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Yr3,4,5 endocrinology > passmed year 5 > Flashcards

passmed year 5 Flashcards

1
Q

If IV access if available in an unresponsive pt - hypoG

A

IV glucose

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2
Q

If pt with acromegaly has raised IGF-1 how do you confirm

A

OGTT and GH levels

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2
Q

what is primary adrenal failure

A

problem is located in the adrenal gland
secreting a smaller amount of cortisol
pituitary gland responding to this drop in cortisol by secreting more ACTH
ACTH is derived from a larger precursor called pro-opiomelanocortin (POMC), which also happens to be a precursor for beta-endorphin and melanocyte stimulating hormone (MST)
this gives hyperpigmentation

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3
Q

what is secondary adrenal insuffiency

A

secondary adrenal insufficiency, as the underlying mechanism of this is hypopituitarism. This means that, as opposed to a lack of cortisol production as in primary disease, the problem is from a lack of ACTH. A lack of ACTH production means that there is also a lack of POMC, and hence a lack of MST.

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4
Q

function of beta endorphin

A

Beta-endorphin is a neuropeptide and hormone that is produced in the brain and nervous system, and is known for its role in pain management and stress relief

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5
Q

cannot tolerate metformin what next

A

MR metformin

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5
Q

elevated prolactin level with secondary hypothyrpidism and hypogonadism indicates what leading to what

A

stalk compression is consistent with a non-functioning pituitary adenoma

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6
Q

4 symptoms cause by pituitary adenomas

A

excess of a hormone -eg cushings due to excess ACTH
depletion of hormones - compression of normal functioning pituitary gand
stretching of dura causing headaches
compression of the optic chiasm (bitemporal heminaopia)

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7
Q

ix if suspected pituitary adenoma

A

a pituitary blood profile (including GH, prolactin, ACTH, FSH, LSH and TFTs)
formal visual field testing
MRI brain with contrast

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8
Q

hypoG commonly mistaken for

A

being drunk so check BM

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9
Q

what does the dexamethasone do in congential

difference between cushing syndrome and congenital adrenal hyperplasia

A

would have an elevated 8am cortisol as body does not respond to the dexamthesone

low dex in congential

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10
Q

fatigue and dizziness , increase pig in creaes and hypopig on forearm

A

addisons causes hypoglycaemia

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11
Q

africa and asia most common cause of hypoT

A

iodine deficiency

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12
Q

Suppressed ACTH but unsuppressed cortisol on high-dose dexamethasone suppression

A

cushing syndrome due to adrenal adenoma

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12
Q

Suppressed ACTH and cortisol on high-dose dexamethasone suppression

A

pituitary adenoma

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13
Q

Unsuppressed ACTH and cortisol on high-dose dexamethasone suppression

A

ectopic ACTH syndrome

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14
Q

acropachy seen in graves - what is it

A

clubbing

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15
Q

thyrotoxic storm treated with

A

beta blockers, propylthiouracil and hydrocortisone

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16
Q

features of thyroxic storm

A

fever > 38.5ºC
tachycardia
confusion and agitation
nausea and vomiting
hypertension
heart failure
abnormal liver function test

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17
Q

post aldosterone/renin ratio ix for primary aldosteronism (which would show high aldosterone alongside low renin- as aldosterone causes sodium retention) what should follow

A

high res CT abdomen and adrenal vein sampling

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18
Q

what is sublcinial hypoT

A

TSH elevated and T4 normal and asx

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19
Q

when do you treat subclinical hypoT with levy

A

if TSH level above 10 on 2 seperate occasions 3 months apart

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20
Q

preg hyperT tx

A

propylthiouracil

21
Q

how do distinguish between T1DM and T2DM

A

C-peptide levels and diabetes-specific autoantibodies (GAD) are useful to distinguish between type 1 and type 2 diabetes

22
Q

Diabetes meliitus diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic what do you need

A

need 2 readings

23
Q

6 causes of raised prolactin

A

pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

24
Q

cardiac drug that can cause gynaecomastia

A

digoxin

25
Q

subclinical hyperthyrodism can lead to what complications
low TSH and normal T4

A

osteoporosis and AF and dementia

offer tx for 6 months to induce remission

26
Q

Graves disease how long on carbimazole

A

12-18m

27
Q

Hyponatraemia, hyperkalaemia and weight loss can indicate

treated with

A

addisons

IV hydrocortisone

28
Q

compare malignancy to pirmary hyperparathyroidism

A

In hypercalcaemia secondary to malignancy, PTH is low, although PTHrP may be raised
primary hyperpara - PTH high

29
Q

Increased, homogenous uptake on a radioactive iodine uptake test suggests

A

graves

30
Q

what thyroid cancer is assoicated with phaechromocytoma ( difficult HTN to control) and requires prophylactic thyroidectomy

A

medullay thyroid cancer

31
Q

hot noduel

A

toxic adenoma

32
Q

what thyroid cancer is most likely to have lymphatic spread - most common in females

A

papillary

33
Q

in 1lm of inuslin how many units

A

1000 units

34
Q

the normal target for blood glyocse level is 48 if on diet and lifestyle or one anitidiabti drug - if they are on a drug which can cause hypos what is the target

A

53

35
Q

subacute thyroiditis is same as

A

de gervain thyrodisits

36
Q

what is de quervains thyrodisits

A

Subacute thyroiditis (also known as De Quervain’s thyroiditis and subacute granulomatous thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism.

37
Q

on thyroid scintigraphy testing with iodine what will you see in a pt with subacute thyroiditis and how manage

A

In De Quervain’s thyroiditis there is globally reduced uptake of iodine-131 during thyroid scintigraphy

self limits - if painful can give aspirin of NSAID

38
Q

thryotoxic storm treated with what three things

A

beta blockers, propylthiouracil and hydrocortisone

39
Q

why do we get an increase in hba1c after a splectomy

A

Conditions that prolong the life of erythrocytes (e.g., aplastic anemia, iron deficiency anemia and after splenectomy) may lead to increased (prolonged) exposure of cells to glucose and to falsely high HbA1c results.

40
Q

hasimoto also known as

A

autoimmune thyroiditis

41
Q

temporal arteritis rarely seen below age of 60

A

true
so more likely to be a migraine

42
Q

pt with bloating and distention after eating in T1DM - how it metaclopramide useful

A

Metoclopramide is used to treat the symptoms of slow stomach emptying (gastroparesis) in patients with diabetes. It works by increasing the movements or contractions of the stomach and intestines

43
Q

sick euthryoid findings

A

Sick euthyroid syndrome = low T3/T4 and normal TSH with acute illness

44
Q

gastroparesis characterised by

A

irratic glucose control
bloated
early satiety
chronic nausea

45
Q

Gastroparesis
occurs secondary to autonomic neuropathy
symptoms include erratic blood glucose control, bloating and vomiting
management options include

A

metoclopramide, domperidone or erythromycin (prokinetic agents)

46
Q

two other autonomic problems with diabtes

A

Chronic diarrhoea
often occurs at night

Gastro-oesophageal reflux disease
caused by decreased lower esophageal sphincter (LES) pressure

47
Q

hypokalaemia and hypertension
thirsty raise suspicion of

A

primary aldosteronism

48
Q

how do differentiate between HHS or DKA and how would you treat HHS

A

HHS or DKA? - HHS has no acidosis/significant ketosis, the history is longer and the glucose is often significantly raised eg >30mmol/L

HHS - IV crystalloid fluid and montior blood glucose after 1 hour

49
Q

in preg what should you do with levothyroxine dose

A

Women with hypothyroidism may need to increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy

50
Q

what is whipples triad for an insulinoma

A

Whipple’s triad of symptoms of 1) hypoglycaemia with fasting or exercise, 2) reversal of symptoms with glucose, and 3) recorded low BMs at the time of symptoms is hallmark for an insulinoma

Phaeochromocytoma, alcoholism and anxiety are reasonable diagnoses to consider, however the episodes do not typically go away with food.

51
Q

insulinoma related to what MEN

A

men 1

52
Q

The release of PTHrP in malignancy suppresses PTH secretion and the result is a low PTH with an elevated calcium.

A

true

Yr3,4,5 endocrinology (8 decks)

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