What are the buzzwords for: Medullary Papillary Follicular Anaplasitc Thyroid tumours?

Medullary: cancers arise from parafollicilar "C" cells that secrete calcitonin. Associated with MEN2 syndrome. Papillary: are associated with psammoma bodies and Orphan Annie eyes Follicular are associated with nodules and mets Anaplastic affect the elderly, metastasise widely.

Chempath Flashcards by Jeremias Reich

Distinguish between HHS (HONK) and DKA

DKA presents with a high anion gap due to ketoacidosis. HHS is not characterised by acidosis.

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What are the buzzwords for:

Medullary
Papillary
Follicular
Anaplasitc

Thyroid tumours?

Medullary: cancers arise from parafollicilar “C” cells that secrete calcitonin. Associated with MEN2 syndrome.
Papillary: are associated with psammoma bodies and Orphan Annie eyes
Follicular are associated with nodules and mets
Anaplastic affect the elderly, metastasise widely.

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Rate limiting haem synthesis

ALA synthase

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Deficiency of this –> high urea

HGPRT in e.g. Lesch Nyhan Syndrome Hyperuricaemia, Gout, PRT (Prutt)

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Gynaecomastia + wants viagra

Prolactinoma (prolactin will be >6000)

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Rounded mass with glands and mucin in Liver

Met from pancreatic adenocarcinoma

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Histology of acute fatty liver hep

Ballooned cells, mallory denk bodies, neutrophils

Does this not describe alcoholic hepatits instad of acute liver disease?

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Alcoholic hepatitis with fibrosis

Ballooned cells, mallory denk bodies, MEGAMITOCHONDRIA, pericentricular fibrosis

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AFP raised in?

HCC, pregnancy, testicular Ca

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What type of Billrubin can be seen in urine?

Conjugated only (e.g. obstructive jaundice)

Unconjugated bilirubin is not watersoluble

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Corrected calcium

measured + 0.02(40-albumin)

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Baby with seizures, low Ca, low PTH

Primary hypoparathyroidism in e.g. Di George

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Low mood after renal transplant for longstnading renal disease (high Ca, high PTH)

Tertiary hyperparathyroidism

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B12 vs folate deficiency

B12: glossitis, jaundice, dementia, other AI conditions, vegans Folate: diarrhoea, methotrexate IBD can cause either (methotrexate->folate, loss of terminal ileum absorption->B12)

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Vitamins B1 B2 B3 (Niacin) B6

B1 - thiamine. WKS/beri beri –> cardio/neuro (RBC transketeolase)

B2 - Riboflavin (glossitis, RBC glutanthione reductase)

B3 Niacin - Pellagra - dementia, diarrhoea, dermatitis, casals necklace

B6 - Pyridoxine (dermatitis, anaemia, neuropathy)

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Denosumab target

RANK-L on Osteoclasts (inhibit) for osteoporosis or bony mets

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Allopurinol interacts with

Azathioprine

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Acute intermittent porphyria Ix

Urine PBG (and Urine ALA)

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In guthrie how do you measure Hypothyroid CF MCADD

TSH Immune reactive trypsin Acylcarnitine

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Normal anion gap

18mM

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Primary hyperparathyroidism Vit D levels

Vit D is low as it is consumed

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High Ca + haematuria (painful)

Renal stone

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Band keropathy

Long term hyperCa

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Addisons + primary hypothyroidism + diabetes

Schmidt syndrome (AIPS2) Think the diagram I drew of the organs in a funny shape to remember

= APECED

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HTN + Adrenal mass (3 causes)

Phaeo, Conns, Cushings

High functioning adrenal (3 causes)

Cushings, Conns, CAH

Low functioning adrenal

Sepsis, haemorrhage, discontinuation of steroids, Addisons

MI Markers

Troponin - rises within 4-6 hours, peaks 12-24 hours, remains high for 3-10 days CK - rises withing 24 hours (check if double MI) Myoglobin rises quickly

MEN 1

Pituitary, Pancreas, Parathyroid

MEN 2a

Parathyroid, Phaeo, Thyroid (med)

Men 2b

Phaeo, Thygoid, Ganglioneuroma

High TSH, high T4, low T3

Sick Euthyroid??

Tertiary hyperparathyroidism

Often in people with CKD Longstanding 2° hyperparathyroidism --\> gland hyperplasia --\> permanent dysregulated high secretions of TSH --\> 1° hyperparathyroidism picture End result: High PTH, high Calcium, variable PO4 levels

T1DM has low Na, everything else is normal

hyperlipidaemia

High K, low Na, urine osmolality \>20

CKD/Renin (RAS) cause not aldosterone

Urine osmolality \> plasma osmolality

SIADH

Low K, alkalosis, hypotension, hypercalciuria

Bartter

Low K and acidosis

RTA (renal tubular acidosis)

NAFLD LFTs

High ALT and AST ratio 1:1 High GGT Normal Br and Alb

Low caeruloplasmin

Wilsons

Vitamin C deficiency affects what thing to cause bleeding gums and poor dentition?

Collagen

Vit E deficiency

Haemolytic anaemia, areflexia, ataxia

Vit B6 deficiency

Pyroxidine Dermatitis, peripheral neuropathy, sideroblastic anaemia can be caused by isoniazid

Fair skin, brittle hair, developmental delay, LDs

HCU (homocystinuria)

G6PD, hypoglycaemia, big kidneys and liver

von Gierke's

Toxic encephalopathy causing poor feeding, hypotonia and seizures Sweet odour and sweaty feet

MSUD

Cherry-red spot and dymorphia

LYsosomal storage disorder (e.g. Fabry's)

Phenytoin toxicity

ataxia and low BP

Lithium

tremor and thirst

Gentamicin toxicity

Ears and kidneys Tinnitus - ringing in ear Gentleman caller ringing

Low vit D, low Ca, high PTH

Osteomalacia (not 2° hyperparathyroidism as vit D is the causative problem)

Chronic renal failute, high Ca, high PTH

3° hyperparathyroid

Thiamine (B1) test

Red cell trasketolase activity

Floppy neonate not feeding Cataract and conjugated jaundice post milk feed

Galactosaemia

Why do you give Calcium gluconate in hyperkalaemia

As it is cardioprotective and helps prevent fatal dyrhythmia (does not lower K)

CKMB is useful for what in heart medicine

detecting re-infarction as levels rapidly return to normal so would know if was a second one

In an SIADH picture what must you exclude before diagnosing SIADH?

Drugs causing it

1. Causes of pseudo-hyponatraemia 2. what will the osmolality be doing?

1. High lipids or proteins or a spurious sample 2. The osmolality will be normal (low in true hyponatraemia) It is caused by dilution

High PTH but high PO4 and low Ca

Pseudohyperparathyroidism Generic resistance to PTH High PTH but Ca and PO4 respond as if low PTH

Anion gap MUDPILES (or KULT)

Metformin \*Uraemia \*DKA (Ketones) Paraldehyde Iron \*Lactic acid Ethanol/methanol Salicylates \* Are KUL Non\* are all the Toxins

Acute intermittent porphyria treatment and route of administration

IV haem arginate

PTH derivative used to treat osteoporosis

terparatide

Type of gallstone present in patients with hereditary spherocytosis (or any increased haemolysis)?

Calcium bilirubinate

What liver enzyme is raised in MI?

AST

Scan for neuroendocrine tumours

Gellium 68 dotatate

Scan for general cancer mets

Fluorodeoxyglucose

Bone scan

Technetium bisphosphonate

Scan for thyroid cancer

Technetium pertechnetate

Scan for phaeochromocytoma

MIBG scan

What is the value for impared fasting and glucose tolerance?

Fasting = 6-7 Glucose tolerance 7.9-11