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Medicine for Finals > Endocrinology and Clinical Biochemistry > Flashcards

Endocrinology and Clinical Biochemistry Flashcards

1
Q

hypokalaemia: symptoms

A
  • muscle weakness
  • hypotonia
  • palpitations
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2
Q

hypokalaemia: causes

A
  • iatrogenic (fluids)
  • type 1 or 2 RTA
  • thiazide or loop diuretics
  • hyperaldosteronism
  • hypomagnesaemia
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3
Q

hypokalaemia: key investigation(s)

A
  • Mg
  • ECG
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4
Q

hypokalaemia: management

A

Mg replacement, then IV K replacement up to a maximum 10mmol/hr

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5
Q

hyperkalaemia: symptoms

A
  • tachycardia
  • palpitations
  • chest pain
  • SOB
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6
Q

hyperkalaemia: causes

A
  • pseudohyperkalaemia
  • iatrogenic (fluids)
  • renal disease (CKD or Type 4 RTA)
  • Addison’s disease (hypoaldosteronism)
  • potassium-sparing diuretics, NSAIDs, ACEi, trimethoprim
  • internal redistribution due to acidosis, low insulin, burns, rhabdomyolysis, tumour lysis syndrome, digoxin
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7
Q

hyperkalaemia: key investigation(s)

A
  • consider repeat
  • ECG
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8
Q

hyperkalaemia: management

A
  • calcium gluconate (cardiac protection)
  • IV insulin & dextrose or salbutamol (redistribute)
  • Lokelma or calcium resonium (eliminate)
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9
Q

hypernatraemia: symptoms

A
  • lethargy
  • weakness
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10
Q

hypernatraemia: causes

A

Hypervolaemia
- iatrogenic (fluids)
- hyperaldosteronism

Hypovolaemia
- dehydration
- osmotic diuresis
- diarrhoea
- loop diuretic

Euvolaemia
- diabetes insipidus (central or nephrogenic)

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11
Q

diabetes insipidus: causes

A

Central = pituitary tumour or haemorrhage

Nephrogenic = hypercalcaemia, lithium, post-obstructive diuresis

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12
Q

diabetes insipidus: investigation

A

8h water deprivation test causes increased plasma osmolality but stable (low) urine osmolality.

If desmopressin causes increased urine osmolality, indicates central cause

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13
Q

diabetes insipidus: management

A

central = desmopressin
nephrogenic = salt restriction and thiazides

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14
Q

hyponatraemia: symptoms

A
  • confusion
  • lethargy
  • weakness
  • seizure
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15
Q

hyponatraemia: causes

A

Normal osmolality:
- pseudohyponatraemia
- TURP syndrome

Hypervolaemia
- renal, heart or liver failure
- hypothyroidism
- nephrotic syndrome

Hypovolaemia:
- diuretics
- Addison’s disease
- GI losses
- burns

Euvolaemia:
- SIADH

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16
Q

SIADH: causes

A
  • haemorrhage or thrombosis
  • meningitis
  • GBS
  • post-operative
  • antipsychotics or anticonvulsants
  • ectopic source (small cell lung cancer)
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17
Q

hypernatraemia: key investigation(s)

A

urine output and osmolality (distinguishes renal vs. extra-renal fluid losses)

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18
Q

hyponatraemia: investigations

A

urinary sodium (distinguishes renal vs. extra-renal losses)

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19
Q

SIADH: management

A
  • fluid restriction
  • tolvaptan
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20
Q

hyper- and hyponatraemia: management

A
  • correct reversible causes
  • consider hypo/hypertonic fluids, correcting at same rate as onset to avoid central pontine demyelinosis
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21
Q

respiratory acidosis: causes

A
  • acute respiratory failure (e.g. asthma attack, opioids, benzodiazepines, acute obstruction)
  • COPD
  • paralysis
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22
Q

respiratory alkalosis: causes

A
  • hypoxia (e.g. PE, pneumonia, anaemia, HF)
  • anxiety
  • altitude sickness
  • aspirin
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23
Q

Anion Gap: calculation and normal range

A

(Na + K) - (Cl + HCO3)

12-16mmol/L

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24
Q

normal anion gap metabolic acidosis: causes

A
  • GI loss of HCO3 (diarrhoea, pancreatic fistula, ileal conduit)
  • renal tubular acidosis
  • acetazolamide
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25
raised anion gap metabolic acidosis: causes
- aspirin - ethylene glycol - methanol - metformin - liver failure - DKA
26
metabolic alkalosis: causes
- vomiting - loop diuretics - liquorice - hyperaldosteronism (associated with hyperK)
27
primary hyperparathyroidism: causes
parathyroid adenoma or hyperplasia
28
primary hyperparathryoidism: findings
PTH - raised Ca - raised Pi - low
29
secondary hyperparathyroidism: causes
- Renal failure (pathogenesis is failure of phosphate retention and Vit D activation) - Low vitamin D
30
secondary hyperparathyroidism: findings
Vit D - low Pi - high PTH - high Ca - low in end-stage
31
tertiary hyperparathyroidism: causes
Long-term secondary hyperparathyroidism, due to which the parathyroid glands begin to act autonomously
32
tertiary hyperparathyroidism: findings
PTH - very high Ca - high
33
secondary hyperparathyroidism: management
- Vit D supplementation (alfacalcidol in CKD) - Pi binders - Consider Ca replacement - Cinacalcet
34
malignant hyperparathyroidism: causes
Small cell lung cancer Breast cancer Renal cell carcinoma
35
primary hypoparathyroidism: causes
- iatrogenic - congenital (Di George) - Autoimmune
36
Primary hypoparathyroidism: features
PTH - low Ca - low Pi - high
37
Secondary hypoparathyroidism: causes
- surgery or radiation - hypomagnesaemia
38
Pseudohypoparathyroidism: findings
Ca - low (due to failure of target organs to respond to PTH) PTH - may be high
39
Pseudopseudohypoparathyroidism
Hypocalcaemia due to mutation in GNAS gene (AD)
40
hypercalcaemia: symptoms
- bones (pain and fractures) - stones (renal stones and nephrogenic DI) - groans (abdo pain, constipation, nausea) - psychic overtones (depression)
41
hyperthyroidism: management
Carbimazole, either up-titrate to effect or block + replace approach (give levothyroxine) In Grave's Disease, treat for 12-18mo then withdraw. 50% relapse, in which case consider radioiodine or surgery.
42
hypothyroidism: management
levothyroxine, aim to normalise TSH
43
Addisonian crisis: presentation
- hypotensive shock - tachycardia - pale, clammy, cold - oliguria
44
Addisonian crisis: management
- IV fluids - IV hydrocortizone - IV dextrose Treat the cause
45
Addison's Disease: management
hydrocortisone (increase dose on sick days) fludrocortisone (no sick day rules)
46
Cushing's Syndrome: management
- medication review - for Cushing's Disease: pituitary surgery - adrenal resection
47
hyperaldosteronism: management
- spironalactone (switch to eplerenone if gynaecomastia, impotence, mentrual dysfunction) - for Conn's Disease: adrenelectomy
48
Adrenal insufficiency: causes
- Addison's Disease (autoimmune) - Secondary causes (steroid withdrawal, TB, Waterhouse-Friderichson syndrome, CMV, infiltrating cancer, Sheehan syndrome)
49
Cushing's syndrome: causes
- Cushing's Disease (ACTH producing pituitary tumour) - Ectopic ACTH (small cell lung cancer, carcinoid) - benign adrenal adenoma or adrenal carcinoma - iatrogenic (steroid therapy)
50
hyperaldosteronism: causes
- Conn's Disease (bilateral adrenocortical adenoma) - Bilateral adrenal hyperplasia - Secondary causes (renal hypoperfusion)
51
hyperthyroidism: causes
- Grave's Disease (anti-TSHr, eye disease & pretibial myxoedema) - Toxic multinodular goitre or adenoma - de Quervain's thyroiditis (post-viral) - amiodarone, lithium - post-partum
52
hypothyroidism: causes
- primary atrophic thyroiditis - Hashimoto's thyroiditis (autoimmune infiltrate, goitre) - iodine deficiency - iatrogenic (post-thyroidectomy or radioiodine)
53
DKA: management
1. Fluids 2. Check potassium and supplement in 2nd and 3rd bag if required 3. Insulin 0.1unit/kg/hour
54
DKA: criteria
hyperglycaemia > 11mmol/l ketosis >3mmol/l acidosis pH <7.3
55
DKA: resolution criteria
pH >7.3 ketones <0.6mmol/l bicarbonate >15mmol/l
56
HHS: criteria
hyperglycaemia >35mmol/L Osmolality >340mOsM/kg hypernatraemia
57
Type 1 (distal) RTA: causes
- idiopathic - AID/inflammatory diseases (RA, SLE, Sjogren's) - analgesic nephropathy
58
Type 2 (proximal) RTA: causes
- idiopathic - Fanconi syndrome - Wilson's Disease - cystinosis - tetracyclines - carbonic anhydrase inhibitors
59
Type 4 RTA: causes
- hypoaldosteronism - diabetes mellitus
60
Type 1 (distal) RTA: findings
- metabolic acidosis - hypokalaemia - hypercalciuria (= renal stones)
61
Type 2 (proximal) RTA: findings
- metabolic acidosis - hypokalaemia - osteomalacia (low Vit D)
62
Type 4 RTA: findings
- metabolic acidosis - hyperkalaemia

Medicine for Finals (10 decks)

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