Poo Poo Help

Question 1

Hyperglycaemia and raised ketones in the absence of acidosis is known as what?

Answer 1

Diabetic ketosis

Question 2

How would you manage diabetic ketosis?

Answer 2

(Random blood glucose of above 11.1mmol/L is sugggestive of new diagnosis)

Subcutaneous insulin and fluids and careful monitoring of blood glucose and ketones

Question 3

Normal blood ketone level?

Answer 3

<0.6 mmol/L

Question 4

Initial management of those with diabetic ketoacidosis with evidence of hypotension is to

Answer 4

bolus 500ml 0.9% sodium chloride (slains)

Question 5

What does bolus mean

Answer 5

an intravenous injection of a single dose of a drug over a short period.

Question 6

Headache , drop in consciousness, (rise in blood pressure, drop in pulse and seizures) complication of DKA in a children is what

Answer 6

Cerebral oedema or swelling of brain parenchyma

Question 7

When would you give only oral fluids and subcutaneous fluids in DKA, Vs IV 0.9% sodium chloride?

Answer 7

Mild DKA in children
Alert
Not nauseous
Not vomiting
No signs of dehydration

Question 8

Man with diabetes. Blood glucose low- all other parameters in normal range. Symptoms of confusion and clammy. Do what

Answer 8

Give sugary drink. This isn’t DKA you doink.

Question 9

U&Es investigation for DKA when? Vs capillary blood gas and capillary blood ketones?

Answer 9

Latter is first as to find out pH and bicarbonate and glucose and ketone levels: assesses severity and CONFIRMs diagnosis.

THEN you would do U&Es for potassium levels once diagnosis is confirmed to check for dehydration and electrolyte disturbance

Question 10

adrenal gland is at what level

Answer 10

T12

Question 11

I know that zona reticularis secretes sex hormones, what specific example can you think of

Answer 11

DHEA

Question 12

I know the adrenal medulla secretes catecholamines… what 3 ( >3< mind you) can you think of

Answer 12

epinephrine
dopamine
norepinephrine

Question 13

When is the peak of cortisol secretion

Answer 13

6-9am

Question 14

what is the most common cause of congenital adrenal hyperplasia

Answer 14

21-hydroxylase hyperplasia, as there is lack of negative feedback on CRH and ACTH, patients keep pumping out CRH and ACTH and stimulate adrenal gland therefore hyperplasia and sex hormones

Question 15

95% of cortisol is bound to what

Answer 15

cortisol binding globulin

Question 16

what is cortisol diabetogenic?

Answer 16

suppression of insulin

Question 17

lack of cortisol can lead to

Answer 17

hypoglycaemia

Question 18

affect of cortisol on glucagon

Answer 18

permissive- helps increase blood glucose

Question 19

affect on bones with cortisol

Answer 19

osteoporosis via stimulation of bone resorption

this is not the same as absorption.
it’s the opposite. Cortisol wants to free the amino acids. etc.

Question 20

is Cushing’s disease associated with hypertension or hypotension

Answer 20

Cushing’s disease = excess cortisol.
cortisol is produced in the adrenal glands due to the presence of ACTH. This stimulation of the adrenal glands = hypertension.

This is due to the permission of norepinephrine! Nothing to do with aldosterone.

Question 21

Apart from cushings disease of the pituitary gland = ACTH dependant, what is the most common cause of Cushing’s syndrome?

Answer 21

iatrogenic i.e. too many steroids

Question 22

How do you screen for cushing’s?

Answer 22

24 hour urinary free from cortisol

Question 23

How do you diagnose Cushing’s?

Answer 23

dexamethasone suppression test.

Too much cortisol- where is it coming from?

low dose given (like 1mg), if that blocks therefore low cortisol in normal person. or if cushings then it remains elevated. Measure in the morning cuz it will be overnight.

But
high dose 8mg, that’ll be enough for -ve feedback to suppress CRH therefore ACTH in the pituitary.

Question 24

Addison’s diagnosis is via what test

Answer 24

Short Synacthen

so.
Addison’s is not enough cortisol.
so if you give ACTH then if increases, not Addison’s? Should double in an hour.

Question 25

why hypotension with Addison’s

Answer 25

due to hypovolaemia

Question 26

how do we treat Addison’s. Obviously we replace… but what with?

Answer 26

glucocorticoids with prednisolone, hydrocortisone or dexamethasone

replacement of mineral corticoids which is aldosterone. So we replace that with fludrocortisone

Question 27

Someone with Addison’s is pretty ill. What do we do to their dose???

Answer 27

Double the gluco ones. So double the dexamethasone, or prednisolone, or whatever it is, but keep the f the same.

Think- in illness, we NEED to double the sugar.

Question 28

what do we do when confronted with Addisonian crises?

Answer 28

Give the glucocorticoids but as IV. IV hydrocortisone

Question 29

What’s the actual issue when you encountering Addisonian crises?

Answer 29

Hypoglycaemia and therefore hypotension

Question 30

what’s the triad for phaeochromocytoma?

Answer 30

tremor
sweating
palpitations
hypertension

Question 31

how do we diagnose the phaeochromocytoma?

Answer 31

24 hour urine collection to check levels of epinephrine and norapinephrine etc.

Question 32

adrenal hypersecretion hormone levels please for primary, secondary, tertiary…

Cortisol, ACTH, CRH

Answer 32

cortisol, acth, crh

high low low
high high low
high high high

Question 33

Conn’s syndrome is too much aldosterone. (hypertension??) How do we check if it’s primary or secondary?

Answer 33

Renin to aldosterone level. If above 20 = primary. Because Conn’s syndrome = too much aldosterone, which can be primary at the adrenal gland. OR it can be because there is too much angiotensin 2 stimulating release of aldosterone. That would mean too much renin. And that’s because the juxtaglomerular cells sense the hypovolaemia.

Question 34

Conn’s on sodium and potassium levels

Answer 34

Conn’s would mean you have too much serum sodium, and not enough k

Question 35

what’s normal calcium level?

Answer 35

2.2-2.6mmol/l

Question 36

is tetany hypocalcaemia or hyper?

Answer 36

hypo

Question 37

hypertension or hypotension for hypocalcaemia?

Answer 37

hypotension

Question 38

diarrhoea with hypocalcaemia or hypercalcaemia?

Answer 38

hypo

Question 39

explain Trousseau’s sign, and what it represents

Answer 39

when you inflate the blood pressure cuff and the hand spasms = hypocalcaemia

Question 40

hypocalcaemia in alkalosis or acidosis? What condition may lead to this?

Answer 40

In alkalosis

imagine sour milk- milk is acidic

hypothyroidism

Question 41

what if it seems like hypothyroidism, but calcium levels remain high, and PTH levels are also high?

Answer 41

guess it just means that the levels are high but organs are unresponsive, pseudo

Question 42

when would you administer IV calcium gluconate?

Answer 42

severe hypocalcaemia where the patient is symptomatic

Question 43

mild hypocalcaemia?

Answer 43

oral calcium tablets and replace vitamin D

Question 44

You have vomiting and nausea with hypercalcaemia. Which endocrine condition would you associate it with?

Answer 44

hyPERthyroidism.

Question 45

is secondary or primary hyperthyroidism low calcium levels?

Answer 45

Secondary. Its hyper to counteract the low calcium levels. Low calcium levels to do with CKD