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4th Year > Renal/ Endocrinology > Flashcards

Renal/ Endocrinology Flashcards

1
Q

In prerenal disease: what would the serum urea:creatinine ratio be?

What will urine sodium be?

what would the urine osmolality be?

A

Raised

Sodium <20

Osmolaltiy >500

In prerenal uraemia, think of the kidneys holding on to sodium to preserve volume

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2
Q

What factors may affect eGFR result?

A

Pregnancy, muscle mass, eating red meat 12 hours prior

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3
Q

Wegner’s: what would autoantibody?

What symptoms

can lead to what condition?

A

cANCA

chronic sinusitis, cough, caved nose, cresenteric glomerulonephritis

  • rapidly progressive glomerulonephritis
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4
Q

What is the triad for haemolytic uraemic syndrome?

Most likely caused by?

A

1) Acute kidney injury
2) Microangiopathic haemolytic anaemia
3) Thrombocytopenia

E.coli - following diarrhoeal illness

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5
Q

What is the most common viral infection in solid organ transplant patients?

Tx?

A

cytomegalovirus

ganciclovir

Get symptoms such as: anorexia, fatigue, arthralgia, jaundice, lymphadenopathy, hepatomegaly

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6
Q

Treatment for NEPHROGENIC diabetes insipidus?

A

Thiazide

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7
Q

What drugs have nephrotoxic potential?

A

DAAMN

Diuretics
ACE inhibitors
ARBs
Metformin
NSAIDs

NSAIDs, aminoglycosides, ACE inhibitors, Angiotensin II receptor antagonists, diuretics

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8
Q

how many months up to is acute graft rejection classified as?

A

6 months

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9
Q

Features of renal cell carcinoma

A 
classical triad: haematuria, loin pain, abdominal mass
pyrexia of unknown origin
left varicocele (due to occlusion of left testicular vein)
endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
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10
Q

help prevent the formation of ascites in patients with chronic liver disease - what drug would you use?

A

spironolactone

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11
Q

In Cushing’s do you get high or low potassium?

Metabolic acidosis or alkalosis?

A

hypokalaemic metabolic alkalosis

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12
Q

History of what condition is pioglitazone contraindicated in?

A

Pioglitazone is contraindicated by his history of bladder cancer

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13
Q

Management of Addison’s disease

A

glucocorticoid and mineralocorticoid replacement therapy.

hydrocortisone + fludrocortisone

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14
Q

Primary hyperaldosteronism can present with …

Ix?

Tx?

A

Primary hyperaldosteronism can present with hypertension, hypernatraemia, and hypokalemia (e.g. muscle weakness)

aldosterone/renin ratio is the first-line investigation –> high resolution CT abdo and adrenal vein sampling is used to differentiate between unilateral and bilateral sources of aldosterone excess

adrenal adenoma: surgery
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

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15
Q

Electrolyte features of an addisonian crisis

A

Features of an addisonian crisis:
Hyponatraemia
Hyperkalaemia
Hypoglycaemia

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16
Q

Treatment of phaeochromotoma

A

PHaeochromocytoma - give PHenoxybenzamine before beta-blockers

then definitive managment is surgery

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17
Q

Investigation for Subacute (De Quervain’s) thyroiditis

A

thyroid scintigraphy: globally reduced uptake of iodine-131

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18
Q

Pioglitazone side effect

A

It is a Thiazolidinediones

Side effect is fluid retention

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19
Q

In newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be…

A

a basal–bolus using twice‑daily insulin detemir

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20
Q

Addisonian crisis management

A

hydrocortisone 100 mg im or iv

1 litre normal saline infused over 30-60 mins or with dextrose if hypoglycaemic

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21
Q

MODY autosomal?

A

dominant

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22
Q

What causes

Higher-than-expected levels of HbA1c (due to increased red blood cell lifespan)

A

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

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23
Q

best test to diagnose Addison’s disease

A

short synacthen (ACTH) test

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24
Q

Treatment for bilateral adrenocortical hyperplasia

Treatment for adrenal adenoma

A

Aldosterone antagonist

Surgery

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25
Q

What is myxoedemic coma features?

A

Hypothermia, hyporeflexia, bradycardia, seizures, thin & brittle hair, periorbital oedema, reduced reflexes

26
Q

The standard HbA1c target in type 2 diabetes mellitus…

A

is 48 mmol/mol

27
Q

What is Pseudo-Cushing’s? What causes it?

A

mimics Cushing’s
often due to alcohol excess or severe depression
causes false positive dexamethasone suppression test or 24 hr urinary free cortisol
insulin stress test may be used to differentiate

28
Q

What are the features of insulinoma?

A
  • Symptoms and signs of hypoglycaemia
  • Plasma glucose <2.5 mmol/L
  • Reversibility of symptoms on the administration of glucose
  • C-peptide production does not fall on exogenous insulin injection in patients with an insulinioma
29
Q

If a postmenopausal woman has a fracture she should be put on

A

bisphosphonates (Risedronate and calcium supplements)

30
Q

Thiazide can cause…

A

hypercalcaemia

31
Q

Pepperpot skull is a characteristic X-ray showing…

A

hyperparathyroidism

32
Q

First line test for acromegaly

A

Serum IGF-1

33
Q

Hyperpigmentation is caused by…

A

Increase in ACTH (from pituitary) as it is also a precursor for POMC which is a precursor for MST. MST stimulates melanocytes giving the hyperpigmentation that is seen in primary adrenal failure

34
Q

What diabetes medication has an increased risk of osteoporosis and consequently fractures?

A

Thiazolidinediones

35
Q

IN the acute management of DKA

A

Insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin

36
Q

What drugs causes gynaecomastia?

A

Spironolactone

37
Q

Long-term corticosteroid use can cause what bone issue?

A

Osteopaenia & osteoporosis

38
Q

What cardiac problem can you get in thyrotoxicosis?

A

High-output cardiac failure may occur in elderly patients
Palpitations
Tachycardia

39
Q

What is the treatment of choice for toxic multinodular goitre?

A

Radioiodine therapy

40
Q

Which thyroid carcinoma presents with phaeochromocytoma?

A

Medullary carcinoma

41
Q

What condition presents with thyrotoxicosis and hot solitary nodule?

A

Toxic adenoma

42
Q

What’ is the most common type of thyroid cancer?

A

Papillary carcinoma

43
Q

What neurological condition can you get from corticosteroid therapy?

A

steroid psychosis

44
Q

What’s MEN type 1

A

Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)

Most common presentation = hypercalcaemia

45
Q

What’s MEN Type IIA?

A
  • Medullary thyroid cancer
    Parathyroid (60%)
    Phaeochromocytoma
46
Q

What’s MEN Type IIB?

A
  • Medullary thyroid cancer
    Phaeochromocytoma
    Marfanoid body habitus
    Neuromas
47
Q

For MEDULLARY thyroid cancer, what do you use to screen for disease recurrence?

What about for Papillary and Follicular?

A

Medullary thyroid cancers often secrete calcitonin and monitoring the serum levels of this hormone is useful in detecting sub clinical recurrence.

Papillary and follicular thyroid cancer are monitored with thyroglobulin

48
Q

Which diabetic drugs causes weight gain?

A

Insulin
Sulfonylureas
Glitazones

49
Q

What important blood test needs to be performed for patients taking Carbimazole?

A

FBC - Agranulocytosis is associated with carbimazole use

50
Q

What does orlistat do?

A

Orlistat works by inhibiting gastric and pancreatic lipase to reduce the digestion of fat

51
Q

Example of sulfonylureas

A

Gliclazide

52
Q

How to treat thyroid toxic storm

A

Thyrotoxic storm is treated with beta blockers, propylthiouracil and hydrocortisone

53
Q

First line treatment for most patients with a pituitary tumour causing acromegaly

A

Trans-sphenoidal surgery

54
Q

What is the optimal treatment for maturity onset diabetes of the young (MODY) (type Hepatic Nuclear Factor 1 Alpha (HNF1A))

A

Sulfonylureas (e.g. gliclazide)

55
Q

What happens to phosphate in hyperparathyroidism

A

PTH - phosphate trashing hormone

Makes phosphate low

56
Q

How many units is there in 1ml?

A

1ml = 100Units

57
Q

Management of hypercalcaemia

A

IV 0.9% N saline [1st]

Bisphosphonates [2nd]

58
Q

What is labetalol’s role

A

Labetalol blocks both alpha and beta receptors

  • lABetalol
59
Q

How to define Impaired glucose tolerance (IGT)

A

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

60
Q

How to define impaired fasting glucose (IFG)

A

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l

61
Q

What neuropathy drug do you avoid in benign prostatic hyperplasia?

A

Amitriptyline

4th Year (8 decks)

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