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Medicine Year 1 > Case 9 SAP > Flashcards

Case 9 SAP Flashcards

1
Q

Effects of hypothyroidism in foetus and neonates

A

Severe mental retardation, dwarfism, iodine deficiency, lack of nerve myelination around birth

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2
Q

Symptoms of hypothyroidism in adults

A

decreased metabolic rate, mental and physical slowing, cold intolerance, weight gain, menorrhagia, depression symptoms, hypoventilation from diaphragm weakness, constipation from decreased GI motility, decreased cardiac output and stroke volume

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3
Q

Most common cause of hypothyroidism in developing countries

A

Iodine deficiency

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4
Q

Hashimoto’s thyroiditis

A

primary hypothyroidism. Autoimmune, thyroid peroxidase (TPO, more common) and thyroglobulin (less common) antibodies found. Low T4 and high TSH

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5
Q

Pituitary gland dysfunction effect on thyroid hormone levels

A

low TSH and low T4

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6
Q

What effect does thyroid gland ablation for hyperthyroidism have on thyroid hormone levels?

A

low T4 and high TSH

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7
Q

Drugs causing hypothyroidism (CLAPS)

A

amiodarone, carbamazepine, lithium, phenytoin, tyrosine kinase inhibitors (sunitinib)

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8
Q

Myxoedema coma

A

severe decompensated hypothyroidism, life threatening emergency, 70% fatalities.

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9
Q

What cause of hypothyroidism can pregnancy unmask?

A

subclinical autoimmune thyroid disease

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10
Q

How does oestrogen impact on T4 levels?

A

increases binding protein so decreases free T4

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11
Q

How does mother’s hypothyroidism affect the foetus?

A

impairs psychomotor development

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12
Q

What is given to keep maternal TSH in normal range?

A

levothyroxine

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13
Q

Tertiary hypothyroidism

A

decreased TRH release which leads to decreased TSH release and decreased T3 and T4. Causes include euthyroid-sick syndrome

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14
Q

Symptoms of hyperthyroidism

A

high metabolic rate, weight loss, tachycardia, tremor, nervousness, heat intolerance, goitre, reduced menses, anxiety symptoms

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15
Q

Describe graves’ disease

A

most common in females aged 30-40.
autoimmune condition in which antibodies attack the thyroid causing it to become overactive

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16
Q

Symptoms of graves’ disease

A

all hyperthyroidism symptoms plus increased lipolysis and protein catabolism leading to muscle weakness, increased GI motility, palpitations, increased cardiac contractility, hyperkinesia, increased bone turnover leading to fractures, and dermopathy

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17
Q

What else can cause hyperthyroidism?

A

Toxic multinodular goitre (Plummer’s disease) and thyroid adenoma

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18
Q

Describe thyroid storm and its causes

A

Severe decompensated (undiagnosed or poorly controlled) hyperthyroidism caused by trauma, pregnancy, infection, or surgery

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19
Q

Symptoms of thyroid storm

A

fever, agitation, delirium, congestive heart failure, loss of consciousness

20
Q

Define domestic abuse

A

Any incident or pattern of incidents of controlling, coercive, or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality

21
Q

Types of domestic abuse

A

psychological, emotional, physical, sexual, and financial. Also includes ‘honour’ based violence, FGM, and forced marriage

22
Q

Describe controlling behaviour

A

a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour

23
Q

Describe coercive behaviour

A

an act or a pattern of acts of assault, threats, humiliation, and intimidation or other abuse that is used to harm, punish, or frighten their victim

24
Q

Scale of domestic abuse

A

1 in 4 women, 1 in 6 men, 2 women killed every week, 1 man killed every 3 weeks, 30 women attempt suicide every week and 3 succeed. biggest prevalence in ages 16-19.

25
Q

Effect of COVID on domestic abuse

A

Substantial increase due to COVID – reports that abuse has gotten worse, having to spend more time with the abusive partner, children witnessing more abuse, support line activity increases, ChildLine self-referrals increase

26
Q

Risk factors for domestic abuse

A

pregnancy (foetal morbidity from violence more common than gestational diabetes and pre-eclampsia), disability (2x risk of DA), mental health problems (3x risk), teenaged, female gender, LGBTQ

27
Q

Biopsychosocial impact of domestic abuse

A

Biological impact: cuts, scrapes, bruises, wounds, fractures, dislocations, lost teeth, STIs, unwanted pregnancies, non-specific symptoms (GI disorders, headaches, gynaecological problems x3, chronic pain, fainting, seizures), self-neglect, homicide.

Psychological: emotional distress, low self-esteem, depression x4, anxiety, suicidality x4, self-harm, PTSD (more common in males), alcohol and substance abuse, eating disorders, sleep disturbances.

Social: financial dependence on partner, impact on work, isolation from friends/family/support networks, homelessness, impact on ability to make decisions, impact on ability to parent, drink/drug behaviours, perpetrator always attending appointments to less chance to disclose

28
Q

Impact of domestic abuse on health and health service

A

People experiencing DA use the health service more - tend to come into contact with GP before seeking help from authorities

29
Q

Impact of DA on children

A

1 in 5 children have been exposed to DA, 62% of those in DA households are also directly harmed. Behavioural/emotional/mental health issues, neglect, physical abuse, truanting, bed wetting, premature sexual behaviour, drug and alcohol use

30
Q

Define medically unexplained symptoms

A

physical symptoms persisting for more than several weeks for which adequate medical examination has not revealed a condition that adequately explains the symptoms

31
Q

Common medically unexplained symptoms diagnoses

A

IBS, pelvic pain, non-cardiac chest pain, chronic headache, dizziness/vertigo, chronic fatigue, fibromyalgia

32
Q

Medically unexplained symptoms stats

A

10-20% have multiple episodes
0.2% have severe with early onset (<30)
15-45% GP consultations have MUS
3-10% adults in primary care have persistent or recurrent
50-75% will have symptom decrease over 12 months
10-30% symptoms will worsen or increase
<4% with IBS have organic explanation
10% with fatigue have explanation

33
Q

Impact of MUS

A

depression and anxiety more common in patients, can have significant impact on quality of life, similar rates of consultation as those with explanations

34
Q

Theory of central sensitization

A

heightened perception of and distress from sensory input

35
Q

Hyperalgesia

A

more pain than should be experienced from painful stimuli

36
Q

Allodynia

A

pain from non-painful stimuli

37
Q

Cause of hyperalgesia and allodynia

A

synaptic plasticity and loss of inhibition

38
Q

Endocrine dysregulation theory

A

evidence of hypothalamic-endocrine dysfunction in many patients affecting the feedback loop that regulates stress responses. May be linked to the over production of cortisol which can result in chronic fatigue and pain

39
Q

Immune system sensitization theory

A

chronic immune activation with production of cytokines that don’t switch off when the stressful stimulus is removes. Can give a feeling of illness.

40
Q

Signal-filter model

A

uses the idea that we filter out signals in a manner very similar to that of pain which uses the gate theory. If our gates are broken, our perception of symptoms increases.

41
Q

Management of MUS

A

acceptance of the person’s suffering and validation of their experience. Give explanation through models and analysis. Avoid opiates. Offer psychological support, exercise if appropriate, occupational support, patient support groups

42
Q

Non-pharmacological treatments for schizophrenia

A

CBT, family therapy, arts therapy

43
Q

Non-pharmacological treatments for dementia

A

CBT, psychotherapy, behavioural management therapy, memory training, music/dance therapy, support groups

44
Q

Non-pharmacological treatments for depression

A

CBT, acupuncture, supplements, electroconvulsive therapy, repetitive transcranial magnetic stimulation

45
Q

Non-pharmacological treatments for anxiety

A

limit caffeine, alcohol, nicotine, balanced diet, exercise, CBT, sleep

Medicine Year 1 (23 decks)

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