GP FELLOWSHIP EXAM > Endocrine > Flashcards

Endocrine Flashcards

(52 cards)

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1
Q

Dose of calcium for >50

A

1300mg daily

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2
Q

Starting dose of thyroxine

A

1.6mcg/kg
Adjust 4-8 weekly

OR
Partial treatment
25-50mcg adjust 4-8 weekly
*better for oldies and mild derrangement

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3
Q

Automatic high risk for diabetes (AND screening type and frequency)

A
  • GDM
  • Overweight and >40
  • First degree relative w diabetes
  • CVD
  • Pacific islander, indian subcontinent,ASTI
  • PCOS

FBG or HbA1c EVERY 3 YEARS

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4
Q

Starting dose for hyperthyroidism

A

Carbimazole 10-20mg in 2-3 divided doses
adjust dose 4-6 week interval

If severe (ie t3-t4 2.5 x normal) then 30-40mg

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5
Q

When to use radioidoine or thyroidectomy for graves?

A
  • Severe graves or large goitre
  • Toxic adenoma or multinodular goitre
  • When TSH receptor antibody remains elevated despite therapy
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6
Q

Signs of adrenal insufficiency

A
  • Malaise
  • Weakness
  • Anorexia
  • Weight loss
  • HYPERPIGMENTATION
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7
Q

Diagnosis of adrenal insufficiency

A
  • Morning serum cortisol
  • Urinary cortisol measurement
  • SHORT SYNACTHEN TEST
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8
Q

Cushing’s syndrome diagnosis

A
  • 24hour urinary free cortisol (measured twice)
  • 1mg overnight dexamethasone suppression test
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9
Q

Signs and symptoms of Cushing’s syndrome:

A

Features:
- Truncal obesity
- Hirsutism
- Acne
- Weakness
- Thin skin
- Bruising
- Insomnia
- Depression

Signs
- Moon facies
- Buffalo hump
- purple striae

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10
Q

Exercise restriction for diabetics (specific example/condition)

A
  • Proliferative retinopathy
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11
Q

Diabetic ideal range for BGL pre-exercise & when to check (HINT: which meds)

A

5-13.9

Insulin or sulfonylureas

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12
Q

Diabetes exercise guidelines (hint: aerobic and resistance)

A

1) 150 min mod-vigourous aerobic over at least 3 days with no more than 2 days without activity

2) 60mins resistance exercise
2-3 sessions/ week non- consecutive days

also: interrupt sitting every 30 mins

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13
Q

Minimal trauma fracture when to inititate treatment vs when to refer to specialist (hint T score cut off)

A

T score <-1.5 start treatment

if T score >-1.5 then refer for specialist review

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14
Q

Diabetes in pregnancy: pre-conception hba1c target

A

<6.5

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15
Q

Hypoglycaemia emergency management
1) able to eat
2) not able to eat

A

15g short acting carbohydrate (eg 6 jellybeans)

1mg glucagon IM

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16
Q

Frequency for diabetes screening for ATSI patients >18

A

yearly

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17
Q

Low risk individuals: how often to assess AUSDRISK? and from what age?

A

Every 3 years from 40

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18
Q

Licence restriction for severe hypoglycaemia episode (severe = not able to treat themselves)

A
  • 6 weeks
  • must see specialist
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19
Q

Incidental adrenal mass investigation next step:

A
  • 1mg dexamethasone supression test
  • 24hr urine metanephrines and catecholamines

If HTN
Then aldosterone- renin ration

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20
Q

When do we use Cabergoline?

A
  • Prolactinoma
  • Medically indicated suppression of lactation (still birth, severe mastitis)
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21
Q

Diet advice for diabetes (lifestyle)

Study These Flashcards
A
  • 1.5 serves of dairy
  • 3 serves of wholegrains
22
Q

Pharmacotherapy principles for diabetic retinopathy

Study These Flashcards
A
  • Optimise BGL
  • Control BP
  • Add: fenofibrate 145mg daily
  • Treat hypercholesterolaemia
23
Q

Assessment for diabetic peripheral neuropathy (clinical)

Study These Flashcards
A
  • 10g monofilament pressure sensation at MTJ
  • Ankle reflex
  • Vibration sensation with 128hz fork
  • Pinprick sensation
24
Q

Neuropathic pain treatment (pharmacology) be specific

Study These Flashcards
A

Amitriptyline 10mg nocte
OR
Pregabalin 75mg nocte
or
Duloxetine 30mg daily

25
Addison's crisis treatment
IV 100mg Hydrocortisone or prednisolone 40mg orally IV fluid resuscitation 10-20ml/kg bolus
26
Addisons (adrenal insufficiency) symptoms
- Diarrhoea - Vomiting - Weight loss - Fatigue, - postural hypotension - HYPERpigmentation
27
Cushings sydnrome tests
ONE OF THE FOLLOWING - Late night saliva cortisol - 24hr urinary free cortisol - Dexamethasone 1mg supression test
28
When to order Thyroid scintigraphy
- HIGH T3/T4 HYPERthyroidism Looking for - graves - toxic adenoma - thyroiditis
29
Inital dose for HYPERthyroidism
Carbimazole 10-20mg (mild symptoms) Carbimazole 30-50mg (severe)
30
Rare side effect of Carbimazole
Agranulocytosis
31
3 main blood tests to distinguish T1DM from T2D
- Insulin auto-antibodies (IAA) - Islet cell auto-antibodies (iCA) - GAD - C peptide (lower in type 1)
32
GDM Cut off values (Hba1c and OGTT)
Hba1c 5.5 OGTT >8
33
Investigation for primary aldosteronism
- Change antihypertensive to verapamil SR, Prazosin, moxonidine or hydralazine. - Wait 6 weeks - Test Renin: aldosterone ratio
34
Acromegaly: Too much what ?
Excessive growth hormone (pituitary adenoma)
35
Acromegaly: What test?
Serum insulin like growth factor-1 (IGF-1)
36
Signs of Acromegaly
- Frontal bossing - Enlargement of hands and feet - Oily Skin - Sweating - OSA
37
Post partum raised T3 & 4 potential diagnoses
- Postpartum thyroiditis - Graves
38
Thyroid autoantibodies in Graves
TSH Receptor ab positive TPO sometimes elevated
39
Frequency for diabetes screening in ATSI population
YEARLY hba1c or FBG
40
6 causes for thyrotoxicosis
Graves Toxic multinodular goitre Toxic adenoma Painless thyroiditis Post partum thyroiditis Painful subacute thryoiditis
41
Hypothyroidism in pregnancy dose change to thryoxine advice
25% increase as soon as falls pregnant (4-6 weeks)
42
Hypothyroidism in pregnancy rate of testing in early pregnancy
4-6 weeks
43
Causes for moderate hypophosphataemia
Vit D deficiency Iron infusion Primary Hyperparathyroidism Antacid abuse
44
Adrenal insufficiency/Addisons signs on exam?
- HYPERpigmentation - Postural hypotension - Dehydration - Decreased body hair - Vitiligo - Tachycardia
45
When to order thyroid scintigraphy?
Hyperthyroidism
46
Timing pattern in Painless postpartum thyroiditis
1-6 months PP Thyrotoxicosis followed by hypothyroidism (20% of the time permanent)
47
Pathogenesis in painless postpartum thyroiditis
Autoimmune destruction of thyroid follicles causing release of stored thyroid hormone
48
6 main causes of HYPERthryoidism
- Graves - Painless post partum thyroiditis - Toxic adenoma/multinodular goitre - Exogenous thryoid hormone - PAINFUL subacute thyroiditis (De-Quervain's) - Amiodarone
49
Threshold for TSH in pregnancy to commence thyroxine (regardless of T3/4)
4 between 2.6-4 controversial
50
What do you give to someone with Postpartum thyroiditis?
NO thyroid medication (transient) --> if symptomatic then for propanolol
51
Raised TSH approach (diagram given) tests and imaging
52
Causes of hyperthyroidism
- Graves disease - Toxic multinodular goitre - Toxic adenoma - Postpartum thryoiditis - Exogenous thyroid hormone - Painless sporadic thyroiditis - Painful subacute thryoiditis - Amiodarone induced thyroiditis
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