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Y3 - Conditions and Procedures > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Recall some symptoms of acromegaly

A 
Hyperhidrosis
Hyperprolactinoma
Hypopituitary
Headaches
Carpal Tunnel
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2
Q

Describe the skin of an acromegaly patient

A

Thick and greasy

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3
Q

In which endocrinological condition is bitemporal hemianopia a symptom?

A

Acromegaly

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4
Q

Which specific blood test should be orderd for suspected acromegaly?

A

IGF-1

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5
Q

Recall the medical and surgical options for acromegaly treatment

A

medical: bromocriptine, octreotide
surgical: transphenoidal hypophysectomy

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6
Q

Differentiate primary and secondary adrenal insufficiency

A 
Primary = AI: Addisson's
Secondary = hypothalamopituitary disease
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7
Q

What is the main endocrinological consequence of cessation of long-term steroid therapy?

A

Adrenal failure

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8
Q

What are the presenting features of acute adrenal insufficiency?

A

Addissonian crisis = sudden haemodynamic collapse: hypotensive shock, tachycardia, pale, cold, oligouria

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9
Q

What are the chronic features of adrenal insufficiency?

A

Dizziness, nausea, anorexia, depression, abdominal pain

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10
Q

Recall 3 signs of adrenal insufficiency

A

Hair loss
Hyperpigmentation
Postural hypotension

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11
Q

Which test is done to confirm a diagnosis of adrenal insufficiency?

A

Short synacthen

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12
Q

Which test is done to determine pathological mechanism of adrenal insufficiency?

A

Long synacthen

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13
Q

What is the main electrolyte imbalance resulting from adrenal failure?

A

Hyperkalaemia

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14
Q

Define the carcinoid syndrome

A

Constellation of symptoms caused by systemic release of humoral factors from carcinoid tumours

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15
Q

Recall 2 types of tumours that are commonly implicated in the carcinoid syndrome

A
  1. Slow-growing neuroendocrine tumours

2. Small bowel - enterochromaffin cell tumours that secrete 5-HT

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16
Q

What are the main symptoms of the carcinoid syndrome?

A

Paroxysmal flushing, wheeze, tachycardia, abdominal pain (if enterochromaffin cell tumour)

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17
Q

What is themain hormone implicated in the carcinoid syndrome?

A

5- HT

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18
Q

What electrolyte imbalance is produced by Cushing’s syndrome?

A

Hypokalaemia

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19
Q

What is the use of the LDDST and the HDDST?

A 
LDDST = diagnosis of Cushing's
HDDST = determine cause of Cushing's
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20
Q

Recall 2 drugs that can be used to manage Cushing’s

A

Meyrapone

Ketoconazole

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21
Q

Recall 2 options for the surgical management of Cushing’s syndrome?

A

Transsphenoidal hypophysectomy

Bilateral adrenalectomy

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22
Q

Which part of the kidney does ADH act on?

A

Collecting duct

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23
Q

Recall the medical management of central and nephrogenic diabetes insipidus

A 
Central = desmopressin
Nephrogenic = thiazide diuretics
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24
Q

What is the main electrolyte imbalance that results from diabetes insipidus?

A

Hypernatraemia

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25
Q

Recall 2 auto-antigens related to T1DM

A

GAD

anti-insulin

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26
Q

Recall the fasting and random blood glucose values indicative of DM

A

Fasting >7

Random > 11.1

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27
Q

What abnormality is seen on an FBC of someone with a DKA?

A

High WCC

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28
Q

What do U&Es show in DKA?

A

Dehydration

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29
Q

Recall the 3 components of an initial management plan for a T1DM patient

A
  1. Short-acting insulin eg. lispro TDS
  2. Long-acting insulin OD
  3. HbA1c every 3-6months
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30
Q

How is DKA managed?

A
  1. Soluble insulin in normal saline
  2. –> Subcut insulin for 1-2 days
  3. Insulin will drive K+ into cells so replace potassium
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31
Q

What happens to HGO in T2DM?

A

Increases

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32
Q

Recall 2 monogenic causes of T2DM

A

MODY

Mitochondrial diabetes

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33
Q

Recall the diagnostic criteria for T2DM

A

1 or more of the following present:

  1. Symptoms + random plasma BM of >11.1
  2. Fasting BM >7
  3. 2-hour BM after 75g OGTT >11.1
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34
Q

What may happen to urine protein as a result of T2DM?

A

Microalbuminuria

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35
Q

Recall 3 medications for diabetes (and write another Q on this)

A

Metformin
Citagliptin
Sulphonylureas

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36
Q

What is the T2DM equivalent of DKA?

A

Hyperosmolar hyperglycaeimc state

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37
Q

How does the HHS differ from DKA?

A

No acidosis

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38
Q

What are the ranges for “impaired” fasting and random glucose?

A

Fasting: 5.6-6.9
Random: 7.8-11.0

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39
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

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40
Q

Recall 3 signs of Grave’s disease seen in the hands

A

Palmar erythema
Sweaty and warm
Tremor

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41
Q

Describe 2 signs of hyperthyroidism in the limbs

A

Proximal myopathy

Hyperreflexia

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42
Q

Which endocrinological condition can cause lid lag?

A

Hyperthyroidism

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43
Q

Differentiate the possible causes of hyperparathyroidism depending on if it is primary or secondary

A 
Primary = parathyroid adenoma/ hyperplasia
Secondary = chronic renal failure, vit D deficiency
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44
Q

Describe the serum calcium in each type of hyperparathyroidism

A

Primary: hypercalcaemia
Secondary: hypocalcaemia
Tertiary: hypercalcaemia

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45
Q

Describe the serum Vit D in each type of hyperparathyroidism

A

Primary: high
Secondary: low
Tertiary: low

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46
Q

Recall the symptoms of hypercalcaemia

A

Bones, stones, abdominal groans and psychiatric groans

47
Q

Which 2 products of the liver should be measured in suspected hyperparathyroidism?

A

ALP

Albumin

48
Q

What sort of diuretics can exacerbate hypercalcaemia?

49
Q

What is the main risk of a parathyroidectomy?

A

Hitting recurrent laryngeal nerve

50
Q

Recall the possible aetiologies of primary female hypogonadism

A

Dysgenesis (Turner’s)

Damage (chemotherapy, autoimmune)

51
Q

Recall the possible aetiologies of secondary female hypogonadism

A

Functional (stress, EDs)
Hypothalamopituitary tumours
Infiltrative disease eg sarcoidosis/ amyloidosis

52
Q

What imaging would you do in female hypogonadism?

A

Pituitary MRI to see if there is a tumour

53
Q

What would cause gonadal dysgenesis in males?

A

Kleinfelter’s

54
Q

What is the name given to GnRH deficiency in men?

A

Kallman’s

55
Q

What blood tests would be done to investigate male hypogonadism?

A

Serum SHBG, Albumin, testosterone, LH and FSH

56
Q

Describe the levels of DHT, FSH and LH in primary and secondary male hypogonadism

A

Primary: low DHT, high LH and FSH
Secondary: low DHT, normal FSH and LH

57
Q

What is hypopituitarism?

A

Cessation of production of ANTERIOR pituitary hormone

58
Q

What are the 2 main symptoms of pituitary apoplexy?

A

Headache

Visual field loss

59
Q

What is the name of the autoimmune cause of hypothyroidism?

A

Hashimoto’s

60
Q

Recall the mnemonic for and the symptoms of hypothyroidism

A 
MOM'S SO TIRED
Memory loss
Obesity
*Malar flush*
Slowness
Skin dryness
Onset is gradual
Tiredness
Intolerance to cold
Raised BP
Energy levels fall
Depression
61
Q

Recall the 5 key symptoms of myxoedema coma

A 
Hypothermia
Hypoventilation
Hyponatraemia
Heart failure
Confusion
62
Q

Recall the management of myxoedema crisis

A 
O2
Rewarming
Rehydration
IV T4 
IV hydrocortisone
63
Q

What is multiple endocrine neoplasia?

A

Autosomal dominant predeliction to develop endocrine tumours

64
Q

Recall the subtypes of multiple endocrine neoplasia

A

Men 1, Men 2a and Men 2b

65
Q

To which tumours are Men1 sufferers predisposed?

A

Pituitary adenoma

Parathyroid tumours

66
Q

To which tumours are Men2a/b sufferers predisposed to?

A

Parathyroid tumours
Medullary thyroid tumours
Phaeochromocytoma

67
Q

What BMI is definitive of obesity?

A

> 30kg/m^2

68
Q

Define osteoporosis

A

Bone mass of more than 2.5 standard deviations below the mean achieved by healthy adults

69
Q

What is the most likely cause of primary osteoporosis?

70
Q

Recall some causes of secondary osteoporosis

A

Malignancy
Cushing’s
Steroid drugs
Malabsorption

71
Q

What are the most common fractures in osteoporosis?

A

Neck of femur
Vertebral
Colles’ fracture (distal radius, after falling on out-stretched hand)

72
Q

Recall the mnemonic for and bloods taken in suspected osteoporosis

A

CAP
Calcium
ALP
Phosphate

73
Q

What unusual symptoms may present alongside Paget’s disease of the bone?

A

Headaches and deafness

74
Q

Recall the CAP in Paget’s disease of the bone

A

Calcium: normal
ALP: high
Phosphate: normal

75
Q

Where do most phaeochromocytomas occur?

A

Chromaffin cells of adrenal medulla

76
Q

What is the most likely cause of Paget’s disease of the bone?

A

Familial (30% are inherited)

77
Q

Recall the mnemonic for and the symptoms of phaeochromocytoma

A 
Catecholamines Produce Headache And Difficulty When Passing Stool 
Constipation
Palpitations
Headache
Anxiety
Dyspnoea
Wheezing
Pain
Sweating
78
Q

What is the first line investigation is suspected phaeochromocytoma?

A

24-hour urine catecholamine levels

79
Q

What are non-functioning pituitary tumours defined as?

A

Tumours of the pituitary that do not produce any active hormones

80
Q

What is the most common type of non-functional pituitary adenoma?

A

Macroadenoma (>1cm)

81
Q

What symptoms may present in a non-functioning pituitary tumour?

A

Headache

Visual changes

82
Q

Define PCOS

A

Characterised by: oligomenorrhoea, hyperandrogenism

Associated with: obesity, T2DM, dyslipidaemia

83
Q

Recall 3 signs of PCOS

A

Hirsuitism
Acne
Acanthosis Nigrans

84
Q

Which hormones will be high in the blood of someone with untreated PCOS?

85
Q

What is the most common cause of primary hyperaldosteronism?

A

Conn’s (adrenal adenoma)

86
Q

What causes hypertension and hypokalaemia in primary hyperaldosteronism?

A

Autonomous aldosterone overproduction –> increased sodium and water retention –> hypertension + decreased renin production.
Increased retention –> K+ loss

87
Q

Recall the symptoms of hypoaldosteronism

A

Usually asymptomatic

88
Q

How can you confirm a diagnosis of primary hyeraldosteronism?

A

Salt load and failure to suppress aldosterone

89
Q

What is the “postural test” used for?

A

Determining cause of hyperaldosteronism

90
Q

How do you perform a postural test?

A

8am with pt lying down: measure renin, cortisol and aldosterone
~4 hours of being upright~
If aldosterone decreases: adrenal adenoma
If renin and aldosterone increase: adrenal hyperplasia

91
Q

Recall the medical management of bilateral adrenal hyperplasia

A

Spironolactone and amiloride

These are potassium-sparing

92
Q

Which demographic is prolactinoma most common in?

A

Pre-menopausal women

93
Q

Recall some symptoms of prolactinoma in women

A

Galactorrhoea
Hirsuitism
Reduced libido
Amenorrhoea

94
Q

Recall some symptoms of prolactinoma in men

A

Reduced beard growth
Reduced libido
Erectile dysfunction
~very subtle symptoms~

95
Q

What specific blood test must be done in suspected prolactinoma and why?

A

TFTs

High TRH stimulates prolactin secretion

96
Q

Recall the medical management of prolactinoma

A

DA agonists like cabergoline/bromocriptine

97
Q

Recall the mnemonic for and the causes of SIADH

A 
SIADH CAUSES
Small cell lung cancer
Injury
Abscess
Disease of lungs
Haemorrhage
Carbamazepine
Aspergillosis
U-ther lung causes (pneumonia, bronchiectatsis)
Surgery
EtOH withdrawal
Sarcoidosis
98
Q

What electrolyte imbalance is associated with SIADH?

A

Hyponatraemia

99
Q

What are the signs of hyponatraemia?

A

Extensor plantar reflexes

Hyporeflexia

100
Q

What are the 4 types of thyroid cancer?

A

Medullary
Papillary
Follicular
Anaplastic

101
Q

Recall the symptoms of thyroid cancer

A

Slow-growing neck lump
Odynophagia
Hoarseness

102
Q

What TFTs would you expect in a thyroid cancer patient?

103
Q

What is a thyroid nodule?

A

Abnormal growth of thyroid cells that form a lump in the gland and are usually non-functioning

104
Q

What sort of thyroid nodules are most likely to be malignant?

A

Single ones (benign are usually multiple)

105
Q

What is the most common cause of thyroiditis in the UK?

A

Hashimoto’s thyroiditis

106
Q

What are the symptoms of thyroiditis?

A

Pretty much those of an under-active thyroid

107
Q

Recall the antibodies present in Hashimoto’s disease

A

Anti-TPO

Anti-TG

108
Q

What is osteomalacia?

A

Disorder of bone matrix mineralisation

109
Q

What sort of drugs can cause vitamin D deficiency?

A

Anti-convulsants

110
Q

How does a lack of vitamin D affect kidney function?

A

Can cause renal phosphate wasting

111
Q

What must you include in an examination for hypocalcaemia?

A

Try and elicit Chovstek’s sign and Trousseau’s sign

112
Q

What electrolyte imbalance is common in vitamin D deficiency and osteomalacia?

A

Hypocalcaemia

113
Q

What is the most commonly seen type of fracture in osteomalacia?

A

Looser’s zone fractures

114
Q

Recall the mnemonic for and the complications of hypocalcaemia

A 
CATs go Numb
Convulsions
Arrhythmias
Tetany
Numbness

Y3 - Conditions and Procedures (17 decks)

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