Non-Diabetes Endo

Question 1

Addisonian Crisis management

Answer 1

Fluid resuscitation
IM hydrocortisone 100mg STAT
Glucose

Continue fluids
IM hydrocortisone every 8h until dexamethasone at 72h

Question 2

When do Addison’s pt need to increase their hydrocortisone

Answer 2

medical procedures
illness (fever, nausea, vomiting)
strenuous exercise (marathon)
discuss fasting

Question 3

Daily doses for Addison’s

Answer 3

Hydrocortisone: 15-25mg spread over 3 times

Fludrocortisone: 50-200mcg

Question 4

Grave’s management (acute and chronic)

Answer 4

propranolol
Anti-thyroid: carbimazole 40mg then reduce
PTU if pregnant

Consider radioiodine and surgery
No radioiodine if eye disease

Question 5

Management of Thyroid Storm

Answer 5

IV propranolol 60mg +/- digoxin
carbimazole
hydrocortisone IV
iodine after 4h

consider IV fluids, sodium and cooling, abx

Question 6

management of myxoedema coma

Answer 6

IV T3
IV hydrocortisone

consider warming blanket, fluids (caution), Abx

Question 7

two philosophies of Grave’s disease

Answer 7

1) titrate for 12-18m

2) block and replace for 6-9m (fixed high dose carbimazole)

Question 8

management of hypothyroidism

Answer 8

Thyroxine, check TFTs in 8-12w

aim for normal TSH

Question 9

drugs that interact with thyroxine

Answer 9

iron
CaCO3

leave 4h gap between

Question 10

Phaeo crisis management

Answer 10

short acting alpha blockade (phentolamine)

then long acting (phenoybenzamine)

then beta blockade for tachycardia

surgery in 4-6w

post-op recheck metanephrines

Question 11

Management for prolactinoma

Answer 11

dopamine agonist: bromocriptine/cabergoline

consider surgery

Question 12

Management for acromegaly

Answer 12

1) Transsphenoidal transnasal hypophysectomy
2) octreotide/dopamine agonists
3) irradiation

Question 13

Management for Cushing’s disease

Answer 13

surgery (ketoconazole first to make them fit for surgery, 3-4w)
radiation
ketoconazole

hydrocortisone after surgery

Question 14

management for adrenal Cushing’s syndrome

Answer 14

adrenalectomy and steroid replacement to wake other adrenal gland up

Question 15

Management for ectopic Cushing’s syndrome

Answer 15

ketoconazole, metyrapone, mifepristone

Treat cause

Question 16

Management for unilateral Conn’s syndrome

Answer 16

Spironolactone/epleronone
SandoK

consider surgery

Question 17

Management for bilateral Conn’s

Answer 17

spironolactone

cannot consider surgery

Question 18

management for hypovolaemic hyponatraemia

Answer 18

slow 0.9% saline

Question 19

management for euvolaemic hyponatraemia

Answer 19

fluid restrict and treat underling cause

Question 20

management of hypervolaemic hyponatraemia

Answer 20

fluid restrict and treat underlying cause

Question 21

management for SEVERE hyponatraemia (<120)

Answer 21

150ml IV 3% saline over 20 minutes
check again
150ml IV 3% saline over 20 minutes
repeat if <5mmol increase in Na

once 5mmol increase: stop infusion
switch to 0.9% saline, raising Na MAX 10mmol over 24h
after, aim for 8mmol/24h until 130

check Na 6h/12h/daily until stable

if raised too quick, you get central pontine myelinolysis

Question 22

What happens if you treat hyponatraemia too quickly

Answer 22

central pontine myelinolysis

Question 23

management of hyperkalaemia

Answer 23

10 ml 10% calcium gluconate
100ml 20% dextrose
10U insulin actrapid
consider nebulised salbutamol
consider dialysis

Question 24

management of mild/moderate hypokalaemia with NO SYMPTOMS

Answer 24

oral sandoK

Question 25

definition of mild/moderate hypokalaemia

Answer 25

no symptoms, K 2.5-3.5

Question 26

management of severe hypokalaemia OR symptomatic

Answer 26

IV KCl
3x1L 0.9% saline with 40mmol KCl/24h
cannot exceed 20mmol/h

Question 27

management of hypercalcaemia

Answer 27

aggressive fluid resuscitation (4-6L in 24h)
bisphosphonates (IV pamidronate)

Consider furosemide if you need to drive urine output for more fluids

Question 28

Investigation for solitary thyroid nodules

Answer 28

US and FNAC

Question 29

When to avoid radioiodine

Answer 29

when there is eye disease (makes it worse)
pregnant (avoid pregnancy for 6m after both genders)
must stay away from kids for 2w

Question 30

Graves: risk with carbimazole/PTU

Answer 30

neutropaenia

Question 31

management for Paget’s

Answer 31

none may be needed
analgesia
consider calcitonin and IV pamidronate

Question 32

management of acute hypocalcaemia

Answer 32

10ml 10% calcium gluconate boluses
OR 20-50 in 1L saline over 4h

must also check PTH, magnesium, and cardiac monitoring

Question 33

signs of hypocalcaemic crisis

Answer 33

signs of tetany (chvostek/trousseau)

OR long QTi

Question 34

management of primary hyperparathyroidism

Answer 34

stop any thiazides
increase fluid intake
DEXA +/- renal US for stones
check vitamin D
?cinacalcet
surgery

Question 35

management of multinodular goiter

Answer 35

long-term carbimazole usually

can consider radioiodine

Question 36

management of singular toxic goiter

Answer 36

cytology to exclude malignancy
surgery if pressure symptoms
radioiodine is 1st line

consider long-term carbimazole if old

Question 37

management of post-partum thyroiditis

Answer 37

supportive
NSAIDs
propranolol

Question 38

management of SIADH

Answer 38

treat symptomatic hyponatraemia (hypertonic saline boluses, measure every 1-2h and raise slowly to avoid CPM)

Fluid restrict

Consider tolvaptan

Question 39

Management of diabetes insipidus

Answer 39

fluid resuscitation with hypotonic saline/dextrose
Cranial: desmopressin
Nephrogenic: stop offending drug, drink more fluids (sometimes lithium is irreversible)

Question 40

Result of DDAVP test

Answer 40

Fluid deprived: nephrogenic and central still low osmolality, psychogenic and normal high osmolality

DDAVP administration: nephrogenic still low osmolality, central now normal high osmolality