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Finals > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

what increases when glucose is low

A

glucagon, adrenaline, GH, cortisol

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2
Q

criteria for diagnosis of diabetes

A

symptoms + 1 chemical
or no symptoms + 2 seperate chemical

> 6.9 fasting
11 random
48/ 6.5% HbA1c
11 2 hour OGTT

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3
Q

diagnosis of pre diabetes

A

5.5-7 fasting
7.8 - 11.1 random
42 -47 HbA1c

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4
Q

diagnosis for gestational diabetes

A

> 5.6 fasting

>7.8 2h OGTT

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5
Q

management of gestational diabetes

A

metformin or insulin

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6
Q

what monitoring should diabetics have

A

HbA1c 3 monthly

BP, cholesterol, eyes, kidney, neuropthy anually

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7
Q

first line management of T2DM

A

weight loss - 5-10% for 3 months

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8
Q

first line drug used in T2DM (side effects, contraindications, mechanism)

A

metformin

  • lactic acidosis and GI upset
  • C/I kidney disease
  • increases sensitivity to insulin
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9
Q

3 drugs that may be added second line to metformin

side effects, contraindications, mechanism

A
  1. sulfonyureas (glicazide)
    - hypoglycaemia and weight gain
    - stimulates insulin secretion
  2. DPP4I’s (gliptins)
    - pancreatitis, weight loss
    - increases incretin = increase insulin
  3. pioglitizone
    - weight gain, liver failure, bladder ca
    - C/I Heart failure
    - increases insulin sensitivity
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10
Q

drugs added into metformin + second line to make triple therapy for T2DM
(side effects, contraindications, mechanism)

A
  1. SGLT2 i’s (flozins)
    - weight loss, hypos, DKA, UTIs
    - glucose lost via kidney
  2. GLP1 antagonists (exenotide)
    - weight loss
    - mimicks incretin = increase insulin
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11
Q

which daibetes drugs cause hypos and what is target HbA1c?

A

sulfonylureas (gliclazide)
flozins (SGLT2 i’s)
aim for <58

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12
Q

management of diabetic with proteinuria

A

ACEi

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13
Q

BP aim in diabetes

A

130/80

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14
Q

causes of hypothyroidism

A 
hashimoto's thyroiditis
iodine deficiency
pituitary tumour
subclinical/ de quervain's
drugs: lithium, amioderone, radioiodine
thyroidectomy
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15
Q

causes of hyperthyroidism

A

graves disease
toxic nodules
drugs: overtreatment with levothyroxine, amioderone, IFN alpha, iodine

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16
Q

DDx for high TSH and low T4

A

primary hypothyroidism

  • TPO Abs = hashimotos
  • iodine deficiency
  • subclinical
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17
Q

DDx for low/normal TSH and low T4

A

secondary hypothyroidism

- pituitary tumour

18
Q

investigation findings in graves disease

A

TSH r Abs
low TSH and high T4
increased uptake of radioactive iodine
USS - enlarged vascular thyroid (bruits)

19
Q

management of graves disease

A

radioactive iodine/ surgery
carbimazole
propanolol

20
Q

management of toxic thyroid nodules

A

radioactive iodine

21
Q

what do you need for diagnosis of diabetes insipidus (and other findings)

A

> 3 L DILUTE urine a day

high sodium, high plasma osmolality, low urine osmolality, polydipsia, polyuria

22
Q

how to tell apart nephrogenic and cranial diabetes insipidus

A

desmopressin:
cranial = urine becomes concentrated
nephrogenic = no response to desmopressin, remains dilute

23
Q

diagnosis of SIADHS

A

concentrated urine
hyponatremia
euvolemic
absence of oedema and diuretics

24
Q

causes of SIADHS

A

malignancy - SCLC, pancreatic, lymphoma

CNS disorders - stroke, subdural, vasculitis

25
Q

management of SIADHS

A

fluid restriction
hypertonic saline
furosemide

26
Q

what does the anterior pituitary secrete

A

GH, TSH, ACTH, FSH, LH, prolactin

27
Q

what does the posterior pituitary secrete

A

ADH, oxytocin

28
Q

explain pathophysiology and symptoms of acromegaly

A

pituitary tumour secretes GH which increases ILGF1
ILGF1 binds to insulin receptors so causes DM (OGTT)
large hands and feet, sweating, coarse facial features, gap between teeth, paresthesia and muscle weakness

29
Q

investigations in acromegaly

A

ILGF1 and GH measurement
OGTT (measure GH)
MRI pituitary

30
Q

management of acromegaly

A

transsphenoidal surgery

octreotide

31
Q

explain pathophysiology of cushing’s disease

A

high ACTH from pituitary causes high cortisol from zona fasciculata in adrenal cortex
(ACTH can be from ectopics: SCLC)

32
Q

what investigations can you do in cushing’s

A

24 hour urinary cortisol:
high

dexamethasone suppression test:
high cortisol = pituitary adenoma or ectopic (SCLC)
suppressed cortisol = adrenal adenoma/carcinoma

CT abdomen for adrenal cause, CT chest for SCLC

low potassium

33
Q

describe pathophysiology of addisons

A 
hypocortisolism
adrenal cortex cannot produce steroids due to;
autoimmunity
malignancy
sarcoid
amyloid
TB
surgery
stopping steroids abruptly (crisis)
34
Q

what investigations can you do in addisons

A 
short ACTH test (cortisol does not increase)
21 hydroxylase adrenal antibodies
high renin
low aldosterone
high potassium
35
Q

how does addisons present

A

thin, tanned, tired, low BP, depression, GI problems, abdo pain

36
Q

describe the pathophysiology of Conns

A

hyperaldosteronism
increased aldosterone from zona glomerulosa due to adrenal tumour
or increase in aldosterone due to kidney disease (increased renin)

37
Q

what investigations can you do in Conn’s

A

renin and aldosterone levels
CT adrenals
low potassium
HTN

38
Q

investigations in pheochromocytoma

A

24 hour urinary catecholamines

39
Q

diagnosis of DKA

A

high glucose (>11)
acidosis (pH <7.35)
bicarbonate <15
urine or blood positive for ketones

40
Q

management of DKA

A

saline, insulin and potassium

measure BMs

Finals (18 decks)

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