Endocrinology, breast, urology, renal Flashcards
How does Type 2 Diabetes (T2D) differ from Type 1 Diabetes?
T2D involves decreased insulin secretion and increased insulin resistance, while T1D is characterized by autoimmune destruction of β cells.
What is the underlying cause of Type 1 Diabetes (T1D)?
Insulin deficiency due to autoimmune destruction of pancreatic β cells
What causes Type 2 DM in the young
Maturity-onset diabetes of the young
What are the diagnostic criteria for diabetes based on fasting glucose levels?
≥7 mmol/L.
How is diabetes diagnosed using OGTT (Oral Glucose Tolerance Test)?
A diagnosis is made if glucose levels are ≥11.1 mmol/L.
What level of HbA1c indicates diabetes?
≥48 (6.5%).
Define Prediabetes based on HbA1c.
42-47
What are the symptoms of hypoglycemia?
Sweating, shaking, anxiety, palpitations, hunger, nausea.
What are the symptoms of neuroglycopenia during hypoglycemia?
Confusion, slurred speech, visual disturbances, drowsiness, aggression.
Describe the characteristics of Diabetic Ketoacidosis (DKA).
Common in T1D, with symptoms including gradual drowsiness, vomiting, dehydration, Kussmaul’s respiration, confusion, and tachycardia.
What are the diagnostic criteria for DKA?
Hyperglycemia (>11.0 mmol/L), ketosis (blood ketone >3mmol/L or urine ketone ++), and acidosis (pH <7.3).
Outline the treatment steps for DKA.
Administer 0.9% sodium chloride 500mL boluses, then 1L over specific intervals. Use insulin, monitor glucose and ketone levels.
What is the significance of HbA1c in diabetes diagnosis?
HbA1c provides a 3-month picture of glycemic control
Describe the mode of action of Metformin.
Metformin improves insulin sensitivity in the liver/muscle and suppresses hepatic gluconeogenesis.
What are the side effects of Metformin?
Nausea, diarrhea, and the risk of Metformin-Associated Lactic Acidosis
How does DDP4i (Sitagliptin) work in diabetes treatment?
It increases GLP-1, leading to the ‘incretin effect.’
What side effect is associated with DDP4i (gliptin)?
Pancreatitis and nasopharyngitis.
What is the mechanism of action of Sulfonylurea (Gliclazide)?
It enhances insulin secretion.
What is the primary side effect of Sulfonylureas?
Hypoglycaemia
Explain the action of GLP-1 mimetic (Exenatide injection).
Acts via the ‘incretin effect’ and is given if BMI >35 or >33 (Asian).
What is the preferred long-acting basal insulin in T1D?
Twice-daily insulin detemir.
What is the first intensification step in T2D treatment for HbA1c >58 (7.5%)?
Dual therapy.
What is the primary risk factor for gestational diabetes?
Obesity
What is the role of glucagon in glucose homeostasis?
Glucagon raises blood glucose levels by promoting glycogen breakdown in the liver.
How does chronic kidney disease affect insulin metabolism?
CKD can lead to insulin resistance and altered insulin metabolism
Explain the concept of diabetic nephropathy.
Diabetic nephropathy is kidney damage resulting from diabetes, marked by proteinuria, hypertension, and decreased kidney function.
How is diabetic retinopathy managed?
Management includes regular eye exams, blood sugar control, blood pressure management, and, if necessary, laser therapy or injections
How does smoking affect diabetes?
Smoking increases the risk of diabetes complications, including cardiovascular disease and peripheral vascular disease.
How is diabetic foot ulcers managed?
Management includes wound care, infection control, offloading pressure on the affected area, and, in some cases, surgical intervention.
What is the role of metformin in polycystic ovary syndrome (PCOS)?
Metformin is used in PCOS to improve insulin sensitivity and regulate menstrual cycles
What is the impact of diabetes on the microvasculature?
Diabetes can lead to microvascular complications, including retinopathy, neuropathy, and nephropathy, affecting small blood vessels.
What is the most common type of breast cancer?
Invasive ductal carcinoma is the most common type of breast cancer.
What are the risk factors for breast cancer?
BRCA1 or BRCA2 mutations, family history, previous benign breast disease, smoking, alcohol consumption, and exposure to unopposed estrogen.
Describe the clinical presentation of breast cancer.
Symptoms include a unilateral breast lump (irregular, non-mobile, hard, painless), nipple changes (inversion, Paget’s disease), and skin changes (Peau d’orange).
What is the diagnostic approach for breast cancer?
The triple assessment includes clinical examination, imaging (mammogram), and tissue diagnosis (biopsy).
What are the treatment options for breast cancer involving axillary lymph nodes?
Axillary node clearance is considered. Pre-op ultrasound is done, and if no lymphadenopathy, a negative sentinel node biopsy is performed; if lymphadenopathy is present, axillary node clearance is done.
What hormonal therapy is used for ER-positive pre/peri-menopausal breast cancer?
Tamoxifen
How is breast cancer managed surgically?
Surgery options include wide local excision + radiotherapy for smaller lesions and mastectomy + radiotherapy for larger or more advanced cases.
What hormonal therapy is used for ER-positive post-menopausal breast cancer?
Anastrozole, an aromatase inhibitor,
What is the recommended screening for breast cancer?
Mammograms every 3 years for women aged 47-73 years are recommended.
What are the clinical manifestations of hypothyroidism?
Symptoms include weight gain, cold intolerance, bradycardia, constipation, menorrhagia, and dry skin
Outline the symptoms associated with hyperthyroidism.
Hyperthyroidism symptoms encompass weight loss, heat intolerance, tachycardia, palpitations, diarrhea, and sweating
Compare Graves’ disease and toxic nodular goitre
Graves’ disease is characterized by a diffuse goitre with bruit, exophthalmos, ophthalmoplegia, and thyroid acropachy. Toxic nodular goitre presents as a solitary nodule or multinodular goitre.
What is Subclinical Hyperthyroidism, and when is treatment indicated?
Subclinical hyperthyroidism is usually asymptomatic but carries risks. Treatment is considered if symptomatic, >65y, post-menopausal, or having specific risk factors.
What is the cause of Subacute Thyroiditis/De Quervain’s and how is it managed?
Subacute thyroiditis is often post-viral. Management includes diclofenac for pain relief.
What antibodies are associated with Hashimoto’s thyroiditis?
Anti-TPO
Explain Sick Euthyroid Syndrome.
during systemic illness, leading to low T3/T4 levels despite normal/low TSH.
What is the most common type of thyroid cancer, and who does it commonly affect?
Papillary thyroid cancer is the most common and often affects young females. It has a favorable prognosis
List common drugs used in thyroid disorders and their indications.
Drugs include Carbimazole (hyperthyroidism), Levothyroxine (hypothyroidism), Propranolol (symptomatic control), Prednisolone (anti-inflammatory), Radioiodine (hyperthyroidism or cancer), Thyrotoxic drugs (ATDs, lithium, amiodarone).
Describe Follicular thyroid cancer and its distinguishing features.
Follicular thyroid cancer commonly affects middle-aged individuals
What is Medullary thyroid cancer, and what hormone does it produce?
Medullary thyroid cancer arises from parafollicular cells, produces calcitonin, and can be part of MEN-2a or MEN-2b.
How is thyroid cancer diagnosed, and what is the treatment?
Diagnosis involves blood tests, ultrasound, and fine-needle biopsy. Treatment includes total thyroidectomy, radioiodine, and levothyroxine. Monitoring involves thyroglobulin (Tg) and, if medullary, calcitonin.
What are common causes of midline neck lumps?
Midline neck lumps include goitre and thyroglossal cyst
Common causes of lateral neck lumps
Lymph nodes, branchial cysts, and cystic hygroma.
What movements help differentiate a thyroglossal cyst from other neck lumps?
typically don’t move on swallowing but do move on tongue protrusion.
Explain the term “block-and-replace” in the context of hyperthyroidism treatment.
Block-and-replace” involves simultaneously giving antithyroid drugs (block) and thyroid hormone replacement (replace) to maintain thyroid hormone levels within a normal range.
How does PTH influence calcium and phosphate homeostasis?
PTH increases osteoclast activity, activates vitamin D for GI calcium absorption, and enhances renal calcium reabsorption. It inhibits phosphate reabsorption in the kidneys.
Describe the primary treatment for primary hyperparathyroidism
Parathyroidectomy
What is the primary cause of secondary hyperparathyroidism, and how is it managed?
Chronic kidney disease is a leading cause. Management involves cinacalcet, cholecalciferol, and phosphate binders.
Explain how tertiary hyperparathyroidism differs from secondary hyperparathyroidism.
Tertiary hyperparathyroidism is a long-term form of secondary hyperparathyroidism. Parathyroidectomy is performed after prolonged secondary hyperparathyroidism.
How is hypercalcaemia managed?
Management involves fluids, loop diuretics, bisphosphonates, calcitonin.
What are the characteristics of SIADH?
SIADH is characterized by high ADH and hyponatraemia.
Hypercalcaemia causes
Primary and tertiary hyperparathyroidism, cancer, thiazide diuretics, sarcoidosis, myeloma, and Paget’s disease
What is the treatment approach for SiADH?
fluid restriction and, if necessary, ADH antagonists like demeclocycline.
Differentiate between central diabetes insipidus (CDI) and nephrogenic diabetes insipidus (NDI).
CDI involves reduced ADH secretion, while NDI involves impaired kidney response to ADH.
Compare treatment of Cranial diabetes insipidus and nephrogenic DI
Desmopressin is used to treat CDI, and thiazide diuretics for NDI.
What is the primary cause of Addison’s disease in the UK, and what is the treatment during illness?
utoimmune adrenalitis (Addison’s disease) is the primary cause in the UK. During illness, double the hydrocortisone dose.
What is seen on bloods in Addison’s disease
Hyponatraemia, hyperkalaemia, metabolic acidosis
Cushing’s syndrome diagnosis
Low-dose and high-dose overnight dexamethasone suppression tests and plasma ACTH levels.
What are the common causes of Cushing’s syndrome?
Iatrogenic, adrenal adenoma, pituitary adenoma, ectopic production
What is the leading cause of primary hyperaldosteronism?
Adrenal adenoma (Conn’s syndrome)
Treatment of primary hyperaldosteronism (Conn’s)
Spironolactone +/- adrenalectomy
What is seen on bloods in Conn’s
Hypertension, mild acidosis, hypokalaemia
Outline the diagnosis and treatment of phaeochromocytoma.
Diagnosis involves 24h urinary metanephrines and CT. Treatment includes α-blockers (phenoxybenzamine), β-blockers (propranolol, labetalol), and laparoscopic adrenalectomy.
What is acromegaly, its common cause, and how is it managed?
Acromegaly is characterized by excess growth hormone. Pituitary adenoma is a common cause. Management involves transsphenoidal adenectomy and somatostatin analogues like octreotide.
1st line drugs in prolactinoma
Dopamine agonists like bromocriptine are the primary treatment.
1st line drugs in acromegaly
somatostatin analogues like octreotide.
What is seen in bloods in PCOS
high insulin and LH, leading to androgen production
Symptoms of PCOS
hypertension, hirsutism, acne, oligo/amenorrhoea, and metabolic syndrome features
Primary Hyperparathyroidism bloods
High PTH, high Ca, low PO4
Secondary Hyperparathyroidism:
High PTH, low Ca, high PO4 (e.g., CKD).
Tertiary Hyperparathyroidism:
high PTH, high Ca, high PO4.
Complications of CKD
Cardiovascular disease, anaemia, renal osteodystrophy, kidney stones.
Causes of CKD
Hypertension, diabetic nephropathy, infections, polycystic kidney disease.
Explain chronic graft failure in renal transplantation
Occurs after 6 months, antibody and T-cell mediated, leads to fibrosis in the transplanted kidney.
Define acute graft failure in renal transplantation.
Occurs within the first 6 months, T-cell mediated, reversible with steroids and immunosuppressants.
Indications for dialysis.
Metabolic acidosis, hyperkalaemia, fluid overload uraemia, uraemic pericarditis, acute intoxication
Stress incontinence definition
Stress: Increased abdominal pressure (e.g., laughing), common in females.
Stress incontinence treatment
Pelvic floor retraining
Urge incontinence definition
Detrusor overactivity, sudden urge, frequent incontinence.
Functional incontinence definition
Unable to reach the bathroom due to physical or mental reasons.
Overflow incontinence definition
Involuntary release from an overfull bladder without urge, common in males.
Define nephrotic syndrome
Proteinuria >3g, hypoalbuminaemia <30g/dL, oedema
Complications of haemodialysis
thrombosis, stenosis, infection.
Complications of peritoneal dialysis
Peritonitis
Complications of renal transplant
ejection and immunosuppressant issues e.g. SCC
Define minimal change disease and who it affects and its treatment
In children, normal light microscopy, responds to steroids.
Pre-renal causes of AKI
Due to factors before kidneys (e.g., hypovolaemia)
Explain AKI staging based on creatinine levels
Stage 1: Creatinine ≥1.5 x baseline.
Stage 2: Creatinine ≥2 x baseline.
Stage 3: Creatinine ≥3 x baseline.
Renal causes of AKI
Vasculitis, glomerulonephritis
Post-renal causes of AKI
Urinary tract obstruction (e.g., renal stone).
Membranous nephropathy definition
Thickened GBM, treated with ACEi/ARB and immunosuppressants.
What are the risk factors for prostate cancer?
Age >55, African-Caribbean, obesity.
Name the common medications for BPH.
Alpha-blockers (tamsulosin), 5-alpha-reductase inhibitors (finasteride).
What is the first-line treatment for lower UTI?
Nitrofurantoin or trimethoprim.
What is the treatment for minimal change disease?
Steroids.
Identify the characteristic feature of IgA nephropathy.
Episodic macroscopic hematuria, especially post-URTI.
Differentiate between seminoma and NSGCT in testicular cancer
Seminoma: LDH high, NSGCT: AFP high.
Identify common symptoms of kidney cancer.
Hematuria, flank pain, palpable abdominal mass.
Describe the characteristics of urine in pre-renal AKI
High urine osmolality, low urine sodium.
What are the common causes of pre-renal acute kidney injury (AKI)?
Hypovolemia, renal artery stenosis, and sepsis.
Which antibody is seen in Hashimoto’s thyroiditis?
Anti thyroid peroxidase (TPO)
Is the goitre in Hashimoto’s thyroiditis (autoimmune hypothyroidism) painful / painless?
Painless
Which protein is seen in urine in multiple myeloma?
Bence Jones Protein
Which condition usually presents with anaemia, pathological fracture and renal dysfunction?
Multiple myeloma
What electrolyte abnormality is seen on U&Es in acute pancreatitis?
Hypocalcaemia
Which antibody is associated with drug-induced lupus?
Antihistone antibodies
Which drug (used in TB management) can cause drug-induced lupus?
Isoniazid
What is seen on US KUB in pyelonephritis?
Perinephric fat stranding
Use of which antibiotic can cause achilles tendon rupture?
Ciprofloxacin
Which LFT is disproportionately raised in cholestatic liver injury?
ALP
What causes deranged LFTs in blood loss / acute hypoperfusion
Ischaemic hepatitis
Which cancer is CA 125 a tumour marker for?
Ovarian cancer
Which cancer is CA 19-9 a tumour marker for?
Pancreatic cancer
Which cancer is CEA a tumour marker for?
Bowel cancer
Which cancer is AFP a tumour marker for?
Liver cancer and germ cell tumours
Which cancer is HER2 a tumour marker for?
Breast cancer
Most common type of lymphoma in the UK
Diffuse large B cell lymphoma
Which surgical procedure is used in anal fissure if trial of laxatives and fibre lubricant fails?
Sphincterotomy
What symptoms are seen in anal fissure?
Pain on defecation, Hx of constipation / anal sex, fresh blood
Symptoms of pyelonephritis
Increased urination, fever, low-grade back pain and rigors
Most common pathogen causing pyelonephritis
E coli
What do patients on metformin need to do after a contrast CT scan and why?
Metformin should be discontinued for 48 hours following a contrast CT due to the risk of renal impairment
Most common type of prostate cancer
Adenocarcinoma
What clinical pattern is seen in anti-GBM
haemoptysis + AKI/proteinuria/haematuria
Which type of cancer has a “starry sky” appearance on lymph node biopsy
Burkitt Lymphoma
Which biologic is used alongside R-CHOP chemotherapy in lymphoma?
Rituximab
How is C-peptide used to differentiate between Type 1 DM and Type 2?
Low in Type 1, high in 2
Formula to calculate serum osmolality
(Na+ X 2) + glucose + urea
Blood test results in Cushing’s syndrome
Hypokalaemic metabolic alkalosis
What’s the diagnosis in thumb pain after repeated use e.g. in someone who sews?
Tenosynovitis
Which medication should be added to morbidly obese diabetic patients (BMI >35)
GLP1 mimetics e.g. exenatide, liraglultide. Switch one of their medication to this if they’re already receiving triple therapy.
Which diabetic medication should be avoided in heart failure?
Pioglitazones
What’s seen on ABG in DKA
Raised anion gap metabolic acidosis
Which clinical sign is associated with reactive arthritis?
Dactylitis
Which drug is used in renal colic for analgesia?
IM diclofenac
What can cause AKI after starting ACE inhibitors in young female patients?
Fibromuscular dysplasia
Complications of tumour lysis syndrome
Hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia
acute renal failure
Which type of cancer is associated with tumour lysis syndrome
Burkitt’s lymphoma
Symptoms of tumour lysis syndrome
Confusion and muscle cramps in legs following chemotherapy
What drug is given prior to chemotherapy in Burkitt’s lymphoma to reduce risk of tumour lysis syndrome
Rasburicase - catalyses the conversion of uric acid to allantoin to allow for easier renal excretion
Which virus is associated with Burkitt’s lymphoma
EBV (Epstein-Barr Virus)
Which cause of hyperthyroidism may present with a tender / painful goitre
Subacute (De Quervain’s) thyroiditis
Subacute (De Quervain’s) thyroiditis pattern of disease
Initially hyperthyroidism > longer term hypothyroidism
Antibody in antiphospholipid syndrome
Anticardiolipin antibody
Features of antiphospholipid syndrome
venous/arterial thrombosis
recurrent miscarriages
livedo reticularis
other features: pre-eclampsia, pulmonary hypertension
What medication should be first prescribed in Phaeochromocytoma whilst awaiting surgery?
Phenoxybenzamine, an alpha-receptor blocker
Features of phaeochromocytoma
Headaches, palpitations, sweating, and sustained hypertension
Diagnostic test for phaeochromocytoma
24 hours urinary collection of metanephrines
Which MEN group is associated with phaeochromocytoma
MEN II
What is phaeochromocytoma?
A catecholamine secreting tumour
What is Fournier’s gangrene?
Necrotising fasciitis of the genitalia or perineum
Which medication most commonly causes Fournier’s gangrene?
SGLT-2 inhibitors e.g. dapigaflozin
Most common cause of infection after renal transplant
Cytomegalovirus
Which thyroid cancer leads to raised calcitonin and who does it typically affect?
Medullary - middle aged women
Which malignancy is associated with Hashimoto’s thyroiditis?
MALT lymphoma
Which medication has been shown to reduce the rate of cyst growth and disease progression in ADPKD
Tolvaptan
How do you detect dehydration as a cause of decreased urinary output?
Urea that is proportionally higher than the rise in creatinine
Which cancers are most likely to cause bony mets?
Prostate (ment), breast (women)
Presenting symptoms of SLE
Fatigue
- Weight loss
- Arthralgia / joint pain
- Non-erosive arthritis
- Myalgia / muscle pain
- Fever
- (Photosensitive) malar rash
- Lymphadenopathy
- Splenomegaly
- Shortness of breath
- Pleuritic chest pain
- Mouth ulcers
- Hair loss
- Raynaud’s phenomenon
- Oedema (due to nephritis)
1st line DMARD in SLE
Hydroxychloroquine
Complications of SLE
- Coronary artery disease
- Hypertension
- Anaemia
- Pericarditis
- Pleuritis
- Pulmonary fibrosis / interstitial lung disease
- Lupus nephritis
- Psychosis / seizures / neuropsychiatric SLE
2 most specific tests for SLE
Anti-double stranded DNA and Anti-Smith
U&E abnormality to be worried about in rhabdomyolysis / AKI
Hyperkalaemia
What is seen in Waterhouse- Friderichsen syndrome ?
Diffuse haemorrhage of adrenal glands on CT scan in a patient with sepsis / coagulopathy - a very poor prognostic sign
Electrolyte abnormality in compression syndrome
Hyperkalaemia, secondary to muscle wasting / AKI
Antibodies seen in Grave’s
TSH Receptor Antibody
Most serious SE of carbimazole
Agranulocytosis
Why do CKD patients get renal anaemia
Decreased EPO production
Which part of the adrenal gland is responsible for adrenaline/noradrenaline secretion?
Medulla
Which part of the adrenal gland is responsible for aldosterone secretion?
Zona glomerulosa
Which part of the adrenal gland is responsible for cortisol secretion?
Zona fasciculata
Which part of the adrenal gland is responsible for androgen secretion?
Zona reticularis
Sarah’s mnemonic for adrenal gland and secretions
Make Good Sex, Go Find Rex (mineralocorticoids, glucocorticoids, sex hormones) => (Glomerulosa, fasciculata, reticularis)
Where are renal stones most likely to become lodged?
Pelviureteric junction / where renal pelvis becomes ureter
Crossing the pelvic brim
Vesicoureteric junction / where the ureter enters the bladder
Features of nephritic syndrome
Haematuria / oliguria / mild proteinuria / fluid retention or oedema
Causes of nephritic syndrome
- Goodpastures / anti GBM
- IgA nephropathy / Berger’s disease
- Membranous nephropathy
- Membranoproliferative glomerulonephritis
- Post-streptococcal glomerulonephritis
- Rapidly progressive glomerulonephritis / crescentic glomerulonephritis
- Henoch-Schonlein purpura
- Microscopic polyangiitis / granulomatosis with polyangiitis
- Lupus nephritis
Treatment of hyponatraemia in SiADH
Fluid restriction / demeclocycline or tolvaptan
Diagnostic test of choice in bladder cancer
Flexible cystoscopy
Medical management of Raynaud’s
Nifedipine
