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Flashcards in Endocrinology Deck (52):
1

3 basic problems with endocrine system?

- excess hormones - widespread effect
- reduced hormones - widespread effect
- physical gland enlargement - mass pressure/effect

2

pituitary gland produces what hormone that encourages the thyroid to produce T4/T3?

TSH

3

Thyroxine excess is a disease of the thyroid causing?

hyperthyroidism
thyrotoxicosis

4

Thyroxine lack is a disease of the thyroid causing?

hypothyroidism

5

Thyroid mass changes is a disease of the thyroid causing?

Goitre

6

incidence of hyperthyroidism?

2-3% of women
0.2% men
age common = 20-40 years

7

most common causes of hyperthyroidism?

autoimmune e.g graves disease = most common
goitre or toxic adenoma
pituitary driven

8

symptoms of hyperthyroidism?

sweating, heat intolerance
irrtable, poor sleep, anxiety, palpitations
excess appetite, weight loss, diorrhea
breathlessness

9

signs of hyperthyroidism?

warm moist skin
tachycardia - irregular heart rate
increased blood pressure, heart failure
fine tremor
goitre

10

what is graves disease?

eye disease
exopthalmus
opthalmaplegia
lid lag/retraction
loss of visual activity

11

signs of graves disease?

pretibial myxoedema

12

diagnose graves disease?

clinical
blood tests - thyroid function - low TSH, high T3/4, autoantibodies
radiology sometimes

13

management of graves disease?

anti thyroid drugs - carbimazole, propylthiouracid
beta blockers - control symptoms while other tx
surgery - control disease first, poss eye surgery
radioactive iodine - caution if youner/pregnant/breastfeeding

14

incidence of hypothyroidism?

2% women
0.2% men
mean age of diagnosis = 60 yrs

15

causes of hypothyroidism?

autoimmune most common = destructive
iatrogenic - surgery, radioiodine
iodine deficiency - rare - iodised salt/fish, poor mountainous areas
rarely pituitary disease

16

symptoms of hypothyroidism?

cold intolerance
weight gain
constipation
hoarse voice
puffed face/extremities
mental slowness/poor memory
hair loss

17

signs of hypothyroidism?

slow pulse
large tongue
deep voice
thin/dry hair
loss of eyebrows
goitre
coarsening of features
acute - rare - coma - hypothermia

18

diagnosis of hypothyroidism?

clinical
blood tests - thyroid function tests - high TSH, low T4/T3
auto antibodies
radiology

19

management of hypothyroidism?

replacement
thyroxine
levothyroxine

20

what is goitre?

thyroid masses

21

types of goitre?

- no association with intrinsic thyroid disease - simple cysts/adenomas - iodine deficiency

- associated with intrinsic thyroid disease - autoimmune, toxic multi nodular goitre/adenoma

- Malignant = rare

22

Goitres can cause?

retro sternal extension = dysphagia/breathing difficulties

23

what is an ominous sign of goitre?

look for lymph node enlargement

24

goitre investigations?

radiology - ultrasound/radioisotope scans
fine needle aspiration
blood tests

25

treatment of goitre?

remove underlying cause
may need surgery

26

anti thyroid drug carbimazole can cause what orally?

neutropenia
taste distrubances

27

types of adrenal disease?

- excess corticosteroid - Cushings
- deficient corticosteroid production - Addisons

28

what is Cushings syndrome?

excess ACTH caused by pituitary adenoma
or ectopic production by lungs = cancer

29

excess corticosteroids caused by?

adrenal adenomas
carcinomas
iatrogenic

30

Cushings syndrome has what systemic risk factors?

can cause high bp
diabetes
pt prone to infection

31

what is Addison's disease?

- caused iatrogenically by withdrawl of steroids after long term use
- hypopituitarism - b/c cancer, infection, vascular, trauma
- adrenal destruction - b/c autoimmune disease

32

what is chronic addisons?

general malaise

33

what is acute addisons?

response to stress
infection/trauma/surgery
life threatening
=> shock, hypoglycaemia, vomiting, abdominal pain

34

signs of addisons?

hyperpigmentation
buccal mucosa scars, pressure points, skin creases

35

treatment of addisons?

replacement therapy = baseline tx
hydrocortisone - glucocorticoid 20mg am 20mg pm
flufrocortisone - mineralcorticoid

36

what is an acute addisonian crisis?

medical emergency
need fluid replacement
glucose
hydrocortisone injection
treat if infection is present
hospital

37

dentally look out for what with addisons pt? cushings?

addisons - hyperpigmentation
cushings - oral infections/poor wound healing

38

what is an excess of growth hormone?

acromegaly
caused by pituitary adenoma - rare = 2-3/million

39

signs of acromegaly?

large tongue
excess hair
spade like hands/feet - myopathy/arthritis
pronounced supraorbital ridge
broad nose
prognathism
inderdental seperation
thick greasy skin
diabetes
high bp
heart failure

40

treatment of acromegaly?

medically - somatostatin analouges
surgery - compressing nearby structures, also radiotherapy

41

types of diabetes?

type 1 - IDDM 10% autoimmune young pts
type 2 - NIDDM 90% - insulin resistance/deficiency - more likely if obese >40 yrs. 10% are over 70

42

what does diabetes cause an increased risk of?

increased risk of all infections

43

what is seen on skin/mouth with diabetes?

boils, abscesses, cellulitis, candidosis

44

what kind of diseases are seen commonly with diabetic pt's?

diabetic retinopathy
diabetic nephropathy
diabetic neuropathy - loss of sensation, loss of bowel/bladder/sexual function, muscle weakeness/pain

45

what type of heat condition is common with diabetic pts?

atherosclerosis

46

foot problems with diabetes?

atherosclerosis
neuropathy
infections

47

treat type 1 with?

insulin

48

type 2 treat with?

sometimes insulin
initially dietary
sulphonylureas
biguanides
glitazones

49

emergencies with diabetes - high blood sugar?

DKA
HONK - hyperosmolar non ketotic coma

50

low blood sugar?

hypoglycaemia

51

what is DKA?

insulin not taken in because no food intake
inadequate insulin in acute physiological stress = infection/surgery

52

what is dka often a combo with?

gastroenteritis
impaired consciousness, dehydration, ketones on breath