day3 Flashcards
(175 cards)
1
Q
acute tenderness in goitre in a diffuse swelling, sometimes with severe pain is suggest of
A
acute viral thyroiditis (de quervains)
2
Q
in multi nodular goitre what is the thyroid levels usually
A
euthyroid
3
Q
what is the most common cause of tracheal and or oesophageal compression and can lead to laryngeal nerve palsy
A
multi nodular goitre
4
Q
you get fibrotic nodular goitre in
A
riedels thyroiditis
5
Q
what should be a concern in a solitary nodule
A
malignancy
6
Q
are majority of solitary nodules cystic or benign
A
yes
7
Q
most thyroid cancers are
A
painless and slow growing
8
Q
fibrotic goitre producing a woody gland
A
riedels thyroidits
9
Q
a goitre associated with euthyroidism rarely requires intervention and the patient can be reassured that spontaneous resolution is likely during
A
puberty and pregnancy
10
Q
carcinomas derived from thyroid epithelium may be
A
papillary, folliciular or anaplastic
11
Q
medullary carcinomas arise from calcitonin producing c cells
A
12
Q
most common thyroid carcinoma
A
papillary
13
Q
papillary carcinoma is common in what kind of people
A
young
14
Q
what can be used as a tumour marker in thyroid carcinomas after thyroid ablation
A
thyroglobulin
15
Q
what do you use for residual thyroid tissue post op
A
RAI ablation
16
Q
what can you give to minimise risk of recurrence of papillary and follicular carcinomas
A
levothyroxine
17
Q
when is the measurement of thyroglobulin(tumour marker) most sensitive
A
when TSH is high so requires withdrawal of levothyroxine
18
Q
what can be used to stimulate thyroglobulin without stopping levothyroxine
A
recombinant TSH
19
Q
what suggests recurrence of papillary/follcular carcinomas
A
detectable thyroglobulin
20
Q
medullary carcinoma is often associated with
A
Men2
21
Q
approx 1 in 4 patients diagnosed with medullary thyroid cancer have a mutation on the
A
RET proto oncogene
22
Q
people with MEN2 mutations are advised to have what as early of 5 years of age to prevent the development of medullary thyroid carcinoma
A
prophylactic thyroidectomy
23
Q
is local invasion or metastasis frequent in medullary thyroid carcinoma
A
yes
24
Q
what is usually indicated in medullary thyroid carcinoma
A
total thyroidectomy and wide lymph node clearance
25
what controls progression through puberty and the capacity for reproduction
hypothalamo- pituitary gonadal axis
26
what is primary amenorrhoea
failure to begin spontaneous menstruation by age 16
27
what is secondary amenorrhoea
absence of menstruatuon for 3 months in a woman who has previously had cycles
28
GnRH is released from where
hypothalamus
29
GnRH stimulates
LH and FSH release from the pituitary
30
in males, LH stimulates
testosterone
31
FSH stimulates what cells in males to produce mature sperm
Sertoli cells
32
in females, LH and FSH stimulates
androgen and oestrogen production
32
in females, LH and FSH stimulates
androgen and oestrogen production
33
what indicates primary gonadal disease
high gonadotrophins with low testosterone or oestradiol
34
normal or low LH/FSH with low testosterone/oestridiol
hypothalamic pituitary disease
35
what test to exclude hypogonadism in males
basal testosterone
36
what test in female to exclude hypogonadism
basal oestradiol
37
male with an extra X chromosome
klinefelters syndrome
38
early indications of klinefelters syndrome
cryptochidism (absence of a test) , behavioural problems, tall stature and learning difficulties
39
pea sized but firm tsts
klinefelters syndrome
40
isolated GnRH deficiency
kallmans syndrome
41
what is gynaecomastia
development of breast tissue in the male
42
causes of gynaecomastia
hyperthyroidism, hyperprolactinaemia, renal and liver disease, hypogonadism drugs
43
common drugs to cause gynaecomastia
digoxin and spironolactone
44
cause of gynaecomastia in young person
oestrogen excess
45
cause of gynaecomastia in older male
aromatase activity increases
46
low testosterone increases risk of
osteoporosis
47
most common presentation of female gonadal disease
amenorrohea (absence of periods)
48
what is oligomenorrhoea
irregular infrequent periods
49
what is the most common cause of oligomenorrhoea and amenorrhoea
polycystic ovary syndrome
50
premature menopause before the age of 40 is called
premature ovarian insufficiency
51
what is a cause of premature ovarian insufficiency, frequently with delayed puberty and primary amonohorrea
turners syndrome
52
phenotype is a female with female external genitalia
turners
53
features of turners
short stature, webbing of the neck, wide carrying angle of the elbows, high arched palate and low seat ears
54
what confirms diagnosis of premature ovarian insuffiecny
elevation of LH and FSH to menopausal levels
55
if oestrogen deficiency is not reversed in premature ovarian insuffiency what should be given
hormone replacement therapy
56
increased hair in sex hormone dependent areas is most likely
polycystic ovary syndrome
56
excess hair in sex dependent hormone areas is due to
increased ovarian adrenal androgen production
57
most common cause of hirsutism
polycystic ovary syndrome
58
what is characterised by multiple small cysts within the ovary and and by excess androgen production from the ovaries
polycystic ovary syndrome
59
what is PCOS associated with
hyperinsulinaemia and insulin resistance, hypertension, hyperlipidaemia and increased cardiovascular risk
60
most patients with PCOS present with what
amonehoorhoea/oligomenorrhoea and or hirsutism and acne shortly after starting period
61
should diet and exercise be indicated in polycystic ovarian syndrome
yes
62
what worsens androgen excess and insulin resistance
obesity
63
what is in oral contraceptives
oestrogen
64
increasing SBHG levels does what
reduce free androgens
65
treatment if only symptom if menstrual disturbance
cyclical oestrogen/ progestogen
66
treatment for fertility in PCOS
clomifene or ietrozole
67
what is a strong determinant of timing of puberty
timing of parental puberty
68
GHRH is under inhibitory control by
somatostatin
69
gh binds to a receptor in the
liver
70
-increasing collagen and protein synthesis
- promoting retention of calcium, phosphorus and nitrogen(necessary substrates for anabolism)
-opposing action of insulin
are
metabolic actions from growth hormones
71
gh release is mainly
nocturnal
72
what stimulates gh
stress and exercise
73
what suppresses gh
hyperglycaemia
74
inhibition of GnRH
initiating puberty
75
what peptide plays a crucial role in the regulation of GnRH production and timing of puberty
KISS1R
76
what are low in the prepubertal child
Lh and FSH
77
what is more helpful than current height in measuring growth
height velocity
78
what is associated with short stature in females
turners
79
hypo or hyper thyroids can cause short stature
hypothyroidism
80
chromosomal abnoramlitites that can cause tall stature
klinefelters syndrome and marfans syndrome
81
in obesity are SHBG levels reduced or increased and same with androgens
shbg reduced and androgens increased
82
specific features of acromegaly
prognathism(extension or bulging out of lower jaw), interdental separation, large tongue, spade like hands and feet
83
gh excess causes what in children and what in adults
gigantism in children and acromegaly in adults
84
gigantism and acromegaly are due to gh secreting pituitary tumour called
somatotroph adenoma
85
acromegaly usually occurs
sporadically
86
what is common in acromegaly
sleep apnoea
87
what is very common in acromegaly
headaches
88
how useful is gh levels in acromegaly
may exclude acromegaly if they are undetectable but a detectable value is not diagnostic alone
89
what test for acromegaly is diagnostic if there ice no suppression of gh
glucose tolerance test
90
example of a visual defect in acromegaly
bitemporal hemianopia
91
what do people die from in acromegaly
heart failure, coronary artery disease or hypertension
92
first line therapy in acromegaly
trans-sphenoidal surgery
93
3 receptor targets in acromegaly
pituitary somatostatin receptors
dopamine receptors
Gh receptors
94
side effects of somatostatin analogues eg octreotide and ianreotide
gallstones
95
what drugs are most effective in GH producing or prolactin producing tumours
dopamine agonists
96
growth hormone antagonist
pegvisomant
97
what is mainly controlled by tonic inhibition by hypothalamic dopamine
prolactin
98
what stimulates JAK2
prolactin
99
what does prolactin do
stimulate milk secretion (but not breast tissue development) and inhibits gonadal activity
100
what produces hypogonadism even when the pituitary gonadal axis is intact
prolactin
101
what can these drugs cause:
oestrogen (contraceptive pill)
dopamine antagonists
antidepressants
antiemetics eg metoclopramide
verapamil
102
common signs in hyperprolactinaemia
galactorrhea (nipple milk discharge)
oligomenorrhoea
decreased libido (sex drive)
103
common signs in hyperprolactinaemia
galactorrhea (nipple milk discharge)
oligomenorrhoea
decreased libido (sex drive)
104
how is hyperprolactinaemia confirmed
repeat measurements
105
what can be a cause of hyperprolactinaemia
primary hypothyroidism
106
hyperprolactinaemia is controlled with a dopamine agonist eg
cabergoline
107
in prolactianemia what is done If dopamine agonists aren't working
transphenoidal surgery- only for micro adenoma
108
where is ash synthesised
hypothalamus
109
predominant site of adh/vasopressin
kidneys
110
what does vasopressin do
allows collecting ducts to to become permeable to water
111
vasopressin results
retention of water
112
problems involving vasopressin
diabetes insipidus and SIADH
113
what is a common cause of hyponatraemia in hospital patients
syndrome of inappropriate antidiuretic hormone (SIADH)
114
most common cause of diabetes insidipidus
hypothalamic pituitary surgery
115
excess secretion of dilute urine so compensatory increase in thrust so can lead to dehydration
diabetes insipidus
116
what can mask diabetes insidious
cortisol defiency
117
absent or poorly developed posterior pituitary
DIDMOAD syndrome
118
treatment of choice in cranial DI
synthetic vasopressin called desmopressin
119
polyuria can be helped with
thiazide diuretics
120
water deprivation test for
DI and primary polydipsia
121
psychiatric disturbance characterised by the excessive intake of water
primary polydipsia
122
retention of water and hyponatraemia
SIADH
123
retention of water and hypernatraemia in plasma
DI
124
is there oedema in SIADH
no
125
symptoms of SIADH
vague with confusion, nausea and can lead to coma
126
what is absent in SIADH
hypokalaemia or hypotension
127
management fo SIADH
fluid intake restriction
128
what drug inhibits the action of vasopressin o the kidney and can eb used for SIADH
demeclocycline
129
serum calcium levels are mainly controlled by which 2 things
parathyroid hormone and vitamin D
129
serum calcium levels are mainly controlled by which 2 things
parathyroid hormone and vitamin D
130
mild hypercalcaemia is mainly due to
primary hyperthyroidism
131
what cells secrete parathyroid hormone
chief cells
132
parathyroid levels rise as
serum ionised calcium falls
133
PTH acts to
increase plasma calcium
134
what does these:
increase osteoclastic resorption of bone
increase intestinal absorption of calcium
increase excretion of phosphate
PTH
135
most common cause of excess pTH secretion
primary hyperparathyroidism but adenoma is still common
136
most primary hyperparathyroidism is caused by what
single parathyroid adenomas
137
secondary hyperparathyroidism is compensatory of
hypocalcaemia
138
when is there hypocalacemia often
chronic kidney disease or vitamin D deficient
139
genereal symptoms of hypercalcaermia
tiredness, malaise, dehydration and depression
140
brown tumours occurs in advanced disease of
hyeprcalcemia
141
corneal calcification is a marker of
longstanding hypercalcaemia
142
severe hypercalcemia is usually associated with
malignant disease, hyperparathyroidism, chronic kidney disease, or vitamin D therapy
143
what is the hallmark of primary hyperparathyroidism
hypercalcaemia and hypophosphataemia with detectable PTH LEVELS DURING HYPERCALCAEMIA
144
if undetectable PTH level in context of hypercalcemia need to exclude
malignancy
145
medical management for primary hyperparathyroidism
high fluid intake and replaectn of vitamin d if needed
146
how does acute hypercalaemia present
dehydration, nausea, vomiting,nocturia(causes you to wake up in night to pee), polyuria, drowsiness and altered consciousness
147
treatments for acute severe hypercalcemia
rehydrate
IV Biphosphanates (treatment of choic)
148
what is the major danger after operation
hypocalcemia
149
causes of hypocalcaemia
chronic kidney disease and phosphate therapy (increased phosphate levels)
acute pancreatitis
calcitonin , biphosphanatates
ostemalacis/rickets
surgery around neck
severe vitamin D deficiency
150
most common cause fo hypocalcemia is
chronic kidney disease
151
hypocalcemia presents as
neuromuscular irritability, paraesthesia, anxiety, tetany
152
2 signs of hypocalcemia
chvosteks sign and trousseaus sign
153
what sign is this: gentle tapping over the facial nerves causes twitching of the ipsilateral facial muscles
chvosteks sign
154
what sign is this: inflation of the sphygmomanometer cuff above systolic pressure for 3 min induces titanic spasm of the fingers and wrist
trousseaus sign
155
what may cause prolonged qt interval on ecg
hypocalcemia
156
diagnostic of hypocalcemia
Low serum calcium
157
most appropriate treatment fro hypcalcemia if vitamin d deficient
cholecalciferol
158
presenting features fo insulinoma
Diplopia (seeing double)
sweating, palpitations
confusion
159
classic presentation of insulinoma
fasting hypoglycaemia
160
whiles triad for insulinoma:
symptoms are associated with fasting or exercise
hypoglycaemia is confirmed during these episodes
glucose relieves the symptoms
161
medical treatment for insulinomas
diazoxide
162
what is a problem in acute hepatic failure
hypocalcemia
163
drugs that can cause hypoglycaemia
sulphonylureas
propanolol
164
alcohol inhibits what
gluconeogenesis
165
can alcohol cause hypoglycaemia
yes
166
what is the name given to the simultaneous occurrence of tumours involving a number of endocrine glands
multiple endocrine neoplasias (MEN)
167
men 2 caused by mutations of
RET on chromosome 10
168
all glands are typically involved in
MEN1
169
essence of management in MEN is
annual screening
170
first manifestation of MEN1
hyperparathyroidism
171
useful tumour marker in medullary carcinoma of the thyroid
calcitonin
172
carcinoid syndrome is due to what tumour
neuroendocrine
