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1
Q

What is carcinoid syndrome?

A

Signs and symptoms of 5HT secretion, produced by neuroendocrine tumours often in the lungs/GIT.
Presence of syndrome strongly indicates liver mets, as bypassing 1st pass metabolism (if GIT origin)

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2
Q

Describe the presentation of carcinoid syndrome

A 
Flushing: intermittent
Diarrhoea
Wheeze
Valve fibrosis: TR, PS 
Pellagra
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3
Q

Describe the investigations for carcinoid syndrome

A
  • Urine: metabolites
  • Blood: plasma chromogranin A, FBC, U+Es, LFTs, etc
  • Imaging: CT CAP for primary, USS liver mets
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4
Q

Describe the management of carcinoid syndrome

A

Medical:
-Octreotide

Surgical:
-Excision

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5
Q

Describe the types of multiple endocrine neoplasia syndromes (inheritance pattern, characteristics)

A

MEN 1: AD
-3 Ps: pituitary adenoma, parathyroid hyperplasia, pancreatic NETs

MEN 2A:

  • Parathyroid hyperplasia/adenoma
  • Phaeo
  • Medullary thyroid cancer

2B:

  • Thyroid cancer
  • Phaeo
  • Marfanoid body
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6
Q

Describe the characteristics of von-Hippel Lindau syndrome

A
  • Phaeos
  • Renal: cysts, bilateral renal cell carcinoma
  • Haemangioblastomas
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7
Q

Describe the characteristics of neurofibromatosis 1 and 2

A

NF1:

  • Cafe au Lait spots
  • Neurofibromas
  • Lisch nodules (iris)
  • Optic glioma
  • Phaeo

NF2:
-Bilateral vestibular schwannomas (acoustic neuroma)

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8
Q

Describe the characteristics of PCOS

A
  • Anovulation: oligomenorrhoea
  • Hyperandrogenism: hirsutism, acne
  • Polycystic ovarian morphology

Also often overweight/obese + insulin resistant

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9
Q

Describe the investigations for PCOS

A
  • BP, weight
  • UPT
  • Bloods: standard + 9 am cortisol, TFTs, testosterone, prolactin, HbA1c
  • USS pelvis
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10
Q

Describe the management of PCOS

A

Conservative:
-Hair removal, weight loss + diet

Medical:

  • Hormonal: COCP, POP etc
  • Add: metformin, spironolactone
  • Fertility: clomifene, letrozole, IVF, etc
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11
Q

Describe the management of menopause

A

Conservative:
-Keeping cool: fans, clothing, avoid caffeine, etc

Medical:

  • Vaginal oestrogens
  • HRT: topical or PO, combined or oestrogen, cyclical or continuous prep
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12
Q

Describe the signs of POI

A
  • Hot flushes
  • Sleeping difficulties
  • Fatigue
  • Memory difficulties
  • Vaginal dryness
  • Amenorrhoea
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13
Q

Describe the management of obesity

A

Conservative:
-Diet, exercise

Medical:

  • RF management: statins, anti-HTN, DM
  • Orlistat

Surgical: when BMI >40 or >35 w complications

  • Sleeve gastrectomy
  • Gastric bypass
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14
Q

Describe the aetiology of SIADH

A

Respiratory: lung cancer, pneumonia
Intracranial: infection, injury
Drugs: SSRIs, thiazides, carbamazepine

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15
Q

Describe the criteria for SIADH diagnosis

A

Decreased plasma osm + hyponatraemia
Increased urine osm + increased urinary Na

+ no evidence of HF, renal or liver failure
+ normal cortisol, TFTs

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16
Q

Describe the causes of hyponatraemia

A

Hypovolaemic:

  • Diuretics
  • Dehydration: D+V, burns, etc

Euvolaemic:

  • Adrenal insufficiency, thyroid disease
  • SIADH

Hypervolaemic:
-3 failures

17
Q

Describe the management of hyponatraemia

A

Correct cause:

  • Hypovolaemic: stop diuretics, replace fluids slowly
  • Eu/hypervolaemic: fluid restriction. Diuretics/vaptans if needed

Correct Na slowly!! 8-10 mmol/L in 24 hours

18
Q

Describe the causes of hypernatraemia

A
  • D+V and not drinking
  • Fever, sweating
  • Hyperaldosteronism
  • DI
19
Q

Describe the management of hypernatraemia

A
  • Rehydrate: PO or 5% dextrose IV

- Slow decrease or risk cerebral oedema

20
Q

Describe the presentation of hypokalaemia

A
  • Weakness
  • Fatigue
  • Muscle cramps
21
Q

Describe the causes of hypokalaemia

A 
GI loss: diarrhoea, vomiting 
Alkalosis
Refeeding syndrome 
Drugs: insulin, salbutamol, loop diuretics  
Endocrine: Conn's syndrome, Cushing's
22
Q

Describe the ECG changes in hypokalaemia

A

Peaked p waves
Flattened T waves
U waves
Long QTc

23
Q

Describe the management of hypokalaemia

A

Replacement:

  • Mild: oral SandoK
  • Severe: IV KCl max rate 10mmol/h
  • **Check and give Mg also
24
Q

Describe the presentation of hyperkalaemia

A
  • Arrhythmia + palpitations
  • Chest pain
  • Death
25
Q

Describe the aetiology of hyperkalaemia

A
  • CKD
  • Acidosis
  • Drugs: thiazides, ACEi/ARBs, spironolactone
  • Endo: adrenal insufficiency
  • Tumour lysis syndrome, rhabdo
26
Q

Describe the ECG changes in hyperkalaemia

A
  • Flattened p waves
  • Wide QRS
  • Tented T waves
  • > VF
27
Q

Describe the management of hyperkalaemia

A

Mild/mod: review meds, stop as needed

Cardiac monitor and IV access
Severe (>6 or symptomatic)
-Ca gluconate 10ml of 10%
-100ml 20% glucose
-10 units Actrapid (insulin) 
-Neb salbutamol

Consider RRT

Endo finals (6 decks)

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