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Rhi’s MSRA > Endocrinology/metabolic > Flashcards

Endocrinology/metabolic Flashcards

1
Q

How does diabetic peripheral sensory neuropathy present?

A

Glove and stocking distribution
Numbness, pain, paraesthesia
Significant motor neuropathy uncommon

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2
Q

Most common cause of SIADH?
Other causes

A

-most common: IDIOPATHIC.
Others:
-CNS ie tumour, infection, GBS, MS
-Pulmonary ie tumour, pneumonia, CF
-Drugs ie vasopressin, NSAIDs, diuretics, carbamazepine, TCAs, SSRIs,
-Surgery

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3
Q

Older patient, has AF, has irregular, bumpy, nodular thyroid and minimal tremor. Most likely Dx?

A

Toxic multinodular goitre

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4
Q

Most common cause of hypOthyroidism in developing countries?

A

Hashimoto’s thyroiditis

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5
Q

Younger patient, with smooth diffuse goitre marked hyperthyroid symptoms, likely Dx?

A

Grave’s disease!
-younger age group
-smooth diffuse goitre
-more marked syx than for toxic MNG

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6
Q

What is Grave’s disease?

A

Autoimmune disorder - TSH receptor stimulating antibodies - excessive secretion & hyperplasia causing toxic diffuse goitre

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7
Q

Risk factors for Grave’s?

A

FH or personal hx of autoimmune disorders ie T1DM

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8
Q

What is toxic multinodural goitre caused by?
Risk factors?

A

2 or more autonomously functioning thyroid nodules (adeonomas) that secrete thyroid hormones
-RF: age (>60), iodine deficiency ie Denmark

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9
Q

TSH and T3/4 levels in hyperthyroidism?
-subclinical hyperthyroidism?

A

-Low TSH, raised T3/4
-Subclinical: low TSH, normal T3/4

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10
Q

Symptoms of hypOcalcaemia? & 2 signs?

A

Paraesthesia
Tetany
Carpopedal spasm (wrist flexing & fingers drawn together)
Muscle cramps
-Chvostek’s sign - twitching of face after tapping on facial nerve
-Trousseau’s sign - carpopedal spasm after compression of upper arm with BP cuff

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11
Q

ECG changes in hypercalcaemia?

A

Shortened QT
Severe: J waves may be seen

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12
Q

3 things that characterise DKA?

A

-blood glucose >11 (or known DM)
-Ketonaemia >/=3mmol or significant ketonuria (>2 on urine stick)
-acidosis: pH <7.3 or bicarbonate <15

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13
Q

How to calculate plasma osmolality?
How high should it be for DKA?

A

2Na + urea + glucose
>290 for DKA

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14
Q

Cut off HbA1c to diagnose diabetes mellitus?

A

42 (6.5%)

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15
Q

70 y/o woman - muscle weakness and diffuse bone pain. Reduced serum calcium. Most likely Dx?

A

Osteomalacia

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16
Q

Patient with PVD started on enalapril for HTN. Renal impairment develops 2 weeks later. Most likely Dx?

A

Renal artery stenosis

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17
Q

Treatment options for hyperhidrosis?

A

-Topical: 1st line = aluminium chloride. Others: Iontophorrsis, Botox, anticholinergics
-Systemic: anticholinergics, CCBs
-Surgical: Symphathectomy, surgical excision/liposuction, laser

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18
Q

4 aspects of SIADH?

A

-hyponatraemia (<125)
-elevated urine osmolality (>500)
-excess urine sodium excretion (>20)
-decreased serum osmolality (<260)

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19
Q

Cause of T1DM?

A

Loss of beta cells (which produce insulin) in the islets of Langerhans in the pancreas —>insulin deficiency

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20
Q

Cause of T2DM?

A

Insulin resistance or reduced sensitivity -most commonly related to central obesity

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21
Q

Most common cause of primary hyperparathyroidism?

A

Solitary parathyroid gland adenoma

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22
Q

Causes of primary hypoparathyroidism?

A

-Failure of the gland from autoimmune causes (ie pernicious anaemia, vitiligo, congenital)
-Removal of/trauma to the parathyroid glands ie thyroid surgery (note NOT secondary hypoparathyroidism - this is distinct state in which PTH levels are low in response to primary process that causes hypercalcaemia)

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23
Q

What is secondary hyperparathyroidism?
Most common causes?

A

-Excessive secretion of PTH by parathyroid glands in response to hypOcalcaemia
-Chronic renal failure, low Vit D

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24
Q

What is pseudohypoparathyroidism?

A

Rare autosomal dominant disorder - target cells fail to respond to PTH

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25
Q

Acromegaly - cause?
-not common presentation symptoms?
-other symptoms?

A

-Increased unregulated growth hormone production, usually from GH secreting pituitary tumour
-Headaches, visual field defects (usually bitemporal hemianopsia from pressure on optic chiasm)
-Enlargement of extremities, hyperhidrosis, coarsening facial features, frontal bossing, macroglossia, arthritis, OSA, glucose intolerance, HTN, CHF…

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26
Q

65 y/o, joint pain, constantly tired, polydipsia, tanned skin. Hepatomegaly on examination. Dx?

A

Haemachromatosis

27
Q

Triad of (late onset) symptoms of haemachromatosis?
Other symptoms?
Related cancer?

A

-liver cirrhosis, diabetic mellitus, skin pigmentation
-hepatocellular carcinoma

28
Q

Most common cause of chronic pancreatitis?

A

Excessive alcohol consumption

29
Q

Most common cause of hypothyroidism in developed countries?
And worldwide?

A

-Hashimoto thyroiditis
-worldwide: iodine deficiency

30
Q

What is Riedel (fibrosing) thyroiditis?
How does it present?
What does the thyroid feel like?

A

-Rare disease - chronic inflammation and fibrosis of thyroid.
-Presents with hypOthyroidism, and obstructive symptoms ie dyspnoea, dysphagia, and hoarseness
-thyroid feels ‘hard as wood’, non tender

31
Q

What is subacute (de Quervain) thyroiditis?

A

-transient inflammatory thyroid disease, characterised by PAIN & TENDERNESS of gland. Result of viral infection, usually 2-8 weeks beforehand.
-presents as hypERthyroidism

32
Q

Most frequent thyroid neoplasm?
How does it present?

A

Papillary thyroid carcinoma
Painless, hard thyroid mass, with enlargement of regional cervical lymph nodes

33
Q

Symptoms of Cushing’s disease?
What conditions may they do on to have?

A

Weight gain with central obesity, facial rounding, thinning of skin (striae), bruising, proximal muscle weakness
-metabolic complications: diabetes mellitus, dyslipidaemia, HTN

34
Q

4 tests you can do for Cushing’s (hypercortisolism)?

A

-late night salivary cortisol
-1mg overnight low-dose dexamethasone suppression testing
-24-hour urinary free cortisol
-48-hour 2mg dexamethasone suppression testing

35
Q

25 y/o woman. New-onset headaches, fatigue, constipation. No flushing/weight changes. Dad had kidney stones

A

Multiple endocrine neoplasia type 1

36
Q

48 y/o man. 4/12 tired all the time, reduced appetite, weight loss, increased skin pigmentation including oral mucosa

A

Addison’s disease.
(NB haemochromatosis rarely involves mucosa!

37
Q

Test to diagnose Addison’s?

A

ACTH stimulation test

38
Q

What is congenital adrenal hyperplasia ?

A

Autosomal recessive metabolic disorder - most cases caused by 21-hydroxylase deficiency —> deficient cortisol and/or aldosterone. In response - increased ACTH secretion

39
Q

Treatment for congenital adrenal hyperplasia?

A

Lifelong replacement of hydrocortisone. Plus salt-retaining steroid ie FLUDROCORTISONE

40
Q

3 main symptoms of diabetes insipidus?
Hallmark clinical test ?

A

Polyurea, polydipsia, nocturia
-urine specific gravity of 1.005 or less, and urine osmolality <200

41
Q

LH levels low or raised in eating disorders?

A

Low

42
Q

Syndrome caused by Neisseria meningitidis that leads to DIC, haemorrhage into adrenal glands and shock

A

Waterhouse-Friderichsen syndrome

43
Q

Older pt with weight gain, generalised weakness and bruising. Overnight dexamethasone suppression test fails to suppress cortisol levels. Plasma ACTH levels undetectable. Dx?

A

Primary Cushing’s (Adrenal Adenoma)
-often discovered incidentally
-usually presents as subclinical Cushing’s syndrome
-undetectable ACTH = very likely AA

44
Q

Difference between Cushing’s syndrome and Cushing’s disease?

A

Cushing’s syndrome = hormone disorder caused by high levels of cortisol ie from glucocorticoid drugs, or adrenal adenomas

Cushing’s disease = PITUITARY ADENOMA, that produces large amounts of ACTH, which in turn elevates cortisol (is the most common cause of Cushing’s syndrome!)

45
Q

40 y/o woman presents with muscle cramps, raised BP, high Na and low K. Dx?

A

Conn’s Syndrome

46
Q

Symptoms of Conn’s syndrome?

A

-Fatigue, muscle weakness, cramps, headaches, palpitations (from HypOkalaemia)
-Polydipsia/polyuria from diabetes insipidus

47
Q

What Dx should always be considered in a patient (not on diuretics) with a hypokalaemic alkalotic hypertension?

A

Conn’s syndrome

48
Q

Main symptoms of primary hyperparathyroidism?

A

Vague symptoms (most minimally symptomatic): general weakness, fatigue, poor concentration, depression, kidney stones

49
Q

What is pseudoparathyroidism and how does it present?

A

-inherited resistance to parathyroid hormone
-unusual development and skeletal defects: short stature, round face, shortened 4th metacarpals, obesity, dental hypoplasia, soft tissue calcifications

50
Q

Complications of Haemaochromatosis?

A

Cardiomyopathy
Hypogonadism
Hypothyroidism
Hepatocellular carcinoma

51
Q

Where in bowel is most common place for colorectal cancer?

A

Rectum (45%)

52
Q

FIT test cut-off to refer adults using urgent suspected cancer pathway?

A

> /= 10ug Hb/f faeces

53
Q

What is primary sclerosing cholangitis?
What disease is it strongly linked to?

A

Rare disease, unknown aetiology - CHRONIC INFLAMMATION & FIBROSIS OF BILE DUCT.

IBD - particularly UC.

54
Q

Symptoms of primary sclerosing cholangitis ?

A

Early syx: priorities, fatigue
May also present with fevers, night sweats and RUQ pain

55
Q

What is primary biliary cirrhosis?
Related diseases?

A

Autoimmune disease of liver with destruction of bile canaliculi.

-osteoporosis, sicca syndrome

56
Q

Presentation of primary biliary cirrhosis?

A

Commoner in women 30-65 y/o
Fatigue, pruritis, stearorhoea, jaundice, hyperpigmentation, hepatomegaly, splenomegaly

57
Q

Antibodies in primary biliary cirrhosis?

A

Antimitochondrial antibodies

58
Q

Topical treatment for anal fissure?

A

If very painful- topical anaesthetic for a few days
If persisting symptoms - topical GTN or diltiazem for 6-8 weeks

59
Q

Conservative Mx of anal fissure? Other options if conservative and topical options fail?

A

-improve diet (high fibre, increase fluids)
-sitz baths

Botox toxin injections (to relax sphincter and allow fissure to heal)

60
Q

How is campylobacter usually acquired?
Symptoms?
Complications

A

-Undercooked poultry in developed countries
-Diarrhoea - can be watery/bloody, associated crampy abdo pain
-reactive arthritis, Guillain-Barré syndrome

61
Q

Yersinia enterocolitica - usual food culprit?
Symptoms?

A

Pork meat/intestine
Bloody diarrhoea, can mimic Crohn’s or appendicitis as causes colitis

62
Q

Complications of H pylori?

A

-Peptic ulcer disease
-Gastric MALT lymphoma
-Gastric adenocarcinoma
-Menetrier’s disease
-Coronaritis (inflammation of coronary arteries)
-Iron deficiency anaemia

Note: NOT associated with oesophageal carcinoma

63
Q

Symptoms of Glucagonoma? (Neuroendocrine tumour of pancreatic Islet cells that secrete glucagon)

A

‘6 Ds’ !!
Diabetes
Dermatosis (necrolytic migratory erythema)
Deep vein thrombosis
Depression
Diarrhoea
Decreased weight

Rhi’s MSRA (10 decks)

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