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Endocrinology Flashcards

1
Q

What are the microvascular comps of DM?

A

Retinopathy
Nephropathy
Neuropathy

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2
Q

Define Mody

A

Rare autosomal dominant form of type 2 DM that affects the young

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3
Q

What fasting glucose level is dx of diabetes?

A

> 7

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4
Q

When is HbA1c not a useful measure?

A

pregnancy
haemoglobinopathies
children

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5
Q

What random plasma glucose is dx of diabetes?

A

11.1

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6
Q

What tx can ophthalmology do to try and prevent progression of diabetic retinopathy?

A

Laser therapy

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7
Q

Which autoantibodies are raised in type 1 DM?

A

Anti-GAD

Islet cell Abs

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8
Q

Which test can hep differentiate type 1 DM from type 2?

A

C peptide

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9
Q

At what HbA1c level would you start a patient on a second diabetic drug?

A

58

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10
Q

What example drug would you commence if metformin alone has failed to tx dm?

A

Sulphonylurea (e.g. gliclazide)

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11
Q

What is the main side effect of metformin?

A 
GI upset 
(lactic acidosis if low GFR)
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12
Q

What is a key benefit of using metformin?

A

Doesn’t cause hypoglycaemia

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13
Q

What is the triad of symptoms present in HHS?

A

Hypovolaemia
Marked hyperglycaemia (>30)
Osmolality >320

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14
Q

How does HHS px/

A

Extreme dehydration with altered mental state

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15
Q

What is the tx for HHS?

A

Rehydrate slowly with 0.9% saline over 48 hrs

only use insulin if glucose not falling with fluids

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16
Q

What can precipitate HHS/

A 
Infection
MI
Dehydration
Diuretics 
Poor control
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17
Q

Which features make up metabolic syndrome?

A 
Truncal obesity
Hypertension
reduced HDLs
High triglycerides
Pre-diabetes
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18
Q

Which diseases is metabolic syndrome associated with?

A

T2DM
NAFLD
PCOS
CVD

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19
Q

What BMI would class you as underweight?

A

Less than 18.5

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20
Q

Which medications commonly cause obesity?

A 
Corticosteroids
Antidepresssants (esp mirtazapine)
Sulphonylurea
lithium
Beta blockers
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21
Q

Which drug can help tx obesity?

A

Orlistat (lipase inhibitor)

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22
Q

Which conditions does untreated hypothyroidism predispose you to?

A

Heart disease

Dementia

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23
Q

Which drugs most commonly cause hypothyroidism?

A

Lithium

Amiodarone

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24
Q

Name some causes of hypothyroidism

A 
Atrophic hypothyroidism
Hashimotos thyroiditis
Postpartum thyroiditis
Drugs
Iodine deficiency
Thyroidectomy
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25
Q

What’s the most common cause of hypothyroidism in the UK?

A

Atrophic hypothyroidism (no goitre)

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26
Q

What risks are associated with overmedication of levothyroxine?

A

Osteoporosis

arrhythmia (AF)

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27
Q

What are the causes of hyperthyroidism?

A

Grave’s disease
Toxic adenoma
Toxic multinodular goitre
De Quervains

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28
Q

Which antibodies are positive in graves?

A

Anti-TSH receptor Abs

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29
Q

Signs of thyroid eye disease

A 
Lid lag
Lid retraction
Opthalmoplegia
Exophtalmus
diplopia
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30
Q

Which two drugs are used in the long term mx of hyperthyroidism?

A

Carbimazole

Propylthiouracil

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31
Q

What is the main side effect associated with carbimazole?

A

Agranulocytosis leading to neutropaenic sepsis

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32
Q

What are the comps associated with hyperthyroidism?

A 
HF
Angina
AF
Osteoporosis
Gynaecomastia
Thyroid storm
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33
Q

What is first line tx for thyroid storm?

A

propranolol IV

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34
Q

Which drugs would you give after propranolol to tx thyroid storm?

A

Carbimazole PO
Lugols solution
IV hydrocortisone

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35
Q

What is the most common cause of thyroid cancer?

A

Papillary carcinoma

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36
Q

Which drugs commonly cause hypercalcaemia?

A

THIAZIDES

LITHIUM

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37
Q

Which causes of hypercalcaemia cause a raised ALP?

A

Bone metastases
Sarcoidosis
Thyrotoxicosis
Lithium

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38
Q

What does high calcium and low phosphate typically suggest?

A

Primary hyperparathyroidism

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39
Q

What would causes hypercalcaemia with raised/normal phosphate and normal ALP?

A

Myeloma
Vit D excess
Sarcoidosis

40
Q

Which malignancies most commonly metastasise to bone?

A

Breast, kidney, bronchus, thyroid, prostate

41
Q

What is the definitive tx for primary hyperparathyroidism?

A

Surgery

42
Q

What conservative measure would you suggest to patient with mild primary hyperparathyroidism to prevent formation of renal stones?

A

Overhydration

43
Q

What tx would protect BMD in primary hyperparathyroidism?

A

bisphosphonates

44
Q

What is tx for acute severe hypercalcaemia?

A

Rehydrate (4-6l saline over 24 hours)

IV bisphosphonates

45
Q

What biochemical abnormalities would suggest secondary hyperparathyroidism?

A

High PTH, low calcium, high phosphate, low vit D

46
Q

How can you treat secondary hyperparathyroidism due to CKD?

A

Calcitriol

Gut phosphate binders

47
Q

What are the causes of hypocalcaemia?

A 
CKD
Hypoparathyroidism (e.g. post-surgery)
Vit D deficiency!!
Drugs
acute pancreatitis
48
Q

What are the sx of hypocalcaemia?

A 
Cramps
Perioral numbness
Carpopedal spasm (trousseaus sign)
Convulsions
psychosis
49
Q

What is chvosteks sign?

A

Tapping of facial nerve causes ipsilateral twitching of facial muscles (seen in hypocalcaemia)

50
Q

How do you adjust calcium for albumin level?

A

+0.1 for every 4g/L albumin is below 40

-0.1 for every 4g/L albumin is above 40

51
Q

Why do you need to adjust calcium for albumin level?

A

Only unbound albumin is physiologically important

52
Q

Which hormone do pituitary adenomas most commonly produce in ranking order/

A

Prolactin > GH > ACTH > TSH > LH/FSH

53
Q

What are the local effects of a pituitary adenoma?

A

Headache

Visual field defects

54
Q

How does a craniopharyngioma px?

A

Headache
Visual field defect
Hypopituitarism

55
Q

What is the drug tx for prolactinoma?

A

Bromocriptine or cabergoline

56
Q

What are the three main causes of raised prolactin?

A

Prolactinoma
Pregnancy/puerperium
Antipsychotics

57
Q

How does prolactinoma px in men?

A

Erectile dysfunction and loss of libido

+- mass effect

58
Q

Which two conditions does acromegaly increase the risk of?

A

T2DM

colon cancer

59
Q

What are the symptoms of acromegaly?

A 
Acroparaesthesia
Amennorhoea
Decreased libido
Headache
Increased sweating
Snoring
Arthralgia
back ache
60
Q

What are the signs of acromegaly?

A

Increased growth of hands
Macroglossia
Acanthosis nigricans
carpel tunnel syndrome

61
Q

How is acromegaly diagnosed?

A

OGTT (measure GH)

Serum IGF-1

62
Q

Why is a random GH test poorly diagnostic for acromegaly?

A

Secretion is pulsatile

63
Q

How is acromegaly treated?

A

1) Transphenoidal surgery

2) Somatostatin analogues (e.g. octreotide) +- radiotherapy

64
Q

What are the causes of cushings syndrome?

A

Iatrogenic (steroids)
Adrenal adenoma

Cushings disease
Ectopic ACTH (e.g. Small cell lung Ca)
65
Q

What are the first line tests for cushings syndrome?

A

Overnight dexamethasone suppression test or 24h urinary free cortisol

66
Q

Which antibodies are raised in autoimmune Addisons disease?

A

21-hydroxylase autoantibodies

67
Q

What electrolyte abnormalities are seen in Addisons disease?

A

Low sodium
Raised potassium (memory tool = add k up, k conns down)
Low glucose

68
Q

What test is diagnostic for Addisons disease?

A

Synacthen test (short ACTH stimulation test)

69
Q

Which conditions is addisons associated with?

A

vitiligo
T1DM
pernicious anaemia
thyroid disorders

70
Q

How do you manage Addisonian crisis?

A

Bloods for cortisol and ACTH
U & Es (for sodium and potassium)
IV HYDROCORTISONE STAT

71
Q

What are the features of conn’s syndrome?

A

Oedema (water and Na retention)
HTN
Hypokalaemia (weakness, cramps, paraesthesia)

72
Q

What are the causes of secondary hyperaldosteronism?

A 
Reduced renal perfusion:
renal artery stenosis
diuretics
CCF
accelerated hypertension
73
Q

What are the Ix for hyperaldosteronism?

A

U & E
BP
ALDOSTERONE:RENIN ratio

74
Q

What does a high aldosterone:renin ratio tell you?

A

PRIMARY hyperaldosteronism

75
Q

Aet of hyperkalaemia

A

AKI and CKD
Addisons
Drugs (spironolactone, ACE-I/ARB, NSAID, heparin, beta blockers)
Burns, rhabdomyolysis, trauma

76
Q

What ECG changes indicate hyperkalaemia?

A

Loss of P waves
PR prolonged
QRS widened
Peaked T waves

77
Q

What are the main causes of hypokalaemia?

A

Diuretics
GI fluid loss (chronic diarrhoea)
hyperaldosteronism (conn’s/cushings etc)

78
Q

What are the sx of hyperkalaemia/

A 
Fast irregular pulse
Chest pain
Weakness 
Palpitations
Light-headedness
79
Q

What are the sx of hypokalamia?

A 
Muscle weakness
Hypotonia
Hyporeflexia
Cramps
Tetany
palps
light-headedness
80
Q

What should you not do when tx hypokalaemia?

A

never give IV K+ as fast stat bolus!!

81
Q

What are the ECG signs of hypokalaemia?

A

Small T waves
Prominent U waves
Long PR
Depressed ST segment

82
Q

Which other electrolyte is important to check and correct in hypokalaemia?

A

magnesium

83
Q

Define phaeochromocytoma

A

Catecholamine producing adrenal tumour

84
Q

What are the main Ix for phaeochromocytoma?

A

24h urine for metanephrines/metadrenaline

Abdo CT

85
Q

What is first line tx for phaeochromocytoma?

A 
alpha blockade (e.g. phenoxybenzamine) pre-operation
(only give beta blocker once BP controlled)
86
Q

What molecule is released by tumours in carcinoid syndrome?

A

Serotonin

87
Q

What are two of the most common symptoms of carcinoid syndrome?

A

Flushing

Diarrhoea

88
Q

Which cells form the tumour in carcinoid tumours?

A

enterochromaffin cells

89
Q

What is the 1st line Ix for DI?

A

water deprivation test

90
Q

What happens to urine and serum osmolality in DI?

A

Urine osmolality low

Serum osmolality normal/high

91
Q

What is the consequence of hydrated a DI patient with severe hypernatraemia too rapidly?

A

Cerebral oedema

92
Q

How do you distinguish cranial DI from nephrogenic DI?

A

Give desmopressin and look for response during water deprivation test
MRI head

93
Q

What are the three biochemical features of SiADH?

A

Concentrated urine
Hyponatraemia
Low plasma osmolality
(absence of hypovolaemia or oedema)

94
Q

What can cause siADH?

A

Malignancy (e.g. small cell lung Ca)
CNS disorders
TB
drugs

95
Q

How do you tx hyponatraemia?

A

Rule out drug causes - THIAZIDE DIURETICS

Tx cause and fluid restrict

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