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CCs > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are hyperglycaemic symptoms?

A
  • Increased frequency of urination
  • Increased thirst
  • Unexplained weight loss
  • Blurred vision
  • Genital Thrush
  • Lethargy
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2
Q

What are the venous glucose diagnostic criteria for diabetes?

A

Fasting 7mmol/L

Normal 11 mmol/L

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3
Q

What HbA1C indicates diabetes?

A

48mmol/L

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4
Q

What receptor is type 1 diabetes associated with?

A

HLA DR3 (+4)

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5
Q

What drug for diabetes increased insulin sensitivity and can cause lactic acidosis?

A

Metformin

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6
Q

What drug for diabetes increases insulin secretion?

A

Sulfonylurea

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7
Q

What are the clinical features of diabetic neuropathy?

A
  • Absent ankle jerk
  • Loss of foot arch
  • Glove and stocking sensations loss
  • Worse at night
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8
Q

How are foot ulcers graded in diabetes?

A
  • Neuropathic
  • Ischaemia
  • Bony deformation
  • Infection
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9
Q

If the visual acuity decreases in a diabetic what would you suspect?

A

Maculopathy

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10
Q

What are symptoms of a DKA?

A
  • Abdo pain
  • SOB
  • Acetone breath
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11
Q

What antibodies are produced in Graves disease?

A

IgG autoantibody: binds TSH receptors on thyroid

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12
Q

What does a low TSH and raised T4 suggested?

A

Primary hyperthyroidism

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13
Q

In which thyroid disorder might you see anxiety?

A

Hyperthyroidism

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14
Q

In which thyroid disorder might you see low mood?

A

Hypothyroidism

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15
Q

Name a thyroid suppressor?

A

Carbimazole

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16
Q

What symptom must someone taking carbimazole report to their doctor and why?

A

Sore throat

Rare side effect of carbimazoles is bone marrow suppression.

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17
Q

Which thyroid disorder is associated with oligomenorrhoea (irregular periods)?

A

Hyperthyroidism

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18
Q

What are the complications of hyperthyroidism?

A
  • Heart Failure
  • Angina
  • AF
  • Osteoporosis
  • Gynaecomastia
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19
Q

What is the most common cause of hypothyroidism in the developed world?

A

Hashimoto’s thyroiditis - atrophy due to lymphocytic infiltration of the thyroid

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20
Q

What is the most common cause of hypothyroidism in the developing world?

A

Iodine deficiency

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21
Q

In which thyroid disorder might you see ascites and a round, puffy face?

A

Hypothyroidism

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22
Q

What type of radiotherapy can be used to manage hyperthyroidism?

A

radioiodine

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23
Q

What is the treatment for hypothyroidism?

A

Levothyroxine (50-100mcg in young, 25mcg in elderly)

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24
Q

Which thyroid disorder can cause problems in pregnancy such as eclampsia, still born, low birth weight, prematurity and anaemia?

A

Hypothyroidism

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25
Q

What type of goitre is associated with Grave’s, Hashimoto’s, iodine deficiency & radiation?

A

Diffuse

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26
Q

What type of goitre is associated with cancers, thyroglossal cysts and fibrotic goitres?

A

Nodular

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27
Q

What symptoms can a goitre cause?

A
  • Cough
  • Stridor
  • Dysphagia
  • Hoarse voice
  • Tigh throat
28
Q

What happens to a goitre during swallowing?

A

It moves up

29
Q

What treatments are there for a goitre?

A
  • Small & benign: watch and wait
  • Radioiodine
  • Iodine supplements
  • Thyroidectomy
30
Q

What nerve risks being damaged in a thyroidectomy?

A

Left recurrent laryngeal nerve

31
Q

What features will a cancerous nodule of the thyroid have?

A
  • Firm
  • Fixed
  • Nodular
32
Q

What effect does PTH have on

a) the kidneys
b) bones
c) the intestine

A

a) increased reabsorption of calcium and magnesium in the distal convoluted tubule, increases phosphate excretion
b) Stimulates osteoblasts, which activate osteoclasts leading to resorption of bone, increasing circulating calcium
c) Increases vit D activation, which increases calcium reabsorption

33
Q

What is the general effect of PTH?

A

Increases calcium

34
Q

In hyperparathyroidism what will symptoms be due to?

A

Hypercalcaemia

35
Q

What is the most common cause of primary hyperparathyroidism?

A

Adenoma of parathyroid gland

36
Q

What symptoms occur in hyperparathyroidism?

A
  • Bones: pain, fractures, osteopenia, osteoporosis
  • renal stones
  • Abdominal groans: pain, ulcers
  • Moans: weak, thirsty, tired, depressed
  • Increased BP
37
Q

In hyperparathyroidism will the following be raised or lowered:

a) calcium
b) PTH
c) phosphate
d) alk phos

A

a) raised
b) raised
c) lowered
d) raised (bone activity)

38
Q

What drugs should be avoided in hyperparathyroidism?

A

a) Thiazides
b) high calcium
c) vit D

39
Q

When would someone be considered for adenomal gland removal?

A
  • over 50
  • high serum and urine calcium
  • bone disease
  • renal calculi
40
Q

What mutations are parathyroid adenomas associated with?

A

MEN 1 & MEN 2

41
Q

What investigations are carried out for a parathyroid adenoma?

A

Blood tests (PTH, Ca, PO4)
DEXA scan for bone density
USS - kidney stones
CT

42
Q

How is a parathyroid adenoma managed?

A
  • Surgical removal
  • HRT
  • Calcimimetics - reduce PTH secretion
  • Watch and wait
43
Q

What is Cushing’s syndrome?

A

Chronic glucocorticoid excess, with loss of feedback mechanism & cortisol circadian rhythm.

44
Q

Where is ACTH produced and what is its affect on the body?

A
  • Anterior pituitary gland

- Stimulates cortisol production (adrenal cortex)

45
Q

What are ACTH dependent causes of Cushing syndrome?

A
  • Cushing’s disease: ACTH producing pituitary tumour

- Small cell lung carcinoma

46
Q

What is Cushing’s disease?

A

An ACTH producing pituitary tumour

47
Q

What are ACTH independent causes of Cushing’s syndrome?

A

Steroids

Adrenal adenoma/carcinoma

48
Q

What are symptoms of Cushing’s syndrome?

A
  • Weight gain
  • Acne
  • Proximal weakness
  • Achilles tendon rupture
  • Gonadal dysfunction
  • Mood change - depression/lethargy
49
Q

What are the signs of Cushing’s syndrome?

A
  • Central obesity
  • Skin thinning and bruises
  • Muscle wastage
  • Plethoric face: red/swollen
  • Osteoporosis
  • Infection prone, poor healing
  • Increased BP & glucose
50
Q

What investigations are carried out for Cushing’s syndrome?

A
  • Plasma cortisol
  • Overnight dexamethasone suppression: check at 8am
  • If negative 48 hours dexamethasone suppression
  • Test plasma ACTH: adrenal tumour likely if undetectable, if detectable CT for pituitary or ectopic release.
51
Q

What is the management of Cushing’s syndrome?

A
  • Stop steroids
  • Remove pituitary adenoma in Cushing’s disease
  • Radiotherapy/removal for adrenal adenoma
  • Ectopic: remove source if possible
52
Q

What is Addison’s disease?

A

A primary adrenocortical insufficiency.
Destruction of adrenal cortex results in
- lowered glucocorticoids
- lowered mineralocorticoids

53
Q

What is the most common cause of Addison’s disease in the UK?

A

Autoimmune

54
Q

What is the most common cause of Addison’s disease worldwide?

A

Tuberculosis

55
Q

What are other causes of Addison’s disease?

A
  • Adrenal mets
  • Lymphoma
  • HIV
  • Adrenal haemorrhage: SLE
  • Congenital
56
Q

How can long term steroids cause secondary Addison’s?

A
  • Suppression of the pituitary adrenal axis
57
Q

What are the three Ts of Addison’s?

A

-Tanned: bronze pigmentation of skin
-Tired
-Tearful: depression, psychosis, low self esteem
+/- weakness

58
Q

What are the signs and symptoms of Addison’s disease?

A
  • Bronze pigmentation, pigmented palmar creases & buccal mucosa, vitiligo
  • Depression, psychosis, low self esteem
  • Weight loss
  • GI disturbances: constipation/diarrhoea/abdo pain
  • Postural hypotension
59
Q

What is an Addisonian crisis?

A

An acute insufficiency of cortisol

60
Q

What are the signs and symptoms of an Addisonian crisis?

A
  • Severe nausea
  • Dehydration
  • Profound fatigue
  • Shock: drop in BP
  • Extreme weakness
  • Confusion
  • Temperature
  • Renal shut down: hyperkalaemia & hyponatraemia
  • Coma
61
Q

What electrolyte imbalance can be caused by Addison’s disease?

A

Hyperkalaemia
Hyponatraemia
Due to lack of mineralocorticoid
- hypercalcaemia

62
Q

What happens to glucose in Addison’s?

A

It is low - lack of cortisol

63
Q

What stimulation test can be used to help diagnose Addison’s?

A

Short ACTH stimulation test

64
Q

What might be seen on X ray in Addison’s?

A
  • TB
  • Lung fibrosis
  • Adrenal calcification
65
Q

What antibodies are present in autoimmune Addison’s?

A

80% have 21-Hydroxylase adrenal autoantibodies

66
Q

How is Addison’s managed?

A

Replace steroids with daily hydrocortisone.
Fludrocortisone for postural hypotension (mineralocorticoid)
Monitor BP, U&Es annually

67
Q

How does Addison’s affect life expectancy?

A
  • Reduces men’s by 11 years

- Reduces women’s by 3 years

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