MRCP Endo Flashcards
Which sex hormone is responsible for ovulation induction?
Luteinising hormone
Can be seen by rise in progesterone level
What is Kallmann syndrome?
Isolated GnRH deficiency (Xlinked)
Associated anosmia and hypogonadism
What is hypokalaemic periodic paralysis?
channelopathy caused by skeletal muscle ion channel mutations, mainly affecting calcium or sodium channels.
praoxysmal weakess due to hypokalaemia
When do you see raised gonadotrophins (FSH/LH)?
primary ovarian failure
What is non-functioning adenoma?
Does not produce hormones, just large enough to compress nearby structures
Headache,
bitemporal hemianopia,
pituitary insufficiency
What blood test differentiates between exogenous and endogenous insulin causing hypoglycaemia?
Exogenous- low c-peptide
Endogenous- high c-peptide
When do you see low FSH and LH
Hypothalamic anemorrhoea
anorexia/stress/excessive exercise
shut down for survival
How should you dose adjust thyroxine?
Guided by TSH levels
Adjust every 4-8 weeks.
(TSH lag behind T4)
What is the mode of imaging to determine the volume of thyroid gland?
Ultrasound
When is glucose tolerance test used?
Diabetes
Acromegaly
What is the causes of secondary hypoparathyroidism?
Damage to parathyroid glands during thyroid surgery
DiGeorge
What are the 4 stages of Hypertensive retinopathy
I = Tortuous (one word)
II = AV nipping (two words)
III = cotton wool spots (three words)
IV = papilloedema is the worst (four words lol)
What is branch retinal vein occlusion?
segmental haemorrhage
What is the mechanism of action of levonogestrel in emergency contraception?
Delay ovulation
Outline management of thyroid storm
Life threatening thyrotoxicosis with systemic failure.
beta blocker (IV propanolol)
antithyroid drug (propylthiouracil)
inorganic iodide
steroid (dexamethasone to block T4->T3)
cooling
volume resus
respiratory support in ITU
What is the biochemical finding in PCOS?
Low SHBG hence free testosterone
Rise in LH : FSH (3 : 1 ratio)
Rise in testosterone and DHEA
What is DiGeorge syndrome?
Microdeletion on Chr 22
Thymic hypoplasia,
cardiac defect (ToF)
LD
hypoparathyroidism-> hypocalcaemia
What cardiac complication is hypothyroidism associated with?
Pericardial effusion
What is the order of puberty in girls
Boobs
Pubes
Grow
Flow
What is the order of puberty in boys
Grapes
Drapes
Grow
Flow
What is likely to occur with oestrogen only pill?
breakthrough bleed
What drugs cause SIADH?
SIADH Cannot Void
SSRI
Indomethacin
Antidepressant TCA
Diuretic thiazide
Haloperidol
Carbamazepine
Cyclophosphamide
Vincristine
What cranial cancer can cause craniopharygioma
Diabetes insipidus
inferior quadratanopia
Other than cough, what side effect is ACEi associate with?
Angioedema
Which 3 compounds contribute to ketosis in DKA? (ABA)
Acetone (pear drop)
Beta-hydroxybutyrate -> can linger after 36 hr
Acetoacetic acid
Acetone and acetoacetic acid fall after 36hr
What is charcot arthropathy?
Diabetic neuropathic arthropathy- trauma to foot -> exaggerated local inflammatory response -> osteoarthropathy
Outline conservative management for diabetic retinopathy
- optimise glycaemic control slowly
- optimise BP and lipids
- Annual eye exam
What is Albright’s hereditary osteodystrophy?
Autosomal dominant, G protein defect-> PTH resistance -> pseudohypoparathyroisim
short stature
brachydactyly
soft tissue calcification
hypocalcaemia
high PTH
All bright people are fake
What is the most common side effect of oestrogen treatment (HRT)
Breast tenderness
Bloating
Nausea
Drop in which hormone is causes shedding of endometrium?
Progesterone as corpus luteum dies
Post partum thyroiditis is more likely in patients with which antibody?
anti-TPO ab pre pregnancy
What is Sturge Weber syndrome
Vascular disorder in brain and eye abnormal
- Epilepsy
- Birth mark: Port wine naevus on face
a/w phaeochromocytoma
What medication is beneficial for HF, CKD, and T2DM?
ACEi (even if normotensive)
Which male sex hormone is associated with pubic hair growth?
Dihydrotestosterone
DHT
What is VIPoma?
Vasoactive intestinal peptide -> chronic diarrhoea and hypokalaemia and normal anion gap
aka pancreatic cholera syndrome
Neuroendocrine tumour
Outline management for hyperthyroidism?
Medical:
Carbimazole (monitor FBC and LFT)
- risk of agranulocytosis
Beta blockers for palpitations
Pregnant women:
Propylthiouracil in early pregnancy
- switch to carbimazole in later preg due to hepatotoxicity maternal
Surgical:
Radioactive iodine treatment- if high uptake
Subtotal/total thryoidectomy (failed meds/radioiodine)
- pregnant women if medical fail
- risk of hypothyroidism hypoparathyroidism, vocal cord paralysis
Which gene is associated with T1DM?
HLA-DR3
What does high 17-hydroxyprogesterone indicate?
Congenital adrenal hyperplasia
Presents with:
primary amenorrhoea
hyperandrogenism
cliteromegaly
Manage:
1. glucocorticoid replacement to reduce ACTH and minimise adrenal androgen
2. fludrocortisone if deficient
3. flutamide (anti-androgen)
What are the 3 types of congenital adrenal hyperplasia?
21- hydroxylase: 1 at back only so: no HTN, only virilisation
11-hydroxylase: 1 in both front and back- so both HTN and virilisation
17 hydroxylase - only 1 in front- so only HTN,no virilisation
Mnemonic : 1 in front- HTN. 1 at back- virilisation
Which cytokine causes hypercalcaemia in myeloma?
Osteoclast (clear) activating cytokine
What 3 features are associated with neurofibromatosis type 1?
cafe au lait spots
axillary freckling
cutaneous neurofibromas
What is von Hippel Lindau syndrome
Predispose to cancer:
phaeochromocytoma
haemagioblastoma (bleed)
renal cell carcinoma
pancreatic tumour
autosomal dominant- abdormal VHL gene on Chr 3
What causes lid retraction and lag in thyrotoxicosis?
sympathetic overactivity
What are the features seen in Grave’s only?
exopthalmos
pretibial myxoedema
thyroid acropathy
Which hormones are anterior pituitary responsible for?
GH
Prolactin
TSH
ACTH
FSH/LH
Which hormones are posterior pituitary responsible for?
Vasopressin
Oxytocin
ADH
What is carney complex?
Autosomal dominant mutation inactivating protein kinase A on Chr 17.
Present with predispose to cancer:
spotting skin pigmentation
myxoma
endocrine tumour
melanotic schwannoma
What is the most common pituitary tumour?
Prolactinomas
What is the management of DKA
First: IVF to reduce acidosis
FRII
What risks are associated with HRT?
Breast cancer
Heart disease
VTE
Stroke
Endometrial cancer
Describe the pathogenesis of lipid synthesis and how lipoprotein lipase deficiency/apoC2 deficiency cause hyperlipoproteinaemia
- dietary triglyceride in cholesterol packed in GI cell into chylomicrons
- secreted into GI lymph into circulation
- chylomicron bind to lipoprotein lipase
- apolipoprotein C2 in chylomicrons activate lipoprotein lipase to liberate free fatty acid which enter fat/muscle cells
- therefore inactive lipoprotein lipase/apo C2 would cause accumulation of chylomicron
Which hormones are elevated in anorexia?
Cortisol
Cholesterol
What does beta hcg do to thyroid function in normal pregnancy?
First trimester- can see suppression of TSH due to beta hCG.
What is the sick day rule for addisons?
double glucocorticoid dose
What is glucagonoma?
pancreatic alpha cell tumour
impaired glucose tolerance as increases sugar levels.
skin rash- necrotic migratory erythema
normocytic anaemia
Why does cushing’s present with hypokalaemia?
Because glucocorticoid can act on mineralocorticoid receptor
What is IV pentagastrin test?
Inject pentagastrin -> measure calcitonin
Medullary thyroid carcinoma (HIGH)
What is c-peptide
by product of proinsulin -> c-peptide and active insulin
Outline management of secondary hyperparathyroidism:
Phosphate binders (1-alpha calcidol)
Vit D and calcium
Pancreatic cells and hormones:
Alpha: glucagon
Beta: insulin
Delta: somatostatin
What is thyrotoxicosis factitia?
Exogenous excess intake of thyroid hormone
decreased uptake on scitigraphy
raised T4
How do you treat papillary and follicular thyroid cancer?
Total thyroidectomr
Then radioiodine to kill residual
Thyroxine replacement
Which part of the nephron does ADH act on?
Cortical and medullary collecting tubules (increased aquaporin 2 expression)
What is the mechanism of action of tamoxifen?
Tamoxifen is a Selective oEstrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist.
breast: antagonist
uterus: agonist (risk of cancer)
When is radioiodine treatment not recommended for Graves?
Thyroid eye disease may worsen
Outline DVLA law for diabetics on insulin
ensure no severe hypos in last 1 year
must have hypoglycaemic awareness
can drive as long as stable BM control
How does hypothalamic anemorrhoea occur?
weight loss -> increase ghrelin -> inhibit HPA axis -> slow GnRH pulse -> therefore low LH/FSH -> low oestrogen -> osteoporosis
At what TSH level should you replace thyroxine?
> 10 mU/l or if very symptomatic with +ve antibodies
Which gliptin is associated with heart failure?
Saxagliptin
Symptoms of klinefelter syndrome (XXY)?
tall
gynacomastia
small testicular vol (<12 ml)
infertility.
Need chromosomal analysis (karyotype)
What does high ALP and mixed lytic and sclerotic lesion indicate?
Paget’s disease
What is the mainstay treatment for Paget’s?
Bisphosphonates
Which thyroid condition can cause raised prolactin?
Hypothyroidism
What is the consequence of non functioning pituitary adenoma
HYPOPITUITARISM
Bitemporal hemianopia
How does hyperemesis cause transient hyperthyroidism?
High hCG levels stimulate TSH receptors
Which condition is HLA B47 associated with
CAH
What is McCune Albright syndrome?
Somatic mutation in GNAS gene
Cafe au lait skin pigment
Polyostotic fibrous dysplasia (bone)
Autonomous endocrine hyperfunction
What is central pontine myelinolysis?
Rapid Na correction complication.
Demyelinating pons.
Quadriplegia sparing eyes.
unable to speak/swallow
What is miller fisher syndrome?
MFS is variant of GBS.
Miller Fisher: Remember from Miller beer
- Drinking too much beer causes “low IQ” hence GQ1b and causes the other symptoms of being drunk (ataxia, areflexia, ophthalmoplegia)
- descending paralysis (eye downwards)
- anti- GQ1b ab
- opthalmoplegia, areflexia, ataxia
What condition is 45X and delayed puberty?
Turner syndrome
(any child with short stature/LD/delayed puberty)
What is a male Turner?
Noonan
What would you counsel pregnant women with thyroid autoantibodies?
High risk of miscarrigage and preterm
What endocrine condition should you consider in hyperlipidaemia?
Hypothyroidism
Inhibit LDL mediated catabolism and lipoprotein lipase activity decreases.
Differentiate between classical CAH and non classical CAH
Classical: severe
salt wasting and ambiguous genitalia
Low cortisol and aldosterone
Non classical: milder
hyperandrogenism
high 17-OH progesterone and testosterone
Both due to 21 hydroxylase deficiency
What is the treatment for diabetic gastroparesis?
First: domperidone
What sign is specific of Grave’s?
Pre-tibial myxoedema
Accumulation of glycosaminoglycans
How would you replace fluids in DKA?
0.9% saline 1L over 1hr
0.9% saline+kcl over 2hr
0.9% saline+kcl over 4hr
0.9% saline+kcl over 6hr
What is the insulin dose for FRII for DKA?
0.1 U/Kg/hr
What is pseudohyperparathyroidism?
rare genetic disorder that prevents the body from responding to parathyroid hormone (PTH), causing high phosphate low calcium
albright
What does severe hypopituitarism cause?
Hypothyroid
Low cortisol
Hyponatraemia
What is saline suppression test?
Used to confirm equivocal Renin:aldosterone ratio for Conn’s
What is the target BM and HbA1c for women planning pregnancy?
premeal/bedtime/overnight: 3.3-5.4
peak postprandial: 5.4-7.1
HbA1c < 6%
Outline complete androgen insensitivity (XY karyotype)?
partial or complete inability to respond to androgens (lack dihydrotestosterone receptor)
- impaired masculinisation
- develop normal breast
- lack of pubic hair
- infertile
- bilateral inguinal hernia infantile
- serum testosterone level high
What is Exenatide and when is it contraindicated?
GLP1 agonist
(renal impairment)
How does GLP1 agonist work?
increases insulin release with glucose load
delay gastric emptying
What are the causes of hypokalaemia?
LESS K
Lasix (diuretics)
Enteric loss
Steroid
Shift in from insulin/salbutamol
Kidney disease
What are the causes of hyperkalaemia
K BANK
(k supplement, beta blocker, ace/arb/aki, nsaid, k sparing)
What does ketonuria indicate?
Insulinopaenia as in T1DM
Management of diabetic foot ulcer
Non removable casting
wound debridement
infection management
revascularisation procedures
What should lithium be switched to in pregnancy?
Lamotrigine
Which hormone is responsible for cessation of growth and long bone fusion?
Oestrogen
Why does feminisation occur in obesity or alcoholism?
increased aromatase activity
cholesterol->testosterone->oestradiol by aromatase
Management for profound hypothyroidism (myxoedema coma)
T3 infusion/NG 5 microgram every 8 hrs
convert to T4 when conscious
How does glucagon reverse hypoglycaemia
Activate adenylate cyclase
breaks down glycogen to free glucose
What metabolic abnormality does cushing’s disease cause?
Hypochloraemic
metabolic alkalosis
When is radioisotope scan helpful?
Thyrotoxicosis/cold nodules ?neoplasm
Not in euthyroid patients
How is thyroid lymphoma treated?
Chemotherapy (R-CHOP)
Radiotherapy (external beam)
Rituximab
Not surgically treated.
What is the most specific feature on bone biopsy that suggests Paget’s disease?
Multinucleated osteoclasts
What causes lipohypertrophy?
Repeated insulin injection into same site
Outline treatment for Kallmans
Not planning pregnancy:
- testosterone patches/injection/implant
Planning pregnancy:
- pulsed subcut therapy with GnRH analogue to stimulate spermatogenesis
What is the order of most common post op complication for subtotal thyroidectomy?
- Hypothyroidism
- Recurrent hyperthyroidism
- Transient hypoparathyroidism
- Recurrent laryngeal nerve palsy
What causes raised DHEA?
PCOS
Non classical CAH (11Bhydroxylase)
Adrenal hormone and location
G - SALT
F- SUGAR
R- SEX
What is familial hypocalciuric hypercalcaemia
Autosomal dominant
mutated CASR gene
lack of calcium sensor -> raise PTH->high calcium
No treatment.
What is Gordon syndrome?
pseudohypoaldosteronism
mimic addisons
- hyperkalaemia
- metabolic acidosis
fail to respond to aldosterone therefore high aldosterone.
What is turner’s syndrome and management?
X deletion (45X)
Treatment:
Growth: GH
Puberty and prevent osteoporosis: oestrogen
followed but progesterone 2 years later
