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Repetition > INVESTIGATIONS - endocrine > Flashcards

INVESTIGATIONS - endocrine Flashcards

1
Q

What should you check in someone presenting with hypercalcaemia?

A

PTH

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2
Q

In someone with hypercalcaemia, low PTH, low albumin and low Cl-, what should you be worried about?
What tests might you do?

A

Malignancy

Consider x-ray, CT, MRI or isotope bone scan

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3
Q

Investigation of choice for suspected adrenal insufficiency?
What would the results be?

A

Short synacthhen test

i.e. measure plasma cortisol levels 30 minutes before and after ACTH injection. In a healthy person, cortisol levels will increase from 250nmol/l to >550.
In someone with adrenal insufficiency, cortisol will be <500 even after ACTH injection.

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4
Q

What test can be used to differentiate between primary (adrenal), secondary (pituitary) and tertiary (hypothalamic) adrenal insufficiency?

A

Serum ACTH

Elevated ACTH = Addison’s / primary disease

Normal or low suggests a pituitary or hypothalamic problem.

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5
Q

What will renin and aldosterone levels be in Addison’s disease?

A

Renin is elevated (to compensate for no aldosterone synthesis in the adrenal cortex)

Aldosterone is suppressed due to non-functioning adrenal cortex (may help to differentiate Addison’s from secondary adrenal insufficiency)

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6
Q

Which antibodies may be present in Addison’s disease?

A

Anti-adrenal autoantibodies

21-hydroxylase antibodies

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7
Q

First line test for diagnosing Cushings?

What would the results of this test be?

A

Overnight dexamethasone suppression test

Healthy person: dexamethasone will trigger negative feedback response resulting in low ACTH and cortisol levels. In Cushing’s there is no such suppression.

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8
Q

If the pituitary is the cause of Cushing’s syndrome, what with ACTH levels be?

What would ACTH levels be if the adrenal gland was the cause?

A

High ACTH = pituitary cause or ectopic ACTH production

Low ACTH = adrenal cause (cortisol release is indpendent of ACTH levels)

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9
Q

When is cortisol usually highest, and when is it lowest?

A

Highest first thing in the morning

Lowest at night

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10
Q

Gold standard test for diagnosing pituitary adenoma?

A

Insulin stress test

Healthy person: It will create an acute hypoglycaemic state, so should trigger cortisol and GH.

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11
Q

If prolactin levels are raised, what imaging might you undertake?

A

MRI to look for pituitary tumour

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12
Q

What test is used to diagnose acromegaly?

A

Glucose tolerance test
(measure growth hormone after glucose is given; GH will be suppressed in a healthy person to <0.4ug/L, but won’t be suppressed in someone with acromegaly)

Can also measure IGF1 which will be elevated (note: IGF1 doesn’t fluctuate much throughout the day)

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13
Q

What test is used to confirm diabetes insipidus?

A

Water deprivation test

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14
Q

In diabetes insipidus what will urine osmolarity be?

And what about serum osmolarity?

A

Low urine osmolarity

High serum osmolarity

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15
Q

What investigation may be useful in the diagnosis of Conn’s? Why is this hard to carry out?

A

Aldosterone : renin ratio
High aldosterone, low renin (due to feedback from aldosterone)

If the R:A ratio is raised, investigate further with saline suppression test.

Patients tend to be on hypertensive medication which alters RAAS making results unreliable.

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16
Q

Which enzyme is usually deficient in congenital adrenal hyperplasia?

A

21 hydroxylase deficiency

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17
Q

What test should be carried out in cases of suspected CAH?

A

Measure 17 OH progesterone levels. Usually elevated in CAH.

Also do genetic analysis

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18
Q

What is calcitonin used as a marker for?

A

Medullary thyroid cancer (cancer of the parafollicular C cells)

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19
Q

Which differentiated thyroid cancer spreads via lymphatics? Which one is blood?

A

Papillary is lymphatics

Follicular is blood

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20
Q

Which antibodies may be present in Hashimoto’s thyroiditis?

A

anti-TPO

thyroid peroxidase

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21
Q

Why does medullary thyroid cancer result in hypocalcaemia?

A

Parafollicular c cells release calcitonin, which lowers calcium levels

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22
Q

Which antibodies would increase your suspicion of Graves disease being the diagnosis?

A

TSH receptor antibody

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23
Q

What’s the main risk factor for thyroid cancer?

A

Radiation

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24
Q

What grading on ultrasound of a thyroid nodule would warrant FNA?

A

U3 with worrying signs, or U4 or U5 should all undergo FNA

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25
Q

Which type of thyroid cancer cannot be diagnosed on FNA? WHy is this?

A

Follicular

Diagnosis requires thyroid lobectomy to assess extent of capsular invasion

26
Q

What is AMES? What does it constitute and what’s it used for?

A

Age
Metastasis
Extent of primary tumour
Size of primary tumour
Used post-op to stratify patients as low risk or high risk
Low risk: young patients with no evidence of mets.
High risk: 40+ (men) or 50+ (women), with invasion / mets, or primary timour >5cm

27
Q

What’s the prognosis for AMES high risk?

What about for low risk?

A

High risk: 61% 20 year survival

Low risk: 99% 20 year survival

28
Q

What are U1, U2, U3, U4 and U5?

A 
Ultrasound assessment of thyroid lumps
U1 = normal 
U2 = benign
U3 = indeterminate 
U4 = suspicious
U5 = malignant
29
Q

Investigations for toxic multinodular goitre?

A

TSH (should be suppressed)
Free T4 (elevated)
Iodine uptake scan - multiple hot and cold areas
CT may be indicated if signs of neck compression

30
Q

What level of fasting plasma glucose is diagnostic of diabetes?

A

> 7 mmol/l

31
Q

What level of plasma glucose is diagnostic of diabetes following an oral glucose tolerance test?

A

> 11.1 mmol/l two hours after 75g oral glucose load

32
Q

What constitutes impaired glucose tolerance in the context of an oral GGT?

A

Plasma glucose of 7-11 mmol/l after 2 hours

33
Q

What are glucose levels in hypoglycaemia?

A

<4 mmol/l

34
Q

What’s the criteria for random plasma glucose to give a diagnosis of diabetes?

A

> 11.1 on repeat testing, or with symptoms

35
Q

What’s the normal HbA1c in a healthy individual?

A

<41 mmol

36
Q

What’s the target HbA1c for most diabetics?

A

48-58 mmol

37
Q

What does HbA1c measure? What is it an indicator of?

A

Measures glycated haemoglobin

Indicator of blood glucose control over 2-3 months

38
Q

What’s the difference between bicarbonate levels in DKA and HHS?

A

In DKA, bicarb is low

It’s high in HHS

39
Q

Which ketones should you measure in the urine?

Which ketones should you measure in the blood?

A

Urine: acetoacetate
Blood: beta hydroxybutyrate

40
Q

What should be used to screen for diabetic kidney disease?

A

ACR

Albumin creatinine ratio

41
Q

Give some reasons for microalbuminuria false positives

A

Pregnancy
UTI
Vaginal discharge

42
Q

What’s the blood pressure target for diabetics?

A

<130 / 80

43
Q

What constitutes MILD background diabetic retinopathy (R1)?

What’s the appropriate next step?

A 
Dot and blot haemorrhages 
Microaneurysms
Hard exudates 
Cotton wool spots (ischaemia)
Flame haemorrhages

Reassess in 12 months

44
Q

What constitutes OBSERVABLE background diabetic retinopathy (R2)?

What’s the appropriate next step?

A

4 or more blot haemorrhages in one hemi field only

Reassess in 6 months (or refer to ophthalmology)

45
Q

What constitutes referable background diabetic retinopathy (R3)?

A

Any of the following:

  • 4 or more blot haemorrhages in both inferior and superior hemi fields
  • venous bleeding
  • intra-retinal microvascular abnormalities
46
Q

What constitutes proliferative diabetic retinopathy (R4)?

A

Active new vessels or vitreous haemorrhage

Refer and treat (e.g. laser therapy)

47
Q

First line test in secondary amenorrhoea?

A 
Pregnancy test
(human chorionic gonadotropin, hCG)
48
Q

What is primary and secondary hypogonadism in females?

A 
Primary = problem with ovaries
Secondary = problem with hypothalamus or pituitary
49
Q

WHO classifies ovulatary disorders as Group I, II and III.

What is each of these groups and how would you investigate each one?

A

Group I: hypothalamic pituitary failure
- progesterone challenge test (negative - oestrogen deficiency)

Group II: hypothalamic pituitary dysfunction

  • progesterone challenge test (positive - normal oestrogen)
  • e.g. PCOS

Group III: ovarian failure / hypergonadotrophic hypogonadism.
- measure TSH / LH (will be raised, but low oestrogen)

50
Q

What’s progesterone challenge testing?

A

Give progesterone. If period follows it indicates normal oestrogen levels (= positive, as with group II ovulation disorders).

If period doesn’t follow 5 days of progesterone, oestrogen levels are low (negative result, as with group I and III)

51
Q

What group of ovulatary disorder is suggested by LOW FSH and LOW LH?

A

Group I (pituitary / hypothalamic failure)

52
Q

Results of low oestradiol, and low / normal FSH and LH are suggestive of what?

A

Secondary hypothalamic amenorrhoea

i.e. hypogonadism due to pituitary or hypothalmic problems

53
Q

What 2 `things would you look for in terms of ovarian morphology on ultrasound in PCOS?

A

Increased ovarian volume (>10ml)

> 12 follicles between 2 and 8mm in diameter

54
Q

What are LH levels in PCOS?

A

High

raised LH : FSH ratio

55
Q

What are testosterone levels usually in PCOS?

A

High

56
Q

What would gonadotrophin levels be in primary ovarian failure?

A

High (FSH and LH)

57
Q

What would oestrogen levels be in primary ovarian failure?

A

Low

58
Q

In men with hypogonadism (and therefore low testosterone), what would LH and FSH levels be in

a) primary hypogonadism
b) secondary hypogonadism

A

a) primary = High FSH and LH

b) secondary = pituitary or hypothalmic problems, so low LH / FSH

59
Q

What would testosterone and FSH / LH levels be in Kleinfelters?

(47 XXY)

A

Low testosterone
High FSH / LH

elevtaed SHBG (sex hormone binding globulin)

60
Q

What would testosterone and FSH / LH levels be in Kallman’s?

A 
Low testosterone
(results in delayed or absent puberty - due to loss of GnRH secretion)
61
Q

What measurement can be taken to confirm ovulation?

A

Mid-cycle LH (day 21)

Repetition (17 decks)

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