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Phase 2A (HV) > Miscellaneous- Endo > Flashcards

Miscellaneous- Endo Flashcards

1
Q

Causes of hypoglycaemia

A

Diabetics- excess insulin or se of sulfonylureas
Non-diabetics- EXPLAIN (exogenous drugs, pitiatary insufficiency, liver disease, addisons, insulinoma, non-pancreatic neoplasm)

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2
Q

What is HHS

A

Hyperosmolar hyperglycaemia is a medical condition resulting in marked hyperglycaemia, hyperosmolality and mild/no ketosis

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3
Q

What is the tx for HHS

A

1) normalise osmolality
2) Fluid replacement
3) slow infusion of insulin
4) correct potassium if required and give lmwh

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4
Q

What are the lab values for DKA (glucose, ph, bicarbonate and ketones)

A

Glucose >11.1
Ph<7.3
Bicarbonate<15mmol
Ketones >3mmol

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5
Q

What is the treatment for DKA

A

1) fluid replacement IV 0.9% saline
2) intravenous infusion of insulin (administer slowly, 18-25 risk of cerebral oedema0
3) correction of electrolytes
4) long insulin should be continue, short insulin should be stopped

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6
Q

Causes of hyperglycaemia

A

Withdrawal/reduced insulin utilisation
Increase glucose production
Secondary to pancreatitis, Cushing/acromegaly, use of gloucocorticoids

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7
Q

Complication of diabetes

A

Micro vascular- nephropathy, neuropathy, retinopathy

Macrovascular- mi, stroke, pvd (gangrene)

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8
Q

What is a prolactinoma

A

Benign lactrophs adenoma secreting prolactin

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9
Q

What inhibits the production of prolactin

A

Dopamine

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10
Q

Sx of prolactinomas

A 
Oligomenorrhaea/ammenorrhoea 
Loss of libido 
Erectile dysfunction 
Galactorrhoea 
Infertility 
Osteoporosis 
Opthamaloplegia 
Headaches 
decrease facial hair
Weight gain
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11
Q

Tx for prolactinoma

A

1st line- dopamine agonist- cabergoline or bromocriptine

2nd line- transpenoidal surgery

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12
Q

Secretion of GH from anterior pituitary acts on the liver. What does the liver secrete in response to this

A

IGF-1

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13
Q

What are the sx of acromegaly

A 
Large forehead- frontal bossing 
Large nose 
Large hands and feet 
Large protruding jaw 
Large tongue 
Arthritis from imbalanced growth of joints
Skin tags 
Profuse sweating 
Headaches
Visual lesions

(exams will refer to increase in shoe size or ring size)

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14
Q

What substance can suppress GH

A

High levels of glucose

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15
Q

What are the ix for acromegaly

A

1st line- measure serum IGF-1 , Random serum growth hormone

GS- OGTT- Whilst measuring GH, high levels of glucose suppress GH

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16
Q

Tx for acromegaly

A

1st line- transphenoidal surgery
2nd line- Somatostatin analogues- octreotide
3rd line GH antagonist- pigvisomant
4th line- dopamine agonist- cabergoline or bromocriptine

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17
Q

What substance inhibits GH SECRETION

A

Somatostatin

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18
Q

What is Cushing syndrome

A

General term referring to excessive levels of cortisol

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19
Q

What is Cushing disease

A

Excess glucocorticoids resulting from inappropriate ACTH secretion due to pituitary tumour

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20
Q

What are the causes of Cushing

A

ACTH Dependant-
Ectopic tumour
Pituitary adenoma

ACTH Independent
Iatrogenic
Adrenal adenoma

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21
Q

List 5 functions of cortisol

A

1- increase in carbohydrate and protein catabolism
2- increase deposition of fat and glycogen
3- Na retention
4- increase k+ renal loss
5- diminished host responses to infection

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22
Q

Signs and symptoms of Cushing

A 
Purple striae 
Moon face 
Buffalo hump 
Hirsuitism 
Acne 
Central obesity 
Irregular menses/ED
Mood changes- depression, lethargy, psychosis 
Osteoporosis 
Increase bp
HTN
Increase glucose
Proximal muscle weakness
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23
Q

Gold standard Ix for Cushing and the results presented

A

1mg dexamethasone
Low cortisol levels= normal
Normal/high cortisol levels= Cushing’s syndrome

8mg dexamethasone 
Low cortisol- Cushing diseases (pit tumour)
Normal/high cortisol- 
    ACTH low- adrenal Cushings 
    ACTH high- ectopic ACTH
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24
Q

Tx for cushings

A

GS- removal of tumour

Drugs-Metyrapone or ketoconazole (ek flash)
Drug class- Adrenal Steroid Synthesis Inhibitor

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25
Q

What is cranial and nephrogenic diabetes insipidus

A

Cranial- decreased secretion of ADH

Nephrogenic- insensitivity to ADH

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26
Q

Where is ADH secreted from

A

Supraoptic nucleus in posterior pituitary

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27
Q

List 5 causes of cranial and nephrogenic DI

A

Cranial

  • CNS infections
  • idiopathic
  • head trauma
  • brain/pituitary surgery
  • congenital
  • subarachnoid haemorrhage
  • autoimmune disorders

Nephrogenic

  • electrolyte abnormalities (hyper/hypokalaemia)
  • systemic diseases
  • medications (lithium, cisplatin, gentamicin)
  • CKD
  • uropathy
  • inherited
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28
Q

What is the serum and urine osmolality in DI

A

Serum osmolality high

Urine osmolality is low

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29
Q

What is the Ix required in order to diagnose DI and it’s specific type

A

Gs- water deprivation test (urine osmolality low, serum osmolality high)- diagnoses DI

Desmopressin test- distinguishes which type
Cranial- (low serum osmolality, high urine osmolality)
Nephrogenic- (low urine osmolality, high serum osmolality)

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30
Q

Sx of DI

A 
Polyuria
Polydipsia
Children may have nocturia 
No glycosuria 
Dehydration 
Sx of hypernatraemia
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31
Q

Tx for cranial and nephrogenic DI

A

Cranial- give synthetic arginine vasopressin analogue desmopressin (DDAVP)- desmomelt tablets

Nephrogenic- treat the underlying cause
Low sodium diet

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32
Q

What are the three characteristics that are concurrent with SIADH

A

1- euvolaemia
2- hyponatraemia
3- increase urine na+ (high urine osmolality)

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33
Q

Causes of SIADH

A
  • malignancy- ectopic or pituitary tumour
  • drugs- CARDISH (chemotherapy, antidepressants, recreational, diuretics, inhibitors (ssris, ACEI), sulfonylureas, hormones (desmopresssin))
  • trauma
  • post operative
  • neurological- meningitis, encephalitis, SAH
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34
Q

Sx of SIADH

A
  • absence of hyper/hypovolaemia
  • n+v
    Fatigue
    Headaches
    Muscle aches and cramps
    Hyponatraemia
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35
Q

Ix for SIADH

A

Diagnosis of exclusion. Short synacthen test to exclude adrenal insufficiency

Serum sodium- low
Urine sodium- high

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36
Q

Tx for SIADH

A

Acute severe hyponatraemia- IV hypertonic saline solution (3%)
Acute mild hyponatraemia- fluid restriction

Rx- tolvaptan- ADH receptor blocker

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37
Q

What is hypokalaemia

A

Serum potassium <3.5mmol/l

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38
Q

Causes of hypokalaemia

A
  • increase GI loss (D+V)
  • reduced potassium intake- anorexia nervous a, bulimia
  • ckd
    Increase availability of insulin
    Increased potsssium excretion- loop diuretics
    Liquorice abuse
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39
Q

Sx of hypokalaemia-

A 
Muscle weakness
Hypotonia\hyporeflexia  (sign)
Cramps
Tetany 
Palpitation
Constipations
Lethargy
40
Q

What ecg changes are seen in hypokalaemia

A

Small/inverted T waves
Prolonged PR interval
ST depression segments
U waves

41
Q

What is the definition of hyperkalaemia

A

Serum potassium >5.5mmol/l

42
Q

Causes of hyperkalaemia

A 
Insulin deficiency 
Tumour lysis syndrome 
Haemolysis 
Trauma 
Extensive burns
Acidosis 
ACE inhibitors/NSAIDs
43
Q

ECG changes associated with hyperkalaemia

A

Tall tented t waves
Long PR interval
Wide QRS complex
Absent/small P waves

Ventricular fibrillations

44
Q

Sx of hyperkalaemia

A 
PHADI M
Palpitations
Hypereflexia
Anxiety 
Diarrhoea 
Irritability 
Muscle cramps
45
Q

Tx of hyperkalaemia

A

If cardiotoxicity present on ecg- stabilise cardiac membrane by IV CALCIUM GLUCONATE/CHLORIDE

If no cardiotoxicity- combined insulin/dextrose infusion w/ nebulised salbutamol

Additionally Remove potassium- calcium reasonium

46
Q

What is conns syndrome

A

Aka primary hyperaldosteronism. Too much aldosterone secreted by adrenal glands

47
Q

Causes of primary hyperaldosteronism

A
  • bilateral cortical adenoma *
  • bilateral adrenal adenoma
  • familial hyperaldosteronism
48
Q

What is the role of the hormone aldosterone and where is it secreted from

A
  • increases sodium reabsorbtion from DCT
  • increases potassium excretion from DCT

Secreted from zona glomerulosa of adrenal cortex

49
Q

What are the Sx of conns syndrome

A 
HTN
lethargy (low potassium)
Mood disturbances (low potassium)
Difficulty concentrating (low potassium)
Nocturia
Polyuria 
Weakness/cramps 
Parasthesia
50
Q

Ix for conns

A

Plasma potassium is low

GS- Aldosterone to renin ratio
high aldosterone and low renin- primary hyperaldosteronism
high aldosterone and high renin- secondary hyperaldosteronism

51
Q

Tx for conns

A

1st line- aldosterone antagonist- spironolactone, eplerenone

Gs- laparoscopic adrenalectomy

52
Q

Sx of hyponatraemia

A 
Altered mental status 
Oedema
Nausea and vomiting 
Poor skin turgor 
Low urine output
53
Q

What are the complications of hyponatraemia

A

Seizures
Coma
Death
Cerebral oedema

54
Q

Sx of hypernatraemia

A

Diarrhoea and vomiting
Impaired thirst
Weight loss
Decreased jugular venous pressure (hypovolaemia)
CNS manifestations- intracranial haemorrhage, seizures, death

55
Q

What is Addison’s disease

A

Primary adrenal insufficiency (low cortisol, high ACTH)

An autoimmune condition where adrenal glands have been damaged, resulting in reduced secretion of cortisol and aldosterone

56
Q

What are the causes of Addison’s disease

A 
UK and developed countries- autoimmune 
Most common cause worldwide- TB
Metastases 
Meningococcal septicaemia 
HIV
57
Q

Sx of Addison’s disease

A 
Hyperpigmentation of the palmar creases 
Lean
Weight loss
Weakness 
Lethargy 
Vitiligo 
Loss of pubic hair in women 
Loss of libido 
Nausea and vomiting

Signs
Hyponatraemia
Hyperkalaemia

58
Q

Ix of Addison’s disease

A

1st line- FBC, electrolytes (low Na, high K), serum glucose (low)

Gold standard- short syncathen test (synthetic ACTH given but cortisol still low)

Other- presence of 21-hydroxylase adrenal autoantibodies (non-specific)

59
Q

Tx for Addison’s disease

A

1st line- hydrocortisone (glucocorticoid) + fludrocortisone (mineralocorticoid)

60
Q

Tx in Addisonian crisis

A 
Intensive monitoring 
Paraenteral steroids (IV hydrocortisone)
IV fluid resuscitation 
Correct hypoglycaemia 
Monitor electrolytes and fluid balances
61
Q

What is secondary adrenal insufficiency

A

Characterised by ⬇️cortisol ⬇️ACTH, normal aldosterone and normal renin

62
Q

What are the levels of aldosterone and renin in Addison’s disease

A

⬇️aldosterone

⬆️renin

63
Q

What are the causes of secondary adrenal insufficiency

A 
Exogenous glucocorticoids
Adrenal adenoma/carcinoma 
Surgery
Infection 
Hypoplasia of pituitary gland
64
Q

Sx of secondary adrenal insufficiency

A 
Weakness
Lethargy 
Anorexia
Vomiting 
Hypoglycaemia 
Hypotension
65
Q

Ix for secondary adrenal insufficiency

A

Gs- short syncacthen test- cortisol will increase

66
Q

Tx for secondary adrenal insufficiency

A

Glucocorticoid replacement- prednisalone, hydrocortisone

67
Q

What is carcinoid syndrome

A

Is the release of serotonin and other vasoactive peptides into the Systemic circulation from a carcinoid tumour

68
Q

What cells do carcinoid tumour arise from

A

Neuroendocrine cells

69
Q

Where do carcinoid tumours most commonly arise from

A

GI tract, lungs, ovaries, thymus

  • small intestine malignancy most common
  • appendix the most common site in GI tract
  • Liver most common site for metastasise
70
Q

Sx of carcinoid syndrome

A 
Flushing- upper face and trunk 
Diarrhoea 
Bronchospasm 
Fibrosis, heart valve thickening 
Pellagra (niacin deficiency)
Dermatitis
71
Q

Ix for carcinoid syndrome

A

1st line- urinary 5 hydroxyindoleacetic acid test (raised levels)

Gs- chromagranin-A-octreoscan (pts should avoid banana, chocolate and caffeine)

Other- CXR/CT/MRI chest and pelvis

72
Q

Tx for carcinoid syndrome

A
  • surgery

Somatostatin analogue- octreotide

73
Q

What is serotonin syndrome

A

An excess of synaptic serotonin in the CNS

74
Q

What is the classical triad of manifestations in serotonin syndrome

A

Neuromuscular excitation
Autonomic effects
Altered mental status

75
Q

Sx of serotonin syndrone

A

Neuromuscular excitation- hypereflexia, clonus, tremors
Autonomic hyperactivity- vomiting, diarrhoea, hypertension, tachycardia, hyperthermia, mydriasis
Altered mental status- confusion, anxiety, agitation

76
Q

What is phaechromocytoma

A

A tumour arising from catecholamine producing chromaffin cells of adrenal glands

77
Q

What is the classic triad of symptoms in phaechromocytoma

A

Palpitations
Headaches
Diaphoresis

78
Q

Sx of phaechromocytoma

A 
Perspiration 
Palpitations 
Pallor
Pain (headache)
High bP
79
Q

Ix for phaechromocytoma

A

24hr urine collection for catecholamines, metanephrines, normetanephrines, creatinine and serum free meta and normetanephrines (elevated)

CT/MRI Scan

80
Q

Tx for phaechromocytoma

A

Surgery
Alpha blockers- Doxazosin
Beta blockers- propanalol

81
Q

Causes of hypercalcaemia

A

CHIMPANZEES

Calcium supplements 
Hyperparathyroidism 
Iatrogenic (thiazide)
Milk alkali 
Padgett disease of the bone 
Acromegaly and Addison’s 
Neoplasia
Zollinger-Ellison syndrome 
Elevated vitamin D
Elevated vitamin A 
Sarcoidosis
82
Q

What is the definition of Impaired Glucose Tolerance

A

A glucose level of 7.8-11mmol/L after an oral glucose tolerance test

83
Q

What substance is responsible for the hyperpigmentation in addisons?

A

Pro-opromelanocortin (POCM)- a precursor to both ACTH and MSH (Melanocyte Stimulating Hormone)

84
Q

What is the MOA and SE of carbimazole

A

MOA- inhibits thyroid peroxidase

SE- agranulocytosis

85
Q

How do you calculate anion gap

A

(Na + k)-(cl+hco3)

86
Q

List 5 Sx of hyperthyroidism

A 
Weight loss
Heat intolerance 
Diarrhoea 
Oligomneorrhoea 
Increased sweating
87
Q

List 5 Sx of hypothyroidism

A 
Weight gain 
Constipation
Menorrhagia
Cold intolerance 
Lethargy
Dry skin/coarse hair
Lateral loss of 1/3 eyebrow
88
Q

List 3 primary and secondary causes of hyperthyroidism

A

Primary-
Graves
Toxic multi modular goitre
Toxic adenoma

Secondary
Lithium 
Amiadorone 
Overdose of levothyroxine 
Gestational 
Iodine excess
89
Q

Tx for hyperthyroidism

A

Carbimazole- inhibits thyroid peroxidase

Propylthiouracil

90
Q

Name two se of levothyroxine

A

Osteoporosis

Arrhythmias

91
Q

Most likely cause of primary Hyperparathyroidism

A

Solitary adenoma (80%)
Hyperplasia
Multiple adenoma
Carcinoma

92
Q

Definitive/gs tx for primary Hyperparathyroidism

A

Total parathyroidectomy

93
Q

Give 5 symptoms of hypercalcaemia

A 
Abdominal pain 
Renal stones 
Polyuria 
Bone pain/fractures 
Depression
94
Q

Name 3 types of cancers that can cause SIADH

A

Small cell lung cancer
Lymphoma
Prostate cancer
Pancreatic cancer

95
Q

List 3 complications of acromegaly

A

OSA
T2DM
Cardiomyopathy
HTN

96
Q

When is metformin contraindicated

A

When eGFR is less than 30n

Phase 2A (HV) (13 decks)

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