Case 9 SAP

Question 1

Effects of hypothyroidism in foetus and neonates

Answer 1

Severe mental retardation, dwarfism, iodine deficiency, lack of nerve myelination around birth

Question 2

Symptoms of hypothyroidism in adults

Answer 2

decreased metabolic rate, mental and physical slowing, cold intolerance, weight gain, menorrhagia, depression symptoms, hypoventilation from diaphragm weakness, constipation from decreased GI motility, decreased cardiac output and stroke volume

Question 3

Most common cause of hypothyroidism in developing countries

Answer 3

Iodine deficiency

Question 4

Hashimoto’s thyroiditis

Answer 4

primary hypothyroidism. Autoimmune, thyroid peroxidase (TPO, more common) and thyroglobulin (less common) antibodies found. Low T4 and high TSH

Question 5

Pituitary gland dysfunction effect on thyroid hormone levels

Answer 5

low TSH and low T4

Question 6

What effect does thyroid gland ablation for hyperthyroidism have on thyroid hormone levels?

Answer 6

low T4 and high TSH

Question 7

Drugs causing hypothyroidism (CLAPS)

Answer 7

amiodarone, carbamazepine, lithium, phenytoin, tyrosine kinase inhibitors (sunitinib)

Question 8

Myxoedema coma

Answer 8

severe decompensated hypothyroidism, life threatening emergency, 70% fatalities.

Question 9

What cause of hypothyroidism can pregnancy unmask?

Answer 9

subclinical autoimmune thyroid disease

Question 10

How does oestrogen impact on T4 levels?

Answer 10

increases binding protein so decreases free T4

Question 11

How does mother’s hypothyroidism affect the foetus?

Answer 11

impairs psychomotor development

Question 12

What is given to keep maternal TSH in normal range?

Answer 12

levothyroxine

Question 13

Tertiary hypothyroidism

Answer 13

decreased TRH release which leads to decreased TSH release and decreased T3 and T4. Causes include euthyroid-sick syndrome

Question 14

Symptoms of hyperthyroidism

Answer 14

high metabolic rate, weight loss, tachycardia, tremor, nervousness, heat intolerance, goitre, reduced menses, anxiety symptoms

Question 15

Describe graves’ disease

Answer 15

most common in females aged 30-40.
autoimmune condition in which antibodies attack the thyroid causing it to become overactive

Question 16

Symptoms of graves’ disease

Answer 16

all hyperthyroidism symptoms plus increased lipolysis and protein catabolism leading to muscle weakness, increased GI motility, palpitations, increased cardiac contractility, hyperkinesia, increased bone turnover leading to fractures, and dermopathy

Question 17

What else can cause hyperthyroidism?

Answer 17

Toxic multinodular goitre (Plummer’s disease) and thyroid adenoma

Question 18

Describe thyroid storm and its causes

Answer 18

Severe decompensated (undiagnosed or poorly controlled) hyperthyroidism caused by trauma, pregnancy, infection, or surgery

Question 19

Symptoms of thyroid storm

Answer 19

fever, agitation, delirium, congestive heart failure, loss of consciousness

Question 20

Define domestic abuse

Answer 20

Any incident or pattern of incidents of controlling, coercive, or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality

Question 21

Types of domestic abuse

Answer 21

psychological, emotional, physical, sexual, and financial. Also includes ‘honour’ based violence, FGM, and forced marriage

Question 22

Describe controlling behaviour

Answer 22

a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour

Question 23

Describe coercive behaviour

Answer 23

an act or a pattern of acts of assault, threats, humiliation, and intimidation or other abuse that is used to harm, punish, or frighten their victim

Question 24

Scale of domestic abuse

Answer 24

1 in 4 women, 1 in 6 men, 2 women killed every week, 1 man killed every 3 weeks, 30 women attempt suicide every week and 3 succeed. biggest prevalence in ages 16-19.

Question 25

Effect of COVID on domestic abuse

Answer 25

Substantial increase due to COVID – reports that abuse has gotten worse, having to spend more time with the abusive partner, children witnessing more abuse, support line activity increases, ChildLine self-referrals increase

Question 26

Risk factors for domestic abuse

Answer 26

pregnancy (foetal morbidity from violence more common than gestational diabetes and pre-eclampsia), disability (2x risk of DA), mental health problems (3x risk), teenaged, female gender, LGBTQ

Question 27

Biopsychosocial impact of domestic abuse

Answer 27

Biological impact: cuts, scrapes, bruises, wounds, fractures, dislocations, lost teeth, STIs, unwanted pregnancies, non-specific symptoms (GI disorders, headaches, gynaecological problems x3, chronic pain, fainting, seizures), self-neglect, homicide. Psychological: emotional distress, low self-esteem, depression x4, anxiety, suicidality x4, self-harm, PTSD (more common in males), alcohol and substance abuse, eating disorders, sleep disturbances. Social: financial dependence on partner, impact on work, isolation from friends/family/support networks, homelessness, impact on ability to make decisions, impact on ability to parent, drink/drug behaviours, perpetrator always attending appointments to less chance to disclose

Question 28

Impact of domestic abuse on health and health service

Answer 28

People experiencing DA use the health service more - tend to come into contact with GP before seeking help from authorities

Question 29

Impact of DA on children

Answer 29

1 in 5 children have been exposed to DA, 62% of those in DA households are also directly harmed. Behavioural/emotional/mental health issues, neglect, physical abuse, truanting, bed wetting, premature sexual behaviour, drug and alcohol use

Question 30

Define medically unexplained symptoms

Answer 30

physical symptoms persisting for more than several weeks for which adequate medical examination has not revealed a condition that adequately explains the symptoms

Question 31

Common medically unexplained symptoms diagnoses

Answer 31

IBS, pelvic pain, non-cardiac chest pain, chronic headache, dizziness/vertigo, chronic fatigue, fibromyalgia

Question 32

Medically unexplained symptoms stats

Answer 32

10-20% have multiple episodes 0.2% have severe with early onset (<30) 15-45% GP consultations have MUS 3-10% adults in primary care have persistent or recurrent 50-75% will have symptom decrease over 12 months 10-30% symptoms will worsen or increase <4% with IBS have organic explanation 10% with fatigue have explanation

Question 33

Impact of MUS

Answer 33

depression and anxiety more common in patients, can have significant impact on quality of life, similar rates of consultation as those with explanations

Question 34

Theory of central sensitization

Answer 34

heightened perception of and distress from sensory input

Question 35

Hyperalgesia

Answer 35

more pain than should be experienced from painful stimuli

Question 36

Allodynia

Answer 36

pain from non-painful stimuli

Question 37

Cause of hyperalgesia and allodynia

Answer 37

synaptic plasticity and loss of inhibition

Question 38

Endocrine dysregulation theory

Answer 38

evidence of hypothalamic-endocrine dysfunction in many patients affecting the feedback loop that regulates stress responses. May be linked to the over production of cortisol which can result in chronic fatigue and pain

Question 39

Immune system sensitization theory

Answer 39

chronic immune activation with production of cytokines that don’t switch off when the stressful stimulus is removes. Can give a feeling of illness.

Question 40

Signal-filter model

Answer 40

uses the idea that we filter out signals in a manner very similar to that of pain which uses the gate theory. If our gates are broken, our perception of symptoms increases.

Question 41

Management of MUS

Answer 41

acceptance of the person’s suffering and validation of their experience. Give explanation through models and analysis. Avoid opiates. Offer psychological support, exercise if appropriate, occupational support, patient support groups

Question 42

Non-pharmacological treatments for schizophrenia

Answer 42

CBT, family therapy, arts therapy

Question 43

Non-pharmacological treatments for dementia

Answer 43

CBT, psychotherapy, behavioural management therapy, memory training, music/dance therapy, support groups

Question 44

Non-pharmacological treatments for depression

Answer 44

CBT, acupuncture, supplements, electroconvulsive therapy, repetitive transcranial magnetic stimulation

Question 45

Non-pharmacological treatments for anxiety

Answer 45

limit caffeine, alcohol, nicotine, balanced diet, exercise, CBT, sleep