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JL Endocrinology > Week 3 > Flashcards

Week 3 Flashcards

(108 cards)

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1
Q

Name two macrovascular complications of diabetes?

A

IHD

Stroke

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2
Q

What percentage of patients with diabetes will develop some degree of neuropathy?

A

60 - 70%

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3
Q

What type of neuropathy involves pain/loss of feeling in feet, hands?

A

Peripheral

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4
Q

What type of neuropathy involves changes in bowel, bladder function, sexual response, sweating, heart rate, BP and hypoglycaemic unawareness?

A

Autonomic

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5
Q

What type of neuropathy involves pain in the thighs, hips or buttocks leading to weakness in the legs (amyotrophy)?

A

Proximal

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6
Q

What type of neuropathy involves sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy and cranial nerve palsy?

A

Focal neuropathy

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7
Q

Which type of diabetes is more prone to neuropathy?

A

type I

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8
Q

Name a cream that may help treat painful neuropathy?

A

Capsaicin cream

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9
Q

For treating painful neuropathy - what might be started after paracetamol?

A

TCA’s (amitryptiline)
Gabapentin
dULOZETINE/PRE-GABALIN
Oxycodone/tramadol

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10
Q

Name a digestive complication of diabetes that can make blood glucose levels fluctuate widely, due to abnormal food digestion?

A

Gastroparesis

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11
Q

A gastric pacemaker can be used to treat gastroparesis - name three drugs that can also be trialed?

A
  1. Metoclopramide
  2. Domperidone
  3. Erythromycin
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12
Q

What might happen to blood pressure in a diabetic complication?

A

May drop sharply after sitting or standing, causing a person to feel light-headed

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13
Q

What does nodular glomerulosclerosis occur in?

A

Diabetic nephropathy

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14
Q

What should you use to screen for diabetic kidney disease?

A

Urinary albumin creatinine ratio (ACR)

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15
Q

In diabetic nephropathy what signals impending doom?

A

Microalbuminuria

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16
Q

What should be screened and treated aggressively in a patient with microalbuminuria?

A

Hypertension

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17
Q

What does exercise, protein load and fluid load vary?

A

Microalbuminuria

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18
Q

Name a few other false positives for microalbuminuria?

A

Menstruation, vaginal discharge, UTI, pregnancy etc

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19
Q

What class of drugs reduce progression on diabetic nephropathy?

A

ACE inhibitors

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20
Q

Give four effects of ACE inhibitors or ARBS in diabetic nephropathy?

A
  1. Dilatation of renal arterioles
  2. Decrease filtration pressure
  3. Decrease proteinuria
  4. Decrease GFR
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21
Q

In all patients with diabetes - what should their blood pressure be maintained at?

A
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22
Q

Name four diabetic eye pathologies that people with diabetes get?

A
  1. Retinopathy
  2. Cataract
  3. Glaucoma
  4. Acute hyperglycaemia - visual blurring
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23
Q

What part of the eye is involved in fine vision?

A

Fovea

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24
Q

What is the area around the fovea?

A

Macula

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25
What three ways can retinopathy be treated?
Laser, vitrectomy and anti-VEGF injections
26
What two anti-hypertensive drugs can commonly cause erectile dysfunction?
Thiazides and beta blockers
27
Name a few CNS drugs that can commonly cause erectile dysfunction?
1. Antidepressants, tricyclics 2. Tranquilisers 3. Sedatives 4. Analgesics
28
Name two drugs which can be used to treat ED in diabetes?
Sildenafil | Vardenafil
29
What therapy should be commensed in all patients with diabetes over age 40?
Statin for cholesterol lowering
30
What is the most diverse hormone subtype?
Proteins and peptides
31
What are steroids derived from?
Cholesterol
32
Name two cytokine receptors?
Prolactin and growth hormone receptors
33
In steroid hormone receptors, once steroid complex binds DNA response elemtns what occurs?
Change in gene transcription
34
What is the major determinant of hormone concentration?
Rate of secretion
35
What does a raised TSH suggest?
Hypothyroidism
36
What does a suppressed TSH suggest?
Hyperthyroidism
37
When might TSH not be a reliable marker of thyroid status?
Pituitary dysfunction
38
What does ACTH released from anterior pituitary work on?
Adrenal cortex
39
What measurement may give indication of HPA axis function?
9am cortisol
40
What indicates GH hypersecretion?
IGF-1 measurement
41
What does evaluation of female sex hormones depend on?
Timing in menstrual cycle
42
What is prolactin (PRL) secreted by>?
Lactotroph cells of the anterior pituitary
43
What is Prolactin secretion under tonic inhibition by?
Hypothalamic dopamine
44
What are the effects of prolactin mediated by?
Prolactin receptor
45
What disease involves primary adrenal failure?
Addison's disease
46
What condition is associated with cortisol excess?
Cushings syndrome
47
Name a steroid stimulation test?
Synacthen test
48
Name a steroid suppression test?
Dexamethasone suppression test
49
What condition involves chushingoid facies, acne, hirsutism, abdo striae & centripetal obesity, interscapular and supraclavicular fat pads, proximal myopathy, osteoporosis, hypertension and impaired glucose tolerance?
Cushings syndrome
50
What is cushings disease?
Pituitary cushing's - tumour arising from the corticotroph cells of anterior pituitary
51
Is the adrenal cause of cushings syndrome ACTH-independent or ACTH-dependent?
Independent
52
Is the pituitarty cause of cushings syndrome ACTH dependent or independent?
Dependent
53
Is the ectopic ACTH cause of cushings syndrome ACTH dependent or independent?
Dependnet
54
What sort of test is used for cushings?
Suppression
55
Name three screening tests for cushings?
1. 1mg overnight dexamethasone suppression test 2. 24 hour urinary free cortisol 3. Midnight cortisol
56
What is the formal diagnostic test for Cushings?
Low dose dexamethasone suppression test
57
If the ACTH is low - what does it suggest about the cushings?
It is adrenal origin
58
If the ACTH is raised - what does it suggest about cushings?
Need to distinguish between cushings disease and ectopic ACTH
59
In relation to cushings - what does a rise in cortisol and ACTH on CRH test indicate?
Pituitary source
60
What is the gene type of multiple endocrine neoplasia MEN1?
Autosomal dominant - MEN1 gene 11q Classic tumour suppressor
61
What is the gene type of multiple endocrine neoplasia MEN2?
Autosomal dominant, RET gene 10q Classic proto-oncogene
62
In the thyroid - what do parafollicular C cells secrete?
Calcitonin
63
What is the main fuel of thyroid gland?
Iodine
64
What are the four steps in synthesis and storage of T3 and T4?
1. Iodine taken up by follicle cells 2. Iodine attached to tyrosine residues on thyroglobulin to form MIT and DIT 3. Coupling of MIT + DIT (T3) & 2 DITs (T4) 4. Stored in colloid thyroglobulin till required
65
What makes up 90% of thyroid hormones secreted?
t4
66
What is T4 converted to T3 by?
LIver and kidney
67
What is the major biologically active thyroid hormone?
T3
68
What allows T3 and T4 to bind to plasma proteins?
Hydrophobic/lipophilic
69
Name three plasma proteins which bind to T3 and T4?
1. Thyroxine binding globulin 2. Thyroxine binding prealbumin 3. Albumin
70
What do you get decreased TBG in?
Cushings S
71
What hormones increase responsiveness to adrenaline and sympathetic NS neurotransmitter, noradrenaline, by increasing numbers of receptors?
Thyroid hormones
72
What class of drug is used to treat symptoms in initial stages of hyperthyroidism?
Propranolol - beta-blocker
73
What hormone from the hypothalamus stimulates thyroid stimulating hormone?
Thyrotrophin release hormone (TRH)
74
What stimulates TRH release?
LOW TEMPERATURES
75
what inhibits TRH and TSH release?
Stress
76
What is the most common type of thyroid cancer?
Papillary 76% then follicular 17%
77
What do most differentiated thyroid cancers take up and secrete?
Take up iodine and secrete thyroglobulin
78
What types of cancers are TSH driven?
Differentiated thyroid cancer
79
Does thyroid cancer have an association with diet, smoking etc?
No only nuclear exposure
80
What do most thyroid cancer patients present with?
Palpable nodules
81
How does papillary thyroid cancer spread?
Via lymphatics
82
What is papillary thyroid cancer associated with?
Hashimoto's thyroiditis
83
How does follicular cancer spread?
Haematogenously
84
How is thyroid cancer usually investigated?
Via ultrasound guided FNA of the lesion
85
What age groups for new thyroid nodules suggest malignancy?
less than 20 or over 50
86
Is male or female more likely for malignant nodules on thyroid?
Male
87
What is treatment of choice for thyroid cancer?
Surgery
88
What surgery would you do for papillary microcarcinoma, MININALLY INVASIVE follicular carcinoma with capsular invasion only and patients in AMES low risk group?
Thyroid lobectomy with isthmusectomy
89
What surgery would you do for DTC with extra-thyroidal spread, bilateral/multifocal DTC, DTC with distant metastases, DTC with nodal involvement and patients in AMES high risk group?
Sub-total or total thyroidectomy
90
What is checked within 24 hours after thryoid cancer surgery?
Calcium - calcium replacement initiated if corrected or calcium falls below 2 mmol/l
91
What is a patient discharged on after thyroid cancer surgery?
T3 and T4
92
What technique is used in patients who have undergoe sub-total or total thyroidectomy?
Whole body iodine scanning
93
What needs to rise to greater than 20 before whole body iodine scanning?
TSH
94
If iodine is taken up in thyroid on whole body scan after surgery what occurs?
Thyrpid remnant ablation
95
What indicates a cured thyroid cancer patient?
Undetectable thyroglobulin levels
96
What bounds the anterior triangle superiorly and what makes up the anterior border laterally?
Bounded by mandible superiorly and anterior border of SCM laterally
97
What makes up the boundaries of posterior triangle in neck?
Posterior border SCM anteriorly Anterior border trapezius laterally Clavicle inferiorly
98
Give three examples of superficial swellings?
1. Sebaceous cysts 2. Lipomas 3. Neurofibromas
99
Give three examples of midline swellings in the neck?
1. Thyroid 2. Thyroglossal cyst 3. Dermoid cyst - suprasternal notch
100
Name four anterior triangle swellings?
1. lymph nodes 2. branchial cyst 3. salivary glands 4. carotid body tumour
101
Name two posterior triangle swellings?
1. Lymph nodes | 2. Cystic hygroma
102
Give three investigations for cervical lumphadenopathy?
1. CXR 2. ENT 3. Fine needle aspiration
103
What moves with the tongue, presents in teenage years and contains lymphatics which may become infected?
Thyroglossal cyst
104
What is a rare congenital cyst, usually presents in teenage years and is soft, nonfluctuant?
Dermoid cyst
105
What is persisting second branchial arch, arises in upper part of ant. triangle, usually presents in teenage years, 'haklf filled water bottle', FNA-cholesterol crystals and can fistulate?
Branchial cyst
106
What normally presents in first year of life and can cause pressure symptoms, lymph filled and transilliuminate?
Cystic hygroma - posterior triangle
107
What salivary gland are stones most common in?
Submandibular
108
What is a swelling in the parotid salivary gland more likely to be?
Tumour

JL Endocrinology (12 decks)

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