Endocrinology & Diabetes — Flashcards
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To remember the Gestation Diabetes diagnosting glucose values remember the numbers _____
Hint: 4 digits
Pregnant patients with T1DM should monitor their glucose _____
Add _____ if fasting glucose level is >=7 mmol/l
Cyrpoterone Acetate is a _____ which is used in combination with e.g. Goserelin to prevent increase in tumour flare symptoms
_____ would qualify a patient for OGTT
Hint: risk factor
All obese (BMI>30) women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at _____
What is the conversion for Oral Morphine to SC Diamorphine _____
Symptoms of _____ in the groin in children <2 years old should prompt investigation of type 1 diabetes
What is the conversion for Oral Oxycodone to Subcutaneous Diamorphine _____
The breakthrough dose of morphine is _____ the daily dose of morphine
Endocrinology & Diabetes UK Medical PG Flashcards - Medical Study Cards
Master Endocrinology & Diabetes with OnCourse flashcards. These spaced repetition flashcards are designed for medical students preparing for NEET PG, USMLE Step 1, USMLE Step 2, MBBS exams, and other medical licensing examinations.
Endocrinology & Diabetes Flashcard Deck - 662 Cards
Flashcard 1: To remember the Gestation Diabetes diagnosting glucose values remember the numbers _____
Answer: 5678
Flashcard 2: Pregnant patients with T1DM should monitor their glucose _____
Answer: multiple times during the day
Flashcard 3: Add _____ if fasting glucose level is >=7 mmol/l
Answer: Insulin
Flashcard 4: Cyrpoterone Acetate is a _____ which is used in combination with e.g. Goserelin to prevent increase in tumour flare symptoms
Answer: GnRH antagonist
Flashcard 5: _____ would qualify a patient for OGTT
Answer: Previous Macrosomia
Flashcard 6: All obese (BMI>30) women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at _____
Answer: 24-28 weeks
Flashcard 7: What is the conversion for Oral Morphine to SC Diamorphine _____
Answer: divide by 3
Flashcard 8: Symptoms of _____ in the groin in children <2 years old should prompt investigation of type 1 diabetes
Answer: Candida infection
Flashcard 9: What is the conversion for Oral Oxycodone to Subcutaneous Diamorphine _____
Answer: Divide by 1.5
Flashcard 10: The breakthrough dose of morphine is _____ the daily dose of morphine
Answer: one-sixth
Flashcard 11: _____ may be useful in patients with resistant problems in diabetic neuropathy
Answer: Pain Management Clinics
Flashcard 12: A subarachnoid hemorrhage can irritate or damage the hypothalamus and pituitary gland causing _____
Answer: SIADH
Flashcard 13: _____ prevents potassium absorption So correct magnesium before correcting hypokalaemia
Answer: Hypomagnesemia
Flashcard 14: The conversion of coral codeine to oral morphine is _____
Answer: divide by 10
Flashcard 15: _____ Is the most common cause of Secondary Hypertension
Answer: Primary Hyperaldosteronism (Conn's)
Flashcard 16: Aspirin can potentiate: _____
Answer: sulfonureas Warfarin Steroids
Flashcard 17: Adrenaline acts on β adrenergic receptors to stimulate _____ whilst also stimulating ACTH and stimulating lipolysis by adipose tissue
Answer: glucagon secretion in pancreas
Flashcard 18: The action of Adrenaline on α1 adrenoreceptors is _____
Answer: increased vasoconstriciton, pupildilation and urethral sphincter contraction
Flashcard 19: Where is Adrenaline released from naturally _____
Answer: the medulla of the adrenal glands
Flashcard 20: Adrenaline act on α adrenergic receptors to inhibit _____ and stimulate glycogenolysis in liver and muscle also stimulating glycolysis in muscle
Answer: insulin secretions by pancreas
Flashcard 21: What can cause Hypercalcaemia? 2
Answer: Two conditions account for 90% of cases of hypercalcaemia: 1. Primary Hyperparathyroidism 2. Malignancy - PTHrP from tumour e.g. squamous cell lung cancer - Bone Mets - Myeloma * measuring parathyroid hormone level is ley
Flashcard 22: What is the main cause of Primary Hyperparathyroidism?
Answer: • Parathyroid Adenoma (85% of cases)
Flashcard 23: What can be the symptomatic features of primary hyperparathyroidism? 4
Answer: • 'bones, stones, abdominal groans and psychic moans" - Bone pain/fracture - Renal Stones - Peptic ulceration, nausea, constipation, anorexia - Depression *polydipsia, polyuria, pancreatitis, hypertension
Flashcard 24: What can cause postural hypotension + erectile dysfunction?
Answer: • Diabetes
Flashcard 25: What do carcinoid tumours secrete?
Answer: • bradykinin • serotonin • ACTH (pituitary hormone) -> Cushing syndrome signs
Flashcard 26: What is the recommended blood glucose monitoring in T1DM?
Answer: • Atleast 4 times a day, including before each meal and before bed
Flashcard 27: What is Cushing's Disease?
Answer: • Cortisol excess • resulting from an ACTH-producing pituitary tumour
Flashcard 28: What will the blood results show for an Addisonian crisis?
Answer: • Low sodium • High Potassium • Low glucose
Flashcard 29: If Cortisol is Low after High dose dexamethasone supression test and ACTH is Low?
Answer: Adrenal Cushings (adrenal adenoma)
Flashcard 30: What is osteomalacia?
Answer: • The softening of bones due to inadequate Vit D
Flashcard 31: If cortisol is high/normal after a low dose dexamethasone supression test, diagnosis?
Answer: • Cushing's Syndrome
Flashcard 32: If Cortisol is Low after High dose dexamethasone supression test and ACTH is High?
Answer: Ectopic ACTH E.G. Lung cancer
Flashcard 33: What can corticoteroids do to glycaemic control?
Answer: • They can worsen glycaemic control • due to anti-insulin effects • Can cause hyperglycaemia
Flashcard 34: What type of diabetes medication is liraglutide?
Answer: • GLP-1 analog
Flashcard 35: What are the Bone Profile Results of Osteomalacia?
Answer: • Low calcium • Low phosphate • Raised ALP • Raised PTH *hypocalcaemia, hypophosphataemia due to impaired intestinal absorption. Raised ALP due to response of calcium absorption on bone
Flashcard 36: What is the treatment for sick euthyroid?
Answer: • No treatment
Flashcard 37: Excess Parathyroid hormone results in excess....
Answer: Phosphate excretion
Flashcard 38: Water deprivation test results for nephrogenic diabetes insipidus?
Answer: Low urine osmolality after fluid deprivation AND after desmopressin
Flashcard 39: Why does impaired hypoglycaemia awareness occur?
Answer: • Due to neuropathy of parts of the autonomous nervous system
Flashcard 40: T2DM initial therapy: If metformin is contraindicated (and no risk of CVS, established CVD or heart failure)?
Answer: choice of: - DPP-4 inhbitior - Pioglitazone - Sulfonylurea - SGLT-2 inhibitor
Flashcard 41: What are the typical blood test results in osteogenesis imperfecta?
Answer: Calcium, PTH, ALP, and phosphate are usually NORMAL
Flashcard 42: T2DM initial therapy: If metformin is contraindicated + patient has a risk of CVD, established CVD or chronic heart failure then ....
Answer: SGLT-2 monotherapy
Flashcard 43: In Cushing's disease, what is the response of cortisol to the low-dose and high-dose dexamethasone supression test?
Answer: • Cortisol not suppressed by low-dose • Cortisol supressed by high-dose
Flashcard 44: What are the TFT values for Sick Euthyroid?
Answer: • TSH -> low or normal range • T4 -> low • T3 -> low
Flashcard 45: What is the first-line investigation for suspected primary hyperaldosteronism?
Answer: Plasma aldosterone/renin ratio
Flashcard 46: What are LH, FSH, and testosterone levels in Kallmann’s syndrome?
Answer: LH and FSH low-normal; testosterone low
Flashcard 47: What is Phaeochromocytoma?
Answer: • A rare catecholamine secreting tumour • Causes hypertension
Flashcard 48: What is the target systolic blood pressure in a patient with T2DM?
Answer: <140 / 80 mmHg
Flashcard 49: HbA1c target for patients on a drug that may cause hypoglycaemia (e.g. sulfonylurea)?
Answer: 53 mmol/mol
Flashcard 50: Best test to diagnose Cushing's syndrome?
Answer: • Low-dose (overight) dexamethasone suppression test
Flashcard 51: Hypoglycaemia with High Insulin levels, but Low C-peptide?
Answer: • Exogenous Insulin Administration • aka Insulin Overdose
Flashcard 52: What is the first-line investigation in suspected primary hyperaldosteronism?
Answer: • Aldosterone/renin ratio
Flashcard 53: What should be done to an Addison's patients steroid replacement during intercurrent illness?
Answer: • Double the glucocorticoids • Keep fludrocortisone the same *during illness the body usually increases cortisol production as a stress response
Flashcard 54: In T2DM management when should SGLT-2 inhibitors be introduced?
Answer: • If a patient develops CVD (e.g. diagnosed with ischaemic heart disease) • a QRISK >= 10% or chronic heart failure
Flashcard 55: What is the maximum dose of metformin in T2DM management?
Answer: 2g daily
Flashcard 56: What is the most appropriate imaging investigation for patients with Cushing's Syndrome?
Answer: CT Adrenals
Flashcard 57: Which diabetes medication may have to be stopped in AKI due to risk of toxicity (but doesn’t usually worsen AKI itself)?
Answer: Metformin
Flashcard 58: What diabetes medication may cause fluid retention?
Answer: • Pioglitazone *Thiazolidinedione
Flashcard 59: With hypercalcaemia caused by malignancy, what will PTH and PTHrP be?
Answer: • PTH low -> negative feedback of hypercalcaemia • PTHrP high -> released from the tumour e.g. sqamous cell lung cancer
Flashcard 60: What would excess PTH do to Calcium and Phosphate levels?
Answer: • Calcium raised • Phosphate low
Flashcard 61: What is the fasting plasma glucose range for Impaired Fasting Glycaemia (IFG) ?
Answer: • 6.1-6.9 mmol/l • Pre-diabetic
Flashcard 62: What is the normal gylcaemic control HbA1c range?
Answer: <41 mmol/mol
Flashcard 63: What should all diabetic patients with a urinary ACR of 3mg/mmol be started on?
Answer: • ACE inhibitors • ARBs
Flashcard 64: What is the pre-diabetes gylcaemic control HbA1c range?
Answer: 42-47mmol/mol
Flashcard 65: What should people with Impaired Fasting Glucose (IFG) be offered ?
Answer: • Oral Glucose Tolerance Test (OGTT)
Flashcard 66: What is the HbA1c threshold for Diabetes?
Answer: >48 mmol/mol
Flashcard 67: What is the management of DKA?
Answer: 1. 0.9% Saline 2. IV Insulin infusion 3. 10% Dextrose infusion (once blood glucose <14 mmol/l) 4. Potassium
Flashcard 68: _____ is caused by increased production/ingestion of H+ or loss of HCO3-
Answer: Metabolic acidosis
Flashcard 69: What is the initial investigation for Carcinoid Syndrome?
Answer: • Urinary 5-hydroxyindoleacetic acid
Flashcard 70: The causes of _____ anion gap metabolic acidosis may be remembered with the mnemonic MUDPILES: M = Methanol (toxic alcohol → formic acid) U = Uremia (renal failure → retention of uremic toxins) D = Diabetic ketoacidosis (DKA) (accumulation of ketones) P = Propylene glycol I = Isoniazid or Iron overdose L = Lactic acidosis E = Ethylene glycol (toxic alcohol → oxalic acid) S = Salicylates (aspirin overdose)
Answer: raised
Flashcard 71: What blood test is needed to be performed for a paitent starting on carbimazole for hyperthyroidism?
Answer: • FBC [agranulocytosis is associated with carbiomazole]
Flashcard 72: What can mimic Cushing's disease?
Answer: • Alcohol excess
Flashcard 73: Patient presents with fatigue, erectile dysfunction and arthralgia?
Answer: • Haemochromatosis
Flashcard 74: Chronic kidney disease causing _____ hyperparathyroidism: Phosphate: increased Ca2+: decreased PTH: increased
Answer: secondary
Flashcard 75: _____ causes mesangial expansion, GBM thickening,& glomeruloscerosis, making it the most common cause of secondary nephrotic syndrome
Answer: Diabetic nephropathy
Flashcard 76: Hypertension in CKD is managed with ARB or ACE inhibitors IF the patient has diabetes mellitus AND urine ACR > _____
Answer: 3 mg/mmol
Flashcard 77: CKD with mesangial cell hypertrophy, glomerular basement membrane thickening, and glomerulosclerosis is assocaited with _____
Answer: diabetic nephropathy
Flashcard 78: sitagliptin and linagliptin are _____
Answer: DPP4-inhibitors
Flashcard 79: Diabetes mellitus may present with _____ due to glycosuria
Answer: recurrent UTIs
Flashcard 80: Which classes of diabetic medications cause _____? Sulfonylureas and Insulin
Answer: hypoglycaemia
Flashcard 81: gliclazide, glimepiride, glipizide are all _____
Answer: Sulfonylureas
Flashcard 82: The majority of type 2 diabetes patients are _____ at diagnosis. Some patients may have symptoms including: polyuria and polydipsia
Answer: asymptomatic
Flashcard 83: pioglitazone is a _____
Answer: thiazolidinedione
Flashcard 84: A weight-loss goal of _____% is recommended for overweight type 2 diabetics
Answer: 5-10
Flashcard 85: -flozin drugs are all _____
Answer: SGLT2 inhibitors
Flashcard 86: _____ diabetes mellitus is caused by insulin resistance and impaired insulin secretion from pancreatic β-cells
Answer: Type 2
Flashcard 87: Type 2 diabetics starting on insulin should take _____ insulin once nightly or twice daily
Answer: NPH (intermediate)
Flashcard 88: _____ is a cutaneous manifestation of insulin resistance
Answer: Acanthosis nigricans
Flashcard 89: Elderly patients with undiagnosed type 2 diabetes may initially present with _____
Answer: HHS
Flashcard 90: The onset of type _____ diabetes is gradual
Answer: 2
Flashcard 91: Patients who are _____, african carribean or south asian are at a higher risk of developing type 2 diabetes
Answer: black african
Flashcard 92: Does a family history of type 2 diabetes increase the risk of developing type 2 diabetes? _____
Answer: YES - strong association
Flashcard 93: _____ obesity is a risk factor for type 2 diabetes
Answer: Central
Flashcard 94: The onset of type _____ diabetes typically occurs in middle-aged adults
Answer: 2
Flashcard 95: Which class of diabetic medications can cause euglycaemic DKA? _____
Answer: SGLT2 inhibitors
Flashcard 96: Which diabetic medication is associated with lactic acidosis as a side effect? _____
Answer: Metformin
Flashcard 97: _____ is the most common side effect of metformin
Answer: Gastrointestinal upset
Flashcard 98: Patients with a thyroid nodule and cervical/supraclavicular lymphadenopathy should recieve a(n) _____ referral to a thyroid surgeon or endocrinologist
Answer: 2-week-wait
Flashcard 99: Patients with a rapidly growing thyroid nodule should recieve a(n) _____ referral to a thyroid surgeon or endocrinologist
Answer: 2-week-wait
Flashcard 100: _____ is also known as Plummer's disease
Answer: Toxic multinodular goitre
Flashcard 101: Patients with a thyroid nodule and a change in voice should recieve a(n) _____ referral to a thyroid surgeon or endocrinologist
Answer: 2-week-wait
Flashcard 102: Patients with a thyroid nodule and compressive symptoms should recieve a(n) _____ referral to a thyroid surgeon or endocrinologist
Answer: 2-week-wait
Flashcard 103: All children with a thyroid nodule should recieve a(n) _____ referral to a thyroid surgeon or endocrinologist
Answer: 2-week-wait
Flashcard 104: What is the likely diagnosis in a patient with labile blood pressure complaining of episodic headaches, sweating attacks, palpitations, or abdominal pains? _____
Answer: Phaeochromocytoma
Flashcard 105: What antihypertensive is given to a 65 year old Black African with T2DM? _____
Answer: ARB (preferred) or ACEi
Flashcard 106: Elevated blood glucose levels in _____ accelerates atherosclerosis & contributes to the development of diabetic cardiomyopathy, leading to heart failure
Answer: diabetes mellitus
Flashcard 107: What is the likely diagnosis in a patient with resistant hypertension complaining of weight loss, sweating, heat intolerance, & palpitations? _____
Answer: Hyperthyroidism
Flashcard 108: What is the likely diagnosis in a young patient with resistant hypertension, hypokalaemia and an ↑ aldosterone:renin ratio? _____
Answer: Primary hyperaldosteronism (Conn syndrome)
Flashcard 109: What is the second-line definitive management of Grave's disease? _____
Answer: Radioactive iodine abalation
Flashcard 110: The management of _____, non-functional (non-secretory) pituitary adenomas is observation only
Answer: asymptomatic
Flashcard 111: _____ pituitary adenomas are also known as Cushing's disease
Answer: Corticotroph
Flashcard 112: What is the first line symptomatic management of hyperthyroidism in asthmatic patients? _____
Answer: CCBs (e.g. verapamil or diltiazem)
Flashcard 113: Which anti-thyroid drug regime is preferred? _____
Answer: Titration-block regime
Flashcard 114: What investigations are used to screen for hormonal abnormalities in patients with asymptomatic pituitary adenomas? • _____ • TFTs • 24-hour urine cortisol • IGF-1 • FSH/LH
Answer: Serum prolactin
Flashcard 115: _____ uses a single dose of iodine-131 which emits beta rays to induce DNA damage causing death of thyroid tissue
Answer: Radioactive iodine ablation
Flashcard 116: _____ pituitary adenomas present with acromegaly (in adults) or gigantism (in childhood)
Answer: Somatotroph
Flashcard 117: _____ pituitary adenomas present with galactorrhea and amenorrhea in women
Answer: lactotroph (prolactinoma)
Flashcard 118: What investigations can be used to confirm acromegaly/gigantism? _____, Oral glucose tolerance test (OGTT)
Answer: Serum IGF-1
Flashcard 119: What investigation can be used to confirm _____gonadism? GnRH stimulation test
Answer: hypo
Flashcard 120: _____ is the first-line dopamine agonist used to treat symptomatic prolactinomas
Answer: cabergolin
Flashcard 121: _____ pituitary adenomas present with reduced libido and infertility/erectile dysfunction in men
Answer: lactotroph (prolactinoma)
Flashcard 122: _____ is used in the management of thyroid storms to treat hyperadrenergic symptoms
Answer: Propanolol
Flashcard 123: _____ is the most common pituitary adenoma
Answer: Prolactinoma
Flashcard 124: Functional Pituitary adenomas result in _____pituitarism
Answer: hyper
Flashcard 125: _____ may be used to induce remission in patients with Grave's disease. This typically takes 12-18 months
Answer: Anti-thyroid drugs
Flashcard 126: What is the first line symptomatic management of hyperthyroidism? _____
Answer: Propanolol
Flashcard 127: What is the remission rate of Grave's disease following 12-18 months of anti-thyroid drug regimes? _____
Answer: ~50%
Flashcard 128: _____ are benign tumours of the anterior pituitary gland
Answer: Pituitary adenomas
Flashcard 129: What is the first-line management of toxic multinodular goitre/toxic adenoma while awaiting definitive treatment? _____
Answer: Titration-block regime (or block and replace regime)
Flashcard 130: A 22-year old female asthmatic patient with symptomatic hyperthyroidism presents to GP requesting medication to control her symptoms. What should you give her? _____
Answer: CCBs (e.g. verapamil or diltiazem)
Flashcard 131: _____ is used in the management of thyroid storms to inhibit peripheral conversion of T4→T3
Answer: hydrocortisone
Flashcard 132: _____ is used in the management of thyroid storms to inhibit thyroid hormone release
Answer: Lugol's solution (potassium iodide)
Flashcard 133: What investigation can be used to confirm hyper/hypothyroidism? _____
Answer: TFTs (including TSH, T4 & T3)
Flashcard 134: Pituitary adenomas can be categorised based on their size: ≤_____ mm = Microadenoma >10 mm = Macroadenoma
Answer: 10
Flashcard 135: Radioative iodine ablation is contraindicated in _____ women
Answer: pregnant/breastfeeding
Flashcard 136: Lugol's solution should be given _____ after propylthiouracil in the management of a thyroid storm
Answer: 1 hour
Flashcard 137: Headaches associated with pituitary adenomas are usually worse _____
Answer: on waking
Flashcard 138: _____ is the first-line management for all symptomatic pituitary adenomas except for prolactinomas
Answer: Trans-sphenoidal hypophysectomy
Flashcard 139: A patient with a pituitary adenoma experiences sudden-onset hypopituitarism. What complication is likely to have occured? _____
Answer: Pituitary apoplexy
Flashcard 140: _____ may be contraindicated in Grave's disease if the patient has thyroid eye disease
Answer: Radioative iodine ablation
Flashcard 141: What is the management of a thyroid storm? • _____ - Hyperadrenergic symptom control • Propylthiouracil (orally) - Inhibition of thyroid hormone synthesis • Lugol's solution 1 hour after propulthiouracil (potassium iodide) - Inhibits thyroid hormone release • Hydrocortisone - Inhibits peripheral conversion of T4 → T3 • +supportive therapy e.g. oxygen, IV fluids, paracetamol (fever)
Answer: Propanolol
Flashcard 142: Radioative iodine ablation typically involves _____ dose(s) of iodine-131
Answer: 1
Flashcard 143: Functional pituitary adenomas produce the hormone of the cell type from which they arise: _____: Prolactin Somatotroph adenoma: Growth hormone Corticotroph adenoma: ACTH Thyrotroph adenoma: TSH Gonadotroph adenoma: LH/FSH
Answer: Lactotroph adenoma (prolactinoma)
Flashcard 144: _____ Microadenomas of the pituitary are usually asymptomatic
Answer: Non-functional
Flashcard 145: _____ is used in the management of thyroid storms to inhibit thyroid hormone synthesis
Answer: Propylthiouracil
Flashcard 146: 2nd-line management of prolactinomas following failure of dopamine agonists (e.g. cabergolin, bromocriptine) is _____
Answer: trans-sphenoidal hypophysectomy
Flashcard 147: _____ pituitary adenomas present with symptoms of mass effect
Answer: Non-functional
Flashcard 148: _____ is a treatment regime used for chronic hyperthyroidism that involves titrating anti-thyroid drugs to the lowest possible dose while maintaining euthyroidism. This is done by regularly measuring free T4
Answer: Titration-block
Flashcard 149: What is the first-line definitive management of Toxic multinodular goitre/Toxic adenoma? _____
Answer: Radioactive iodine abalation
Flashcard 150: Pituitary adenomas can be _____ or non-functional (non-secretory)
Answer: functional (secretory)
Flashcard 151: Thyroid storm presents with _____thermia, tachycardia and hypertension
Answer: hyper
Flashcard 152: What is the gold-standard imaging investigation for pituitary adenomas? _____
Answer: MRI sella with IV contrast
Flashcard 153: Anti-thyroid drugs are typically only used in conditions causing _____ hyperthyroidism
Answer: chronic
Flashcard 154: _____, macroadenomas of the pituitary result in hypopituitarism due to destruction/compression of surrounding pituitary tissue
Answer: Non-functional
Flashcard 155: Patients with pituitary adenomas that are incompletely resected or remain hypersecretory after surgery may require _____
Answer: radiotherapy
Flashcard 156: Hyperprolactinaemia can cause _____gonadotropic hypogonadism
Answer: hypo
Flashcard 157: _____ tumors may invade the cavernous sinus, leading to opthalmoplegia (presents with double vision/squint)
Answer: Pituitary
Flashcard 158: What is the first-line definitive management of Grave's disease? _____
Answer: Anti-thyroid drug therapy
Flashcard 159: What investigation is used to confirm hyper/hypoprolactinaemia? _____
Answer: Serum prolactin
Flashcard 160: What is the most common complication of radioative iodine ablation? _____
Answer: Hypothyroidism → requires life long thyroid hormone replacement
Flashcard 161: Thyroid storm TFTs: • TSH: _____ • T3/T4: ↑
Answer: ↓
Flashcard 162: Pituitary adenomas may present with symptoms of mass effect such as _____, headache and diplopia
Answer: bitemporal hemianopia
Flashcard 163: What is the second-line definitive management of Toxic multinodular goitre/Toxic adenoma? _____
Answer: Thyroidectomy (total in TMG/lobectomy in toxic adenoma))
Flashcard 164: _____ is a treatment regime used for chronic hyperthyroidism that involves using anti-thyroid drugs to block thyroid hormone synthesis and replacing them with levothyroixine
Answer: Block and replace
Flashcard 165: _____ may be used to investigate for bitemporal hemianopia in patients with pituitary tumours
Answer: Formal visual field testing (e.g. perimetry)
Flashcard 166: What investigations can be used to confirm hypercortisolism? _____, 24-hour urinary free cortisol, late-night salivary cortisol
Answer: Low-dose dexamethasone suppression test
Flashcard 167: _____ is a life-threatening complication of thyrotoxicosis characterised by fever, tachycardia, N&V and altered mental state
Answer: Thyroid storm
Flashcard 168: Diagnosis of thyroid storm is based on _____
Answer: clinical features
Flashcard 169: _____ pituitary adenomas cause secondary hyperthyroidism
Answer: Thyrotroph
Flashcard 170: _____ are the first-line management of symptomatic prolactinomas of the pituitary gland
Answer: Dopamine agonists (e.g. cabergolin, bromocriptine)
Flashcard 171: Auscultation of the thyroid in Grave's disease may reveal a _____
Answer: bruit
Flashcard 172: Grave's disease typically occurs in _____ people
Answer: younger
Flashcard 173: Radioactive iodine uptake is _____ in Graves disease
Answer: increased
Flashcard 174: Radioactive iodine uptake is _____ in toxic adenomas
Answer: normal/mildly raised
Flashcard 175: _____thyroidism causes upregulation/sensitisation of beta-adrenergic receptors leading to activation of the sympathetic nervous system
Answer: Hyper
Flashcard 176: What is the first-line investigation for hyperthyroidism? _____
Answer: TFTs (TSH → FT4 (if TSH is abnormal) → FT3 (if FT4 does not explain abnormal TSH))
Flashcard 177: Palpitations/Atrial fibrillation are associated with _____thyroidism
Answer: Hyper
Flashcard 178: Iodine-induced hyperthyroidism may be induced by iodine excess from where? _____, contrast, amiodarone
Answer: diet
Flashcard 179: Toxic adenomas cause _____thyroidism
Answer: hyper
Flashcard 180: _____ are benign, hyperfunctional nodules of follicular cells in the thyroid
Answer: Toxic adenomas
Flashcard 181: What are the _____ causes of thyroid nodules? • Multinodular goitre • Thyroid adenoma • Hashimoto's thyroiditis • Cysts
Answer: benign
Flashcard 182: What auto-antibody is associated with postpartum thyroiditis? _____
Answer: Anti-TPO antibodies
Flashcard 183: _____ is usually not the first-line anti-thyroid drug due to a small risk of severe liver injury
Answer: Propylthiouracil
Flashcard 184: A singular hot nodule upon thyroid scintigraphy is characteristic of _____
Answer: toxic adenoma
Flashcard 185: The goitre associated with toxic multinodular goitre is _____
Answer: multinodular
Flashcard 186: _____thyroidism can cause menstrual irregularities in women due to raised levels of SHBG (sex hormone-binding globulin)
Answer: Hyper
Flashcard 187: Tachycardia is associated with _____thyroidism
Answer: Hyper
Flashcard 188: TSH is _____ during the thyrotoxic phase of de Quervain's thyroiditis
Answer: ↓
Flashcard 189: _____ is a condition characterised by overproduction of thyroid hormones from the thyroid gland
Answer: Hyperthyroidism
Flashcard 190: In order to diagnose subclinical hyperthyroidism, perform repeat _____ 3 months after the initial result
Answer: TFTs
Flashcard 191: _____ is a common cause of hyperthyroidism in iodine deficient countries
Answer: Toxic multinodular goitre
Flashcard 192: What additional medication is used in the management of severe thyrotoxicosis as a result of thyroid hormone overdose? _____
Answer: Oral Colestyramine
Flashcard 193: The goitre associated with Grave's disease is _____
Answer: smooth
Flashcard 194: _____thyroidism can cause ophthalmological features such as lid lag due to spasming of levator palpebrae superioris smooth muscle caused by increased sympathetic nervous system activity
Answer: Hyper
Flashcard 195: Thyroid scintigraphy of subacute lymphocytic thyroiditis will show _____ uptake of iodine
Answer: reduced
Flashcard 196: Untreated hyperthyroidism can cause what cardiac arrhythmia? _____
Answer: Atrial fibrillation
Flashcard 197: _____thyroidism can cause symptoms of sexual dysfunction, gynaecomastia and low libido in men due to raised levels of SHBG (sex hormone-binding globulin)
Answer: Hyper
Flashcard 198: _____tension with a wide pulse pressure is associated with hyperthyroidism
Answer: Hyper
Flashcard 199: What is the likely diagnosis of a solitary hot nodule found on thyroid scintigraphy? _____
Answer: Toxic adenoma
Flashcard 200: Which antibodies are associated with toxic multinodular goitre? _____
Answer: None
Flashcard 201: A patient has noticed a long-standing thyroid nodule that moves superiorly whenever they stick out their tongue. What is the most likely diagnosis? _____
Answer: Thyroglossal cyst
Flashcard 202: de Quervain's thyroiditis is associated with _____ antibodies
Answer: Anti-TPO
Flashcard 203: Thyroid nodules are more common in _____
Answer: women
Flashcard 204: What is the management of non-severe thyrotoxicosis as a result of thyroid hormone overdose? _____
Answer: Gradually taper thyroid hormone to normal dose
Flashcard 205: Myopathy of the _____ muscles may occur in patients with hyper/hypothyroidism
Answer: proximal
Flashcard 206: Patients with _____ may experience hyperthyroidism following iodine excess (e.g. diet, contrast, amiodarone)
Answer: iodine deficiency hypothyroidism
Flashcard 207: If an ultrasound of a thyroid nodule shows features suspicious of malignancy, the next investigation is _____
Answer: fine-needle aspiration
Flashcard 208: Patients with thyroid nodules may have a _____ to determine the functional status of the nodule
Answer: thyroid scintigraphy
Flashcard 209: What are the _____ causes of thyroid nodules? • Thyroid carcinoma • Lymphoma
Answer: Malignant
Flashcard 210: Which auto-antibody is associated with Grave's disease _____
Answer: TRAbs (TSH receptor antibodies)
Flashcard 211: Radioactive iodine uptake is _____ in exogenous hyperthyroidism
Answer: reduced
Flashcard 212: The initial investigation for thyroid nodules in GP is _____
Answer: TFTs
Flashcard 213: The majority of thyroid nodules are _____
Answer: benign
Flashcard 214: _____ adenoma is the most common type of thyroid adenoma
Answer: Follicular
Flashcard 215: The management of follicular adenoma of the thyroid is _____
Answer: surgical excision
Flashcard 216: What common complication of Grave's disease affects the eye(s)? _____
Answer: Thyroid disease of the eye
Flashcard 217: _____ intolerance is a feature of hyperthyroidism caused by increased metabolism
Answer: Heat
Flashcard 218: _____ tremor is associated with hyperthyroidism
Answer: Fine
Flashcard 219: Hyperreflexia is associated with _____thyroidism
Answer: hyper
Flashcard 220: Which investigations for assessment of hyperthyroidism are contraindicated in _____? Thyroid scintigraphy & Radioactive iodine uptake
Answer: pregnant/breastfeeding women
Flashcard 221: An adult with longstanding, unchanging thyroid nodule(s)/mass may be monitored in _____
Answer: primary care
Flashcard 222: Insomnia is associated with _____thyroidism
Answer: hyper
Flashcard 223: Patients with uncertain etiology of hyperthyroidism may have a _____ performed
Answer: thyroid scintigraphy
Flashcard 224: _____ hyperthyroidism: • TSH: ↓ • T4/T3: ↔
Answer: Subclinical
Flashcard 225: Weight loss is associated with _____thyroidism
Answer: hyper
Flashcard 226: In order to diagnose subclinical hypothyroidism, perform repeat _____ 3 months after the initial result
Answer: TFTs
Flashcard 227: The risk of thyroid nodules being malignant in children/adolescents is _____
Answer: higher
Flashcard 228: Patients with thyroid nodule(s) who have any of the following should recieve what type of referral? • Change in voice (e.g. hoarseness) • Cervical/supraclavicular lymphadenopathy • Sudden onset/rapidly growing painless nodule • Compressive symptoms (e.g. breathlessness or dysphagia) • They are a child _____
Answer: Suspected cancer pathway referral to a thyroid surgeon or endocrinologist
Flashcard 229: _____ is an autoimmune condition characterised by hyperthyroidism induced by autoantibodies to TSH receptors (TRAbs)
Answer: Grave's disease
Flashcard 230: Toxic multinodular goitre typically occurs in _____ people
Answer: older
Flashcard 231: Thyroid scintigraphy of toxic multinodular goitre will show _____ of iodine uptake
Answer: multiple focal areas
Flashcard 232: TSH is _____ during the hypothyroid phase of de Quervain's thyroiditis
Answer: ↑
Flashcard 233: What is the likely diagnosis of multiple hot nodules found on thyroid scintigraphy? _____
Answer: Toxic multinodular goitre
Flashcard 234: Histological examination of toxic multinodular goitre will show patches of enlarged _____ cells
Answer: follicular
Flashcard 235: _____ hyperthyroidism: • TSH: ↓ • T4/T3: ↑
Answer: Overt
Flashcard 236: _____ is the most common cause of malignant thyroid nodules
Answer: Papillary carcinoma
Flashcard 237: Patients with thyroid nodule(s) should have emergency hospital admission if they experience symptoms of _____
Answer: upper airway obstruction (e.g. stridor)
Flashcard 238: Which antibody is most commonly associated with subacute lymphocytic thyroiditis? _____
Answer: Anti-TPO
Flashcard 239: Hyperthyroidism is more common in _____
Answer: females
Flashcard 240: What is the alternative investigation for assessment of hyperthyroidism in pregnant women instead of thyroid scintigraphy & radioactive iodine uptake measurement? _____
Answer: Doppler ultrasound
Flashcard 241: Anxiety is associated with _____thyroidism
Answer: hyper
Flashcard 242: What is the first-line investigation in secondary care for thyroid nodule(s)? _____
Answer: Ultrasound
Flashcard 243: _____thyroidism can cause nail features such as onycholysis and clubbing
Answer: Hyper
Flashcard 244: _____ is the most common cause of hyperthyroidism in iodine sufficient countries
Answer: Graves disease
Flashcard 245: _____ is a condition characterised by chronic hyperthyroidism and multinodular goitre which can be caused by chronic idodine deficiency or radiation to the neck
Answer: Toxic multinodular goitre
Flashcard 246: The management of toxic multinodular goitre is _____ or surgery (total thyroidectomy)
Answer: radioiodine
Flashcard 247: The management of toxic adenoma is _____ or surgery (lobectomy)
Answer: radioiodine
Flashcard 248: What are the thyroid cancer red flags for thyroid nodules? • _____ • Young or elderly (<20, >70) • History of radiation to the neck • Family history of MEN2 or thyroid cancer
Answer: Male
Flashcard 249: _____ is a rare dermatological feature of Grave's disease characterised by non-pitting oedema of the shin as a result of fibroblast stimulation
Answer: Pre-tibial myxoedema
Flashcard 250: _____ is an anti-thyroid drug that is contraindicated during Pre-conception & First trimester of pregnancy therefore patients must be taking effective contraception
Answer: Carbimazole
Flashcard 251: Thyroid scintigraphy: _____ nodules are more likely to be malignant → FNA reccomended Hot (hyperfunctioning) nodules are more likely to be benign → FNA NOT reccomended
Answer: Cold (hopofunctioning)
Flashcard 252: What baseline investigations should be performed prior to starting antithyroid drugs? _____ & FBC
Answer: LFTs
Flashcard 253: Postpartum thyroiditis is histologically characterised by infiltration of _____
Answer: lymphocytes
Flashcard 254: The most important modifiable risk factor for thyroid eye disease is _____
Answer: smoking
Flashcard 255: Thyroid eye disease typically begins with an _____ phase lasting <2 years, followed by and chronic fibrotic phase where symptoms stabilise. The condition slowly improves over the next few years
Answer: inflammatory
Flashcard 256: _____ is the most common complication of thyroid eye disease
Answer: Exposure keratopathy
Flashcard 257: Lithium-induced hypothyroidism is treated with _____
Answer: levothyroxine
Flashcard 258: Postpartum thyroiditis classically presents with _____thyroidism followed by hypothyroidism before returning to euthyroidism
Answer: hyper
Flashcard 259: Postpartum thyroiditis presents with a _____ goitre
Answer: non-tender
Flashcard 260: _____ hypothyroidism is characterised by inappropriately low/normal TSH levels and low T4
Answer: Secondary
Flashcard 261: What is the most common outcome of postpartum thyroiditis? _____
Answer: Full recovery over several months
Flashcard 262: _____thyroidism is associated with hyperlipidaemia
Answer: Hypo
Flashcard 263: _____ is a life-threatening complication of hypothyroidism
Answer: Myxoedema coma
Flashcard 264: What is the management of derranged TFTs in a female with hypothyroidism who is trying to get pregnant? _____
Answer: Delay conception until stabilised on levothyroxine
Flashcard 265: Myxoedema coma presents with _____thermia
Answer: hypo
Flashcard 266: Hypothyroidism is managed with _____ - a synthetic form of T4
Answer: levothyroxine
Flashcard 267: Constipation is associated with _____thyroidism
Answer: hypo
Flashcard 268: Hypothyroidism may be caused by _____ used to treat hyperthyroidism
Answer: radioiodine
Flashcard 269: What is the management of thyroid eye disease while awaiting review by an ophthalmologist? _____, artificial tears, eye protection (e.g. sunglasses) and head elevation while sleeping
Answer: Smoking cessation
Flashcard 270: Lethargy is associated with _____thyroidism
Answer: hypo
Flashcard 271: What type(s) of anaemia can be caused by hypothyroidism? _____
Answer: Microcytic, normocytic, macrocytic
Flashcard 272: Is thyroid eye disease symmetrical? _____
Answer: Often asymmetrical (unilateral in most patients)
Flashcard 273: _____ primary hypothyroidism is characterised by high TSH levels and low T4 levels
Answer: Overt
Flashcard 274: _____ is an autoimmune condition characterised by slow-growing rock-hard goitre
Answer: Riedel's thyroiditis
Flashcard 275: _____ is an autoimmune disease that causes expansion of extraocular muscles and orbital fat
Answer: Thyroid eye disease
Flashcard 276: How should the dose of levothyroxine be altered in women who become pregnant? _____
Answer: Increase the dose
Flashcard 277: Thyroid eye disease typically presents when patients are _____thyroid
Answer: hypo/eu/hyper
Flashcard 278: _____ hypothyroidism is caused by dysfunction of the hypothalamus resulting in low levels of TRH
Answer: Tertiary
Flashcard 279: When first starting levothyroxine, _____ should be monitored every 3 months. Once stable, the TSH level should be checked every year
Answer: TFTs
Flashcard 280: Liothyronine can be prescribed by who? _____
Answer: Consultants ONLY
Flashcard 281: Which treatment for graves disease is known to worsen thyroid eye disease? _____
Answer: Radioactive iodine ablation
Flashcard 282: The pathogenesis of thyroid eye disease is thought to involve autoimmunity against _____ receptors, primarily mediated by T Lymphocytes
Answer: TSH
Flashcard 283: A patient with longstanding hypothyroidism presents with acute confusion, hypothermia and cardiovascular collapse. What is the most likely diagnosis? _____
Answer: Myxoedema coma
Flashcard 284: Hair loss is associated with _____thyroidism
Answer: hypo
Flashcard 285: What is the initial screening test for hypothyroidism? _____
Answer: Serum TSH
Flashcard 286: _____ can cause hypothyroidism
Answer: Lithium
Flashcard 287: Bradycardia is associated with _____thyroidism
Answer: hypo
Flashcard 288: Postpartum thyroiditis is associated with what antibody? _____
Answer: Anti-TPO
Flashcard 289: What is the confirmatory test for primary hypothyroidism following an abnormal TSH? _____
Answer: Free T4
Flashcard 290: 25-40% of people with _____ disease experience thyroid eye disease
Answer: Graves
Flashcard 291: The thyrotoxic stage of postpartum thyroiditis is symptomatically managed with _____
Answer: propanolol
Flashcard 292: _____ supplements can reduce the absorption of levothyroxine and so they should be given 4 hours apart
Answer: Iron
Flashcard 293: _____ is the inactive pro-hormone produced by the thyroid gland. It is converted into the active hormone T3 in the periphery
Answer: T4
Flashcard 294: Dry skin is associated with _____thyroidism
Answer: hypo
Flashcard 295: Weight gain is associated with _____thyroidism
Answer: hypo
Flashcard 296: The hypothyroid stage of postpartum thyroiditis is managed with _____
Answer: levothyroxine
Flashcard 297: Worsening of thyroid eye disease from radioiodine can be reduced with _____
Answer: corticosteroids
Flashcard 298: What is the management of hypothyroidism in women who are pregnant, planning a pregnancy, treated with T4 during pregnancy or diagnosed with postpartum thyroiditis? _____
Answer: Referral to endocrinology
Flashcard 299: AF and worsening of angina are complications of which thyroid medication? _____
Answer: Levothyroxine
Flashcard 300: Aside from the typical investigations for graves disease (e.g. TFTs, antibody testing), what additional investigation may be indicated for thyroid eye disease? _____
Answer: CT/MRI of the orbit
Flashcard 301: _____ is indicated in patients with thyroid eye disease and vision-threatening complications such as optic nerve compression, globe subluxation, corneal exposure (exposure keratopathy)
Answer: Urgent admission to ophthalmology
Flashcard 302: A patient with longstanding hypothyroidism presents with acute confusion, hypothermia and cardiovascular collapse. You suspect a myxoedema coma. What is the mainstay of management? _____
Answer: IV levothyroxine & IV liothyronine
Flashcard 303: Hoarse voice is associated with _____thyroidism
Answer: hypo
Flashcard 304: Thyroid eye disease may cause compression of the _____ which can lead to vision loss without prompt treatment
Answer: optic nerve
Flashcard 305: Thyroid eye disease may cause the eye to 'pop out' for a few seconds. This is called _____
Answer: globe subluxation
Flashcard 306: Riedel's thyroiditis is characterised by replacement of normal thyroid tissue with _____ tissue
Answer: fibrotic
Flashcard 307: Hypothyroidism can cause oedema of the face, hands & feet, this is called _____
Answer: myxoedema
Flashcard 308: Nearly all of thyroid eye disease is associated with _____ disease
Answer: Graves
Flashcard 309: In severe cases of thyroid eye disease, _____ may be required in order to relieve pressure in the orbit
Answer: surgery
Flashcard 310: Patients with hypothyroidism who have cardiac disease, severe hypothyroidism or >50 y/o starting levothyroxine should have a starting dose of _____
Answer: 25mcg OD
Flashcard 311: A patient with known thyroid eye disease presents with blurred vision, field defect and a relative afferent pupillary defect. What is the most likely diagnosis? _____
Answer: Optic neuropathy due to compression/stretching of the optic nerve
Flashcard 312: _____ hypothyroidism is caused by dysfunction of the pituitary resulting in low levels of TSH
Answer: Secondary
Flashcard 313: Exophthalmos, diplopia and inability to close eyelids completely in a patient who smokes and has Grave's disease is suggestive of _____
Answer: thyroid eye disease [Credit: Jonathan Trobe, MD]
Flashcard 314: Cold intolerance is associated with _____thyroidism
Answer: hypo
Flashcard 315: _____ is caused by eyelid retraction/proptosis which results in dryness and irritation of the eye leading to corneal ulceration
Answer: Exposure keratopathy
Flashcard 316: A patient with known thyroid eye disease presents with blurred vision, field defect and a relative afferent pupillary defect. You diagnose acute optic neuropathy. What is the next step in management? _____
Answer: Emergency admission to ophthalmology
Flashcard 317: Hypothyroidism can cause _____ due to compensatory release of TRH from the hypothalamus
Answer: hyperprolactinaemia
Flashcard 318: Decreased tendon reflexes are associated with _____thyroidism
Answer: hypo
Flashcard 319: All patients with stable thyroid eye disease should have a _____ referral to a specialist thyroid eye clinic
Answer: routine
Flashcard 320: Thyroid _____ testing should be considered in patients with suspected autoimmune thyroiditis
Answer: antibody
Flashcard 321: Suspected _____ hypothyroidism should be urgently referred to an endocrinologist
Answer: secondary
Flashcard 322: _____ is a synthetic form of T3
Answer: Liothyronine
Flashcard 323: _____ primary hypothyroidism is characterised by high TSH levels and normal T4 & T3 levels
Answer: Subclinical
Flashcard 324: _____ is the most common cause of hypothyroidism in developed countries
Answer: Hashimoto's (autoimmune) thyroiditis
Flashcard 325: Rickets can be _____ or hypophosphatemic depending on which mineral is deficient
Answer: hypocalcaemic
Flashcard 326: _____ is the first-line managment for primary hyperparathyroidism in patients who meet one or more of the following criteria: symptomatic disease, <50 years of age, serum adjusted calcium >2.85 mmol/L, eGFR <60
Answer: Parathyroidectomy
Flashcard 327: PTH is secreted by chief cells in response to _____ detected by cells in the parathyroid gland
Answer: hypocalcaemia
Flashcard 328: X-ray of bones in patients with _____ may show characteristic looser zones (pseudofractures)
Answer: rickets/osteomalacia
Flashcard 329: Hypophosphatemic rickets is generally due to abnormal loss of phosphate from the _____
Answer: kidneys
Flashcard 330: _____ should be considered in any patient with hypercalcaemia
Answer: Malignancy
Flashcard 331: Following diagnosis of primary hyperparathyroidism, a differential diagnosis of _____ should be excluded
Answer: familial hypocalciuric hypercalcaemia
Flashcard 332: Thyroid pain associated with subacute granulomatous thyroiditis (De Quervain's) may improve with _____ or other NSAIDs
Answer: aspirin
Flashcard 333: _____ is a condition that occurs in all ages and is caused by insufficient calcium and/or phosphate usually due to a deficiency of vitamin D
Answer: Osteomalacia
Flashcard 334: Osteomalacia/rickets is managed with vitamin D supplementation in addition to _____ supplementation if dietary intake is inadequate
Answer: calcium
Flashcard 335: In patients with primary hyperparathyroidism where a parathyroidectomy is not feasible/unsuccessful, patients may be offered _____
Answer: cinacalcet
Flashcard 336: Osteomalacia/rickets is managed with _____
Answer: vitamin D supplementation
Flashcard 337: _____ is associated with Anti-TPO & Anti-Tg
Answer: Hashimoto's thyroiditis
Flashcard 338: Vitamin D-dependent rickets type _____ is an autosomal recessive condition characterised by a mutation preventing the conversion of calcidiol into calcitriol
Answer: 1
Flashcard 339: The most common inherited cause of hyperparathyroidism is _____
Answer: multiple endocrine neoplasia (MEN)
Flashcard 340: PTH induces _____ expression in osteoBlasts which binds to and activates osteoClasts
Answer: RANKL
Flashcard 341: _____ and serum PTH can be used to diagnose primary hyperparathyroidism
Answer: Albumin-adjusted serum calcium (corrected calcium)
Flashcard 342: Hypercalcaemia increases the risk of _____ due to polyuria and reduced oral intake
Answer: dehydration
Flashcard 343: Rickets can present with deformities of the knees, especially _____
Answer: genu varum
Flashcard 344: Most patients with primary hyperparathyroidism are _____
Answer: asymptomatic
Flashcard 345: The goitre associated with Hashimoto's thyroiditis is _____
Answer: painless
Flashcard 346: Hypothyroidism more commonly affects _____
Answer: women
Flashcard 347: Subacute granulomatous thyroiditis (De Quervain's) is a self-limiting disease that often occurs following _____
Answer: viral infection
Flashcard 348: Hyperparathyroidism causes _____
Answer: hypercalcaemia
Flashcard 349: _____ is characterised by inappropriate secretion of PTH from cells in the parathyroid gland irrespective of serum calcium concentration
Answer: Primary hyperparathyroidism
Flashcard 350: Hashimoto's thyroiditis initially presents with transient _____thyroidism followed by hypothyroidism
Answer: hyper
Flashcard 351: _____ is a self-limiting variant of subacute lymphocytic thyroiditis occuring up to 1 year following child birth
Answer: Postpartum thyroiditis
Flashcard 352: What class of drugs most commonly causes osteomalacia? _____
Answer: Anticonvulsants
Flashcard 353: Vitamin D-dependent rickets type _____ is an autosomal recessive condition characterised by a mutation causing end organ resistance to vitamin D
Answer: 2
Flashcard 354: PTH increases _____ excretion and calcium reabsorption from the kidney resulting in more ionized calcium in the blood
Answer: phosphate
Flashcard 355: Osteomalacia and Rickets are characterised by: _____ calcium ↓ phosphate ↑ PTH ↑ ALP
Answer: ↓
Flashcard 356: Subacute granulomatous thyroiditis (De Quervain's) presents initially with _____thyroidism followed by hypothyroidism before full recovery
Answer: hyper
Flashcard 357: Subacute granulomatous thyroiditis (De Quervain's) is associated with multinucleated giant cells and _____ formation on histological examination
Answer: granuloma
Flashcard 358: Following diagnosis of hyperparathyroidism, patients should have further investigations to screen for complications such as _____, DXA scan (lumbar spine, distal radius, hip), USS of the renal tract
Answer: eGFR
Flashcard 359: Hashimoto's thyroiditis presents with a _____ goitre
Answer: diffuse, firm, non-tender
Flashcard 360: Bowing of the long bones, craniotabes (soft skull), delayed growth and frontal bossing in young patients with _____ deficiency is likely to be rickets
Answer: vitamin D
Flashcard 361: _____ is the most common cause of hypothyroidism worldwide
Answer: Iodine deficiency
Flashcard 362: Hyperparathyroidism is more common in _____
Answer: females
Flashcard 363: Following diagnosis of hyperparathyroidism, patients may require _____ dietary supplements
Answer: vitamin D
Flashcard 364: Subacute granulomatous thyroiditis (De Quervain's) is associated with a _____ goitre
Answer: very-tender
Flashcard 365: Iodine uptake is _____ in subacute granulomatous thyroiditis (De Quervain's)
Answer: reduced
Flashcard 366: Bone pain, muscular/bone tenderness, pathological fractures and waddling gait in adults with _____ deficiency is likely to be osteomalacia
Answer: vitamin D
Flashcard 367: What is the most common final outcome in patients with subacute granulomatous thyroiditis (De Quervain's)? _____
Answer: Full recovery
Flashcard 368: Rickets can only occur in children if the _____ are still open
Answer: growth plates
Flashcard 369: Histological exam of Hashimoto's thyroiditis will show well developed _____ and Hurthle cells
Answer: germinal centres
Flashcard 370: What is the mnemonic for remembering the symptoms of _____? Stones, Bones, Abdominal groans, Thrones, and Psychiatric overtones
Answer: hypercalcaemia
Flashcard 371: Rickets can present with _____ at the costochondral junction
Answer: rachitic rosary
Flashcard 372: Osteomalacia/Rickets can be caused by direct inhibition of _____ due to chronic use of bisphosphonates
Answer: bone mineralisation
Flashcard 373: Rickets can present with pathology of the skull including: _____ and frontal bossing
Answer: craniotabes (soft skull)
Flashcard 374: The most common cause of osteomalacia/rickets is _____
Answer: vitamin D deficiency
Flashcard 375: _____ is the most common cause of hyperparathyroidism
Answer: Parathyroid adenoma
Flashcard 376: Rickets is caused by decreased mineralization of _____ at epiphyseal growth plates
Answer: hyaline cartilage (type 2)
Flashcard 377: Rickets can present with pectus _____
Answer: carinatum
Flashcard 378: _____ is a condition that occurs in children with open growth plates and is caused by insufficient calcium and/or phosphate usually due to a deficiency of vitamin D
Answer: Rickets
Flashcard 379: _____ is an autoimmune condition associated with HLA-DR3 that causes hypothyroidism
Answer: Hashimoto's thyroiditis
Flashcard 380: Loss of libido and body hair in Addison's disease are features of _____
Answer: hypoandrogenism
Flashcard 381: IV/IM Hydrocortisone given for addisonian crisis may be switched to oral replacement after _____ hours (AND haemodynamically stable)
Answer: 24
Flashcard 382: How are the following affected in addisonian crises? Serum Na+: _____ Serum K+: high Serum glucose: low
Answer: low
Flashcard 383: Stress in patients with adrenal insufficiency can cause _____
Answer: addisonian crises
Flashcard 384: _____ is characterised by insufficient production of glucocorticoids (e.g. cortisol) and mineralocorticoids (e.g. aldosterone)
Answer: Addison's disease
Flashcard 385: What complication of bacterial septicemia can cause addisonian crises? _____
Answer: Waterhouse-Friderichsen syndrome
Flashcard 386: What is the 1st line investigation for suspected adrenal insufficiency in primary care? _____
Answer: 9am serum cortisol
Flashcard 387: The most common infectious cause of Addison's disease is _____
Answer: Tuberculosis
Flashcard 388: Addison's disease causes a _____ due to deficiency of aldosterone resulting in reduced excretion of H+ in the urine
Answer: metabolic acidosis (normal anion gap)
Flashcard 389: Sick day rules for Addison's disease are: _____
Answer: double glucocorticoid dose, keep mineralocorticoid dose the same
Flashcard 390: Hydrocortisone should be given _____ hourly until the patient is stable in Addisonian crisis
Answer: 6
Flashcard 391: Critically ill patients (e.g. sepsis) who do not respond to measures to treat hypotension may be experiencing _____ insufficiency
Answer: adrenal
Flashcard 392: _____cortisone is not required in the management of addisonian crisis because hydrocortisone exerts weak mineralocorticoid action
Answer: Fludro
Flashcard 393: Cortisol raises serum glucose by stimulating _____
Answer: gluconeogenesis
Flashcard 394: Addison's disease _____ rules should be implemented during periods of physical stress such as surgery, trauma, acute illness
Answer: sick day
Flashcard 395: _____ is an ACTH analogue that stimulates the adrenal glands to secrete cortisol
Answer: Synacthen
Flashcard 396: Hyperpigmentation in Addison's disease occurs particularly on the _____
Answer: palmar creases
Flashcard 397: Sudden discontinuation of glucocorticoids can cause _____
Answer: addisonian crises
Flashcard 398: Chronic _____ is the most common cause of tertiary adrenal insufficiency
Answer: steroid therapy
Flashcard 399: Patient's with Addison's disease are at increased risk of other _____ diseases so consider screening
Answer: autoimmune
Flashcard 400: _____ is most commonly caused by autoimmune destruction of the adrenal cortex
Answer: Addison's disease
Flashcard 401: Diagnosis of addisonian crisis is based on _____
Answer: clinical suspicion
Flashcard 402: Hydrocortisone is a _____corticoid
Answer: gluco
Flashcard 403: Fludrocortisone is a _____corticoid
Answer: mineralo
Flashcard 404: Hypotension and salt craving in Addison's disease are features of _____
Answer: hypoaldosteronism
Flashcard 405: _____ may be help in female Addison's disease patients with reduced libido, low energy or low mood
Answer: DHEA
Flashcard 406: The most common congenital cause of Addison's disease is _____
Answer: congenital adrenal hyperplasia (CAH)
Flashcard 407: Lethargy, weakness, N&V and anorexia in Addison's disease are features of _____
Answer: hypocortisolism
Flashcard 408: _____ is a complication of bacterial septicemia characterised by haemorrhagic necrosis of the adrenal glands
Answer: Waterhouse-Friderichsen syndrome
Flashcard 409: Patients with Addison's disease should take their largest dose of _____ in the first half of the day
Answer: hydrocortisone
Flashcard 410: Patients with Addison's disease should wear a _____ and carry a steroid card at all times
Answer: medical alert bracelet
Flashcard 411: In adrenal insufficiency, serum Na+ is _____ and K+ is raised due to lack of aldosterone
Answer: low
Flashcard 412: What diagnostic test is used to confirm primary adrenal insufficiency (Addison's disease) in secondary care? _____
Answer: Short Synacthen test
Flashcard 413: _____ adrenal insufficiency is called Addison's disease
Answer: Primary
Flashcard 414: _____ adrenal insufficiency is caused by conditions that decrease ACTH production
Answer: Secondary
Flashcard 415: Adrenal insufficiency can be caused by long-term use of _____
Answer: corticosteroids
Flashcard 416: _____ replacement is not required in the management of secondary/tertiary adrenal insufficiency because aldosterone production is stimulated by renin
Answer: Mineralocorticoid
Flashcard 417: Management of Addison's disease is with daily glucocorticoid replacement with _____ and mineralocorticoid replacement with fludrocortisone
Answer: hydrocortisone
Flashcard 418: Patients with secondary/tertiary adrenal insufficiency _____ experience an increased in serum cortisol 30 minutes after being given 250ug Synacthen IM
Answer: will
Flashcard 419: What complication of adrenal insufficiency can cause hypotension, shock, severe abdominal pain and decreased consciousness? _____
Answer: Addisonian crisis
Flashcard 420: Hyperpigmentation in Addison's disease is a feature of _____
Answer: elevated ACTH
Flashcard 421: A diagnosis of _____ should be suspected in patients with adrenal insufficiency, hypoparathyroidism and thyroid disease
Answer: autoimmune polyglandular syndrome (1/2)
Flashcard 422: Sick day rules must be followed for Addison's disease in order to prevent _____
Answer: addisonian crisis
Flashcard 423: The management of addisonian crisis is with immediate _____ followed by 1L normal saline over 30-60 minutes
Answer: Hydrocortisone 100mg IM/IV
Flashcard 424: _____ adrenal insufficiency is caused by conditions that decrease CRH production
Answer: Tertiary
Flashcard 425: A patient has no increase of serum cortisol 30 minutes after being given Synacthen 250ug IM, what is the most likely diagnosis? _____
Answer: Primary adrenal insufficiency (Addison's disease)
Flashcard 426: _____ autonomic diabetic neuropathy may cause resting tachycardia, baroreceptor insensitivity, postural hypotension
Answer: Cardiac
Flashcard 427: A diabetic patient has an ACR >3.5 mg/mmol at their annual screening, what are the next investigatory steps? _____
Answer: Repeat ACR at the next 2 clinic visits (within 3-4 months)
Flashcard 428: _____ is an umbrella term for elevated serum levels of total cholesterol, LDL, triglycerides, or all of them combined
Answer: Hyperlipidaemia
Flashcard 429: What clinical finding is common on the skin of patients with familial hypercholesterolaemia? _____
Answer: Tendon xanthomata
Flashcard 430: Diabetic nephropathy may present with _____ due to increased albumin in the urine
Answer: frothy urine
Flashcard 431: Typical blood test results for pseudohypoparathyroidism: • Calcium: _____ • PTH: High
Answer: Low
Flashcard 432: Chronic _____ can cause extrapyramidal symptoms due to calcification of the basal ganglia
Answer: hypocalcaemia
Flashcard 433: Hypocalcaemia typically presents with symptoms of numbness and tingling around the _____ and the extremities
Answer: mouth
Flashcard 434: _____ hormone raises serum calcium by increasing calcium absorption in the small intestine, stimulating calcium release from bones and increasing calcium reabsorption in the kidneys
Answer: Parathyroid
Flashcard 435: Hypocalcaemia can have life-threatening complications of the airway as a result of _____
Answer: laryngospasm
Flashcard 436: All diabetic patients should be screened _____ a year for diabetic nephropathy by measuring their albumin:creatinine ratio (ACR). The sample should ideally be taken early in the morning
Answer: once
Flashcard 437: _____ is the largest cause of chronic kidney disease
Answer: Diabetes (type 1 particularly)
Flashcard 438: Management of hypoparathyroidism without severe hypocalcaemia is with _____ and vitamin D (e.g. calcitriol)
Answer: oral calcium
Flashcard 439: _____ is due to a PTH deficiency Pseudohypoparathyroidism is due to PTH resistance
Answer: Hypoparathyroidism
Flashcard 440: Target serum calcium levels in patients with hypoparathyroidism are _____-normal in order to avoid renal complications (e.g. hypercalciuria)
Answer: low
Flashcard 441: If the cause of hypoparathyroidism is autoimmune, there may also be deficiency of the _____ and adrenal glands
Answer: thyroid
Flashcard 442: Diabetic nephropathy management involves tight control of risk factors including control of _____, BP, dyslipidaemia as well as smoking cessation
Answer: glucose
Flashcard 443: Typical blood test results for hypoparathyroidism: • Calcium: _____ • Phosphate: High • PTH: Low/Inappropriately normal • ALP: Normal
Answer: Low
Flashcard 444: _____, a complication of autonomic diabetic neuropathy, may be managed with medications that promote gastric emptying
Answer: Gastroparesis
Flashcard 445: Diabetic nephropathy occurs _____, if renal disease occurs rapidly then consider an alternative diagnosis
Answer: gradually
Flashcard 446: Examination of a patient with _____ may show physical signs such as Chvostek's sign and Trousseau's sign
Answer: hypocalcaemia
Flashcard 447: The first-line investigation for hyperlipidaemia is a _____
Answer: fasted lipid profile
Flashcard 448: Diabetic patients should recieve a diabetic foot exam at least _____ a year to screen for diabetic neuropathy
Answer: once
Flashcard 449: Consider the use of _____ in all patients with type 1 diabetes for the prevention of CVD
Answer: statins
Flashcard 450: _____ autonomic diabetic neuropathy may cause N&V, dysphagia, diarrhoea
Answer: Gastrointestinal
Flashcard 451: Carpopedal spasm when taking a patients blood pressure is suggestive of what metabolic abnormality? _____
Answer: Hypocalcaemia (Trousseau's sign)
Flashcard 452: Diagnosis of hypoparathyroidism requires _____ in the presence of undetectable/inappropriately low levels of PTH. Hypomagnesaemia should also be excluded as a causes as it can cause impaired PTH secretion
Answer: hypocalcaemia
Flashcard 453: In addition to an ACEi, type 2 diabetic patients with nephropathy should also consider taking an _____
Answer: SGLTi (e.g. dapagliflozin)
Flashcard 454: _____ can be given for painful diabetic neuropathy in patients who wish to avoid oral treatment
Answer: Capsacin cream
Flashcard 455: _____ hyperlipidaemia is the most common polygenic dyslipidaemia.
Answer: Familial combined
Flashcard 456: _____ may have a congenital cause such as DiGeorge's syndrome due to abnormal development of the parathyroid glands
Answer: Hypoparathyroidism
Flashcard 457: Clinical diagnosis of _____ is based on the Simon Broome criteria
Answer: familial hypercholesterolaemia
Flashcard 458: Hypoparathyroidism that does not respond sufficiently to oral calcium and vitamin D (e.g. calcitriol) should be treated with _____
Answer: PTH replacement therapy
Flashcard 459: Chronic _____ can cause cataracts
Answer: hypocalcaemia
Flashcard 460: Consider referral to _____ for painful diabetic neuropathy for refractory pain that has a significant impact on daily living
Answer: pain clinic
Flashcard 461: _____ is a complication of chronic diabetes characterised by bone destruction as a result of peripheral neuropathy and changes in circulation
Answer: Charcot foot
Flashcard 462: Hypocalcaemia can have life-threatening complications such as cardiac arrhythmias due to _____
Answer: QT prolongation
Flashcard 463: The 2nd most common cause of hypoparathyroidism is _____ conditions such as APS-1/APS-2
Answer: autoimmune
Flashcard 464: The most common complication of diabetic neuropathy is _____
Answer: neuropathic ulcers
Flashcard 465: The most common cause of hypoparathyroidism is _____
Answer: anterior neck surgery
Flashcard 466: Levels of parathyroid hormone are _____ in pseudohypoparathyroidism
Answer: elevated
Flashcard 467: Chronic hyperglycaemia in the kidney causes glycation of the _____ leading it to become thicker, as well as stiffening the efferent arteriole. Together these cause the GFR to increase, leading to glomerular hypertrophy and eventually glomerulosclerosis
Answer: basement membrane
Flashcard 468: _____ should be started in all patients with diabetic nephropathy with confirmed albuminuria, and titrated to the maximum dose
Answer: ACEi
Flashcard 469: GI autonomic diabetic neuropathy can cause _____ particularly at night
Answer: diarrhoea
Flashcard 470: _____ autonomic diabetic neuropathy may cause erectile dysfunction, retrograde ejaculation, urinary hesitancy
Answer: Genitourinary
Flashcard 471: _____ is due to chronic hyperglycaemia causing glycation of axon proteins
Answer: Diabetic neuropathy
Flashcard 472: _____ is the most common type of diabetic neuropathy and is characterised by sensory loss in a symmetrical, glove & stocking distribution
Answer: Peripheral sensorimotor
Flashcard 473: Patients with diabetic neuropathy may experience irritation, itching, or burning called _____
Answer: dysesthesia
Flashcard 474: 50% of patients with diabetic neuropathy are _____ at diagnosis
Answer: asymptomatic
Flashcard 475: low urine osmolality _____ improve following administration of desmopressin in patients with nephrogenic diabetes insipidus
Answer: does not
Flashcard 476: The most common symptoms of diabetes insipidus are _____ and polydipsia. Patients may also experience daytime sleepiness due to nocturia
Answer: polyuria
Flashcard 477: _____ diabetes insipidus is due to resistance to ADH in the kidney
Answer: Nephrogenic
Flashcard 478: Mainstay of management for diabetic neuropathy is with tight _____ control
Answer: glycaemic
Flashcard 479: Overdose of _____ or sulfonylureas is the most common cause of medication induced hypoglycaemia
Answer: insulin
Flashcard 480: If attempts to resolve the underlying cause of nephrogenic diabetes insipidus FAIL → patients can take _____ and NSAIDs (indomethacin)
Answer: thiazide diuretics
Flashcard 481: Secondary cranial diabetes insipidus may occur due to _____ syndrome if the patient has had a post-partum haemorrhage
Answer: Sheehan
Flashcard 482: What is the diagnosis in a patient with low urine osmolality that improves by > 50% following administration of desmopressin? _____
Answer: Central diabetes insipidus
Flashcard 483: _____ disease can cause hypoglycaemia due to deficiency of cortisol
Answer: Addison's
Flashcard 484: During sick day rules for T1DM, patients should contact medical services urgently if they are _____ or unable to tolerate fluids
Answer: drowsy
Flashcard 485: The sympathoadrenal physiological response to hypoglycaemia is the release of _____
Answer: adrenaline
Flashcard 486: _____ diabetes insipidus can be caused by medications such as: lithium or demeclocycline
Answer: Nephrogenic
Flashcard 487: _____ are the most common cause of endogenous hyperinsulinism
Answer: Insulinomas
Flashcard 488: In diabetes insipidus, the water deprivation test fails to _____ urine osmolality
Answer: increase
Flashcard 489: If neuropathic painkillers do not provide enough analgesia for diabetic neuropathy, _____ can be used as a rescue therapy only
Answer: tramadol
Flashcard 490: _____ is the most common non-iatrogenic cause of hypoglycaemia in adults
Answer: Alcohol
Flashcard 491: _____ diabetes insipidus is due to insufficient release of ADH from the posterior pituitary gland
Answer: Cranial (aka central)
Flashcard 492: Diabetic neuropathy typically affects _____ first due to length of sensory neurons
Answer: lower legs
Flashcard 493: _____ is a synthetic analogue of ADH
Answer: Desmopressin
Flashcard 494: Conscious hypoglycaemic patients who are able to swallow with should be given a _____. If blood glucose levels do not rise begin IM glucagon or IV dextrose
Answer: fast-acting oral carbohydrate
Flashcard 495: Painful diabetic neuropathy is managed with one of the following medications: _____, duloxetine, gabapentin or pregablin
Answer: amitriptyline
Flashcard 496: Renal failure in diabetics can cause _____ due to decreased clearance of insulin
Answer: hypoglycaemia
Flashcard 497: Overdose of desmopressin can cause _____
Answer: hyponatraemia
Flashcard 498: _____ diabetes insipidus can be caused by electrolyte disturbances such as: hypercalcaemia or hypokalaemia
Answer: Nephrogenic
Flashcard 499: Diagnosis of diabetes insipidus involves a _____ to differentiate between primary polydipsia and diabetes insipidus, followed by administration of desmopressin to differentiate between cranial and nephrogenic diabetes insipidus
Answer: water deprivation test
Flashcard 500: If diabetes insipidus is untreated and patients do not consume enough fluid, they may develop severe _____
Answer: dehydration
Flashcard 501: Primary polydipsia is treated with _____
Answer: fluid restriction
Flashcard 502: What is the diagnosis in a patient with low urine osmolality that improves to > 800 mOsm/kg after 2-3 hours of water deprivation? _____
Answer: Primary polydipsia
Flashcard 503: The cause of _____ diabetes insipidus can be genetic (ADH receptor mutation) or acquired
Answer: Nephrogenic
Flashcard 504: Hypoglycaemia in diabetics is nearly always due to medications or _____
Answer: acute illness
Flashcard 505: _____ is a condition where blood glucose is <4 mmol/L
Answer: Hypoglycaemia
Flashcard 506: Reduced consciousness hypoglycaemic patients who are unable to swallow with should be given a _____. If there is no response after 10 mins, begin treatment with IV dextrose (10/20%)
Answer: IM glucagon
Flashcard 507: _____ serum sodium/serum osmolality is more likely to be Diabetes insipidus
Answer: High
Flashcard 508: Diabetic neuropathy causes _____ ankle jerk reflexes
Answer: decreased
Flashcard 509: Severe hypoglycaemia (<2.8 mmol/L) causes neuroglycopenic symptoms such as confusion, seizures, coma due to inadequate glucose supply to the _____
Answer: brain
Flashcard 510: _____ diabetic neuropathy is characterised by motor loss and muscle wasting of the proximal leg/hip muscles
Answer: Proximal motor
Flashcard 511: The initial physiological response to hypoglycaemia is hormonal with decreased secretion of _____ followed by secretion of glucagon
Answer: insulin
Flashcard 512: Management of cranial diabetes insipidus is ADH replacement with _____
Answer: desmopressin
Flashcard 513: _____ serum sodium/serum osmolality is more likely to be primary polydipsia (instead of DI)
Answer: Low
Flashcard 514: _____ is a condition where the kidneys do not sufficiently concentrate urine which results in hypotonic polyuria
Answer: Diabetes insipidus
Flashcard 515: _____ is the main differential for diabetes insipidus. It is due to excess fluid consumption often associated with psychiatric disorders
Answer: Primary polydipsia
Flashcard 516: During sick day rules for T1DM, patients should try to maintain a normal meal pattern but can replace meals with _____ if their appetite is reduced
Answer: carb-containing drinks
Flashcard 517: During sick day rules for T1DM, patients should aim to drink plenty of fluids/sugary drinks to prevent _____
Answer: dehydration
Flashcard 518: _____ diabetes insipidus aetiology is split into primary and secondary The cause of primary is idiopathic The cause of secondary is brain injury
Answer: Cranial (central)
Flashcard 519: Moderate hypoglycaemia _____ causes autonomic symptoms such as sweating, tremor, palpitations and anxiety due to the release of glucagon and adrenaline
Answer: (2.8-3.9 mmol/L)
Flashcard 520: Diagnostic criteria for DKA includes: Glucose: _____ pH: <7.3 Ketones: ++, >3 mmol/L
Answer: >11 mmol/L
Flashcard 521: Insulin therapy for HHS SHOULD NOT begin until _____ UNLESS there is ketonaemia in which case insulin therapy should begin quickly
Answer: glucose levels have plateaued
Flashcard 522: Children and young adults are vulnerable to _____ after fluid resuscitation for DKA and therefore require 1:1 nursing to monitor neuro-observations
Answer: cerebral oedema
Flashcard 523: There are 3 main areas of management for DKA: _____, insulin therapy, potassium repletion
Answer: fluid resuscitation
Flashcard 524: _____ should be monitored every 3-6 months in patients with T1DM
Answer: HbA1c
Flashcard 525: The most common presenting symptoms of DKA are _____, polyuria and polydipsia
Answer: abdominal pain
Flashcard 526: Patients with T1DM should self-monitor blood glucose at least _____ times a day: before meals and bed
Answer: 4
Flashcard 527: Does family history increase risk of developing T1DM? _____
Answer: yes
Flashcard 528: The onset of _____ is days. The onset of DKA is <24hrs.
Answer: HHS
Flashcard 529: T1DM is associated with other _____ conditions such as Celiac disease and Hashimoto thyroiditis
Answer: autoimmune
Flashcard 530: Fluid resuscitation management of DKA should consist of _____ followed by the addition of 10% dextrose once blood glucose is <14 mmol/L
Answer: 0.9% saline
Flashcard 531: _____ and short acting insulins have a quick onset and short duration. They are used to replicate insulin spikes in respose to glucose from a meal or sugar Intermediate and long acting insulins have a slow onset and long duration. They are used to replicate endogenous basal insulin secreted continuously throughout the day
Answer: Rapid
Flashcard 532: All patients with a diagnosis of T1DM should receive serological testing for _____
Answer: coeliac disease
Flashcard 533: During sick day rules for T1DM, patients should consider checking blood or urine _____ regularly including through the night
Answer: ketones
Flashcard 534: HHS pathophysiology is predominantely characterised by severe _____
Answer: dehydration
Flashcard 535: DKA causes the blood to become _____osmolar which leads to osmotic diuresis in the kidneys causing patients to be hypovolaemic
Answer: hyper
Flashcard 536: DKA may cause _____ due to hypovolaemia
Answer: AKI
Flashcard 537: There is no one insulin regimen suitable for all T1DM patients. Options include: • _____ • Mixed (biphasic) - 1/2/3 injections per day • Continuous insulin infusion (insulin pump)
Answer: Multiple daily injections (basal-bolus)
Flashcard 538: DKA primarily affects patients with _____, but can rarely affect patients with type 2 diabetes
Answer: type 1 diabetes
Flashcard 539: There are 3 types of insulin: _____, human insulin analogues, animal insulin
Answer: human insulin
Flashcard 540: HHS is caused by insufficient _____ which may be precipitated by illness or medications
Answer: insulin
Flashcard 541: Why does pear drop breath not occur in HHS? _____
Answer: No ketones in breath
Flashcard 542: Serum _____ levels may be normal or elevated in DKA however, there is a total body deficit
Answer: potassium
Flashcard 543: The main adverse effect of insulin therapy is _____
Answer: hypoglycaemia
Flashcard 544: Target HbA1c in T1DM is ≤_____ (may vary patient to patient)
Answer: 48
Flashcard 545: _____ is the most important electrolyte to consider in DKA. DKA causes an intracellular deficit of potassium
Answer: Potassium
Flashcard 546: _____ is the first manifestation of T1DM in 25-50% of cases
Answer: DKA
Flashcard 547: _____ is a byproduct of insulin production, therefore in patients with T1DM it will be low/undetectable
Answer: C-peptide
Flashcard 548: During sick day rules for T1DM, patients should check blood glucose _____ including through the night
Answer: more frequently (e.g. at least every 4 hours)
Flashcard 549: The mainstay of management for HHS is _____
Answer: fluid resuscitation
Flashcard 550: Why does hyperventilation/Kussmaul breathing not occur in HHS? _____
Answer: No acidosis (no respiratory compensation required)
Flashcard 551: There is no specific criteria, but HHS typically presents with: • Serum glucose: _____ mmol/L • Serum osmolarity: significantly raised • Ketones: Normal (<3 mmol/L) • pH: Normal (>7.3)
Answer: >30
Flashcard 552: _____ should be suspected in children with hyperglycaemia (>11 mmol/L) and polyuria, polydipsia, weight loss and excessive tiredness
Answer: T1DM
Flashcard 553: Lack of intracellular glucose for ATP production in DKA results in increased lipolysis which produces free fatty acids that are converted into _____
Answer: ketones
Flashcard 554: Severe dehydration in HHS may cause the blood to become _____ increasing the risk of MI, stroke, peripheral arterial occlusion etc. Therefore all patients should be treated with prophylactic LMWH
Answer: hyperviscous
Flashcard 555: During sick day rules for T1DM, patients should NEVER stop insulin, patients _____ adjust doses as required
Answer: can
Flashcard 556: _____ is much more profound in HHS due to later presentation
Answer: Dehydration
Flashcard 557: T1DM patients with a BMI ≥_____ should be prescribed metformin
Answer: 25
Flashcard 558: Patients with suspected T1DM may be tested for autoantibodies such as: _____, IA2 or ZnT8
Answer: anti-GAD
Flashcard 559: Which of the following are only found in DKA (not HHS)? • Severe abdominal pain • Polyuria/polydipsia • N&V • Hyperventilation/Kussmaul breathing • Pear drop breath_____, Hyperventilation/Kussmaul breathing, pear drop breath
Answer: Severve abdominal pain
Flashcard 560: Diagnosis of T1DM involves confirmation of _____, followed by identifying T1DM as the cause
Answer: diabetes mellitus
Flashcard 561: _____ should be measured hourly for the first 6 hours during treatment of HHS to avoid sudden osmotic shifts (e.g. cerebral oedema or central pontine demyelination)
Answer: Serum osmolality
Flashcard 562: Fluid resuscitation for HHS should consist of _____ given at a rate of 0.5-1L/hour
Answer: 0.9% saline
Flashcard 563: Capillary blood glucose and urinalysis _____ be use to make a diagnosis of diabetes mellitus
Answer: should not
Flashcard 564: HHS typically affects _____ with type 2 diabetes
Answer: the elderly
Flashcard 565: T1DM is associated with the genetic variants _____ and HLA-DR4
Answer: HLA-DR3
Flashcard 566: DKA is caused by lack of _____. This may be due to treatment failure (e.g non-adherence) or increased demand (e.g. infection, MI, surgery)
Answer: insulin
Flashcard 567: HHS patients should have postassium repletion if serum potassium is <_____ mmol/hr at a rate of 40 mmol/L. If serum potassium is <3.5, the patient requires a senior review, as higher levels of potassium are required
Answer: 5.5
Flashcard 568: DKA may cause _____ breathing that smells like pear-drops
Answer: Kussmaul
Flashcard 569: Unlike DKA, in HHS the pancreas still produces small amounts of insulin which is sufficient to prevent _____ by supressing lipolysis
Answer: DKA
Flashcard 570: _____ should be suspected in adults with hyperglycaemia (>11 mmol/L) and ketosis, weight loss, BMI <25 or history of autoimmune disease
Answer: T1DM
Flashcard 571: T1DM is caused by _____
Answer: autoimmune destruction of pancreatic β-cells
Flashcard 572: Insulin therapy for DKA should consist of: 1) stopping regular _____-acting insulin and continuing long-acting insulin 2) Starting a fixed-rate infusion at 0.1 units/kg/hr
Answer: short
Flashcard 573: HHS presents with similar features to DKA however, the signs of _____ will be much more prominent
Answer: dehydration
Flashcard 574: DKA patients should have postassium repletion if serum potassium is <_____ mmol/L at a rate of 40 mmol/L of fluid. If serum potassium is <3.5, the patient requires a senior review, as higher levels of potassium are required
Answer: 5.5
Flashcard 575: Diabetes Mellitus diagnosis: • Venous blood glucose: fasting ≥_____ mmol/L, non-fasted ≥11.1 mmol/L • Oral glucose tolerance test ≥11.1 mmol/L • HbA1c ≥48 mmol/mol
Answer: 7.0
Flashcard 576: DKA resolution is defined as: • pH >_____ • Blood ketones <0.6 mmol/L • Bicarbonate >15.0 mmol/L Patients who have met this criteria may be switched to subcutaneous insulin if they are eating/drinking
Answer: 7.3
Flashcard 577: The onset of T1DM is usually during _____
Answer: childhood
Flashcard 578: What ABG result is characteristic of DKA? _____
Answer: Metabolic acidosis with raised anion gap
Flashcard 579: Blood glucose targets for patients with T1DM: • _____ mmol/L on waking • 4-7 mmol/L before meals and throughout the day
Answer: 5-7
Flashcard 580: SGLT-2 inhibitors cause an increased risk of _____ because of ↑ excretion of glucose
Answer: urinary tract infection
Flashcard 581: What metabolic disorders are associated with pseudogout? _____
Answer: Haemochromatosis & hyperparathyroidism
Flashcard 582: Hemochromatosis can cause gonadal dysfunction in males leading to _____ atrophy
Answer: testicular
Flashcard 583: _____ is raised in De Quervain's Thyroiditis
Answer: ESR
Flashcard 584: What is the most common cause of hyperalbuminaemia? _____
Answer: Dehydration
Flashcard 585: Patients who are prescribed 16mg oral dexamethasone for metastatic spinal cord compression should be co-prescribed a _____ and should have glucose levels monitored regularly
Answer: PPI
Flashcard 586: What metabolic abnormalities can lead to constipation? _____
Answer: Hypercalcemia & Hypokalaemia
Flashcard 587: Nausea and vomiting caused by _____ is can be managed with Metoclopramide or Haloperidol
Answer: metabolic disturbances
Flashcard 588: One clinical feature of Cushing syndrome is _____, which is a result of an upregulation of α1-adrenergic receptors, causing increased sensitivity of blood vessels to catecholamines
Answer: hypertension
Flashcard 589: Blood tests (_____,TFT, & serum glucose) can be done to rule out reversible causes of essential tremor
Answer: U&Es
Flashcard 590: One clinical feature of Cushing syndrome is abdominal striae which is a result of impaired _____ synthesis, allowing blood vessels to rupture easily
Answer: collagen
Flashcard 591: Clinical features of _____ include moon facies, buffalo hump, and truncal obesity due to increased fat storage, secondary to excess insulin
Answer: Cushing syndrome
Flashcard 592: High dose dexamethasone suppression test: _____ cortisol ↑ ACTH = Ectopic ACTH (small cell lung cancer)
Answer: ↑
Flashcard 593: One clinical feature seen in women with Cushing's syndrome is _____ as a result of increased androgen levels
Answer: virilization
Flashcard 594: High dose dexamethasone suppression test: _____ cortisol ↓ ACTH = Adrenal adenoma
Answer: ↑
Flashcard 595: What is the management of Cushing's disease if trans-sphenoidal surgery / radiation fails? _____
Answer: Bilateral adrenalectomy
Flashcard 596: High dose dexamethasone suppression test: ↓ cortisol = _____
Answer: Cushing's disease
Flashcard 597: One clinical feature of Cushing syndrome is muscle weakness with _____ extremities
Answer: thin
Flashcard 598: What investigation is used to localise the pathology causing Cushing's disease? _____
Answer: High-dose dexamethsone suppression test
Flashcard 599: One clinical feature of Cushing syndrome is _____, which is a result of decreased osteoblast activity
Answer: osteoporosis
Flashcard 600: Cushing's disease causes _____ obesity as well as redistribution of adipose tissue causing moon face and buffalo hump
Answer: central
Flashcard 601: Ectopic ACTH production can uncommonly occur in _____ to cause Cushing's Syndrome
Answer: small cell lung cancers
Flashcard 602: First-line management of type 2 diabetes with CVD is _____.
Answer: metformin+ SGLT-2 inhibitor
Flashcard 603: Diagnostic tests for Cushing's syndrome include: First line: _____ Second line: 24hr urinary free cortisol
Answer: Overnight (low-dose) dexamethasone suppression test
Flashcard 604: Most patients with De Quervain's Thyroiditis _____ require treatment
Answer: will not
Flashcard 605: Patients with symptoms of type 2 diabetes can be diagnosed if: • HbA1c is _____ OR • Fasting glucose is ≥7 mmol/L OR • Random glucose/OGTT is ≥11.1 mmol/L
Answer: ≥48 mmol/mol
Flashcard 606: Cushing's syndrome may show a _____ upon ABG testing
Answer: hypokalaemic metabolic alkalosis
Flashcard 607: Patients with cushing's syndrome _____ have their morning cortisol spike suppressed upon overnight (low-dose) dexamethasone suppression test Patients with cushing's disease will not have their morning cortisol spike suppressed upon overnight (low-dose) dexamethasone suppression test
Answer: will not
Flashcard 608: Pre-diabetic/high risk HbA1c range is _____
Answer: 42 to 47 mmol/L
Flashcard 609: An _____ can be used to differentiate between Cushing's syndrome and pseudo-cushings
Answer: insulin stress test
Flashcard 610: What is the first line management of Cushings DISEASE? 1st Line: _____ 2nd Line: Pituitary radiotherapy OR further surgical removal of the pituitary
Answer: Trans-sphenoidal removal of pituitary tumour
Flashcard 611: What is the 2nd line management of T2DM if HbA1c is _____ while on metformin? Dual therapy (metformin + DPP-4i/pioglitazone/sulfonylurea/SGLT-2i)
Answer: >48
Flashcard 612: _____ is caused by a pituitary tumour which secretes excessive ACTH. Excessive ACTH causes adrenal hyperplasia
Answer: Cushing's disease
Flashcard 613: Patients who are asymptomatic of type 2 diabetes must have an abnormal _____ on one blood test OR plasma glucose on 2 seperate occasions
Answer: HbA1c
Flashcard 614: Cushing's disease causes dermatological symptoms such as _____, acne vulgaris, seborrheic dermatitis
Answer: hirsutism
Flashcard 615: Pre-diabetic/high risk FASTING blood glucose range is _____
Answer: 5.5 to 6.9 mmol/L
Flashcard 616: First-line management of type 2 diabetes without CVD is _____.
Answer: standard release metformin
Flashcard 617: Pseudo-cushing's can mimic Cushing's syndrome and is usually due to _____ or severe depression
Answer: excessive alcohol
Flashcard 618: HbA1c should not be used for diagnosis of T2DM in patients with _____, children, HIV, pregnancy
Answer: increased RBC turnover
Flashcard 619: HbA1c should be checked in patients with T2DM every _____ until stable and then 6 monthly
Answer: 3-6 months
Flashcard 620: Cushing's syndrome can be unrelated to ACTH. The most common cause is _____
Answer: steroids
Flashcard 621: _____ should not be added to T2DM treatment until metformin has been titrated up to the final dose
Answer: SGLT2 inhibitors
Flashcard 622: Cushing's disease causes MSK symptoms due to _____ and osteopenia/porosis
Answer: proximal myopathy
Flashcard 623: Children with Cushing's disease may experience _____ due to suppression of growth hormone secretion or precocious puberty due to increased adrenal androgens
Answer: stunted growth
Flashcard 624: If triple therapy does not control T2DM consider replacement of one drug for a _____
Answer: GLP-1 agonist
Flashcard 625: What is the 3rd line management of T2DM if not controlled on dual therapy? _____
Answer: Triple therapy
Flashcard 626: Patients who do not tolerate metformin should be switched to _____
Answer: modified release metformin
Flashcard 627: Type 2 diabetes target HbA1c levels: Lifestyle alone → _____ Lifestyle + Metformin → 48 mmol/mol Lifestyle + Hypoglycaemia causing drug → 53 mmol/mol Already on 1 drug but HbA1c has risen to 58 mmol/mol → 53 mmol/mol + intensify drug treatment
Answer: 48 mmol/mol
Flashcard 628: Patients with suspected Cushing's syndrome who do not experience suppressed cortisol and ACTH following high dose dexamethasone suppression test are likely to have _____
Answer: ectopic ACTH syndrome
Flashcard 629: Testicular cancer can present with _____ due to ↑ β-hCG levels
Answer: gynaecomastia
Flashcard 630: Advanced pancreatic cancer can present with _____ because of loss of endocrine function
Answer: diabetes mellitus
Flashcard 631: Perianal abscesses can be caused by underlying _____ due to impaired wound healing
Answer: diabetes
Flashcard 632: Sick euthyroid syndrome is more commonly seen in _____ patients
Answer: elderly
Flashcard 633: TSH levels in sick euthyroid syndrome are often _____
Answer: normal range
Flashcard 634: What is the mangament of sick euthyroid syndrome? _____
Answer: supportive care (self limiting)
Flashcard 635: Patients with sick euthyroid syndrome will have _____ levels of T4 (thyroxine) and T3.
Answer: low
Flashcard 636: Large cell carcinoma of the lung may secrete the hormone _____
Answer: β-hCG
Flashcard 637: Which lung cancer is associated with SIADH as a paraneoplastic syndrome? _____
Answer: Small cell carcinoma
Flashcard 638: Which lung cancer is associated with Cushing's syndrome as a paraneoplastic syndrome? _____
Answer: Small cell carcinoma
Flashcard 639: Sarcoidosis is associated with _____ due to increased 1α-hydroxylase activity in epithelioid histiocytes
Answer: hypercalcemia
Flashcard 640: The most common cause of neuropathic ulcers is _____
Answer: diabetes mellitus
Flashcard 641: What investigations should be done for a suspected neuropathic ulcer? _____
Answer: Blood glucose and B12 levels
Flashcard 642: Management of neuropathic foot ulcers includes 1 or more of the following: _____, control of foot infection, control of ischaemia, wound debridement, wound dressings
Answer: offloading
Flashcard 643: Pulses are _____ in neuropathic ulcers
Answer: present
Flashcard 644: How do the following laboratory values typically change in patients with osteoporosis? Calcium: _____ Phosphate: normal Alkaline phosphatase: normal
Answer: normal
Flashcard 645: DEXA scan _____ score is adjusted for age, gender, & ethnic factors!
Answer: Z
Flashcard 646: DEXA scan T score _____ = normal -1.0 to -2.5 = osteopenia < -2.5 = osteoporosis
Answer: > -1.0
Flashcard 647: BMI _____ than 19kg/m2 increases the risk of osteoporosis
Answer: less
Flashcard 648: _____ have ↑ risk of osteoporosis, partly due to loss of oestrogen post-menopause
Answer: Women
Flashcard 649: What medication poses the BIGGEST risk factor for osteoporosis? _____
Answer: Glucocorticoids!
Flashcard 650: Women with any risk factors for gestational diabetes should be offered an _____
Answer: OGTT at 24-28 weeks
Flashcard 651: Diagnostic thresholds for gestational diabetes are fasting blood glucose ≥ _____
Answer: 5.6 mmol/L
Flashcard 652: How should gestational diabetes be treated if fasting plasma glucose < 7 mmol/L? _____
Answer: Diet and exercise trial for 1-2 weeks
Flashcard 653: How should gestational diabetes be treated if fasting plasma glucose < 7 mmol/L and glucose targets are not met after 1-2 weeks of diet and exercise trial? _____
Answer: Add metformin, then insulin if glucose targets are still not met
Flashcard 654: What is the investigation of choice for screening of gestational diabetes? _____
Answer: Oral glucose tolerance test (OGTT)
Flashcard 655: Gestational _____ is the second most common gestational disorder
Answer: diabetes
Flashcard 656: Diagnostic thresholds for gestational diabetes are 2-hour glucose ≥ _____
Answer: 7.8 mmol/L
Flashcard 657: Pregnant women with a BMI of > _____ kg/m2 are at higher risk for gestational diabetes
Answer: 30
Flashcard 658: How would you screen for gestational diabetes in a pregnant woman who have had gestational diabetes in a previous pregnancy? _____
Answer: OGTT as soon as possible after booking, and again at 24-28 weeks
Flashcard 659: What is the management of pregnant women with pre-existing diabetes mellitus? _____
Answer: Stop oral hypoglycaemic agents, apart from metformin + commence insulin
Flashcard 660: Weight loss for pregnant women with pre-existing diabetes with BMI of > _____ kg/m2
Answer: 27
Flashcard 661: How should gestational diabetes be treated if fasting plasma glucose ≥ 7 mmol/L? _____
Answer: Insulin ± metformin
Flashcard 662: How should gestational diabetes be treated if fasting plasma glucose < 7 mmol/L? (step by step - 3) _____
Answer: Diet & exercise trial 1-2 weeks → add metformin → add insulin
Keywords: Endocrinology & Diabetes flashcards, medical flashcards, NEET PG preparation, USMLE Step 1 flashcards, Anki alternative, spaced repetition medical, OnCourse flashcards
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