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Flashcards in ENDOCRINE SYSTEM Deck (151):
1

what percentage of all diabetes sufferers have diabetes type 1?
a) 5%
b) 10%
c) 50%
d) 100%

b) 10%

2

which immune complexes is diabetes type 1 associated with?

HLA

3

what occurs to the pancreas in type one diabetes?

beta cell destruction
absolute insulin deficiency

4

what enzyme is used in diagnostic antibody testing for DMT1?

Glutamate acid dehydrogenase

5

give 2 risk factors for diabetes type 1

family history
other autoimmune conditions

6

what 2 substances will be present in the urine of a patient with DMT1?

ketones
glucose

7

how do DMT1 patients normally first present?

Diabetic ketoacidosis

8

give 2 physiological features of a DKA

ketones used for gluconeogenesis
hyperglycaemia
metabolic acidosis

9

what will be present to smell on the breath of someone with DMT1?

ketones on breath

10

what causes polydipsia/polyuria in DMT1?

osmotic diuresis

11

what diagnostic test would you use to test for DMT1?

HBA1C

12

what would be first line treatment for a DKA and DMT1 in general?

insulin

13

why would you give potassium in treatment for a DKA?

to prevent rebound hypokalaemia in response to hyperkalemia in DKA

14

why don't DMT1 patients get AKI as soon as expected in a DKA?

polyuria is a protective factor for the kidney

15

why does caution have to be exercised in giving fluids in a DKA?

to avoid cerebral overload as brain hydration is maintained

16

in relation to insulin, what two things can cause DMT2?

increased resistance
decreased secretion

17

name 2 drugs that are associated with DMT2

glucocorticoids
thyroxine
olanzepine (antipsychotic can increase weight)
Diazoxide

18

give 4 symptoms of DMT2

polydipsia
polyuria
weight loss
blurred vision/visual disturbances
fatigue

19

name 2 diagnostic tests used for DMT2

fasting glucose
random glucose
HBA1C
Glucose tolerence test

20

what is first line treatment for DMT2?

metformin

21

what time of drug is metformin?

biguanide

22

how does metformin work?

increases insulin sensitivity

23

give 2 side effects of metformin

anorexia (can be good thing in obese patients)
D&V
reduced B12 absorption

24

what is second line treatment for DMT2?

sulfonylureas

25

how do sulphonylureas work?

increase insulin secretion from beta cells

26

give 2 examples of sulphonylureas

gliclazide
glibenclamide
tolbutamide

27

give a side effect of sulfonylureas

weight gain and hypoglycaemia

28

what is third line treatment for diabetes?

thiazolidinedione (glitazone)

29

what does glitazone do?

increases insulin sensitivity

30

who does cushion's syndrome most commonly affect?
a) middle aged women
b) middle aged men
c) old women
d) old men

a) middle aged women

31

what causes cushing's syndrome?

hyperadrenocorticolism
over production of glucocorticoids
long term corticosteroid treatment e.g. autoimmune/inflamm
adrenal carcinoma/adenoma
Carney Complex
Cushings disease

32

what causes 90% of cushings cases?

ACTH over production from pituitary gland & adrenal hyperplasia

33

where in the body except the pituitary can ACTH be produced?

Ectopic ACTH production due to tumour formation ( benign and malignant)
Thyroid
Lung= small cell lung cancer
Pancreas
Thymus glands

34

what 5 things make up Carney Complex ?
Multiple Endocrine Neoplasia (men)

adrenal hyperplasia
pituitary adenoma
myopia
schwannoma
testicular tumour

35

what is the point of an overnight dexamethasone suppression test in the diagnosis of Cushing's?

giving body steroids should cause serum levels to decrease in a normal patient. If don't can be cushings

36

why might you suggest a CT/MRI in the diagnosis of Cushing's?

of adrenal glands to check for hyperplasia

37

give 2 types of weight gain that are characteristic of Cushing's

central obesity
moon face

38

give 2 skin symptoms of Cushing's

purple abdominal striae
thin bruising skin
poor wound healing

39

give two genitor-reproductive symptoms of Cushing's

amenorrhoea
impotence
libido loss

40

give 2 bone symptoms of Cushing's

osteoporosis
fractures

41

what is hirtuism? (symptom of Cushing's)

hair growth on face

42

give 2 drugs that can be given in treatment of Cushing's by decreasing plasma cortisol

aminoglutethimide
ketoconazole
metyrapone

43

excess of what can cause pseudo-cushings?

alcohol

44

which gender is thyroid problems most common in?

females

45

what causes 2/3 of hyperthyroidism?

grave's disease

46

what causes Grave's disease?

IgG antibodies bind to TRH receptors and cause excess hormone and thyroid hyperplaseia

47

give 3 triggers of grave's

infection
stress
childbirth

48

what other conditions is Grave's associated with?

Addisons, DMT1 and Vitiligo

49

give 4 other causes of hyperthyroidism

toxic multi nodular goitre
toxic adenoma of thyroid gland
follicular carcinoma
sub acute (de-quervain's) thyroiditis (self limiting)
choriocarcinoma (ocarina teratoma w thyroid tissue)

50

Out of these 3 hormone,TSH/T3/T4 which would be low and which would be high in hyperthyroidism?

low TSH
high T3, T4

51

give 3 symptoms characteristic of Grave's disease

exophthalmus
pretibial myxoedema
thyroid acropatchy
thyroid bruis
Clubbing

52

what is a risk of thyroidectomy surgery?

recurrent laryngeal nerve damage

53

give 5 complications of hyperthyroidism

HF
Atrial fibrillation
thyroid eye disease
osteoporosis
gynaecomastia

54

what is hashimoto's thyroiditis?

autoimmune destruction of thyroid gland

55

give 2 drugs which can cause hypothyroidism

amiodarone
lithium
iodine
carbimazole

56

Name 2 genetic syndromes that can cause hypothyroidism

Pended's
Turner's

57

what is pendred's syndrome?

thyroid problems & bilateral sensorineural deafness

58

what is Turner's syndrome?

female missing one sex chromosome (45X)

59

what is the cause of secondary hypothyroidism?

pituitary failure

60

which of these indicates thyroid failure and which indicates pituitary failure?
a) high TSH, low T3/4
b) low TSH, low T3/4

a) thyroid failure
b) pituitary failure

61

Give 5 limb-related symptoms of hypothyroidism

myxoedema
myalgia
arthralgia
paraesthesia in hands
neuropathy (carpal tunnel)
Slow reflexes due to cerebellar ataxia

62

give 2 facial symptoms of hypothyroidism

face swelling
hair loss outer 1/3 of eyebrow

63

give 2 complications of hypothyroidism in pregnancy

pre-eclampsia
low birth weight
premature birth

64

What are the causes of thyroid nodules?

cyst
thyroiditis
tumour
overgrowth of normal tissue
Iodine deficiency

65

how many of the population have palpable goitres?
a) 1%
b) 9%
c) 30%
d) 70%

b) 9%

66

how can smoking cause a goitre

thiocyanate in cigarettes interferes with body's use of iodine

67

how many goitres are thyroid cancer?
a) 1 in 10
b) 1 in 20
c) 1 in 100
d) 1 in 200

b) 1 in 20

68

give 5 differential diagnoses for goitre

pharyngeal pouch
tumour
cyst
submandibular stones
carotid aneurysm/tortuous (pulsatile)

69

What are the ranges of HB1ac for DMT1?
Normal, pre diabetic and diabetic?

<42mmol/ml = normal
42-47mmol/ml = pre diabetic
>48mmol/ml = diabetic

70

How can you diagnose diabetes other than using the HB1ac?

2 out of 3 on 2 separate occasions
Fasting glucose >7
Random glucose >11
Glucose tolerance test

71

What does the HB1ac test look at?

The average amount of glucose in your blood in the last 2 to three months

72

What is DKA?

When you body lacks insulin it breaks down fat to produce and high level of glucose also causes hyperglycemia. Can be fatal

73

What are the physical symptoms a DMT1 patient might get?

Blurred vision
Fatigue
Weight loss
Feel very thirsty
Increase urine output especially at night
Takes longer for cuts and grazes to heal
Itchiness around the genital area

74

Differential diagnosis of DMT1?

Type 2
Maturity onset diabetes of the young

75

What is MODY?

It is caused by single gene passing through family
Diabetes under 25 with parents having diabetes

76

What lifestyle factors should you consider with DMT1?

Reduce weight
Healthy eat
No smoking
Exercise
Reduce BP

77

What are risk factors of DMT2?

Age
Obesity
Diabetes or pre diabetes while pregnant
5 * more common if South asian or African Carribean (over 25)
First degree relative with DMT2

78

Before you have medical treatment what should you advice patients to do who have DMT2?

Reduce weight
More exercise
Eat healthier= less sugar and fat. More fibre

79

What should you monitor regularly in a patient with DMT?

Eyes and feet

80

What treatment do you give if the first 3 lines of treatment for DMT2 don't work?

Insulin

81

What are thyroid nodules?

Solid/fluid filled lumps in thyroid gland

82

What are the risk factors for thyroid nodules?

Smocking
FHx
Amiodarone and lithium side effects

83

What are the symptoms of thyroid nodules

Often asymptomatic
Release thyroxine which is a causes by hyperthyriodism

84

What are the signs of thyroid nodules?

On swallowing see movement of nodules
Enlarged thyroid

85

How can you diagnose thyroid nodules and goitre?

Often incidental
Physical examination
US
TFT's and autoantibodies
Fine needle aspiration
Radioactive iodine scan

86

What is red flag symptom of thyroid nodule?

Stridor with thyroid mass

87

What developments of thyroid would indicate urgent referral?

Child with thyroid nodule
Painless thyroid mass that has enlarged rapidly
Hoarseness or change in voice with goitre
Palpable cervical lymphadenopathy

88

What is treatment for thyroid nodule?

Treat underline cause
Excision if malignant
Treat hyperthyroidism

89

What are the two type of goitre?

Diffuse smooth goitre
Nodular goitre

90

What are the causes of diffuse smooth goitre?

Iodine deficiency
Graves disease

91

What is a goitre?

Abnormal swelling of thyroid gland

92

What are the causes of goitre?

Pregnancy
Menopause
Hypo/hyperthyriodism
thyroid cancer (1 in20 of goitres)
smoking
Iodine deficiency
Drugs: lithium and immunosuppressors

93

What can be a serious side effect of goitre?

Can compress trachea or esophagus

94

What is cushings syndrome?

When the body produces to much cortisol

95

What type of hormone is cortisol and what is its main aim?

It's the stress hormone and maintains homeostasis

96

What is cushings disease and how does it cause cushings syndrome?

It is hyperplasia and tumour growth on the pituitary gland causing excess production of ACTH which leads to excess production of cortisol

97

How does Corticotroponin releasing hormone from the hypothalamus cause Cushing's?

While rare it can cause excessive production of ACTH by the pituitrary gland

98

What does ACTH stand for?

Adrenocorticotropic hormone

99

What are non ACTH causes of cushings syndrome?

Excessive glucocorticoid
Adrenal adenoma and carcinoma
Long term corticosteroids use

100

What is the ratio of female to male in cushings?

5:1

101

What group of people have high incidence of cushings?

Diabetics
Osteoporsis group
Hypertension
Obese people

102

How long free does the urine have to be of cortisol to not have cushings?

24hours

103

What happens to your mood in cushings?

Depression and fatigue

104

What happens to your BP and glucose levels in cushings?

Hypertension
Hyperglycaemia

105

What is sub acute (de-quervain's) thyroiditis (self limiting)?

Self limiting painful goitre
Causes rise in erythrocyte sedimentation rate and no radio iodine uptake

106

What are the risk factors of hyperthyriodism?

Fhx
Pregnancy
Female
High iodine uptake
HAART
Child birth
Trauma and surgery to thyroid
smoking

107

Why does high uptake of iodine increase chance of hyperthyriodism?

Increases production of thyroxine

108

What are the physical signs and symptoms of hyperthyroidism?

Weight loss
Heat intolerance
Hair loss
Goitre
Sweaty
Over active
Diarrohea
Labile emotions

109

What happens sexually in hyperthyroidism?

Oligomenorrhoea
Infertility

110

What heart related symptoms do you get in hyperthyroidism?

Palpitations (AF, SVT) and tremor

111

What rare signs and symptoms do you get in hyperthyroidism?

Alopecia
Uriticaria
Physiocosis
itch

112

What drugs would you give to prevent thyroid production?

Propanolol
Carbimaazole

113

What are common side effects of hypothyriodism?

Weight gain
Constipation
Lethargy
Cold intolerance
Amenorrhoea
Hair loss in outer 1/3rd of eyebrow

114

How mentally does hypothyriodism effect a patient?

Depression
Lipid loss
Difficulty concentrating

115

What heart complications can you get in hypothyriodism?

Pericardial effusion

116

What is the treatment of hypothyriodism?

Levothyroxine

117

What drugs does Levothyroxine interact with?

Carbamexapine
Phenytoin
Rifampicin
Iron tablet

118

What complication of hypothyriodism increases chance of CVD?

High cholesterol levels

119

What is the role of TSH and what organ is it released from?

It is released from the anterior pituitary gland and it controls the production of T3 and T4 from the thyroid gland

120

What is TRH and what organ is it released from?

Thyrotropin-releasing hormone (TRH) from the hypothalamus causes the release of TSH

121

In response to TSH how much T3/T4 is produced by the thyroid gland?

More T4 to T3

122

Where is T4 activated to T3?

Peripherals in the kidney and liver

123

Is all of the T4 and T3 in a active state?

No only the hormones that are free are in the active state. Most of T4 and T3 are bounded to proteins (thyroglobulin)

124

What is the effect of circulating T4 and T3 on the TSH and TRH?

Circulating T4/3 depresses the release of TRH and TSH from hypothalamus and anterior pituitary respectively

125

What is the function of the parathyroid gland?

4 tiny glands that sit behind the neck and controls the level of calcium by releasing parathyroid hormone (PTH)

126

How does the release of PTH increase the levels of calcium in the body?

Breaks down bone and releases the body
Increases the ability to absorb calcium from food
Increase the kidney's ability to hold onto calcium instead of it being excreted via urine

127

What in parathyroid adenoma?
What does it cause

Benign tumour of the parathyroid gland
Increase release of Calcium from the bones causing hypercalcaemia

128

What are the symptoms of parathyroid adenoma?

Primary hyperparathyroid symptoms
Kidney stones
Depression due to hormone imbalance
Constipation
Fatigue

129

What is the diagnosis of Pt adenoma?

Blood: PTH and calcium levels

130

What is the treatment of PT adenoma and how effective is it?

Surgery for removal of affected gland and 95% successful

131

What is hyperparathyroidism?

Inappropriate activity of the parathyroid gland causing ^^PTH

132

What is primary hyperparathyroidism and what is the cause?

PTH levels is not determined by calcium serum levels. hypercalcaemia is the outcome
Caused by PT adenoma or dysfunction of the PT

133

What is secondary hyperparathyroidism and what is the cause?

It is when calcium levels do not respond to changes in PTH, causing hypocalcaemia
Parathyroid try to respond by increase the production of PTH
Caused by vitamin D3 deficiency

134

What causes Vitamin D3 deficiency?

CKD
Lack of sunshine
Dietary
Inability to convert from cholesterol

135

What is tertiary hyperparathyroidism?

It is long term secondary that leads to hyperplasisa and lowered response

136

What are symptoms of primary hyperparathyroidism?

Osteoporosis
Bone deformity
Bone fracture
Bone, muscle and abdo pain
Kidney stones
Urinary calculi
Cognitive impairment

137

What are symptoms of secondary hyperparathyroidism?

Rickets
Osteomalacia--> soften bone
Renal osteodystrophy

138

what is renal osteodystrophy?

It is weekend bones due to kidney inability to maintain normal calcium and phosphate levels

139

What is the diagnosis of a blood test if their is either :
a) high PTH and Calcium
b) high PTH but low Calcium

a) priamry
b) secondary

140

What is the treatment for
a) primary
b) secondary

a) surgery
b) treat the Vitamin D3 deficiency

141

What is addisons?

Adrenal gland insufficiency
Do not produce enough cortisol or aldosterone

142

What are the causes of addisons disease?

Developed world = autoimmune disease
Developing = TB
Sepsis and bleeding into the gland

143

What are the 4 main functions of cortisol?

Help to regulate BP, immune system
Help to balance insulin regulatory effects on blood glucose level
Help to control bodies response to stress

144

What is the function of aldosterone?

Helps to regulate salt levels in blood and control BP

145

What are the signs and symptoms of addisons disease?

Weight loss and loss of apeptite
Weakness
Light headness
Low blood pressure
Skin hyperpigmintation
Abdo pain and fatigue
Anxiety and low mood changes
the need to urinate frequently
increased thirst
craving for salty foods
Dehydration

146

What is adrenal crisis?

Low BP and syncope
Low back pain
Hyponatremia, hypokalaemia, hypercalcaemia, hypoglycaemia
Triggered by stress (injury, surgery, infection etc.)

147

What do you see in ABG for addisons patients?

Metabolic acidosis

148

What is treatment for addisons disease?

Hormone replacement e.g. hydrocortisone, prednisolone, fludrocortisone
o Normally oral
o Can have injection & dextrose in crisis
High salt diet

149

What are normal glucose levels in the
a) urine
b) blood?

A) 0-0.8mmol/L
b) 3.9-5.5 mmol/L

150

What is diabetes insipidus?

When you produce large amounts of urine and are very thirsty. Not linked to DM

151

When is oral glucose tolerance test normally used?

Diabetes in pregnancy