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Phase 2a Lauren > Peer Teaching Endo > Flashcards

Peer Teaching Endo Flashcards

1
Q

What hormone are thyroid disorders to do with?

A

T4

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2
Q

Which hormone is Cushing’s to do with?

A

Too much cortisol

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3
Q

Which hormone is acromegaly to do with?

A

Too much GH

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4
Q

Which hormone is Conn’s to do with?

A

Too much aldosterone

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5
Q

Which hormone is Addison’s to do with?

A

Too little cortisol & too little aldosterone

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6
Q

Which hormone is diabetes insipidus to do with?

A

Not enough ADH

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7
Q

What does CRH released by the hypothalamus do?

A

Act on ant. pituitary —> ACTH —> Adrenal cortex —> glucocorticoids

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8
Q

What does GRH released by the hypothalamus do?

A

Act on ant. pituitary —> LH & FSH —> gonads —> various effects inc. producing testosterone and oestrogen

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9
Q

What does GHRH released by the hypothalamus do?

A

Act on ant. pituitary —> GH —> liver —> IGF-1

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10
Q

What does TRH released by the hypothalamus do?

A

Act on ant. pituitary —> TSH —> thyroid —> T3 & T4

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11
Q

What does dopamine released by the hypothalamus do?

A

Ant. pituitary -x-> DECREASED prolactin

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12
Q

Which two hormones are stored in the posterior pituitary for release?

A

Oxytocin

Vasopressin (ADH)

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13
Q

What is hyperthyroidism?

A

Excess thyroid hormone
Females&raquo_space; males
Mainly 20-40yo

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14
Q

What are the causes of hyperthyroidism?

A

Graves’ - 2/3rds
Toxic multinodular goitre
Toxic thyroid adenoma
Less common: iodine excess congenital

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15
Q

What are the symptoms of hyperthyroidism?

A 
Diarrhoea, 
Weight loss,
Sweats,
Heat tolerance,
Palipitations,
Tremor,
Anxiety,
Menstrual disturbance
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16
Q

Signs of hyperthyroidism?

A 
Tachycardia
Thin hair,
Lid lag,
Onycholysis (nail comes away from the nail bed),
Lid retraction,
Exophthalmos (eyes sticking out)
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17
Q

What would the bloods show in primary hyperthyroidism?

A

Low TSH, High T3/T$

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18
Q

What would the bloods show in secondary hyperthyroidism?

A

High TSH, High T3/T4

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19
Q

Apart from TSH and T3/4, what other investigations could you do to diagnose hyperthyroidism?

A
  • Thyroid autoantibodies (thyroid peroxidase thyroglobulin, TSH receptor antibody)
  • Radioactive iodine isotope uptake scan
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20
Q

What drugs would you use for rapid symptom control in hyperthyroidism?

A

B-Blocker

eg. Propanalol

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21
Q

What drugs would you use to treat hyperthyroidism?

A

Antithyroid drug
Thionamides
eg. CARBIMAZOLE

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22
Q

What non-pharmacological treatments would you use for hyperthyroidism?

A

Radioiodine therapy

Thyroidectomy

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23
Q

What is graves’ diesease?

A
  • AUTOIMMUNE
  • IgG autoantibodies
  • High TSH receptor stimulator antibody (TRAb) = excess TH secretion
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24
Q

What unique signs would you see in graves’ disease?

A

Graves’ opthamlmology - extraocular muscle swelling, eye discomfort, lacrimation, diplopia

Thyroid acropachy (clubbing, finger and toe swelling)

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25
What are the main causes of hypothyroidism?
Hashimoto's thyroisitis, | iodine deficiency, previous radioiodine therapy, overtreatment of hyperthyroidism
26
What are the symptoms of hypothyroidism?
``` Fatigue/tiredness/lethargy Cold intolerance Weight gain (& anorexia) Myalgia Constipation Oedema Mennorrhagia Hoarse voice ```
27
What are the signs of hypothyroidism?
BRADYCARDIAC ``` Bradycardia Reflexes relax slowly Ataxia Dry thin hair/skin Yawning Cold hands Ascites Round puffy face Defeated demeanor Immobile Congestive HF ```
28
What is the main cause of acromegaly?
Pituitary adenoma Slow onset over many years
29
What are the symptoms of acromegaly?
Acroparaestesia, arthralgia, sweating, decreased libido, headache
30
What are the signs of acromegaly?
``` Massive growth of hands, feet and jaw Big tongue with widely spaced feet, Puffy lips, eyelids and skin, Darkening skin Obstructive sleep apnoea deep voice ```
31
What investigation is diagnostic for acromegaly?
NOT random growth hormone test because GH is a pulsatile protein and levels vary throughout the day Oral glucose tolerance test: -Normally a rise in blood glucose will suppress GH levels -Give glucose and then test GH levels, if still high this is diagnostic for acromegaly MRI the pituitary fossa for adenomas
32
What is the first-line treatment for acromegaly?
Trans-sphenoidal surgery
33
What is the treatment for acromegaly if surgery fails?
Somatostatin analogues (SSA) eg. IM Octreotide/IM lanreotide GH Receptor antagonists eg. SC Pegvisomant Dopamine agonist eg. Oral cabergoline Radiotherapy
34
Define Conn's?
Excess production of aldosterone independent of the renin-angiotensin-aldosterone system Aldosterone works in the kidney to cause potassium loss, excess causes hypokalaemia and sodium & water retention
35
What are the causes of Conn's?
``` 2/3rds = Conn's syndrome: a solitary aldosterone producing adenoma 1/3 = bilateral adrenocortical hyperplasia ```
36
What are the symptoms of hypokalaemia AND HENCE CONN'S?
``` Constipation Weakness and cramps Paraesthesia polyuria & polydipsia Heart rhythm changes ```
37
What are the signs of hypokalaemia AND HENCE CONN'S?
Hypertention | Metabolic alkalosis - due to H secretion in alpha intercalated cells
38
What are the investigations for Conn's?
``` U&Es Decreased renin Increased aldosterone ECG: flat T, long PR, long QT, U waves Adrenal CT ```
39
What are the treatment for Conn's?
Laparoscopic adrenalectomy Aldosterone antagonist eg. Spironolactone
40
When do the parathyroids secrete PTH?
In response to low Ca levels
41
What is the action of PTH?
-Increased bone resorption by osteoclasts -Increased intestinal calcium absorption -Actives 1,25-dihydroxyVD (calcitriol) in kidney -Increased calcium reabsorption and phosphate excretion in the kidney
42
What is the cause of hyperparathyroidism?
``` 80% = solitary adenoma 20% = parathyroidhyperplasia Rare = parathyroid cancer ```
43
What can hyperparathyroidism be secondary to?
CKD, Vitamin D deficiency, GI disease eg. Chron's
44
What are the signs and symptoms of hyperparathyroidism?
Bones, stones, groans and psychic moans: -Bones - bone resorption from PTH - pain, fractures, osteopenia etc Stones - excess Ca - renal colic, biliary stones -Groans - abdo pain, malaise, nausea, constipation, polydipsia etc -Psychiatric moans - depression, anxiety etc. HTN
45
What are the blood results for primary hyperparathyroidism?
High PTH High Calcium Low Alk. Phos.
46
What are the blood results for secondary hyperparathyroidism?
High PTH Low Calcium High Alk. Phos.
47
What are the blood results for tertiary hyperparathyroidism?
High PTH High Calcium High Alk. Phos. High everything! progression of everything!
48
What other investigations apart from bloods can you do for hyperparathyroidism?
Increased 24hr urinary calcium excretion | DEXA scan for osteoporosis
49
What is the treatment for hyperparathyroidism?
Fluids, Surgically manage underlying cause Bisphosphonates
50
What are the causes of hypoparathyroidism?
``` Autoimmune destruction of PT glands Congenital Surgical removal (secondary) Mg deficiency VD deficiency ```
51
What are the signs and symptoms of hypoparathyroidism?
Same as hypocalcaemia..
52
What is the treatment of hypoparathyroidism?
Calcium supplements Vitamin D analogue eg. CALCITRIOL Synthetic PTH
53
What is pseudohypothyroidism?
Decreased RESPONSE to PTH
54
What is the bloodwork for pseudohypothyroidism?
Low Ca, high PTH Treat as hypoparathyroidism
55
What is the range for hypokalemia?
<3.5mmol/L
56
What does hypokalemia cause?
Low K+ in serum = water concentration gradient out of cell | Increased leakage from ICF = hyperpolarisation of monocyte membrane = myocyte excitability
57
What are the ECG changes for hypokalemia?
U have NO POT (K+), NO Tea but a LONG PR and a LONG QT. 1) U waves 2) No T waves/inversion 3) Long PR 4) Long QT
58
What is the treatment for hypokalemia?
Give potassium Oral/IV
59
What are the ECG changes for hyperkalemia?
Tall tented T waves, small P, wide QRS
60
What is the treatment for hyperkalemia?
Non urgent- Polystyrene sulphonate resin = binds K+ in gut decreasing uptake Urgent- Calcium gluconate = decreases VF risk in the heart Insulin = drives K+ into cells
61
Why could ACEi cause hyperkalemia?
Blocks the binding of aldosterone to receptor
62
Why could AKI cause hyperkalemia?
Decreased filtration rate so more K+ is maintained in blood
63
Why could cause hypokalemia?
High aldosterone
64
Would hypokalemia cause acidosis or alkalosis?
Alkalosis as H+ is transported out of cells and K+ in
65
Would hyperkalemia cause acidosis or alkalosis?
Alkalosis as H+ is transported in of cells and K+ out
66
What drugs could cause hypokalemia?
B2 agonists (SABA/LABA) - increase B2 pumping of K+ into cell Insulin - K+ follows insulin into cells
67
What drugs could cause hypokalemia?
B blocker - inhibits pumping of K+ into cell
68
Potassium is important in maintaining resting potential.. what does this lead to?
Hypo - slows everything down Constipation, weakness/cramps, arrythmias & palpitations Hyper - speeds everything up Cramping, weakness/flaccid paralysis, arrythmias & arrest
69
Causes of hypocalemia?
``` H - hypoparathyroidism (low phos) A - acute pancreatitis (high phos) V - vitamin D deficiency (high phos) O - osteomalacia (high phos) C - chronic kidney disease (low phos) ```
70
Presentation of hypocalcemia?
SPASMODIC Spasms Perioral paraesthesia Anxious, irritable, irrational Seizures Muscle tone increases in smooth muscle = wheeze Orientation impaired & confusion Dermatitis Impetigo herpetiformis - reduced Ca2+& pustules in pregnancy Chvostek's sign, cataract, cardiomyopathy
71
What ECG changes can you see in hypocalcaemia?
Long QT interval
72
What is the treatment of hypocalcaemia?
Mild - Adcal | Severe - calcium gluconate
73
What are the symptoms of hypercalcemia?
Bones, stones, moans and psychic moans Painful bones Kidney stones Nausea, vomiting, constipation, indigestion Lethargy, fatigue, memory loss, psychosis, depression
74
What investigations would you do for hypercalcemia?
Find the cause: - Corrected calcium levels - big in cancer - PTH - high in hyperparathyroidism, low in cancer Damage? - U&E - renal - X Ray Treatment: Saline (NaCl) Bisphosphonates
75
What is hypercalcemia of malignancy?
Causes osteoclast stimulation = increased bone breakdown Inhibits osteoblast prrecursors Most commonly in myeloma & non-hodgkin lymphoma
76
What bloods would you expect in hypercalcemia?
CXR | Bloods = high Ca, high phosphate
77
What ECG results would you expect in hypercalcemia?
Tented T waves, short QT interval
78
What is the pathophysiology of cushing's SYNDROME?
Excess cortisol Loss of hypothalamic pituitary axis feedback Loss of circadian rhythm
79
What is the pathophysiology of cushing's DISEASE?
All the factors of cushing's syndrome + caused by pituitary adenoma
80
What is the first line of treatment for iatrogenic causes of Cushing's?
STOP STEROIDS
81
What is the treatment for Cushing's disease?
Trans-sphenoidal removal of pituitary adenoma | Bilateral adrenalectomy
82
What is the treatment for ectopic Cushing's syndrome?
Surgery if tumour is located and hadn't spread | Adrenal Steroid Synthesis Inhibitors (inhibit cortisone synthesis) eg. MetyraponeTr
83
Symptoms of Cushing's?
``` Cushing Cataracts Ulcers Skin - striae HTN, hyperglycaemia Infections increase Necrosis Glucosuria ``` ``` Aesthetic: Truncal obesity Moon face Buffalo hump Acne Hirsutism Weight gain ```
84
What investigations would you undertake for Cushing's?
NOT random plasma cortisol - pulsatile, stress, illness etc Dexamethasone supression test: failure to suppress in 24hrs = cushing's 24hr urinary free cortisol, normal = unlikely
85
Treatment for adrenal adenoma cushing's?
Adrenalectomy, radiotherapy
86
Risk factors for DMT2?
``` Male Asian Older Obese Lack of exercise High calorie intake ```
87
Symptoms for DMT2?
Asymptomatic | Late: hyperglycaemia, polyuria, polydipsia
88
Investigations and diagnostic for DMT2?
Random plasma glucose - >11.1 Fasting plasma glucose >7 2 hr post-prandial >11.1 HbA1c >48mmol/mol
89
Investigation and diagnostic levels for impaired glucose tolerance?
Abnormal 2hr post-prandial result but glucose level not high enough to be diabetic
90
Investigation and diagnostic levels for impaired fasting glucose?
Abnormal fasting result but glucose level not high enough to be diabetic
91
DMT2 treatment?
``` Lifestyle changes and advice Sort out HTN - ACEi eg. ramipril 1. Metformin (biguanides) 2. 43-58mmol/mol Metformin + DPP4 inhbitor eg. sitagliptin OR metformin + pioglitazone (glitazone) OR metformin + sulphonylurea eg. oral gliclazide OR Metformin + SGLT-2i (glifazon) 3. >58 Triple therapy (met + SU + GLP1) OR Insulin ```
92
Weight change when taking biguanides (metformin)?
Weight loss
93
Weight change when taking sulfonylurea (gliclazide)?
Weight gain
94
Weight change when taking DPP4 inhibitors (sitagliptin)?
No change
95
Weight change when taking glitazones (plioglitazone)?
Weight gain
96
What genes increase the risk of DMT1?
HLA-DR3-DQ2 | HLA-DR4-DQ8
97
What is the cause of DMT2?
Autoimmune B-cell destruction
98
What is the cause of DKA?
Insufficient insulin =More ketogenesis due to less glucose available = more ketones produced
99
What are the signs & symptoms of DKA?
Pear breath Vomiting & abdo pain Dehydration Kussmaul's breathing (deep and rapid)
100
What is used to diagnose DKA?
Acidaemia (blood pH) Hyperglycaemia Ketonaemia/ketoniuria
101
What is the management of DKA?
Fluid | Insulin
102
What is the cause of hypoglycaemia?
Too much insulin/oral hypoglycaemic agents Insufficient glucose to the brain
103
What are the signs & symptoms of hypoglycaemia?
Odd behaviour (aggression) Sweating (fight or flight) Raised pulse Seizures
104
What is used to diagnose hypogylcaemia?
Blood glucose levels
105
What is the management of hypoglycaemia?
Glucose | Glucagon
106
What is the cause of HHS?
Insufficient oral hypoglycaemic agents Not ketones, just hyperglycaemia
107
What are the signs & symptoms of HHS?
Dehydration | watered down DKA
108
What is used to diagnose HHS?
Blood glucose level
109
What is the management of HHS?
Low molecular weight heparin Fluids Insulin (if severe)
110
What is the most common cause of primary adrenal insufficiency?
``` TB = worldwide Addison's = UK ```
111
Signs and symptoms of Addison's?
Lean, tanned (pigmented) Depressed, tearful N&V, abdo pain Tanned, tired, tones, tearful
112
Diagnosis of Addison's?
Short ACTH stimulation test (Give ACTH (synacthen), then measure cortisol level; in Addison, cortisol remains low after giving ACTH) Test for 21-hydroxylase adrenal autoabs (+ve in 80% of Addison’s) Bloods will show low sodium and high potassium due to low aldosterone
113
Treatment of Addison's?
Hydrocortisone (glucocorticoids) to replace cortisol, fludrocortisone (glucocorticoids) to replace aldosterone
114
What emergency is associated with Addison's?
Addisonian crisis@ | Patients present with shock, treat with fluids and hydrocortisone
115
Causes of cranial DI?
Head injury, pituitary tumours
116
Causes of nephrogenic DI?
Drugs eg. lithium
117
Signs and symptoms of DI?
Polyuria, polydipsia, dehydration
118
Diagnosis of DI?
Water Deprivation Test 1. Restrict fluid 2. Measure urine osmolarity (+ve for DI if urine osmolarity is low) 3. Desmopressin (ADH analogues) to differentiate cranial or nephrogenic. Urine will NOT be concentrated in nephrogenic DI, will in cranial 4. MRI hypothalamus for masses in cranial DI
119
Treatment of DI?
Cranial DI - desmopressin | Nephrogenic DI - bendroflumethizide, NSAIDs
120
Causes of SIADH?
Malignancy, dugs, CNS disorder
121
Signs and symptoms of SIADH?
Confusion Anorexia Nausea Concentrated urine
122
Diagnosis of SIADH?
Measure urine and plasma osmolarity
123
Treatment of SIADH?
Treat the underlying cause Restrict fluid Vasopressin receptor antagonists (vaptans)
124
Upon waiting for an adrenalectomy, what medication would you use to stabilise BP & K+?
Spironolactone
125
Both renin and aldosterone are raised. Diagnosis?
Renin screting tumour or | Secondary hyperaldosteronism
126
Low aldosterone. Dx?
Addison's
127
Low renin, high aldosterone. Dx?
Adrenal adenoma/carcinoma. Adrenal hyperplasia syndromes
128
Classic Cushing's presentation?
abdominal striae, moon face, buffalo hump | and weight loss in extremities
129
Classic Addison's presentation?
hyperpigmentation, central | weight loss as well as hypotension
130
Classic carcinoid syndrome?
triad of cardiac | involvement, diarrhoea and flushing. Its due to the tumour cells producing 5-HT

Phase 2a Lauren (15 decks)

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