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Life Maintenance > Week 14 - Thyroid, Endocrinology > Flashcards

Week 14 - Thyroid, Endocrinology Flashcards

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1
Q

Role of oestrogen and progesterone

A

Oestrogen

xxxx

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2
Q

What does testosterone turn into in females? by what enzyme?

A

Oestrogen

By aromatase

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3
Q

What does testosterone turn into in men?

A

xxx

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4
Q

CARDS ON FLOW CHART SLIDE

A

xxx

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5
Q

On what day does menstrual cycle start?

A

Day 25

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6
Q

What happens at three months?

A

Corpus liteum -> placenta

Placenta is now mature and it takes over

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7
Q

What are the actions of oestrogen? (4 categories)

A

Development
Menstrual
Pregnancy
Cellular

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8
Q

What are the menstrual actions of oestrogen?

A

Menstrual - Endometrial proliferation, watery cervical mucus, maturation of vaginal epithelium, female sex behaviour

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9
Q

What are the developmental actions of oestrogen?

A

Development - secondary sex characterstics, breast development, fat distribution, uterine development, bone deposition

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10
Q

What are the pregnancy actions of oestrogen?

A

Pregnancy - Breast ductal development, fluid retention, increased uterine blood flow

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11
Q

What are the cellular actions of oestrogen?

A

Cellular - acts via a nuclear receptor, expression of progesterone receptor, decrease plasma cholesterol, hepatic enzyme inducers

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12
Q

What are the actions of progesterone? (3 categories)

A

Menstrual
Pregnancy
Cellular

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13
Q

Causes of female infertility

A

Anovulatory - Central and ovarian

Ovulatory

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14
Q

Anorexia nervosa and infertility - outline

A

Lack of adipose tissue, body can tell you are not storing enough fat through lack of leptin

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15
Q

Central causes of anovulatory female infertility

A

xx

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16
Q

Ovarian causes of anovulatory female infertility

A

xxx

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17
Q

Ovulatory causes of female infertility

A

xxx

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18
Q

Test for female infertility (5)

A 
Karyotype
Gonadaotrophins oestradiol
Progesterone
LHRH test
Pelvic ultrasound
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19
Q

What does LH being much higher than FSH indicate?

A

Ovulatory surge

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20
Q

OUTLINE FSH and INHIBIN

A

xxx

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21
Q

Luteinising hormone and testosterone

A

xxx

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22
Q

Testosterone production in women (3)

A 
Ovarian synthesis (granulosa cell)
Peripheral conversion of precursor androgen
Adrenal synthesis (zon reticularis)
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23
Q

How to measure testosterone

A

Very unreliable in women

9am fasted sample
Patient in good physical health
Repeated measure (at least 2, 6 weeks apart)

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24
Q

Actions of testosterone

A

XXXX

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25
Why are men taller?
Later and longer puberty | Heavier bones
26
Causes of male infertility
Central Testicular Post-testicular
27
Tests for male infertility (4)
Karyotype Gonadotrophins testosterone LHRH test Testicular ultrasound
28
Describe Cushing's syndrome
EXCESS of glucocorticoids (cortisol) Obesity Facial plethora (redness) Male pattern hair in female
29
Describe Addison's syndrome
SHORTAGE of glucocorticoids (cortisol) | Tiredness, weight loss, postural hypotension
30
Causes of Addison's syndrome
``` Autoimmune Steriod use TB Metastases Infiltration Infection Enzyme defect ```
31
Describe 21-hydroxylase deficiency (Classical CAH)
Commonest form of CAH 1:10000 births Autosomal recessive HLA linked Excess sex steroids No aldosterone, salt-losing crisis
32
Outline 11B-hydroxylase deficiency (Non-classical)
About 5% of reported 5% 0.5: 100,000 live births Increased in Moroccan Jews (1:6000) HLA linked Salt retention Excess sex steriods No aldosterone but HIGH DOC (agonist at NC receptors) - hypertension and hypokalaemia
33
In what case do you treat with fludocortisone?
21-hydroxylase deficiency to replace absent mineralcorticoid activity
34
Where is renin produced?
Juxtaglomerular cell
35
Outline primary and secondary excess of aldosterone
xxx
36
Outline Conn's syndrome and treatment
xxx
37
Outline phaeochromocytoma - what is it? symptoms?
Tumour of the enterochromaffin cells of the adrenal medulla (can be outside adrenal gland, but is a tumour of the nerve ganglion) Produces adrenaline (nor adrenaline, dopamine) Rule of 10% (10% bilateral, malignancy, extra adrenal, inherited) Causes sweating, anxiety, fever, abdominal pain, headache, angor aminii
38
Management of phaechromocytoma
Emergency Alpha blockade - non-competitive alpha antagonist Beta blockade - non-selective beta blocker Fluid resuscitation Surgery
39
Management of phaechromocytoma
Emergency Alpha blockade - non-competitive alpha antagonist - FIRST Beta blockade - non-selective beta blocker - 24 hours after alpha Fluid resuscitation Surgery
40
What is shock?
Reduction of effective blood flow and inadequate tissue perfusion with decreased delivery of oxygen to the capillary exchange beds
41
What are the common things that change with inadequate O2? (4)
Heart rate Blood pressure Respiratory rate Urine output
42
What is ABCDE?
Approach to examination in sick patient - must prioritise crucial issues ``` Airway and oxygenation Breathing and ventilation Circulation and management of shock Disability due to neurological deterioration Exposure and examination ```
43
How do you assess breathing / ventilation?
Is the chest clear? Is ventilation bilateral / equal? Cyanosis? SaO2? On room or O2?
44
What are management options of acute breathing issues?
Oxygen Treat with nebulisers of wheeze - steriods, magnesium Decompression for pneumothorax / haemothorax NIV for hypercapnic respiratory failure
45
Assessing circulation and management of shock in very sick patient
``` HR BP Cap refill Temp of limbs Heart sounds Urine output Oedema ```
46
Impact of a fluid challenge
Helps improve preload ``` Heart rate decreases Mean arterial pressure / arterial pulse pressure increase Urine output increases Lactate clearance increases Cardiac output or strike volume increase ```
47
Assessment of disability due to neurological deteriotation
GCS AVPU Blood glucose
48
How do you communicate your findings?
S - Situation B - Background A - Assessment R - Recommendation
49
Total vs free hormone assay
Total - dependent on binding protein levels so NOT always reflective of the free hormone level, cheap Free - representative of the active hormone fraction, complex and expensive, can have poor reproducibility
50
Overview of immunoassay
xxx
51
Thyroid investigations
xxx
52
Describe release of cortisol
xxx
53
Investigations of Cushing's (3 stages)
Screening - urinary free cortisol, diurnal rhythm Confirmation of diagnosis - Low dose dexamethasone suppression test Differentiation of the cause - ACTH, high dose dexamthasone suppression, localisation
54
When best to measure cortisol levels for Cushings diagnosis?
At night (it should be low)
55
What is dexamethasone?
So similar to cortisol, brain can't tell difference | BUT won't come up on assay
56
Outline the types of dexamethasone suppression test
Low dose - 0.5 six hourly complete suppression in normal subject High dose - 2mg six-hourly, suppresses cortisol up to 50% in Cushings DOES NOT suppress in ectopic ADTH or adrenal neoplasia
57
Outline synacthen tests
xxx
58
Outline insulin tolerance test
xxx (insulin or glucagon)
59
Outline oral glucose tolerance test
xxx acromegaly, anorexia nervosa
60
Describe acromegaly
xxx
61
Outline syndrome of inappropriate ADH (SIADH)
Too much ADH | Brain infection / injury, lung cancer / infection, pneumonia, metabolic (hypothyroidism / addison's)
62
What is diabetes insipidus?
Underproduction of ADH Can be cranial or nephrogenic Polyuria, polydipsia
63
Outline water deprivation test
xxx
64
If you can do one investigation with neck lump what do you do? and why?
Ultrasound | Can do biopsy at the same time
65
Identifying benign vs. malignant neck lumps
xxx
66
Neck lumps in different age groups
xxx
67
Thyrotoxicosis vs hyperthyroidism
Thyrotoxicosis is excess thyroid hormones in blood due to any reason( outside source). Hyperthyroidism is excess thyroid hormones only due to increased synthesis from thyroid gland.
68
Signs of T3 toxicosis
xxx
69
Describe diagnosis of hyperthyroidism in patient with overt opthalmopathy
xxx
70
Describe diagnosis of hyperthyroidism in patient without overt opthalmopathy
xxx
71
Treatment of hyperthyroidism
``` Antithyroid drug (ATD) B-blockers Glucocorticoids Radioiodine Subtotal thyroidectomy ```
72
Outline types of thionomides
Carbimaxole, propythiouracil, methimizole
73
Which patients are unlikely to undergo remission following hyperthyroidism treatment
``` Large goitre Positive TSH receptor antibodies Thyroid disease Opthalmopathy Smoking Men ```
74
Indications and contraindications of radio-iodine
Safe and appropriate treatment in nearly all types of hyperthyroidism, especially in elderly Contraindicated in children, pregnancy and women who are breast feeding Women of childbearing age should wait for 4 months after 131I before becoming pregnant Should be used with caution in patients with opthalmopathy Use prophylactic steroids and avoid hypothyroidism
75
Side effects of radio-iodine (4)
Radiation induced thyroiditis. Transient worsening of thyrotoxicosis. Hypothyroidism. Cancer risk.
76
Describe thyroid hormone resistance
May present as hypo or hyper - may not require treatment
77
Developing hyper or hypo when on Amiodrone
Hypo - will likely go away when you stop treatment so you can just treat with T4 in the meanitime Hyper - two types Type 1 - XXX
78
Increase of thyroxine dose during pregnancy
50mcg

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