Metabolic IM Flashcards
Symptoms of Hypothyroidism?
Cold intolerance
Weight gain
Lethargy
Bradycardia
Constipation
Proximal myopathy
Slow relaxing reflexes
Nerve entrapment
Impaired cognition
Coarse, smooth skin
Menorrhagia
Infertility
Symptoms of Myxoedema coma?
Hypothermia
Pericardial effusion
Cardiac failure
Altered mental status
Hypoventilation
Symptoms of Hyperthyroidism?
Heat intolerance
Weight loss
Irritability, insomnia
Palpitations
AF
Diarrhoea
Anxiety
Rest tremor
Lid lag
Proximal myopathy
Brisk reflexes
Sweaty, warm skin
Oligomenorrhoea
Symptoms of thyroid storm/thyrotoxicosis?
Hyperpyrexia
Tachycardia
Cardiac failure
Vomiting
Diarrhoea
Jaundice
Delirium, seizure, coma
2 phases of thyroiditis?
Hyperthyroid phase at first, then hypothyroid.
Thyroid inflammation initially causes release of pre-formed hormones. After gland damage, hypoT arises. With continued antibody stimulation (e.g. Hashimoto’s), a goitre will grow.
Goitres are initially ____, but may become____ with time. Similar to idiopathic MNG
Goitres due to longstanding iodine deficiency are usually initially diffuse. But can become Multinodular over time cuz some thyroid follicles grow faster than others.
Which biochemical test has highest sensitivity and specificity in diagnosing thyroid disorders?
TSH
Normal TSH makes thyroid disorder unlikely
Difference between DKA vs HHS?
HHS = still abit of insulin secretion. Sufficient to prevent DKA by suppressing lipolysis and in turn, ketogenesis.
DKA affects T1DM, HHS affects T2DM
DKA is acute onset, HHS usu over days.
Pathophysiology is similar tho
How does pituitary adenoma cause secondary hyperthyroidism?
Pit adenoma can suppress other pituitary hormones. Gonadotropins are lost first and TSH is only suppressed very late.
Reproductive-aged patients will have amenorrhea or loss of libido before hypoT manifests.
What does pituitary gland produce?
Prolactin
Follicle-stimulating hormone (FSH)
Luiteinising hormone (LH)
ACTH
ADH (release only)
Growth Hormone
Oxytocin
Typical clinical features of DKA and HHS?
Polyuria, polydipsia, N/V, volume depletion, eventually altered mental state and coma.
DKA uniquely has fruity breath, hyperventilation, abdo pain.
Principles of treatment of DKA and HHS?
IV fluid resuscitation, electrolyte repletion, insulin therapy
What is acromegaly?
Pituitary adenomas cause excess secretion of GH and IFG-1.
Signs of acromegaly?
Headache, vision loss, CN palsies
Coarsening of facial features
Soft tissue overgrowth e.g. enlarged nose, widened hands fingers feet
Need to increase shoe/ring sizes?
5 ‘P’s of Phaeochromocytoma?
high blood Pressure
head Pain
Perspiration
Palpitations
Pallor
3 criterias for Pyrexia of unknown origin?
T >38.3
3 weeks
Have undergone workup
Stigmata of dyslipidemia?
Xanthelesma
Xanthomas
Arcus cornealis
Thick achilles tendon
What is corneal arcus and what does it mean?
Blue ring around cornea.
Sign of HTN, high CRL, atherosclerosis
Causes of hypoglycemia in diabetics?
Insulin overdose/non-compliance/not eating
Increased physical activity
Alcohol consumption
Concomitant kidney/liver dysfunction
Infection / operation / body stress
Infection can cause hypoglycemia even in well controlled DM
How often to trend HbA1c in diabetics?
What should pre-meal blood glucose be for good control?
Trending HbA1c should be at least every 3-6 months.
Pre-meal blood glucose should be below 7
Symptoms of proteinuria?
Swelling of eyes and legs
Urinary frequency
Cramping muscle
SOB on exertion
Mnemonic SUCS
What cancer is acromegaly associated with?
Colorectal Cancer
What is hot vs cold nodule on Tc-99 thyroid scintography?
Thyroid nodules that absorb the radioiodine are usually not cancerous (called hot)
Thyroid nodules that do not absorb the radioiodine are called cold and have a 5% risk of being cancerous.
95% of thyroid nodules are cold.
4 specific signs of Graves?
Chemosis
Exophthalmos
Pretibial myxedema
Thyroid acropachy
Difference btw Exophthalmos vs Lid retraction in Graves’?
Exoph can see bottom of sclera, lid retraction is if can see top of sclera.
When can physiological proteinuria come?
Can come in the morning.
Protein shake lovers can also get physiological proteinuria
Secondary causes of DM/factors that can suddenly cause GLC levels to spike in a well-controlled diabetic?
Pancreatic cancer has TRO!!!
Cushing’s possible
Top causes of uremia?
BGIT, dehydration.
Less commonly prednisolone
In BGIT, urea rises out of proportion to Creatinine
Causes of increased, normal and decreased uptake in Iodine uptake test?
High uptake = Graves, Hashitoxicosis
Normal uptake = Hashimoto disease
Low uptake = DeQuervain’s, Hashimoto’s, excess Iodine uptake
How to differentiate btw nephrogenic vs central Diabetes Insipidus?
Water deprivation test! Involves not drinking anything and having urine measured hourly, being weighed and some blood taken through the cannula every two hrs. If you have DI, then even without drinking you will continue to pass larger than average amounts of dilute urine
Night blindness points to what condition?
Vit A deficiency
Which vitamins are absorbed with fat?
Pancreatic insufficiency can cause lack of these vitamins.
vitamin ADEK
What cancer is SIADH associated with?
Small cell lung Ca.
Tumour cells show neuroendocrine differentiation, secreting ADH and ACTH
What is Milk-Alkali syndrome?
Syndrome caused by excessive Calcium consumption and absorbale alkali.
Presents with HyperCa, metabolic alkalosis, AKI
3rd most common etiology of HyperCa
What is diabetic amyotrophy?
Form of lumbosacral plexus injury due to DM.
Microvasculitis damages plexus T12-S4, typically in recently diagnosed or well-controlled DM.
Asymmetric focal onset of pain followed by weakness and weight loss.
Which type of jaundice has tea coloured urine, pale stools and pruritus?
Direct hyperbilirubinemia (Conjugated BRB)
How to test for HyperK?
24 hr urine K is best
spot urine K is a worse alternative
Symptoms of hyperK?
ECG changes = tall tented T waves
Cardiac arrhythmias
Muscle weakness
Renal impairment
ECG is insensitive for K changes
Mx for hyperK?
IV 10% Calcium gluconate
IV insulin + dextrose
IV Furosemide
Can add Beta 2-adrenergic agonists + dialysis + Resonium
What is thyrotoxic periodic paralysis?
Rare dangerous complication in thyrotoxicosis.
HypoK + acute proximal symmetrical LL weakness.
Eventually has all 4 limbs will paralyze.
Drugs for acromegaly?
Dopamine agonist = Cabergoline
Somatostatin analogue = Octreotide
GH receptor antagonist = Pegvisomant
