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MRCP part 2 > Endocrinology / Metabolic disease > Flashcards

Endocrinology / Metabolic disease Flashcards

1
Q

Hypertriglyceridaemia treatment

A

1) Fibrates (fenofibrate, gemfibrozil)
2) Add statin OR ezetimibe
Omega 3 good for all (reduces CVD deaths)

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2
Q

Treatment (familial) hypercholesterolaemia

A

1) high dose statin
2) Add ezetimibe
Others:
- evolucumab - if LDL peristently >3.5
- fibrates… more for hypertriglyceridaemia

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3
Q

Hypothyroidism features

A
  • main: tired, cold intolerance, bradycardia, weight gain
  • skin: sweating, yellow tinge, brittle nails, coarse hair, myxoedema, co-exsistant alopecia / vitiligo
  • eyes: periorbital oedema
  • GI: constipation, decreased taste, co-existant pernicious anaemia, co-existant coeliac
  • neuromuscular: thyroid myopathy, carpal tunnel / peripheral neuropathies, myxoedema coma, hashimoto encephalopathy
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4
Q

McArdle’s Disease

A
  • autosomal recessive type V glycogen storage disease
  • decreased muscle glycogenolysis
  • muscle pain and stiffness following exercise w/ second wind phenomenon
  • muscle cramps
  • myoglobinuria
  • low lactate levels during exercise
  • avoidance of low carbohydrate diets
  • low intensity aerobic exercise
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5
Q

Hypokalaemia

A

1) urinary K
- low? Alkalosis, insulin, extrarenal losses
- high? renal losses confirmed

2) blood pressure, renin, aldosterone, blood gas
- high blood pressure, high renin: malignant HTN, renovascular disease, renin secreting tumour
- high blood pressure, low renin, high aldosterone: hyperaldosteronism e.g. Conn’s / adrenal hyperplasia
- high blood pressure, low renin, low aldosterone: Liddle’s, apparent mineralocorticoid excess (congenital adrenal hyperplasia, liquorice ingestion), cushing’s, mineralocorticoid ingestion

  • low/normal blood pressure, alkalosis: Bartter, Gietelman, diuretics, magnesium deficiency
  • low/normal blood pressure, acidosis: RTA (1/2 - 4 is hyperK)
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6
Q

Criteria for atorvastatin 20mg ON in T1DM

A

aged > 40 OR
>10 years diagnosis OR
diabetic nephropathy OR
other CVD risk factors

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7
Q

Fabry Disease

A

X linked recessive lysosomal storage disease
Symptom onset in adolescence

Pain on exercise

Hypertension
Cardiomegaly
CKD
Thrombosis e.g. VTE / CVA

Angiokeratomas on skin (red macules / papules) typically peri-umbilical

Mx: alpha galactosidase A - enzyme replacement

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8
Q

Diagnosing sulfonylureas as cause of hypoglycaemia

A
  • insulin / c-peptide measurement not helpful

- urinary sulfonylurea can be measured

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9
Q

Addisonian patients taking steroids during periods of illness should change their steroid dose by how much and for how long?

A

2-3 x dose for 3 days and review

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10
Q

Side effects of sulfonylureas

A

Hypogylcaemia, weight gain

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11
Q

Indications for GLP-1 drugs e.g. exenatide, liraglutide, dulaglutide

A

Add to metformin / sulfonylurea for BM control if

  • BMI ≥35 and problems associated with high weight
  • BMI <35 and insulin is unacceptable because of hypo risk OR weight loss would benefit co-morbidities (e.g. ischaemic heart disease)
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12
Q

DPP4 inhibitors e.g. sitagliptin

A
  • do not cause weight gain
  • no hypos
  • HOWEVER, has a heart failure risk
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13
Q

SGLT2 inhibitors e.g. dapagliflozin

A

Benefits: weight loss, improvements in heart failure, no hypos

Indications: BM control in addition to metformin in heart failure patients

Risks: UTIs, DKA

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14
Q

Subacute (post viral) thyroiditis mx

A

1) NSAIDs

2) prednisolone

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15
Q

MEN-1

A 
AD
PaPaPi
- parathyroid adenoma
- pancreatic tumour (most typically gastrinoma -> zollinger-ellison syndrome)
- pituitary gland tumours
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16
Q

MEN-2a

A 
AD
PaPhThy
- parathyroid adenoma
- phaeo
- medullary thyroid cancer
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17
Q

MEN-2b

A

AD

PhThy + marfanoid and neurofibromas

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18
Q

Sick euthyroidism

A
  • low T3 and T4
  • normal / low TSH
  • associated with severe illness
  • do not treat!
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19
Q

Type 1 amiodarone thyroiditis

A
  • goitre
  • USS hypervascularity
  • Mx: stop amiodarone, carbimazole
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20
Q

Type 2 amiodarone thyroiditis

A
  • no goitre
  • low radioiodine uptake
  • Mx: stop amiodarone, start steroids
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21
Q

Type of diabetes caused by hereditary haemochromatosis

A

Type 2 DM

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22
Q

Papillary carcinoma

A
  • most common
  • hard nodules
  • often young females
  • good prognosis
  • Mx: total thyroidectomy + radioiodine therapy
  • yearly thyroglobulin to monitor recurrence
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23
Q

Folliculuar adenoma and carcinoma

A
  • adenoma is without local capsular invasion
  • solitary thyroid nodule
  • Mx: total thyroidectomy + radioiodine therapy
  • yearly thyroglobulin to monitor recurrence
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24
Q

Medullary carcinoma

A
  • MEN-2 associated
  • secretes calcitonin - marker of recurrence
  • poor prognosis when nodes invovled
25
Anaplastic carcinoma
- elderly females - local invasion common - Mx: resection where possible. Consider palliative surgery + RT
26
Thyroid lymphoma
- rare | - associated with Hashimoto's
27
Relevance of TSH in thyroid cancer
- high risk cancers should have TSH suppressed <0.1 with supplemental thyroxine post op - if low risk aim TSH 0.1-0.5
28
Thyroid nodule ix
- USS: <1cm, age 20-60, no symptoms, not rapidly growing, no prev ca / irradiation -> no further ix - otherwise FNA
29
Congenital adrenal hyperplasia phenotypes
- classical phenotype: presents early childhood with salt wasting and failure to make cortisol - non-classical phenotype: androgen excess -> hirsuitism, primary amenorrhoea, acne, precocious puberty in males
30
Causes of CAH
- 95% 21 hydroxylase deficiency. 60-70% salt wasting crisis in early life - 11 beta hydroxylase deficiency: apparent mineralocorticoid excess (low renin/aldosterone), androgen excess. Classically ambiguous genitalia - 17-hydroxylase deficiency: non-virilising in females, inter-sex in boys, hypertension
31
Management of hyperthyroidism in pregnancy
- 1st trimester: propylthiouracil (risk hepatotoxicity) - 2nd trimester: carbimazole (risk congenital defects) - breast feeding: propylthiouracil - keep free T4 in upper 1/3 of normal range to avoid foetal hypothyroidism
32
Management of hypothyroidism in pregnancy
- most require 50% increase in dose - do this in steps of 25mcg and review every month - thyroxine is safe with pregnancy and breastfeeding
33
Post partum thyroiditis
- hyperthyroidism in first few months after birth -> normal / low thereafter - TPO and TSH -R abs may be +ve
34
Grave's in pregnancy
- measure TSH-R abs and treat if +ve, even if euthyroid | as can cross placental barrier
35
Pseudohypoparathyroidism
- PTH insensitivity - AD inheritance of receptor GPC-R defect - low calcium, high phosphate, but HIGH PTH - short 4-5th metacarpals, short stature, cognitive impairment, obesity
36
VIPoma
- pancreatic tumour with malignant potential - watery diarrhoea, hypokalaemia, acidosis - facial flushing
37
Klinefelter syndrome
- XXY Males - tall - cognitive impairment - lack of secondary sexual characteristics - infertile - gynaecomastia - raised FSH & LH - low testosterone
38
Autoimmune polyglandular syndrome type 2
Triad - primary adrenal insufficiency - type 1 diabetes - hypothyroidism NB: sometimes primary gonadal failure is also present. Assoc with vitiligo and pernicious anaemia
39
Autoimmune polyglandular syndrome type 1
2+ - hypoparathyroidism - primary adrenal insufficiency - chronic mucocutaneous candidiasis - primary gonadal failure - primary hypothyroidism
40
Thyrotoxicosis fictitia
- thyroxine OD - high T4, low TSH - THYROGLOBULIN LEVELS LOW - low uptake of thyroid scintigraphy - NO GOITRE
41
Hyperprolactinaemia causes
- pituitary adenoma -> pituitary stalk compression - prolactinoma (macro >10000) - acromegaly - drugs: D-R antagonists, verapamil, - hypothyroidism - pregnancy - oestrogens - physiological: stress, sleep, exercise - seizures
42
Features of hyperprolactinaemia
- men: impotence, loss of libido - women: amenorrhoea - both: galactorrhoea
43
Thyroid storm mx
- IV fluids - electrolyte replacement - carbimazole / propylthiouracil -> then lugol's iodine - hydrocortisone 100mg - VTE prophylaxis
44
Myxoedema coma management
- IV fluids - IV hydrocortisone (until adrenal insufficiency excluded) - levothyroxine (T4) and liothyronine (T3) IV - electrolyte replacement
45
Features of acquired GH deficiency (e.g. secondary to TBI)
- fatigue - depression - reduced muscle mass - reduced libido - increased fat mass
46
Acromegaly mx
1) Transphenoidal excision | 2) Somatostatin analogues e.g. octreotide
47
Cushing's ix
Initial test options - 24 hour urinary cortisol - midnight cortisol 1st proper test - overnight dexamethasone suppression test -> failure to suppress indicates Cushing's Late night ACTH is used for localisation - suppressed indicates adrenal adenoma / tumour - non-suppressed suggests ACTH dependent cause e.g. pituitary OR ectopic ACTH Other localisation tests - MRI pituitary (>6mm significant) - high dose dex suppression (pituitary adenoma will suppress) - inferior petrosal sinus sampling (central -> peripheral ACTH gradient suggests central cause)
48
Type of diabetes insipidus caused by lithium
Nephrogenic diabetes insipidus
49
Mx nephrogenic diabetes insipidus
- Low salt diet - Discontinue precipitating agent 2) Thiazide diuretics or amiloride
50
Mx hypertension in Conn's
Spironolactone
51
Mx of Grave's if neutropenia occurs during carbimazole
- stop carbimazole permanently - not for propylthiouracil - surgery or radioiodine instead
52
Mx macroprolactinoma
- dopamine agonist e.g. cabergoline | - transphenoidal excision only if medical mx fails
53
Ix insulinoma
- insulin, C-peptide and glucose during an episode - no role for random bloods of the above - exercise provocation after overnight fast +/- above bloods
54
Apparent mineralocorticoid excess
- low renin and aldosterone - AR 11-hydroxysteroid dehydrogenase mutation - excess liquorice can inhibit this enzyme too
55
Gestational diabetes diagnosis and management
Diagnosis - fasting glucose ≥5.6 - 2 hour glucose ≥7.8 Fasting BM <7 - > trial diet/exercise and re-check in 1-2 weeks - if BMs still raised but <7 -> metformin (OR glibenclamide) - if BMs still raised, <7 but complications with baby -> insulin BMs ≥ 7 - insulin
56
Thyroid eye disease
Aetiology - 25-50% graves - can have any thyroid status - RFs: smoking, radioiodine Features - exopthalmos - conjuntival oedema - optic disc swelling - loss of colour vision - complex ophthalmoplegia Mx - topical lubricants - steroids +/- decompressive surgery
57
Agents that reduce thyroxine absorption
- calcium - iron - PPIs - antacids - colestyramine
58
Effect of beta blockers on thyroxine
reduces conversion to more active t3

MRCP part 2 (11 decks)

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