ENT/thyroid

Question 1

neck lump features during examination

Answer 1

site
size
consistency
edge
relationship to: muscles, trachea, hyoid

Question 2

what nerve lies behind the superior thyroid artery?

Answer 2

external laryngeal nerve

Question 3

hormones secreted by the posterior pituitary?

Answer 3

oxytocin

ADH

Question 4

hormone secreted by the anterior pituitary

Answer 4

TSH
ACTH
FSH & LH
GH
Prolactin
Endorphins

Question 5

features of hyperthyroidism

Answer 5

heat intolerance, sweating
weight loss, diarrhoea, increased appetite
tremor, coma
tachycardia, HF, dyspnoea
eye disease
myopathy, periodic paralysis
menstrual irregularity
gynaecomastia

Question 6

features of hypothyroidism

Answer 6

cold intolerance
dry nails, skin, hair
facial oedema
pallor
non-pitting oedema
constipation
psychosis, coma, death

Question 7

examination findings in hyperthyroidism

Answer 7

agitation
tachycardia
warm clammy hands
brisk reflexes
eye signs - proptosis, exopthamlos. lid lag, lid retraction
opthalmoplegia
thyroid acropachy
pre-tibial myxoedema
goitre

Question 8

examination findings in hypothyroidism

Answer 8

coarse features
bradycardia
slow relaxing reflexes
goitre

Question 9

aetiology of hyperthyroidism

Answer 9

grave's disease - 70%
multinodular goitre - 20%
toxic adenoma - 5%
thyroiditis
amiodarone/iodine induced (Jod-Basedow phenomenon)

Question 10

aetiology of hypothyroidism

Answer 10

Grave's disease (toxic diffuse goitre)
thyroiditis
iatrogenic (surgery, radiotherapy)
Drugs - amiodarone, lithium
congenital
iodine excess or deficiency

Question 11

thyrotoxic

Answer 11

TSH low

FT4 high

Question 12

Hypothyroid

Answer 12

TSH high

FT4 low

Question 13

risk factors for grave’s eye disease

Answer 13

smoking
Male
high initial FT4 >70

Question 14

anti-thyroid drugs (thyrotoxicosis)

Answer 14

carbimazole, propylthiouracil

inhibit iodination of tyrosine, inhinit FT4 –> FT3 conversion

Question 15

risks of thyroidectomy

Answer 15

hypocalcaemia

hypo/hyperthyroidism

Question 16

features of thyroid storm

Answer 16

tachycardia, fever, encephelopathy, fits, stroke, HTN, D&V, circulatory collapse, death
(treat with propylithiouracil, iodine, steroids, beta-blockers, I.V. fluids

Question 17

treatment of hypothyroidism

Answer 17

L-Thyroxine (100-150mg OD)
tri-iodothyronine
(+ IV fluids and steroids for hypothroid coma)

Question 18

Normal FT4/FT3

Low TSH

Answer 18

subclinical hyperthyroisism

e.g. recent treatment for hyperthyroidism, drugs (steroids, dopamine), non-thyroidal illness (NTI)

Question 19

Normal FT4/FT3

High TSH

Answer 19

subclinical hypothyroidism
e.g. poor compliance with thyroxine
malabsorption of thyroxine
drugs (amiadarone)
NTI recovery phase
TSH resistance

Question 20

adrenal disease - Cushing’s

Answer 20

illness resulting from chronic exposure to high levels of cortisol

Question 21

clinical features of cushings

Answer 21

moon face
acne, thinnig of skin, striae, bruising
hirsuitism, thinning of scalp hair
truncal obesity
proximal muscle weakness
mood disturbances, depression

Question 22

associated features of cushings

Answer 22

HTN (>50%)
impaired glucose tolerance/DM
osteopenia & osteoporosis
vascular disease
coagulopathy
susceptibility to infection

Question 23

endogenous causes of cushings

Answer 23

ACTH-dependent:
Pituitary adenoma, ectopic ACTH syndrome, ectopic CRH secretion
ACTH-independent (adrenal):
adenoma, carcinoma, nodular hyperplasia

Question 24

DDx for cushings

Answer 24

psuedo-cushings
alcoholism
severe depression

Question 25

Hypoadrenalism causes:

Answer 25

primary: autoimmune, secondary deposits, TB, HIV secondary: prolonged exogenous steroids, pituitary lesions

Question 26

Hypoadrenal/addisonian crisis

Answer 26

causes: severe physical shock, e.g. car crash; severe infection; severe dehydration

Question 27

Sx of hypoadrenal crisis

Answer 27

``` extreme weakness confusion drowiness --> coma pronounced dizziness nausea and/or vommiting headache abnormal heart rate low BP feeling v. cold possibly febrile possible abdo tenderness ```

Question 28

Addisons is:

Answer 28

detruction of the adrenal cortex leading to cortisol and aldosterone deficiency.

Question 29

Aldosterone:

Answer 29

essential for Na conservation in the kidney | e.g when dehydrated, increase Na reabsorption to decrease water loss

Question 30

Cortisol:

Answer 30

released in response to stress and low blood glucose. e.g will prepare the body for activity by freeing up glucose into the blood

Question 31

renin-angiotensin system

Answer 31

In response to low sodium, or reduced renal blood flow, juxtaglomerular cells secrete renin. this converts angiotensin I into angiotensin II via the enzyme ACE. angiotensin II triggers aldosterone release by adrenal glands, which act on the kidneys to decrease sodium and therefore water excretion (raise BP)