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Progress > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

what does hypokalaemia associated with hypertension indicate?

A

primary hyperaldosteronism

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2
Q

which 2 tests are most commonly used to diagnose cushing’s? which is the most sensitive?

A

overnight dexamethasone suppression test (most sensitive)

24h urinary free cortisol

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3
Q

2 conditions that can cause diabetes

A

chronic pancreatitis
haemochromatosis

damage pancreas’s insulin-producing cells

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4
Q

name a drug that causes raised glucose levels

A

glucocorticoids

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5
Q

what is a glucose tolerance test?

A

fasting BG taken, then 75g glucose taken

2hrs later - BG taken again

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6
Q

diagnosis of DM by blood glucose

A

if symptomatic:
fasting glucose of 7+
random glucose of 11+ (or after 75g OGTT)

if asymptomatic, these must apply on 2 occasions

6.1-6.9 fasting - prediabetes

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7
Q

HbA1c in diagnosis of DM

what can cause misleading results?

A

42-47 - prediabetes
48+ - diagnostic
less than 48 doesn’t exclude
if asymptomatic, repeat test to confirm

increased red cell turnover - misleading

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8
Q

how does metformin work?

A

increases insulin sensitivity

decreases hepatic gluconeogenesis

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9
Q

2 SEs metformin

A

GI upset

lactic acidosis

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10
Q

when can you not use metformin?

A

eGFR < 30

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11
Q

what type of drug is gliclazide?

A

sulfonylurea

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12
Q

how do sulfonylureas (gliclazide) work?

A

stimulate beta cells to produce insulin

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13
Q

3 SEs of sulfonylureas (eg gliclazide)

A

hypoglycaemia
weight gain
hyponatraemia

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14
Q

3 SEs of thiazolidinediones

name the thiazolidinedione used

A

weight gain
fluid retention
liver impairment

pioglitazone

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15
Q

how to distinguish DM 1 from other types?

A

c-peptide - low in DM1

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16
Q

DVLA - rules if on insulin/sulfonylureas for HGV drivers

A

no severe hypo in last year

monitor BG 2x daily

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17
Q

DVLA - rules for drivers on insulin (group 1)

A

not more than 1 hypo needing others’ help in last year

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18
Q

3 things that can precipitate DKA

A

infection
missed insulin
MI

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19
Q

management of DKA

A

0.9% saline 1L over 1h
then IV insulin infusion 0.1u/kg/h
once BG <15: 5% dextrose
correction of hypokalaemia

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20
Q

what are the 2 roles of ADH?

A

regulates tonicity of body fluids:
makes kidneys reabsorb water to return to blood → concentrates urine + reduces its volume
constricts arterioles → increased peripheral vascular resistance → BP raised

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21
Q

how does SIADH present on blood + urine tests?

A

hyponatraemia
low plasma osmolality
high urine osmolality

22
Q

what endocrine effect can small cell lung cancer have?

A

SIADH

23
Q

BP target in diabetes

A

140/80

or 130/80 if end organ damage

24
Q

diagnosis of follicular thyroid carcinoma

A

USS + FNA + hemithyroidectomy

25
Q

papillar/follicular thyroid cancer - mgmt + monitoring

A

total thyroidectomy
then radioiodine
yearly thyroglobulin levels

26
Q

patients on steroids long-term - what to do with dose if get intercurrent illness?

A

double it

27
Q

what effects can glucocorticoids have on the eye?

A

glaucoma

cataracts

28
Q

2 SEs of mineralocorticoids (fludrocortisone + hydrocortisone)

A

fluid retention

HTN

29
Q

how does pioglitazone (a thiazonidiledione) work?

A

inreases insulin sensitivity (reduces peripheral insulin resistance)

30
Q

what is an adverse effect of thiazides?

A

hypercalcaemia

31
Q

what are the commonest causes of hypercalcaemia?

A

primary hyperPTH

malignancy (due to variety of processes eg bone mets, myeloma)

32
Q

what is one finding of myeloma on bloods?

A

hypercalcaemia

33
Q

how can hyperPTH present on bloods?

A

hypercalcaemia

34
Q

how can malignancy present on bloods?

A

hypercalcaemia

35
Q

what kind of drug is sitagliptin?

A

DPP-4 inhibitor

36
Q

what is a SE of exenatide?

A

weight loss

37
Q

what is deep, laboured breathing a sign of?

A

DKA or metabolic acidosis

Kussmaul’s breathing - inhales excess CO2 to compensate

38
Q

whats the main issue in addisons?

A

little/no endogenous steroid production

39
Q

what happens to cortisol levels when ill?

A

increase

40
Q

addisons pt unwell - what to do with hydrocortisone + fludrocortisone doses?

A

same fludrocortisone

double hydrocortisone

41
Q

addisons - management

A

fludrocortisone + hydrocortisone

42
Q

what are the 4 insulin antagonists?

A

adrenaline
glucagon
growth hormone
cortisol

(is this why growing, stress, illness can precipitate DKA?)

43
Q

DKA - metabolic pathway

A

consider as fats + sugars:
increased stress hormones + reduced insulin cause:

1) lipolysis -> ketoacidosis -> kussmaul, ketone breath, negative inotropism
2) hyperglycaemia -> osmotic diuresis -> dehydration, K depletion + renal impairment

44
Q

what causes the hypokalaemia in DKA?

A

1) osmotic diuresis
2) RAS activated to hold onto Na + fluid but causes you to excrete K. means total body K always low but serum K sometimes normal/high - ‘potassium paradox’ - prerenal AKI

45
Q

explain a normal-high K in DKA

A

1) acidosis - H+ in cells forces K+ out to maintain intracellular cation balance
2) no insulin - no K+ uptake until insulin replaced - then sudden drop
3) prerenal AKI - oliguria with failure of K+ excretion

46
Q

4 causes of macroglossia

A

acromegaly
down’s
amyloid
congenital hypothyroidism

47
Q

euthyroid with neck lump - what is it?

A

multinodular goitre - commonest large goitre

rarely can go thyrotoxic (toxic multi nodular goitre

48
Q

what doesn’t take up radioiodine?

A

thyroid cancer or cyst

49
Q

multinodular goitre - indications for surgery

A

cosmetic

local structure compression eg voice change, stridor

50
Q

what are pemberton’s test + sign?

A

test for retrosternal goitre - raise arms + pink face from SVC obstruction, can cause stridor

51
Q

neurofibromatosis - inheritance?

A

autosomal dominant condition

52
Q

neurofibromatosis - features

A

axillary freckling
cafe au lait spots
type 2 - acoustic neuroma

Progress (20 decks)

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