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Endocrinology Flashcards

1
Q

How do we diagnose Cushing’s?

A

Free cortisol in urine and low dose dexamethasone suppression test.

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2
Q

What are two main changes we seen in diabetic nephropathy?

A

Proteinuria

Hypertension

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3
Q

GLUT 4 is activated by insulin. True or false?

A

True; pumps glucose into the cell.

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4
Q

Can fat be converted to glucose?

A

No. Triglycerides are broken down into glycerol and NEFAs. GLYCEROL can be made into glucose.

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5
Q

Which is the last method of energy use - really only used in survival?

A

Degrading protein.

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6
Q

What is the order in which we use energy?

A

Glucose, then FAs, then ketones.

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7
Q

Why can fatty acids not be used by the brain?

A

Cannot cross the BBB. The brain instead uses ketones.

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8
Q

What is acetoacetate?

A

A ketone: will be used by the brain when there is not enough glucose.

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9
Q

Does insulin signal the fed or fasted state?

A

Fed state.

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10
Q

How does insulin influence ketone production?

A

Insulin decreases ketone production.

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11
Q

Why do we see glycosuria in diabetes?

A

Low insulin so glucose is not being taken up by cells.

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12
Q

How do we treat ketoacidosis?

A

Give insulin. Insulin lowers ketones.

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13
Q

Kussmaul breathing is characteristic of….?

A

Diabetic ketoacidosis. = deep, shallow breathing.

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14
Q

In which Diabetes do we see diabetic ketoacidosis?

A

T1DM; DO produce enough insulin in t2dm, but cells to reduce glucose are resistant.

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15
Q

How does insulin work?

A

Increases insulin sensitivity.

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16
Q

What is the cutoff for high fasting glucose levels?

A

> 7.0mmol/L

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17
Q

Which Diabetes has a stronger familial history?

A

t2dm.

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18
Q

Gliclazide is what type of Diabetic medication?

A

Sulphonylurea

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19
Q

Metformin is what type of Diabetic medication?

A

Biguanide

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20
Q

Give x3 causes of DKA

A

Diabetic ketoacidosis:

  1. Unknown
  2. infection
  3. no insulin
  4. new diagnosis of T1DM.
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21
Q

Give x5 clinical features of DKA

A 
Polydipsia (increased thirst)
Polyuria (increased urination)
Sweating
Abdominal pain
Glycosuria, ketonuria
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22
Q

Where will you see Kussmaul’s breathing?

A

Diabetic ketoacidosis.

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23
Q

Give x3 metabolic defects with insulin deficiency

A

Proteolysis
Lipolysis
Glycogenolysis

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24
Q

Which structure is at the base of the hypothalamus?

A

The arcuate nucleus

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25
Which are the two populations which stimulate/ inhibit food intake?
[In the arcuate nucleus]: Stimulatory: NPY (neuropeptide Y), Agrp. Inhibitory: POMC (pro-opiomelanocortin).
26
What affect does POMC have on appetite?
It inhibits appetite.
27
Could stimulation or inhibition of POMC cause obesity?
Inhibition of POMC; POMC works to inhibit appetite after sufficient food intake.
28
What is the relationship between leptin and body fat?
high body fat = high leptin (as compensation). Otherwise leptin is a satiety hormone.
29
Which hormone activates POMC?
Leptin; wants to signal satiety.
30
Which hormone resistance is obesity associated with?
Leptin resistance
31
Give two ways the patient may present with low leptin:
Hyperphagia | Fertility problems
32
What affect can insulin have on food intake?
Lower food intake
33
Which is the special functional group on Ghrelin?
A fatty acid.
34
Which neuron group does Ghrelin stimulate?
Stimulates the NPY/Agrp neurones; a hunger hormone
35
Which hormone has an opposite effect to Ghrelin - how so?
PYY; Stimulates POMC Inhibits NPY/Agrp.
36
What effect does PYY have on appetite?
Inhibits appetite.
37
What does GLP-1 stand for and what does it do?
Glucagon-like peptide 1. | Has an incretin effect.
38
If something has an incretin role, what does it do?
Stimulate insulin release.
39
What is Liraglutide?
GLP-1 receptor agonist = increases insulin and increases satiety = used as a weight loss treatment
40
What is the difference between osteoporosis and osteomalacia?
``` Osteoporosis = reduction in mass of bones Osteomalacia = softening of bones ```
41
What can a DEXA scan show you?
Bone density - used to assess osteoporosis
42
What is the difference between primary and secondary hyperparathyroidism?
``` Primary = problem with the Parathyroid gland itself; potential tumour. Secondary = may be compensatory high PTH due to low calcium in bone. ```
43
What is the main side effect of metformin?
bloating, diarrhoea, nausea.
44
What is the main side effect of statins?
Muscle pain
45
What diabetes class are Gliptins?
DPP-4 Inhibitors.
46
What diabetes class is gliflozin?
SGLT-2 Inhibitor
47
What diabetes class is Metformin?
Biguanide
48
What diabetes class is gliclazide?
Sulphonylurea
49
Which diabetes class treatments are given together and why?
GLP-1 agonists and DPP4 inhibitors (prevents breakdown of GLP-1 agonists)
50
How do GLP-1 agonists work?
Increase insulin secretion and increase satiety.
51
What are the choices of drug treatment in acromegaly?
Somatostatin analogues to reduce growth.
52
Desmopressin is usually given in which form?
As a nasal spray (for majority)
53
Desmopressin is used to treat cranial diabetes insipidus. True or false.
True.
54
Which has a shorter half life - T3 or T4?
T3
55
What is Plummer's disease?
Toxic nodule producing thyroxine.
56
Why will a large dose of iodine cause short term hypothyroidism?
; Wolff-Chaikoff effect. An autoregulation mechanism where the thyroid rapidly reduces thyroxine production. Used prior to surgery for patients with hyperthyroidism.
57
Why will an overdose of thyroxine in a normal individual cause lid lag?
Causes contraction of the Muller muscle.
58
Which is the first therapeutic step in treating phaeochromocytomas?
Alpha blockade
59
What is the difference between Cushing's syndrome and Cushing's disease?
Cushing's disease is due to a pituitary origin.
60
What is the difference between Cushing's syndrome and Cushing's disease?
Cushing's disease is due to a pituitary origin. | DP
61
Spirinolactone is a diuretic. Fludrocortisone is a corticosteroid. What are each of their effects on aldosterone receptors?
Aldosterone receptor antagonist | Aldosterone receptor agonist
62
What are fludrocortisone, hydrocortisone and dexamethasone?
Glucocorticoids.
63
Does NPY stimulate or inhibit food intake?
Stimulates; the Agrp/NPY neuronal population
64
Do we see hyperpigmentation in Addison's or Cushing's?
Both; both have high levels of ACTH!
65
Is Ghrelin a hunger or fasting hormone?
A hunger hormone = stimulates Agrp/NPY.
66
Where is GLP-1 produced?
From L cells in the gut
67
What does the 'Ethinyl' in estradiol mean?
Makes it orally active so it does not undergo first pass metabolism.
68
What are the LH levels like during menopause?
High; low oestrogen.
69
hCG acts on which receptors?
LH receptors
70
What must the sperm undergo to be able to penetrate the egg?
Capacitation
71
Does fertilisation need an oestrogen or progesterone dominated environment?
Progesterone dominated environment
72
Give x3 signs of Acromegaly
Frontal bossing, prognathism, enlargement of supraorbital ridges.
73
What is the relationship between IGF-1 and GH?
Growth hormone controls production of IGF-1.
74
Which main hormone is raised in acromegaly?
IGF-1
75
Why do we give DDAVP rather than ADH directly to patients with DI? (not DM, DI!)
DDAVP is selective for v2 receptors in kidney. ADH would stimulate v1 receptors also
76
Which form of cortisol do we give primarily in Addison's?
Hydrocortisone
77
Which cortisol substitute is given as an aldosterone analogue?
Fludrocortisone
78
When will metryrapone be used?
In Cushing's; steroidogenesis inhibitor. Also, ketoconazole.
79
What is the daily dose of hydrocortisone and which chunks?
20mg a day. x3 a day in 10mg, 5mg and 5mg divisions.
80
What do hormone levels look like in pregnancy?
High oestrogen, low LH, low FSH.
81
If PTH is raised due to calcium levels being low, what type of hyperparathyroidism is it?
Secondary
82
What is primary hyperparathyroidism?
When PTH AND Ca2+ are high
83
The brain is mineralised by what?
Calcium phosphate - hydroxyapatite crystals.
84
What are osteocytes?
Mature bone cells - former osteoblasts.
85
Which bone borders the lacrimal bone on a diagram?
The ethmoid bone
86
What is the name of the posterior suture of the brain?
The lambdoid suture
87
Name the three branches of the trigeminal nerve
``` V1 = Opthalmic (sensory) V2 = Maxillary (sensory) V3 = Mandibular (sensory and motor) ```
88
How many cranial nerves enter the middle cranial fossa?
4; 2 enter the anterior cranial fossa, 4 enter the middle cranial fossa and 6 the posterior cranial fossa.
89
Which cranial nerve pass through the supraorbital fissure?
Oculomotor, trochlear, trigeminal (v1 division) and abducens.
90
Which two cranial nerves pass through the internal acoustic meatus?
Facial and vestibulococchlear nerve.
91
What is the name of the bone which has a greater and lesser wing?
The sphenoid bone

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