flutamide/finasteride (under specialist guidance)
62
Q

How is infertility managed in PCOS?

A
  • weight loss
  • clomifene - block oestrogen receptors so FSH is not inhibited
  • metformin
  • gonadotrophins
63
Q

What lab findings would you see in Premature ovarian failure?

A
  • High FSH/LH (Demonstrated on 2 blood samples take 4/52 apart)
  • Low oestrogen
64
Q

What type of insulin resistance is impaired fasting glucose?

A

Hepatic insulin resistance

65
Q

What type of insulin resistance is impaired glucose tolerance?

A

Muscle insulin resistance

66
Q

What are the results of IGT?

A

below 11.1 mmol/l but above 7.8 mmol/l

67
Q

What blood results are seen in Kallman syndrome?

A

LH & FSH low-normal and testosterone is low

68
Q

What is the mode of inheritance in Kallman syndrome?

A

X-linked recessive

69
Q

What is the pathophysiology of Kallman syndrome?

A

Failure of GnRH neurones to migrate to the hypothalamus

70
Q

What are the features of Kallman Syndrome

A
  • Delayed puberty
  • Low sex hormones
  • Hypogonadism
  • Cryptorchidism
  • Anosmia
  • Normal/above average height
71
Q

What is the management of Kallman syndrome?

A
  • Testosterone replacement
  • GnRH - if fertility is later desired
72
Q

How does SGLT-2 inhibitors work?(gliflozins)

A

Prevents reabsorption of glucose from PCT –> glucose excretion

73
Q

What are the side effects of SGLT-2 inhibitors?

A
  • Weight loss
  • UTIs
  • Thrush
  • Genital infections
  • Fourniers gangrene
  • Normoglycaemic ketoacidosis
  • Increased risk of lower limb amputation
74
Q

(make an incision ACROSS parathyroid when)

What are the indications for parathyroidectomy in hyperparathyroidism?

A
  • Age <50
  • eGFR <60
  • Ca >0.25 of upper limit of normal
  • Renal stones
  • Osteoporosis/osteoporotic fracture
  • Symptomatic disease
    *
75
Q

What cancer risk is increased with HRT + progesterone?

A

Breast cancer

76
Q

What are the side effects of HRT?

A
  • 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
Q

What is the MoA of thiazolidinediones?

A

PPAR-gamma receptor agonist –> reducing peripheral insulin resistance, reduce hepatic gluconeogenesis

78
Q

What are the side effects of Pioglitazone?

A
  • Weight gain
  • Fluid retention - c/i in heart failure
  • Liver impairment - monitor LFTs
  • Increased risk of fractures
  • Bladder cancer
83
Q

Why do uterine fibroids cause polycythaemia?

A

Due to autonomous production of EPO

84
Q

What is the first line management of infertility in PCOS?

85
Q

What are the sex hormone levels in Kleinfelter syndrome?

A

High LH and FSH
Low testosterone

86
Q

What are the Xray findings in Primary Hyperparathyroidism?

A
  • Pepperpot skull
  • Osteitis fibrosa cystica
87
Q

What tests are used in the investigation of Acromegaly?

A
  • IGF-1 levels
  • OGTT and serial GH measurements for confirmation if above raised –> no suppression of GH in acromegaly
88
Q

What is Bartters syndrome?

A

defective NKCC2 channel in the ascending loop of Henle

89
Q

What is Liddles Syndrome?

A

Activation of epithelial sodium channels (ENaC) in the collecting duct.

90
Q

What is Gitelman’s syndrome?

A
  • defective sodium-chloride co-transporter in the distal tubule
  • Autosommal recessive
91
Q

What is the treatment for MODY associated with HFN1-a?

A

Low dose sulfonylurea

92
Q

What are the features of RTA Type 1?

A
  • inability of urine to generate H+ ions in distal tubules
  • Hypokalaemia
93
Q

What are the causes of RTA 1?

A
  • SLE
  • Srojren’s
  • Rheumatoid
  • NSAIDs
94
Q

What are causes RTA 2?

A

Reduced absorption of HCO3 in proximal tubule
Causes hypokalaemia

95
Q

What are the causes of RTA 2?

A
  • Osteomalacia
  • Fanconi syndrome
  • Wilson’s disease
  • Cystinosis
  • Carbonic anhydrase inhibitors
96
Q

Which HPV serotypes cause cervical cancer?

A

HPV 16, 18 & 33

97
Q

What will water deprivation test show in psychogenic polydypsia?

A
  • Urine osmolality after deprivation: High
  • Urine osmolality after desmopression: High
98
Q

How does Lithium cause hypothyroidism?

A

Inhibition of T4 release from the thyroid gland

99
Q

How does Amiodarone cause Hyperthyroidism?

A

Excess iodine in Amiodarone
Drug induced damage (thyroiditis)

100
Q

What is Cushing’s Syndrome?

A

Sustained overproduction of cortisol?

101
Q

What are the features of Cushing’s syndrome?

A
  • Central obesity
  • Moon face
  • Osteoporosis
  • Recurrent infections
  • Hypokalaemia
  • Straie
  • Oligomenorrhoea
102
Q

What are the causes of Cushing’s syndrome?

A
  • Adrenal tumour
  • Pituitary tumour (cushing’s disease)
  • Ectopic ACTH prodn - small cell lung Ca
  • Ectopic CRH prodn
103
Q

What happens to levels ACTH in Cushing’s disease?

A

Inappropriately normal/raised

104
Q

What happens to ACTH levels in adrenal disease?

A

ACTH is suppressed

105
Q

What is the JVP wave form in cardiac tamponade?

A

Absent Y descent - due to limited right ventricular filling
TamPaX

106
Q

What is the JVP waveform in constrictive pericarditis?

A

X+Y descent

107
Q

What are the features of Tetralogy of Fallot?

A
  • Overriding aorta
  • Right ventricular hypertrophy
  • Right ventricular outflow tract obstruction
  • VSD
108
Q

What causes persistent ST elevation post MI with no chest pain?

A

Left ventricular aneurysm

109
Q

What mutation causes HOCM?

A

Mutation in gene encoding B myosin chain / myosin binding protein C

110
Q

What type of cardiac dysfunction is seen in HOCM?

A

Diastolic dysfunction
LVH –> decreased compliance –> decreased C.O

111
Q

Which part of the aorta is involved in a Type A dissection?

A

Ascending Aorta
BP + surgery

112
Q

What part of the aorta is involved in a Type B dissection?

A

Descending aorta
BP control

113
Q

What is the treatment of Prinzmetal angina? (coronary vasospasm)

A

dihydropyridine calcium channel blocker
Felodipine

114
Q

Which type of pulse is seen in Left ventricular failure?

A

Pulsus alternans due to beat-to-beat variation in stroke volume

Heart is unable to maintain contractile force

115
Q

Which part of the JVP wave form is associated with closure of the tricuspid valve?

116
Q

Which part of the JVP wave form is associated with atrial contractions?

117
Q

Which conditions cause large ‘a’ waves? (large atrial pressures)

A
  • Tricuspid regurg
  • Pulmonary stenosis
  • Pulmonary HTN
118
Q

What causes canon a waves?

A

Atrial contraction against closed tricuspid valve
* complete heart block
* VT
* single chamber pacing
* nodal rhythms

119
Q

What causes X descent in the JVP wave form?

A

Fall in atrial pressure during ventricular systole

120
Q

What are the features of papillary muscle rupture post MI?

A
  • Mitral regurg
  • systolic murmur
  • hypotension
  • pulmonary oedema

MRCP PART 1 (4 decks)

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