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Medical School Finals > Speciality: Endocrinology > Flashcards

Speciality: Endocrinology Flashcards

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USMLE® Step 1 flashcards
1
Q

Hyperthyroidism

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Graves’ disease. Toxic nodular goitre. etc
  2. sweating, tremor, agitation, fast HR, AF, eye disease, thin, heat intolerance.
  3. TFT - low TSH, high T4/3. Thyroid antibodies.
    - If T3/4 are low and TSH is low - consider secondary hypothyroidism
  4. Stop the over-activity and replace w/ thyroxine. Radioactive iodine ablation.
    - Propanolol for Sx relief.
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2
Q

DKA

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Uncontrolled lipolysis due to inability to use glucose (no insulin) fatty acid break down in the liver to ketones.
  2. Abdominal pain, diabetic triad, Kussmaul, ketogenic breath.
  3. High glucose, high ketones, low pH.
  4. Fluid resus + Insulin + sugar + correction of hypokalaemia.
    - Insulin given initially at 0.1unit/kg/hour.
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3
Q

Endocrine response to stress - such as major surgery

A

Increased - GH, cortisol, renin, ATCH, aldosterone, prolactin, ADH, glucagon.
Decreased - Insulin, TTrone, Oestrogen.
No change - TSH, LH, FSH

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4
Q

Congenital adrenal Hyperplasia

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. 21-hydroxylase deficiency etc. AR inherited. Due to low cortisol - increased ATCH secretion. Increased androgens.
  2. Virilisation in females, or increased androgen secretion in female children.
    - Early menarche
    - Facial hair
  3. Measuring hormone levels, low cortisol, high hydroxyprogesterone etc.
  4. Supplement glucocorticoids - reduces hyperplasia and therefore androgen secretion.
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5
Q

T2DM management

A
  1. Lifestyle and diet (allow 2 months)
  2. Metformin (if HbA1c is >58mmol/mol add another drug)
  3. Gliclazide or sitagliptin (if high BMI as doesn’t cause weight gain)
  4. Insulin
  5. Manage HTN (<140/80 w/ no end organ damage or <130/80 w/ end organ damage.
    - Lipid management.
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6
Q

Multiple endocrine neoplasia 1

A
  • Parathyroid (hyper)
  • Pituitary
  • Pancreas (insulinoma or gastrinoma (ulceration))
  • MEN1 gene.
  • Presents w/ peptic ulcers, galactorrhoea and hypercalcaemia.
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7
Q

MEN 2

A
  • Medullary thyroid cancer
  • Parathyroid
  • Pheochromocytoma
  • RET oncogene
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8
Q

MEN 2b

A
  • Medullary thyroid cancer

- Pheochromocytoma

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9
Q

Hypercalcaemia

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Primary hyperparathyroidism, malignancy, sarcoid, acromegaly, thyrotoxicosis.
  2. Bone, stones, groans, thrones and psychiatric moans.
  3. Bloods - calcium, parathyroid hormone. Look for causes. VIT D, albumin. ECG (brady, AV block)
  4. Rx cause.
    - Increase urinary excretion, hydrate. Loop diuretics (inhibit reabsorption). Glucocorticoids. Bisphosphonates.
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10
Q

Primary hyperaldosteronism

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Adrenal adenoma (Conn’s syn) or BL idiopathic adrenal hyperplasia.
  2. HTN, Hypokalaemia (muscle weakness), Alkalosis.
  3. Aldosterone/renin ration is first line.
    - CT abdo
  4. Adrenal adenoma resection.
    - Aldosterone antagonist - spironolactone.
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11
Q

Addisonian Crisis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Sepsis
    - Surgery
    - Acute exacerbation of chronic insufficiency.
    - steroid withdrawal.
  2. Low glucose, low sodium, high potassium.
    - History of steroid use.
  3. Bloods - U&E
  4. Hydrocortisone 100mg IM or IV.
    - 1L NACL over 30-60 mins w/ dextrose if hypoglycaemia.
    - Continue hydrocortisone every 6 hours until stable.
    - Oral replacement after 24hrs and reduced to maintenance over 3-4 days.
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12
Q

Addison’s disease

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Autoimmune destruction of the adrenal glands.
    - Reduced cortisol and aldosterone.
    - Primary causes = autoimmune, TB, mets, sepsis, HIV and antiphospholipid syndrome.
    - Secondary causes = Pituitary disorders.
  2. Lethargy
    - weakness
    - anorexia
    - weight loss
    - salt craving
    - Hyperpigmentation ) palmar creases and gums.
    - Hypotension
    - Hypoglycaemia
    - Acute Addisonian crisis
  3. ATCH (short synacthen test) - plasma cortisol is measured before and 30mins after giving 250ug IM of synacthen.
    - 9am serum cortisol.
    - Adrenal antibodies for anti-21-hydroxylase
    - Electrolyte levels.
  4. Replacement glucocorticoid and mineralcorticoid.
    - Hydrocortisone in 2/3 doses per day.
    - Fludrocortisone.
    - Education
    - double steroids in illness.
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13
Q

Primary Hyperparathyroidism

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. often solitary adenoma.
    - Hyperplasia
    - Multiple adenoma
    - carcinoma.
  2. Bones, stones, groans, thrones and moans.
    - Polydipsia and polyuria
    - Bone pains
    - Renal stones
    - HTN
    - Hand XR - erosion of terminal phalyngeal tufts (acro-osteolysis)
  3. Raised Calcium and low phosphate.
    - PTH may be raised or normal
    - Pepperpot skull
  4. Total parathyroidectomy
    - Conservative Rx id calcium is low and not Sx.
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14
Q

Thyrotoxic storm

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Surgery
    - trauma
    - Infection
    - acute iodine loading - CT contrast.
  2. Fever >38.5
    - Tachycardia
    - Confusion and agitation
    - N&V
    - HTN
    - HF
    - Abnormal LFT
  3. Clinical
    - TFT - elevated T3/4 and suppressed TSH
    - Systemic upset; U&E, CK, LFT, FBC.
    - ECG
    - CXR
    - ABG
  4. Once suspected - commence Rx.
    - Rx underlying cause.
    - Resus; IV fluids.
    - BB for HR + propylthiouracil (for thyroid) + steroid (blocks conversion of T4 to T3 and helps with adrenal insufficiency)
    - Other = paracetamol, lugols iodine solution (to prevent new hormone synthesis)
    - Carbimazole - SE = agranulocytosis - monitor FBC
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15
Q

De Quervain’s thyroiditis

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Following viral infection.
  2. Presents w/ hyperthyroidism
    4 phases;
    1 - Hyperthyroidism, painful goitre and raised ESR
    2 - euthyroid
    3 - Hypothyroid
    4 - Thyroid structure and function return to normal.
  3. Thyroid scintigraphy - global reduced uptake or radioactive iodine.
  4. Usually self-limiting
    - Thyroid pain w/ NSAIDS
    - severe = steroids.
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16
Q

TFT in different thyroid diseases

  1. Thyrotoxicosis
  2. Primary hypothyroidism
  3. Secondary hypothyroidism
  4. Sick euthyroid syndrome
  5. Subclinical hypothyroid
  6. Poor compliance w/ thyroxine
  7. steroid
A
  1. TSH = low, T4 = high
  2. TSH = high, T4 = low
  3. TSH = low, T4 = low
  4. TSH = low, T4 = low
  5. TSH = high, T4 = normal
  6. TSH = high, T4 = normal
  7. TSH = low, T4 = normal
17
Q

Monitoring of T1DM

A
  1. HbA1c every 3-6 months.
    - Target of 48mmol/mol or lower.
  2. Self monitoring 4x daily including before each meal and before bed.
    - 5-7mmol/L on waking
    - 4-7mmol/L before meals and other times of the day.
  3. More frequent when ill, pregnant, breastfeeding, activity.
18
Q

Thyroid eye disease

  1. Causes and risks
  2. Presentation
  3. Ix
  4. Rx
A
  1. Graves’ disease
    - Autoimmune response against an autoantigen TSH receptor. Retro-orbital inflammation.
    - GAG and collage deposition in the eye muscles.
    - Risks = smoking
  2. Exopthalmos
    - Conjunctival swelling
    - optic disc swelling
    - Opthalmoplegia
    - Inability to close eyes, sore, dry eyes.
  3. Eye exam
    - TFT
  4. Topical lubricants
    - Steroids
    - Radiotherapy
    - surgery
19
Q

Hyperosmolar Hyperglycaemic state.

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Medical emergency.
    - Hyperglycaemia results in an osmotic diuresis. dehydration and electrolyte deficiencies.
    - Elderly w/ T2DM
    - Differentiate from DKA.
  2. Insidious onset.
    - Fatigue, lethargy, N&V
    - Altered consciousness, headaches, papilloedema.
    - Hyper viscosity
    - Dehydration, hypotension and tachycardia.
  3. Diagnosis =
    - Hypovolaemia
    - Marked hyperglycaemia >30
    - Raised serum osmolarity >320
  4. Normalise the osmolality gradually
    - replace fluid and electrolytes
    - Normalise blood glucose
20
Q

Hypoparathyroidism

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A

1) Decreased PTH secretion
- Secondary to surgery; thyroid
- Low calcium and high phosphate
- Radiation
- alcohol
- HH and wilsons disease - destruction of parathyroid glands.

  1. Main Sx are those of hypocalcaemia
    - Tetany; trousseau (BP cuff) and chvosteks sign (parotid tapping)
    - Muscle twitching and spasm.
    - Prolonged QT
  2. Bloods; calcium, phos and PTH and ALP.
    - Typically = Low calcium, high phos, low PTH and normal ALP.
  3. Severe (tetany) - IV calcium.
    - Calcium and vit D
21
Q

Phaeochromocytoma

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Rare catecholamine secreting tumour.
    - Associated w/ MEN 2, neurofibromatosis, von hippel lindau.
  2. HTN
    - Headaches
    - Palpitations
    - Sweating
    - Anxiety
  3. 24hr collection of metanephrines/catecholamines
    - CT
    - Biopsy
  4. Surgical removal following stabilisation;
    - Alpha and beta blockade to control BP.
22
Q

Hypoglycaemia Management

A

1) Normal GCS - Buccal glucogel

2) Low GCS = IV glucose or IM glucagon

23
Q

Prolactinoma

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Pituitary adenoma secreting prolactin.
    - Benign
  2. In men - impotence, loss of libido and milk
    In women - amenorrhoea, infertility, milk and osteoporosis
  3. MRI
  4. Sx treated with Bromocriptine (dopamine agonist), inhibit the release of prolactin.
    - Surgery - trans-spenoidal.
24
Q

Hypokalaemia

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. Increased potassium loss; thiazides, loop diuretics, laxatives, steroids and Abs, GI losses, Dialysis, hyperaldosteronism.
    - Trans-cellular shifts; insulin/glucose therapy, salbutamol, theophylline.
    - Decreased K intake
  2. Palpitations
    - Muscle weakness
    - Hypotonia.
  3. ECG - U waves, T wave flattening, ST segment changes.
  4. Mild to mode w/o ECG changes; Oral potassium.
    - Severe or w/ ECG changes; IV replacement. Cardiac high dependency w/ lots of fluid.
25
Q

HSP

  1. Causes
  2. Presentation
  3. Ix
  4. Rx
A
  1. IgA small vessel vasculitis.
    - IgA nephropathy.
    - Seen in kids following an infection.
  2. Palpable purpuric rash over buttocks and extensor surfaces of arms and legs.
    - Abdo pain
    - Polyarthritis
    - IgA nephropathy
  3. Clinical
  4. Analgesia
    - Rx nephropathy
    - ?steroids

Medical School Finals (24 decks)

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