Endocrine Flashcards

Question

hypotonic euvolemic hyponatremia

Answer 1

1. SIADH 2. Post op hyponatremia 3. Hypothyroidism 4. Psychogenic polydipsia 5. Beer potornania 6. Drugs - diuretics, thiazide, ace - 7. Edurance exercise 8. adrenocorticotropin deficiency

Answer 2

OEDEMATOUS STATES - CCF - liver disease - Nephrotic syndrome - Advanced kidney disease

Answer 3

hypervolemia or euvolemic - fluid restrict, water intake < 1.5 hypovolemic - give them normal saline or RINGERS with hyponatraemia with moderate &severe symptoms, 3% saline( usually 150mls

Answer 4

- Na+ at 0.5mmol / h Not more than 12 -16 h or 0.5 - 1.0mmol per hour Correct slowly to prevent osmotic demyelination

Answer 5

elderly confused, children unconscious

Answer 6

Serum osmolality ( hyperosmolar in hypernatraemia) Urine osmolality Low: often have Diabetes insipidus - see DI lecture High: unreplaced GI, renal, or insensible losses or osmotic diuresis Check glucose (to look for uncontrolled diabetes as a cause) Urinary sodium

Answer 7

DI - low urine osmolality (can't concentrate urine - therefore low solutes in urine) - High serum osmolality SIADH - high urine osmolality - low serum osmolality

Answer 8

h2O orally | - give IV fluids slowly to prevent cerebral oedema

Answer 9

all tented T waves, small p waves, widened QRS- eventually becoming sinusoidal & leading to ventricular fibrillation

Answer 10

10ml calcium gluconate IV ( Insulin- dextrose e.g. 5-10 units actrapid in 50mls of 50% Dextrose IV Nebulised salbutamol 2.5-5mg neb stat Patients in renal failure with hyperkalaemia - dialysis

Answer 11

find the cause - Polystrene sulfonate resin (e.g. Calcium reosnium 15 g/ po tds) can be used as it binds K+ in the gut , bringing down K+ levels over a few days.

Answer 12

Vomiting/ nasogastric suction Diarrhoea Intestinal fistula Ileostomy Rectal villous adenoma Renal tubular failure/ other renal losses Medications e.g. Diuretic therapy, salbutamol Cushing’s syndrome/ Conn’s syndrome Alkalosis Bowel cleansing pre-colonoscopy preparations/ laxatives Osmotic diuresis

Answer 13

``` Usually asymptomatic Muscle weakness Hypotonia Hyporeflexia Cramps Tetany Palpitations Light-headedness (arrhythmia) ```

Answer 14

Arrhythmia paralysis rhabdomyolysis diaphragmatic weakness

Answer 15

``` U wAVE decreased T waves ST segment depression PR interval prolongation QRS prolongation ```

Answer 16

MILD-MOD 10-20kcl ORAL given 2-4 times a day SEVERE IV 20-40 KCL in 1 L of normal saline over 6-8 hours

Answer 17

10-20 mmol/h

Answer 18

``` Severe diarrhoea Alcohol misuse Diuretics Total parenteral nutrition Renal tubular acidosis Malabsorption/ malnutrition Diabetic ketoacidosis ```

Answer 19

Cardiac arrest

Answer 20

Mil - oral Mg | Severe - IV Mg sulfate in a solution of normal saline or dextrose

Answer 21

``` Asymptomatic Paraesthesia Ataxia Seizures Arrhythmias Tremor Tetany ```

Answer 22

IV saline administration (watch for fluid overload) Bisphosphonates (inhibit osteoclasts e.g. IV zolendronic acid SE: Flu like illness, osteonecrosis of jaw, bone pain, hypocalcaemia) Calcitonin Steroids: used in hypercalcaemia associated with sarcoidosis

Answer 23

Mild - ORAL vit D and calcium - if no response on oral switch to UV Severe- 10ml of 10% calcium glucoronate Correct Mg if low

Answer 24

Calcitriol (this is the active form and therefore prevents the kidney from activating it

Answer 25

``` low blood surgery when level drops < 3.9 mmol/L It consistent Whipple's train - symptoms consistent hypoglycaemia measurement low plasma glucose relief of symptoms after plasma glucose ```

Answer 26

15-20mg fast acting carb - dextrose, lucosade(100mls), sweetened fruit juice - glucotabs - 4g each so 4-5 chewable ones If severe with coma or confusion - At home - IM glucagon 1mg - Inhospital - 50% dextrose 50mls IV 200-300 of 10% dextrose IV

Answer 27

Growth hormone deficiency testing: 1) Insulin induced hypoglycaemia test- risk of seizures/ angina/ hypoglycaemia/adrenal crisis. 2) Arginine & growth hormone releasing hormone test ACTH deficiency testing: 1) Short synacthen test to assess adrenal axis 2) Cosyntropin/ rapid ACTH stimulation test

Answer 28

10% are malignant 10% are extra- adrenal 10% bilateral 10% familial MEBF

Answer 29

24hour urinary testing VMA, catecholamines or metenephrines ( most sensitive) - repeat urinary testing x 3 (episodic) Plasma catecholamines & metenephrines

Answer 30

MRI ( T2 weighted ) with gadolinium contrast CT with contrast Nuclear imaging with radioactive tracer can also be used e.g PET, MIBG scan

Answer 31

``` TSH mildly increase , T3 and T4 normal ONLY TX Reasons to treat 1. Risk to become clinical - previous Graves/ autoimmune - positive thyroid antibody - goitre 2. Hyperlipidaemia 3. atherosclerosis 4. Pregnancy or trying 5. Reduce quality of life if symptomatic 6. TSH >10 ```

Answer 32

HIGH ESR | TENDER THYROID

Answer 33

Hashimotos thyroidisim - HIGH ANTIBODIES TITERS anti-thyroids peroxidase antibodies (anti TPO) anti-thyroidgnobulin antibodies

Answer 34

Start 50-100 mcg per day increase 25-50mcg in increments by 4-6 weeks until TSH stable ONCE stable monitor in 6-12 months

Answer 35

Caution in Start at 25micrograms daily & adjust slowly in 4 weekly increments of 25 micrograms ( risk of precipitating angina or myocardial infarction)

Answer 36

AFFECTS ABSORPTION Antacids (aluminum containing) Iron tables Calcium tablets INCREASES METABLOSIM - anti-epileptic - Rifampin

Answer 37

``` Myxoedema coma Ischaemic heart disease Weight gain/ obesity Rare neurologic problems include reversible cerebellar ataxia, dementia, psychosis, and myxedema coma. Hashimoto's encephalopathy ```

Answer 38

SMOKING - exopthalmous - ptosis - conjunctival edema - ophthalmoplegia - papillodema - loss of colour vision RETRO - orbital inflammation and lymphocyte inflammation results in swelling of orbit

Answer 39

hyperthyroidism following administration of iodine

Answer 40

``` Graves’ disease ( 60-80% of cases) Toxic multi-nodular goitre Solitary toxic thyroid nodule Thyroiditis (Hashimoto’s; deQuervains) Post-partum thyroiditis Ectopic thyroid tissue eg. metastatic follicular thyroid cancer, struma ovarii Medications eg amiodarone, l-thyroxine excess Jod-Basedow phenomenon ```

Answer 41

DUE to TSH receptor - fibroblast behind the eye and skin have TSH receptors therefore glycoamminoglycans "DOUGH like apperenace"

Answer 42

``` TSH receptor antibodies (graves) antithyroid peroxidase (autoimmune) ```

Answer 43

1. Beta blockers - symptoms 2. Carbimazole or Propylthiouracil (PTU) 3. Radio-iodine 4. Surgery - obstructive goitre - contraindication to RAI

Answer 44

STOP medication if they get a sore throat or mouth ulcers | - b.c can can agranulocytosis

Answer 45

``` Analgesia- NSAIDS Beta-blockers Steroids (taper over 2 weeks) L- thyroxine --> if become hypothyroid Monitor TFT’s closely- every 2-4 weeks until normalise ```

Answer 46

``` Atrial fibrillation Osteoporosis Increased cardiovascular disease risk Progression to clinical hyperthyroidism Multi nodular Goitre ```

Answer 47

``` Atrial fibrillation Heart failure Angina Osteoporosis Ophthlamopathy Oligomenorrhoea/ amenorrhoea Gynaecomastia ```

Answer 48

10-205 FAIL frist time and require a 2nd dose

Answer 49

Fasting Plasma Glucose > 7.0 mmol/l ⃰ Fasting is defined as no caloric intake for at least 8 hours Plasma glucose > 11.1 mmol/l two hours following Oral Glucose Tolerance Test. (OGTT) ⃰ Random plasma glucose >11.1 mmol/l ( in symptomatic patient) HBA1C > 48 mmol/mol. ( >6.5%) ⃰

Answer 50

AntiGAD | isle cell antibody

Answer 51

FBG: 5-7 mmol/litre PG: 4-7 mmol/litre before meals PG: 5-9 mmol/litre at least 90 minutes after eating HbA1C: <6.5%

Answer 52

think hypercalemia | - measure serum Calcium levels

Answer 53

THINK ADDISONS disease - SYNACTHEN TEST you inject synacthen (ACTH) and you would expect their to be an increase cortisol

Endocrine Flashcards

(78 cards)