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Y3 CORE CONDITIONS > ENDOCRINE SYSTEM > Flashcards

ENDOCRINE SYSTEM Flashcards

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1
Q

what percentage of all diabetes sufferers have diabetes type 1?

a) 5%
b) 10%
c) 50%
d) 100%

A

b) 10%

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2
Q

which immune complexes is diabetes type 1 associated with?

A

HLA

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3
Q

what occurs to the pancreas in type one diabetes?

A

beta cell destruction

absolute insulin deficiency

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4
Q

what enzyme is used in diagnostic antibody testing for DMT1?

A

Glutamate acid dehydrogenase

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5
Q

give 2 risk factors for diabetes type 1

A

family history

other autoimmune conditions

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6
Q

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

A

ketones

glucose

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7
Q

how do DMT1 patients normally first present?

A

Diabetic ketoacidosis

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8
Q

give 2 physiological features of a DKA

A

ketones used for gluconeogenesis
hyperglycaemia
metabolic acidosis

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9
Q

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

A

ketones on breath

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10
Q

what causes polydipsia/polyuria in DMT1?

A

osmotic diuresis

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11
Q

what diagnostic test would you use to test for DMT1?

A

HBA1C

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12
Q

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

A

insulin

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13
Q

why would you give potassium in treatment for a DKA?

A

to prevent rebound hypokalaemia in response to hyperkalemia in DKA

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14
Q

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

A

polyuria is a protective factor for the kidney

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15
Q

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

A

to avoid cerebral overload as brain hydration is maintained

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16
Q

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

A

increased resistance

decreased secretion

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17
Q

name 2 drugs that are associated with DMT2

A

glucocorticoids
thyroxine
olanzepine (antipsychotic can increase weight)
Diazoxide

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18
Q

give 4 symptoms of DMT2

A 
polydipsia
polyuria
weight loss
blurred vision/visual disturbances
fatigue
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19
Q

name 2 diagnostic tests used for DMT2

A

fasting glucose
random glucose
HBA1C
Glucose tolerence test

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20
Q

what is first line treatment for DMT2?

A

metformin

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21
Q

what time of drug is metformin?

A

biguanide

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22
Q

how does metformin work?

A

increases insulin sensitivity

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23
Q

give 2 side effects of metformin

A

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

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24
Q

what is second line treatment for DMT2?

A

sulfonylureas

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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

Y3 CORE CONDITIONS (15 decks)

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