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The Endocrine System > Disease Profiles > Flashcards

Disease Profiles Flashcards

1
Q

Diabetes: Symptoms of High Blood Glucose - Urinary Tract (4)

A

Polyuria
Thirst
Polydypsia
Genital thrush

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2
Q

Diabetes: Symptoms of High Blood Glucose - General (3)

A

Blurred vision - altered osmotic pressure in the anterior chamber of the eye
Fatigue
Weight loss

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3
Q

Diabetes: Investigations - Blood glucose threshold is set by what?

A

Retinopathy risk

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4
Q

Diabetes: Investigations - Blood glucose in gestational diabetes is set by what?

A

Risk to the foetus or neonate

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5
Q

Diabetes: Investigations - Fasting Glucose thresholds

A

> 7.0 mmol/L

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6
Q

Diabetes: Investigations - Random or 2 hour glucose in OGTT threshold

A

> 11.1 mmol/L

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7
Q

Diabetes: Investigations - HbA1c threshold

A

> 48mmol/mol

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8
Q

HbA1c: What happens when Hb becomes exposed to glucose?

A

Glycated

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9
Q

HbA1c: Extent of glycation is proportional to what?

A

Glucose concentration

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10
Q

HbA1c: Level gives a representation of glucose exposure for how long?

A

90 days

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11
Q

HbA1c: Must analyse cautiously in what situations?

A

Increased or Reduced RBC turnover

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12
Q

Type I Diabetes Mellitus

A

Autoimmune destruction of the pancreatic beta cells resulting in Beta cell deficiency and therefore absolute insulin deficiency

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13
Q

Type I Diabetes Mellitus: Average age of onset

A

<20 years old

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14
Q

Type I Diabetes Mellitus: High incidence in what countries? (2)

A

Scandinavia
Saudi Arabia

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15
Q

Type I Diabetes Mellitus: This is more commonly diagnosed in what sex post-puberty?

A

Males

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16
Q

Type I Diabetes Mellitus: Aetiologies - Genetic cause

A

HLA Complex - DR3-DQ2 or DR4-DQ8

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17
Q

Type I Diabetes Mellitus: Aetiologies - Peak age of onset

A

10-14 years

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18
Q

Type I Diabetes Mellitus: Environmental Risk Factors - Maternal factors (2)

A

Older in age
Gestational infection

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19
Q

Type I Diabetes Mellitus: Environmental Risk Factors - Example of a viral infection

A

Coxsackie B4

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20
Q

Idiopathic Type I Diabetes Mellitus

A

Patients with permanent insulinopenia and are prone to DKA but have no evidence of Beta Cell Autoimmunity

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21
Q

Latent Autoimmune Disease in Adults

A

Late onset Type I Diabetes Mellitus

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22
Q

Type I Diabetes Mellitus: Pathophysiology - Autoantibodies present (4)

A

Glutamic Acid Decarboxylase (GAD-65)
Islet-antigen 2
IAA
ZnT8 Transporter (ZnT8Ab)

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23
Q

Type I Diabetes Mellitus: Pathophysiology - What immune response mediates this?

A

T-cell mediated autoimmune response with production of autoantibodies to target and destroy Beta Cells

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24
Q

Type I Diabetes Mellitus: Pathophysiology - What is visible on a Beta Cell Biopsy?

A

Insulitis with lymphocytic infiltrate

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25
Q

Type I Diabetes Mellitus: Clinical Presentation - Onset

A

Acute

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26
Q

Type I Diabetes Mellitus: Clinical Presentation - Urinary Tract Symptoms (3)

A

Polydypsia
Polyuria
Thrush

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27
Q

Type I Diabetes Mellitus: Clinical Presentation - General symptoms (4)

A

Weakness
Fatigue
Blurred vision
Severe weight loss

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28
Q

Type I Diabetes Mellitus: Diagnosis - Biochemical markers (5)

A

Increased glucose
Ketones
Decreased insulin
Decreased beta cell mass
Decreased C peptide

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29
Q

Type I Diabetes Mellitus: Insulin Management - Examples of Insulin Analogues

A

Insulin Aspart, Lispro or Glulisine

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30
Q

Type I Diabetes Mellitus: Insulin Management - Onset of insulin analogues

A

10-15 minutes

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31
Q

Type I Diabetes Mellitus: Insulin Management - Peak action of insulin analogues

A

60-90 minutes

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32
Q

Type I Diabetes Mellitus: Insulin Management -Duration of action of insulin analogues

A

4-5 hours

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33
Q

Type I Diabetes Mellitus: Insulin Management - Examples of soluble insulin

A

Actrapid or Humulin S

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34
Q

Type I Diabetes Mellitus: Insulin Management - Onset of action of Soluble Insulin

A

30-60 minutes

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35
Q

Type I Diabetes Mellitus: Insulin Management - Peak action of Soluble insulin

A

2-4 hours

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36
Q

Type I Diabetes Mellitus: Insulin Management - Duration of Soluble Insulin

A

5-8 hours

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37
Q

Type I Diabetes Mellitus: Isophane Basal insulin - Examples (2)

A

Insulatard
Humulin I

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38
Q

Type I Diabetes Mellitus: Isophane Basal insulin - Peak action

A

4-6 hours

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39
Q

Type I Diabetes Mellitus: Isophane Basal insulin - Duration

A

12 hours

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40
Q

Type I Diabetes Mellitus: Analogue Basal insulin - Examples (2)

A

Glargine
Detemir

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41
Q

Type I Diabetes Mellitus: Pancreas Transplantation - Options (2)

A

Kidney-pancreas auto-transplantation
Islet autotransplantation

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42
Q

Type I Diabetes Mellitus: Pancreas Transplantation - Indications (3)

A

Imminent End Stage Renal Disease
Severe hypoglycaemia or metabolic complications
Uncontrolled diabetes despite maximum treatment

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43
Q

Type I Diabetes Mellitus: Pancreas Transplantation - How are islets infued?

A

Into the portal vein to be transferred to the liver

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44
Q

Type I Diabetes Mellitus: Pancreas Transplantation - Immunosuppression options (2)

A

Mycophenalate
Tacrolimus

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45
Q

Type I Diabetes Mellitus: Associated Conditions (3)

A

Cystic Fibrosis
Wolfram Syndrome
Bardet-Biedl Syndrome

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46
Q

Type I Diabetes Mellitus: Pancreas Transplantation - Cystic Fibrosis DM Screening

A

OGTT from the age of 10

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47
Q

Type I Diabetes Mellitus: Pancreas Transplantation - Cystic Fibrosis DM Management

A

Insulin

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48
Q

Type I Diabetes Mellitus: Pancreas Transplantation - Wolfram Syndrome DM clinical presentation (3)

A

DI or DM
Optic atrophy
Deafness

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49
Q

Type I Diabetes Mellitus: Pancreas Transplantation - Bardet-Biedl Syndrome DM Clinical presentation (4)

A

Obesity
Polydactyly
Hypogonadism
Visual impairments

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50
Q

Type I Diabetes Mellitus: Complications - Microvascular complications are largely driven by what?

A

Hyperglycaemia

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51
Q

Type I Diabetes Mellitus: Complications - Examples of microvascular complications (3)

A

Retinopathy
Neuropathy
Nephropathy

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52
Q

Type I Diabetes Mellitus: Complications - Examples of Macrovascular complications (4)

A

Myocardial infarction
ACS
Stroke
Peripheral Vascular Disease

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53
Q

Type I Diabetes Mellitus: Complications - Macrovascular complications are due to what? (3)

A

Hyperglycaemia
Hypertension
Dyslipidaemia

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54
Q

Type I Diabetes Mellitus: Retinopathy - 4 types

A

Diabetic retinopathy
Diabetic macular oedema
Cataracts
Glaucoma

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55
Q

Type I Diabetes Mellitus: Retinopathy - Cataract

A

Clouding of the lens

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56
Q

Type I Diabetes Mellitus: Retinopathy - Glaucoma

A

Increase in fluid in the eye to cause optic nerve damage due to increased pressure

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57
Q

Type I Diabetes Mellitus: Retinopathy Grading - R1 Features and Monitoring

A

Mild Background Diabetic Retinopathy - microaneurysms, flame exudates, >4 blot haemorrhages and cotton wool spots

Monitoring - rescreen in 12 months

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58
Q

Type I Diabetes Mellitus: Retinopathy Grading - R2

A

Moderate Background Diabetic Retinopathy - >4 blot haemorrhages in one hemifield

Monitoring - Rescreen in 12 months

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59
Q

Type I Diabetes Mellitus: Retinopathy Grading - R3

A

Severe non-proliferative or pre-proliferative Diabetic Retinopathy - >4 blot haemorrhages in both hemifields with intraretinal microvascular anolies and venous beading

Monitoring - Refer

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60
Q

Type I Diabetes Mellitus: Retinopathy Grading - R4

A

Proliferative Retinopathy - Vitreous haemorrhage, Retinal detachment and Neovascularisation

Monitoring - Refer

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61
Q

Type I Diabetes Mellitus: Retinopathy - Cotton wool spots indicate wht?

A

Areas of ischaemia

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62
Q

Type I Diabetes Mellitus: Retinopathy - Intra-retinal microvascular abnormalities are a precursor to what?

A

Neovascularisation

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63
Q

Type I Diabetes Mellitus: Retinopathy - Maculopathy

A

Hard exudate with 1 disc diameter of the fovea

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64
Q

Type I Diabetes Mellitus: Retinopathy - 3 options for management

A

Lasers
Vitrectomy
Intra-vitreal Anti-VEGF

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65
Q

Type I Diabetes Mellitus: Retinopathy - Laser management mechanism

A

Pan retinal photocoagulation - Reduces the oxygen requirement of the retina to reduce ischaemia

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66
Q

Type I Diabetes Mellitus: Retinopathy - Vitrectomy used when?

A

If a vitreal haemorrhage is present

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67
Q

Type I Diabetes Mellitus: Retinopathy - Management for Macular Oedema

A

Intra-viteal Anti-VEGF

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68
Q

Type I Diabetes Mellitus: Diabetic Nephropathy

A

Progressive kidney disease caused by damage to the capillaries of the kidney glomeruli characterised by proteinuria and diffuse scarring of the glomeruli

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69
Q

Type I Diabetes Mellitus: Diabetic Nephropathy -Complocations (3)

A

Hypertension
Decline in renal function
Accelerated vascular disease

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70
Q

Type I Diabetes Mellitus: Diabetic Nephropathy -Measure what to analyse urine protein?

A

Protein:Creatinine Ratio

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71
Q

Type I Diabetes Mellitus: Diabetic Nephropathy -Proteinuria diagnostic

A

ACR<PCR

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72
Q

Type I Diabetes Mellitus: Microalbuminuria - Urinary Albumin Excretion Rate varies with what factors (4)

A

Exercise
Protein load
Fluid load
Time of day

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73
Q

Type I Diabetes Mellitus: Microalbuminuria - Urinary Albumin Excretion Rate False positives (5)

A

Menstruation
Vaginal discharge
UTI
Pregnancy
Non-diabetic renal disease

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74
Q

Type I Diabetes Mellitus: Diabetic Nephropathy - Management First Line

A

ACEI or ARB

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75
Q

Type I Diabetes Mellitus: Diabetic Nephropathy - Blood pressure target

A

<140/80 mmHg

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76
Q

Type I Diabetes Mellitus: Diabetic Nephropathy - Glucose target for management

A

53 mmol/mol

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77
Q

Type I Diabetes Mellitus: Diabetic Neuropathy - Peripheral

A

Distal symmetric or Sensorimotor Pain or loss of feeling in the feet or hands

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78
Q

Type I Diabetes Mellitus: Diabetic Neuropathy - Proximal

A

Pain in the thighs, hips or bottom leading to weakness in the legs

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79
Q

Type I Diabetes Mellitus: Diabetic Neuropathy - Autonomic

A

Changes in automatic functions

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80
Q

Type I Diabetes Mellitus: Diabetic Neuropathy - Focal

A

Sudden weakness in one nerve or a group of nerves causing muscle weakness or pain

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81
Q

Type I Diabetes Mellitus: Peripheral Neuropathy - Symptoms (5)

A

Numbness or insensitivity
Tingling or burning
Sharp pains or cramps
Sensitivity to touch
Loss of balance or coordination

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82
Q

Type I Diabetes Mellitus: Peripheral Neuropathy - Charcot Foot

A

Destructive inflammatory process with fractures and bony destruction causing deformity to the foot

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83
Q

Type I Diabetes Mellitus: Peripheral Neuropathy - Charcot Foot Presentation

A

Hot swollen foot in someone with neuropathy

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84
Q

Type I Diabetes Mellitus: Peripheral Neuropathy - Charcot Foot Management

A

Non-weight bearing and total contact cast

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85
Q

Type I Diabetes Mellitus: Peripheral Neuropathy - Oral Management Options (4)

A

Amitryptyline
Duloxetine
Gabapentin
Pregabalin

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86
Q

Type I Diabetes Mellitus: Peripheral Neuropathy - Topical Management Option

A

Capsaicin cream

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87
Q

Type I Diabetes Mellitus: Proximal Neuropathy -Clinical Presentation (3)

A

Pain in the thighs, hips, bottom or legs on one side
Proximal muscle weakness
Marked weight loss

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88
Q

Type I Diabetes Mellitus: Autonomic Neuropathy - Digestive System Presentation (3)

A

Gastric slowing and reduced frequency of movement - constipation and diarrhoea
Gastroparesis - reduced speed of gastric emptying
Oesophageal nerve damage - dysphagia and weight loss

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89
Q

Type I Diabetes Mellitus: Autonomic Neuropathy - Symptoms on impact on sweating

A

Profuse sweating at night or whilst eating

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90
Q

Type I Diabetes Mellitus: Autonomic Neuropathy - Treatment for Excess Sweating (3)

A

Topical Glycopyrrolate
Clonidine
Botulinum Toxin

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91
Q

Type I Diabetes Mellitus: Mononeuropathy - Examples (2)

A

VI Cranial Nerve Palsy
Carpal Tunnel Syndrome

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92
Q

Type I Diabetes Mellitus: Mononeuropathy - VI Cranial Nerve Palsy

A

Abducens cranial nerve causes inability to abduct the eye

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93
Q

Type II Diabetes Mellitus: Onset

A

Middle aged adults and elderly

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94
Q

Type II Diabetes Mellitus

A

Impaired glucose control due to increased insulin resistance and insulin deficiency

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95
Q

Type II Diabetes Mellitus: Aetiologies (5)

A

Obesity
Sedentary Lifestyle
Family History
Pregnancy
Calorie-dense diet

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96
Q

Type II Diabetes Mellitus: What ethnicities are at a greater risk? (3)

A

South asian
African
Afro-carribean

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97
Q

Type II Diabetes Mellitus: Abnormalities of Insulin Action - How does central obesity like to this?

A

Increased plasma levels of FFA causes impaired insulin-dependent glucose uptake into hepatocytes, myocytes and adipocytes

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98
Q

Type II Diabetes Mellitus: Abnormalities of Insulin Action - What role does increased tyrosine kinase have in this?

A

Decreased activation of downstream pathways causing decreased GLUT channel expression and decreased cellular glucose uptake

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99
Q

Type II Diabetes Mellitus: Abnormalities of Insulin Secretion - Early sign is loss of what?

A

Normal biphasic insulin secretion

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100
Q

Type II Diabetes Mellitus: Abnormalities of Insulin Secretion - What is toxic to Beta Cells in this? (2)

A

Increased FFAs and Adipokines

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101
Q

Type II Diabetes Mellitus: Onset

A

Gradual onset

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102
Q

Type II Diabetes Mellitus: Clinical signs

A

Acanthosis nigricans - insulin driven epithelial overgrowth

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103
Q

Type II Diabetes Mellitus: Clinical presentation

A

Obesity
Standard - polyuria, polydypsia and fatigue

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104
Q

Type II Diabetes Mellitus: HbA1c threshold

A

<7% or 53mmol.mol

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105
Q

Type II Diabetes Mellitus: HbA1c threshold for patients on triple oral therapy or insulin

A

58 mmol/mol

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106
Q

Type II Diabetes Mellitus: First line management

A

Lifestyle management + Metformin

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107
Q

Type II Diabetes Mellitus: Management - Diabetics with Atherosclerotic CVD

A

Metformin + GLP-1 Receptor Antagonist

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108
Q

Type II Diabetes Mellitus: Management - Diabetics with HF or CKD

A

Metformin + SGLT2 Inhibitors (GLP-1 antagonist second line)

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109
Q

MODY

A

Maturity Onset Diabetes of the Young

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110
Q

MODY: Definition

A

Early onset (<25 years old) of non-insulin dependent diabetes

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111
Q

MODY: Aetiology

A

Single gene mutation

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112
Q

MODY: 3 types of mutation (3)

A

Glucokinase
Transcription factors
MODY X

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113
Q

MODY: Glucokinase Mutations Pathophysiology

A

Activity impairment results in glucose sensing defect, causing an increase in the threshold for insulin secretion

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114
Q

MODY: Transcription Factor Mutations - Main mutations (3)

A

HNF-1-alpha
HNF-1-Beta
HNF-4-alpha

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115
Q

MODY: Clinical Presentation - Glucokinase Mutation onset and presentation

A

Onset at birth
Stable hyperglycaemia

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116
Q

MODY: Clinical Presentation - Transcription factor mutation onset and presentation

A

Adolescent onset
Progressive hyperglycaemia

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117
Q

MODY: Diagnosis - Main test

A

Oral Glucose Tolerance Test

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118
Q

MODY: Diagnosis - OGTT Glucokinase Mutations result

A

High fasting blood glucose but brings glucose down with oral challenge

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119
Q

MODY: Diagnosis - OGTT Transcription Factor Mutations result

A

Normal fasting blood glucose with bad response to glucose challenge

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120
Q

Neonatal Diabetes: Main aetiology

A

Monogenic mutation

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121
Q

Neonatal Diabetes: Pathophysiology

A

Mutations within the K-ATP Channel - mainly Kir6.2 mutations

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122
Q

Neonatal Diabetes: Diagnosis - Timeframe

A

<6 months

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123
Q

Neonatal Diabetes: Diagnosis - Clinical presentation (4)

A

Polydypsia
Polyuria
Dehydration
DKA

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124
Q

Neonatal Diabetes: Management

A

Sulphonylureas - inhibit K-ATP channel

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125
Q

Congenital Hyperinsulinism: Mutations

A

Kir6.2 or SUR1 mutation

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126
Q

Congenital Hyperinsulinism: Characterised by what?

A

Inappropriate and unregulated insulin secretion resulting in severe hypoglycaemia in newborns or children

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127
Q

Congenital Hyperinsulinism: Management

A

Diazoxide

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128
Q

Diabetic Ketoacidosis

A

Disordered metabolic state occurring due to absolute or relative insulin deficiency accompanied by an increase in counter-regulatory hormones

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129
Q

Diabetic Ketoacidosis: More commonly a complication of what?

A

Type I Diabetes Mellitus

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130
Q

Diabetic Ketoacidosis: Increased Insulin Demand - 5 Aetiologies

A

Infection
Inflammation
Intoxication
Infarction
Iatrogenic

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131
Q

Diabetic Ketoacidosis: Aetiologies - Examples of Infections (3)

A

Pneumonia
UTI
Cellulitis

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132
Q

Diabetic Ketoacidosis: Aetiologies - Examples of Inflammatory (2)

A

Pancreatitis
Cholecystitis

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133
Q

Diabetic Ketoacidosis: Aetiologies - Examples of Intoxication (4)

A

Alcohol
Cocaine
Salicyclate
Methanol

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134
Q

Diabetic Ketoacidosis: Aetiologies - Examples of Iatrogenic causes (2)

A

Steroids
Surgery

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135
Q

Diabetic Ketoacidosis: Pathophysiology - Ketone bodies are formed where?

A

Liver mitochondria

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136
Q

Diabetic Ketoacidosis: Pathophysiology - Ketone bodies are important for metabolism where? (2)

A

Heart
Renal cortex

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137
Q

Diabetic Ketoacidosis: Pathophysiology - When are ketones formed?

A

If pyruvate or oxalonacetate is limited, excess Acetyl CoA diverted into ketones

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138
Q

Diabetic Ketoacidosis: Pathophysiology - When does this occur?

A

If insulin supplementation is missed

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139
Q

Diabetic Ketoacidosis: Pathophysiology - Why is it rare in Type II DM?

A

There is still inhibition of lipolysis

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140
Q

Diabetic Ketoacidosis: Pathophysiology - Why can this occur in starvation?

A

Oxaloacetate is consumed for gluconeogenesis and when glucose is not available fatty acids are oxidised to provide energy - excess Acetyl-CoA is converted into ketones

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141
Q

Diabetic Ketoacidosis: Clinical Presentation - Osmotic related (2)

A

Thirst and Polyuria
Dehydration

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142
Q

Diabetic Ketoacidosis: Clinical Presentation - Ketone body related (5)

A

Flushed
Vomiting
Abdominal pain and tenderness
Increased respiratory rate
Distinct smell on breath

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143
Q

Diabetic Ketoacidosis: Clinical Presentation - Associated conditions (2)

A

Underlying sepsis
Gastroenteritis

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144
Q

Diabetic Ketoacidosis: Diagnosis - 3 things monitored

A

Ketonaemia - >3 mmol/L or >2 on urine stick
Blood Glucose - >11
Bicarbonate - <15 mmol/L or venous pH <7.3

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145
Q

Diabetic Ketoacidosis: Diagnosis - Impact on potassium

A

> 5.5 mmol/L

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146
Q

Diabetic Ketoacidosis: Diagnosis - Creatinine

A

Increased

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147
Q

Diabetic Ketoacidosis: Diagnosis - Sodium

A

Reduced

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148
Q

Diabetic Ketoacidosis: Diagnosis - Amylase

A

Increased - can be due to pancreatitis

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149
Q

Diabetic Ketoacidosis: Diagnosis - WCC

A

Increased

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150
Q

Diabetic Ketoacidosis: Management - Fluid Losses

A

1L NaCl 0.9% in the first hour
2L NaCl 0.9% by the end of hour 2
3L NaCl 0.9% by the end of hour 3

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151
Q

Diabetic Ketoacidosis: Management - If blood glucose concentration falls below 14 mmol/L

A

IV glucose 10% in addition to 0.9% NaCl infusion

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152
Q

Diabetic Ketoacidosis: Management - For electrolyte losses (3)

A

NaCl 0.9%
IV Potassium
Phosphate replacement - rare

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153
Q

Diabetic Ketoacidosis: Management - Insulin replacement

A

IV insulin 0.1 units/kg per hour with usual subcutaneous daily basal insulin - continue until ketoacidosis has been resolved

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154
Q

Diabetic Ketoacidosis: Monitoring and timing

A

Every hour - Blood Ketone and Blood Glucose
Every 2-4 hours - Blood gas and electrolytes

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155
Q

Diabetic Ketoacidosis: Dehydration increases the risk of what?

A

Thromboembolism

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156
Q

Diabetic Ketoacidosis: Complications - Main one in children

A

Cerebral oedema

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157
Q

Diabetic Ketoacidosis: Complications - Main ones in adults (3)

A

Hypokalaemia - can lead to cardiac arrest and paralytic ileus
Aspiration pneumonia
ARDs

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158
Q

Alcoholic Ketoacidosis

A

Metabolic acidosis caused by increased production of ketone bodies with normal or low glucose levels resulting from alcohol and starvation

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159
Q

Alcoholic Ketoacidosis: Most common patient groups

A

Malnourished individuals with alcohol dependency

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160
Q

Alcoholic Ketoacidosis: Associated with episodes of what?

A

Binge drinking with poor food intake, dehydration and vomiting

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161
Q

Alcoholic Ketoacidosis: Why is there an accumulation of ketone bodies? (3)

A

Depleted glycogen stores in the liver from malnutrition
Increased lipolysis and FFA release
Volume depletion e.g. due to vomiting

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162
Q

Alcoholic Ketoacidosis: Clinical Presentation (4)

A

Nausea and Vomiting
Abdominal pain
Increased respiratory rate
Dehydration

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163
Q

Alcoholic Ketoacidosis: Management (4)

A

IV Pabrinex - high dose vitamins with thymine
IV fluids - 5% dextrose in 0.9% NaCl
IV anti-emetics
Insulin occasionally

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164
Q

Alcoholic Ketoacidosis: High dose vitamins used to prevent what?

A

Wernicke Encephalopathy

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165
Q

Hyperthyroidism

A

Conditions in which overactivity of the thyroid gland leads to thyrotoxicosis

166
Q

Thyrotoxicosis

A

Clinical, physiological and biochemical state arising when tissues are exposed to excess thyroid hormone

167
Q

Hyperthyroidism: Main cause

A

Grave’s Disease - 85% of cases

168
Q

Hyperthyroidism: Graves Disease - More common in what sex?

A

Females

169
Q

Hyperthyroidism: Graves Disease - Usual age of presentation

A

20-40 years

170
Q

Hyperthyroidism: Graves Disease - Chance of developing autoimmune thyroid disease if mother has it?

A

5-8%

171
Q

Hyperthyroidism: Graves Disease - Associated genes? (3)

A

HLA genes
CTLA-4
PTPN-22

172
Q

Hyperthyroidism: Three aetiologies

A

Graves Disease
Excessive Thyroid stimulation
Thyroid nodules

173
Q

Hyperthyroidism: Causes of Excessive Thyroid Stimulation (4)

A

Hashitoxicosis
Thyrotopinoma
Thyroid Cancer
Choriocarcinoma

174
Q

Hashitoxicosis

A

Transient hyperthyroidism causes by inflammation due to Hashimoto’s Thyroiditis - followed by hypothyroidism

175
Q

Thyrotropinoma

A

TSH secreting pituitary adenoma

176
Q

Choriocarcinoma

A

Trophoblast tumour secreting hCG

177
Q

Thyrotoxicosis: Causes of thyrotoxicosis not associated with hyperthyroidism (3)

A

Thyroid inflammation
Exogenous Thyroid hormones
Ectopic thyroid tissue

178
Q

Thyrotoxicosis: Causes of Thyroid Inflammation (3)

A

Subacute Thyroiditis - de Quervain’s
Post-partum Thyroiditis
Drug-induced Thyroiditis

179
Q

Thyrotoxicosis: Cause of Drug-induced thyroidits

A

Amiodarone

180
Q

Thyrotoxicosis: Causes of exogenous thyroid hormones (2)

A

Over treatment with Levothyroxine
Thyrotoxicosis factitia

181
Q

Thyrotoxicosis: Causes of Ectopic Thyroid Tissue (2)

A

Metastatic thyroid carcinoma
Struma ovarii - teratoma containing thyroid tissue

182
Q

Hyperthyroidism: Graves Disease - Pathophysiology

A

Auto-antibodies target the TSH receptor, thyroid peroxisomes and thyroglobulin - anti-TSH receptor antibodies stimulate the thyroid to increase function

183
Q

Hyperthyroidism: Clinical Presentation - General symptoms (3)

A

Weight loss - despite increased appetite
Sweating
Heat intolerance

184
Q

Hyperthyroidism: Clinical Presentation - GI symptom

A

Frequent loose bowel movements

185
Q

Hyperthyroidism: Clinical Presentation - Thyroid symptom

A

Goitre
- Graves - diffuse
- Toxic multinodular Goitre - firm nodules

186
Q

Hyperthyroidism: Clinical Presentation - Thyroid sign

A

Thyroid bruit

187
Q

Hyperthyroidism: Clinical Presentation - What does a thyroid sign demonstrate?

A

Hypervascularity of the thyroid

188
Q

Hyperthyroidism: Clinical Presentation - Eyes (2)

A

Double vision
Graves Opthalmopathy

189
Q

Hyperthyroidism: Clinical Presentation - Cardiac (3)

A

Increased pulse rate
Palpitations
Atrial Fibrillation

190
Q

Hyperthyroidism: Clinical Presentation - Musculoskeletal (2)

A

Fine tremor of outstretched fingers
Muscle weakness - in thighs and upper arms

191
Q

Hyperthyroidism: Clinical Presentation - Neuropsychiatric (4)

A

Increased nervousness
Sleep disturbance
Depression
Insomnia

192
Q

Hyperthyroidism: Clinical Presentation - Hair and Skin (2)

A

Hair - thin and brittle
Rapid fingernail growth

193
Q

Hyperthyroidism: Clinical Presentation - Reproductive in females

A

Menstrual cycle changes - lighter bleeding with less frequent periods

194
Q

Hyperthyroidism: Clinical Presentation of Graves Disease - Presentation on legs

A

Pretibial myxoedema - thick scaly skin and swelling on the lower legs

195
Q

Hyperthyroidism: Clinical Presentation of Graves Disease - Thyroid Acropachy

A

Thickening of the extremities manifested by digital clubbing, soft tissue swelling of the hands and feet and periosteal new bone formation

196
Q

Hyperthyroidism: Graves Eye Disease

A

Autoimmune inflammatory disorder of the orbit and periorbital tissues

197
Q

Hyperthyroidism: Graves Eye Disease - Characterised by what? (6)

A

Upper eye lid retraction
Lid lag
Swelling
Erythema
Conjunctivitis
Bulging eyes - Exophthalmos

198
Q

Hyperthyroidism: Graves Eye Disease - Results from autoimmune inflammation of what?

A

Extra-ocular muscles as orbital fat and connective tissue TSH receptors

199
Q

Hyperthyroidism: Graves Eye Disease - Associated with what modifiable factor?

A

Smoking

200
Q

Hyperthyroidism: Diagnosis - Primary Hyperthyroidism

A

TSH low
Free T3/T4 high

201
Q

Hyperthyroidism: Diagnosis - Secondary hyperthyroidism

A

TSH high
Free T3/T4 high or normal

202
Q

Hyperthyroidism: Diagnosis - Thyroid Antibodies (3)

A

Anti-TPO
Anti-thyroglobulin antibody
TSH receptor stimulating antibody

203
Q

Hyperthyroidism: Diagnosis - When is Scintiscan used?

A

To look for toxic nodular disease if antibodies are negative

204
Q

Hyperthyroidism: Graves Disease - First line management

A

Carbimazole

205
Q

Hyperthyroidism: Graves Disease - First line management in first trimester of pregnancy

A

Propylthiouracil

206
Q

Hyperthyroidism: Graves Eye Disease - Management

A

Mild - Lubricants
Severe - Steroids, Radiotherapy or Surgery

207
Q

Hyperthyroidism: Graves Disease - Management for symptomatic relief

A

Beta Blockers - CCBs in asthma

208
Q

Hyperthyroidism: Graves Disease - Management if relapse present or Nodular thyroid disease

A

Radioiodine

209
Q

Hyperthyroidism: Graves Disease - If radioiodine used in Graves Disease what is there a high risk of?

A

Hypothyroidism

210
Q

Hyperthyroidism: Management - Thyroidectomy useful when?

A

When radioiodine is contraindicated

211
Q

Hyperthyroidism: Management - Thyroidectomy risks (3)

A

Recurrent laryngeal nerve palsy
Hypothyroidism
Hypoparathyroidism

212
Q

Hyperthyroidism: Complications - Main complication

A

Thyroid Storm

213
Q

Hyperthyroidism: Thyroid Storm

A

Rapid deterioration of hyperthyroidism

214
Q

Hyperthyroidism: Thyroid Storm - Presentation (5)

A

Hyperpyrexia
Tachycardia
Restlessness
Cardiac failure
Liver dysfunction

215
Q

Hyperthyroidism: Thyroid Storm - Typically seen in what patients?

A

Hyperthyroid patient with an acute infection or recent thyroid surgery

216
Q

Hyperthyroidism: Thyroid Storm - Management

A

High dose carbimazole
Beta Blockers - Propanolol
Potassium Iodide
Hydrocortisone
IV fluids

217
Q

Hyperthyroidism: Diagnosis - Primary Hyperthyroidism Calcium

A

Hypercalcaemia

218
Q

Hyperthyroidism: Diagnosis - Primary Hyperthyroidism Alkaline Phosphatase

A

Increased

219
Q

Hyperthyroidism: Diagnosis - Primary Hyperthyroidism Hypercalcaemia and Alkaline Phosphatase reflective of what?

A

Increased bone turnover and osteoporosis

220
Q

Hyperthyroidism: Diagnosis - Primary Hyperthyroidism WCC

A

Leucopenia - due to ATD-induced Agranulocytosis

221
Q

Hyperthyroidism: Management - Carbimazole side effects

A

Aplasia cutis in early pregnancy

222
Q

Hyperthyroidism: Management - Propylthiouracil Mechanism of Action

A

Inhibits DIO1 to reduce T4 to T3 conversion

223
Q

Hyperthyroidism: Management - Side effects of Propylthiouracil

A

Liver failure

224
Q

Hyperthyroidism: Management - What is advised if agranulocytosis occurs?

A

Do not use Anti-tyroid Drugs again

225
Q

Hyperthyroidism: Management - Risk of agranulocytosis is highest when?

A

First 6 weeks

226
Q

Hyperthyroidism: Management - When is radioiodine contraindicated? (2)

A

Pregnancy
Active thyroid eye disease

227
Q

Hyperthyroidism: Management - Dose titration for Graves Disease

A

12-18 months or Block and replace for 6 months

228
Q

Myxoedema Coma: Most common patient group

A

Elderly women

229
Q

Myxoedema Coma: Diagnosis - ECG results (3)

A

Bradycardia with low voltage complexes
T wave inversion
Prolonged QT interval

230
Q

Myxoedema Coma: Diagnosis - Respiratory sign

A

Type II Respiratory failure - Hypoxia + Hypercarbia + Respiratory Acidosis

231
Q

Subacute Thyroiditis

A

Transient patchy inflammation of the thyroid

232
Q

Subacute Thyroiditis: 3 types

A

De Quervain’s Thyroiditis
Post-partum Thyroiditis
Drug-induced Thyroiditis

233
Q

De Quervanin’s Thyroiditis

A

Presentation of a viral infection with fever, neck pain and tenderness, dysphagia and features of hyperthyroidism

234
Q

De Quervanin’s Thyroiditis: Peak Age

A

20-50 years old

235
Q

De Quervanin’s Thyroiditis: May be triggered by what?

A

Viral infection

236
Q

De Quervanin’s Thyroiditis: Clinical presentation (3)

A

Painful firm goitre
Fever
Malaise

237
Q

De Quervanin’s Thyroiditis: Phase Pathophysiology

A

Hyperthyroid phase followed by a hypothyroid phase as TSH levels fall

238
Q

De Quervanin’s Thyroiditis: Management

A

NSAIDs for pain and inflammation
Beta Blockers for Symptomatic relief of hyperthyroidism

239
Q

Drug-induced Thyroiditis: Drugs involved (2)

A

Amiodarone
Lithium

240
Q

Drug-induced Thyroiditis: How does Amiodarone cause this?

A

Inhibits DIO1 - increases T4, decreases T3 and normal TSH

241
Q

Drug-induced Thyroiditis: Hypothyroidism occurs where?

A

Iodine rich areas

242
Q

Drug-induced Thyroiditis: Drug-induced Thyroiditis: Hyperthyroidism occurs where?

A

Iodine deficient areas

243
Q

Hypothyroidism

A

Insufficient secretion of thyroid hormones from the thyroid gland

244
Q

Hypothyroidism: Congenital Causes (4)

A

Absent or under-developed thyroid gland
Dyshormogenesis - cannot synthesise thyroid hormones
Iodine deficiency during pregnancy
Maternal transmission of anti-thyroid drugs

245
Q

Hypothyroidism: Aetiologies of Primary Hypothyroidism (3)

A

Hashimoto’s Thyroiditis
Iodine deficiency
Iatrogenic - due to Radioiodine or Surgery

246
Q

Hypothyroidism: Primary Hypothyroidism - Hashimoto’s Thyroiditis is most common where?

A

Iodine-sufficient regions

247
Q

Hypothyroidism: Primary Hypothyroidism - Hashimoto’s Thyroiditis affects what group of people?

A

Middle aged women - 45-60 years

248
Q

Hypothyroidism: Primary Hypothyroidism - Hashimoto’s Thyroiditis associated with what genetics?

A

HLA-DR3 or -DR5

249
Q

Hypothyroidism: Secondary Hypothyroidism

A

Pituitary disorders resulting in TSH deficiency

250
Q

Hypothyroidism: Tertiary Hypothyroidism

A

Hypothalamic disorders resulting in TRH deficiency

251
Q

Hypothyroidism: Hashimotos Thyroiditis - Pathophysiology

A

Autoimmune destruction of thyroid tissue causing gradual failure of thyroid function

252
Q

Hypothyroidism: Hashimotos Thyroiditis - What are the associated antibodies? (2)

A

Anti-thyroglobulin antibodies
Anti-peroxidase antibodies

253
Q

Hypothyroidism: Hashimotos Thyroiditis - What cells may mediate destruction of thyroid epithelium?

A

CD8+ T cells

254
Q

Hypothyroidism: Hashimotos Thyroiditis - What mediates cell death?

A

Cytokines

255
Q

Hypothyroidism: Hashimotos Thyroiditis - Role of Gamma Antibodies

A

Production from T cell activation recruits macrophages to destroy thyroid follicles

256
Q

Hypothyroidism: Hashimotos Thyroiditis - May be preceded by what?

A

Transient hyperthyroidism

257
Q

Hypothyroidism: Hashimotos Thyroiditis - Most common in what sex?

A

Females

258
Q

Hypothyroidism: Hashimotos Thyroiditis - Most common in what age range?

A

45-60 years old

259
Q

Hypothyroidism: Hashimotos Thyroiditis - Higher incidence in what populations?

A

White populations

260
Q

Hypothyroidism: Hashimotos Thyroiditis - Histology (4)

A

Prominent lymphoid infiltrate - lymphocytes, plasma cells and reactive follicles with germinal centres
Thyroid follicles atrophy
Hurthle Cells - Follicular cells with abundant eosinophilic cytoplasm
Progressive fibrosis within the gland

261
Q

Hypothyroidism: Primary Hypothyroidism - Goitrous causes (4)

A

Hashimotos Thyroiditis
Iodine deficiency
Drug-induced
Maternally transmitted Anti-Thyroid drugs

262
Q

Hypothyroidism: Primary Hypothyroidism - Non-Goitrous causes (4)

A

Atrophic thyroiditis
Post-ablative therapy - Radioiodine and Surgery
Post-radiotherapy
Congenital defect

263
Q

Hypothyroidism: Clinical Presentation - Hair and Skin (6)

A

Coarse hair and loss of eyebrow hair
Periorbital face - dull and expressionless
Pale cool skin
Vitiligo
Hypercarotenamia
Dry skin

264
Q

Hypothyroidism: Clinical Presentation - Cardiac features (4)

A

Bradycardia
Cardiac dilatation
Pericardial effusion
Worsening heart failure

265
Q

Hypothyroidism: Clinical Presentation - Metabolic features (4)

A

Hyperlipidaemia
Decreased appetite
Weight gain
Fatigue

266
Q

Hypothyroidism: Clinical Presentation - Gastrointestinal Features (3)

A

Constipation
Megacolon and intestinal obstruction
Ascites

267
Q

Hypothyroidism: Clinical Presentation - Respiratory features (4)

A

Deep hoarse voice
Macroglossia - large tongue
Obstructive sleep apnoea
Goitre - enlarged thyroid

268
Q

Hypothyroidism: Clinical Presentation - Gynaecological features (4)

A

Menorrhagia
Oligomenorrhoea
Hyper-prolactinaemia - due. toincreased TRH
Infertility

269
Q

Hypothyroidism: Clinical Presentation - Mxyoedma

A

Accumulation of mucopolysaccharide in subcutaneous tissue

270
Q

Hypothyroidism: Clinical Presentation - Myopathy (30

A

Myalgia
Stiffness
Cramps

271
Q

Hypothyroidism: Clinical Presentation of Congenital Hypothyroidism

A

Cretinism - dwarfism and limited neural functioning

272
Q

Hypothyroidism: Diagnosis - Primary Hypothyroidism Thyroid Hormones

A

Low Free T3/4
High TSH

273
Q

Hypothyroidism: Diagnosis - Primary Hypothyroidism Cell factors

A

Macrocytosis

274
Q

Hypothyroidism: Diagnosis - Primary Hypothyroidism CK

A

Increased

275
Q

Hypothyroidism: Diagnosis - Primary Hypothyroidism LDL Cholesterol

A

Increased

276
Q

Hypothyroidism: Diagnosis - Primary Hypothyroidism Sodium

A

Hyponatraemia - decreased renal tubular water loss

277
Q

Hypothyroidism: Diagnosis - Primary Hypothyroidism Prolactin

A

Hyperprolactinaemia

278
Q

Hypothyroidism: Diagnosis - Primary Hypothyroidism Autoantibodies present (3)

A

Anti-TPO Antibody
Anti-Thyroglobulin Antibody
TSH-Receptor Antibody

279
Q

Hypothyroidism: Diagnosis - Secondary Hypothyroidism

A

Low Free T3/4
Low or Normal TSH

280
Q

Hypothyroidism: Management - Young patients

A

Levothyroxine - 50-100 micrograms per day

281
Q

Hypothyroidism: Management - Elderly Patients or a History of CHD

A

Levothyroxine - 25-50 micrograms per day and adjusted every 4 weeks

282
Q

Hypothyroidism: Management - TSH checked when?

A

Every 12-18 months

283
Q

Hypothyroidism: Management - Secondary Hypothyroidism

A

Titrate the dose of Levothyroxine to free T4 level

284
Q

Hypothyroidism: Management - Levothyroxine administration when?

A

Before breakfast - must be on an empty stomach

285
Q

Hypothyroidism: Management - Levothyroxine absorption is impacted by what? (30

A

PPI
Iron tablets
Calcium tablets

286
Q

Subclinical Thyroid Disease

A

Abnormal TSH concentration with normal thyroid hormone concentration

287
Q

Subclinical Thyroid Disease: Diagnosis - Subclinical Hypothyroidism

A

Increased TSH with normal T3/T4

288
Q

Subclinical Thyroid Disease: Subclinical Hypothyroidism - Risk of progressing to what?

A

Overt hypothyroidism

289
Q

Subclinical Thyroid Disease: Subclinical Hypothyroidism - Higher risk of progressing if what is present?

A

Strong TPO Antibody positive result

290
Q

Subclinical Thyroid Disease: Subclinical Hypothyroidism - Management advised when?

A

TSH > 10

291
Q

Subclinical Thyroid Disease: Subclinical Hypothyroidism - Pregnancy management

A

Always treat to maintain normal TSH

292
Q

Subclinical Thyroid Disease: Subclinical Hyperthyroidism

A

Decreased TSH with normal hormone levels

293
Q

Subclinical Thyroid Disease: Subclinical Hyperthyroidism - Risk of progression to what?

A

Overt hyperthyroidism

294
Q

Subclinical Thyroid Disease: Subclinical Hyperthyroidism - Often seen in what cases?

A

Multinodular goitre

295
Q

Subclinical Thyroid Disease: Subclinical Hyperthyroidism - Associated with what diseases? (2)

A

Osteoporosis
Atrial fibrillation

296
Q

Subclinical Thyroid Disease: Subclinical Hyperthyroidism - Management advised when?

A

TSH <0.1
Osteoporosis
Fracture
Atrial Fibrillation

297
Q

Thyroid Nodules: More common in what sex?

A

Females

298
Q

Thyroid Nodules: What % are benign?

A

95%

299
Q

Thyroid Nodules: Size of a thyroid mass

A

> 4cm

300
Q

Thyroid Nodules: Size of a Thyroid Nodule

A

1-4 cm

301
Q

Thyroid Nodules: Size of a thyroid lesion

A

<1cm

302
Q

Thyroid Nodules: Microcarcinomas

A

<10mm

303
Q

Thyroid Nodules: Benign - 4 types

A

Cyst
Colloid Nodule
Benign follicular adenoma
Hyperplastic nodule

304
Q

Thyroid Nodules: Benign - Clinical presentation

A

Soft smooth mobile nodules with pain

305
Q

Thyroid Nodules: Malignant - % of cases

A

5%

306
Q

Thyroid Nodules: Malignant - Examples (4)

A

Papillary thyroid carcinoma
Medullary thyroid carcinoma
Lymphoma
Anaplastic Thyroid Nodules

307
Q

Thyroid Nodules: Malignant - Anaplastic Nodule

A

Poorly differentiated aggressive nodules

308
Q

Thyroid Nodules: Malignant - Clinical presentation

A

Firm hard and immobile nodule that is increasing in size (>4cm)

309
Q

Thyroid Nodules: Clinical Presentation - How to know if this is in the thyroid?

A

Lump moves on swallowing - shows investment in the pretracheal fascia

310
Q

Thyroid Nodules: Clinical Presentation - Pain is associated with what?

A

Intra-thyroidal bleed into a cyst

311
Q

Thyroid Nodules: Clinical Presentation - Signs of malignancy (2)

A

Enlarged neck lymph nodes
Hoarseness

312
Q

Thyroid Nodules: Hot nodule

A

Functioning nodule

313
Q

Thyroid Nodules: Cold Nodule

A

Non-functioning nodule

314
Q

Thyroid Nodules: Diagnosis - US Classifcation (U2-5)

A

U2 - Benign
U3 - Atypical
U4 - Probably malignant
U5 - Malignant

315
Q

Thyroid Nodules: Diagnosis - When is Fine Needle Aspiration Used?

A

Any U4 or U5
U3/4 - >1cm
U3 - >1.5cm

316
Q

Thyroid Nodules: Scoring System - Thy1/1c

A

Insufficient or Insufficient cystic

317
Q

Thyroid Nodules: Scoring System - Thy2/2c

A

Non-neoplastic or cystic

318
Q

Thyroid Nodules: Scoring System - Thy3a

A

Neoplasm is possible - nuclear are atypical

319
Q

Thyroid Nodules: Scoring System - Thy3f

A

Neoplasma possible - Follicular or Oncocytic neoplasms

320
Q

Thyroid Nodules: Scoring System - Thy4

A

Malignancy possible

321
Q

Thyroid Nodules: Scoring System - Thy5

A

Malignancy

322
Q

Thyroid Nodules: Diagnosis - Requirements (4)

A

Thyroid function tests
Thyroid imaging
Nodule cytology

323
Q

Thyroid Nodules: Management - Thy3a or Thy3f

A

Diagnostic Hemi-thyroidectomy or repeat FNA - consider thyroidectomy + radioactive iodine if cancerous

324
Q

Thyroid Nodules: Management - Thy4 or 5

A

Hemi-thyroidectomy or Complete Thyroidectomy + Radioactive Iodine

325
Q

Thyroid Nodules: Thyroidectomy - Complication of stridor due to what?

A

Deep haematoma and thus laryngeal oedema

326
Q

Thyroid Nodules: Thyroidectomy - Complication of Chyle Leak occurs when?

A

Left level VI lymph node dissection

327
Q

Follicular Adenoma

A

Benign encapsulated tumour of the thyroid gland that is surrounded by a thin fibrous capsule

328
Q

Follicular Adenoma: More common in what sex?

A

Females

329
Q

Follicular Adenoma: Increased incidence where?

A

Regions of iodine deficiency

330
Q

Follicular Adenoma: Genetic Mutations (3)

A

Ras
PIK3CA
TSH Receptor signalling pathways

331
Q

Follicular Adenoma: 1% develop into what?

A

Toxic adenoma

332
Q

Follicular Adenoma: Toxic adenoma

A

Benign tumour that produces thyroid hormone autonomously

333
Q

Follicular Adenoma: Histology

A

Neoplastic thyroid follicles encapsulated by a surrounding collagen cuff

334
Q

Follicular Adenoma: Clinical presentation

A

Discrete solitary mass in an otherwise normal thyroid gland - larger tumours may present with local symptoms e.g. dysphagia

335
Q

Follicular Adenoma: Investigations

A

US
FNA
Serum TSH

336
Q

Follicular Adenoma: Problem with FNA

A

Cannot distinguish between follicular adenoma and carcinoma

337
Q

Follicular Adenoma: Management

A

Lobectomy with biopsy for definitive diagnosis and management

338
Q

Thyroid Carcinomas: Affects which sex more commonly?

A

Females

339
Q

Thyroid Carcinomas: 4 types

A

Papillary
Follicular
Analplastic
Medullary

340
Q

Thyroid Carcinomas: Where are they derived from?

A

Follicular epithelium - except for Medullary Carcinomas which arise from C cells

341
Q

Thyroid Carcinomas: Most common

A

Papillary

342
Q

Papillary Carcinoma: Derived from where?

A

Follicular epithelium

343
Q

Papillary Carcinoma: Associated with what disease?

A

Hashimoto’s Syndrome

344
Q

Papillary Carcinoma: Associated with what environmental factor?

A

Ionising radiation

345
Q

Papillary Carcinoma: Associated mutations (5)

A

Activate the MAP Kinase Pathway
- Ras
- Point mutation in BRAF
- Rearrangements of RET or NTKR1

346
Q

Papillary Carcinoma: Histology

A

Solitary nodule in the thyroid that is cystic or multi-focal

347
Q

Papillary Carcinoma: May be calcified to form what?

A

Psammoma bodies

348
Q

Papillary Carcinoma: When is analysis required for an occult papillary carcinoma?

A

If thyroid tissue or a psammoma body is found in the lymph node

349
Q

Papillary Carcinoma: Main route of spread

A

Lymphatics

350
Q

Papillary Carcinoma: Spread to where via the blood?

A

Lung
Bone
Liver
Brain

351
Q

Papillary Carcinoma: Local Presentation (4)

A

Hoarsness
Dysphagia
Cough
Dyspnoea

352
Q

Papillary Carcinoma: Prognosis worsened by what? (3)

A

Age >40
Extra-thyroid extension
Distant metastasis

353
Q

Papillary Carcinoma: Investigations

A

TSH
US
US-FNA - can involve excisional biopsy of the lymph node

354
Q

Papillary Carcinoma: What should be conducted if vocal cord palsy is suspected?

A

Pre-operative laryngyoscopy

355
Q

Follicular Carcinoma: Derived from what?

A

Follicular epithelium

356
Q

Follicular Carcinoma: Increased incidence in what sex?

A

Females

357
Q

Follicular Carcinoma: Higher incidence in what age group?

A

40-50 years old

358
Q

Follicular Carcinoma: Incidence higher where?

A

Regions of iodine deficiency

359
Q

Follicular Carcinoma: Associated Genetic Mutations (5)

A
  • Mutations in the PI3K/AKT Pathway
  • Mutations in the ras family
  • Translocation involving Pax8 and PPAR-gamma 1
360
Q

Follicular Carcinoma: Diagnosis depends on what?

A

Invasion of the capulse or vasculature

361
Q

Follicular Carcinoma: Widely invasive characteristics (2)

A

Solid architecture - less follicular architecture
More mitotic activity

362
Q

Follicular Carcinoma: Minimally invasive characteristics (2)

A

Well-differentiated follicular architecture
Surrounding capsule may be present

363
Q

Follicular Carcinoma: Most common spread of disease mechanism

A

Haematagenous

364
Q

Follicular Carcinoma: Haematagenous spread most common to wear? (3)

A

Bones
Lungs
Liver

365
Q

Follicular Carcinoma: Prognosis is dependent on what?

A

Extent of invasion
Stage at presentation

366
Q

Follicular Carcinoma: Clinical presentation

A

Slowly enlarging painless single nodule carcinoma that is not functional

367
Q

Follicular Carcinoma: Investigations

A

TSH
US
US-FNA - can involve excisional biopsy for the lymph node

368
Q

Follicular and Papillary Carcinomas: Management - What are the low risk group?

A

Aged <50 years or tumour <4cm

369
Q

Follicular and Papillary Carcinomas: Management - Low risk surgical option

A

Tyroid lobectomy + biopsy and thyroidectomy following biopsy if required

370
Q

Follicular and Papillary Carcinomas: Management - High risk group characteristics

A

Stage Thy3 or higher on FNA

371
Q

Follicular and Papillary Carcinomas: Management - High risk group surgical option

A

Sub-total or Total thyroidectomy +/- Radioactive iodine

372
Q

Follicular and Papillary Carcinomas: Management - Whole body Iodine Scanning used for what patients?

A

3-6 months after a sub-total or total thyroidectomy

373
Q

Follicular and Papillary Carcinomas: Management - RAI ablation mechanism

A

Ablate residual thyroid tissue to destroy the occult microfoci

374
Q

Follicular and Papillary Carcinomas: Management - RAI ablation increases risk of what?

A

Acute Myeloid Leukaemia

375
Q

Follicular and Papillary Carcinomas: Management - What can be used as a tumour marker for monitoring?

A

Thyroglobulin

376
Q

MTC

A

Medullary Thyroid Carcinoma

377
Q

Medullary Carcinoma

A

Tumour of the C cells - neuroendocrine parafollicular cells that secrete Calcitonin

378
Q

Medullary Carcinoma: Associated with what disease?

A

Multiple Endocrine Neoplasia Type 2a - Phaeochromocytoma and Hyperthyroidism

379
Q

Medullary Carcinoma: Occurs in what age if sporadic or familial cases?

A

40-50 years old

380
Q

Medullary Carcinoma: Occurs in what age in MEN cases?

A

Young adults

381
Q

Medullary Carcinoma: Genetic mutation

A

RET mutations

382
Q

Medullary Carcinoma: Morphology - Sporadic cases are often what type?

A

Solitary nodule

383
Q

Medullary Carcinoma: Morphology - Familial cases are often what type?

A

Bilateral or Multi-centric

384
Q

Medullary Carcinoma: Histology

A

Spindle or polygonal cells arranged into nests, trabeculae or follicles

385
Q

Medullary Carcinoma: Morphology - Associated with deposition of what?

A

Amyloid

386
Q

Medullary Carcinoma: Amyloid deposition represents what?

A

Abnormally folded calcitonin protein

387
Q

Medullary Carcinoma: Clinical Presentation - Local effects (3)

A

Dysphagia
Hoarseness
Airway compromise

388
Q

Medullary Carcinoma: Clinical Presentation - Paraneoplastic Syndrome with Symptoms

A

VIP Production - Diarrhoea
ACTH Production - Cushing’s Syndrome

389
Q

Medullary Carcinoma: Investigations

A

US-FNA
Serum base calcitonin
24 hoururinary metanephrines

390
Q

Medullary Carcinoma: Management

A

Total thyroidectomy

391
Q

Medullary Carcinoma: Prognosis - Increased by what? (3)

A

Young age
Female
Tumour confined to the thyroid with no metastases

392
Q

Medullary Carcinoma: Prognosis - Decreased by what? (5)

A

Necrosis
Many mitoses
Squamous metaplasia
Small cell morphology
<50% cells are calcitonin positive

393
Q

Anaplastic Carcinoma

A

Undifferentiated aggressive tumours derived from the follicular epithelium

394
Q

Anaplastic Carcinoma: Can arise due to what?

A

Dedifferentiation of carcinomas

395
Q

Anaplastic Carcinoma: Most common age range

A

> 60 years old

396
Q

Anaplastic Carcinoma: Strong association with what mutations? (5)

A

TP53
Over expression of Cyclin D1
Low expression of p27
Inactivation of PTEN and p16
Mutations of Beta Catenin

397
Q

Anaplastic Carcinoma: Investigations

A

TSH
US-FNA or Biopsy

398
Q

Anaplastic Carcinoma: Management

A

Total thyroidectomy +/- adjuvant radiochemotherapy

399
Q

Thyroid Cancers: Post-operative Care - Calcium

A

Monitor within 24 hours - replace if corrected calcium <2mmol/L

400
Q

Thyroid Cancers: Post-operative Care - Process of Whole Body Iodine Scanning

A

rhTSH injected and 1-2 days later 2-4 mCi I-131 is admnistered as capsule then returns for imaging two days later

401
Q

Thyroid Cancers: Thyroid Remnant Ablation - Side effects (2)

A

Sialadenitis
Sore throat

402
Q

Thyroid Cancers: Thyroid Remnant Ablation - Process

A

Pre-treatment with rhTSH then admitted to a lead lined room and 2/3 of a GBq capsule of I-131 is administered

403
Q

Thyroid Cancers: Thyroid Remnant Ablation - When to discharge?

A

Count rate <500cps at 1m

404
Q

Thyroid Cancers: Thyroid Remnant Ablation - Treatment afterwards

A

Patients maintained on T4

405
Q

Thyroid Cancers: Thyroid Remnant Ablation - T4 treatment aim

A

TSH <0.1mU/L
FT4 <25

406
Q

Thyroid Cancers: Thyroid Remnant Ablation - Advice in pregnancy

A

Avoid pregnant women for 11 days and do not try to conceive for 4 months

407
Q

Thyroid Lymphoma

A

Lymphoma that arises from the thyroid gland

408
Q

Thyroid Lymphoma: Most common sex

A

Female

409
Q

Thyroid Lymphoma: Most common age

A

70-80 years

410
Q

Thyroid Lymphoma: Investigation

A

Core biopsy

The Endocrine System (5 decks)

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