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AMC MCQ > ENDOCRINOLOGY by Dr Cinitia > Flashcards

ENDOCRINOLOGY by Dr Cinitia Flashcards

1
Q

Hypothyroidism (Hashimoto Thyroiditis) CLINICAL FEATURES

A

Bilateral, firm, rubbery goitre

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2
Q

Hypothyroidism (Hashimoto Thyroiditis) FIRST INVESTIGATION (3):

A
  1. TSH
  2. US If nodule
  3. CT Scan if goitre is causing compression
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3
Q

Hypothyroidism (Hashimoto Thyroiditis) BEST INVESTIGATION (3):

A

1.Antithyroglobulin (TgAb)
2.Antithyroid peroxidase Ab (TPO)
3.Biopsy: Chronic lymphocytic thyroiditis

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4
Q

Hypothyroidism (Hashimoto Thyroiditis) TREATMENT

A
  1. Tx if TSH>7.
    Monitor tx at 3m, 6m, 1y. You start with low dose and you increase it progressively.
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5
Q

Myxedema coma CLINICAL FEATURES

A

Hypotension, hypoventilation, hypoglycaemia, hyponatraemia

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6
Q

Myxedema coma TREATMENT

A

IV Levothyroxine + IV hydrocortisone

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7
Q

Congenital hypothyroidism CLINICAL FEATURES

A

Macroglossia, harsh cry, dry skin, umbilical hernia

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8
Q

Congenital hypothyroidism FIRST INVESTIGATION

A

Neonatal Heel prick TSH is (NEXT) if hypotonic kid with large open ant fontanelle

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9
Q

Congenital hypothyroidism TREATMENT

A

Start thyroxine before 2 weeks of age

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10
Q

Subclinical hypothyroidism CLINICAL FEATURES

A

High TSH and normal T3, T4

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11
Q

Subclinical hypothyroidism FIRST INVESTIGATION

A

TSH

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12
Q

Subclinical hypothyroidism TREATMENT

A
  • TSH 5-10: Review TSH in 3 months
  • TSH>10: Levothyroxine
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13
Q

Sick Euthyroid Syndrome CLINICAL FEATURES

A

Decrease conversion from T4 to T3 so T3 will be low and T4, TSH, and reverse T3 could be normal or even high

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14
Q

Hyperthyroidism CLINICAL FEATURES

A

Fine tremor, proximal myopathy, frozen shoulder

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15
Q

Hyperthyroidism FIRST INVESTIGATION

A
  1. TSH
  2. Radioactive iodine uptake: -
    Low uptake: Thyroiditis -
    High uptake:
    Homogeneous (Graves), heterogenous (multiple- toxic multinodular goitre, single area-toxic adenoma)
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16
Q

Hyperthyroidism TREATMENT (4)

A

1.Carbimazole (Agranulocytosis)
2.Propylthiouracil (Risk of liver dx)
3.Surgery
4.Radioactive iodine (If CIs to surgery)

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17
Q

Graves Disease FIRST INVESTIGATION

A

TSH

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18
Q

Graves Disease BEST INVESTIGATION

A

TSH receptor antibody, anti- TPO

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19
Q

Graves Disease TREATMENT

A

Same than above + Tx of vision threatened:
1. IV Methylprednisolone
2. Oral high dose prednisolone

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20
Q

Hyperthyroidism in pregnancy TREATMENT

A
  1. Propylthiouracil in 1st trimester
  2. Carbimazole in 2nd/3rd trimester
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21
Q

Subacute thyroiditis (De Quervains) CLINICAL FEATURES

A

Pain/Tenderness, fever

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22
Q

Subacute thyroiditis (De Quervains) FIRST INVESTIGATION

A
  1. TSH
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23
Q

Subacute thyroiditis (De Quervains) BEST INVESTIGATION

A
  1. ESR>50mm/Hr
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24
Q

Subacute thyroiditis (De Quervains) TREATMENT

A
  1. Analgesia: NSAIDs
  2. Severe: Oral prednisolone.
  3. If constitutional symptoms: BB
    NOT antithyroid medication
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25
Q

Thyroid Storm CLINICAL FEATURES

A

Anxiety, weight loss, hyperpyrexia, tachycardia

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26
Q

Thyroid Storm TREATMENT

A

Hospital admission: IV saline, IV steroids

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27
Q

Thyroid Nodule CLINICAL FEATURES

A

Moves with swallowing, can cause compression.

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28
Q

Thyroid Nodule FIRST INVESTIGATION

A
  1. TSH -TSH Normal or
    High: Next: US. Next: FNA -TSH
    Low: Next T3 & T4. Next: Radioisotope scan and US. If cold nodule: FNA
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29
Q

Thyroid Nodule BEST INVESTIGATION

A
  1. FNAC
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30
Q

Retrosternal Goitre CLINICAL FEATURES

A

Compression

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31
Q

Retrosternal Goitre FIRST INVESTIGATION

A
  1. X-ray
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32
Q

Retrosternal Goitre BEST INVESTIGATION

A

CT of neck and upper chest

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33
Q

Retrosternal Goitre TREATMENT

A

Total thyroidectomy

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34
Q

Thyroid Cancer CLINICAL FEATURES (4)

A

-Hoarseness
-Psammoma bodies: PapillaryThyroid Ca
-Follicular cells: always do excisional biopsy bc it’s hard to diff between non and carcinoma. - Parafollicular C cells (secrete calcitonin): Medullary thyroid Ca. MEN2.
-Rapidly growing: Anaplastic

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35
Q

Thyroid Cancer FIRST INVESTIGATION

A
  1. TFT
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36
Q

Thyroid Cancer BEST INVESTIGATION

A
  1. FNAB
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37
Q

Hyperparathyroidism CLINICAL FEATURES

A

HyperCalcaemia (Stones, polyuria, hypoPh, constipation, psych disturbance)

38
Q

Hyperparathyroidism FIRST INVESTIGATION

A
  1. Ca
39
Q

Hyperparathyroidism BEST INVESTIGATION

A
  1. PTH
40
Q

Hyperparathyroidism TREATMENT

A

Qx for Ca<0.25, nephrolithiasis, bone erosions, reduction in bone mass, reduction of Cr clearance.

41
Q

Diabetes Mellitus Type 1 FIRST INVESTIGATION (2)

A

Urine Dipstick for sugar.
Other: Abs against Hashimoto

42
Q

Diabetes Mellitus Type 1 BEST INVESTIGATION

A

FSB

43
Q

Diabetes Mellitus Type 1 TREATMENT (4)

A
  1. Admission
  2. Insulin
  3. Follow up w/ HbA1c e/3m (<7%)
  4. Vaccine for Pneumococcal, Influenza, and dTPa
44
Q

Diabetes Mellitus Type 2 FIRST INVESTIGATION

A

RBG≥11.1

45
Q

Diabetes Mellitus Type 2 BEST INVESTIGATION

A

FBG:
- If ≥7: DM
- If 5.5-6.9->OGTT. If
OGTT≥11.1: DM, if 7.8-11
Retest in a year, if <7.8 with
FBG 6.1-6.9 retest in a year, OGTT≤7.7 Retest in 3 years - HbA1c: ≥6.5: DM, 6-6.4: retest in 1y, ≤5.9 retest in 3
years

46
Q

Diabetes Mellitus Type 2 TREATMENT (5):

A

1.Lifestyle modifications for 3-6m
2.Metformin
3.Metformin+Sulfonilurias or acarbose
4.Insulin (If HbA1c>9%)
5.Follow-up with HbA1c e/3m (<7) except in risk of hypoglycaemia (7-8)
- Pioglitazone - bladder Ca
- Rosiglitazone-HF

47
Q

Diabetic Nephropathy TREATMENT (2)

A

Annual screening for albuminuria
Photocoagulation

48
Q

Diabetic Retinopathy FIRST INVESTIGATION

A

Screening e/2y.
- If nonproliferative dx: e/1y
- If proliferative dx: Urgent referral
- If vitreous
hemorrhage: Same day referral

49
Q

Diabetic Retinopathy TREATMENT

A

Photocoagulation

50
Q

Diabetic Neuropathy FIRST INVESTIGATION

A
  1. Check Vitamin B12 levels (Metformin can decrease them)
51
Q

Diabetic Neuropathy TREATMENT

A
  1. Amitriptyline
  2. Gabapentin/Pregabalin
52
Q

Diabetic Ketoacidosis CLINICAL FEATURES

A

MCC: Infections, HypoK, HypoNa, ketones

53
Q

Diabetic Ketoacidosis FIRST INVESTIGATION

A

MCC: Infections, HypoK, HypoNa, ketones

54
Q

Diabetic Ketoacidosis BEST INVESTIGATION

A

Ketones in serum or urine

55
Q

Diabetic Ketoacidosis TREATMENT (2)

A
  1. Rehydration (NS IV 15-20mL/kg)
  2. Short acting insulin IV
56
Q

Hypoglycaemia CLINICAL FEATURES

A

Early dumping: 30 mins-1hr: Tx diet
Late dumping:1-3 hrs after meals

57
Q

Hypoglycaemia TREATMENT

A

Conscious:
-<1yr: Milk, >1yr something sweet Unconscious: If Glucose<3
-Children: 10% dextrose
-Adults: 50% Dextrose
Next: IM Glucagon

58
Q

Hyperglycaemic hyperosmolar nonketotic Coma CLINICAL FEATURES

A

Glucose >33 with normal ketones

59
Q

Hyperglycaemic hyperosmolar nonketotic Coma TREATMENT (2)

A
  1. Rehydration (NS 0.45%)
  2. Insulin with caution
60
Q

Addison’s dx CLINICAL FEATURES

A

Hypotension, weakness, fatigue, HypoNa, HyperK

61
Q

Addison’s dx FIRST INVESTIGATION

A

Cortisol level

62
Q

Addison’s dx BEST INVESTIGATION

A

Short synacthen stimulation test

63
Q

Addison’s dx TREATMENT

A
  1. IV line with fluids
    - Dx made: Hydrocortisone
    - No Dx: Dexamethasone
64
Q

Hyperaldosteronism CLINICAL FEATURES

A

Hypertension, HyperNa, HypoK. Renin low if primary. Renin high if secondary

65
Q

Hyperaldosteronism FIRST INVESTIGATION

A

Plasma aldosterone and renin.
- Next: Adrenal CT if primary

66
Q

Hyperaldosteronism TREATMENT (2)

A
  1. Spironolactone/Amiloride
  2. Surgery to remove adenoma
67
Q

Cushing Syndrome CLINICAL FEATURES

A

Hyperglycaemia, Hypertension, amenorrhoea, weakness, obesity, HyperNa, HypoK

68
Q

Cushing Syndrome FIRST INVESTIGATION (3)

A
  1. 24-hour cortisol
  2. Early morning cortisol levels following a low dose dexamethasone suppression test
  3. ATCH
69
Q

Cushing Syndrome BEST INVESTIGATION

A
  1. High dose dexamethasone suppression test. 2. Cranial CT/MRI
70
Q

Cushing Syndrome TREATMENT

A

Surgery. Give steroids if ACTH is supressed

71
Q

Pheochromocytoma CLINICAL FEATURES

A

Headache, palpitations, diaphoresis

72
Q

Pheochromocytoma FIRST INVESTIGATION

A
  1. 24-hour free catecholamines (increased VMA)
73
Q

Pheochromocytoma BEST INVESTIGATION

A
  1. Plasma metanephrines +MRI
74
Q

Pheochromocytoma TREATMENT (3)

A
  1. Alpha Blockers (Phenoxybenzamine)
  2. BB
  3. Qx
75
Q

Adrenal Tumours TREATMENT

A
  • <4cm and benign: Follow up in 3-6m - ≥4cm and suspicious: Adrenalectomy
76
Q

Pituitary Tumour FIRST INVESTIGATION (2)

A
  1. TFT
  2. CT
77
Q

Pituitary Tumour BEST INVESTIGATION

A
  1. MRI
78
Q

Pituitary Tumour TREATMENT

A

-If <1cm: Review in 1y
-If ≥1cm: with visual field symptoms: Transphenoidal resection

79
Q

Hyperprolactinaemia CLINICAL FEATURES

A

Reduced libido, amenorrhoea, erectile dysfunction

80
Q

Hyperprolactinaemia FIRST INVESTIGATION

A
  1. Prolactin:
    - >5000: Prolactinoma
    - <5000: other causes
81
Q

Hyperprolactinaemia BEST INVESTIGATION

A
  1. MRI
82
Q

Hyperprolactinaemia TREATMENT (2)

A

1.Dopamine agonist (Cabergoline, bromocriptine)
2.Surgery

83
Q

Acromegaly CLINICAL FEATURES

A

Spade like hands, frontal bossing, greasy skin, thickened palms, increased shoe size, heteronymous hemianopia

84
Q

Acromegaly FIRST INVESTIGATION

A
  1. IGF-1.
  2. Measurement of GH following OGTT. If GH is no supressed by glucose, acromegaly
85
Q

Acromegaly BEST INVESTIGATION

A

Pituitary MRI

86
Q

Diabetes Insipidus CLINICAL FEATURES

A

Low ADH, HyperNa, HypoK

87
Q

Diabetes Insipidus FIRST INVESTIGATION

A
  1. Plasma Na and osmolality
88
Q

Diabetes Insipidus BEST INVESTIGATION

A

Water deprivation test: - In primary polydipsia osmolarity will go back to normal. Desmopressin administration to see if its central (Osm increases) or nephrogenic

89
Q

Diabetes Insipidus TREATMENT

A

1.Central: Desmopressin
2.Nephrogenic: Solute restriction and thiazides

90
Q

SIADH CLINICAL FEATURES

A

High ADH, HypoNa, concentrated urine. Caused by SSRI, morphine, surgery, etc

91
Q

SIADH FIRST INVESTIGATION

A
  1. Plasma Na and osmolality
92
Q

SIADH TREATMENT (3)

A

1.Water restriction
2.Hypertonic saline if pt is severely symptomatic.
3. Demeclocycline

AMC MCQ (55 decks)

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