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Year 5 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What levels of HbA1c and glucose are diagnostic for diabetes?

A

HbA1c >48
Random glucose >11
Fasting glucose >7

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2
Q

Medical management of type II diabetes

A

1st line - metformin
2nd line (if HbAa1c >58) - add 2nd drug from other diabetes drugs
3rd line - (if HbA1c remains above 58) - consider insulin therapy

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3
Q

Name the most common sulphonylurea medication and it’s mechanism of action

A

Gliclazide

Increases insulin release from pancreas

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4
Q

Name the common thiazolidinedione and its MOA

A

Pioglitazone

Increases insulin sensitivity

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5
Q

Name the common SGLT2-inhibitors

A

Empagliflozin, canagliflozin, dapagliflozin

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6
Q

Name the common DDP4 inhibitor and it’s MOA

A

Sitagliptin

Inhibits breakdown of GLP-1 (which in turn stimulates insulin release)

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7
Q

Name the common GLP-1 Mimetic

A

Exenatide

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8
Q

Which diabetes medication class increases the risk of bladder cancer

A

Thiazolidinediones e.g, pioglitazone

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9
Q

Which diabetes medication is contraindicated in patients with heart failure?

A

Thiazolidinediones e.g, pioglitazone

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10
Q

Which diabetes medication class increase the risk of fournier’s gangrene?

A

SGLT-2 inhibitors e.g, empagliflozin

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11
Q

Which diabetes medication is preferable in patients who are overweight

A

DPP4 inhibitors e.g, sitagliptin

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12
Q

Pathophysiology of hyperosmolar hyperglycaemic state (HHS)

A

Hyperglycaemia leads to osmotic diuresis with associated loss of sodium and potassium
Severe volume depletion leads to raised serum osmolarity
Hyperviscosity of blood can lead to vascular complications

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13
Q

Clinical features of Hyperosmolar hyperglycaemic state (HHS)

A

Nausea, vomiting
Polydipsia
Neurological symptoms e.g, reduced GSC, headaches, weakness
Cardiovascular symptoms - hypotension, tachycardia
Significantly raised serum osmolarity
Hypovolemic
Hyperglycaemic (>30)

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14
Q

Management of HHS

A

Admit
Normalise osmolality (gradually) - isotonic solution (normal saline)
IV fluid and electrolyte replacement
Normalise blood glucose (Gradually)

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15
Q

Medical management of diabetic neuropathy

A 
Amitriptyline 
Duloxetine 
Gabapentin 
Pregabalin 
Topical capsaicin - may be used for localised neuropathic pain
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16
Q

Management of gastrointestinal autonomic neuropathy in type II diabetes

A

Metoclopramide

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17
Q

What are the diabetes sick day rules

A

Continue meds are normal
Increase frequency of BM monitoring
Encourage fluid intake
May need sugary drinks

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18
Q

Presentation of diabetic ketoacidosis

A 
Abdominal pain 
Polyuria/polydipsia 
Dehydration 
Kussmaul respiration 
Acetone smelling breath
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19
Q

Management of diabetic ketoacidosis

A

IV Fluid replacement - isotonic saline
Fixed rate IV insulin replacement: 0.1 units/kg/hour
Correction of hypokalaemia
- if 3.5-5.5 give 40mmol/L in infusion
- if <3.5 seek senior review for additional K+

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20
Q

What should happen in regular insulin medication during diabetic ketoacidosis

A

Stop short acting

Continue long acting

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21
Q

What are the risks of diabetic ketoacidosis managemetnt

A

Arrthymias - secondary to hyperkalaemia
Cerebral oedema - secondary to fluid infusion, more common in children and needs to be closely monitored
Acute respiratory distress syndroem
AKI

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22
Q

What is maturity onset diabetes of the young (MODY)?

A

Development of type II diabetes in patients <25 years old

Typically autosomal dominant condition

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23
Q

Medical management of MODY

A

Sulfonylureas e.g, gliclizide

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24
Q

Features of insulinoma

A

Hypoglycaemia
Rapid weight gain
Raised insulin
Raised C-peptide

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25
Q

Clinical Features of Hyperthyroidism

A 
Weight loss 
Restlessness 
Heat intolerance 
Palpatiations 
Diarrhoea 
Oligomenorrhoea
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26
Q

Signs specific to Graves’ disease

A

Exophthalmos
Pretibial myxoedema
Digital clubbing

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27
Q

Medical management of Graves Disease

A

Propanolol - for symptom relief

Carbimazole - titration or block and replace

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28
Q

Main side effect to consider when starting carbimazole

A

Agranulocytosis
Need to monitor FBCs
Need to warn patient what to do if they get sore throat etc

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29
Q

Alternative management of Graves’ disease if medical management is unsuccessful

A

Radioactive idodine

Surgery

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30
Q

What is a thyroid storm?

A

Life threatening complication of thyroidtoxicosis

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31
Q

Risk factors for thyroid storm

A

Thyroid surgery
Trauma
Infection
Acute iodine load e.g, CT contrast media

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32
Q

Clinical Features of Thyroid Storm

A 
Fever 
Tachycardia 
Confusion 
Nausea/vomiting 
Hypertension 
Abnormal LFTs - jaundice may be seen clinically
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33
Q

Management of thyroid storm

A

Beta blockers - IV Propanolol
Propylthiouricil
IV hydrocortisone - blocks conversation of T4 to T3

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34
Q

Antibodies in Graves’ disease

A

Anti-TSH

35
Q

Antibodies in Hashimotos

A

Anti-TPO

36
Q

Drug causes of hypothyroidism

A

Lithium

Amiodarone

37
Q

Clinical features of hypothyroidism

A 
Weight gain 
Lethargy 
Cold intolerance 
Dry skin 
Oedema 
Constipation 
Menorrhagia 
Decreased reflexes
38
Q

Cause of secondary hypothyroidism

A

Pituitary insufficiency

39
Q

Management of hypothyroidism

A

Levothyroxine

40
Q

What is myxoedema coma

A

Complication of longstanding untreated hypothyroidism

41
Q

Presentation of myxoedema coma

A 
Confusion 
Hypothermia 
Odema 
Reduced respiratory drive 
Seizures
42
Q

Management of myxoedema coma

A

IV thyroid replacement
IV fluids
IV corticosteroids

43
Q

What is subclinical hypothyroidism

A

TSH raised

T3/T4 normal

44
Q

When would you treat subclinical hypothyroidism

A

TSH between 4-10
<65 years and symptomatic - trial levothyroxine
If asymptomatic - no treatment

TSH >10
<70 years - start treatment even if asymptomatic
>80 - no treatment

45
Q

What is de Quevain’s thyroiditis

A

Hyperthyroidism following viral infection
May present with painful goitre and raised ESR
Period of hypothyroidism following a few months of hyperthyroidism
No treatment needed

46
Q

Types of thyroid cancer and age groups typically found in

A

Papillary (65%) - seen in young females
Follicular (20%) - seen in women >50 years
Medullary
Anaplastic (Rare) - occurs in elderly patients

47
Q

Thyroid tumour markers for different cancers

A

Papillary and follicular - thyroglobulin

Medullary - calcitonin (originates from parafollicular cells)

48
Q

Management of hyperthyroidism in pregnancy

A

1st trimester - replace carbimazole with propylthiouracil as increased risk of congenital abnormalities
2nd trimester - switch back to carbimazole

Monitor thyroixine levels throughout pregnancy - should be kept in upper 1/3rd of normal limit to avoid fetal hypothyroidism

49
Q

Management of Hypothyroidism in pregnancy

A

Levothyroxine should be increased in pregnancy - 50% increase in dose as early as 4-6 weeks of pregnancy

50
Q

What is sick euthyroid syndrome

A

Deranged thyroid levels during infection or viral illness
Low/normal TSH
Low T3
Low T4

51
Q

Clinical features of primary hyperparathyroidism

A

Hypercalcemia
Low phosphate
Polyuria/Polydipsia - due to raised calcium
PTH may be raised or inappropriately normal due to raised calcium
Kidney stones

52
Q

What would an X-ray head show in primary hyperparathyroidism

A

Pepper pot skull

53
Q

Management of primary hyperparathyroidism

A

Surgery - total parathyroidectomy

Conservative management may be considered if patient is older and has no end organ damage
Cinacalcet considered in patients unsuitable for surgery

54
Q

Blood results on secondary hyperparathyroidism

A

PTH - high
Calcium - Low or normal
Phosphate - High

55
Q

Blood results in tertiary hyperparathyroidism

A

PTH - very high
Calcium - normal or high
Phosphate - normal or low

56
Q

Blood results in primary hyperparathyroidism

A

PTH - normal or high
Calcium - high
Phosphate - low

57
Q

Causes of primary hyperaldosteronism

A

Idiopathic bilateral adrenal hyperplasia
Conns syndrome
Adrenal carcinoma

58
Q

Features of primary hyperaldosteronism

A

Hypertension
Hypokalaemia - due to increased aldosterone
Alkalaosis - due to raised bicarbonate associated with increased aldosterone

59
Q

Diagnostic test in primary hyperaldosteronism

A

Plasma aldosterone/renin ratio - shows high aldosterone and low renin ratio

60
Q

Management of primary hyperaldosteronism

A

Bilateral adrenocortical hyperplasia - spironolactone

Adrenal adenoma - surgery

61
Q

What is Addison’s disease

A

Autoimmune destruction of adrenal glands

Leads to reduction in cortisol and aldosterone production

62
Q

Clinical features of Addison’s

A

Lethargy, weakness, anorexia
Hyperpigmentation - especially in palmer creases
Hypotension
Salt craving
Increased thirst - as sodium and water is being lost due to reduced aldosterone

63
Q

Blood results in Addison’s

A

Hyponatraemia
Hyperkalamia
Hypoglycaemia

64
Q

Diagnostic test for Addison’s

A

Short synacthen test

  • ACTH is given which would usually increase cortisol
  • in Addison’s cortisol will not rise in response due to defective adrenal gland
65
Q

Medical management of Addison’s

A

Glucocorticoid replacement - hydrocortisone

Mineralcorticoid replacement - fludrocortisone

66
Q

Advise on medication changes for Addison’s patients when they have intercurrent illness

A

Double glucocorticoid dose (double hydrocortisone)

67
Q

Management of Addisonian crisis

A

IV hydrocortisone

IV saline with dextrose

68
Q

What is Cushing’s syndrome

A

Symptoms due to excess cortisol

69
Q

Common causes of Cushing’s syndrome

A

Cushings disease - pituitary secreting ACTH
Ectopic ACTH production e.g, small cell lung cancer
Adrenal adenoma
Iatrogenic - excess steroids

70
Q

Differentiating between causes of cushings

A

Dexamethasone suppression test
Low dose - will not suppress pituitary tumour OR other causes
High dose - will suppress pituitary tumour releasing ACTH
High dose - will NOT suppress ectopic ACTH production or adrenal adenoma

Measuring ACTH to help differentiate - this will be low in adrenal adenoma

71
Q

What is a phaeochromocytoma?

A

Catecholamine secreting tumour of the adrenal glands

72
Q

Symptoms of phaeochromocytoma

A 
Hypertension 
Headache 
Palpitations 
Sweating 
Anxiety
73
Q

Diagnosis of phaeochromocytoma

A

24hr collection of urinary meranephrines

74
Q

Management of phaeochromocytoma

A

Surgery

Pt must be stabilised with alpha blocker first e.g, phenoxybenzamine

75
Q

MEN type 1

A

Parathyroid hyperplasia
Pituitary hyperplasia
Pancreas - e.g, insulinoma, gastrinoma

76
Q

MEN Type IIa

A

Parathyroid hyperplasia

Phaeochromocytoma

77
Q

MEN type IIb

A

Thyroid cancer

Phaeochromocytoma

78
Q

What is kallman’s syndrome

A

Hypogonadotrophic hypogondism
X linked recessive trait
Leads to delayed puberty in boys

79
Q

Hormone levels in Kallmann syndrome

A

Low testosterone

Low LH and FSH

80
Q

Clinical presentation of kallman’s syndrome

A

Delayed puberty
Anosmia
Reduced sex hormones
Normal or above average height

81
Q

What is Klinefelter syndrome

A

Genetic disease causing XXY in men

82
Q

Hormone levels in Klinefelter syndrome

A

Low testosterone

Increase LH and FSH

83
Q

Clinical features of Klinefelter syndrome

A 
Taller than average 
Lack of secondary sexual characteristics 
Small, firm testes 
Infertility 
Gynaecomastia

Year 5 (17 decks)

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