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Endocrinology Flashcards

1
Q

Name the 3 hormones involved in calcium and phosphate homeostasis

A
  1. Vitamin D
  2. Parathyroid hormone
  3. Calcitonin
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2
Q

What is the mechanism of action of calcitriol in the renal tubule?

A

Acts on the proximal convoluted tubule to increase calcium reabsorption

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3
Q

What are the 4 principle causes of Cushing’s syndrome?

A
  1. Exogenous steroids
  2. Cushing’s disease ( a ACTH secreted pituitary adenoma)
  3. Adrenal adenoma
  4. Paraneoplastic Cushing’s syndrome
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4
Q

What is the most common cause of paraneoplastic Cushing’s syndrome?

A

Small cell lung cancer

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5
Q

Interpret the potential results of a high dose dexamethasone suppression test based on the recorded ACTH and cortisol levels in each case.

A
  1. Pituitary adenoma - Both cortisol and ACTH is suppressed
  2. Adrenal Adenoma - Only ACTH is suppressed, normal cortisol levels
  3. Ectopic ACTH production - Neither Cortisol nor ACTH is suppressed.
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6
Q

From which direction is a pituitary adenoma removed from surgically?

A

Trans-sphenoidal

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7
Q

Name the 5 hormones released by the anterior pituitary gland

A
  1. TSH
  2. ACTH
  3. FSH and LH
  4. Growth hormone
  5. Prolactin
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8
Q

Name the 2 hormones released by the posterior pituitary gland

A
  1. Oxytocin

2. ADH

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9
Q

What is the physiological action of growth hormone

A

Induces the secretion of insulin like growth actor (IGF-1) from the liver

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10
Q

Outline 3 physiological states that will induce the secretion of parathyroid hormone from the parathyroid glands

A
  1. Low serum calcium
  2. Low serum magnesium
  3. High serum phosphate
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11
Q

How does PTH increase serum calcium concentration? (3)

A
  1. Increases the number and activity of osteoclasts in bon, thus causing reabsorption of calcium from he bones into the bloodstream.
  2. Also induces increased calcium reabsorption in the proximal convoluted tubule of the nephron
  3. Induces conversion of vitamin D3 to calcitriol. This in turn promotes calcium absorption from the small intestines
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12
Q

Renin is released by what cell type?

A

Juxtaglomerular cells of the kidney nephron

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13
Q

What are the 2 principle actions of angiotensin II?

A
  1. Systemic vasoconstriction

2. Induces release of aldosterone from the adrenal glands

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14
Q

Outline the 3 principle actions of aldosterone on the kidney nephron

A
  1. Increase sodium reabsorption from the distal tubule
  2. Increase potassium secretion from the distal tubule
  3. Increase hydrogen secretion from the collecting ducts
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15
Q

Compare the thyroid status in hyperthyroidism, primary hypothyroidism and secondary hypothyroidism respectively

A

Hyperthyroidism - Low TSH and high T3 and T4

Primary Hypothyroidism - High TSH and low T3 and T4

Secondary Hypothyroidism - Low TSH and low T3 and T4

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16
Q

Name the antibody that is most commonly implicated in autoimmune thyroid disease

A

Antithyroid peroxidase (anti TPO)

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17
Q

Name 3 thyroid disorders that can have antithyroglobulin antibodies

A
  1. Grave’s disease
  2. Hashimoto’s thyroiditis
  3. Thyroid cancer
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18
Q

Name the antibody that is responsible for Grave’s disease

A

TSH receptor antibodies

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19
Q

Diffuse high uptake in a radioisotope scan can be indicative of what type of thyroid disease?

A

Grave’s disease

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20
Q

Focal high uptake of a radioisotope scan can be indicative of what types of thyroid disease?

A
  1. Toxic multi nodular goitre

2. Adenoma

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21
Q

Abnormally low uptake of a radioisotope scan can be indicative of what type of thyroid disease?

A

Thyroid cancer

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22
Q

Define Grave’s disease

A

An autoimmune disease in which TSH receptor antibodies cause a primary hyperthyroidism

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23
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

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24
Q

What type of thyroid disease is sometimes refereed to as ‘Plummer’s disease’

A

Toxic multi nodular goitre

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25
Pretibial myxoedema is specific to what type of thyroid disease?
Grave's disease
26
Suggest 7 universal features of hyperthyroidism
1. Anxiety 2. Sweating/ heat intolerance 3. Tachycardia 4. Weight loss 5. Fatigue 6. Frequent loose stools 7. Sexual dysfunction
27
Recall 4 unique features associated with Grave's disease
1. Diffuse goitre (without nodules) 2. Grave's eye disease 3. Bilateral exophthalmos 4. Pretibial myxoedema
28
What is De Quervain's Thyroiditis?
A viral infection presenting with fever, neck pain and tenderness, dysphagia and features of hyperthyroidism
29
What is the first line anti-thyroid drug?
Carbimazole
30
What are the 2 dose regimes for carbimazole used in the treatment of patients with hyperthyroidism?
1. Titration-Block | 2. Block and replace
31
Why is carbimazole preferred over Propylthiouracil as the first line treatment for hyperthyroidism?
Small risk of severe hepatic reactions and death association with Propylthiouracil
32
What is the beta blocker of choice for symptomatic control in patients with hyperthyroidism?
Propanolol
33
What is the most common cause of hypothyroidism in the developed world?
Hashimoto's thyroiditis
34
Name 2 medications that can potentially lead to hypothyroidism
1. Lithium | 2. Amiodarone
35
Name the 4 potential aetiologies of hypopituitarism
1. Tumours 2. Infection 3. Vascular (e.g. Sheehan syndrome) 4. Radiation
36
What is the ideal range for blood glucose concentration?
4.4 -6.1 mol/l
37
Suggest 2 viral infections that can cause T1DM through damage to the pancreas
1. Cocksackie B virus | 2. Enterovirus
38
What are the 3 principle medical complications associated with an acute presentation of DKA?
1. Decompensated ketoacidosis 2. Dehydration 3. Potassium imbalances
39
Outline the 3 diagnostic criteria for DKA
1. Hyperglycaemia. Blood glucose > 11mmol/l 2. Ketosis i.e. blood ketones >3 mmol/l 3. Acidosis (pH <7.3)
40
Recall the components of the menuominc 'FIG-PICK' for the treatment of DKA
F - IV fluid resuscitation with normal saline I - Insulin infusion G - Glucose P - Potassium I - infection (important to treat any precipitating factors of the DKA if present) C - Chart the patient's fluid balance K - Ketones (monitor serum level)
41
Suggest 2 medications that cane be used in the treatment of severe hypoglycaemia
1. IV dextrose | 2. Intramusclar glucagon
42
Outline 4 macrovascular complications of diabetes
1. Coronary artery disease 2. Peripheral vascular disease 3. Stroke 4. Hypertension
43
Outline the 3 main microvascular complication associated with diabetes
1. Peripheral neuropathy 2. Retinopathy 3. Kidney disease - particularly glomerulosclerosis
44
Recall 4 infection related complications associated with diabetes
1. UTI's 2. Pneumonia 3. Skin and soft tissue infections 4. Fungal infections (particularly oral and vaginal candidiasis
45
Recall 3 ethnicities that have an identified increased risk of developing T2DM
1. Black 2. Chinese 3. South Asian
46
Outline the 4 main parameters used in diagnosis of diabetes
1. HbA1C >48 mmol/l 2. Random glucose > 11mmol/l 3. Fasting glucose > 7mmol/l 4. OGTT 2 hour result > 11mmol/l
47
What is the initial first line treatment for T2DM?
Metformin titrated from an initial does of 500mg once daily as tolerated
48
To what drug class does metformin belong to?
Biguanide
49
What are the main side effects associated with the use of metformin?
1. Diarrhoea and abdominal pain | 2. Lactic acidosis
50
Recall 5 side effects associated with the use of pioglitazone
1. Weight gain 2. Fluid retention 3. Anemia 4. Heart failure 5. Extended use may increase the risk of bladder cancer
51
Give 3 notable side effects associated with the use of sulphonyureas drugs
1. Weight gain 2. Hypoglycaemia 3. Increased risk of CV disease and MI when used as a mono therapy
52
Name the most commonly used sulphonylureas drug
Gliclazide
53
What are the 3 main functions of the incretin hormones?
1. Increase insulin secretion 2. Inhibit glucagon production 3. Slow absorption by the GI tract
54
Name the most commonly used DPP-4 inhibitor
Sitagliptin
55
Give 3 notable side effects associated with Sitagliptin
1. GI tract upset 2. Symptoms of upper respiratory tract infection 3. Pancreatitis
56
Classify the drug exenatide
GLP-1 mimetic
57
Name 3 rapid acting insulins
1. Novarapid 2. Humalog 3. Apidra
58
Name 3 short acting insulins
1. Actrapid 2. Humulin S 3. Insuman rapid
59
Name 3 Intermediate acting insulins
1. Insulatard 2. Humulin I 3. Insuman Basal
60
Name 3 long acting insulins
1. Lantus 2. Levemir 3. Degludec
61
What is the adverse effect commonly associated with sulphonylureas?
Hypoglycaemia
62
Briefly outline the methodology of a glucose tolerance test
Fasting blood glucose is taken, then the patient is given a 75g glucose load. A second blood glucose reading is then taken after 2 hours.
63
What are the 3 main side effects associated with the use of insulin?
1. Hypoglycaemia 2. Weight gain 3. Lipodystrophy
64
Outline the mechanism of action of metformin
1. Increases insulin sensitivity | 2. Decreases hepatic gluconeogenesis
65
What are the principle side effects associated with the use of metformin?
1. GI upset | 2. Lactic acidosis
66
Outline a patient subgroup for which the use of metformin is contra-indicated
Those with an eGFR <30 ml/min
67
Name 2 examples of sulphonylureas
1. Gliclazide | 2. Glimepiride
68
Give an example of a thiazolidinedione
Pioglitazone
69
Recall 2 side effects associated with pioglitazone
1. Weight gain | 2. Fluid retention
70
Outline the mechanism of action of the thiazolidinediones
Activate PPAR-gamma receptors in adipocytes to promote angiogenesis and fatty acid uptake
71
Outline the mechanism of action of DPP-4 inhibitors
Increase incretin release thereby inhibiting glucagon secretion from the pancreatic alpha cells
72
Outline the mechanism of action of SGLT-2 inhibitors
Inhibit the reabsorption of glucose in the kidney
73
Outline the mechanism of action of GLP-1 agonists
Incretin mimetic that will inhibit glucagon secretion
74
Which class of diabetes medication has been linked with an increased incidence of pancreatitis?
GLP-1 agonists
75
Which is the most common electrolyte abnormality associated with small cell lung cancer?
Hypercalcaemia
76
What is the most appropriate clinical investigation for acromegaly?
Serum IGF-1
77
Though not always present, suggest 2 clinical signs which may be seen in patients with familial hypercholesterolaemia
1. Premature arcus senilis | 2. Tendon Xanthomata
78
Name the criteria used to diagnose familial hypercholesterolaemia
Simon Broome Criteria
79
What is the mode of action of Statin medications?
Competitively inhibit HMG-CoA reductase
80
Recall 3 significant (but rare) side effects associated with the use of statins
1. Myalgia and in severe cases rhabdomyolysis 2. Hepatotoxicity 3. Statin induced diabetes
81
Give 4 contra-indications for the use of fibrates
1. Hypoalbuminaemia 2. Gallbladder disease 3. Nephrotic syndrome 4. Photosensitivity to fibrates
82
Name a drug type that may inhibit iodide transport
Thiocyanates
83
Outline the 4 main clinical features of subacute thyroiditis
1. Hyperthyroidism 2. Painful goitre 3. Raised ESR 4. Globally reduced uptake on iodine-131 scan
84
When prescribing levothyroxine for hypothyroidism, name two patient groups that should be started on a lower than normal dose
1. Elderly | 2. Patients with ischaemic heart disease
85
Name 4 side effects associated with thyroxine therapy
1. Hyperthyroidism as a result of overreplacement 2. Reduced bobe mineral density 3. Worsening of angina 4. Atrial Fibrillation
86
Name the clinical test used to diagnose acromegaly
Oral glucose tolerance test
87
Diabetes insipidus leads to what type of sodium imbalance?
Hypernatraemia
88
Give 3 complications associated with acromegaly
1. Hypertension 2. Diabetes 3. Cardiomyopathy
89
Suggest a medical treatment for acromegaly
Somatostatin analogue e.g. octreotide
90
What electrolyte imbalance is most commonly associated with Cushing's syndrome?
Hypokalaemic metabolic alkalosis
91
How can you distinguish clinically between pituitary and ectopic ACTH secretion?
Petrosal sinus sampling
92
List the 3 causes of concurrent hypokalaemia and hypertension
1. Cushing's syndrome 2. Conn's syndrome 3. Liddle's syndrome
93
Name 2 'drugs' that can potentially cause hypokalaemia associated with hypertension
1. Carbenoxolone | 2. Liquorice excess
94
What is the medical treatment for Liddle's syndrome?
Either amiloride or triamterene
95
What are the 5 potential causes of hypokalaemia without hypertension?
1. Diuretics 2. GI losses 3. Renal tubular acidosis 4. Bartter's syndrome 5. Gitelman's syndrome
96
Outline the 4 electrolyte abnormalities associated with Addison's disease
1. Hyperkalaemia 2. Hyponatraemia 3. Hypoglycaemia 4. Normal anion gap metabolic acidosis
97
What is the most common extra-adrenal location for a pheochromocytoma?
Organ of Zuckerkandl (adjacent to the bifurcation of the aorta)
98
Which virus is associated with a higher incidence of Burkitt's lymphoma?
EBV
99
Recall Whipple's triad of symptoms associated with an insulinoma
1. Hypoglycaemia with fasting or exercise 2. Reversal of symptoms with glucose 3. Recorded low BMs at the time of symptoms
100
Name a common complication of a PCP infection
Pneumothorax
101
What is the first line treatment for a PCP infection?
Co-trimoxazole
102
Recall the 3 types of frontotemporal lobar degeneration
1. Frontotemporal dementia (Pick's disease) 2. Progressive non fluent aphasia (Chronic progressive aphasia (CPA) 3. Semantic dementia
103
What are the '4Ds' of causes of postural hypertension with a compensatory tachycardia?
1. Deconditioning 2. Dysfunctional heart: aortic stenosis 3. Dehydration: Disease (acute illness, adrenal insufficiency), dialysis and drugs (diuretics or narcotics) 4. Drugs: Levodopa, antidepressants, antipsychotics, tamsulosin
104
What is the triad of symptoms associated with Parkinson's disease?
1. Bradykinesia 2. Tremor 3. Rigidity
105
Outline the 5 main causes of adrenal failure
1. Autoimmune 2. Adrenal haemorrhage 3. Adrenal metastatic disease 4. Sepsis 5. TB
106
Bilateral adrenalectomy will lead to which clinical syndrome?
Nelson's syndrome
107
Name the 5 adrenal tumour types of functional significance
1. Conns syndrome 2. Cushing's syndrome 3. Virilizing tumours (testosterone releasing) 4. Pheochromocytoma 5. Metastatic disease
108
Suppression during a high dose dexamethasone suppression test is indicative of what kind of adrenal disease?
Pituitary adenoma - Cushing's disease
109
What are the 2 main clinical 'risks' associated with Conn's syndrome?
1. Severe hypertension | 2. Flash pulmonary oedema
110
Define Glucocorticoid remediable aldosteronism
Autosomal dominant disorder characterised by increased sensitivity of the zona glomerulosa to ACTH thereby leading to hypersecretion of aldosterone.
111
What is the name of an extra-adrenal pheochromocytoma?
Paraganglioma
112
Suggest 6 potential causes of endocrine hypertension
1. Pheochromocytoma 2. Conn's syndrome 3. Cushing's disease 4. Renal artery stenosis 5. Acromegaly 6. Diabetes Mellitus
113
What is an important expected affect of metformin?
Reduction in patient's insulin resistance i.e. smaller doses will likely be required

Clinical Medicine (8 decks)

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