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MLA Endocrinology Flashcards

1
Q

OGTT threshold for diabetes diagnosis?

A

> 11.1

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2
Q

Which investigation as an alternative to HbA1c is recommended in patients with existing haemoglobinopathy?

A

Fructosamine test

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3
Q

What is the diagnostic threshold for type 2 diabetes mellitus on fasting blood glucose?

A

> 7.0

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4
Q

What is the HbA1c range associated with impaired glucose tolerance?

A

42-47

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5
Q

Which auto-antibody (3) is associated with type 1 diabetes mellitus?

A

Islet cell
Anti-GAD
ZnT8

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6
Q

Which blood test should be performed in patients with suspected type 1 diabetes?

A

C-peptide (low) indicates insulin deficiency (marker of beta-cell function)

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7
Q

Which type of T1DM presents in adulthood?

A

Latent autoimmune diabetes in adults (LADA)

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8
Q

What is the cause of type 3c diabetes mellitus?

A

Pancreatogenic e.g., chronic pancreatitis, pancreatic cancer, CF, haemochromatosis

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9
Q

What are the side effects associated with metformin?

A

Diarrhoea

Lactic acidosis

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10
Q

What are the common adverse effects associated with SGLT-2 inhibitors?

A

UTIs
Thrush
Fournier’s gangrene
Euglycaemic ketoacidosis

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11
Q

What should be done to sustained release metformin in patients presenting with diarrhoea?

A

Switch to a modified release

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12
Q

Which anti-hyperglycaemic drug is associated with weight gain?

A

Sulfonylureas / glitazones

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13
Q

Which cancer risk is increased in patients on glitazones?

A

Bladder cancer

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14
Q

What is the initial insulin regimen for diabetes?

A

Basal bolus regimen

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15
Q

What severe features are associated with non-proliferative diabetic retinopathy?

A

Cotton wool spots

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16
Q

On biopsy, what is the characteristic finding observed in patients with diabetic nephropathy?

A

Kimmelstein-Wilson nodules

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17
Q

Which neuropathic medication is indicated in the management of diabetic neuropathy?

A

Duloextine
Amitriptyline
Gabapentin
Pregablin

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18
Q

Which nerve in the thigh is affected in amyotrophy (diabetes)?

A

Femoral nerve

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19
Q

What rheumatological manifestations are associated with T2DM?

A

Charcot neuroarthropathy
Adhesive capsulitis

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20
Q

What is the glucose threshold for hypoglycaemia in patients with diabetes?

A

<4.0 mmol/L

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21
Q

Which drug class can cause impaired hypoglycaemia awareness?

A

Beta-blockers

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22
Q

What is the first-line management option in patients with hypoglycaemia (conscious)?

A

Oral glucogel
Sugary drink

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23
Q

Unconscious - hypoglycaemia management (1st line)

A

IM glucagon or IV glucose (10-20%)

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24
Q

pH diagnostic threshold for DKA?

A

<7.3

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25
Q

Bicarbonate threshold for DKA?

A

<15

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26
Q

1st line management for DKA?

A

1L stat 0.9% sodium chloride then 1 hour then 2 hours.

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27
Q

Following fluid resuscitation, what is the next most appropriate management for DKA?

A

Fixed-rate insulin 0.1 Units /kg

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28
Q

What is the glucose threshold to begin administering glucose?

A

CBG <14

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29
Q

What is the complication of rapid correction of glucose?

A

Central pontine myleinolysis

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30
Q

What is the fasting plasma glucose level for gestational diabetes?

A

5.6

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31
Q

What is the 2-hour OGTT threshold for gestational diabetes?

A

7.8

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32
Q

What are the foetal complications associated with gestational diabetes?

A

Macrosomia

Shoulder dystocia

Polyhydramnios

Hypoglycaemia (neonatal)

Stillbirth

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33
Q

When is a 75 g 2 hour OGTT test performed during pregnancy?

A

At 24-28 weeks

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34
Q

If the FPG is >7.0 during pregnancy, what medication is recommended?

A

Insulin

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35
Q

1st line management for gestational diabetes if fasting blood glucose is 6.0 - 6.9?

A

Metformin

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36
Q

When are diabetic drugs discontinued during gestational diabetes?

A

Immediately postpartum

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37
Q

Which criteria is used to diagnose FH?

A

Simon–Broome Criteria

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38
Q

What is the inheritance pattern for familial hypercholesterolaemia?

A

Autosomal dominant

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39
Q

What is the total cholesterol threshold for FH?

A

> 7.5 mmol/L

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40
Q

What is the first line management of cranial diabetes insipidus?

A

Desmopressin

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41
Q

What is a common cause of pseudohyponatraemia?

A

High glucose, lipids or paraproteins

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42
Q

What sodium level is associated with severe hyponatraemia?

A

<120 mmol/L (normal range 135-145)

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43
Q

What is the management of hyponatraemia in patients with SIADH?

A

Fluid restriction and vaptans

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44
Q

What is the most common cause of hypercalcaemia?

A

Primary hyperparathyroidism (parathyroid adenoma)

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45
Q

What ECG findings are consistent with hypercalcaemia?

A

Short QT interval
J waves

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46
Q

What is the most important blood test to perform in a patient with hypercalcaemia?

A

Serum parathyroid hormone

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47
Q

What is the first line management of hypercalcaemia?

A

Intravenous fluids 4-6 L in 24 hours

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48
Q

What is the second step in the management of hypercalcaemia?

A

IV bisphosphonates

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49
Q

What is the main cause of secondary hyperparathyroidism?

A

Vitamin D deficiency, Chronic kidney disease

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50
Q

What is the mechanism of action of Denusomab?

A

RANK-L inhibitor

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51
Q

What is a common complication of thyroidectomy?

A

Hypocalcaemia

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52
Q

What is the first line management of severe symptomatic hypocalcaemia?

A

IV calcium gluconate

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53
Q

What ECG findings are associated with hypokalaemia?

A

ST depression
T-wave flattening
PR prolongation
U waves

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54
Q

What is the standard rate of potassium replacement in hypokalaemia?

A

10 mmol/hour

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55
Q

What drug is indicated to stabilise the cardiac membrane in patients with hyperkalaemia and ECG changes?

A

Calcium gluconate

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56
Q

Where is aldosterone produced in the adrenal cortex?

A

Zona glomerulosa

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57
Q

Where are glucocorticoids produced in the adrenal cortex?

A

Zona fasciculata

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58
Q

Which drugs can induce adrenal insufficiency?

A

Long-term steroids
Ketoconazole

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59
Q

What is the first line test for diagnosing Addison’s disease?

A

9 am cortisol + ACTH (Synacthen test)

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60
Q

What is the first line management for an Addisonian crisis?

A

IV hydrocortisone

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61
Q

Sick day rules for Addison’s disease?

A

Double hydrocortisone dose and keep the fludrocortisone dose the same

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62
Q

What is the acid-base status for Addison’s?

A

Hyperkalaemic metabolic acidosis

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63
Q

What is the most common autoimmune cause of hypothyroidism?

A

Hashimoto’s thyroiditis, primary atrophic hypothyroidism

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64
Q

Which mineral deficiency is associated with hypothyroidism?

A

Iodine deficiency

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65
Q

What is a hallmark feature of severe hypothyroidism?

A

Myxoedema coma - marked by hypothermia, hypoventilation, hyponatraemia, heart failure and confusion

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66
Q

Which blood test is recommended as first line for suspected hypothyroidism?

A

Serum TSH

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67
Q

↓ T4/T3, ↑ TSH Diagnosis?

A

Primary hypothyroidism

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68
Q

↓ T4/T3 and TSH diagnosis?

A

Secondary hypothyroidism

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69
Q

Which autoantibody is associated with hypothyroidism?

A

Serum thyroid peroxidase antibodies

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70
Q

In patients with normal thyroid function, yet symptoms of hypothryoidism, what investigation is recommended?

A

Neck ultrasound

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71
Q

Elevated TSH levels, and normal free T4, suggests what?

A

Subclinical hypothyroidism

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72
Q

What is the long-term therapy for hypothyroidism?

A

Levothyroxine monotherapy

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73
Q

How is levothyroxine taken?

A

Oral on an empty stomach, in the morning before food

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74
Q

How frequently should TSH be monitored following levothyroxine therapy?

A

Every 3 months

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75
Q

How should the levothyroxine dose be adjusted during pregnancy?

A

Increase by 25-50 micrograms

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76
Q

What is the criteria for starting levothyroxine in subclinical hypothyroidism?

A

TSH is >10 mU/L and FT4 is within the reference range on 2 separate occasions 3 months apart.

or

  • If <65 years, consider a 6-month trial of LT4 if:
  • TSH is 5.5 – 10 mU/L on 2 separate occasions 3 months apart, and there are symptoms of hypothyroidism.
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77
Q

What is the management for asymptomatic subclinical hypothyroidism?

A

Watch and wait; repeat TFTs in 6 months

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78
Q

What is the first line management for myxoedema coma?

A
  • Oxygen
  • Rewarming (for hypothermia)
  • Rehydration
  • IV T4/T3
  • IV hydrocortisone (in case hypothyroidism is secondary to hypopituitarism)
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79
Q

What autoantibody is associated with Graves’ disease?

A

Anti-TSH receptor antibody

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80
Q

What is the second most common cause of hyperthyroidism?

A

Toxic multinodular goitre

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81
Q

Which drug is associated with AIT Type 1 hyperthyroidism?

A

Amiodarone

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82
Q

Which ovarian tumour is associated with hyperthyroidism?

A

Struma ovarii

83
Q

Which is a dose-dependent risk factor for Graves orbitopathy?

A

Smoking

84
Q

What are the signs of Graves’ orbitopathy?

A

Periorbital oedema, proptosis, conjunctival oedema, increased tears, ophthalmoplegia, optic nerve atrophy

85
Q

Goitre description in Graves’ disease?

A

Diffuse symmetrical

86
Q

What is the goitre presentation in toxic adenoma?

A

Unilateral non-tender thyroid mass

87
Q

Which imaging. modality is indicated in patients with a palpable thyroid goitre?

A

Neck ultrasound

88
Q

What are the TFT results for amiodarone-induced hyperthyroidism?

A

Low TSH and raised FT4

89
Q

What is the definitive imaging investigation for Graves’ disease?

A

Radioisotope uptake scan (Tc99) - diffuse uptake

90
Q

Multiple hot nodules with suppression of the rest of the thyroid gland is consistent with what diagnosis?

A
  • Toxic multinodular goitre
91
Q

Thyrotoxicosis following a flu-like illness?

A
  • De Quervains thyroiditis
92
Q

Which investigation is indicated for Graves’ orbitopathy?

A

CT/MRI of orbits

93
Q

What is the first line management for symptomatic hyperthyroidism?

A

Beta-blockade e.g., atenolol, propanolol

94
Q

What is the mechanism of action of carbimazole?

A

Competitive inhibitor of thyroid peroxidase - blocks thyroid hormone synthesis

95
Q

Which anti-thyroid drug inhibits peripheral conversion of T4 to active T3?

A

o Propylthiouracil

96
Q

Which anti-thyroid drug is preferred during the first trimester of pregnancy/pre-pregnancy?

A

o Propylthiouracil

97
Q

What are the contraindications of carbimazole?

A

Severe blood disorders, acute pancreatitis, women of childbearing potential (Risk of congenital malformations during the 1st trimester).

98
Q

Which drugs are interacted with carbimazole?

A

Azathioprine (Increased myelosuppression); warfarin (enhances anticoagulant effect – INR monitoring); methotrexate, digoxin.

99
Q

What is the most concerning adverse effect associated with carbimazole?

A

Agranulocytosis

100
Q

What is the major adverse effect associated with propylthiouracil?

A

Liver disease

101
Q

Normal duration of carbimazole for Grave’s disease?

A

18 months

102
Q

What is the definitive management for Grave’s disease?

A

Radioactive iodine (1-131)

103
Q

How does radioactive iodine therapy work in the management of hyperthyroidism?

A

Destroys thyroid follicular cells

104
Q

What are the contraindications of radioactive iodine thearpy?

A

Pregnancy
Breastfeeding
Active/severe orbitopathy

105
Q

How long should pregnancy be avoided following radioactive iodine therapy?

A

4-6 months

106
Q

What is the indication for a thyroidectomy in hyperthyroidism?

A

Local compression secondary to thyroid goitre e.g., upper airway obstruction/dysphagia

107
Q

What is the pre-operative management for hyperthyroidism?

A

Euthyroid state and control hypertension

Prescribe oral potassium iodide and propranolol

108
Q

What is first line management for Grave’s orbitopathy?

A

Smoking cessation, and consider steroids

109
Q

What is the main cardiac complication associated with hyperthyroidism?

A

Atrial fibrillation (3-fold increase)

110
Q

What rheum complication is associated with hyperthyroidism?

A

Osteoporosis

111
Q

What are the complications of surgery associated with hyperthyroidism?

A

Recurrent laryngeal nerve palsy

Hypothyroidism

Hypoparathyroidism (more common)

112
Q

What is the long-term complication associated with subclinical hyperthyroidism?

A

Osteoporosis and atrial fibrillation

113
Q

What is the tumour marker for papillary thyroid cancer?

A

Thyroglobulin

114
Q

What are the histological findings associated with papillary thyroid carcinoma?

A

Orphan Annie eyes, and Psammoma bodies

115
Q

Which thyroid cancer is associated with a very good prognosis?

A

Papillary thyroid carcinoma

116
Q

Which thyroid cancer is very aggressive, and common in the elderly?

A

Anaplastic thyroid cancer

117
Q

What is the tumour marker associated with medullary thyroid cancer?

A

Calcitonin

118
Q

Which familial disorder is associated with medullary thyroid cancer?

A

Men2a/2b

119
Q

What is the diagnostic investigation for thyroid cancer?

A

Fine needle aspiration cytology (FNAC)

120
Q

What is the most common cause of primary adrenal insufficiency?

A

Autoimmune mediated

121
Q

Why is there hyperpigmentation in Addison’s disease?

A

increased MSH levels (POMC precursor)

122
Q

What electrolyte imbalance is associated with Addison’s disease?

A

Hyponatraemia

Hyperkalaemia

123
Q

What is the acid-base imbalance associated with Addison’s disease?

A

Metabolic acidosis

124
Q

What is the first-line investigation for Addison’s disease?

A

9 am cortisol (<100 - diagnostic - admit)

100 -500 refer to endocrinology

125
Q

What is the diagnostic investigation to confirm adrenal insufficiency?

A

Short SynACTHen test

Administer 250ug Synacthen intramuscularly and measure the subsequent cortisol response (within 30 minutes) . In patients with adrenal hypofunction, there is reduced cortisol secretion unresponsive to ACTH stimulation, thus the cortisol response is absent – minimal change.

126
Q

What is the dose administration for hydrocortisone replacement in Addison’s disease?

A

3 divided doses (10 mg on waking, 5 mg at noon and 5 mg in the early evening).

127
Q

What happens to the hydrocortisone in patients with intercurrent illness?

A

Double dose

128
Q

What is the mineralocorticoid replacement of choice for Addison’s disease?

A

Fludrocortisone

129
Q

What is the first line drug for the management of an Addisonian crisis?

A

IV hydrocortisone and rapid IV fluid rehydration

130
Q

What is the most common cause of hyperaldosteronism?

A

Bilateral adrenal hyperplasia

131
Q

What electrolyte imbalance is associated with primary hyperaldosteronism?

A

Hypokalaemia, Hypernatraemia

132
Q

What is the first line of investigation for hyperaldosteronism?

A

Plasma aldosterone: renin ratio

(Raised - renin is suppressed)

133
Q

What is the diagnostic investigation to confirm primary hyperaldosteronism?

A

CT adrenals

134
Q

Which investigation is indicated to differentiate between unilateral and bilateral hyperaldosteronism?

A

Adrenal venous sampling

135
Q

What is the medical management for hyperaldosteronism?

A

spironolactone, eplerenone

136
Q

What is the management for a unilateral adrenal adenoma?

A

Unilateral laparoscopic adrenalectomy

137
Q

For bilateral adrenal disease (hyperaldosteronism), what is the preferred management?

A

Spironolactone

138
Q

Which cells produce catecholamines?

A

Chromaffin cells of the adrenal medulla

139
Q

Which three familial syndromes are associated with phaeochromocytoma?

A
  • Von-Hippel Lindau

MEN2

NF1

140
Q

What is associated with Von-Hippel Lindau syndrome?

A

Phaeo, renal cell carcinoma, renal cysts, hemangioblastoma

141
Q

What is MEN Type2a syndrome?

A

Phaeochromocytoma
Parathyroid adenoma
Medullary thyroid cancer

142
Q

What is the first line investigation for suspected phaeochromocytoma?

A

24h urinary metadrenaline/metanephrines

143
Q

What precursor test is involved for screening for phaeos?

A

Meta-lodobenzylguanidine scan

144
Q

What is the first line management for phaeo?

A
  • Alpha blockade (first) – phenoxybenzamine for 7-14 days preoperatively.
  • An alpha blockade is first to prevent the precipitating of a hypertensive crisis.
145
Q

What are the two drugs indicated for the management of Phaeochromocytoma?

A

Alpha-blockade and beta-blockade

146
Q

What is the definitive management for phaeochromocytoma?

A

Adrenalectomy

147
Q

What is the normal range of calcium?

A

2.2 to 2.6 mmol/L

148
Q

What is the main cause of secondary hyperparathyroidism?

A

Chronic kidney disease

149
Q

Which type of hyperparathyroidism can be associated with normal serum levels of PTH?

A

Primary hyperparathyroidism

150
Q

Raised Calcium
Low phosphate
Normal/raised PTH
Raised ALP

Most likely diagnosis?

A

Primary hyperparathyroidism

151
Q

Low calcium
Raised phosphate
Raised PTH/ALP

Most likely diagnosis?

A

Secondary hyperparathyroidism

152
Q

Raised PTH, ALP, and low Vitamin D, low calcium and low phosphate

Most likely diagnosis?

A

Osteomalacia

153
Q

Which marker is raised in Paget’s disease?

A

Serum ALP

154
Q

Serum PTH level in hypercalcaemia of malignancy?

A

Low

155
Q

What is pseudohypoparathyriodism?

A

PTH resistance (Type 1a = Albright’s Hereditary Osteodystrophy phenotype).

156
Q

Which sign denotes tapping over the facial nerve eliciting twitching of the upper lip?

A
  • Chvostek’s sign
157
Q

Which sign is associated with a carpal spasm following inflation of a BP cuff?

A
  • Trousseau’s sign
158
Q

What is Albright Hereditary Osteodystrophy?

A
  • Short stature
  • Round face
  • Shortened fourth/fifth metacarpal bones.
  • Lab: Hypocalcaemia and hyperphosphatemia + raised PTH.
159
Q

What is pseudopseudohypoparathyriodism?

A

phenotypic expression of ABO without PTH resistance

160
Q

What ECG changes are associated with hypercalcaemia?

A

Short QT interval

Prolonged PR interval

Widened QRS complex and bradycardia

161
Q

What is the first line management of hypercalcaemia?

A

0.9% saline fluid resuscitation

162
Q

Following fluid resuscitation what is the next line in management?

A
  • Bisphosphonates (IV)
163
Q

Which adrenal zone secretes cortisol?

A

Zona fasciculata

164
Q

Which lung cancer is associated with ectopic secretion of ACTH?

A

Small cell lung carcinoma

165
Q

What is the first line investigation for suspected Cushing’s syndrome?

A
  • Urine-free cortisol (at least two measurements)
  • Late-night salivary cortisol (at least two measurements)
  • 1-mg overnight dexamethasone suppression test (DST)
166
Q

What is the second line investigation to differentiate between ACTH-dependent and ACTH-independent aetiologies of Cushing’s syndrome?

A

Serum ACTH

167
Q

For ACTH-independent causes of Cushing’s syndrome, what is the next line of investigation?

A

CT adrenals

168
Q

For ACTH-dependent causes of Cushing’s syndrome, what is the next line of investigation?

A

Bilateral inferior petrosal sinus sampling

169
Q

Raised cortisol and raised ACTH following a high dose dexamethasone test, indicates what?

A

Ectopic ACTH aetiology

170
Q

Serum cortisol result following high dose dexamethasone suppression test, in Cushing’s disease?

A

Suppressed

171
Q

What is the medical management for Cushing’s?

A

metyrapone

172
Q

What is the definitive management for an adrenal cause of Cushing’s?

A

Adrenalectomy and steroid replacement

173
Q

What is the preferred definitive management for Cushing’s disease?

A

Surgical transsphenoidal resection

174
Q

Which skin condition is suggestive of insulin resistance?

A

Acanthosis nigricans

175
Q

What is the diagnostic cut-off for HbA1c for diabetes?

A

> 48 mmol/mol (>6.5%)

176
Q

What factors can affect HbA1c results?

A

Haemoglobinopathies, severe anaemia, post-splenectomy, recent blood transfusion

177
Q

Fasting plasma glucose cut-off for diabetes diagnosis?

A

> 7.0 mmol/L

178
Q

OGTT cut-off for diabetes diagnosis?

A

> 11.1 mmol/L

179
Q

What is the first line medical management for T2DM?

A

Metformin

180
Q

What is a common side effect of metformin?

A

Diarrhoea

181
Q

Metformin management in patients presenting with diarrhoea (side effect)?

A

Switch to modified-release

182
Q

Which drug should be co-prescribed with Metformin in diabetic patients with chronic heart failure or established CVD?

A

SGLT-2 inhibitor

183
Q

When should an SGLT-2 inhibitor be prescribed in the medical management plan for diabetic patients with underlying heart disease?

A

Once the metformin dose is optimised

184
Q

What is the second line medical management for T2DM?

A

If monotherapy is ineffective consider adding one of the following:
* A DPP-4 inhibitor (e.g., Sitagliptin)
* Pioglitazone
* Sulfonylurea
* SGLT-2 inhibitor

185
Q

What is the preferred triple therapy for T2DM?

A
  • Triple therapy: DPP-4 inhibitor, pioglitazone, a sulfonylurea or an SGLT-2 inhibitor (canagliflozin or empagliflozin)
  • Note: Dapagliflozin is recommended only in combination with metformin and sulfonylurea, not pioglitazone.
186
Q

What is the BMI cut off for starting a GLP-1 receptor agonist?

A
  • BMI >35 kg/m2
187
Q

When should a GLP-1 agonist be discontinued?

A

If there is not demonstrated weight loss within 6 months (<3%)

188
Q

How frequently should HbA1c be measured?

A

Every 3-6 months

189
Q

What is performed during an annual diabetes check-up?

A

Diabetic foot check

Annual retinopathy, neuropathy and nephropathy screening

190
Q

What is the HbA1c target for lifestyle and diet management in T2DM?

A

48 mmol/mol

191
Q

What is the HbA1c target for lifestyle and single drug medical management in T2DM?

A

48

192
Q

What is the HbA1c target for lifestyle and medical management (drug associated with hypoglycaemia e.g., sulfonylurea) in T2DM?

A

53

193
Q

At what HbA1c should an additional diabetic drug be commenced?

A

> 58

194
Q

What is an absolute contraindication for metformin?

A

Severe renal insufficiency - eGFR <30 mL/min

195
Q

What is the risk of metformin in patients with renal impairment?

A

Lactic acidosis

196
Q

What class of diabetic drug is glimepiride?

A

Sulphonylureas

197
Q

Which drug is associated with interacting with ATP-sensitive potassium channels to promote insulin pancreatic secretion?

A

Sulphonylureas

198
Q

What is the main adverse effect associated with Sulphonylureas?

A

Weight gain

199
Q

Which two diabetic drugs are associated with weight gain?

A

Sulphonylureas and glitazones

200
Q

What is the mechanism of action of gliptins?

A

DPP-4 inhibitors

201
Q

What are the adverse effects associated with SGLT-2 inhibitor use?

A

Genital mycotic (fungal) infections – candida albicans (vaginal thrush and balanitis); normoglycemic ketoacidosis, increased risk of Fournier’s gangrene.

202
Q

What type of calcium channel blocker is Verapamil?

A

non-dihydropyridine calcium channel blocker

203
Q

Which calcium channel blocker is contraindicated in HFrEF?

A

non-dihydropyridine calcium channel blocker E.G., Verapamil

204
Q
A

MLA Flashcards (19 decks)

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