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Phase 2a - Endocrinology > Endocrinology Conditions A > Flashcards

Endocrinology Conditions A Flashcards

1
Q

Diabetes Mellitus Type 1 - Description

A

decreased insulin secretion

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2
Q

Diabetes Mellitus Type 1 - Causes (1)

A

1) autoimmunity (90% of HLA-DR3/HLA-DR4)

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3
Q

Diabetes Mellitus Type 1 - Pathophysiology (2)

A

1) autoimmune destruction of β cells in pancreas islet of Langerhans
2) decreased insulin secretion

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4
Q

Diabetes Mellitus Type 1 - Symptoms (6)

A

1) polyuria*
2) polydipsia*
3) weight loss
4) hunger
5) fatigue
6) blurred vision

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5
Q

Diabetes Mellitus Type 1 - Signs (4)

A

1) acute onset (<1 month)
2) ketosis (pear drop breath)
3) Caucasian
4) child/adolescent (esp. 5-15)

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6
Q

Diabetes Mellitus Type 1 - Complications (9)

A

1) vascular disease
2) nephropathy
3) neuropathy (30% painful)
4) retinopathy
5) cataracts
6) diabetic ketoacidosis (uncontrolled)
7) hypoglycaemia (iatrogenic)
8) infection (e.g. thrush, UTI)
9) autoimmune associations (e.g. Hashimoto’s thyroiditis, Addison’s disease, Coeliac disease)

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7
Q

Diabetes Mellitus Type 1 - Investigations (2/2)

A 
initial
1) random plasma glucose* (>11mM)
2) Hb1Ac (>48mmol/mol, >6.5%)
consider
1) fasting plasma glucose (>7mM) (follow-up)
2) glucose tolerance test (rarely used)
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8
Q

Diabetes Mellitus Type 1 - Management (6/4/0)

A 
conservative
1) dietary advice
2) smoking cessation
3) alcohol control
4) regular exercise
5) monitor glucose
6) monitor Hb1Ac
medical
1) basal-bolus insulin (1st line)
2) pre-meal insulin (adjunct)
3) pre-meal amylin (adjunct)
4) fixed-dose insulin (2nd line)
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9
Q

Diabetes Mellitus Type 2 - Description

A

decreased insulin secretion and efficacy

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10
Q

Diabetes Mellitus Type 2 - Risk Factors (10)

A

1) family history
2) Afro-Caribbean
3) Hispanic
4) Asian
5) old age
6) obesity
7) physical inactivity
8) pre-diabetes
9) gestational diabetes
10) hypertension

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11
Q

Diabetes Mellitus Type 2 - Pathophysiology (4)

A

1) dysfunction of β cells in pancreas islet of Langerhans
2) decreased insulin secretion
3) peripheral resistance to insulin
4) decreased insulin efficacy

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12
Q

Diabetes Mellitus Type 2 - Symptoms (3)

A

1) asymptomatic*
2) fatigue
3) blurred vision

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13
Q

Diabetes Mellitus Type 2 - Complications (7)

A

1) vascular disease
2) nephropathy
3) neuropathy (30% painful)
4) retinopathy
5) cataracts
6) hypoglycaemia (iatrogenic)
7) infection (e.g. thrush, UTI)

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14
Q

Diabetes Mellitus Type 2 - Investigations (2/2)

A 
initial
1) random plasma glucose* (>11mM)
2) Hb1Ac (>48mmol/mol, >6.5%)
consider
1) fasting plasma glucose (>7mM) (follow-up)
2) glucose tolerance test (rarely used)
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15
Q

Diabetes Mellitus Type 2 - Management (6/3/0)

A 
conservative
1) dietary advice
2) smoking cessation
3) alcohol control
4) regular exercise
5) monitor plasma glucose
6) monitor Hb1Ac
medical
1) metformin*
2) statin
3) antihypertensive (e.g. thiazide diuretic)
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16
Q

Diabetes Mellitus Type 2 - Management (Failed Hb1Ac Targets) (6)

A

1) pioglitazone
2) sulfonylurea
1) GLP-1 receptor agonist
4) SGLT-2 inhibitor
5) DPP-4 inhibitor
6) insulin (last resort)

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17
Q

Diabetic Ketoacidosis - Description

A

increased plasma ketone bodies

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18
Q

Diabetic Ketoacidosis - Risk Factors (3)

A

1) uncontrolled diabetes mellitus (esp. type 1)
2) infection
3) myocardial infarction

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19
Q

Diabetic Ketoacidosis - Pathophysiology (5)

A

1) decreased insulin secretion
2) increased lipolysis
3) increased hepatic fatty acid metabolism
4) increased plasma ketone bodies
5) decreased plasma pH

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20
Q

Diabetic Ketoacidosis - Symptoms (8)

A

1) polyuria
2) polydipsia
3) abdominal pain
4) nausea
5) vomiting
6) anorexia
7) weight loss
8) weakness

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21
Q

Diabetic Ketoacidosis - Signs (5)

A

1) acute onset (<1 week)
2) Kussmaul’s breathing (deep, laboured breathing)
3) tachycardia
4) hypotension
5) dehydrated

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22
Q

Diabetic Ketoacidosis - Complications (6)

A

1) acute respiratory distress syndrome
2) aspiration pneumonia
3) thromboembolism
4) hypoglycaemia (insulin)
5) hypokalaemia (insulin)
6) cerebral oedema (rehydration)

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23
Q

Diabetic Ketoacidosis - Investigations (5/0)

A

initial

1) plasma ketones* (>3mM)
2) random plasma glucose (>13.9mM)
3) ABG (pH<7.3, HCO3-<15mM)
4) UnE
5) serum osmolality

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24
Q

Diabetic Ketoacidosis - Management (1/5/0)

A 
conservative
1) ICU admission
medical
1) IV fluids (3L in 1st 3 hours)
2) potassium phosphate (replace electrolytes)
3) sodium bicarbonate (metabolic acidosis)
4) insulin
5) vassopressor (DA/NA)
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25
Q

Hyperosmolar Hyperglycaemic State - Description

A

highly increased plasma glucose and osmolality without ketosis

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26
Q

Hyperosmolar Hyperglycaemic State - Risk Factors (3)

A

1) uncontrolled diabetes mellitus (esp. type 2)
2) infection
3) myocardial infarction

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27
Q

Hyperosmolar Hyperglycaemic State - Symptoms (9)

A

1) altered mental status
2) polyuria
3) polydipsia
4) abdominal pain
5) nausea
6) vomiting
7) anorexia
8) weight loss
9) weakness

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28
Q

Hyperosmolar Hyperglycaemic State - Signs (5)

A

1) acute onset (<1 week)
2) Kussmaul’s breathing (deep, laboured breathing)
3) tachycardia
4) hypotension
5) dehydration

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29
Q

Hyperosmolar Hyperglycaemic State - Complications (6)

A

1) acute respiratory distress syndrome
2) aspiration pneumonia
3) thromboembolism
4) hypoglycaemia (insulin)
5) hypokalaemia (insulin)
6) cerebral oedema (rehydration)

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30
Q

Hyperosmolar Hyperglycaemic State - Investigations (5/0)

A

initial

1) plasma ketones (normal)
2) random plasma glucose (>33.3mM)
3) ABG (pH>7.3, HCO3->15mM)
4) UnE
5) serum osmolality (>320mmol/kg)

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31
Q

Hyperosmolar Hyperglycaemic State - Management (1/4/0)

A 
conservative
1) ICU admission
medical
1) IV fluids (1-2L in 1st 3 hours)
2) potassium phosphate (replace electrolytes)
3) insulin
4) vassopressor (DA/NA)
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32
Q

Hypoglycaemia - Description

A

decreased plasma glucose

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33
Q

Hypoglycaemia - Causes (4)

A

1) insulin
2) sulphonylurea
3) kidney disease
4) liver disease

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34
Q

Hypoglycaemia - Symptoms (Autonomic) (3)

A

random plasma glucose <3.8mM

1) sweating
2) palpitations
3) tremor

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35
Q

Hypoglycaemia - Symptoms (Neuroglycopenic) (5)

A

random plasma glucose <2.8mM

1) confusion
2) drowsiness
3) altered behaviour
4) dysphasia
5) incoordination

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36
Q

Hypoglycaemia - Symptoms (Severe Neuroglycopenic) (2)

A

random plasma glucose <1.5mM

1) convulsions
2) coma

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37
Q

Hypoglycaemia - Investigations (3/0)

A

initial

1) random plasma glucose (<3.8mM)
2) RFT
3) LFT

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38
Q

Hypoglycaemia - Management (4/2/0)

A

conservative
1) adjust medications
2) patient education (recognition, treatment)
3) fast acting carbohydrate (15g) (3x 15 minute intervals)
4) long acting carbohydrate (glucose>4mM)
medical
1) IV glucose (unconscious or refractory)
2) IM glucagon (unconscious or refractory)

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39
Q

Hyperthyroidism - Description

A

increased T3/T4 secretion

40
Q

Hyperthyroidism - Causes (6)

A

1) Graves’ disease (2/3)
2) toxic adenoma
3) toxic multinodular goitre
4) drug induced (iodine, amiodarone)
5) post-partum thyroiditis
6) De Quervain’s (subacute) thyroiditis (post-infection)

41
Q

Hyperthyroidism - Pathophysiology (Graves’ Disease) (3)

A

1) autoimmune thyroid stimulating IgGs (TRAb) bind to TSH receptors
2) increased thyroid activation
3) increased T3/T4 secretion

42
Q

Hyperthyroidism - Symptoms (7)

A

1) weight loss
2) increased appetite
3) diarrhoea
4) heat intolerance
5) sweating
6) tremor
7) palpitations

43
Q

Hyperthyroidism - Signs (7)

A

1) goitre (diffuse-Graves’, solitary-adenoma, multinodular-MNG)
2) tachycardia
3) lid lag
4) lid retraction
5) onycholysis
6) palmar erythema
7) warm moist skin

44
Q

Hyperthyroidism - Complications (7)

A

1) angina
2) atrial fibrillation
3) heart failure
4) osteopenia—>osteoporosis
5) hypothyroidism (iatrogenic)
6) recurrent laryngeal nerve damage (thyroidectomy)
7) hypoparathyroidism (thyroidectomy)

45
Q

Hyperthyroidism - Complications (Thyroid Storm) (5)

A

severe hyperthyroidism

1) hyperthermia
2) vomiting
3) diarrhoea
4) confusion
5) coma

46
Q

Hyperthyroidism - Complications (Graves’ Disease) (3)

A

1) ophthalmology (inc. exophthalmos)
2) tibial myxoedema
3) acropachy

49
Q

Primary Hypothyroidism - Description

A

decreased T3/T4 secretion (99% of hypothyroidism)

50
Q

Primary Hypothyroidism - Causes (6)

A

1) Hashimoto’s thyroiditis
2) post-partum thyroiditis
3) iodine deficiency
4) drug induced (iodine, amiodarone)
5) iodine 131 therapy
6) thyroidectomy

51
Q

Primary Hypothyroidism - Pathophysiology (Hashimoto’s Thyroiditis) (3)

A

1) cytotoxic T cell mediated destruction of thyroid cell
2) autoantibodies to thyroid peroxidase and thyroglobulin
3) decreased T3/T4 secretion

52
Q

Primary Hypothyroidism - Symptoms (7)

A

1) weight gain
2) constipation
3) weakness
4) lethargy
5) bad mood
6) cold intolerance
7) amenorrhoea

53
Q

Primary Hypothyroidism - Signs (4)

A

1) bradycardia
2) hyporeflexia
3) hair loss
4) cool dry coarse skin

54
Q

Primary Hypothyroidism - Complications (1)

A

1) pregnancy problems

55
Q

Primary Hypothyroidism - Complications (Myxoedema Coma) (6)

A

severe hypothyroidism

1) hypothermia
2) hypoventilation
3) hypoglycaemia
4) hyponatraemia
5) seizures
6) coma

56
Q

Primary Hypothyroidism - Investigations (1/1)

A

initial
1) TFT* (high TSH, low T3/T4)
consider
1) serum TPOAb (Hashimoto’s, positive)

57
Q

Primary Hypothyroidism - Management (0/1/0)

A

medical

1) synthetic L-thyroxine

58
Q

Secondary Hypothyroidism - Description

A

decreased T3/T4 secretion (1% of hypothyroidism)

59
Q

Secondary Hypothyroidism - Causes (2)

A

1) pituitary adenoma

2) Sheehan’s syndrome

60
Q

Secondary Hypothyroidism - Pathophysiology (2)

A

1) low thyroid stimulation

2) low T3/T4 secretion

61
Q

Secondary Hypothyroidism - Symptoms (7)

A

1) weight gain
2) constipation
3) weakness
4) lethargy
5) bad mood
6) cold intolerance
7) amenorrhoea

62
Q

Secondary Hypothyroidism - Signs (4)

A

1) bradycardia
2) hyporeflexia
3) hair loss
4) cool dry coarse skin

63
Q

Secondary Hypothyroidism - Complications (1)

A

1) pregnancy problems

64
Q

Secondary Hypothyroidism - Complications (Myxoedema Coma) (6)

A

severe hypothyroidism

1) hypothermia
2) hypoventilation
3) hypoglycaemia
4) hyponatraemia
5) seizures
6) coma

65
Q

Secondary Hypothyroidism - Investigations (1/1)

A

initial
1) TFT* (low TSH, low T3/T4)
consider
1) pituitary MRI

66
Q

Secondary Hypothyroidism - Management (0/1/0)

A

medical

1) synthetic L-thyroxine

67
Q

Thyroid Carcinoma - Description

A

malignant proliferation of thyroid cells

68
Q

Thyroid Carcinoma - Types (4)

A

1) papillary (70%)
2) follicular (20%)
3) medullary (5%)
4) anaplastic (5%)

69
Q

Thyroid Carcinoma - Risk Factors (2)

A

1) head/neck irradiation

2) female

70
Q

Thyroid Carcinoma - Prognosis (4)

A

1) papillary - good
2) follicular - good
3) medullary - good
4) anaplastic - poor

71
Q

Thyroid Carcinoma - Symptoms (3)

A

late presentation

1) dysphonia
2) dysphagia
3) dyspnoea

72
Q

Thyroid Carcinoma - Signs (2)

A

1) thyroid nodules

2) cervical lymphadenopathy

73
Q

Thyroid Carcinoma - Investigations (3/0)

A

initial

1) TFT
2) fine needle biopsy cytology
3) neck ultrasound

74
Q

Thyroid Carcinoma - Management (0/2/1)

A 
medical
1) radioactive iodine ablation (papillary, medullary)
2) levothyroxine (TSH suppression)
surgery
1) thyroidectomy
76
Q

Hyperthyroidism - Investigations (1/1)

A

initial
1) TFT* (low TSH, high T3/T4)
consider
1) serum TRAb (Graves’, positive)

77
Q

Hyperthyroidism - Management (1/4/1)

A

conservative
1) smoking cessation
medical
1) carbimazole (block+replace* or titrate)
2) propyluracil (block+replace* or titrate)
3) iodine 131 (refractory) (not in pregnancy or feeding)
4) βB (thyroid storm)
surgery
1) thyroidectomy

78
Q

Acromegaly - Description

A

increased GH secretion

79
Q

Acromegaly - Causes (1)

A

1) pituitary adenoma

80
Q

Acromegaly - Pathophysiology (3)

A

1) pituitary adenoma
2) increased GH secretion
3) increased IGF-1 secretion

81
Q

Acromegaly - Symptoms (6)

A

1) arthralgia
2) sweating (excessive)
3) headaches (late, 50%)
gonadal dysfunction
4) low libido
5) amenorrhoea
6) erectile dysfunction

82
Q

Acromegaly - Signs (8)

A

1) acral enlargement
2) big nose
3) big tongue
4) big jaw
5) big supraorbital ridges
6) dark skin
7) skin tags
8) deep voice

83
Q

Acromegaly - Complications (9)

A

1) gigantism
2) arthritis
3) carpal tunnel syndrome
4) diabetes mellitus
5) hypertension
6) heart conditions (e.g. cardiomyopathy)
7) stroke
8) sleep apnoea
9) bitemporal hemianopia

84
Q

Acromegaly - Investigations (3/1)

A 
initial
1) serum GH (high)
2) serum IGF-1 (high)
3) glucose tolerance test* (nadir GH>1μg/L)
consider
1) pituitary MRI
85
Q

Acromegaly - Management (0/4/1)

A 
medical
1) DA agonist (e.g. cabergoline)
2) SST analogue (e.g. octreotide)
3) GH receptor antagonist
4) radiotherapy (refractory)
surgery
1) transsphenoidal surgery*
86
Q

Cushing’s Syndrome - Description

A

chronic excess cortisol exposure

87
Q

Cushing’s Syndrome - Causes (5)

A

1) Cushing’s disease
2) adrenal adenoma
3) adrenal hyperplasia
4) ectopic ACTH secretion
5) steroids (iatrogenic)

88
Q

Cushing’s Syndrome - Pathophysiology (Cushing’s Disease) (3)

A

1) pituitary adenoma
2) increased ACTH secretion
3) increased cortisol secretion

89
Q

Cushing’s Syndrome - Symptoms (8)

A 
1) weight gain
mood
2) depression
3) lethargy
4) irritability
5) psychosis
gonadal dysfunction
6) hirsutism
7) oligomenorrhoea
8) erectile dysfunction
90
Q

Cushing’s Syndrome - Signs (8)

A

1) central obesity
2) moon face
3) plethoric
4) acne
5) bruising
6) skin atrophy
7) muscle atrophy
8) violaceous striae

91
Q

Cushing’s Syndrome - Complications (6)

A

1) diabetes mellitus
2) hypertension
3) hypokalaemia
4) osteoporosis
5) nephrolithiasis
6) hypopituitarism (iatrogenic)

92
Q

Cushing’s Syndrome - Investigations (2/1)

A 
initial
1) overnight low dose dexamethasone suppression + 9:00am cortisol
2) 24 hour urinary free cortisol*
consider
1) pituitary MRI (70%)
93
Q

Cushing’s Syndrome - Management (2/1/4)

A

conservative
1) alcohol control
2) review steroids
medical
1) metyrapone or mitotane (pre-op)
surgery*
1) transsphenoidal surgery (Cushing’s disease)
2) unilateral adrenalectomy (adrenal adenoma)
3) bilateral adrenalectomy (adrenal hyperplasia)
4) local tumour resection (ectopic ACTH secretion)

94
Q

Hyperaldosteronism - Description

A

increased aldosterone secretion (independent of RAAS)

95
Q

Hyperaldosteronism - Causes (2)

A

1) Conn’s syndrome

2) adrenal hyperplasia

96
Q

Hyperaldosteronism - Pathophysiology (Conn’s Syndrome) (1)

A

1) aldosterone producing adrenal adenoma (aldosteronoma)

97
Q

Hyperaldosteronism - Symptoms (4)

A

1) asymptomatic (often)
2) polyuria
3) nocturia
4) lethargy

98
Q

Hyperaldosteronism - Complications (3)

A

1) hypertension
2) hypernatraemia
3) hypokalaemia*

99
Q

Hyperaldosteronism - Investigations (3/1)

A 
initial
1) UnE (low K+, high Na+)
2) serum renin (low)
3) serum aldosterone (high)
consider
1) adrenal vein sampling* (unilateral - Conn’s syndrome, bilateral - adrenal hyperplasia)
100
Q

Hyperaldosteronism - (0/1/1)

A

medical
1) spironolactone (aldosterone anatgonist)
surgery
1) laparoscopic adrenalectomy (Conn’s syndrome)

Phase 2a - Endocrinology (5 decks)

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