Medicine/Endocrine Flashcards
1
Q
Outline calcium homeostasis
A
2
Q
Hypercalcaemia causes
A
- Hyperparathyroidism
- Malignancy – breast, lung, blood, but especially BONE
- Sarcoidosis
- TB
- Rare genetic disorders
- Medications – lithium
- Excessive vit D supplements – BRENDA
3
Q
Acute hypercalcaemia: Features
A
Features
- Polyuria
- Polydipsia
- Anorexia, nausea, constipation
- Confusion
- MM weakness
4
Q
Acute hypercalcaemia: initial investigations
A
Initial investigations
- A to E
- Assess cognitive function e.g. GCS
- Assess fluid status
- Any examinations that appear relevant from Hx e.g. spine exam if spinal mets suspected
- ECG
- Bloods: calcium, phosphate, PTH, U+Es
5
Q
Acute hypercalcaemia: management
A
Management
- Fluid resus consider dialysis if in renal failure
- IV bisphosphonates (stops bone release of Ca) e.g. pamidronate
- Investigate cause
6
Q
Primary hyperparathyroidism: S&S
A
Symptoms (Bones, moans and stones)
- Multiple fractures
- Bone pain
- Depression, lethargy, confusion
- Kidney stones
- Polyuria
- Polydipsia
- Anorexia, nausea, constipation
- MM weakness
- But most commonly asymptomatic
Signs
- HTN
- ECG – arrhythmia, short QT
- AKI
- Kidney stones
- MM weakness
- Fragility fractures
- Osteoporosis + osteopenia
- FHx
7
Q
Primary hyperparathyroidism: investigations,
A
- Bloods: calcium, phosphate, PTH
- Calculate: calcium clearance to creatinine clearance ratio should be > 0.01 if lower diagnosis is Familial Hypocalcuirc Hypercalcaemia (FHH)
- DEXA scan
- USS of kidneys looking for stones
8
Q
Primary hyperparathyroidism: complications,
A
Complications
- Fragility fractures
- AKI
- Peptic ulcer
- Kidney stones
9
Q
Primary hyperparathyroidism: associated conditions
A
- Gout
- Pancreatitis
- Metabolic syndrome
10
Q
Hypocalcaemia: causes
A
- Acute:
- hyperventilation,
- alkalosis,
- chemo (causes rapid lysis of tumour which causes release of phosphate),
- excessive phosphate intake (enemas),
- blood transfusion with liver disease,
- acute pancreatitis
- Chronic:
- Vit D deficiency,
- CKD,
- hypoparathyroidism (surgery)
11
Q
Hypocalcaemia: S&S
A
Signs
- Chvostek’s sign – facial twitch when tapping CN7 (in front of ear)
- Trousseau’s sign – wrist and MCP flexion when BP cuff inflated on arm for several minutes
- Seizures
- Prolonged QT
- Laryngo/broncho spasm
Symptoms
- Parasthesia (fingers, toes and mouth)
- Tetany (mm spasms)
- Carpopedal spasm (wrist flexion and fingers drawn together)
12
Q
Hypocalcaemia: investigations
A
Investigations
- Bloods: U+E, amylase, creat kinase, calcium, magnesium, phosphate, PTH
- ECG
13
Q
Hypocalcaemia: management
A
- Acute
- A to E
- IV calcium gluconate and calcium
- If present correct hypomagnesia
- If likely to persist oral Vit D
- Monitor urine and serum calcium levels
- Chronic
- Calcium and vit D supplements
- Dietary advice
- Monitor urine and serum calcium levels
14
Q
Hypothyroidism- Causes, signs, symptoms, treatment
A
Causes
- Autoimmune (Hashimoto’s)
- Previous thyroid treatment
- Iodine deficiency (not really UK)
- Congenital
- Medications (Lithium, amiodarone, interferons)
Signs
- Bradycardia
- Hyporeflexia
- Oedema
- Hypohydrosis
- Rare:
- Myxoedema coma
- Hoarseness
- Tongue swelling
Symptoms
- Tiredness
- Cold intolerence
- Weight gain
- Constipation
- Depression
- Slow movements + thoughts
- Muscle aches/cramps and weakness
- dry and scaly skin
- brittle hair and nails
- loss of libido (sex drive)
- pain, numbness and a tingling sensation in the hand and fingers (carpal tunnel syndrome)
- irregular periods or heavy periods
Treatment
- Levothyroxine
15
Q
Hyperthyroidism- Causes, signs, symptoms, treatment
A
Causes
- Excessive TSH-receptor stimulation
- Graves
- Autonomous Thyroid hormone secretion
- multinodular toxic goitre
- solitary toxic thyroid adenoma
- Destruction of follicles releasing hormone
- subacute de quervain thyroiditis
- hashimoto’s thyroiditis
- Extrathyroidal source of TH
- Iatrogenic
Risk Factors
- Smoking
Signs
- weight loss
- tremor
- palmar erythema
- sinus tachycardia
- lid retraction
- lid lag
Symptoms
- weight loss despite…
- Increased apitite
- heat intolerence
- sweating
- palpatations, tremor
- dyspnoea, fatigue
- irritability
- emotional lability
Treatment
- medication (1st episode, <40yrs old)
- block and replace
- titrate
- surgery
- subtotal thyroidectomy (large goitre, poor drug compliance esp in young, reccurent thyrotoxicosis in young)
- radio-iodine (pt >40 yrs, recurrence post surgery, serious comorbidity)
