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NME > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is th genetic mutation most T1 diAbetics have ?

A

HLA DR3 ➕➖DR4 is found in 90% - human leukocyte antigen

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2
Q

I have type one diabetes, what is the chance that my identical twin will also get it? And same question with type 2

A

Twin concordance is around 30% Weirdly, >80% concordance in type 2

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3
Q

Pathophys of diabetic ketoacidosis…………….

A

➡️In diabetes, lack of insulin prevents glucose getting into cells so there is a perceived lack of glucose ➡️This results in the body metabolising fatty acids into ketones ➡️this produces acetoacetic acid and beta hydroxybutyrate Potassium may be low due to acidosis exchanging H+ to move K+ out of cells and from vomiting But beware of it being low from osmotic diuresis (from hyperglycaemia) and the treatment of fluids and insulin

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4
Q

Describe what causes Charcot foot in diabetes?

A

it is caused by neuropathy, which causes increase risk of injury. Fractures and injuries will go unnoticed and are exacerbated by walking on them and slower healing time => this leads to loss of arching of foot etc

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5
Q

Description of Addison’s disease

A

Rare condition where adrenal glands don’t produce sufficient glucocorticoid and mineralcorticoid. Look out for addisonial crisis with very low BP and coma, eg after ,malt trauma, surgery, severe infection (low sodium, high potassium)

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6
Q

Cause of thinning or loss of the outer third of the eyebrows (aka queen Anne’s sign)

A

Hypothyroidism and dermatitis alopecia

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7
Q

DVLA and diabetes

A

If on insulin, or other drugs that can cause hypos then must inform DVLA

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8
Q

Management of diabetic ketoacidosis (with specific fluid guidance and potassium guidance)

A

➡️ Fluid replacement: most patients with DKA are deplete around 5-8 litres. 0.9% NaCl 500ml in 15m, repeat and call senior unless above 90mmhg… ➡️ IV insulin infusion 0.1 unit/kg/hour. ➡️ Give 10% dextrose when glucose under 15 PANICS Potassium, acidosis, normal saline, IV insulin, catheter culture, stomach aspiration Once BP above 90systolic then follow this Fluids: …0.9% NaCl 1L over first hour …then 1L over next two hours …then 1L over next two hours …then 1L over next four hours …then 1L over next four hours …then 1L over next six hours Potassium in first 24hr Over 5.5, no replacement 3.5-5.5 then 40mmol/L Under 3.5 senior review

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9
Q

Description of Onycholysis and causes

A

– painless separation of the nail from the nail bed Idiopathic, trauma, fungal infection, hyperhypothy, detergent reaction

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10
Q

Dka Diagnostic definition… Four things

A
  • Ketonaemia over 3mmol/L or urine ketones 3+
  • Glucose over 11 or known dm
  • pH under 7.3
  • Bicarb under 15
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11
Q

A 40-year-old man is confused. He has an uncontrollable thirst along with the regular passage of large volumes of dilute urine. Urine osmolality 280mOsmol/kg; increases to 620mOsmol/kg after desmopressin 20mg nasally. Which is the single most appropriate explanation for his symptoms?

A

Decreased secretion of anti-diuretic hormone (ADH) by the pituitary… Increased osmolality means increased concentration (so appropriate reaction). ????

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12
Q

Most common extra intestinal feature in both UC and CD

A

Arthritis (asymmetrical and “pauciarticular”=four or less joints)

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13
Q

Ophthalmological diseases related to UC and CD respectively

A

Episcleritis and uveitis

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14
Q

Axr signs of UC

A

Barium enema may show ➡️loss of haustrations ➡️Superficial ulceration ‘Pseudopolyps’ ➡️Long standing disease: narrow and short colon “drainpipe” ➡️Thumb printing - sign of colitis (thickened mucosa)

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15
Q

Which has Decreased goblet cells and which has Increased goblet cells in IBD

A
  • Decreased goblet cells (and therefore, mucin) from gland epithelium in UC
  • Increased goblet cells in Crohn’s
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16
Q

Dose of insulin in diabetic ketoacidosis

A

Fixed rate intravenous insulin infusion of 0.1units/kg/hr

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17
Q

Painful goitre and hyperthyroidism with raised ESR Diagnosis and management

A

subacute de quervains thyroiditis - transient thyroid inflam following viral illness, often in young women - globally reduced iodine 131 scan Hypothyroidism can develop permanently, in 10% Self limiting. NSAIDs for pain

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18
Q

In hypothyroidism, what is single most important blood test to assess response to treatment

A

TSH

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19
Q

Diagnosis of diabetes

A

Fasting above 7, of random above 11.1 If asymp, two readings

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20
Q

Breathing in patients with DKA

A

deep, laboured, gasping respiration

21
Q

Cause of abdo pain in DKA

A

Acidosis causes enteroparesis

22
Q

Common causes of death in DKA

A

Aspiration pneumonia (so perform gastric aspiration or endotrachael tube if no gag reflex) Cerebral oedema (hence give dextrose if glucose below 14) Hypokalaemia (monitor)

23
Q

Cause of hypotension in DKA

A

Acidosis is negatively inotropic

24
Q

Diabetic retinopathy stages

A

Background …microaneurisyms (dots) …haemorrhages (blots) …hard exudate (lipid deposit) Preproliferative ,..over three haemorrhages …cotton wool (infarcts) …retinal ischameia Prolif …new vessel (including rubeosis)

25
Q

Vessel proliferation on Iris of diabetic patient

A

Called rubeosis iridis In proliferative stage

26
Q

Autosomal recessive conditions vs dominant

A

Autosomal recessive conditions are often thought to be ‘metabolic’ as opposed to autosomal dominant conditions being ‘structural’ …notable exceptions: some ‘metabolic’ conditions such as Hunter’s and G6PD are X-linked recessive whilst others such as hyperlipidaemia type II and hypokalaemic periodic paralysis are autosomal dominant some ‘structural’ conditions such as ataxia telangiectasia and Friedreich’s ataxia are autosomal recessive

27
Q

Name for clubbing in Graves’ disease

A

Thyroid acropatchy

28
Q

Counselling patient for Graves’ disease treatment

A

Carbimazole, start at 40mg and reduce until euthyroid remains Look out for sore throat and fever -agranulocytosis Radio iodine is option, not if pregnant or planning

29
Q

Causes of hypothyroidism

A

Primary… Atrophic hypothyroidism (autoimmune, no goitre) Hashimoto’s - also autoimmune, with goitre, even more assx with women Iatrogenic Secondary (rare) pituitary failure, downs, tuners

30
Q

Reflexes in hypothyroidism

A

Slow relaxation biceps jerk

31
Q

Diagnostic test for acromegaly

A

GH fluctuates so random test is unreliable. Hyperglycaemia normally suppresses GH though, won’t be suppressed in acromegaly. And do a pit MRI

32
Q

Features of Hashimotos

A

Hypothy goitre and anti thyroid peroxidase antibody 10:1 F:M

33
Q

When do you add a second drug for diabetic patient

A

Hba1c above 58mmol/mol and if it stays above with dual, add a third

34
Q

Diabetic patient starting insulin rcommendations

A

Continue metformin NICE say start with human insulin (isophane, intermediate action) Take at bedtime or twice a day

35
Q

Definition of myxoedema

A

Deposition of mucopolysaccharides in the dermis which cause subcutaneous swelling

Pre tibial is hallmark of graves Classically myxoedema is hypothy though

36
Q

Indications for surgery in thyroid disease (4)

A
  • Failure of medical management
  • Intolerance of medical management
  • Large goitre
  • Patient choice
37
Q

Complications of thyroid surgery

A

Short term (acute, early, rare)

  • bleeding
  • thyroid crisis

Damage to local

  • hypoparathyroidism (so hypocalcaemia)
  • damage to recurrent laryngeal nerve

Commonest

  • late hypothyroidism (30% after 10 years)
  • recurrent hyperthyroidism (15%)
38
Q

mnemonic for cushing’s complications

A
  • C ateracts / Central obesity
  • U lcers
  • S kin: straie, thinning, bruising / Supraclavicular fat pads
  • H ypertension / hypergly
  • I nfection / Intrascapular fat pads
  • Necrosis (nontraumatic avascular necrosis of femoral head)
  • Glycosuria
  • Osteoporosis
  • Immunosuppression
  • Diabetes (glucocorticoid induced insulin resistance)
39
Q

Symptoms of diabetic ketoacidosis

A
  • abdo pain
  • kussmaul breathing
  • ketotic breath
  • high resp, low bp, low heart
  • n
  • v
  • decreased conciousness
40
Q

Investigations for Cushings

A

overnight dexamethasone suppression test (most sensitive)

  • if pituitary source then cortisol suppressed
  • if ectopic/adrenal then no change in cortisol
41
Q
A
42
Q

electrolytes in addisons

A
  • high calcium
  • low glucose
  • high potassium
  • low sodium
43
Q

Electrolytes in cushings

A
  • Low calcium
  • high glucose
  • low potassium
  • high sodium

(because it causes hyperaldosteronism)

44
Q

Causes of high anion gap in metabolic acidosis

A
  • M - Methanol
  • U - Uremia
  • D - DKA / AKA
  • P - Paraldehyde / phenformin
  • I - Iron / INH
  • L - Lactic acidosis
  • E - Ethylene glycol
  • S - Salicylates
45
Q

What is MEN 1?

A

Multiple endocrine neoplasia type 1 is a genetic disorder that affects the endocrine system through development of neoplastic lesions in the

  • pituitary gland
  • parathyroid gland
  • pancreas
  • 30% of patients with Zollinger-Ellison synd have MEN1
    • multiple GU and DU (high gastrin)
    • abdominal pain
    • diarrhoea

3P, 2P, 1P

(med thyroid ca for 2a2b)

46
Q

What is MEN 2a?

A

Multiple endocrine neoplasia is an auto dom endo condition assx with

  • Medullary thyroid cancer (70%)
  • Parathyroid (60%)
  • Phaeochromocytoma

3P, 2P, 1P

(med thyroid ca for 2a2b)

47
Q

What is MEN 2b?

A

Multiple endocrine neoplasia is an auto dom associated with

  • Medullary thyroid cancer
  • Phaeochromocytoma

3P, 2P, 1P

(med thyroid ca for 2a2b)

48
Q

What test do you do for diabetes insipidus?

A
  • plasma and urine osmalality
  • water deprivation
  • may be hypernatraeamia (because pees loads of unconcentrated urine out)
  • (cant concentrate urine so should be low)

NME (5 decks)

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