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AKT > Endocrinology 3 > Flashcards

Endocrinology 3 Flashcards

1
Q

What is the triad of thyroid acropachy?

A

Clubbing
Soft tissue swelling of hands and feet
Periosteal new bone formation

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2
Q

Autoantibodies in Grave’s disease (2)

Hashimotos (2)

A

TSH receptor stimulating antibodies
Anti-thyroid peroxidase antibodies

Anti-TPO and anti-thyroglobulin (Tg)

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3
Q

What do you see on scintigraphy in Grave’s

A

increased uptake of radioactive iodine

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4
Q

When would you start carbimazole and how?

A

If propranolol hasn’t worked for symptom control.

Start at 40mg and reduce gradually - continued for 12-18 months.

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5
Q

SE of carbimazole (1)

A

agranulocytosis

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6
Q

What is the block and replace regime for Grave’s mx

When should it be used?

A

Carbimazole 40mg, thyroxine when euthyroid - rx lasts 6-9 months

Pregnancy

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7
Q

Contraindications to radioiodine treatment (3)

A

Pregnancy and avoid for 4-6 months after treatment
<16yo
Thyroid eye disesae

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8
Q

Hashimotos associations (4)

A

Vitiligo
Coeliac
MALT lymphoma
T1DM

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9
Q

Mx hypothyroidism

Following a change in medication when should the TFTs be repeated

A

Start at 50-100mcg OD
Unless:
Cardiac disease OR
Severe hypo OR
>50yo
Start at 25mcg

8-12 weeks

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10
Q

In pregnancy in hypothyroidism how should the thyroxine be changed?

A

Increase by 25-50mcg

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11
Q

SE thyroxine (4)

A

reduce bone mineral density
hyperthyroid
AF
worsening of angina

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12
Q

Which two drugs interact with thyroxine?

How to prevent this?

A

Iron
Calcium carbonate

Take 4 hours apart

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13
Q

Secondary causes of hypothyroidism (3)

A

Down’s
Turners
Coeliacs

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14
Q

How often should you test TSH in pregnancy?

A

Each trimester and 6-8 weeks post partum

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15
Q

Mx thyrotoxicosis in pregnancy and why

A

Propylthiouracil if first trimester, switched to carbimazole second and third

Carbimazole can cause congential abnormalities
Propylthiouracil can cause severe hepatic injury

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16
Q

Why should maternal free thyroxine levels be kept in the upper third of the normal reference range?

A

to avoid fetal hypothyroidism

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17
Q

Most common type of pituitary adenoma

A

Prolactinoma

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18
Q

Classification of pituitary adenomas

A

Size:
Micro <1cm
Macro >1cm

Hormonal status

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19
Q

Features of prolactinoma
Women (4)

Male (3)

A

Galactorrhoea
Infertility
Amenorrhea
Osteoporosis

Galactorrhoea
Loss of libido
Impotence

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20
Q

Dx of prolactinomas (1)

Mx (2)

A

MR

Dopamine agonist e.g cabergoline, bromocriptine

surgery - transpheroidal

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21
Q

Causes of raised prolactin (6)

A

prolactinoma
pregnancy
oestrogens
primary hypothyroidism
PCOS
acromegaly

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22
Q

Drug causes of raised prolactin (4)

A

Metoclopramide
Domperidone
Haloperidol
SSRIs

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23
Q

Features of primary hyperparathyroidism

A

Bones, stones, abdominal groans and psychic moans

polydipsia, polyuria
depression
anorexia, nausea, constipation
peptic ulceration
pancreatitis
bone pain/fracture
renal stones

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24
Q

Primary hyperparathyroidism
associations (2)

A

HTN
MEN I+II

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25
Q

Elderly female, unquenchable thirst =

A

primary hyperparathyroidism

26
Q

Physiology of parathyroid gland
Role of PTH
How does it do this? (3)
What is the purpose of vit D?

A

Low calcium leads to increase in PTH
Role of PTH is to increase calcium levels
PTH causes:
1. Increased gut absorption
2. Increased reabsorption of calcium from the kidneys
3. Increased osteoclast activity, to break down bone to increase calcium levels

Vit D does the same as PTH, increase PTH leads to increase conversion of vit D into active form so it can help with above effects.

27
Q

Explain primary hyperparathyroidism
Causes (1)

Mx

A

High PTH
High calcium
Low phosphate

Caused by parathyroid gland tumour

Mx surgery

28
Q

Explain secondary hyperparathyroidism
Causes (2)

Mx

A

High PTH
Low (or normal) calcium
High phosphate

Caused by vit D deficiency or CKD

Mx treat deficiency or renal transplant

29
Q

Explain tertiary hyperparathyroidism

Mx

A

High PTH
High calcium
Low phosphate

Secondary to hyperplasia of parathyroid gland due to secondary hyperparathyroidism after it has been corrected

Mx surgery

30
Q

Characteristic XR finding for hyperparathyroidism

A

pepperpot skull

31
Q

When would you consider conservative mx of primary hyperparathyroidism?

A

the calcium level is less than 0.25 mmol/L above the upper limit of normal AND the patient is > 50 years AND there is no evidence of end-organ damage

32
Q

Medical management of primary hyperparathyroidism if pt not suitable for surgery

A

Cinacalcet - mimics calcium on tissues

33
Q

Primary hyperaldosteronism
Conns

define:

A

bilat idiopathic adrenal hyperplasia is the cause in up to 70%

Conns is secondary to an adrenal tumour

34
Q

Features Conns (4)

A

HTN
Hypernatramiea
Hypokalaemia - muscle weakness
Alkalosis

35
Q

Primary hyperaldosteronism
Ix (3)

A
  1. Aldosterone/renin ratio
    High aldosterone, low renin (due to low feedback system)
  2. high resolution CT abdomen
  3. Adrenal vein sampling to differentiate between unilat and bilat sources
36
Q

Primary hyperaldosteronism
Mx (2)

A

Adrenal adenoma - surgery
Bilateral adrenocortical hyperplasia - aldosterone antagonist e.g spiro

37
Q

Pheochromocytoma associated with (3)

A

MEN II
Neurofibromatosis
von Hippel Lindau syndrome

38
Q

Pheochromocytoma
Ix

A

24 hour urinary collection of metanephrines

39
Q

Pheochromocytoma
Mx
Must be stabilised on which four medications

A

Surgery
Must be medically stabilised with an AB and BB phenoxybenzamine and propranolol

40
Q

Prediabetes/ Impaired glucose regulation numbers
Fasting
HbA1c

A

Fasting BM 6.1-6.9 OR
HbA1c of 42-48 (6.0-6.4)

41
Q

Mx of prediabetes (3)

A

Lifestyle modification
Yearly FU with bloods
Metformin in adults who are high risk

42
Q

Obesity Mx (3)

A

Lifestyle factors
Medical - orlistat
Surgical

43
Q

Orlistat criteria

A

BMI >=28 with associated RF
BMI >=30
Continued weight loss at 3 months
To be used for <1 year

44
Q

Most common cancer in infants

A

Neuroblastoma

45
Q

What is a neuroblastoma

A

Tumour from the neural crest tissue of the adrenal medulla and sympathetic nervous system

46
Q

Neuroblastoma features (6)

A

abdominal mass
pallor
weight loss
bone pain
limp
hepatomegaly

47
Q

MEN = multiple endocrine neoplasia

Type I, IIa, IIb

A

I 3Ps hyperPTH, pituitary, pancreas
MEN I = most common presentation hypercalcaemia

IIa 2Ps PTH, pheo
RET oncogene

IIb 1P pheo, marfans, neuromas
RET oncogene

medullar thyroid and pheo for both types of II

48
Q

Common causes of hypercalcaemia (2)

A
  1. Primary hyperPTH
  2. Malignancy e.g myeloma
49
Q

Other causes of hypercalcaemia (8)

A

Sarcoidosis
Vitamin D intoxication
Acromegaly
Thyrotoxicosis
Thiazides
Dehydration
Addison’s
Pagets

SVAT DAPT

50
Q

Mx hypoglycaemia

A
  1. Oral gluc 10-20g OR glucogel PO/SC/IM

Hospital
As above but if unconscious then SC/IM glucogel

OR
IV 20% glucose

51
Q

Hypoparathyroidism

Caused by

A

Low PTH, low calcium, high phosphate

Secondary to thyroid surgery

52
Q

Hypoparathyroidism
Mx

A

Alfaclcidol

53
Q

Features hypoparathyoidism (6)

A

Secondary to hypocalcaemia

Muscle twitching
Trousseau’s sign
Chvostek’s sign
Periooral parasthesia
Depression/ cataracts
Long QT

54
Q

What is Trousseau’s sign

A

occlude brachial artery with a BP cuff, wrist flexes, thumb adducts

55
Q

What is Chvostek’s sign

A

tapping over parotid causes facial muscles to twitch

56
Q

PseudohypoPTH
What is it?
Biochem

A

target cells are insensitive to PTH

So low calcium, high phosphate but high PTH

57
Q

Pseudopseudohypoparathyroidism
Biochem

A

Normal biochem

58
Q

What is Kallman’s?

A

delayed puberty secondary to hypogonadotrophic hypogonadism

X linked recessive

59
Q

A boy with lack of smell with delayed puberty =

A

Kallmans

60
Q

Features of Kallmans (6)

A

Anosmia
Delayed puberty
Hypogonadism
Cryptorchidism (absence of one testicle)
LH and FSH low
Normal and above average height

61
Q

What is Klinefelter’s karyotype

Features (6)

A

XXY

Tall
Small firm testes
Infertile
Gynaecomastia
Low testosterone
LH and FSH raised

62
Q

Glucagon dosing for hypo’s in children
Under 1 yo
>1yo and <25kg
>1yo >25kg

A

Under 1 yr old - 500mcg
Over 1 yr old AND <25kg - 500mcg
Over 1 yr old AND >25kg - 1mg

AKT (52 decks)

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