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MRCS > Breast and endocrine > Flashcards

Breast and endocrine Flashcards

1
Q

Causes of gyenacomastia

A

METOCLOPRAMIDE

Metaclopramide/ Methyldopa
Ectopic oestrogen
Trauma skull/ Tumour breast/ testes
Orichitis
Cushings/ cimetidine
Liver cirrhosis
Obesity (increased oestrogen in fat tissue)
Paraplegia/ puberty/ physiological (new borns-oestrogen from mom)
RA
Acromegaly/ Anabolic steroids
Mumps (testicular failure)
Isoniazide
Digoxin/ Digitalis
Ethionamide

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2
Q

What is the pathophysiology of gynacomastia

A

Increased ratio of oestrogen: androgens in the body

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3
Q

What are androgens

A

Sex hormones that help with puberty

Testosterone
androstendione
Dihydroepiandrostendione (DHEA)
DHEA-sulphate

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4
Q

Treatment of primary hyperparathyroidism due to a parathyroid adenoma

A

Surgical excision

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5
Q

Cause of zollinger-ellison syndrome

A

Pancreatic gastrinoma made of pancreatic G cells which secrete gastrin

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6
Q

What are the 3 ohases of gastric acid secretion

A

Cephalic
gastric
intestinal

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7
Q

What are the stimulants for the 3 phases of gastrin secretion

A

cephalic= sight/ smell of food
gastric= stomach distension
intestinal= food enters duodenum

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8
Q

What nerve provides the parasympathetic supply to give gastrin secretion

A

Vagus nerve

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9
Q

Describe the events of cephalic phase of gastric secretion

A

sight/ smell of food= vagal stimulation
G-cells of antrum of stomach stimulated
G-cells secrete gastrin
Gastrin stimulates gastric acid/ pepsin/ histamine release from parietal cells/ mast cells

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10
Q

Describe the events of gastric phase of gastric secretion

A

food enters stomach
causes distension of stomach
vagal stimulation from distension
gastrin secreted
gastric acid produced (60% in gastric phase)

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11
Q

T/F: Histamine release inhibits gastrin secretion

A

FALSE- Histamine release stimulates gastric acid secretion

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12
Q

T/F: Somatostatin inhibits gastric acid production

A

TRUE- somatostatin acts directly on parietal cells to inhibit gastric acid secretion

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13
Q

What cells are involved in insulinoma

A

Beta islet cells of pancreas

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14
Q

What is Whipples triad

A

-attacks brought on by fasting
-hypoglycaemic during attacks
-attacks improve with administration of glucose

Triad present in those with an insulinoma-have attacks of lightheadedness, mood swings, unconsciousness (sx of hypo)

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15
Q

What cells are involved in glucagonoma

A

Alpha islet cells of pancreas

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16
Q

Commonest causes of thyrotoxicosis

A

Graves
multinodular toxic goitre
solitary toxic nodule

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17
Q

Which condition causes chronic fibrosis of the thyroid gland

A

Reidel’s thyroiditis

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18
Q

How to differentiate between Graves and other causes of thyrotoxicosis

A

Graves has:
eye signs (exophthalmos, ophthalmoplegia)

pretibial myxoedema

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19
Q

Describe the conditions associated with MEN type 1

A

3 P’s:

Pituitary adenoma
Parathyroid hyperplasia
Pancreatic islet cell tumours

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20
Q

Which MEN syndromes are associated with pheochromocytomas

A

MEN type 2A + 2B

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21
Q

Which MEN syndrome is associated with phaochromcytomas, medullary thyroid cancer, parathyroid hyperplasia

(2P’s 1M)

A

MEN 2A

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22
Q

What conditions are associated with MEN 2B (1 P, 3Ms)

A

phaochromcytomas
medullary thyroid cancer
marfanoid appearance
mucosal neuromas (neurofibramatosis)

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23
Q

What is the gene mutation associated with the MEN syndromes

A

RET proto-oncogene

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24
Q

What is the inheritance pattern for MEN syndrome

A

Autosomal DOMINANT (because MEN like to dominate)

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25
Q

Describe the 2 ways in which chronic renal failure leads to hypocalcaemia

A

1: renal failure= reduced activation of Vit D = reduced Ca absorption in the intestines

2: renal failure= phosphates not excreted= increased phosphates in the blood bind to free Ca= reduced free Ca in blood

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26
Q

What histology would you see in papillary thyroid carcinoma

A

orphan annie nuclei
psammoma bodies

27
Q

What type of thyroid ca is common in young women with prev head/ neck irradiation

A

papillary Ca

28
Q

What condition causes:
raised serum calcium
low urinary calcium
normal/ raised PTH
hypermagnesiemia

A

Familial Hypocalciuric Hypercalcaemia

29
Q

What is the inheritance pattern for FHH

A

Autosomal dominant

30
Q

Pathophysiology of FHH

A

FHH due to non-functioning Ca sensing receptor (CaSR)

CaSR found on parathyroid + kidneys

Parathyroid:
-normally detects serum Ca and regulates PTH secretion via -ve feedback

FHH= CaSR not working= PTH secreted without feedback despite high Ca

Kidneys:
-normally allows for Ca excretion in kidneys and stops reabsorption

FHH= Ca not excreted in kidneys= low Ca levels in urine (hypocalciuric)

31
Q

Management of symptomatic FHH

A

calcimimetics + pamidronate
(bisphosphonates not used)

32
Q

What is a complication of FHH and how is it managed

A

recurrent pancreatitis

Mx= parathyroidectomy

33
Q

Which type of cancer can cause
high Ca
low phosphate

A

SCC lung

causes paraneoplastic syndromes= PTH mimicking peptide secreted

34
Q

Indications for thyroid surgery

A

4C’s:
cosmesis
compression (trachea/ oesophagus)
carcinoma
control (of thyrotoxicosis)

35
Q

How can follicular carcinoma and adenoma be distinguished/ diagnosed

A

thyroid lobectomy + histology to confirm

36
Q

Management of follicular carcinoma

A

total thyroidectomy (if confirmed by histology)

37
Q

Where does papillary thyroid cancer mets to

A

(lymph spread)
cervical lymph nodes

38
Q

Where does follicular thyroid cancer mets to

A

brain
bone
lungs

39
Q

Another name for MEN 2A syndrome

A

Sipples syndrome

40
Q

Commonest causes of primary hyperparathyroidism

A

parathyroid adenoma
parathyroid hyperplasia
carcinoma

41
Q

What are the factors associated with anaplastic thyroid Ca

A

F>M
iodine deficiency
history of multinodular goitre

42
Q

Sx of anaplastic thyroid ca

A

hoarse voice
thyroid mass (rapid growing)
dysphagia

43
Q

Where does anaplastic thyroid Ca mets to

A

brain
bone
lungs

44
Q

Management of anaplastic Thyroid Ca

A

palliative
(doxorubicin/ cisplatin)

45
Q

Biochem difference between osteoporosis and pagets disease:
(Ca, Phos, PTH, ALP levels)

A

Pagets:
ALP= very raised
Ca, Phos, ALP= normal

osteoporosis:
All normal

46
Q

What other conditions is Hashimotos associated with?

A

pernicious anaemia
coeliacs
thyroid lymphoma

47
Q

Which cancers can cause paraneoplastic syndrome

A

small cell lung ca
bronchial carcinoma
Thymic tumours
medullary thyroid cancer
islet cell tumours of pancreas

48
Q

Cushings disease vs syndrome

A

Disease= pituitary adenoma causing raised ACTH= causes increased cortisol from adrenal

Syndrome= increased cortisol from adrenal (any cause- pituitary adenoma/ steroid use/ paraneoplastic tumours/ ectopic sources)

49
Q

Treatment of hyperthyroidism in pregnancy

A

1st trimester= PTU
after 1st trimester= carbimazole

PTU =not after 1st tri= affects liver development
Carbimazole= not in 1st tri= teratogenic
Not surgery= anaeasthetic risk to fetus

50
Q

What condition causes
secondary HTN
hypernatraemia
hypokalaemia
metabolic alkalosis

A

Conns (Hyperaldosteronism)

51
Q

Where is aldosterone made and where does it act

A

Aldosterone
made: zona glomerulosa of adrenal cortex

acts: DISTAL convoluted tubule + collecting ducts kidneys

52
Q

Management options for Conns

A

Spironolactone (aldosterone antagonist)
adrenalectomy

53
Q

What are the biochemical disturbances found in Addison’s disease

A

addisons= adrenal insufficiency

hyponatraemia
hyperkalaemia
hypercalcemia

54
Q

What condition causes
hypercalcaemia
cough/ SOB
hilar lymphadenopathy
afro-carribeans affected
30-40s

A

Sarcoidosis

55
Q

Management of Sarcoidosis

A

Steroids

56
Q

Investigations for Conns

A

Bloods (raised aldosterone)
Adrenal scintigraphy
CT/ MRI adrenals
Diurnal/ positional aldosterone levels

57
Q

What are the antibodies found in Hashimotos thyroiditis

A

anti-microsomal/ anti-thyroid peroxidase
anti- thyroglobulin antibodies

58
Q

What is a complication post bilateral adrenalectomy for cushings syndrome

A

Nelsons syndrome

58
Q

what type of hernia is associated with congenital hypothyroid

A

umbilical hernia in children

59
Q

Pathophysiology of Nelsons syndrome

A

Resection of both adrenals = reduced cortisol

-ve feedback= pituitary secretes ACTH= increasing ACTH production causes swelling of pituitary

pituitary swelling causes sx= headaches, cranial nerves affected

60
Q

What enzyme deficiency causes congenital adrenal hyperplasia

A

21-hydroxylase deficiency

61
Q

Pathophysiology of CAH

A

21-hydroxylase deficiency= not enough cortisol produced= increased ACTH released= increased precursors of cortisol= these precursors are used to make testosterone instead

in females= leads to hermaphrodite
in males= precocious sexual maturation

62
Q

First line investigation for sx of acromegaly

A

Insulin like growth factor levels

MRCS (22 decks)

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