MRCP 1 PASSMED > ENDOCRINO > Flashcards

ENDOCRINO Flashcards

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1
Q

Features of polycystic ovarian syndrome?

A

(Symptoms of hyperinsulinaemia and high levels of luteinizing hormone)
- Subfertility and infertility
- Oligomenorrhea and amenorrhea
- Hirsutism, acne
- Obesity
- Acanthosis nigricans

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2
Q

Investigation of PCOS?

A
  • Pelvic ultrasound
  • LH:FSH can be raised (not diagnostic anymore)
  • Prolactin: normal or mildly elevated
  • Testosterone: normal or mildly elevated
  • Sex hormone-binding globulin: normal to low
  • TSH
  • Impaired glucose tolerance
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3
Q

Diagnostic criteria for PCOS?

A

Rotterdam criteria, 2 out of 3 to make diagnosis :
- Infrequent or no ovulation (usually manifested as infrequent or no menstruation)
- Clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
- Polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)

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4
Q

Side-effects of thyroxine therapy (levothyroxine)?

A
  • hyperthyroidism: due to over treatment
  • reduced bone mineral density
  • worsening of angina
  • atrial fibrillation
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5
Q

What happens to thyroid in pregnancy?

A

Increased level of thyroin-binding globulin (TBG) causing a rise in Total Thyroxine but not in free thyroxine levels

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6
Q

What happens to thyroid hormones in acute non-thyroidal illness (e.g DKA, pneumonia…)?

A

Normal TSH, low T4, low T3 (sick euthyroid syndrome)

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7
Q

Treament of insulinoma?

A
  • Surgery
  • Diazoxide and somatostatin if patient not candidate for surgery
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8
Q

Features associates with metabolic syndrome?

A
  • Raised uric acid levels
  • Non-alcoholic fatty liver disease
  • Polycystic ovarian syndrome
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9
Q

Hypercalcemia + supressed PTH =?

A
  • Highly suspicious of malignancy (myeloma?)
  • Thyrotoxicosis also causes this picture
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10
Q

Hyperinsulinaemia + low c-peptide = ?

A

Exogenous insulin administration

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11
Q

Management of hypoglycaemia?

A

In the community:
- 10-20g of glucose in liquid, gel or tablet - Proprietary glucose solutions GlucoGel/DextroGel - HypoKit (syringe+vial of glucagon for SC or IM home intections)
In a hospital setting
- If patient is alert, quick-acting carbohydrate as above
- If unconscious, SC or IM glucagon injection / alternatively, 20% glucose solution may be given through a large vein

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12
Q

Hyponatremia severity based on values?

A
  • Mild: 130-134 mmol/L
  • Moderate: 120-129 mmol/L
  • Severe: < 120 mmol/L
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13
Q

Treatment of chronic hypovolaemic hyponatremia?

A

Normal isotonic saline 0.9%
- If Na+ rises, then hypovolaemia is confirmed
- If Na+ decreases, alternative diagnosis => SIADH

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14
Q
A
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15
Q

Treatment of chronic euvolemic hyponatremia?

A

Fluid restriction to 500-1000ml/day
Consider medication: Demeclocycline, Vaptans

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15
Q

Treatment of chronic hypervolemic hyponatremia?

A

Fluid restriction 500-1000ml/day
Consider loop diuretics, vaptans

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16
Q

Treatment of severe acute hyponatremia <120mmol/L?

A

Hypertonic saline 3%

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17
Q

Complications of hyponatremia treatment?

A
  • Over-correction of severe hyponatremia can cause osmotic demyelination syndrome, thought to be secondary to astrocyte and possibly oligodendrocyte apoptosis.
    This happens because of loss of organic osmolytes from astrocytes, leading to their dehydration and death
  • To avoid this, only raise Na+ by 4-6 mmol/L /24h
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18
Q

Features of osmotic demyelination syndrome?

A

Appear after 2 days of over-correction of severe hyponatraemia with Sx of:
- dysarthria, dysphagia, paraparesis or quadriparesis, seizures, confusion, and coma (Locked-in syndrome)

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19
Q

Mode of action of
Vasopressin/ADH receptor antagonists (vaptans)?

A

Antagonism of V2 receptors results in selective water diuresis, sparing the electrolytes - avoid them in patients with hypovolemic hyponatremia and liver impairment

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20
Q

Mechanism of action of Meglitinides? (Repaglutide, nateglinide)

A

Bind to ATP-dependent K+ channels on the cell membrane of pancreatic beta cells (Same as SULFONYLUREAS)

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21
Q

Adverse effects of metaglinides? (repaglinide, nateglinide)

A

Weight gain and hypoglycaemia

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22
Q

Mechanism of action of DPP-4 inhibitors?

A

DPP4 is an enzyme that deactivates the glucose-dependent insulinotropic polypeptide (GIP) and GLP-1. The inhibition of this enzyme causes an increased availability of GLP-1 levels in the body.
EXAMPLES: SITAGLIPTIN - ALOGLIPTIN

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23
Q

Mode of action of GLP1 agonists?

A

Stimulation of GLP-1 or incretin receptors, resulting in increased insulin secretion.

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24
Cause of Gitelman's syndrome?
Reabsorptive defect of the NaCl symporter in the Distal Convoluted Tubule
25
Diagnosis of Gitelman's syndrome?
Genetic testing - mutations in the SLC12A3 gene
26
Gitelman's syndrome management?
- Oral K+ and Mg+ supplementation - Potassium-sparing diuretics if still hypokalaemic/symptomatic
27
Gitelman's syndrome features?
Normotension + hypokalaemia + hypocalciuria + hypomagnesaemia + metabolic alkalosis
28
Grave's disease pathophysiology?
IgG antibodies to the thyroid-stimulating hormone (TSH) receptor - Grave's is the most common cause of thyrotoxicosis in women 30-50 yo
29
Features specific to Grave's disease?
- Eye symptoms: exophtalmos + ophthalmoplegia - Pre-tibial myxoedema - Thyroid acropachy: digital clubbing + soft tissue swelling of the hands and feet + periosteal new bone formation
30
Grave's disease's antibodies?
- TSH receptor stimulating antibodies (90%) - Anti-thyroid peroxidase antibodies (75%)
31
Thyroid scintigraphy in Grave's disease?
Diffuse, homogenous, increased uptake of radioactive iodine
32
What are the acute phase proteins?
Acute PHASE proteins: - P: Procalcitonin + Fibrinogen + Ferritin - H: Haptoglobin - A: Alpha-1-antitrypsin - Se: Serum amyloidosis A,P + Caeruloplasmin + CRP
33
What is the physiological response to hypoglycaemia?
HORMONAL RESPONSE - Decreased insulin secretion - Increased glucagon secretion, followed by secretion of cortisol and growth hormone SYMPATHOADRENAL RESPONSE - Increased catecholamines-mediated (adrenergic) and acetylcholine-mediated (cholinergic) neurotransmission in the autonomous peripheral nervous system and central nervous system
34
Causes of hypokalaemia with hypertension?
MNEMONIC = Little Cushing Conned 11 people - Liddle's syndrome - Cushing's syndrome - Conn's syndrome - 11-beta hydroxylase deficiency (causes 90% of congenital adrenal hyperplasia cases) - Carbenexolone and licorice could also be potential causes
35
Causes of hypokalaemia without hypertension?
DR Bill GGates - Diuretics - Renal tubular acidosis type 1 and 2 - Bartter's syndrome - GI loss (e.g. diarrhoea, vomiting) - Gitelman syndrome
36
Causes of nephrogenic diabetes insipidus?
- Renal: CKD, inherited diseases - Electrolytes: HypoK, HyperCa - Drugs: Lithium, demeclocycline (anti-ADH)
37
Management of Grave's disease?
- Initial symptomatic management: Propanolol - Anti-thyroid drugs: Carbimazole started at 40mg/day annd reduced to maintain euthyroidism - treat for 12 to 18 months Alternative regimen "block-and-replace": Carbimazole started at 40mg/day then thryoxine is added when patient is euthyroid - treat for 6-9 months - Patients on titrated ATD have less side-effects than those on block-and-replace - Radioiodine treatment for patients who relapse after ATD or resistant to it
38
Indications of insulin stress test?
Investigation of hypopituitarism - IV insulin is given, GH and cortisol are measured - in normal pituitary, they should rise
39
Contraindications of insulin stress test?
Ischaemic heart disease - Epilepsy - Adrenal insufficiency
40
Urge incontinence management?
- Bladder retraining - Oxybutinin, Tolterodine, Darifenacin, Mirabegron (in frail women in whom oxybutinin is contraindicated) - If troublesome nocturia => desmopressin - Women with overactive bladder that has not responded to non-surgical treatment: Botulinum toxin A wall injection
41
Stress incontinence management?
- Lifestyle measure - Pelvic floor muscle training - Surgical procedures: Mid-urethral tape, intramural bulking agent injections, colposuspension - Duloxetine if surgical options are not accepted
42
Which antidiabetic drug causes flatulence?
Acarbose - lowers absorption of carbs in the gut => more carbs reach colon and get digested by bacteria => excessive gas formation
43
When to test pregnant women for gestational diabetes?
- At 24-28 weeks - If previous gestational diabetes, perform OGTT as soon as possible after booking and at 24-28 weeks if the first OGTT is normal
44
What are diagnostic thresholds for gestational diabetes?
- Fasting glucose is >= 5.6 mmol/L - 2-hour glucose is >= 7.8 mmol/L
45
Which acromegaly medication is used as adjunct to surgery?
Somatostatin analogue => Octreotide
46
Which antidiabetic drug causes glycosuria, recurrent urinary infections, euglycaemic ketoacidosis, Fournier's gangrene?
SGLT-2 inhibitors (Serum Glucose Transporter-2): Dapagliflozin, canagliflozin, empagliflozin
47
Benefits of SGLT-2 inhibitors?
Cardioprotective: lowers BP and CVD risk Renoprotective Weight loss
48
Which thyroid cancer is associated with rapid invasion causing hoarse voice and compression symptoms?
Anaplastic carcinoma
49
Features of uterine fibroids?
- Menorrhagia resulting in iron-deficiency anaemia - Bulk-related symptoms: lower abdominal pain,urinary symptoms - Subfertility - Polycythaemia secondary to autonomous production of erythropoietin
50
Management of menorrhagia secondary to uterine fibroids?
- Levonorgestrel intrauterine system - NSAIDs mefenamic acid - Tranexamic acid - Combined Oral Contraceptive Pills - Oral and injectable progesterone
51
Treatment to shrink/remove uterine fibroids?
- GnRH agonists may be used short-term - Surgery: Myomectomy Hysteroscopic endometrial ablation Hysterectomy Uterine artery embolization
52
Pendred's syndrome?
Autosomal recessive + sensorineural deafness + goitre + euthyroidism + academic progression delay
53
When to start statin primary prevention in patients with T1D?
DO NOT USE QRISK, use this: - >40 years - Diabetes for more than 10 years - Established nephropathy - Other CVD factors
54
WHO's criteria for Metabolic Syndrome?
- Hypertension: > 140/90 mmHg - Dyslipidaemia (Hypertension + High triglyceride) - Central obesity: BMI>30 - Microalbuminaemia
55
What additional screening test should be done after Acromegaly diagnosis?
Colonoscopy => increased risk of colorectal cancer
56
MOA of thiazolidinediones?
PPAR-Gamma agonists (Glitazones), reduce peripheral insulin resistance
57
MOA of Gliptins?
Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1
58
Hypokalaemia + hypertension?
Conn's - Cushing's - Liddle's - Renal artery stenosis
59
Which antidiabetic is associated with severe pancreatitis and renal impairment?
GLP-1 agonists
60
What is the mechanism causin IFG (Impaired Fasting Glucose 6.1-6.9 mmol/L)?
Hepatic insulin impairment
61
What are the complications of untreated subclinical hyperthyroidism ?
- Cardiovascular complications (atrial fibrillation) and osteoporosis (increased bone turnover) - Increased likelihood of dementia
62
Skin manifestations of hypothyroidism?
- Dry, yellow cold skin - Xanthoma - Pruritus - Dry coarse scalp hair, loss of lateral aspect of eyebrow and axillary hair - Eczema
63
Skin manifestations of hyperthyroidism?
- Pretibial myxoedema - Thyroid acropachy: finger clubbing - Scalp hair thinning - Sweating - Pruritus
64
What medication potentiates water retention in patients on Thizolidinediones (pioglitazone)?
Insulin makes water retention worse
65
Criteria for surgery in primary hyperparathyroidism?
- Age <50 - Calcium more than 0.25 mmol above the upper normal range - Renal failure: eGFR<60ml/min - Osteoporosis or osteoporotic fracture - Stones in kidney - Symptomatic disease
66
Most specific sign for Grave's disease?
Pretibial myxedoema
67
Primary amenorrhoea + history of bilateral inguinal hernia repair surgery as a child + normal breast development + absence of pubic hair = diagnosis?
Androgen insensitivity syndrome - confirming male karyotype is the first step in evaluation
68
MEN type 1 + recent diabetes diagnosis + unintentional weight loss = what skin rash would be present?
Necrolytic migratory erythema (associated with glucagonoma)
69
Eastern juvenile jew/Yougoslavian/Hispanic + hyperandrogenism with hirsutism + primary amenorrhoea = diagnosis and management?
Non-classical congenital adrenal hyperplasia, managed by glucocorticoids (flutamide) ( Classical CAH is diagnosed at birth, and testicular feminisation is associated with femal external genitalia + cryptorchidism)
70
Kallman with low FSH, LH and testosterone + no intention to procreate = management?
Testosterone patches (if procreation is wanted, then pulsatile subcutaneousinjection of gonadotropin releasing hormone) (GnRH)
71
Hormonal changes in pregnancy?
Low FSH 10-20 fold increase in Prolactin Significant rise in oestrogen due to placental production Normal Cortisol levels
72
Obesity + high HbA1C + CKD = which antidiabetic?
Dulaglutide (the safest GLP-1 agonist that's safe in CKD)
73
MRCP 1 PASSMED
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