Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mrcp > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Low calcium and phosphate with high ALP in Asian female presenting with bone pain and muscle weakness

A

Osteomalacia (normal bony tissue but decreased mineral content ) treat with calcium with vit d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of hypercalcaemia

A

Primary hyperparathyroidism and malignancy amount for 90%
Sarcoidosis (and tb)
Vitamin d intoxication
Acromegaly
Thiazides, calcium containing antacids, PPI
Dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Paget’s disease Vs osteomalacia bloods

A

Both have raised ALP, bone pain… Osteomalacia may have reduced calcium and phosphate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Multiple endocrine neoplasia 1

A

3 Ps
Parathyroid (95%)
Pituitary (70%)
Pancreas (50%) insulinoma, gastrinoma (causing Zollinger-Ellison syndrome: epigastric pain and diarrhoea)

.. hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Multiple endocrine neoplasia 2a

A

2 Ps

Parathyroid
Pheaochromocytoma

Medullary thyroid cancer (hypocal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Multiple endocrine neoplasia 2b

A

Pheaochromocytoma

Medullary thyroid cancer (hypocal)

Marfinoid body
Neuromas
Absence of hyperparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rate of insulin infusion in DKA

A

0.1 unit/kg/hour… Start dextrose when glucose under 15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Reversible features of haemochromatosis

A

Cardiomyopathy and skin tanning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Genetics of haemochromatosis

A

Autosomal recessive, mutations in HFE gene in chromosome 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What hormone from pituitary is under continuous inhibition?

A

Prolactin (by dopamine from hypothalamus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When do you commence statins for primary prevention hyperlipidemia

A

If 10yr risk above 10%
Or t1dm who are >40yr, diagnosis longer than 10yr or established nephropathy or other risk factors
Or eGFR<60

Then start atorvastatin 20mg. Increase to up to 80 if HDL not fallen by more than 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Secondary prevention with statin

A

Any IHD, CVD, PAD then start atorvastatin 80mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common cause of primary hyperaldosteronism

A

70% caused by bilateral idiopathic adrenal hyperplasia

Second is adrenal adenoma - Conn’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Acromegaly complications

A

Carpal tunnel, sleep apnoea, hypertension, diabetes (>10%), cardiomyopathy, and colorectal cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Diagnosis of acromegaly

A

IGF-1 then OGTT

in normal patients GH is suppressed <2 with hyperglycaemia. In acromegaly there’s no suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management of acromegaly

A

Trans sphenoidal surgery for most

Somatostatin analogues eg octreotide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Cause of hypercalcaemia in squamous cell lung cancer

A

Parathyroid hormone related peptide release is the cause of 80% of hypercalcaemia in malignancy

Also in Ovarian etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

causes of hypomag

A
  • Diuretics like furosemide
  • PPI
  • TPN
  • diarrhoea
  • alcohol
  • metabolic disorders: Gitleman’s and Bartter’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of hypomag

A

Diuretics like furosemide, TPN, diarrhoea, alcohol, PPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Modifiable risk factor for development of thyroid eye disease

A

Smoking is the most important modifiable risk factor for the development of thyroid eye disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

features of Zollinger Ellison syndrome

A

Gastrinoma… epigastric pain and diarrhoea. 30% have MEN type 1 (so would also have hyperparathyroidism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

features of haemochromatosis

A

lethargy, arthralgia, chrondrocalcinosis, diabetes… cardiomyopathy, bronze skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

features of Wilson’s

A

behavioural and psychiatric problems are often the first manifestations, basal ganglia degeneration, speech…
Liver cirrhosis,
blue nails
Kayser-Fleischer rings
renal tubular acidosis (esp. Fanconi syndrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Anti thyroid peroxidase antibody is found in…

A

90% hashimoto (hypothy)

75% Graves (hyperthy) also TSH antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

T2DM with diabetic neuropathy and a background of BPH .. drug treatment for nephropathy

A

Would be amitriptyline but because of risk of retention then pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment for myxoedema coma

A

Hydrocortisone and levo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Osteoblasts Vs osteoclasts

A

OsteoBlasts Build Bone

OsteoClasts Create Calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Treating T1DM for dka, 24 hr later she starts to get confused irritable and slurring. Why?

A

Cerebral oedema

usually occurs 4-12 hours following commencement of treatment but can be present at any time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Test to confirm Cushing’s

A

Overnight low dose dexamethasone suppression test…

Or 24 urinary cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Management for prolactinoma

A

Medical treatment of hyperprolactinemia is based upon use of dopamine agonists

bromocriptine, lisuride, quinagolide andcabergoline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Common endo condition in Turner’s syndrome

A

Hypothyroidism and raised FSH (gonadotropins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Diagnosis of acromegaly

A

iGF 1 levels

then OGTT with serial GH measurements to confirm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Contraindications of radioiodine therapy

A

Pregnancy (incl 4-6months after radioio treatment)
Age <16yr
Thyroid eye disease may get worse so relative contraindication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Precipitating factors of thyroid storm

A

Surgery (thyroid / non thyroid)
Trauma
Infection
Acute ioidine intake (eg CT contrast)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

features and progression of De Quervain’s subacute Thyroiditis

A

Usually post viral and self-limiting
3-6/52 Painful goitre, hyperthy, raised ESR, globally reduced iodine uptake
1-3/52 euthyroid
Weeks/months hypothy (can give steroids if severe)
Then usually returs back to normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

chance of subclinical hypothyroidism progressing to Hypothyroidism

A

2-5% / year

Higher if you’re a man or have thyroid autoantibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Management of subclinical hypothyroidism

A

T4 normal, and if TSH 4-10 then

  • If <65 and ?symptoms then trial treatment, stop if it doesn’t help
  • Watch and wait if asymp / old

If TSH >10

  • Treat everyone under 70
  • watch and wait above
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

management of hypothyr in preg

A

Thyroxine is safe in preg / breast feeding

Some people need increased dose so monitor TSH in each trim and 6-8/52 post partum

39
Q

which thyroid cancer is lnked to MEN2

A

MEdullary (only 5% of all thyroid Cancer, cancer of parafollicular C cells from neural crest…Secretes calcitonin)

40
Q

management of hyperparathyroidism

A

total parathyroidectomy is definitive
Conservative an option if calcium less than 0.25 above upper limit and over 50yr with no end organ damage
Calcimimetics like cinacalcet can be used if surgery not an option

41
Q

Thyroid related cause of galactorrhoea?

A

primary hypothyroidism because thyrotropin releasing hormone stimulates prolactin release

(NOTE hypERthyroidism causes gynaecomastia)

42
Q

What is Wolfram’s syndrome

A

DIDMOAD - association between diabetes insip, diab mellitis, optic atrophy and deafness

43
Q

management of pre-existing diabetic who gets pregnant

A

stop all antidiabetic meds except metformin, add insulin
weight loss
Start folic acid 5mg until 12 weeks
Start Aspirin 75mg from 12weeks until birth
anomaly scan at 20wks including 4chamber view of heart

44
Q

What adrenal autoantibody may be demonstrated in Addison’s disease?

A

anti-21-hydroxylase

note: 21-hydroxylase deficiency is the cause of 90% of congenital adrenal insuff

45
Q

What cells are pheochromocytomas derived from

A

Chromaffin cells in adrenal medulla or extra adrenal in 10%

46
Q

What is the rate of familial, bilateral, malignant, and extra adrenal cases respectively in pheochromocytomas

A

10%

47
Q

most common site of phaeochromocytoma outside of adrenal

A

extra adrenal in 10%

most common is Organ of Zuckerkandl, adjacent to bifurcation of aorta

48
Q

zones of adrenal gland

A 
GFR M - ACDC
zona Glomerulosa - (mostly) Aldosterone
zona Fasciulata - (mostly) Cortisol
zona Reticularis - (androgens, mostly) DHEA
zona Medulla - Catecholamines
49
Q

List investigtions for Acromegaly

A

1) IGF-1
2) if elevated or unequivocal then OGTT
3) positive diagnosis if GH not suppressed by hyperglycaemia
4) MRI or CT
5) Colonoscopy to screen for colorectal Ca
6) Visual fields

50
Q

Side effect of Octreotide

A

Biliary stasis -> gallstones

51
Q

where is grehlin produced

A

P/D1 cells lining fundus of stomach and epsilon cells of pancreas - stimulates hunger

52
Q

where is leptin produced

A

adipose tissue - acts on arcuate nucleus of hypothal to decrease apetite

53
Q

Autoimmune polyendocrinopathy syndrome 1 and 2

A

2 is much more common. It is addison’s + either t2dm or autoimm thyroid - HLA DR3/DR3

type 1 is auto recessive and has two of addison’s, mucocutaneous candidiasis or primary hypoparathyroidism

54
Q

diagnosis for 18yr old with recurrent balanitis and raised fasting glucose. Two family members with t1dm

A

MODY

55
Q

blood results of premature ovarian failure

A

Low Oestradiol but high LH and FSH (due to feedback mechanisms)

56
Q

Investigation for possible insulinoma

A

Supervised fasting

If CBG goes below 4 then measure C-peptide

57
Q

features of psuedohypoparathyroidism

A

auto dom inherited insensitivity to PTH
Low calcium high pth high phosphate

Short stature,
obesity
round face
short 4th and 5th metacarpals
cog impairment
58
Q

Middle aged woman presents with tiredness, weight gain and a hard fixed painless neck lump. Diagnosis?

A

Riedel’s Thyroditis

mostly euthyroid, 30% hypothy

59
Q

bloods of Kleinfelters vs kallmans

A

both are tall with low testosterone…

but kallmans has inappropriately low LH FSH (and anosmia).
Klein has raised LH FSH

60
Q

diabetic patient commenced on degludec liraglutide combination therapy… what is it?

A

Long acting insulin and GLP-1 agonist respectively

so can cause hypos

61
Q

management of thyroid storm

A
  1. Propylthiouracil
  2. Potassium (Lugol’s) iodide
  3. Propranol
  4. Prednisolone
62
Q

what advice should you give to a T2DM on Metformin during Ramadan

A

During Ramadan, one-third of the normal metformin dose should be taken before sunrise and two-thirds should be taken after sunset

63
Q

What medication can interfer with testing for Conn’s

A

Ramipril due to its interference with the renin-angiotensin-aldosterone system

64
Q

Results of Dexa suppression test in Cushing’s disease

A

Low dose - cortisol isn’t suppressed
High dose - cortisol is suppressed
Raised ACTH

65
Q

Low dose dexa - cortisol isn’t suppressed
High dose - cortisol is suppressed
Raised ACTH
What would the MRI pituitary show?

A

Cushing’s disease - adenoma
HOWEVER adenoma in Cushing’s disease is often too small to be picked up on CT or MRI imaging, so negative scan does not exclude it

66
Q

In hypocalcaemia, which is the more sensitive sign?

A

Trousseau’s sign is more sensitive than Chvotsek’s

carpal spasm with BP tight over brachial vs tapping over parotid muscles

67
Q

What biochemical abnormalities are likely seen in Cushing’s syndrome

A

Hypokalaemic metabolic alkalosis…

This is due to increased mineralocorticoid action… Causing increased exchange of potassium and H+ for sodium and water

68
Q

Genetic defect in the majority of MODY cases

A

HNF-1 alpha gene defect in MODY 3

60% of cases

69
Q

What is dipsogenic diabetes insipidus?

A

Defect in thirst mechanism due to damage of hypothalamus

70
Q

Role of ghrelin and leptin

A

Obesity hormones:

  • Leptin Lowers appetite
  • Ghrelin Gains appetite….grrrr I’m hungry
71
Q

Most common cause of hypothyroidism in developed world

A

Hashimoto’s

10 X most common in women
Anti TPO and anti Thyroglobulin antibodies
Associated with other autoimmune and also development of MALT lymphoma

72
Q

What hyperlipidemia results from hypothyroidism?

A

Predominantly hypercholesterolemia rather than hypertriglyceridaemia

Same with nephrotic syndrome and cholestasis

73
Q

Patient presents with bilateral deafness and mild hypothyroidism

A

Pendred’s syndrome

Auto recessive, Ch7
One and a half turns in cochlea (rather than 2.5!)

74
Q

Management of thyrotoxicosis in pregnancy

A

Propylthiouracil in first trimester (monitor LFTs)
Then switch to carbimazole (because could cause congenital abnormalities)

Don’t use block and replace or radioiodine

75
Q

Cause of thyroid disease w amiodarone

A

High iodine content counterintuitively causes hypo (autoreg inhibition of thyroxine formation) Wolff-Chaikoff effect

Type 1:
High iodine causing thyroid synthesis - goitre, stop amiodarone start carbimazole
Type 2:
Destructive thyroiditis -no goitre, corticosteroids and stop amiodarone

76
Q

Most common autoantibodies in Graves’

A

TSH receptor stimulating antibodies

77
Q

Hungry bone syndrome

A

Uncommon occurrence, post parathyroidectomy where you get hypocalcaemia due the rapid change in hormone levels

78
Q

Contraindications to radioiodine therapy

A

Pregnancy and 6 months following

Can worsen eye disease

79
Q

Diagnosis of phaeochromocytoma

A

24h urinary metanephrines
(97% sens)
Better than catecholamines

80
Q

Management of phaeochromocytoma

A

Surgery is definitive after medical stabilisation

With alpha- blocker (phenoxybenzamine) and beta blocker

81
Q

21-hydroxylase Def causes what condition…

A

Congenital adrenal hyperplasia….

… Low cortisol, High androgens - so hypertension and virilusation in females, precocious puberty in males

82
Q

Which is more common cause of primary hyperaldosteronism - adrenal adenoma or adrenal hyperplasia

A

Bilateral idiopathic adrenal hyperplasia is the most common cause of primary hyperaldosteronism

83
Q

Pitaglitazone SE

A

Peripheral oedema

Worsened with using insulin too

84
Q

Metabolic acidosis or alkalosis for Addison’s?

A

Acidosis Addison’s

Alkalosis Cushing’s and Conn’s

85
Q

Started new anti diabetic drug. Gets excessive flatulence

A

Acarbose ( inhibitor of intestinal alpha glucosidases)

86
Q

MODY Vs LADA

A

MODY has family history

LADA has autoimmune history

87
Q

LH and FSH with Klinefelter and kallman

A

Klinefelter’s - LH and FSH raised

Kallman’s - LH and FSH low-normal

88
Q

Which antihypertensive should be started in phaeochromocytoma

A

PHaeochromocytoma - give PHenoxybenzamine

89
Q

pretibial myxoedema

A

Thyrotoxicosis

90
Q

Elderly patient with urge incontinence

A

mirabegron beta-3 agonist

Oxybutynin Contra if urinary retention and can come confusion

91
Q

Hypertension management in diabetic

A

ACE i regardless of age

92
Q

Bloods of osteomalacia

A

Raised ALP, Low calcium low phosphate..
low vitamin D (in 100% of patients, by definition)

So might have raised PTH (but in secondary hyperPTH you would have high phosphate… And this is almost always due to CKD)

93
Q

Management nephrogenic diabetes insipidus

A

thiazides, low salt/protein diet

Mrcp (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions