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endocrine > Pathology > Flashcards

Pathology Flashcards

1
Q

why do you get skin pigmentation in Addisons disease

A

lack of cortisol decreases negative feedback so increase in CRH this causes an increase in ACTH and MSH- MSH causes skin pigmentation

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2
Q

normal range of plasma calcium

A

2.2-2.6

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3
Q

how can we calculate free calcium levels

A

use albumin- increased albumin means decreased free calcium

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4
Q

when is hypocalcaemia

A

levels drop below 1.9

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5
Q

How do we measure growth in <2yrs

A

measure length of the child

head circumference

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6
Q

what is a bone age Tw20

A

test to assess growth and growth potential
Xray of the left wrist and look at the 20 bones comparing bone maturation to that in an atlas
give the bones a score

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7
Q

how do we assess puberty

A 
Tanner method- 
breast development 1-5 (B)
genital development 1-5 (G)
pubic hair 1-5 (PH)
Axillary hair 1-3 (AH_
Testes 2ml-20ml (T)

stage 1 Is no puberty
stage 2 is the start of puberty

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8
Q

how do we measure testicular maturation

A

feel the testicles and compare it to the beads on the prayer orchidometer

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9
Q

what size of testes is the first sign of pubertal development

A

4mm

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10
Q

what are the various stages of growth

A

infantile- up to 20 cm a year
childhood- 5-7cm per year
pubertal growth - 10-15 cm per year

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11
Q

what occurs first and last in female puberty

A

breast budding

periods are last

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12
Q

what occurs first and last in male puberty

A

testicular growth first

facial hair last

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13
Q

what are the three main normal reasons for short stature in kids

A

familial short stature
constitutional delay
small gestational age

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14
Q

pathological causes of short stature

A 
undernutrition 
chronic illness
iatrogenic (steroids) 
psychological and social deprivation 
hormonal 
syndromes
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15
Q

what is abnormal height if your obese

A

obese and short is abnormal

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16
Q

what are autoimmune polyendocrine syndromes

A

group of conditions characterised by functional impairment of multiple endocrine glands due to loss of immune tolerance
due to circulating autoantibodies and lymphocytic infiltration

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17
Q

risks of thyroid surgery

A

bleeding
voice change
hypocalcaemia
hypothyroidism

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18
Q

what is tier 1 of weight management services

A

population wide health improvement work

community interventions such as walking groups etc

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19
Q

what is tier 2 of weight management services

A

exists in primary care
NHS healthy weight programmes to educate those on what it means to have a healthy lifestyle
non surgical weight management - orlistat

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20
Q

what is tier 3 of weight management services

A

referred to a MDT

nutritionist, physio, dietician ect

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21
Q

what is tier 4 of weight management services

A

Bariatric surgery

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22
Q

what is a gastric band surgery

A

band is attached around the stomach and tightened
creates a smaller pouch which food goes into
releases hormones to make us think we are full

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23
Q

what is a laparoscopic sleeve gastrectomy

A

remove 4/5 of the stomach
removed the hormones that make us feel hungry
so they don’t feel hungry and can’t eat as much

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24
Q

what is a laparoscopic gastric bypass

A

Separate the stomach and attach a small pouch to the bowel

means food enters the bowel sooner and stimulates the release of GLP1 making us feel full

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25
Q

what is an intragastric balloon

A

balloon in the stomach that is filled with fluid to make the stomach smaller
only in for 1 year

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26
Q

Who should be referred to bariatric surgery

A

BMI>35
Presence of one of more severe co morbidities that would improve with weight reduction
priority group is those ages 18-44 with BMI 35-40recent onset of type 2 diabetes

second priority group is the same as the first but with BMI 40-50

also have to have completed 6 months of tier 3 intervention and have good glycemic control

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27
Q

what are complications that can occur following bariatric surgery

A

patients struggling to eat and drink at the same time because they fill up too quickly
excess skin
constipation
excess hair loss due to weight loss
lack of nutrients- need to take supplements
require regular blood tests

28
Q

what investigations do we do for acromegaly

A

look for IGF1 in blood samples

29
Q

investigations for cushings

A

overnight DEX test
cortisol levels
ACTH test

30
Q

symptoms of cushings

A 
central obesity 
hypertension 
facial mooning 
buffalo hump 
skin atrophy 
osteoporosis 
growth arrest in children 
increased water retention
31
Q

investigation for diabetes insidious

A

water deprivation test

32
Q

what approach of surgery do we usually do to remove a pituitary tumour

A

transsphenoidal

33
Q

what treatment can we use for hyperthyroidism

A

radiotherapy -radioiodide - only for those without kids and without eye disease
antithyroid drugs -
carbimazole

beta blockers to reduce symptoms such as tremors
surgery

34
Q

symptoms of graves disease

A

goitre
bulging eyes
clubbing
potentially gynaecomastia

35
Q

what can we use as a marker for thyroid cancer

A

thyroglobulin

36
Q

what investigations will we do for suspected addisons

A

short synathchen test, early morning cortisol test

low NA high potassium

37
Q

what does conns syndrome cause

A

increase in hypertension and sodium retention due to the RAAS system
hypokalaemia

38
Q

how do we investigate conns syndrome

A

aldosterone:renin
less than 20 then primary hyperaldosterone
more than 20 then secondary or another cause

39
Q

what is phaeocytochroma

A

tumour of the adrenal medulla

produces excess adrenaline ect

40
Q

how do we diagnose phaeocytochroma

A

24hr urine catecholamines

plasma free metanephrines

41
Q

symptoms of phaeocytochroma

A 
sweating 
headaches
hyperglycaemia 
hypertension 
anxiety 
palpitations
42
Q

what is the treatment for phaeocytochroma

A

alpha blockers
beta blockers
surgery

43
Q

causes of primary hyperparathyroidism

A

tumour of the parathyroid glands causing excess PTH

44
Q

causes of secondary hyperparathyroidism

A

insufficient vit D

chronic renal failure

45
Q

causes of tertiary hyperparathryodisim

A

when secondary hyperparathrydoism goes on for a long time you have had hyperplasia of PTH
so when you have treated the the secondary issue you still have extra PTH being released

46
Q

what does hypocalcaemia cause?

A

increases sodium permeability
so increases the excitation of neurones
leads to tetany

47
Q

what does hypercalcaemia cause

A

decreases neuronal Na
reduces excitability
depresses neuromuscular activity
lead to cardiac arrhythmias

48
Q

when is early or delayed puberty in boys

A

between 9-14

49
Q

when is early or delayed puberty in girls

A

between 8-13

50
Q

when do symptoms of hypocalcaemia develop

A

when levels drop below 1.9

51
Q

what are the classifications of hypercalcaemia

A

greater than 3 mols- mild
3-3.5- may be well tolerated but need prompt treatment
greater than 3.5- severe requires urgent correction

52
Q

broadly how can we treat autoimmune diseases

A

cytotoxic drugs
drugs that remove co stimulation
induction of inhibitory T cells

53
Q

what Is subacute thyroiditis

A

occurs in younger patients usually a viral trigger
you get a painful goitre and then a short period of hyperthyroidism followed by a longer period of hypothyroidism
raised ESR

54
Q

how would we treat subacute thyroidisits

A

may require a short term of steorids

55
Q

most common type of thyroid cnacer

A

papillary

56
Q

how can we treat thyroid cancer

A 
thyroidectomy 
high dose RAI 
long term suppressive thyroxine 
radiotherapy
chemo
57
Q

what antibodies will be present in addisons

A

positive adrenal antibodies

58
Q

what is congenital adrenal hyperplasia

A

issue with the enzyme 21- hydroxylase

59
Q

what is hypocalcamia associated with or due to

A 
disruption of thyroid gland 
magnesium deficiency 
cytotoxic drugs - phytoin, blood transfusions,
autoimmune 
genetic disorders
60
Q

what are chronic symptoms of hypocalcaemia

A 
ectopic calcification 
extrapyramidal signs 
parkinsons 
dementia 
dry skin
61
Q

symptoms of hypercalcaemia

A 
anorexia 
renal syptoms-polyuria, polydipsia
nausea and vomiting 
muscle weakness 
bone pain 
fatigue and decreased concentration 
increased thirs
bradycardia
62
Q

how do we treat hypercalcaemia

A

rehydration
IV bisphonsphonates

second line management depends on the cause
calcitonin if poor response to biphosphonates

calcimdtics
surgery

63
Q

symptoms in MEN1

A

parathyroid hyperplasia
parathyroid adenomas
pancreatic and duodenal endocrine tumours
pituitary adenoma

64
Q

symptoms in MEN 2

A

phaeocytochronma and medullary carcinoma
in A- parathyroid hyperplasia
in B0 neuromas of the skin and mucous membrnaes

65
Q

what is MEN 1 due to

A

mutation of tumour suppressor gene

66
Q

what is MEN 2 due to

A

RET protooncogene mutation

endocrine (3 decks)

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