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Y2 > Endo > Flashcards

Endo Flashcards

1
Q

Hypothalamus neurons

A

Anterior pituitary: parvocellular

Posterior pituitary: magnocellular

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2
Q

Excess growth hormone disorders

A

Gigantism

Acromegaly

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3
Q

Acromegaly symptoms

A 
Sweating
Headache
Macroglossia
Increased hand and feet size
Hypertension and impaired glucose tolerance
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4
Q

Acromegaly diagnosis

A

Oral glucose tolerance test

Paradoxical IGF-1 increase

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5
Q

Acromegaly treatment

A

Trans sphenoidal pituitary surgery
Pre operative somatostatin analogue (octreotide)
Pre operative dopamine agonist (cabergaline)

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6
Q

Prolactinoma effects

A

Prolactin binds to kisspeptin receptors
Kisspeptin release inhibited
Downstream inhibition of GnRH/FSH/LH
Low libido, oligomenorrhoea, osteoporosis

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7
Q

Causes of high serum prolactin

A

Prolactinoma

Macroprolactin(false positive)

Stress of venepuncture(false positive): cannulated prolactin series

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8
Q

Prolactinoma treatment

A

Dopamine receptor agonist(cabergoline)

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9
Q

Effects of TSH on follicular cell

A

Thyroid peroxidase(TPO) and thyroglobulin(TG) synthesis

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10
Q

Enzyme to convert T4 to T3

A

Deiodinase

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11
Q

Proteins which transport T3/T4 in blood

A

Thyroid binding globulin
Albumin
Prealbumin

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12
Q

Regulation of T3/T4 porduction

A

T3 &T4 have -ve feedback on hypothalamus and ant. pituitary

I- has -ve feedback on thyroid gland

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13
Q

Test for infants to check for thyroid disorder

A

Heel prick test to check for hypothyroidism, TSH will be high

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14
Q

Hashimoto’s thyroiditis pathophysiology

A

Primary hypothyroidism

Autoimmune disorder with anti-TPO antibodies

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15
Q

Hashimoto’s symptoms

A 
Fatigue
Bradycardia
Dry skin
Weight gain
Constipation
Depression maybe
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16
Q

Hashimoto’s treatment

A

Levothyroxine(T4)

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17
Q

Hyperthyroidism causes

A

Graves disease
Plummer’s disease
Viral(de Quervain) thyroiditis

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18
Q

Grave’s disease pathophysiology

A

Primary hyperthyroidism

Anti TSH receptor antibodies

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19
Q

Grave’s disease symptoms

A

Smooth goitre
Bilateral exophthalmos(bulging eyes)
Pretibial myxoedema

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20
Q

Plummer’s disease pathophysiology

A

Toxic nodular goitre
Benign adenoma that overproduces T4

Causes lumpy goitre

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21
Q

Viral thyroiditis symptoms

A 
Painful dysphagia
Pyrexia
Thyroid inflammation
Thyroid no visible on radioiodine scan
Hyperthyroidism followed by hypothyroidism
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22
Q

Hyperthyroidism symptoms

A 
Weight loss
Tachycardia
Palpitations
Sweating
Heat intolerance
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23
Q

Hyperthyroid treatment

A

Thionamides: propylthiouracil(PTU), carbimazole(CBZ) inhibit TPO

Potassium iodide: before surgery by inhibiting TPO, H2O2 and iodination

Beta blockers: propanolol

Surgery: beware of recurrent laryngeal nerve and parathyroid glands

Radioiodine: permanently reduces T4, can cause hypothyroidism

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24
Q

Layers of adrenal gland

A 
Zona glomerulosa(aldosterone)
Zona fasciculata(cortisol)
Zona reticularis(sex steroids)
Adrenal medulla(adrenaline)
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25
Q

Aldosterone action

A

Na reabsorption, K and H secretion in DCT and collecting duct

Increases blood volume

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26
Q

Aldosterone regulation

A 
Low renal perfusion pressure
High renal sympathetic activity(JGA)
Low Na at macula densa
Renin secretion by JGA
Renin->AT1->AT2->aldosterone synthesis
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27
Q

Cortisol levels thoughout the day

A

Highest in the morning

Lowest at midnight(must be asleep)

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28
Q

Addison’s disease pathophysiology

A 
Autoimmune disorder(UK)
Tuberculosis of adrenal gland(worldwide)

High ACTH and MSH due to POMC

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29
Q

Addison’s disease symptoms

A 
Hyperpigmentation
Low bp
GI problems
Hypoglycaemia
Hyponatraemia
Hyperkalaemia
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30
Q

Addison’s diagnosis

A

Low 9am cortisol

High ACTH

SynACTHen test

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31
Q

Addison’s treatment

A 
Saline(bp)
Dextrose(hypoglycaemia)
Hydrocortisone(cortisol)
Prednisolone(cortisol)
Fludrocortisone(aldosterone)
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32
Q

Cushing’s syndrome causes

A

Steroids taken by mouth
Cushing’s disease(pituitary adenoma)
Primary adrenal adenoma
Ectopic ACTH (lung cancer)

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33
Q

Cushing’s symptoms

A 
Weight gain
Thin skin
Proximal myopathy
High bp
Diabetes
Red cheeks
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34
Q

Cushing’s syndrome diagnosis

A

Low dose dexamethasone suppression test

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35
Q

Cushing’s treatment

A

Metyrapone(11 hydroxylase i): causes hypertension and hirsutism

Ketoconazole(17 hydroxylase i): causes liver damage

Pituitary surgery is Cushing’s disease

Uni/bilateral adrenectomy

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36
Q

Conn’s syndrome pathophysiology and symptoms

A

Benign adrenal cortical tumour

Excess aldosterone causing hypertension and hypokalaemia

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37
Q

Conn’s syndrome treatment

A

Spironolactone, epleronone: mineral corticoid receptor antagonist

Spironolactone can cause gynaecomastia and menstrual irregularities

Epleronone has milder side effects and similar affinity

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38
Q

Phaeochromocytoma pathophysiology and symptoms

A

Adrenal medulla tumour causing excess adrenaline and noradrenaline

Hypertension and episodic severe hypertension

Can cause ventricular fibrillation & death

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39
Q

Phaeochromocytoma treatment

A

Surgery with careful preparation

Alpha blockers(noradrenaline) to treat high bp

Beta blockers(adrenaline) to treat high bp and heart

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40
Q

21 hydroxylase deficiency

A

Aldosterone and cortisol deficiency

Sex steroid excess->girls have ambiguous genitalia

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41
Q

11 hydroxylase deficiency

A

Aldosterone and cortisol deficiency
11 deoxycorticosterone acts like aldosterone
Excess sex steroids, testosterone and 11-deoxycorticosterone
High bp, low K+, virilisation

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42
Q

17 hydroxylase deficiency

A

Cortisol and sex steroid deficiency
Excess aldosterone

Hypertension
Hypokalaemia
Low glucose
Low sex steroids

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43
Q

Hormones in calcium and phosphate regulation

A

PTH
Calcitriol
FGF23
Calcitonin

44
Q

Calcitriol synthesis

A

Vit D3/D2->25(OH)cholecalciferol-> 1,25(OH)2cholecalciferol by 1-alpha hydroxylase

45
Q

Calcitriol effects

A

Bone:
Increase osteoblast activity

Gut:
Increase calcium absorption
Increase phosphate absorption

Kidney:
Increase calcium reabsorption
Increase phosphate reabsorption(PCT)

46
Q

PTH synthesis

A

Chief cells in parathyroid gland

Level of PTH is inversely proportional to calcium conc.

47
Q

PTH effects

A

Bone:
Calcium mobilisation

Gut(via calcitriol):
Increase calcium absorption
Increase phosphate absorption

Kidney:
Calcium reabsorption
Phosphate secretion(PCT)
1-alpha hydroxylase activity

48
Q

PTH regulation

A

Serum Ca has -ve feedback

Calcitriol has -ve feedback

49
Q

Calcitonin effects

A

Bone:
Reduce osteoclast activity

Kidney:
Increase Ca excretion

50
Q

FGF23 function

A

Inhibit calcitriol

PTH and FGF23 both bind to Na/PO4 cotransporter in PCT->low reabsorption

51
Q

Hypercalcaemia symptoms

A

Stones(nephrocalcinosis)

Abdominal moans(anorexia, constipation, pancreatitis)

Psychic groans(fatigue, depression, coma)

52
Q

Primary hyperparathyroidism pathophysiology

A

Parathyroid adenoma
High serum Ca but no -ve feedback
PTH will be high
Low phosphate

53
Q

Primary hyperparathyroidism treatment

A

Parathyroidectomy
Bisphosphonate
Shockwave lithotripsy
IV fluids

54
Q

Secondary hyperparathyroidism pathophysiology

A

Normal physiological response to hypocalcaemia

Low calcium
High PTH
Commonly vit D deficiency

55
Q

Secondary hyperparathyroidism treatment

A

Vit D replacement:
Normal renal function-> ergocalciferol(D2) or cholecalciferol(D3)

Impaired renal function->alfacalcidol as there is no 1-alpha hydroxylase

56
Q

Tertiary hyperparathyroidism signs and treatment

A

Chronic renal failure so no calcitriol

High PTH
Enlarged parathyroid glands
Hypercalcaemia

Parathyroidectomy

57
Q

Hormone that reduces glucagon and insulin secretion

A

Somatostatin

58
Q

Measure of serum insulin level

A

C-peptide

59
Q

GI incretin effect

A

More insulin is secreted when glucose passes through the gut

GLP1 stimulates insulin, suppresses glucagon

60
Q

GLUT2 vs GLUT4

A

GLUT2 is not insulin sensitive, found in beta cells->ATP used to inhibit K diffusion as K activates Ca channel, causing insulin release

GLUT4 is insulin sensitive, found in myocytes/adipocytes

61
Q

Diabetes mellitus diagnosis

A

HbA1c > 48mmol/mol
Fasting glucose >7mmol/L
Fed glucose >11mmol/L

62
Q

T1DM symptoms and test

A 
Weight loss
Hyperglycaemia
Glycosuria, polyuria, polydipsia, nocturia
Ketones in blood/urine
Blurred vision
Fatigue

Antibodies
Low c-peptide
Ketone presence

63
Q

T1DM management

A

Short acting insulin
Long acting insulin
Technology: real time glucose sensor, insulin pumo therapy
Transplant: islet cell/pancreas+kidney but needs life long immunosuppression

64
Q

T2DM risk factors

A 
Age
Ethnicity
Obesity
Family history
PCOS
65
Q

T2DM complications (micro and macro)

A

Microvascular:
Retinopathy
Neuropathy
Nephropathy

Macrovascular:
Ischaemic heart disease
Cerebrovascular disease
Peripheral vascular disease

66
Q

T2DM treatment

A

Metformin (biguanide)
Sulphonylurea (gliclazide)
DPP4 inhibitor (sitagliptin)
SGLT2 inhibitor (dapagliflozin)

GLP1 agonist (semaglutide)
Pioglitazone
Alpha glucosidase inhibitor

Manage hypertension and cholesterol

67
Q

Male gonad cells and function

A

Sertoli: FSH receptor, spermatogenesis, synthesise inhibin, activin, AMH

Leydig: LH receptor, synthesise androgens

68
Q

Female gonad cells and function

A

Granulosa: FSH receptor, converts androgen to oestrogen, produces progesterone after ovulation

Theca: LH receptor, androgen synthesis, support growing follicle

69
Q

Folliculogenesis stages

A 
Primordial follicle
Primary follicle
Secondary follicle
Mature follicle
Corpus luteum
70
Q

Menstrual cycle hormone changes

A

High FSH to stimulate follicle maturation
Oestrogen stimulates LH receptor synthesis
FSH lower from -ve feedback
High oestrogen->LH surge(ovulation)
High progesterone and oestrogen to maintain endometrium

71
Q

Capacitation of sperm

A

Oestrogen and Ca dependent

Sperm binds to ZP3
Sperm secretes hyaluronidase&protease
Sperm penetrates zona pellucida

72
Q

Implantation mediators

A

Leukaemia inhibitory factor(LIF)

IL-11

73
Q

Oxytocin function

A

Uterine contraction
Cervical dilation
Milk ejection

74
Q

Tanner staging(puberty)

A

Thelarche
Genitalia
Pubarche

75
Q

Enzyme to convert testosterone to oestrogen

A

Aromatase

76
Q

Enzyme to convert testosterone to dihydrotestosterone

A

5 alpha reductase

77
Q

Hypogonadism hormone levels

A 
Primary:
High FSH/LH
Low E2/testosterone
Men: cancer, trauma, infection
Women: menopause
Secondary:
Low FSH/LH
Low E2/testosterone
Pituitary tumour
High prolactin
78
Q

Menopause symptoms

A 
Osteoporosis
Dry skin/thin hair
Mood disturbance
Weight gain
Sexual dysfunction
79
Q

Menopause treatment

A

Oestrogen replacement

Progesterone to prevent endometrial hyperplasia

80
Q

Early menopause(premature ovarian insufficiency) causes and diagnosis

A

Autoimmune
Genetic e.g. Turner’s syndrome/fragile X
Cancer therapy

High FSH(>25iU/L) twice, 4 weeks apart

81
Q

Sheehan’s syndrome pathophysiology

A

Post partum hypopituitarism secondary to hypotension

Anterior pituitary enlarges during pregnancy->post partum haemorrhage-> pituitary infarction

82
Q

Sheehan’s syndrome symptoms

A 
Lethargy(TSH)
Weight loss(ACTH)
Anorexia(ACTH)
Failure of lactation(prolactin)
Failure to resume menses(FSH/LH)
Posterior pituitary usually unaffected
83
Q

Pituitary apoplexy pathophysiology

A

Intra pituitary haemorrhage

Can be caused by anti coagulants

84
Q

Pituitary apoplexy symptoms

A

Severe onset headache
Bitemporal hemianopia
Cavernous sinus involvement: diplopia(CNIV,VI), ptosis(CNIII)

85
Q

Fertile hypogonadism men treatment

A

Gonadotrophin injection, can give hCG as well which acts on LH receptors

86
Q

Non fertile hypogonadism men treatment

A

Replace testosterone
Daily gel
3 weekly injection
3 monthly injection

87
Q

Fertile hypogonadism female treatment

A 
Induce ovulation:
FSH injection
Weight loss, metformin, lifestyle
Letrozole(aromatase inhibitor)
Clomiphene(oestradiol receptor antagonist)
IVF:
GnRH antagonist(short) -> day 6
GnRH agonist(long) -> day -7
88
Q

Causes of male infertility

A

Pretesticular: Klinefelter’s
Testicular: cryptorchidism
Posttesticular: ED, congenital

89
Q

Causes of female infertility

A

Endometriosis: functioning endometrial tissue outside uterus

Fibroids: benign tumours of myometrium

PCOS: hyperandrogenism,oligo/anovulation, polycystic ovaries(US)

90
Q

Endometriosis and fibroids treatment

A

Progesterone
Hysterectomy

Laparoscopic ablation, salpingo-oopherectomy(endometriosis)

91
Q

PCOS treatment

A 
Diet/lifestyle
Metformin
Oral contraceptive pill
Anti androgen
Progesterone
92
Q

AVP function

A

Binds to V2 receptor in kidney

More aquaporin 2 expression on collecting duct

93
Q

AVP regulation

A

Osmotic:
Osmolarity sensed by osmoreceptors in organum vasculosum and subfornical organ

Non-osmotic:
Atrial pressure sensed by atrial stretch receptor(right atrium)

94
Q

Diabetes insipidus symptoms

A

Polyuria
Polydipsia
Nocturia

95
Q

Types of diabetes insipidus

A

Cranial DI: AVP insufficiency

Nephorgenic DI: AVP resistance

96
Q

Diabetes insipidus diagnosis

A

Water deprivation test:
Urine volume drop->psychogenic polydipsia
Give ddAVP->urine volume drop->CDI
Urine volume still high->NDI

> 3% weight loss-> risk of dehydration

97
Q

Diabetes insipidus treatment

A

CDI: desmopressin
NDI: thiazide diuretics

98
Q

Syndrome of inappropriate ADH(SIADH) causes and treatment

A

Too much AVP
Water retention, low urine output
High urine osmolarity, low plasma osmolarity

Causes: head injury, pulmonary disease, malignancy, drugs, idiopathic

Treatment:
Fluid restrict
AVP antagonist but expensive

99
Q

Hormone replacement therapy risks

A

Venous thromboembolism(oestrogen)

Hormone sensitive cancers: give progesterone to prevent endometrial dysplasia

Stroke

100
Q

Transgender therapy

A

Men:
Testosterone injection/gel
Progesterone to prevent menstrual bleeding

Women:
Oestrogen oral/injection/transdermal
Testosterone reduction(GnRH agonist/anti-androgen)

101
Q

Target HbA1c for diabetics to prevent microvascular complications

A

53 mmol/mol

102
Q

Diabetic retinopathy stages

A

Background: hard exudates, microaneurysms, dot haemorrhages
Preproliferative: soft exudates
Proliferative: new vessels
Maculopathy: hard exudates near macula

103
Q

Retinopathy and maculopathy treatment

A

Panretinal photocoagulation

Anti-VEGF injection (maculopathy)

104
Q

What is diabetic nephropathy

A

Hyperglycaemia & hypertension->glomerular hypertension->fibrosis->low GFR->renal failure

105
Q

Diabetic neuropathy distribution and pathology

A 
Glove and stocking
Small vessels(vasa nervorum) supplying small nerves get blocked
106
Q

Diabetic foot management

A

Annual assessment:
Foot deformity, ulceration
Sensation
Foot pulse

Good footwear
Antibiotics if infected
Amputation last resort

Y2 (10 decks)

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