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General Medicine > endocrinology > Flashcards

endocrinology Flashcards

1
Q

Increased sweating is seen in:

A

MenopausePhaeochromocytoma AcromegalyTyrotoxicosisInsulinoma –> hypoglycaemia

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2
Q

Foods high in potassium

A

BananasFresh orange juiceCitrus fruitsAvocados

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3
Q

Appropriate screening for Cushing’s syndrome

A

1mg overnight dexamethasone suppression test - given at 11pm - then measure cortisol at 9am <50 nmol/L = normal

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4
Q

Hypothalamic hormones

A

Dopamine Corticotrophin releasing hormoneGH releasing hormonegonadotropin releasing hormoneThyrotrophic releasing hormoneSomatostatinOxytocin (produced here + secreted by post pituitary) Antidiuretic hormone (produced here + secreted by post pituitary)

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5
Q

Posterior pituitary hormones

A

OxytocinAntidiuretic hormone (ADH) (vasopressin)

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6
Q

Anterior pituitary hormones

A

Adrenocorticotrophic hormone (ACTH) Follicle stimulating hormone (FSH)Growth hormone (GH) Leutenising hormone (LH) Thyroid stimulating hormone (TSH) Melanocyte stimulating hormone (MSH) Prolactin

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7
Q

What is 9 AM cortisol measured for?

A

Adrenal insufficiency.Addisons

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8
Q

What is a dexamethasone suppression test used for?

A

Cushing’s syndrome.

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9
Q

What is a short synacthen test used for?

A

Addison’s disease

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10
Q

What is kallmanns syndrome

A

Failure of episodic GnRH secretion (hypogonadotrophic hypogonadism) + anosmia (absent olfactory bulb) M:F 4:1

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11
Q

Three circumstances leading to the release of renin

A

1) decreased renal perfusion pressure 2) Sympathetic nervous system activation due to decreased arterial BP3) decreased Na delivery to macula densa

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12
Q

Management of hyperkalaemia

A

IV calcium gluconate - 10ml 10%IV insulin + dextrose - 10U actrapid in 50ml 50%Nebulised salbutamol -10mgCalcium resonium + lactulose (Furosemide + fluids)(Haemodialysis)

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13
Q

ECG features of hyperkalaemia

A

Flat P wavesBroad QRSslurred ST segmentTented T-wave

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14
Q

obesity is associated with a higher risk of what medical conditions?

A

OADMbreast carenal caprostate cahypertensiondepression

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15
Q

features of hyperprolactinoma

A

amenorrhoeamilk production

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16
Q

Diagnostic criteria of metabolic syndrome

A

BP > 130/85HDL 1.7fasting blood glucose >6.6waist circ >88cm in F or 102 in M

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17
Q

Primary amenorrhoea and anosmia occurs in…..

A

Kallmann’s syndrome

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18
Q

What does the testis secrete

A

TestosteroneAndrostenedione oestradiolInhibinProgesterone (small amount)

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19
Q

What is a phaeochromocytoma

A

Catecholamine secreting neuro-endocrine tumourIn adrenal medulla V rare

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20
Q

Presentation of pheochromocytoma

A

Palpitations, tachycardia, anxiety and blanchingHypertensive crisisLeft ventricular hypertrophy on ECG

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21
Q

Presentation Cushing’s syndrome

A

Weight gain, muscle weakness, hirsutism, Menstrual irregularities, mood disturbanceMoon FaceInterscapular Fat padThin skinEasy bruisingPurple striaeOsteoporosis and pathological fractures

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22
Q

What is Cushing’s syndrome?

A

Glucocorticoid excess.

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23
Q

What is Cushing’s disease?

A

Pituitary tumour secreting ACTH

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24
Q

Causes of Cushing’s syndrome?

A

Cushing’s disease = pituitary tumour Secreting ACTHSmall-cell carcinoma secreting ACTHIatrogenic steroidsAdrenal adenoma or Carcinoma

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25
Q

How can you distinguish Paget’s disease of the nipple from nipple eczema

A

Paget’s disease has a clear boundary. Eczema does not. Paget’s disease is usually bilateral

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26
Q

Risk factors for breast cancer

A

Early menarcheLate menopauseCOCPSmokingFamily historyParityHRT

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27
Q

What causes acromegally?

A

Pituitary adenomaGHInsulin-like growth factor

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28
Q

Skin tethering in the breast is due to what structure?

A

Ligament of Astley Cooper

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29
Q

Non facial symptoms of acromegaly

A

HypertensionDiabetesOACardiomyopathy Colorectal cancerCarpal tunnelSpade shaped handsSweaty, boggy hands

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30
Q

Medical management of acromegaly

A

Octreotide Bromocryptine

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31
Q

Facial features of acromegaly

A

Large tongueLarge lips Large earsLarge nosePrognathism Prominent supra-orbital ridgeBitemporal hemianopia Wide spaced teeth

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32
Q

Features of a neuropathic ulcer

A

SmallPunched outWell circumscribedPainless

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33
Q

Complications of neuropathic ulcers?

A

Superficial infectionAbscess formationOsteomyelitis

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34
Q

Features of autonomic neuropathy in diabetes?

A

Postural hypotensionErectile dysfunctionGastroparesisUrinary retentionNocturnal diarrhoea

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35
Q

Features of A Charcots joint

A

(Neuropathic joint)Repeated unnoticed traumaAbnormal stresses –> cartilage, ligament, muscle and bone destructionGrossly deformed, unstable but painless joint

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36
Q

Earliest detectable sign of diabetic nephropathy

A

Microalbuminuria(Not detected on standard dipstick)

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37
Q

What is de Quervain’s thyroiditis

A

Inflammation of the thyroid gland secondary to a Self-limiting viral infection. Initial hyperthyroidism then Hypothyroid state followed by euthyroid 4-6 months later

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38
Q

Symptoms of de Quervain’s thyroiditis

A

Goitre, Tenderness - neck, jaw, earsPain worse on swallowing fever, flulike symptoms

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39
Q

What is Graves’ disease

A

AutoimmuneIgG immunoglobulins stimulate TSH receptors on thyroid –> T4 release

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40
Q

Features of graves Eye disease

A

Proptosis (Exophthalmus)OphthalmoplegiaDiplopiaPeriorbital oedemaConjunctival oedema Lid retraction

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41
Q

Symptoms of hyperthyroidism

A

Heat intolerance, weight loss, anxiety, Restlessnessdiarrhoea, tremor, palpitationsOligomenorrhoeaGoitreSweatingIncreased appetiteHair thinningMuscle weaknessFatigue

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42
Q

Causes of hyperthyroidism?

A

Graves’ diseaseToxic solitary adenomaDe quervains thyroiditis (Transient hyperthyroidism)Follicular carcinoma of the thyroidLithiumAmiodaroneOvarian teratoma

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43
Q

Management of hyperthyroidism

A

Beta-blockers for symptomatic controlCarbimazolePropylthiouracilRadio iodine

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44
Q

What is Hashimoto’s thyroiditis

A

Autoimmune disease where the thyroid becomes infiltrated by plasma cells and lymphocytes. Causes goitre and thyroid dysfunction. Often euthyroid at presentation or hypothyroid. (Minority hyperthyroid)Autoantibodies to thyroid peroxidase and thyroglobulin

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45
Q

What is sick euthyroid syndrome?

A

Abnormal thyroid function in the presence of systemic disease

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46
Q

Causes of hypokalaemia

A

DiarrhoeaVomitingConn’s syndrome Diuretic useExcessive sweatingBurns

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47
Q

Features of hypokalaemia

A

Muscle weaknessCrampsECG changes - flat/inverted T, U wave, st depression

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48
Q

Complications of thyroidectomy

A

> Bleeding.>Unilateral recurrent laryngeal nerve injury –> hoarse voice, dyspnoea>Bilateral Recurrent laryngeal nerve injury –> upper airway obstruction at extubation. Potentially life threatening. >Hypoparathyroidism –> hypocalcaemia >Hypothyroidism>Thyrotoxic storm >Infection: 1-2%

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49
Q

How is radio iodine therapy for hyperthyroidism carried out

A

Oral administration of radioactive iodine containing solutionAbsorbed from GIT and transported to thyroid + stored. Damages cells and reduces thyroxine secretion

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50
Q

Common side effect for radio iodine therapy for hyperthyroidism

A

Hypothyroidism May need thyroxine replacement

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51
Q

CI to radioiodine therapy for hyperthyroidism

A

pregnantbreast-feeding F must be advised not to get pregnant for at least four months.May worsen Graves’ eye disease

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52
Q

Why should thyroxine be started with caution in patients with CVD

A

Can cause angina, HF, arrhythmiaStart at 25microg (normally 100)

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53
Q

Management of DKA

A

Aggressive fluid rescusInsulin infusion in saline. 1mg/kg/hrAdd potassium to fluid once k+ <14 start adding 20% dextrose alongside fluid

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54
Q

Management of HHS (hyperglycaemic hyperosmolar state)

A

IV fluidsIV insulin Enoxaparin

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55
Q

Features of hypoglycaemia

A

DizzinessSweating HungerDrowsinessPalpitationsAnxiety

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56
Q

Management of hypoglycaemia

A

If awake - lucozade, gluco-gelIf drowsy / unconscious - 75-80ml 20% dextrose IV or 150-160ml 10% dextrose.Or 1mg IM glucagon

57
Q

What happens to a patients insulin requirement during illness

A

Increases

58
Q

What are the most common type of thyroid tumours

A

Papillary adenocarcinoma (70%)Follicular carincomas (20%) Both most common in adolescence/young adultPresent as single thyroid nodule

59
Q

Why do patients with a history of papillary or follicular thyroid carcinoma take lifelong thyroxine

A

As these carcinomas may be TSH dependent. Lifelong thyroxine acts to suppress endogenous TSH production + reduce recurrence risk

60
Q

Management of papillary or follicular thyroid carcinoma

A

Total thyroidectomy

61
Q

What is reidels thyroiditis

A

Idiopathic fibrosis of the thyroid gland Slow growing goitreFirm and irregular Can cause compressive symptoms - dysphagia, stridor, laryngeal nerve palsy

62
Q

What is Hashimoto’s thyroiditis

A

Autoimmune thyroid conditionMost commonly affects womenDiffusely enlarged rubbery goitre Euthyroid then hypothyroid Autoantibodies to thyroid peroxidase

63
Q

Treatment of Hashimoto’s thyroiditis

A

Thyroxine

64
Q

In who is multi-nodular goitre most common

A

Middle aged F

65
Q

Presentation of multi-nodular goitre

A

Unsightly goitreDysphagia 1 nodule may become an autonomous thyroxine secreting adenoma = toxic multi-nodular goitre –> AF, palpitations

66
Q

Treatment of multi-nodular goitre

A

Radio-iodine or thyroidectomyAnti thyroid medications have little effect

67
Q

What patients get anaplastic thyroid carcinomas

A

Elderly

68
Q

Presentation of anaplastic thyroid carcinomas

A

Acute presentationAggressiveHard, symmetrical, rapidly enlarging goitreSpreads to LN and local structures

69
Q

Treatment of anaplastic thyroid carcinomas

A

None - most die within 1 yearPalliative radiotherapy Debulking surgery

70
Q

What causes conn’s syndrome

A

Aldosterone secreting tumour within the adrenal cortex

71
Q

Presentation of conn’s syndrome

A

Prolonged non-specific illnessPolyuriaPolydipsia Fluid retention, hypervolaemia, hypertension

72
Q

What causes hypernatraemia and hypokalaemia with normal renal function

A

conn’s syndrome

73
Q

How can you confirm the diagnosis of conn’s syndrome

A

Raised plasma aldosterone Low plasma renin

74
Q

Treatment of conn’s syndrome

A

Excision of the aldosterone secreting tumour And spironolactone (aldosterone antagonist)

75
Q

What does a phaeochromocytoma release

A

Catecholamines > Adrenaline > Noradrenaline > Dopamine

76
Q

Diagnosis of phaeochromocytoma

A

24 hour Urine collectionDemonstrates excess catecholamine degradation products = vanillylmandelic acidCT

77
Q

Management of phaeochromocytoma

A

Surgical excisionUnder alpha and beta blockade to protect against potential excessive catecholamine release

78
Q

In a symptomatic patient what test is considered diagnostic of DM

A

Single fasting blood glucose >7 mmol/LOrRandom blood glucose >11 mmol/L

79
Q

In an asymptomatic patient what is considered diagnostic of DM

A

2 separate occasions of: - fasting blood glucose >7 mmol/LOr - Random blood glucose >11 mmol/L

80
Q

What is the diagnostic criteria for impaired glucose tolerance

A

Fasting blood glucose <7 mmol/LAnd oral glucose tolerance test - 7.8 - 11.1 mmol/L 2 hours after 75g glucose bolus

81
Q

What conditions may phaeochromocytoma Be associated with

A

NeurofibromatosisMultiple endocrine neoplasiaVon Hippel-Lindau

82
Q

Best investigation for Addison’s disease

A

Short synacthen test

83
Q

How is the short synacthen test done

A

Plasma cortisol levels measured before and 30 minutes after administration of a single IM dose of ACTH. Normal = rise in cortisolAdrenal insufficiency = no rise in cortisol

84
Q

What hormone is released from small-cell lung carcinomas

A

ACTH

85
Q

Symptoms of congenital adrenal hyperplasia

A

Precocious puberty (in girls)Accelerated growthAmbiguous genitalia (in girls)ClitoromegallyVirilisation

86
Q

Inheritance pattern of congenital adrenal hyperplasia

A

Autosomal recessive

87
Q

What hormones does congenital adrenal hyperplasia affect and how

A

Deficiency of enzyme 21-hydroxylaseEnzyme Required to synthesise mineralocorticoids and glucocorticoids but not adrenal androgens. Low steroid hormones means no feedback on anterior pituitary causing increased ACTH release ACTH causes increased secretion of androgens

88
Q

Diagnostic test for congenital adrenal hyperplasia

A

Raised concentration of precursor 17-hydroxyprogesterone

89
Q

Treatment of congenital adrenal hyperplasia

A

Hydrocortisone Fludrocortisone To replace steroid deficiency

90
Q

What are carinoid tumours?

A

Tumours of enterochromaffin cells of GI tractCommonly of appendix, terminal ileum, rectumThey secrete serotonin which is carried in the portal system to the liver and broken down. But metastasis in the liver - secretes into blood stream

91
Q

Diagnosis of carcinoid syndrome

A

24hr union urinary 5-hydroxindole acetic acid(Breakdown product of serotonin)

92
Q

Management of carcinoid syndrome

A

Resection of tumourSymptomatic tx with octreotide (inhibits serotonin release)

93
Q

Causes of parotid gland swelling

A

Viral parotitis - mumps (bilateral in 90%).Stone in salivary duct.Benign and malignant tumours.Sjögren’s syndrome.Sarcoidosis Acute and chronic bacterial parotitis.Wegener’s granulomatosis.HIV-related lymphocytic infiltration.

94
Q

Causative organisms in salivary gland infection

A

Mumps = most common - bilateral swelling of the parotid glands (other salivary glands affected in 10%. Other viruses = Coxsackie virus, parainfluenza, influenza A, parvovirus B19, herpes.Bacterial infection occurs usually in debilitated or dehydrated patients - ascends from the oral cavity -most frequent = Staphylococcus aureus.

95
Q

What is Spontaneous Atrophic Hypothyroidism

A

primary hypothyroidism increases in incidence with age autoimmune. destructive lymphoid infiltration of the thyroid leading to fibrosis and atrophy.

96
Q

Hyperthyroidism plus a thyroid bruit suggests what

A

Graves’ disease

97
Q

Presentation of myxoedema coma

A

Severe hypothyroidismReduced consciousness HypothermiaBrachycardiaHypoglycaemia

98
Q

Presentation of thyrotoxic crisis

A

FeverTachycardiaAgitationAFHFCan be precipitated by stress or infection

99
Q

Tumours of Multiple endocrine neoplasia type 1

A

Gastrinoma (pancreatic tumour)ProlactinomaParathyroid adeonoma Pituitary adenomaPancreatic islet cell tumour

100
Q

Tumours of Multiple endocrine neoplasia type 2

A

parathyroid adenomaMedullary thyroid carcinomaPheochromocytoma

101
Q

Tumours of Multiple endocrine neoplasia type 3

A

Tumours of mem type 2 (parathyroid, medullary thyroid, phaeochromocytoma)AND Mucosal neuroma of the GI tractMarfanoid phenotype

102
Q

What is diabetes insupidus

A

Lack of ADH secretion Or a peripheral resistance to ADH Causes increased urine production - v diluteDehydration

103
Q

What Are the 2 types of diabetes insipidus

A

NephrogenicCranial

104
Q

How do you distinguish nephrogenic and cranial diabetes insipidus

A

Do water deprivation test then give desmopressinCranial DI = lack of ADH production. - so desmoprin causes urine concentration. Nephrogenic DI = resistance to ADH - so desmopressin has no effect

105
Q

How do you diagnose diabetes insipidus

A

Water deprivation test - measure urine osmolarity hourly + weight. Normal patients concentrate their urine. In DI large volumes of dilute urine continue to be produced

106
Q

Treatment of diabetes insipidus

A

Cranial DI - desmopressinNephrogenic DI - good fluid management, NSAIDs and thiazide diuretics helps reduce urine output

107
Q

Presentation of bilateral renal agenesis

A

Incompatible with life - still birth or early neonatal deathMother has oligohydramnios - as foetus doesn’t produce urine

108
Q

Symptoms of hyperkalaemia

A

LethargyPolyuria PolydipsiaPeptic ulcer Stone formationDepression Cardiac arrest (v. High)

109
Q

What does parathyroid hormone do?

A

Increases serum calcium concentration Promotes bone resorption, renal phosphate excretion and vitamin D synthesis

110
Q

What is primary hyperparathyroidism

A

Parathyroid gland secretes too much PTH Usually parathyroid adenoma

111
Q

What is pseudo-hypoparathyroidism

A

Autosomal dominant End organ resistance to PTHLearning difficulties Short statureShort 4th and 5th metacarpals

112
Q

Complications of thyroid surgery

A

BleedingThyroid crisisHypoparathyroidism –> hypocalcaemia Recurrent laryngeal nerve damage HypothyroidismRecurrence of hyperthyroidism

113
Q

What is the blood supply to the thyroid

A

Dual blood supply- superior thyroid artery (external carotid)- inferior thyroid artery (subclavian)

114
Q

What is pembertons test for a retrosternal goitre

A

Raise pt arms above head and hold there. Elevates the clavicles and raises the thoracic inlet Causes pink face due to temporary SVC obstruction = Pembertons sign

115
Q

What is nelson’s syndrome

A

Follows bilateral adrenalectomy when a patient has Cushing’s disease and the tumour cannot be located. The removal of negative feedback allows the tumour to grow unchecked. Causes skin hyperpigmentation

116
Q

In what patients are selective aromatase inhibitors used (e.g. Arimidex)

A

Post menopausal women with oestrogen sensitive breast cancer. Act to block peripheral conversion of oestrogens.

117
Q

Causes of hirsutism

A

Idiopathic PCOSadrenal hyperplasia Cushing’s

118
Q

Causes of palmar erythema

A

Chronic liver diseaseHyperthyroidism RAPregnancyPolycythaemia

119
Q

What is pickwickian syndrome

A

Obesity hyperventilation syndrome

120
Q

What is an insulinoma

A

Tumour of pancreatic beta cells Over secrete insulin

121
Q

Symptoms of an insulinoma

A

Hypoglycaemia Weak SweatingConfusionHunger Diarrhoea

122
Q

What is whipples triad of symptoms for insulinoma

A

Attacks induced by starvationHypoglycaemia during the attackSymptoms relieved by eating

123
Q

What is a VIPoma

A

Pancreatic islet cell tumourProduces vasoactive intestinal polypeptideStimulates secretion of water and electrolytes

124
Q

What is a glucagonoma

A

Pancreatic alpha cell tumour Secretes glucagonCauses hyperglycaemia

125
Q

Symptoms of a gastrinoma

A

Pancreatic G cell tumourCauses peptic ulcerationDiarrhoea

126
Q

What is Zollinger-Ellison syndrome

A

Features resulting from gastrinoma over producing gastrin

127
Q

Symptoms of a pituitary adenoma

A

HeadacheBi-temporal hemianopia Amenorrhoea (low LH and FSH)Excess of certain hormones e.g. ACTH / GH / prolactin

128
Q

Symptoms of a craniophyaringioma

A

Insidious Some of:- Hypothyroidism - adrenal failure - diabetes insipidus - decreased libido- erectile dysfunction - amenorrhoea Headaches.Bitemporal inferior quadrantanopia / bitemporal hemianopia dementia hydrocephalus - headache, papilloedema, visual impairment.

129
Q

What is McCune Albright syndrome

A

At least two features of the triad of:- Polyostotic fibrous dysplasia.- Cafe au lait skin pigmentation.- Autonomous endocrine hyperfunction (precocious puberty / thyrotoxicosis / pituitary gigantism / Cushing’s syndrome)

130
Q

When should patients with diabetes be scheduled for surgery

A

Early in the dayIdeally 1st on list

131
Q

How long are diabetic patients kept nil by mouth for before surgery

A

6 hours for solids2 hours for clear fluids (Same as other patients)

132
Q

When do patients with diabetes need admitting for surgery

A

Can be say case if well controlled - omit long acting hypoglycaemic or insulin the night before. If poorly controlled - admit night before and start sliding scale

133
Q

In whom is hyperosmolar hyperglycaemic state most common

A

Elderly

134
Q

What is bronzed diabetes

A

New diagnosis of diabetes in haemochromatosis+ hypogonadism+ arthralgia+ deranged LFTs+ pigmentation

135
Q

What is necrobiosis lipoidica

A

Painless rash Central yellowish lipid-like coreSurrounding brown/purple peripheries Ulceration may occur

136
Q

Tx of necrobiosis lipoidica

A

PUVA improved glycemic control

137
Q

SE of metformin

A

N+VDiarrhoea Abdo painLactic acidosis

138
Q

1st investigation in a DM patient with 1st episode of proteinuria on dipstick

A

Albumin : creatinine ratioMicrobiology - infection is a treatable cause

General Medicine (25 decks)

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