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Secondary care Flashcards

1
Q

What type of diabetes has a low C peptide?

A

T1DM

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2
Q

How is an overnight dexamethasone test carried out?

A

1mg dexamethasone @10pm
morning cortisol @9am

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3
Q

What extraocular muscle is affected first in ophthalmoplegia?

A

inferior rectus

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4
Q

Where are the 2 upper parathyroid glands derived from?

A

4th pharyngeal pouch

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5
Q

Where are the 2 lower parathyroid glands derived from?

A

3rd pharyngeal pouch

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6
Q

What is the PTH in hypercalcaemia of malignancy?

A

low PTH

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7
Q

How do you test for phaeochromocytoma?

A

24 hour urine metanephrines

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8
Q

Electrolyte disturbance in Conn’s syndrome

A

hypernatraemia
hypokalaemia

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9
Q

What are the zones of the adrenal cortex?

A

zona glomerulosa
zona fasciculata
zona reticularis

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10
Q

What does the zona glomerulosa of the adrenal gland produce?

A

mineralocorticoids (aldosterone)

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11
Q

What does the zona fasciculata of the adrenal gland produce?

A

glucocorticoids (cortisol)

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12
Q

What does the zona reticularis of the adrenal gland produce?

A

androgens (DHEA, androstenedione)

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13
Q

What does the adrenal medulla produce?

A

catecholamines

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14
Q

When does menopause occur?

A

when follicle supply diminishes and FSH levels rise

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15
Q

When would a non-diabetic patient be considered hypoglycaemic?

A

<2.2

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16
Q

What is the cut off for impaired fasting glucose?

A

6.1-6.9

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17
Q

What fasting triglycerides put you at risk of pancreatitis?

A

> 10

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18
Q

Which statin is particularly good at lowering triglycerides?

A

atorvastatin

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19
Q

Symptoms/signs of agranulocytosis

A

high fever
sore throat

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20
Q

PTU adverse effects

A

hepatotoxic
vasculitic rash (p-anca mediated)

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21
Q

How is toxic multinodular goitre treated?

A

radioactive iodine

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22
Q

Cons of radioactive iodine

A

no work for 5 days
cannot sleep in same bed as someone for 5 days
no contact with children or pregnant women for 3 weeks
cannot father a child within 4 months
cannot become pregnant within 6 months
can become hypothyroid

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23
Q

Drug causes of thyroiditis/thyrotoxicosis

A

amiodarone
oncology checkpoint inhibitors
lithium
interferon (alpha)

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24
Q

Who should you be more cautious giving levothyroxine?

A

older people
ischaemic heart disease

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25
What is the dose of levothyroxine?
roughly 0.6mg/kg
26
When should subclinical hypothyroidism be treated?
pregnant women want to become pregnant children
27
What is raised TSH in pregnancy associated with?
low IQ in baby
28
What is the TSH threshold for levothyroxine treatment?
10
29
Which cancers are most likely to cause hypercalcaemia?
lung myeloma breast kidney lymphoma primary bone
30
Complications of primary hyperparathyroidism
osteoporosis kidney stones
31
Primary hyperparathyroidism treatment
parathyroidectomy
32
Metformin advantages
reduction in fasting blood glucose reduction in HbA1C weight neutral low risk hypoglycaemia
33
When should metformin not be prescribed in the acute setting?
in failure states/sepsis due to the increased risk of lactic acidosis
34
Sulphonylureas adverse effects
hypoglycaemia weight gain
35
Adverse effects of thiazolidinediones
fluid retention osteoporosis weight gain
36
When are thiozolidinediones contraindicated
heart failure uninvestigated macroscopic haematuria bladder cancer
37
Adverse effects of GLP1 receptor agonists
nausea risk of pancreatitis
38
Adverse effects of SGLT2 inhibitors
increased risk of genital and urinary tract infection hypovolaemia dizziness eyglycaemic + hyperglycaemic DKA
39
Insulin action
glucose uptake suppression of hepatic glucose production decreased lipolysis increased lipogenesis decreased proteolysis
40
Insulin MOA
decreases blood glucose by increasing the glucose uptake in peripheral tissues (glucose --> glycogen) decreasing the hepatic glucose output (decreased breakdown of glycogen and diminished gluconeogenesis)
41
What does analogue insulin mean?
modified to be short/long acting etc
42
What does novomix 30 mean?
30% quick-acting insulin 70% long-acting insulin
43
Needing over how many units a day is classed as insulin resistance?
>100 units/day
44
When should metformin be given to type 1 diabetics?
if they are overweight as they can become insulin resistant
45
Which medications should be taken at least 4 hours after levothyroxine?
iron PPIs calcium
46
Which 2 drugs can affect the thyroid?
lithium amiodarone
47
Which group of patients generally will need higher doses of levothyroxine?
coeliac disease (due to malabsorption)
48
What is another name for TSH receptor antibodies?
thyroid stimulating antibody
49
What is a risk of prolonged hyperthyroidism?
osteoporosis due to increased bone resorption
50
What is a contraindication to radioactive iodine?
smoking pregnancy
51
What should you consider if a diabetic patient has rapid progression of renal failure?
think of non-diabetic causes of nephropathy (eg. vasculitis)
52
What should unilateral sensory impairment in a diabetic patient raise suspicions of?
raise questions of other aetiologies - diabetic neuropathies normally bilateral + symmetrical
53
What is a risk of not rotating insulin injection sites?
lipodystrophy - will get lump, insulin not absorbed reliably in these areas
54
Autoimmune polyglandular syndrome type 1 features
chronic candidiasis hypoparathyroidism autoimmune adrenal insufficiency
55
Autoimmune polyglandular syndrome type 2 features
autoimmune adrenal insufficiency (must be present) autoimmune thyroid disease T1DM
56
Autoimmune polyglandular syndrome type 3 features
autoimmune thyroid disease other autoimmune diseases (excluding Addison's, hypoparathyroidism and chronic candidiasis)
57
Autoimmune polyglandular syndrome type 4 features
2 or more organ-specific autoimmune diseases which do not fall into type 1, 2 or 3
58
MEN 1 features
pituitary adenoma parathyroid hyperplasia pancreatic tumours
59
MEN 2A features
parathyroid hyperplasia medullary thyroid carcinoma phaeochromocytoma
60
MEN 2B features
mucosal neuromas marfanoid body habitus medullary thyroid carcinoma phaeochromocytoma
61
When can lack of hypo awareness mean a person cannot drive?
if they cannot feel their hypos when they are below 3
62

Endocrine (21 decks)

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