Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Scott's Notes > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is required for DM diagnosis in symptomatic and asymptomatic patients?

A

Symptomatic -
Fasting >=7 OR
Random >=11.1

Asymptomatic -
Raised venous glucose twice separately OR
2hOGTT >=11.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the secondary causes of DM?

A

Drugs - Steroids, HIV meds, neuroleptics, thiazides
Pancreatic - CF, chronic itis, HH, panc Ca
Endo - phaeo, cushings, acromegaly, hyperthyroidism
Glycogen storage disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outline the conservative management of DM

A

MDT approach

Monitor the 4Cs
Control glucose levels
Complications
Competency
Coping
Life style modifications - DELAYS
Diet
Exercise
Lipids
ABP
Aspirin
Yearly check ups
Smoking cessation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the side effects of metformin?

A

Nausea, diarrhoea, abdo pain, lactic acidosis (therefore CI if GFR<30)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What medication should be added if lifestyle and metformin alone are not controling glucose levels?

A

Sulphonylureas - e.g. Gliclazide MR 30mg with breakfast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the side effects of gliclazide?

A

Hypos and weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What can be added to metformin if the patient is prone to hypos instead of gliclazide?

A

Pioglitazone/sitagliptin (causes weight)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the benefit of Exenatide?

A

Also lowers BP so is cardioprotective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two commonest insulin regimes, and what are their benefits and drawbacks?

A

BD Biphasic -
A mixture of rapid and long acting insulin given 30 minutes before breakfast and dinner good for old people and children but does cause fasting hyperglycaemias

Basal-bolus regime
Bedtime long acting glargine with short acting actrapid before each meal adjusting to meal size
Used for T1Dm allowing greater flexibility if appropriately managed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What considerations surrounding insulin should be made when a patient becomes ill?

A

Insulin requirements rise even when fasting
Maintain calories
Check BMs every 4 hours and test ketones and adjust insulin accordingly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What -broadly- are the complications of DM?

A

Macro and microvavscular

Macro
MI
PVD
CVA

Micro
Retinopathy
Neuropathy
Nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What type of foot ulcers do diabetics tend to get?

A

Ischaemic and neuropathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the progression of diabetic retinopathy?

A

Background
Pre-proliferative
Proliferative
Maculopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the fundoscopy findings of background retinopathy

A

Dots - microaneurysms
Blot haemorrhages
Yellow exudates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the fundoscopy findings of pre-proliferative retinopathy

A

Cotton wool infarcts
Venous beading
Haemorrhages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the fundoscopy findings of proliferative retinopathy

A

Neovascularization

Vitreous haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the fundoscopy findings of maculopathy

A

Impaired acuity +-

Hard exudates close to the macula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the features of autonomic neuropathy secondary to DM?

A 
Postural hypos
Gastroparesis
Diarrhoea
Urinary retention 
ED
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the three features of DKA?

A

DKA

Dehydration
Ketogenesis
Acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the diagnostic criteria for DKA?

A

Acidosis - pH<7.3 (<7.1 is severe)
Hyperglycaemia - >=11.1
Ketosis - >=3 (>=2+ on dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the management of DKA?

A
  1. Fluids
    If SBP<90: 0.9% saline over 15 minutes (repeat if nec)
    If SBP>90: maintenance fluids

Start K+ (if deranged) in second bag (40mmol/L) unless evidence of anuria

  1. Insulin
    Actrapid 0.1u/kg/hr IV (max 15u)
    Continue any SC regimens
3. Assess and investigations
Hx and exam
Catheter
NGT if vomiting or GCS<8
LMWH
Address precipitating factors
Hourly monitoring
  1. Glucose
    Once glucose <14, add 10% dextrose to saline infusion at 125ml/hr
5. Insulin
Once ketones <0.3 AND
pH>7.3 AND
Patient able to eat...
Switch to subcut actrapid and a meal, and stop the insulin infusion 1 hour later
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do hyperosmolar hyperglycaemic non ketotic states usually present?

A

Older pt with first presentation of T2DM

Marked dehydration and hyperglycaemia with NO acidosis due to absence of ketones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the complications of HHNK, and what should be done to prevent them?

A

VTE ->LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is Whipple’s triad?

A

Hypoglycaemia:

Low glucose
Symptoms associated with hypo
Relief of symptoms on glucose administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the role of C-peptide in determining the cause of a hypo?

A

Exogenous insulin doesnt give C-peptide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What endocrine syndrome are insulinomas associated with?

A

MEN1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the features of thyrotoxicosis unique to Graves disease?

A 
Opthalmoplegia
Exopthalmos
Gritty eyes
Pre-tibial myxoedema
Thyroid acropachy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Isotope scan shows increased and decreased uptake in which two conditions?

A

Increased in Graves

decreased in thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which other conditions is Graves associated with?

A

T1DM
Vitiligo
Addisons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the management of thyrotoxicosis?

A

Medical -
B-blockers
Carbimazole - causes agranulocytosis

Radioiodine - CI in pregnancy

Surgical - thyroidectomy; SFx - Laryngeal nerve damage, low pTH, hypothroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the commonest cause of hypothyroidism in the UK and worldwide?

A

UK - Hashimoto’s

Worldwide - Iodine def

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What drugs precipitate hypothyroidism?

A

Carbimazole
Amiodarone
Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What antibodies are seen in Hashimoto’s thyroiditis?

A

Anti-TPO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the four types of thyroid cancer, which is the most common and which is the most aggressive?

A

Papillary - commonest
Follicular
Medullary - CEA+
Anaplastic - worst

35
Q

What are the complications of thyroid surgery?

A 
Early
Haematoma ->airway obst
Laryngeal oedema ->obst
Rec laryngeal palsy
Hypoparathyroidism
Thyroid storm

Late
Hypothyroid
Relapse
Keloid scar (big scar)

36
Q

What is the commonest cause of primary hyperpth?

A

Solitary adenoma

37
Q

What are the investigative findings of primary hyperPTH?

A

HyperCA - Short QT, bradycardia, low PO4
Osteitis fibrosa cystica
Osteoporosis

38
Q

Rx of Primary hyperPTH?

A

Fluid
Reduce Ca intake and thiazides
Surgery

39
Q

What are the causes of secondary hyperPTH?

A

Vit D def

CKD

40
Q

What is the treatment of 2ary hyperPTH?

A 
Phosphate binders (calcichew, sevelamer)
Vit D - alfacalcidiol in CKD, chole in vit D def
Cinaclet
41
Q

What are the features of hypoparathyroidism?

A 
Trousseaus
Parasthesia
Anxiety
Seizures
Spasticity
Confusion
Chvostek
Long Qt
42
Q

What are the causes of hypoparathyroidism?

A

Autoimmune
DiGeorge
Surgical

43
Q

What is pseudohypoparathyroidism?

A

Target organ fails to respond to PTH causing Low Ca and High PTH

44
Q

What is pseudopseudohypoparathyroidism?

A

Normal biochem with pseudohypoparathyroid phenotype

45
Q

What are the features of Cushing’s syndrome?

A 
Catabolic
Prox myopathy
Striae
Bruising
Osteoporosis

Glucocorticoid
DM
Obesity

Mineralocorticoid
HTN
Hypokalaemia

46
Q

What are the commonest causes of Cushings synd?

A

Iatrogenic - commonest by far
Adrenal adenoma
Cushings disease
Ectopic ACTH from SCLC/carcinoid

47
Q

How would you investigate Cushings’s syndrome?

A

24hour urinary cortisol

Dexamethasone supression tests

48
Q

How do you treat cushing’s sundrome?

A

Disease - excisison
Adenoma - adrenalectomy
Ectopic - Excision

49
Q

What is Nelson’s syndrome?

A

Rapid enlargement of a pituitary adenoma following bilateral adrenalectomy for Cuhings presenting with bitemphemianopia and hyperpigmentation

50
Q

What are the features of hyperaldosteronism`/

A

Hypokalaemia - weakness, hypotonia, hyporeflexia, parasthesia
Htn

51
Q

What are the two causes of primary hyperaldosteronism?

A

70% bilateral adrenal hyperplasia

30% solitary adenoma (Conn’s synd)

52
Q

What is the management of primary hyperaldosteronism?

A

Conns - surgery

Hyperplasia - spironolactone

53
Q

What causes secondary hyperaldosteronism?

A

Renal hypoperfusion causes renin secretion

RAS
Diuretics
CCF
Hepatic failure
Nephrotic syndrome
54
Q

How might you differentiate between primary and secondary hyperaldosteronism?

A

Aldosterone: Renin ratio
Normal in 2ary
High in 1ary

55
Q

What are the causes of primary adrenal insufficiency (Addison’s)

A

Worldwide - TB
UK - autoimmune disease
Lung mets
Congenital adrenal hyperplasia

56
Q

What are the syjmptoms of Addison’s disease?

A 
Wt loss + anorexia
n/v
Abdo pain
Diarrhoea/constipation
Lethargy
Depression
Hyperpigmentation
Postural hypotension
Hypoglycaemia
Vitiligo
Crises
57
Q

What would investigatisons show in Addison’s disease?

A

BLood - lowNa high K, hypoglycaemia, hypokalaemia, anaemia

Short synacthen test should be negative

58
Q

What is the management of addison’s?

A

Replace Hydrocortisone and FLudrocortisone

Dont stop steroids suddenly, and increase them during intercurrent illness. Wear medicaalert bracelet

59
Q

What is the pathology of 2ary hypoadrenalism, and therefore its differences with Addisons?

A

HPA dysfunction due to chronic steroid use, pit apoplexy or microadenoma

Normal mineralocorticoid production and ho hyperpigmentation

60
Q

What is the presentation of Addison’s?

A

Shock - tachycardia, postural drop, oliguria, confusion

Hypoglycaemia

61
Q

WHat is the management of an adddisonian crisis?

A

IV hydrocortisone 100mg
IV fluids C
Glucose if needed

62
Q

What is the rule of 10s regarding phaeos?

A

10% malignant
10% extra adrenal
10% bilateral
10% hereditary syndromes

63
Q

WHich hereditary syndromes are linked to phaeos?

A

NF
Men2a and 2b
VHL

64
Q

What is the classic triad of phaeo presentation?

A

Episodic headache, sweating and tachycardia

65
Q

What is the diagnostic test for phaeos?

A

24hr urinary metanephrine

66
Q

What is the treatment for phaeos?

A

Adrenalectomy with pre-op alpha and beta blockade with post op BP monitoring for hypotensive crisis

67
Q

What are the features of MEN1

A

Pit adenoma
Parathyroid adenoma
Pancreatic tumours

68
Q

What are the features of MEN2a/b

A

Thyroid medullary carcinoma
Phaeos
a) hyperthyroidism
b)Marfanoid habitus

69
Q

What are the features of Carney Complex/LAME Syndrome?

A

LAMES

Lentigenes - spotty skin pigmentation
Atrial Myxoma
Endocrine tumours
Schwannomas

70
Q

What are the features of Peutz Jehgers?

A

Mucocutaneous freckls around mouth and on plantar surfaces
GI hamartomas
Pancreatic tumours
Cancer risk

71
Q

What are the features of VHL?

A 
Bilateral RCC
Renal cysts
Haemangioblastomas -> cerebellar signs
Phaeos
Pancreatic endocrine tumours
72
Q

What are the features of NF?

A 
Neurofibromata
Cafe au lait spots
Lisch nodules (eyes)
Axilliary freckling
Phaeos
73
Q

What are the causes of hypopituitarism?

A

Hypothalamic - Kallmanns, tumour, III
Pit stalk - trauma, surgery, tumour
Pituitary - irradiation, tumour, apoplexy, infiltration (HH, amyloid)

74
Q

What hormones are affected by panhypopituiitarism and how does this present?

A

GH - central obesity, atherosclerosis, HF
LH/FHS - libido reduction, ED, hair loss, amenorrhoea
TSH - hypothyroidism
ACTH - 2ary adrenal failure

75
Q

What is the classification of pituitary tumours?

A

<1cm is microadenoma

>1cm is macroadenoma

76
Q

Features of pituitary tumours?

A 
Mostly mass effect - 
Headache
Bitemp hemianopia
CN palsies
DI
Rhinorrhoea CSF

Hormone effects-
PRL - galactorhoea
GF -> acromegaly
ACTH -> Cushings disease

77
Q

What is the commonest cause of acromegaly?

A

Pituitary adenoma - 99%

78
Q

What are the features of acromegaly?

A

Hands - CTS, large, thenar wasting

Face - Prominent supraorbital ridges, coarse face, ugly fuckers, big ears, prognathism,
macroglossia, goitre

79
Q

What are the complications of acromegal?

A

Endo - DM
Cardio - HTN, LVH, IHD
Neoplasia - CRC

80
Q

What is the management of acromegaly?

A

1st - transphenoidal surgery
2nd - somatostatin analogue (octreotide)
3rd - GH antagonits
4th - radiotherapy

81
Q

What are the different types of DI and their causes?

A 
Cranial
Idiopathic
Tumours
Trauma
Haemorrhage
Infection

Nephrogenic
Congenital
Metabolic disturbance
Drugs - Lithium, Vaptans

82
Q

What is the treatment for cranial DI?

A

Desmopressin PO

83
Q

What are the causes of gynaecomastia?

A 
Cirrhosis
Hypogonadism
Hyperthyroidism
Oestrogenic tumours
Spiro, digoxin, oestrogen

Scott's Notes (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions