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SMTS > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Zones of the adrenal gland and what they produce?

A

Zona Glomerulosa - Mineralocorticoids
Zona Fasciculata - Glucocorticoids
Zona reticularis - Androgens
Adrenal medulla - catecholamines

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2
Q

equivalent doses of glucocorticoids?

A

0.5-1mg dexamethasone = 5mg prednisolone = 30mg hydrocortisone

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3
Q

inheritance of CAH?

A

AR

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4
Q

Primary defect in CAH

A

21 hydroxylase deficiency

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5
Q

What is measured in CAH?

A

17alpha - hydroxyprogesterone

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6
Q

Symptoms of addisons?

A

Weakness, fatigue, anorexia, weight loss.
Hyperpigmentation
Hypotension
N/V
Acute adrenal crisis (shock, hypoglycaemia, fever)

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7
Q

Electrolytes in Addison’s

A

hyperkalaemia +/- metabolic acidosis
hyponatraemia
anaemia of chronic disease
increased ACTH

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8
Q

Treatment of Addison’s disease?

A

Glucocorticoid and mineralocorticoid replacement

Monitor BP, electrolytes

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9
Q

Most common cause of Cushing’s syndrome?

A

Iatrogenic

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10
Q

Management of CAH in females?

A

Corrective surgery in first 12 months, vaginoplasty before intercourse
Lifelong glucocorticoids, may need testosterone to increase growth
mineralocorticoids
monitor growth, skeletal maturity, androgens, 17alpha hydroxyprogesterone

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11
Q

Management of CAH in males?

A

Adrenal crisis; IV fluids, hydrocortisone, dextrose
Lifelong glucocorticoids, may need testosterone to increase growth
mineralocorticoids
monitor growth, skeletal maturity, androgens, 17alpha hydroxyprogesterone

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12
Q

Phaeochromocytoma rule of 10s

A

10% bilateral, 10% extra-adrenal, 10% malignant

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13
Q

Tests for phaeochromocytoma?

A

24 hour urine catecholamines or plasma free metanephrines

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14
Q

What are the contents of the cavernous sinus?

A

CN III, IV, V1, V2, VI

Internal carotid artery

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15
Q

Functions of FSH and LH in males?

A

FSH stimulates spermatogenesis, LH stimulates testosterone release from Leydig cells

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16
Q

If pituitary stalk is damaged, what will happen to levels of pituitary hormones?

A

All will DECREASE except Prolactin

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17
Q

Percentage of Cushing;s disease visible on Pituitary MRI?

A

60%

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18
Q

Symptoms of prolactinoma in women?

A

Infertility, galactorrhoea, amenorrhoea

Postmenopausal; mass effect

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19
Q

Symptoms of prolactinoma in men?

A

Hypogonadism, reduced libido, impotence

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20
Q

Causes of raised prolactin?

A

pregnancy
prolactinoma
PCOS
anxiety

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21
Q

Medical treatment of prolactinoma?

A

Dopamine agonist - Cabergoline/Bromocriptine

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22
Q

Medical management of growth hormone secreting tumour?

A

Octreotide (somatostatin analogue) inhibits GH

23
Q

Causes of hypopituitarism?

A 
Pituitary tumour
Surgery
Autoimmune
Haemochromatosis
Sheehan's syndrome
Craniopharyngioma
24
Q

Treatment of panhypopituitarism?

A 
Hydrocortisone
Thyroxine
OCP
testosterone in males
Gonadotropins if seeking fertility
GH not routine
25
Q

Indications for BMD (bone mineral density) testing?

A

Risk factors; >3mo steroid use, malabsorption (CD), hypogonadism, premature menopause, RA
Age >70
Wedge spinal fracture, Minimal trauma fracture (recommended but NOT essential)

26
Q

Recommended daily calcium?

A

1300mg/day for women >50, men >70 or anyone with OP

1000mg for everyone else

27
Q

Recommended Vit.D supplementation

A

800IU/day if deficient

28
Q

Members of MDT in Diabetes care?

A 
Endocrinologist
Ophthalmologist
Pharmacist
Dietician
Podiatrist
GP
Physiotherapist
29
Q

overweight ranges for waist circumference

A

94-102 for men
80-88 for women
below = healthy, above = obese.

30
Q

Alcohol recommendations in Australia

A

No more than 2 standard drinks per day.

No more than 4 standard drinks on any one occasion.

31
Q

1st line pharmacotherapy for T2DM and requirements for initiation?

A

Metformin.
Trial non-pharm for 6 weeks
GFR >30

32
Q

Directions for Acarbose tablets

A

Take with meals, may cause flatulence or diarrhoea

33
Q

Effects of GLP-1?

A

Enhances insulin secretion and inhibits glucagon. Glucose dependent

34
Q

MoA of DPP4-inhibitors?

A

Slow degradation of GLP-1, therefore increasing insulin and decreasing glucagon in a glucose dependent manner.

35
Q

Which hypoglycaemic agents cause actual hypoglycaemia?

A

Sulphonylureas

36
Q

Side effects of Metformin?

A

Anorexia, N/V, diarrhoea, Lactic acidosis (esp. with CKD, CHD, CLD)

37
Q

Example of DPP4-inhibitor?

A

Sitagliptin

38
Q

After trying Metformin and a Sulphonylurea, which medications can be added?

A

Acarbose, Glitazones, DPP4-inhibitors or insulin

39
Q

After trying Metformin and a Sulphonylurea, which medications can be added?

A

Acarbose, Glitazones, DPP4-inhibitors or insulin (single dose of intermediate or long acting)

40
Q

BP target in T2DM?

41
Q

How to achieve BP control in T2DM?

A
  1. Lifestyle
  2. ACEI/ARB
  3. ACEI+Diuretic
  4. BB (may mask Sx of hypoglycemia)
42
Q

Frequency of monitoring for complications in T2DM?

A

6 monthly - foot check
Annual - Microalbuminuria, Neuropathy check (reflexes/sensation)
2 yearly - Ophthal review

43
Q

Conditions in MEN I

A

Pancreatic tumours
Parathyroid adenomas
Pituitary adenoma

44
Q

Conditions in MEN II

A

Medullary thyroid carcinoma
Phaechromocytoma
Parathyroid adenoma

45
Q

Causes of hirsuitism

A 
PCOS
Cushing's
CAH
Androgen therapy
Obesity
Phenytoin
46
Q

Patient is taking Hydrocortisone and Fludrocortisone and is now unwell, what changes need to be made to medications?

A

Double glucocorticoids (Hydrocortisone)

47
Q

definition for DKA? (investigations)

A

Blood Ketones >3mmol
Bicarb <15
pH <7.3
BGL >11 or known T1DM

48
Q

Side effects of Glitazones?

A

Weight gain, fluid retention (use with caution in CHF)

49
Q

Example of DPP4 inhibitor?

A

Sitagliptin

50
Q

Example of Sulphonylurea?

A

Gliclazide

51
Q

What is gastroparesis?

A

Delayed gastric emptying, often caused by damage to the vagus nerve. Can be seen in DM and leads to vomiting and erratic BGLs.

52
Q

Antibodies found in Hashimoto’s?

A

Anti-TPO, Anti-Tg

53
Q

Investigation for Addison’s?

A

Short Synacthen test; Cortisol measured before and 30 minutes after a dose of Synthetic ACTH, if normal, should rise.

54
Q

Investigation for suspected acromegaly

A

OGTT and GH measurement.

IGF-1 measurement

SMTS (16 decks)

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