Term
|
Definition
oesophagitis
osteonecrosis of jaw
GI disturbance |
|
|
Term
| mortality form HONK is mainly due to which complications? |
|
Definition
rhabdomyolysis,
VTE
lactic acidosis
hypertriglyceridaemia
renal failure
stroke and cerebral oedema. |
|
|
Term
| what is the difference in starting insulin for DKA between adults and children? |
|
Definition
in adults you can start insulin straight away at a rate of 0.1units/kg/hour
in children giving insulin too soon can precipitate cerebral oedema so you wait one hour before giving insulin |
|
|
Term
| causes of raised prolactin |
|
Definition
pregnancy
stress
sleeping
acromegaly
polycystic ovary
oestrogen
primary hypothyroidism |
|
|
Term
| in a pt with ADDISONS who is ill nd takes hydrocortisone and fludrocortisone what should you do? |
|
Definition
double dose of hydrocortisone
fludrocortisone can remain the same. |
|
|
Term
osteoporosis, osteomalacia and osteopenia
steroids are linked to 2 of the 3 above
which one is not due to steroids? |
|
Definition
|
|
Term
| SGLT2 inhibitors include DAPAGLIFLOZIN. these are used in type 2 diabetic pts. which complication most commonly found in type 1 diabetes might a person with type 2 using SGLT2 inhibitors present with? |
|
Definition
|
|
Term
| common features of hypercalcemia in malignancy |
|
Definition
nausea vomiting
anorexia
thirst
polydipsia
polyuria
lethargy
bone pain
abdominal pain
constipation, confusion, weakeness |
|
|
Term
| physiology of calcium metabolism |
|
Definition
decrease in serum calcium releases PTH
this increases bone resorbtion, increases renal calcium reabsorption and increases conversion of 25 hydroxy D3 to the active 1,25 dihydroxy D3. the active D3 increases intestinal calcium absorption
these mechanisms restore serum calcium to normal and inhibit further release of PTH and 1,25 dihydroxy D3 |
|
|
Term
| how to work out corrected calcium? |
|
Definition
if the albumin is less than 40 then this is how we do:-
40 - albumin x 0.02 + given calcium level |
|
|
Term
|
Definition
primary hyperparathyroidism
malignancy
drugs: thiazides, vit D and vit A
endocrine: thyrotoxicosis, pheachromo, primary adrenal insufficiency
granulomatous diseases: sarcoid, TB |
|
|
Term
| list the 4 different ways hypercalcemia can occur in malignancy? |
|
Definition
ectopic production of PTHrP by tumour cells
ectopic calcitriol
osteolytic hypercalceamia
ectopic PTH by tumour cells. |
|
|
Term
in presence of raise corrected calcium
what does raised albumin and raised urea indicate? |
|
Definition
|
|
Term
in presence of raise corrected calcium
what does raised albumin in presence of normal urea indicate? |
|
Definition
|
|
Term
in presence of raise corrected calcium
a NORMAL ALK PHOS indicates? |
|
Definition
myeloma (raised plasma proteins)
calcium-alkali syndrome
thyrotoxicosis
sarcoidosis |
|
|
Term
in presence of raise corrected calcium
a RAISED ALK PHOS indicates? |
|
Definition
bony mets
sarcoidosis
thyrotoxicosis |
|
|
Term
in presence of raise corrected calcium
a raised CALCITONIN level is indicative of? |
|
Definition
|
|
Term
corrected calcium is raised.
now if the alk phis is normal what wold you think?
what if it was raised? |
|
Definition
normal? myeloma, milk-alkali syndrome, thyrotoxicosis, sarcoidosis
raised? bony mets, sarcoid, thyrotoxicosis |
|
|
Term
| in which type of malignancies is serum alk phis normal? |
|
Definition
| in haematological malignancies such as myleoma. |
|
|
Term
| raised PTH levels are suggestive of primary, secondary or tertiary hyperparathyroidism. in what conditions do you get low PTH levels |
|
Definition
granulomatous disease
iatrogenic e.g. renal dialysis
adrenal insufficiency
thyrotoxicosis |
|
|
Term
| mx of acute hypercalcemia |
|
Definition
09% saline to increase urinary output of calcium
bisphosphonates: palmidronate or zolendronate
glucorcorticoids useful if hypercalcemia is due to fit d toxicity, sarcoidosis and lymphoma |
|
|
Term
| what can you give to pts with malignant hypercalcemia who are not responding to bisphosphonates? |
|
Definition
gallium
it was discovered when people found that pts with cancer who underwent gallium scans did not get hypercalcemia. |
|
|
Term
| after chemotherapy when does the neutrophil count reach its lowest level? |
|
Definition
| 5-10 days after the last chemo session |
|
|
Term
| pts who are low risk for tumour lysis syndrome are monitored, what about those with intermediate and high risk? |
|
Definition
intermediate risk? 7 days allopurinol and increased hydration
high risk? single fixed dose 3mg of rasburicase (recombinant irate oxidase) and increased hydration |
|
|
Term
| pagets bone involves a disorder of which cells? |
|
Definition
osteoclasts. there is increased and uncontrolled resorption followed by increase osteoblast activity
risk factors
increasing age
male sex
FHx
Northern latitude |
|
|
Term
| clinical features of Pagets disease? |
|
Definition
bone pain in pelvis, lumbar and femur
classic untreated features: bowing of tibia and bossing of skull
raised alk phos but calcium and phosphate are normal
skull xray shows: thickened vault and osteoporosis circumscripta |
|
|
Term
| in Pagets there is raised alk phis. what happens to the levels of calcium and phosphate? |
|
Definition
|
|
Term
| skull X-ray features in pagets bones disease |
|
Definition
thickened vault
osteoporosis circumscripta |
|
|
Term
| when would you rx Pagets and what would you treat with |
|
Definition
treat if bone pain, skull or long bone deformity or a fracture.
treat with bisphosphonates PO risedronate or IV zolendronate |
|
|
Term
| complications of Pagets bone disease |
|
Definition
deafness
fractures
skull thickening
high output cardiac failure
bone sarcoma (1% affected if more than 10 years with condition) |
|
|
Term
| ix for Pagets disease of bone? |
|
Definition
bone alk phis is raised, calcium and phosphate are normal but immobilisation and dehydration may lead to hypercalcemia
X-rays
bone scans
bone biopsy |
|
|
Term
classical X-ray features of Pagets disease
clue: blade of grass pattern, cotton wool |
|
Definition
both osteolysis (seen as radiolucency) and excessive bone formation can be seen
Blade of grass lesion : a V shaped pattern between healthy and disease along bones
cotton wool pattern: in skull indicative of multifocal sclerotic patches. |
|
|
Term
| how would you investigate the extent of disease in Pagets? |
|
Definition
| radionucleotide bone scan |
|
|
Term
| before starting a bisphosphonate what needs to be corrected to avoid hypocalcemia? |
|
Definition
| calcium or vit d deficiency |
|
|
Term
| major risk factors for osteoporosis as used by FRAX |
|
Definition
current smoking
low BMI
alcohol excess
RA
history of parental hip fracture
history of glucocorticoid use |
|
|
Term
| what are T scores and Z scores? |
|
Definition
they are a SD of the bone density.
T score is ion young healthy population
Z score is in people of that age, gender and ethnicity
T is the better one and we remember that as T for target score. this is what we are aiming for |
|
|
Term
| meds others than steroids that can worsen osteoporosis |
|
Definition
SSRIs
antiepileptics
PPIs
glitazones
long term heparin
aromatase inhibitors eg anastrazole |
|
|
Term
| what does a z score -2 indicate in osteoporosis? |
|
Definition
| bone density below normal for that age |
|
|
Term
| according to T scores what is normal, osteopenia and osteoporosis? |
|
Definition
T score >-1 is normal
T score less than -1 but > -2.5 is osteopenia
T score < - 2.5 is osteoporosis |
|
|
Term
FRAX gives 10 year risk of fractures. which ages is it valid for? what are its parameters
when would you refer for a scan?
do you need to do a BMD scan with FRAX? |
|
Definition
valid for ages 40-90 years
paramenters: age, sex, weight, height, previous fractures, parental fractures, RA, steroid use, current smoking, alcohol xs,
you don't have to do a vmd scan with FRAX but doing one does improve accuracy of results.
refer for DEXA if FRAX (without BMD) shows an intermediate result |
|
|
Term
| FRAX is based on international data but say a BREXIT pt wanted their risk for osteoporosis which risk tool could you use and why? |
|
Definition
use QFracture. This is more appropriate as it based on UK data.
suitable for ages 30-99 and does not need BMD scan |
|
|
Term
| what should you use fRAX or QFracture? |
|
Definition
| you can use either but NICE recommend to use FRAX if BMD is available. |
|
|
Term
| name two disease that can mimic osteoporosis and should be investigated and excluded ? |
|
Definition
osteomalacia
myeloma : urinary bence jones protein |
|
|
Term
| pharmacological hierarchy in bisphosphonates and osteoporosis drugs |
|
Definition
1st line Alendronate
2nd line Risedronate or etidronate
if pts can't tolerate bisphosphonates then
strontium ranelate and raloxifene |
|
|
Term
| i am a selective oestrogen receptor modulator beginning with R and used in management of osteoporosis but not first line. |
|
Definition
Raloxifene
se: worsen menopausal symptoms, increased risk of thromboembolic events, may decrease risk of breast cancer |
|
|
Term
| which dual action bone agent workings by inhibiting osteoclasts whilst promoting differentiation of pre-osteoblasts to osteoblasts? |
|
Definition
strontium ranelate.
SE: increased risk for CVS events, thromboembolic events |
|
|
Term
| what can you recommend for secondary prevention of osteoporosis? |
|
Definition
walking aids
exercise: weight bearing exercise
dietary advice: smoking cessation, moderate alcohol intake
bisphosphonates
calcium and Vit d |
|
|
Term
| which bisphosphonate can you take once monthly? |
|
Definition
|
|
Term
|
Definition
Monoclonal antibody
inhibits rank ligandthat in turn inhibits maturation of osteoclasts
given SC injection every 6 months |
|
|
Term
|
Definition
they are given gluccocorticoid and mineralocorticoid
20-30mg hydrocortisone given in 2-3 doses. majority in the morning
mineralocorticoid
do not miss doses
in illness double gluccocorticoid but keep mineralocorticoid the same
wear medialert bracelet |
|
|
Term
| cause and mx of addisonian crisis |
|
Definition
cause: sepsis, surgery, adrenal hemorrhage (waterhouse-friderichsen), steroid withdrawal
mx: 100mg IM/IV hydrocortisone
1 litre normal saline over 30-60 minutes. if hypoglycaemic then add dextrose
cx hydrocortisone 6 hourly until pt is stable
oral replacement can begin after 24 hours and be reduced to maintenance over 3-4 days |
|
|
Term
| why is fludrocortisone not required in addisonian crisis? |
|
Definition
| because high cortisol exerts weak mineralocorticoid action |
|
|
Term
|
Definition
transsphenoidal surgery is rx of choice
somatostain analogues: octreotide is 1st choice medical rx
radiotherapy for refractory disease or when surgery in not suitable e.g in elderly |
|
|
Term
| SE of somatostatin analogues |
|
Definition
abdo discomfort
gallstones
gallbladder sludge |
|
|
Term
other medical treats in acromegaly
somaostatin analogues are first line |
|
Definition
2nd line dopamine agonists: bromocriptine, carbegoline
Pegvisomant (PEG) -analogue of HGH that blocks peripheral synthesis of IGF-1. |
|
|
Term
| carbergoline and bromocriptine are ergot derived DA agonists. what are the SE associated with these? |
|
Definition
cardiac fibrosis
need echo 3-6m after starting treatment and then 6-12 month intervals |
|
|
Term
| in the uk what is PEG licensed to be used for and what are its side effects? |
|
Definition
for use in pts with acromegaly who hav not responded to surgery, radiotherapy or somatostatin analogues
SE: raised liver enzymes so you need to do LFTs monthly for 1st 6 months then every 6 months |
|
|
Term
|
Definition
dopamine agonists eg bromocriptine or carbegoline (monitor for cardiac fibrosis)
if they fail then surgery to reduce tumour size or radiotherapy
women with hypogonadism can get rx with oral contraceptives |
|
|
Term
| prlactinoma classification? |
|
Definition
micradenoma <10mm
macro >10mm
giant pituitary adenoma >40mm
prolactin made by lactotroph cells in anterior pituitary |
|
|
Term
| nephrogenic diabetes insipus can be cause by which mood stabiliser? |
|
Definition
| lithium. it affects up ti 40% of pts |
|
|
Term
| what is the name of the recessively inherited form of diabetes insipid us that also presents with diabetes mellitus optic atrophy and deafness? DIDMOAD? |
|
Definition
|
|
Term
|
Definition
| urine output exceeding 3 litres/daily |
|
|
Term
|
Definition
| because this is due to reduce ADH secretion artificial desmopressin can treat the condition. |
|
|
Term
|
Definition
have access to drinking water
correct metabolic abnormalities
stop offending drugs
combo of thiazide and NSAID may be used to reduce urine volume
high dose desmopressin may be used in mild-moderate disease
those with genetic causes or severe disease may need to practise clean intermittent cathterisation to reduce urinary tract back pressure complications. |
|
|
Term
| primary prevention of hyperlipieademia what are the parameters in order to give 20mg atorvastatin? |
|
Definition
CVS risk of 10% or more
most type 1 diabetics
CKD with eGFR < 60
if non-DL has not fallen by 40% then titrate up to 80mg |
|
|
Term
| a person has known IHD, CVD or PVD what dose atorvastatin should they be on? |
|
Definition
|
|
Term
TSH raised but T3 or T4 normal?
when should you treat this condition? |
|
Definition
subclinical hypothyroidism
treat if:-
TSH >10
presence of thyroid autoantibodies
if pt has another AI disorder
if they had previously been treated for Graves disease |
|
|
Term
| starting dose of levothyroxine for people with cardiac disease, severe hypothyroidism or >50 years of age? |
|
Definition
|
|
Term
SE of thyroxin therapy
interactions with other drugs: IRON reduces absorption of levothyroxine
take at least 2 hours apart |
|
Definition
worsening of angina
AF
reduced bone mineral density
hyperthyroidism from over treatment |
|
|
Term
| features of multiple myeloma |
|
Definition
on xray you see punched out lesions. this represents bony destruction by malignant plasma cells. this increases calcium.
sympotms of hypercalceamia: constripation and depression, abdominal pain, bone pain, kidney stones and psychiatric problems.
bony destruction can lead to pathological fractures.
plasma cells also produce large amount of antibody mainly IgG then IgA then IgM. this can be seen as a spike on electrophoresis as the M band.
Light chains in urine; Bence Jones proteins
plain xray shows lytic lesions |
|
|
