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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
Clinical Features of Hyperthyroidism
``` Weight loss Restlessness Heat intolerance Palpatiations Diarrhoea Oligomenorrhoea ```
26
Signs specific to Graves’ disease
Exophthalmos Pretibial myxoedema Digital clubbing
27
Medical management of Graves Disease
Propanolol - for symptom relief | Carbimazole - titration or block and replace
28
Main side effect to consider when starting carbimazole
Agranulocytosis Need to monitor FBCs Need to warn patient what to do if they get sore throat etc
29
Alternative management of Graves’ disease if medical management is unsuccessful
Radioactive idodine | Surgery
30
What is a thyroid storm?
Life threatening complication of thyroidtoxicosis
31
Risk factors for thyroid storm
Thyroid surgery Trauma Infection Acute iodine load e.g, CT contrast media
32
Clinical Features of Thyroid Storm
``` Fever Tachycardia Confusion Nausea/vomiting Hypertension Abnormal LFTs - jaundice may be seen clinically ```
33
Management of thyroid storm
Beta blockers - IV Propanolol Propylthiouricil IV hydrocortisone - blocks conversation of T4 to T3
34
Antibodies in Graves’ disease
Anti-TSH
35
Antibodies in Hashimotos
Anti-TPO
36
Drug causes of hypothyroidism
Lithium | Amiodarone
37
Clinical features of hypothyroidism
``` Weight gain Lethargy Cold intolerance Dry skin Oedema Constipation Menorrhagia Decreased reflexes ```
38
Cause of secondary hypothyroidism
Pituitary insufficiency
39
Management of hypothyroidism
Levothyroxine
40
What is myxoedema coma
Complication of longstanding untreated hypothyroidism
41
Presentation of myxoedema coma
``` Confusion Hypothermia Odema Reduced respiratory drive Seizures ```
42
Management of myxoedema coma
IV thyroid replacement IV fluids IV corticosteroids
43
What is subclinical hypothyroidism
TSH raised | T3/T4 normal
44
When would you treat subclinical hypothyroidism
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
What is de Quevain’s thyroiditis
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
Types of thyroid cancer and age groups typically found in
Papillary (65%) - seen in young females Follicular (20%) - seen in women >50 years Medullary Anaplastic (Rare) - occurs in elderly patients
47
Thyroid tumour markers for different cancers
Papillary and follicular - thyroglobulin | Medullary - calcitonin (originates from parafollicular cells)
48
Management of hyperthyroidism in pregnancy
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
Management of Hypothyroidism in pregnancy
Levothyroxine should be increased in pregnancy - 50% increase in dose as early as 4-6 weeks of pregnancy
50
What is sick euthyroid syndrome
Deranged thyroid levels during infection or viral illness Low/normal TSH Low T3 Low T4
51
Clinical features of primary hyperparathyroidism
Hypercalcemia Low phosphate Polyuria/Polydipsia - due to raised calcium PTH may be raised or inappropriately normal due to raised calcium Kidney stones
52
What would an X-ray head show in primary hyperparathyroidism
Pepper pot skull
53
Management of primary hyperparathyroidism
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
Blood results on secondary hyperparathyroidism
PTH - high Calcium - Low or normal Phosphate - High
55
Blood results in tertiary hyperparathyroidism
PTH - very high Calcium - normal or high Phosphate - normal or low
56
Blood results in primary hyperparathyroidism
PTH - normal or high Calcium - high Phosphate - low
57
Causes of primary hyperaldosteronism
Idiopathic bilateral adrenal hyperplasia Conns syndrome Adrenal carcinoma
58
Features of primary hyperaldosteronism
Hypertension Hypokalaemia - due to increased aldosterone Alkalaosis - due to raised bicarbonate associated with increased aldosterone
59
Diagnostic test in primary hyperaldosteronism
Plasma aldosterone/renin ratio - shows high aldosterone and low renin ratio
60
Management of primary hyperaldosteronism
Bilateral adrenocortical hyperplasia - spironolactone | Adrenal adenoma - surgery
61
What is Addison’s disease
Autoimmune destruction of adrenal glands | Leads to reduction in cortisol and aldosterone production
62
Clinical features of Addison’s
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
Blood results in Addison’s
Hyponatraemia Hyperkalamia Hypoglycaemia
64
Diagnostic test for Addison’s
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
Medical management of Addison’s
Glucocorticoid replacement - hydrocortisone | Mineralcorticoid replacement - fludrocortisone
66
Advise on medication changes for Addison’s patients when they have intercurrent illness
Double glucocorticoid dose (double hydrocortisone)
67
Management of Addisonian crisis
IV hydrocortisone | IV saline with dextrose
68
What is Cushing’s syndrome
Symptoms due to excess cortisol
69
Common causes of Cushing’s syndrome
Cushings disease - pituitary secreting ACTH Ectopic ACTH production e.g, small cell lung cancer Adrenal adenoma Iatrogenic - excess steroids
70
Differentiating between causes of cushings
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
What is a phaeochromocytoma?
Catecholamine secreting tumour of the adrenal glands
72
Symptoms of phaeochromocytoma
``` Hypertension Headache Palpitations Sweating Anxiety ```
73
Diagnosis of phaeochromocytoma
24hr collection of urinary meranephrines
74
Management of phaeochromocytoma
Surgery | Pt must be stabilised with alpha blocker first e.g, phenoxybenzamine
75
MEN type 1
Parathyroid hyperplasia Pituitary hyperplasia Pancreas - e.g, insulinoma, gastrinoma
76
MEN Type IIa
Parathyroid hyperplasia | Phaeochromocytoma
77
MEN type IIb
Thyroid cancer | Phaeochromocytoma
78
What is kallman’s syndrome
Hypogonadotrophic hypogondism X linked recessive trait Leads to delayed puberty in boys
79
Hormone levels in Kallmann syndrome
Low testosterone | Low LH and FSH
80
Clinical presentation of kallman’s syndrome
Delayed puberty Anosmia Reduced sex hormones Normal or above average height
81
What is Klinefelter syndrome
Genetic disease causing XXY in men
82
Hormone levels in Klinefelter syndrome
Low testosterone | Increase LH and FSH
83
Clinical features of Klinefelter syndrome
``` Taller than average Lack of secondary sexual characteristics Small, firm testes Infertility Gynaecomastia ```

Year 5 (17 decks)

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