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BPT Written > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Refeeding syndrome electrolyte disturbances

A 
Hypophosphatemia
Hypomagnasemia
Hypokalemia
(Hyperglycaemia)
(Fluid retention)
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2
Q

Growth hormone (GH) stimulation

A 
Deep sleep
Exercise
Trauma / sepsis
Malnourishment / hypoglycaemia
High protein meal
Oestrogen
Dopamine
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3
Q

Growth hormone (GH) inhibition

A

Hyperglycaemia
Leptin
Glucocorticoid excess

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4
Q

Most common endocrinopathies post pituitary radiotherapy

A

Growth hormone - most common
Gonadotroph - 2nd most common
ACTH / TSH - least common

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5
Q

Pregnancy - hormone levels

A 
FSH - low
LH - low
Prolactin - high
Oestrogen - high
Testosterone - high
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6
Q

Polycystic ovarian syndrome (PCOS) - hormone levels

A

Testosterone - high
Oestrogen - high or normal
FSH - low or normal
LH - high (in 50%) relatve to FSH

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7
Q

Congenital adrenal hyperplasia (CAH) - hormone levels

A

17-hydroxyprogesterone - high, with exaggerated ACTH stimulation test increase
Renin - low
Aldosterone - low

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8
Q

Hydatiform mole - hormone levels

A

B-hCG - high (higher than intrauterine/ectopic pregnancy)

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9
Q

Prolactinoma - hormone levels

A

Prolactin - high

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10
Q

Primary ovarian insufficiency (POI) - hormone levels

A

FSH - high

Oestradiol - low

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11
Q

Mature onset diabetes of youth (MODY) 1

A

HNF-4 alpha defect

- (Chromosome 20q)

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12
Q

Mature onset diabetes of youth (MODY) 2

A

Glucokinase defect

  • 2nd most common - 15%
  • Mild hyperglycaemia
  • Can be taken off treatment due to minimal complications
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13
Q

Mature onset diabetes of youth (MODY) 3

A

HNF-1 alpha defect

  • Most common - 70%
  • Very sensitive to sulfonylurea treatment
  • Offspring diabetes risk 50%
  • High HDL cholesterol
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14
Q

Indications to treat diabetic foot ulcers

A 
Shock
Bacteraemia
Marked necrosis / gangrene
Ulceration of deep tissue
Severe cellulitis
Osteomyelitis
Septic arthritis
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15
Q

Indications to treat diabetic foot ulcers

A 
Shock
Bacteraemia
Marked necrosis / gangrene
Ulceration of deep tissue
Severe cellulitis
Osteomyelitis
Septic arthritis
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16
Q

Contraindications to bisphosphonate therapy for osteoporosis

A

Recent fracture (4-6 weeks)
Oesophageal disorders
Gastrointestinal intolerance
Chronic kidney disease - eGFR less than 30

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17
Q

Hyperprolactinaemia - presentation

A 
Hypogonadotrophic hypogonadism
Reduced libido
Impotence
Infertility
Gynaecomastia
Galactoorrhoea
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18
Q

Hyponatraemia - BSL correction

A

+2 mmol/L serum Na for each 5.5 mmol/L BSL (over 10 mmol/L)

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19
Q

Primary aldosteronism - hormone levels

A

Renin - low
Aldosterone - high
Aldosterone/renin ratio - more than 20

20
Q

Phaeochromocytoma - hormone levels

A

Metanephrine - high

Urinary catecholamines - high

21
Q

Secondary hyperaldosteronism - hormone levels

A

Renin - high
Aldosterone - high
Aldosterone/renin ratio - approx. 10

22
Q

Causes of secondary hyperaldosteronism

A 
Renovascular hypertension
Diuretic use
Renin secreting tumour
Malignant hypertension
Coarctation of the aorta
23
Q

Glucocorticoid excess - hormone levels

eg. Cushing’s syndrome, exogenous mineralcorticoid, glucorticoid resistance

A

Renin - low

Aldosterone - low

24
Q

Biguanide - mechanism of action

A

eg. metformin
- Increase insulin action
- Decrease hepatic gluconeogenesis
- Increase peripheral glucose uptake
- Minor decrease in gut glucose absorption

25
Q

Biguanide - indications for T2DM

A

eg. metformin
- 1st line initial therapy
- Reduced weight
- Reduced CVS events - in overweight patients
- Reduced all-cause mortality

26
Q

Sulfonylurea - mechanism of action

A

eg. gliclazide
- Stimulate relase of insulin from β-cells
- Used in early T2DM, less effective in advanced / progressive T2DM

27
Q

Sulfonylurea - indications for T2DM

A

eg. gliclazide
- 1st line - if metformin intolerant
- 2nd line - in addition to metformin
- Side effects - weight gain, hypoglycaemia

28
Q

Glucosidase inhibitor - mechanism of action

A

eg. acarbose
- Inhibit saccharide breakdown at brush border of gut
- Reduces post-prandial hyperglycaemia

29
Q

Glucosidase inhibitor - indications for T2DM

A

eg. acarbose
- 3rd line - if post-prandial hyperglycaemia
- Side effects - diarrhoea / flatulence, malabsorption

30
Q

Thiozolidinedione - mechanism of action

A

eg. pioglitazone
- Binds and activates PPAR-gamma receptor
- Decreased hepatic gluconeogenesis
- Increased peripheral insulin sensitivity

31
Q

Thiozolidinedione - indications for T2DM

A

eg. pioglitazone
- 3rd line - if no congestive heart failure
- Side effects - weight gain, fluid retention / CCF, fractures, cardiovascular disease / MI (except pioglitazone)

32
Q

Incretin mimetic - mechanism of action

A

eg. exenatide
- GLP-1 analogue, stimulates β cells, inhibits α cells
- Increases insulin
- Decreases glucagon
- Slows stomach emptying

33
Q

Incretin mimetic - indications for T2DM

A

eg. exenatide
- 3rd line - if BMI more than 30, desire to lose weight, can self-inject
- Improves glycaemic control
- Reduces weight
- No difference in CVS outcomes

34
Q

Dipeptidyl peptidase-4 (DDP-4) inhibitor - mechanism of action

A

eg. sitagliptin
- Inhibits DPP-4 inactivation of GLP-1
- Dependent on endogenous GLP-1 production

35
Q

Dipeptidyl peptidase-4 (DDP-4) inhibitor - indications for T2DM

A

eg. sitagliptin

- 3rd line - if weight gain concerning

36
Q

SGLT-2 inhibitor - mechanism of action

A

eg. dapagliflozin
- Blocks sodium-glucose transport protein 2
- Reduces glucose reabsorption from urine in tubules
- Increased efficacy as BSL increases

37
Q

SGLT-2 inhibitor - indications for T2DM

A

eg. dapagliflozin
- 3rd line - when other drugs contraindicated
- Reduces all-cause mortality, CVD events, CCF admissions, and weight
- Contraindicated in renal impairment eGFR less than 45
- Side effects - genital infections / candidiasis (not UTIs), syncope / hypotension, euglycaemic DKA

38
Q

Most common secretory hormone in silent / non-functioning adenoma

A

Gonadotrophin (80-90%)

39
Q

Most common secretory hormone in functioning adenoma

A

Prolactin (50% all adenomas, typically microadenoma)

40
Q

Most common type of macroadenoma

A

Gonadotroph adenoma

41
Q

Most common factors associated with thyroid opthalmology

A

Genetic factors
Smoking
Female sex

42
Q

Causes of metabolic acidosis - with increased anion gap

A 
Lactic acidosis
Ketoacidosis (diabetes, alcohol, starvation)
Drugs/toxins (salicylates, biguanides)
Renal failure (urate)
43
Q

Causes of metabolic acidosis - with normal anion gap

A 
Renal tubular acidosis
Diarrhoea
Drugs (acetazolamide)
Ammonium chloride ingestion
Addison's disease
Pancreatic fistula
44
Q

Causes of metabolic alkalosis

A

Vomiting
Burns
Potassium depletion (eg. diuretics)
Ingestion of base

45
Q

Primary hyperparathyroidism - hormone levels

A

PTH - inappropriately normal
Ca - high
PO4 - low
Vitamin D (calcitriol) - high

46
Q

Secondary hyperparathyroidism - hormone levels

A

PTH - high
Ca - low
PO4 - high
Vitamin D (calcitriol) - low (in vit D deficiency) or normal

47
Q

Pseudohyperparathyroidism - hormone levels

A

PTH - high
Ca - low
PO4 - high
Vitamin D (calcitriol) - low

BPT Written (20 decks)

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