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Yr 3 ALS > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Diagnostic measures for diabetes

A
  • Glucose >11
  • Fasting glucose >6.9
  • Ketones
  • Hba1c
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2
Q

Specific test for type 1

A

-Islet cell autoAb’s

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3
Q

Chance test that can be elevated in diabetes

A

Serum amylase

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4
Q

Aetiology of type 1 type 1 diabetes

A

Autoimmune destruction of pancreatic Beta-cells. Associated with other autoimmune conditions including thyroid, coeliac and enteroviruses

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5
Q

Pathological features of type 2 diabetes

A
  • Beta cell apoptosis
  • Free fatty acids
  • Alpha cell dysfunction = Increased glucagon
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6
Q

Hba1c - what is it and how long does it indicated glucose activity

A

Hb that has been altered due to glucose presence in the blood stream.
-90 days

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7
Q

What level of Hba1C is diagnostic for diabetes

A

> 6.5

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8
Q

Metformin

  • MOA
  • SE
  • Interactions + contraindications
A
  • Targets AMP kinase increasing sensitivity to insulin and inhibiting gluconeogenesis
  • GI
  • ACEi, MAOI and contrast
  • Renal/hepatic failure
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9
Q

Gliclazide and Glimepiride

  • Class
  • MOA
  • SE
  • contraindications
A
  • Sulphonylureas
  • Islet cell depolarisation and increases insulin secretion
  • Weight gain and electrolyte disturbances
  • Renal and hepatic failure
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10
Q

When is Gliclazide first line and what is a requirement for its use

A
  • Low BMI patients

- Functional Beta cells

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11
Q

Exanatide and Liraglutide “tides”

  • Class
  • MOA
  • SE
  • contraindications
A
  • GLP-1-Analogue
  • Binds to GLP-1 receptor increasing insulin secretion and suppresses glucagon
  • Pancreatitis
  • Renal failure
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12
Q

Thiazolidinediones

  • Examples
  • MOA
  • SE
  • contraindications
A
  • Glitazones
  • Agonist PPAR alpha receptor assisting glucose transport into cells.
  • Only effective with insulin
  • weight/fluid gain
  • Liver or renal impairment
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13
Q

DPP4 inhibitor

  • Examples
  • MOA
  • SE
A
  • Gliptins
  • Inhibits incretin degradation increasing GLP-1
  • Pancreatitis/hepatotoxic
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14
Q

SGLT-2 Inhibitors

  • Examples
  • MOA
  • SE
  • Contraindications
A
  • Flozins
  • Inhibit resorption of glucose in kidneys
  • Weight loss, UTI
  • Renal failure
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15
Q

Definition of hypo-event

A

Glucose<3.5

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16
Q

Triad of DKA and diabetics affected

A
  • Hyperglycemia
  • Ketonaemia
  • Acidosis
  • Type 1
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17
Q

Electrolyte and BP changes associated with DKA

A
  • Variable (hyper/hypo) K

- Low BP

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18
Q

Definition of HHS, presentation -time course and diabetics affected

A

Osmolarity without ketoacidosis. Low levels of bodily insulin prevent lipolysis.

  • Presents slowly over days or weeks
  • Lesser version of DKA
  • Type 2 diabetics
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19
Q

Why are do micro-vascular changes affect the eyes, kidneys and nerves in diabetes.

A

These areas don’t require insulin for glucose uptake so can be easily overloaded

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20
Q

Three features of diabetic eye disease

A
  • Dot hemorrhages
  • Cotton wool spots
  • Leading to maculopathy (cause of blindness presenting with macular oedema)
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21
Q

3 effects of Diabetes on the glomerulus and changes to GFR

A
  • Thickened membrane (hypertrophy)
  • Increased albumin
  • Nephrotic syndrome
  • High GFR
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22
Q

3 internal consequences of Nephropathy

A
  • Erectile dysfunction
  • Bladder issues
  • GI dysfunction
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23
Q

Which thyroid hormone is more bioactive

A

T3

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24
Q

Diagnostic picture of hyperthyroidism

A
  • Low TSH
  • High T3/4
  • autoAb’s TSH receptor(Graves)
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25
Q

Disease picture of multinodular goitre

A

Longer progression than Graves often with an older onset

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26
Q

Symptoms of Thyroid Storm

A
  • Fever
  • Seizures
  • Vomiting
  • Jaundice
  • Coma
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27
Q

Two drugs that suppress Thyroid hormone production and the contraindications for each

A
  • Carbimazole - contraindicated in pregnancy

- Prophythiouricil - Hepatotoxic

28
Q

Main risk of Carbimazole

A

Agranulocytosis - abnormal WCC drop with fever rash and infections

29
Q

Protocol for radioactive iodine treatment, salt used and contraindications

A
  • 131I salt administered in single dose

- contraindicated in pregnancy and thyroid eye disease

30
Q

Diagnostic picture of hypothyroidism

A
  • High TSH
  • Low T3/4
  • TPO (Hashimotos)
  • Raised ESR (Hashimotos)
31
Q

3 Primary causes of hypothyroidism

A
  • Hashimotos
  • Iodine deficiency
  • Drugs
32
Q

Secondary causes of hypothyroidism

A

-Pituitary insufficiency - adenoma

33
Q

What Thyroid conditions produce goitre

A

Mostly hyper but also Hashimotos

34
Q

Biggest risk to uncontrolled hypothyroidism

A

Myxoedema coma - fall in temp, coma and 50% mortality

35
Q
  • MOA Levothyroxine
  • Patient information
  • Interaction
A
  • Agonist thyroid nuclear receptor
  • Empty stomach - no food or drink for 30-60mins after
  • Increases Warfarin effect
36
Q

Definition and diagnostic picture of subclinical thyroid disorders

A
  • Do not produce symptoms
  • Hypo = High TSH normal T3/4
  • Hyper = Low TSH normal T3/4
37
Q

Most common and second most common thyroid cancer subtypes

A
  • Papillary

- Follicular

38
Q

Relationship between radionucleotide scan and pathology extent

A

more uptake = more likely to be benign

39
Q

Hormone released by Hypothalamus and pituitary during cortisol release

A
  • Hypothalamus = CRH

- Pituitary = ACTH

40
Q

Adrenal cortex layers, hormones released

HINT: GFR

A 
SALT = aldosterone - glomerulosa
SWEET = cortisol = fasciculara
SEX = DHEA = reticularis
41
Q

What does adrenal medulla secrete

A

Adrenaline and Noradrenaline

42
Q

Actions of Aldosterone

A
  • Lowers K
  • Increases Na
  • Increases BP
43
Q

Diagnostics for Cushings

A
  • Dexamathesone 48hr supression test = *
  • High dose supression test
  • 24hr free cortisol
44
Q

Define Cushings sndrome

A

Caused by exogenous steroids

45
Q

2 types of Cushings disease

A

ACTH+ secreted from pituitary or +CTH = adenoma

High cortisol from suppressed ACTH = ACTH independent

46
Q

Features of Addisons (adrenal insufficiency)

A
  • Low Na
  • Low BP
  • High K
47
Q

Diagnostic test Addisons

A

-ACTH stimulation test

48
Q

Primary causes of Addisons (High ACTH)

A
  • TB
  • Sepsis
  • Metastasis
49
Q

Secondary causes of Addisons (Low ACTH)

A

Pituitary disoders (present with pigment and high K)

50
Q

Treat Addisons

A

Replace glucocorticoid = hydrocortisone

Replace mineralcorticoid = Fludrocortisone

51
Q

What feature is typically of Addisonian crisis and how do you treat it

A

Dramatic BP drop (Na/BP fall, K/Ca Rise)

-IV hydrocortisone - dont wait!

52
Q

Features of Conns (hyperadrenalism)

A
  • High Na
  • High BP
  • Low K
53
Q

Diagnostic test

A

Plasma aldosterone:renin ratio

High aldosterone due to no feedback

54
Q

Treatment Conns

A
  • Spironalactone

- Adrenalectomy

55
Q

Diabetes Insupidus

  • Cause
  • Pathology-hormone involved
  • Diagnostic test
  • Drug treatment
A
  • Lithium/cranial pathology
  • Fall in ADH from P pituitary
  • Water-deprivation test
  • Desmopressin (ADH analogue)
56
Q

First Line treatment for prolactinoma

A

Bromocryptine - dopamine agonist

57
Q

Acromegaly

  • hormone responsible
  • Cause
  • Diagnostic test
  • Treatment
A
  • Excess GH (somatotropin)
  • Pituitary adenoma
  • Oral-glucose tolerance test = because normally glucose suppresses GH level
  • (Serum IGF-1)
  • Surgery or somatotropin analogue “otides”
58
Q

How often does insulin usually need to be injected

A

4xper day

59
Q

What pathology shows most uptake on thyroid scan

A

Thyroid adenoma

60
Q

Human-quick acting insulin

A

Humulin-S

61
Q

Analogue quick acting insulins

A

Lispro

Aspart

62
Q

NPH/Intermediate/Isophane insulin

A

Insulatard

63
Q

Human Biphasic insulin

A

Humulin-M3

64
Q

Long-acting insulins

A
  • Glargine

- Degludec

65
Q

Features of levothyroxine non-compliance

A
  • Still symptomatic
  • Increase in T3/4 due to quick loading dose before appointment
  • TSH ++ high
66
Q

What medicine interferes with Levothyroxine absorption

A

Iron - give 2hrs apart

Yr 3 ALS (10 decks)

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