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Endocrinology Qs Flashcards

1
Q

What are the diabetes sick day rules?

A

If a patient is on insulin, they must not stop it due to the risk of diabetic ketoacidosis. They should continue their normal insulin regime but ensure that they are checking their blood sugars frequently

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2
Q

When are SGLT2 inhibitors …-flozin, given alongside metformin?

A

When a px has type 2 and cardiovascular disease e.g. hx of MI or TIA

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3
Q

What if a person with suspected DKA has high glucose, high ketones but is not acidotic?

A
  • called diabetic ketosis not DKA
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4
Q

Which diabetic drug carries the risk of hypoglycaemia e.g. after prolonged fasting or those with renal/hepatic impairment?

A

Sulfonylurea - …zide

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5
Q

What fasting glucose indicated pre-diabetes?

A

7+ = diabetes
6.1 - 7 = prediabetes

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6
Q

when is it age related macular degeneration and not diabetic retinopathy

A

Drusen seen

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7
Q

Ace inhibitors and pregnancy?

A

….pril - medications

should be potentially swapped may be tetrogenic

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8
Q

which drug may cause raised prolactin?

A

metoclopramide (dopamine receptor antagonist)

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9
Q

The Ps of raised Prolactin (6)

A

Pregnancy
Prolactinoma
Physiological
PCOS
Primary hypothyroidism
Phenothiazines, metocloPramide, domPeridone

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10
Q

What is severe hypothyroidism causing impaired mental status?

A

Myxoedema coma

tx with IV levothyroxine and liothyrnonine (T3) + IV hydrocortisone, oxygen and rehydration

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11
Q

what organisms found in infected foot ulcer on diabetic?

A

ram-positive organisms such as Staphylococcus aureus, Enterococcus, and gram-negative organisms like Pseudomonas aeruginosa, Escherichia coli, Klebsiella species, Proteus species and anaerobes.

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12
Q

cerebral oedema in DKA signs

A

More common in children

rising BP and slowing pulse
lapse in consciousness
headache
seizure

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13
Q

what type of DKA can SGLT2i cause? (dapagliflozin)

A

euglycaemic DKA (DKA features but not elevated glucose)

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14
Q

Signs on X ray of PTH disorder?

A

Pepper pot skull

(+ osteitis fibrosa cystica which is a low bone mass sign )

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15
Q

SHATTERED FAMILY?

A

Risk factors for oestoporosis

S - steroids
H - hyperparathyroid/hyperthyroid
A - Alcohol + smoking
T - Thin, BMI <22
T - Testosterone def in men
E - early menopause
R - Renal/liver disease
E - Erosive bone disease
D - Diabetes

Family hx

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16
Q

DEXA scan 1st line results for oesteoporosis?

A

T value of < - 2.5 = osteoporosis

T value -1 -> -2.5 = osteopenia

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17
Q

osteoporotic vertebral fracture investigation?

A

X ray spine

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18
Q

how to manage FRAX scan?

A

FRAX scan tells you if a person has a fracture risk in the next 10 yrs

low risk result - reassurance
intermediate - do DEXA scan
high - oral bisphosphonates

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19
Q

normal bloods but fractures?

A

osteoporosis

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20
Q

why may prolactin be high in a pituitary adenoma?

A

due to the compression of the pituitary stalk interrupting dopamine

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21
Q

pituitary tumour genetic risk factor?

A

MEN1

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22
Q

investigation - acromegaly

A

1st do serum IGF-1 levels

then do oral glucose tolerance test to confirm

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23
Q

Most common cause of secondary HTN?

A

Primary intrinsic kidney disease e.g. glomerulonephritis

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24
Q

If someone presents with HTN readings what to do next?

A

if under 180/120 offer ambulatory monitoring + assess for end organ damage + calculate QRISK score

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25
Stages of HTN?
stage 1 - 140/90 (treat from here in under 80s if indication of end organ damage or if QRISK 10%+ ) stage 2 - 160/100 (treat all) stage 3 - 180+ / 120 +
26
Malignant HTN?
severe elation resulting in end organ damage e.g. papulloedema, retinal haemorrhage, confusion, siezure, chest pain, AKI, heart failure if these symptoms present with 180/120+ == same day referral
27
pulmonary HTN Ix and Tx
ix - echocardiogram - CCB for vasodilation
28
Patient is taking an ACEi, a thiazide, a CCB BP still high?
Add spironolactone if K is <4.5
29
Lower than expected levels of HbA1c? factors affecting hba1c
- due to reduced rbc lifespan: - sickle cell anaemia - GP6D - Hereditary spherocytosis
30
Higher than expected levels of HbA1c? factors affecting hba1c
increased rbc lifespan: - B12/folic acid deficiency - Iron def anaemia - splenectomy
30
Higher than expected levels of HbA1c? factors affecting hba1c
increased rbc lifespan: - B12/folic acid deficiency - Iron def anaemia - splenectomy
31
Metformin summary
Increases insulin sensitivity and reduces hepatic gluconeogenesis. Can lead to lactic acidosis and GI side effects (eg. nausea, diarrhoea). Weight neutral.
32
Sulfonylurea summary (gliclazide)
release insulin from beta cells but can cause hypOglycaemia if too much released, can cause weight gain best to add on in non-obese patients Withold this drug on the morning of surgeries due to risk of hypog
33
SGLT2 i - flozin summary
inhibits sodium glucose transporter in renal PCT, increases glucose in urine weight loss naturally can cause UTI + fournier's gangrene if this medication is given with insulin can cause DKA
34
DPP4is - gliptins summary
weight neutral, does increase satiety so useful in obese patients
35
pioglitazone summary
Causes weight gain contraindicated in heart failure as it causes fluid retention liver dysfunction + fractures
36
pathophysio of diabetic neuropthy
glycation of axon proteins
37
Dysaesthesia?
In diabetes neuropathy - burning sensation in feet comes with glove and stocking, worse at nihgt pain, reduced/absent ankle reflexes, painless injuries at pressure points
38
Ix for diabetic neuropathy?
test sensation using 10g monofilament
39
Drug mx for diabetic neuropathy
if painful Try duloxetine first, but also 1st line are amitriptyline, gabapentin, pregabalin avoid amitriptyline in px with BPH due to retention
40
background vs non-proliferative retinopathy
microaneurysms, blot haemorrhages, hard exudates pre = ++ cotton wool spots
41
histological changes in diabetic nephropathy?
renal biopsy: - kimmelstiel-wilson nodules Mesangial expansion GBM thickening, glomerulosclerosis
42
severe life threatening hypoC due to hypoPTH?
ECG isolated prolonged QT interval - prediposes someone to Torsades de pointes
43
hyperPTH primary vs tertiary?
PTH much higher markedly in tertiary Phosphate is also higher in tertiary but low in primary
44
imaging when looking for parathyroid gland adenoma?
US
45
Drugs that inhibit PTH release?
Calcimimetics - cinacalcet
46
hypercalcaemia of malignancy types?
- humoral: tumor secretes PTHrP , SCC, Renal, bladder, breast, ovarian - Local osteolytic: body mets release factors that promote osteoclast function, myeloma breast cancer - Calcitriol mediated: 1,25 dihydroxyvitamin D release due to 1a-hydroxylase activity in tumour cells - lymphomas
47
why does osteomalacia cause waddling gait?
Proximal myopathy - causes muscles weakness, spasms, cramps
48
X-ray sign for osteomalacia?
Looser zones - pseudofractures
49
Vitamin def treatment (osteomalacia)?
ergocalciferol + calcium carbonate (vit D supplementation + calcium )
50
what can cause secondary osteoporosis?
drugs - long term corticosteroids, anticonvulsants, anticoags, PPIs hypogonadism hyperthyroidism cushings hyperparathyroidism
51
Primary osteoporosis causes
post menopausal senile osteoporosis rheumatoid arthritis
52
types of malignant thyroid nodules?
papillary carcinoma: - most common, best prognosis - goes to cervical lymph nodes follicular carcinoma: - later in life ppt - areas of low iodine - goes to lungs and bones medullary carcinoma: - parafollicular cells cancer - calcitonin secreted - MEN2 (genetic link)
53
1st line imaging for thyroid nodule malignancy?
US
54
Diagnosis flowchart thyroid nodule?
US + TSH TSH low --> thyroid scintigraphy --> measure T4/T3 TSH high --> FNA criteria met --> Cytology
55
Thyroid eye summary
Graves disease antibodies against TSHr target the extraocular muscles = swelling behind eye == proptosis SMOKING biggest changeable factor + lidlag + optic disc swelling + opthalmoplegia + dry eyes if vision changes --> opthalmologist review topical lubricants to prevent corneal inflammation High dose IV steroids
56
if statin for hyperCh/Trig is C/I (pregnancy) or interacting (erythromycin) what is 2nd line?
Ezetimibe - cholesterol absorption inhibitor
57
overweight BMI?
25 - 29.9
58
Obesity BMI according to class 1,2,3
Class 1 = 30-34.9 Class 2 = 35-39.9 Class 3 = 40+
59
Class 1 obesity consider medication after lifestyle?
Orlistat (pancreatic lipase inhibitor)
60
Class 2 with comorbidities or class 3 obesity mx?
Surgical - bariatric
61
hyperthermia define?
40 degrees + heat stroke = hyperthermia + CNS dysfunction exertional heat stroke = strenous physical activity heat exhuastion = Hot but not CNS
62
How to assess hyper/hypothermia temperature?
Rectal temperature - best for core body temp
63
mild hypothermia mx mod hypothermia mx severe hypothermia mx?
1 = passive external rewarming, blanket, warm room 2 = active external warming = warm blanker, radiate head, forced warm air 3 = IV warm crystalloid
64
Hypothermia management issues?
rapid rewarming -> vasodilation and shock do not put person in hot bath do not massage their limbs do not use heating pads no alcohol
65
Manage a heat stroke?
stabilisation - ABC, remove clothing rapid active cooling = ice water bath
66
Manage heat exhuastion?
Oral isotonic fluids active cooling
67
Addisons mx + during acute illness?
2/3 doses hydrocortisone 1 dose fludrocortisone 2x the hydrocortisone when sick
68
Mx for Cushings?
Metyrapone /ketoconazole pit adenomectomy / adrenalectomy
69
If someone gets asymptomatic positive findings on fasting/random glucose?
Need to do it again
70
long acting insulin example short acting insulin example
Glargine Lispro / aspart
71
Whipples triad?
Hypoglcyaemia low blood glucose concentration, hypoglycaemic symptoms & resolution of symptoms after raising blood glucose concentration to normal
72
hypoglycaemia mx?
awake = oral 15-20g glucose + fast acting carb asleep = IM glucagon + IV dextrose (20% glucose)
73
Hyperosmolar hyperglycaemia values?
HyperG at 30+ Hyperosmolar at 320+ Dehydration monitor via osmolality
74
Tx of hyperosmolar hyperglycaemia?
IV isotonic saline +- KCL IV insulin 5% dextrose when it falls
75
When to give IV bicarbonate?
Severe metabolic acidosis e.g. DKA causing VBG reading <7.3, ketones 3+
76
Describe diabetic neuropathy - other can the convensional peripheral pain? gastroparesis mx ?
autonomic, erectile dysfunction, urinary sx gastroparesis = metoclopramide
77
What is retinal detachement?
painloss vision loss shadow in the periphery flashers + floaters + flashing lights
78
How does viterous haemorrhage present?
sudden spots, floaters, blurring
79
what is carcinoid syndrome?
NET serotonin, flushing, diarrhoea, SOB Ix urine = serotonin Tx = octreotide
80
CATS go Numb in hypoparathyroidism?
Convulsions Arrythmias Tetany Parasthaesia
81
Hypocalcaemia signs?
Chvosteoks sign = cheeck Trousseu sign = tight BP cuff
82
(hypercalcaemia of malignancy) osteolytic types?
multiple myeloma - no ALP or mets increased ALP
83
what type of hypercalcaemia of malignancy does lymphoma lead to?
calcitriol mediated
84
What drugs cause osteomalacia?
Anticonvulstants - look out for pseudofractures
85
DEXA scan scores what is the Z score?
DEXA scan gives you t score -2.5 lower = osteoporosis -1.0 - -2.5 = osteopenia Z score will adjust for age, gender, ethinicity
86
What is the FRAX score?
10 year fracture risk
87
Medications for osteoporosis?
Give biphosphonates 1 = alendronate 2 = risedronate (to lessen Gi effects) for post menopausal women: -> 1 = denosumab
88
What medicine not to take with levothyroxine?
Calcium carbonate
89
carbimazole is C/ * remember carbimazole can cause agranulocytosis
propylthiouracil
90
how to deal with subclinical hypothyroid e.g. TSH high, T4/T5 low
if patient is under 65 and have symptoms can try levothyroxine
91
How to manage a thyroid storm?
IV propranolol IV digoxin propylthiouracil then give lugols Iodine after 6 hrs give steroids
92
papillary cancer key features follicular carcinoma features medullary carcinoma features
- lymph nodes, commonest, orphan annie cells, - lungs + bone mets, seen in low iodine area - parafolllicular cells, MEN2 link, calcitonin secretions
93
J wave seen in?
Hypothermia
94
hypothermia mild, mod, severe?
mild = 32-35 (shivering, HR, RR up) mod = 28 - 32 (HR BP down) severe - 28 (coma, arrythmia, fixed dilated pupils)
95
familial hypercholesterolaemia - genetic link? - xanthomata? - xanthelasma? - eruptive?
- autosomal dominant - lipid in skin tendons - yellow plaques on eyelids - rush, genetic, lipase def
96
What does a milky white retina mean?
Hypertrig
97
statin interactions?
macrolides - causes myopathy stop statin if transaminase is 3x upper limit

Year 3 (14 decks)

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