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JG EMQ revision > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Nelson’s syndrome

A

Post-bilateral adrenalectomy (for Cushing’s)

Hyperpigmentation + enlargement of corticotroph adenoma

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2
Q

Kallmann’s syndrome

A

Isolated hypogonadotrophic hypogonadism

Anosmic/hyposmic
Colour blindness
Midline facial developmental defects

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3
Q

Anaplastic carcinoma of the thyroid

A

Elderly, worst prognosis, early mets

Large hard mass w/ irregular borders

Pain, stridor, laryngeal nerve palsy

NORMAL TFTs

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4
Q

Prolactin cutoff for micro/macroadenoma

A

> 2000 mU/L

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5
Q

Adrenal carcinoma

A

Elevated cortisol + undetectable ACTH = adrenal adenoma/carcinoma

Acute Hx + severe virilisation suggests CARCINOMA

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6
Q

Addison’s disease

A

Any form of primary hypoadrenalism

Women, autoimmune

Plasma ACTH is HIGH, HYPOnatraemia, HYPERkalaemia, uraemia

Synacthen test = FAILURE of cortisol secretion

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7
Q

Ectopic ACTH secretion

A

Plasma ACTH +++ (>400)
Absolute failure to produce cortisol (HIGH-dose dexamethasone)

Weight GAIN = small bronchial carcinoid tumour

Weight LOSS + hypokalaemic alkalosis = small-cell bronchial carcinoma

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8
Q

Cushing’s disease

A

The usual symptoms etc

Suppression of serum cortisol on HIGH-dose dexamethasone only!

Failure to respond to low-dose dexamethasone, loss of diurnal variation of cortisol secretion, loss to cortisol respones with an INSULIN TOLERANCE test

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9
Q

Pseudo-Cushing’s

A

Body habitus of Cushing’s, elevated MCV, elevated GGT, alcoholic

Suppresses cortisol with LOW-dose dexamethasone

Diurnal variation in cortisol on blood samples

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10
Q

Long term steroids presents with HYPONATRAEMIA - diagnosis?

A

Addison’s disease

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11
Q

Patiently with newly diagnosed T2DM with minimal symptoms - management?

A

Dietary and lifestyle advice

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12
Q

OVERWEIGHT patient with T2DM not responding to dietary and lifestyle advice - management?

A

Metform

BEWARE lactic acidosis

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13
Q

NORMAL WEIGHT patient with T2DM not responding to dietary and lifestyle advice - management?

A

Gliclazide (sulphonylurea)

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14
Q

Patient is on one oral diabetes medicine but they are not responding - what is the next appropriate step in management?

A

Add the other agent

If contraindicated (excess ETOH, renal/hepatic impairment/???overweight)

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15
Q

T2DM is not responding to maximal oral diabetic management - what is the nxt appropriate step in management?

A

INSULIN (twice daily or once daily nighttime)

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16
Q

What hormone is increased in premature ovarian failure?

A

FSH

17
Q

Hypoparathyroidism

A

HIGH phosphate + LOW calcium

Causes = thyroidectomy

18
Q

Primary hyperparathyroidism

A

Lethargy, polyuria, polydipsia, PUD, stone formation, depression (+++Ca = cardiac arrest)

HIGH calcium + LOW phosphate

Treatment = parathyroidectomy

19
Q

Secondary hyperparathyroidism

A

Secondary to chronic renail failure –> hyperphosphataemia = reduced Vit D = chronic hypocalcaemia = INCREASED PTH

Complications = osteodystrophy, bone pain, osteomalacia, pathological #

20
Q

Tertiary hyperparathyroidism

A

Prolonged period of secondary hyperparathyroidism –> gland hypertrophy

HIGH phosphate + HIGH calcium

21
Q

What kind of hormone is secreted by small cell malignancy tumours that causes hypercalcaemia?

A

Ectopic PTH-RELATED protein

22
Q

Paget’s disease of the bone

Epidemiology

A

Eldery

M:F = ~1

23
Q

Paget’s disease of the bone

Presentation

A

Boney pain (esp. in pelvis/lumbar region)

Bitemporal skull enlargement with frontal bossing
Spinal kyphosis
Anterolateral bowing of limbs

Fractures
Heat (inc. vascularity)
Sensorineural deafness)

Cardiac failure, gout

24
Q

Paget’s disease of the bone

Investigation

A

***SINGLE BEST = Bone radiographs

Bloods = ++ AlkPhos with normal calcium/phosphate

25
Q

MEN I syndrome

A

Wermer’s syndrome

A) Pituitary tumour –> prolactinoma / increased GH –> galactorrhoea, acromegaly, visual field defects, headaches

B) Parathyroid tumour –> increased PTH –> increased calcium –> nephrolithiasis

C) Pancreastic tumour –> gastrinoma (PUD) / insulinoma (hypoglycaemia) / VIPoma (diarrhoea / 2^ electrolyte disturbance)

****CT / MRI to visualise tumours

26
Q

MEN IIa syndrome

A

Sipple’s syndrome

A) Medullary thyroid carcinoma –> nodular mass in neck

B) Parathyroid tumour –> increased PTH –> increased calcium –> nephrolithiasis

C) Phaeochromocytoma (adrenal medullary tumour) –> increased adrenaline/noradrenaline –> +++ paroxysmal sympathetic outburts (increased BP, anxiety, palpitations, headache, sweating)

****CT / MRI to visualise tumours

27
Q

MEN IIb/III

A

A) Medullary thyroid carcinoma –> nodular mass in neck

B) Phaeochromocytoma –> increased catecholamines –> +++ paroxysmal sympathetic outbursts (increased BP, anxiety, palpitations, headache, swearing)

C) Mucosal neuromas

D) Marfanoid body habitus

****CT/MRI to visualise tumours

28
Q

PCOS

A

THREE diagnostic criteria –> 2+ cysts on US pelvis >10mm / hirsutism / amenorrhoea

Insulin resistance –> weight gain / obesity
Infertility

****US pelvis = BEST investigation

***Bloods = + testosterone, ++ LH, + FSH, +++ LH:FSH ratio (~3)

29
Q

Cranial diabetes insipidus

A

Failure to produce ADH (vasopression)

Polyuria and polydipsia

Plasma osmolality HIGH, urine osmolality LOW, HYPERnatraemia

****WATER DEPRIVATION TEST –> no change

***Give vasopressin –> osmolalities stabilise

TREATMENT = DESMOPRESSIN

30
Q

Nephrogenic diabetes insipidus

A

Failure to produce ADH (vasopression)

Polyuria and polydipsia

Plasma osmolality HIGH, urine osmolality LOW, HYPERnatraemia

****WATER DEPRIVATION TEST –> no change

***Give vasopressin –> no change

TREATMENT = DESMOPRESSIN

31
Q

T2DM patient is on maximum dose of metformin but is allergic to sulfonyureas - next appropriate management?

A

MEGLITINIDE, e.g. repaglinide

32
Q

Hyperosmolar non-ketotic coma - first management?

A

Insulin infusion at 3U/hour (sliding scale)

33
Q

Which three biochemical abnormalities are diagnostic of DKA?

A

Ketonaemia >3 or ketonuria ++

Blood glucose >11 or known DM

HCO3 <15 +/- venous pH <7.3

34
Q

How is DKA managed?

A

Involve specialist diabetes team + monitor using VBG

FRIII at 0.1U/kg/hr (eg 7U/hr for 70kg patient)

Do NOT give bicarbonate

Give potassium if <5.5

0.9%NaCL 1L over 1 hour (then with KCl if needed)

If BP <90 systolic, fluid challenge 500ml 0.9%NaCl

35
Q

What is used to diagnose HHS (hyperosmolar hyperglycaemic state)?

A

Hypovolaemia

Marked hyperglycaemia (>30mmol/L)

No significant ketonaemia/acidosis

Osmolality usually >320

36
Q

How is HHS managed?

A

0.9%NaCl while measuring osmolality

Give insulin with significant ketonaemia (>1) at 0.05U/kg/hr (HALF of DKA)

Replace potassium if <5.5

LMWH –> anticoagulation

Correct U+Es

37
Q

Which is the MOST COMMON thyroid cancer?

A

Papillary

JG EMQ revision (14 decks)

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