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FRACP Clinical > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are some causes of hyperthyroidism?

A
  • Graves’ disease
  • toxic adenoma or toxic MNG
  • early Hashimoto thyroiditis
  • drugs: amiodarone
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2
Q

What are some causes of hypothyroidism?

A
  • Hashimoto thyroiditis
  • drugs: lithium, amiodarone
  • previous thyroid treatment or surgery
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3
Q

What are some causes of hypopituitarism?

A
  • adenoma
  • craniopharyngioma
  • iatrogenic: surgery, radiation
  • postpartum necrosis: Sheehan syndrome
  • head injury
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4
Q

In hypopituitarism, in what order does hormone loss progress?

A

1) GH and FSH/LH
2) TSH
3) ACTH

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5
Q

Findings in Cushings?

A

Moon face, acne
Buffalo hump
Abdominal striae and central obesity
Proximal myopathy

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6
Q

How would you investigate a goitre / hyperthyroidism?

A 
TSH
Free T3, T4
Thyroid autoantibodies: TSI (thyroid stimulating immunoglobulin)
Thyroid U/S
Thyroid uptake scan
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7
Q

How would you investigate hypothyroidism?

A

TSH (high)
Free T4/T3
Anti TPO (thyroid peroxidase)
Anti thyroglobulin

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8
Q

Features of acromegaly?

A
  • hand shape: spade
  • axilla acanthosis nigricans
  • facies: frontal bossing
  • macroglossia
  • visual field defects
  • CCF, Organomegaly
  • signs of hypothyroidism
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9
Q

What investigations for acromegaly?

A

IGF1 (increased)
OGTT (should suppress GH level)
MRI

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10
Q

What are some causes of diffuse goitre?

A
  • Graves’ disease
  • thyroiditis: Hashimoto, subacute
  • iodine deficiency
  • iodine excess
  • medications: lithium, amiodarone
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11
Q

How to investigate Cushing’s syndrome further?

A
  • mane cortisol
  • 24hr urine collection
  • dexamethasone suppression test (Cushing’s syndrome cortisol level not suppressed)
  • ACTH level
  • petrosal sinus sampling
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12
Q

How to diagnose diabetes?

A

Fasting BSL > 7
Or
OGTT > 11

IGT: OGTT BSL 7-11

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13
Q

What lifestyle mods or mx for T2DM?

A
  • trial 2-3 months of lifestyle mod
  • aim: reduce BMI and waist:hip
  • diet
  • exercise
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14
Q 
What class of OHG is metformin?
How does it work?
What are the side effects?
A
  • biguanide
  • increases insulin sensitivity, decrease hepatic glucose production; bonus wt loss
  • SE: lactic acidosis, B12 malabsorption

Don’t use in renal failure
eGFR

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15
Q 
What are some sulfonylurea class OHG?
How do they work?
What are the side effects?
A
  1. Gliplizide, gliclazide (good for fat people)
  2. Increase insulin secretion from pancreatic B cells
  3. Hypoglycaemia, wt gain

Avoid in elderly or renal failure

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16
Q
  1. What are examples of thiazolidenidiones?
  2. How do they work?
  3. What are the side effects?
A
  1. Pioglitazone
  2. Activates PPAR-gamma -> increases periph gluc uptake
  3. Fluid retention/CCF, increase bladder CA, Rosiglitazone increases CVD events, pio might be ok
17
Q
  1. What are some DPP4 inhibitors?
  2. How do they work?
  3. What are the side effects?
A
  1. The gliptins: sitagliptin, saxagliptin
  2. Inhibits DPP4, which breaks down GLP1: Slows gastric emptying, suppress glucagon
  3. Hypoglycaemia with sulfonylureas, N/V
18
Q
  1. Name one GLP-1 mimetic
  2. How does it work?
  3. What are the side effects?
A
  1. Exanatide
  2. Slows gastric emptying, suppressed glucagon
  3. Hypoglycaemia when used with sulfonylureas, N/V
19
Q

What does dapaglifozin do?

What are the side effects?

A

Inhibits glucose transport in the kidneys, leading to excretion

Side effects: UTI risk

20
Q

How would you commence insulin therapy?

A

0.5 units/kg/day
With 40% being long acting

Aim BSL 3.5 - 7

21
Q

What are factors that contribute to hypoglycaemic episodes?

A
  • altered diet
  • injection errors
  • renal disease
  • exercise
22
Q

What is the Somogyi effect and how is it treated?

A

Rebound hyperglycaemia after nocturnal hypoglycaemia

Mx: reduce note Insulin dose

23
Q

What is the dawn phenomenon?

A

Morning hyperglycaemia without nocturnal hypo

Treat: increase Nocte insulin

24
Q

What are the criteria for micro, macro and nephrotic range proteinuria?

A

Micro: 30-300mg/day
Macro: >300mg/day
Nephrotic: >3g/day

25
Q

What are the investigations for diabetic nephropathy?

A
  • Urine ACR
  • 24hr urine collection for protein
  • EUC
  • renal ultrasound: look for small kidneys
  • hba1c
26
Q

How do you manage diabetic nephropathy?

A
  • control BP (Aim 125/75
27
Q

What are signs of diabetic retinopathy on fundoscopy?

A
  • dot and blot haemorrhages
  • hard and soft exudates (soft: cotton wool spots)
  • neovascularisatiom
28
Q

What is the usual order of progression of microvascular complications?

A
  • retinopathy
  • nephropathy
  • neuropathy
29
Q

What are the features of diabetic neuropathy?

A
  • sensory neuropathy/parasthesia
  • ulcers
  • Charcot foot
  • autonomic neuropathy: impotence, postural hypotension, delayed gastric emptying, bladder dysfunction
30
Q

How do you manage diabetic neuropathy?

A 
Non pharm:
- podiatrist, orthotics, footwear
Pharm:
- BSL control
- analgesia, adjuncts (pregabalin, TCA)
31
Q

How would you manage autonomic neuropathy in diabetes?

A

Postural hypotension: med review, stockings, fludrocortisone
Impotence: med review, exclude other causes, sildafenil, implant
Gastroparesis: promotility agents, such as metoclopramide
Large bowel: (constipation or diarrhea) loperamide, codeine, aperients
Bladder: self cath, regular toileting

32
Q

What investigations for osteoporosis?

A
  • BMD (-2.5 or -1.5 on steroids)
  • Ca and Vit D
  • PTH
  • LFT/ALP
  • TFT
  • EUC
  • EPG/IEPG
  • testosterone in males
33
Q

What are the management options for osteoporosis?

A

Non pharm: prevent falls and fracture
Pharm:
- Ca and Vit D replacement
- bisphosphonates
- denosumab (use if CRF)
- raloxifene: SERM - reduces postmenopausal bone loss; decreased risk of breast Ca, higher risk of DVT - use if high risk of breast ca
- teriparatide: synthetic PTH - increases bone formation; side effect of sarcoma risk. (2nd line)

FRACP Clinical (11 decks)

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