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Endocrine Flashcards

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1
Q

The 10 signs of HYPERTHYROIDISM

A

WWE GB TAP DL

Weight loss
Warm Skin/ HEAT INTOLERANCE
Exophthalmos

Goitre (+/- bruit heard via stethoscope)
BRISK REFLEXES

TREMOR
ANXIETY
PALPITATIONS

DIARRHOEA
LID LAG

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2
Q

The three causes of HYPERTHYROIDISM

A

Graves’- autoimmune- distinguishable from others via OCULAR changes and PRETIBIAL MYXOEDEMA

Toxic Multinodular Goitre/ Toxic Solitary Nodule Goitre- Higher risk in old people and females

DE QUERVAIN’s THYROIDITIS- develops after viral infection

  • Transient hyperthyroidism
  • Period of hypothyroidism may follow
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3
Q

Investigations for Hyperthyroidism (4 things)

A

TFTs (LOW TSH, HIGH T3/T4)
US scan of nodules
FNA of solitary nodules to exclude malignancy
Isotope scan to assess hot and cold thyroid nodules

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4
Q

Treatment of Hyperthyroidism (4 things)

A

Symptomatic control-

  • Palpitations and tremors- BETA BLOCKERS
  • Eye symptoms- EYE DROPS for LUBRICATION

Anti-thyroid medication-

  • CARBIMAZOLE
  • PROPYLTHIOURACIL
  • Side effects- AGRANULOCYTOSIS (monitor bloods carefully)

Radioactive iodine ablation-

  • Definitive treatment
  • Patient MUST BE EUTHRYOID before commencing

Surgical- subtotal tyroidectomy

  • Patient MUST BE EUTHYROID before commencing
  • Give patient POTASSIUM IODIDE before surgery as it decreases thyroid gland vascularity
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5
Q

Complications of Hyperthyroidism (4 things)

A

Atrial fibrillation
Cardiomyopathy
High Output Cardiac Failure
OSTEOPOROSIS

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6
Q

Two types of Hypothyroidism and 4 things about each

A

Primary hypothyroidism

  • Iodine deficiency
  • Hashitmoto’s autoimmune
  • Post-thyroidectomy/ radioactive iodine therapy
  • Drug-induced (Lithium/ overtreatment of hyperthyroidism)

Secondary hypothyroidism

  • Dysfunction of hypothalamus-pituitary axis
  • Pituitary ADENOMA
  • Sheehah’s Syndrome (ischaemic necrosis of the pituitary gland after child birth)
  • Inflitrative disease (TB/ Haemochromatosis)
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7
Q

8 Signs and Symptoms of Hypothyroidism

A
  • Weight GAIN
  • Cold skin/ Cold intolerance
  • Constipation
  • DELAYED reflexes
  • Bradycardia
  • Depression
  • THINNING of SKIN
  • DRY SKIN
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8
Q

Investigations for Hypothyroidism

A

FBC (anaemia)

TFTs (HIGH TSH, LOW T3/T4)

Guthrie Test for congenital screening

Cholesterol (as it is a complication)

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9
Q

Treatment for Hypothyroidism

A

Lifelong treatment with LEVOTHYROXINE

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10
Q

Complications of Hypothyroidism

A

Hypercholesterolaemia
Hyperthyroidism from overtreatment
MYXOEDEMA COMA

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11
Q

4 types of Thyroid Carcinomas

A

Papillary-

  • Most common
  • Spreads to CERVICAL LYMPH NODES
  • GOOD prognosis

Follicular-

  • More common in LOW IODINE areas
  • Spreads to BONES and LUNGS
  • GOOD prognosis

Medullary-

  • Arises from PARAFOLLICULAR CELLS
  • CALCITONIN is a biochemical marker
  • Associated with M.E.N.
  • Spreads to LYMPH NODES

Anaplastic-

  • Affects older patients
  • AGGRESSIVE
  • Spreads to LYMPH NODES as well
  • POOR PROGNOSIS
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12
Q

Investigations of Thyroid Carcinoma

A
  • Bloods to assess TFTs
  • FNA Cytology
  • Diagnostic Lobectomy
  • Thyroid isotope scan (hot nodules less likely to indicate malignancy)
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13
Q

Treatment for the 4 Thyroid Carcinomas

A

Papillary/ Follicular-
- Lesion<1cm- Thyroid Lobectomy then lifelong LEVOTHYROXINE and ANNUAL THYROGLOBULIN measurements

  • Lesion>1cm- Total Thyroidectomy/ Radio-iodine ablation then lifelong LEVOTHYROXINE and ANNUAL THYROGLOBULIN measurements

Medullary-
- Same as lesion>1cm and SCREEN FAMILY for M.E.N.

Anaplastic- Debulking surgery and palliative care unfortunately

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14
Q

Complications of Thyroid Carcinoma

A

HYPOTHYROIDISM

Complications of surgery-

  • Damage to Recurrent Laryngeal Nerve
  • HYPOPARATHYROIDISM
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15
Q

The two textbook risks of Diabetes Type 1 and Type 2

A

Type 1- KETOACIDOSIS

Type 2- HYPEROSMOLAR STATE

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16
Q

3 extra causes of DIabetes

A

CHRONIC Pancreatitis
Gestational Diabetes
Cystic Fibrosis

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17
Q

6 signs of GENERAL DIABETES and 4 signs of TYPE 1

A
  • Polyuria
  • Polyphagia
  • Polydipsia
  • Blurred Vision
  • Glycosuria
  • Sign of MICROVASCULAR and MACROVASCULAR disease
  • Acetone breath
  • WEIGHT LOSS
  • KUSSMAUL BREATHING
  • Nausea and Vomiting
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18
Q

Investigations of Diabetes

A

HbA1c>6.5%
Fasting Plasma glucose>7mmol/L

FOR borderline cases-
- Impaired glucose tolerance test- Fasting plasma glucose <7mmol/L

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19
Q

Treatment of Diabetes

A
  • Dietary advice
  • Smoking Cessation
  • Decrease alcohol intake
  • Regular blood glucose and HbA1c monitoring
  • Encourage exercise

ANTIDIABETIC AGENTS

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20
Q

4 Microvascular and 4 Macrovascular Complications of diabetes

A

Microvascular-

  • Nephropathy
  • Peripheral neuropathy
  • Retinopathy
  • Erectile dysfunction

Macrovascular-

  • Hypertension
  • Increased risk of STROKE
  • MI
  • Diabetic foot
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21
Q

7 Antidiabetic Agents

Study These Flashcards
A

Biguanides (Metformin)

Sulfanylureas

Meglitinides

Thiazolidinediones

Incretins (Exenatide)

Incretins (Saxagliptin)

Alpha-glucosidase

Amylin analogues

22
Q

Biguanides

  • Mechanism
  • Uses
  • Side effects
  • Contraindications
  • Drug interactions
Study These Flashcards
A

Mechanism-

  • Increase in PERIPHERAL insulin resistance
  • Increase in GLUCOSE UPTAKE into skeleton
  • Decrease in HEPATIC GLUCOGENESIS
  • Decrease in INTESTINAL GLUCOSE ABSORPTION

Uses-

  • POI
  • T2 DM

Side effects-

  • Lactic ACIDOSIS
  • GI DISTURBANCES
  • Nausea/ Vomiting

Contraindications-
- Renal/ Cardiac/ Hepatic/ Respiratory Failure

Drug Interactions-

  • ACE inhibitors
  • Alcohol
  • NSAIDs
  • Steroids
23
Q

Sulphonylureas and Meglitinides (-glinides)

  • Mechanism
  • Uses
  • Side effects
  • Contraindications
  • Drug interactions
Study These Flashcards
A

Mechanism-
- Block POTASSIUM CHANNELS on PANCREATIC BETA CELLS- stimulating INSULIN RESISTANCE

Uses-
- T2 DM

Side effects-

  • Hypoglycaemia (extreme glucose control)
  • Weight gain
  • GIT disturbances (SULPHONYLUREAS)

Contraindications-

  • Hepatic failure
  • Pregnancy and Breastfeeding
  • Renal failure/ Porphyria (SULPHONYLUREAS)

Drug interactions (SULPHONYLUREAS (same as BIGUANIDES))-

  • ACE inhibitors
  • Alcohol
  • NSAIDs
  • Steroids

Drug interactions-

  • CICLOSPORIN
  • TRIMETHOPRIM
  • CLARITHROMYCIN
24
Q

Thiazolidinediones (-glitazones)

  • Mechanism
  • Uses
  • Side effects
  • Contraindications
  • Drug interactions
Study These Flashcards
A

Mechanisms-
- Activates NUCLEA PPAR (receptor)

Uses-T2 DM

Side effects-

  • Hypoglycaemia
  • Weight gain
  • HEPATOTOXICITY

Contraindications-

  • TYPE 1 DM
  • LIVER DISEASE
  • HEART FAILURE
  • BLADDER CANCER

Drug interactions-

  • RIFAMPICIN
  • Paclitaxel
25
Exenatide (INCRETIN) - Mechanism - Uses - Side effects - Contraindications - Drug interactions
Mechanism- - Analogue of GLP-1 (glucagon-like peptide) Uses- T2 DM Side effects- - GIT disturbances - Acute PANCREATITIS Contraindications- - --> M.E.N. - --> Thyroid cancer Drug interactions- - Bexarotene
26
Saxagliptin (INCRETIN) - Mechanism - Uses - Side effects - Contraindications - Drug interactions
Mechanism- - Inhibits DPP-4 (dipeptidul peptidase Uses- T2 DM Side effects- - GIT disturbances - UTI/ Respiratory infection - HEPATOTOXICITY - Peripheral oedema Contraindications- - History of HYPERSENSITIVITY REACTIONS Drug interactions- - THIAZOLIDINEDIONES
27
Only one of the seven drugs that can be used in T1 DM
Amylin analogues (Pramlintide)
28
Antidiabetics that don't cause GI disturbances
Thiazolidinediones (glitazones) Meglitinides (glinides)
29
Antidiabetics that shouldn't be used in: - Heart failure - Renal failure - Respiratory failure - Hepatic failure
Heart failure- - Biguanides - Thiazolidinediones (glitazones) Renal failure- - Biguanides - Sulphonylureas Respiratory failure- - Biguanides Hepatic failure- - Biguanides - Sulphonylureas - Meglitinides (glinides)
30
Insulin Types ``` Rapid acting- Short acting- Intermediate acting- Long acting- Biphasic- ```
LSIGI ``` Insulin LISPRO SOLUBLE Insulin ISOPHANE Insulin Insulin GLARGINE Biphasic ISOPHANE Insulin ```
31
The two Tyrosine Kinase receptors (involved in insulin action)
MAP KINASE- cell growth/ proliferation PI-3K- transport of GLUT-4 to cell surface membrane- responsible for protein, lipid and glucose synthesis
32
4 side effects of Insulin
Weight gain Hypoglycaemia LOCALISED LIPOATROPHY HYPOKALAEMIA
33
5 drug interactions of INSULIN
LEVOTHYROXINE- decreases effects of insulin THIAZIDE DIURETICS- decreases effects of insulin CORTICOSTEROIDS- decreases effects of insulin REPAGLINIDE (anti-diabetic)- increases risk of HYPOGLYCAEMIA and MYOCARDIAL INFARCTION MAO INHIBITORS- may increase insulin secretion
34
Causes of Cushing's- ACTH independent, ACTH dependent and one other
Prescription of GLUCOCORTOIDS for ASTHMA ACTH DEPENDENT- - Occurs when ACTH produced from a pituitary ADENOMA - Use low dose DEXAMETHASONE test to confirm - ECTOPIC ACTH production - like from SMALL CELL CANCER ACTH INDEPENDENT (CARS) - Cancer (adrenal carcinoma) - Adrenal nodular hyperplasia - Rare cause (McCune-Albright Syndrome) - Steroid use
35
Signs and Symptoms of Cushing's (10 things)
- Moon face - Purple striae - Buffalo hump - Central obesity - Proximal muscle wasting - Vertebral collapse - Acne - HYPERTENSION - HYPERGLYCAEMIA - PSYCHOSIS
36
Investigations for Cushing's
- URINARY FREE CORTISOL - LOW and HIGH DEXAMETHASONE suppression test - CXR to look for LUNG CANCER and VERTEBRAL COLLAPSE - Dual Energy X-ray (DEXA) scan
37
Treatment of Cushing's
- DECREASE ALCOHOL Medical- - KETOCONAZOLE - METYRAPONE - MITOTANE - Treat complications such as hypertension and diabetes mellitus Surgery- - TRANS-SPHENOIDAL SURGERY to remove PITUITARY ADENOMA - BILATERAL ADRENALECTOMY to remove ADRENAL ADENOMA
38
7 Complications of Cushing's
- Diabetes mellitus - Hypertension - Striae formation - Cataracts - Osteoporosis - ULCERS - IMMUNOSUPPRESSION
39
3 Functions of Cortisol
- mAke glucose in liver - Anti-stress pathway - Anti-inflammatory pathway
40
Causes of PRIMARY ADRENAL DEFICIENCY (ADDISON's DISEASE)
MAIL- - Metastases from breasts, lungs and renal cancers - Autoimmune - Infections (TB most common) and CMV in HIV patients) - Lymphomas + Postadrenalectomy
41
Causes of SECONDARY ADRENAL DEFICIENCY
Prolonged PREDNISOLONE use Pituitary adenoma SHEEHAN's SYNDROME
42
7 Signs and Symptoms of Adrenal Deficiency
- BODY HAIR LOSS - SKIN PIGMENTATION - POSTURAL HYPOTENSION (BP drops when standing up) - Unintentional weight loss - Myalgia - DEPRESSION - Nausea/ Vomiting
43
Investigations in Adrenal Deficiency
- ACTH and cortisol measurements - Insulin tolerance tests - SHORT SYNACTHEN TEST Blood Tests- - LOW Na/ HIGH K - SERUM CALCIUM Radiology- - CXR- look for LUNG CANCER - CT and MRI scan of adrenal glands
44
Complications of Adrenal Deficiency
- ALOPECIA - HYPOGLYCAEMIA - HYPERKALAEMIA - EOSINOPHILIA
45
Conditions that Addison's disease is associated with
3PGH - Pernicious anaemia - Premature ovarian failure - Polyglandular syndrome - GRAVES' - HASHIMOTO's
46
5 parts of ADRENAL CORTEX and MEDULLA (from outside to inside)
CAPSULE- - In= mesoderm ZONA GLOMERULOSA- - Out= ALDOSTERONE ZONA FASCICULARIS- - Out= CORTISOL ZONA RETICULARIS- - Out= ANDROGENS MEDULLA- - In= neural crest - Out= ADRENALINE/ NORADRENALINE
47
Causes of Acromegaly (results from excessive growth hormone)
- PITUITARY ADENOMA- most common | - GHRH production from BRONCHIAL CARCINOID
48
Signs and Symptoms of ACROMEGALY
- LOWER PITCH OF VOICE - CARPAL TUNNEL SYNDROME - Increased Jaw/ Hand/ Tongue size - Ask to see old photos to compare appearances
49
Investigations in Acromegaly
- --> Bloods- - GH levels - IGF 1 levels (raised in acromegaly) - HIGH PROLACTIN ECG and ECHO to assess for cardiac complications ---> Visual field testing to test for BILATERAL HEMIANOPIA
50
Treatment for Acromegaly
- Inform patients bone changes will NOT REVERT after TREATMENT Medical- - Somatostatin analogues (OCTREOTIDE) - Dopamine agonists (CABERGOLINE) - --> GH antagonists (PEGVISOMANT) --->Surgery- TRANS-SPHENOID surgical excision of the ADENOMA
51
Complications of Acromegaly
- Hypertension - Diabetes - Increased risk of colon cancer - Increased risk of cardiovascular disease - Erectile Dysfunction - Postsurgical complications (infection/ CSF leak)

Medicine (15 decks)

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