Endocrine Flashcards
1
Q
Process of T3/4 production
A
Hypothalamus makes TRH
Pituitary makes TSH
Thyroid makes T3/4
2
Q
Difference between Grave’s and De Quervain’s
A
Graves is painless goitre, de Quervains is painful goitre
3
Q
treatment graves
A
Propanolol and carbimazole
4
Q
Treatment hashimoto
A
Levothyroxine
5
Q
Treatment de Quervains
A
NSAIDs
6
Q
Treatment iodine deficiency
A
Iodine replacement
7
Q
Diabetes 2 treatment pathway
A
lifestyle changes
metformin
Gliclazide when no concern about weight, sitagliptin when there is
8
Q
Cushings cause
A
high cortisol - steroids or pituitary tumour
9
Q
Cushing’s symptoms
A
Moon face, buffalo hump, high BP, striae, loss of strength
10
Q
Addison’s cause
A
Low cortisol and low aldosterone
destructions of adreansl
11
Q
Bloods for Addisons
A
Low Na+, low glucose, high K+
12
Q
Sx Addisons
A
Lethargy, hyperpigmentation, vitiligo, hyponatraemia and hyperkalaemia
13
Q
Signs fibroidd
A
menorrhagia and dysmenorrhea
Suprapubic mass
Pelvic pressure and discomfort
14
Q
Diagnosing fibroids
A
Transvaginal US
15
Q
management fibroids
A
<3cm mirena coil + NSAID + tranexamic acid
>3cm surgery
16
Q
Endometriosis sx
A
Abdominal pain, chocolate cysts on USS
17
Q
Diagnosing endometriosis
A
Laparoscopy
18
Q
Sx ectopic pregnancy
A
Shoulder tip pain, unilateral pelvic pain, chandelier’s sign
19
Q
treatment ectopic pregnancy
A
methotrexate or surgery
20
Q
Stress incontinence
A
Leaking of urine due to increases abdominal pressure
21
Q
Urge incontinence
A
Involuntary loss of urine associated with urgency
22
Q
Tx stress incontinence
A
Pelvic floor exercise, duloxetine
23
Q
Tx urge incontinence
A
Bladder train and anticholinergic
24
Q
Missing 1 COCP
A
Take missing pill, no extra protection needed
25
Missing >1 COCP
Take most recent missed pill ASAP
Abstain from sex until 7 days taking pill
26
Missing POP
Take pill ASAP, continue with next pill and extra contraception for 48 hours
27
When can you start COCP after pregnancy?
6 weeks
28
When can you start POP after pregnancy?
Anytime
29
bacterial vaginosis sx
Fishy smelling, watery discharge
pH >4.5
30
Tx bacterial vaginosis
Metronidazole 400mg
31
Candidiasis sx
pH <4.5
Cottage cheese discharge
32
candidiasis treatment
clotrimaxole
33
Chlamydia sx
Dysuria, abnormal bleeding
34
tx chlamydia
doxycycline 100mg
35
Gonorrhoea sx
dysuria, abnormal discharge - odourless but yellow/green
Abnormal bleeding
36
tx gonorrhoea
Ceftriaxone
37
PID sx
dysuria, abnormal discharge, cervical tenderness
38
Tx PID
doxycycline + ceftriaxone
39
Ovarian torsion sx
Worst pain
Palpable pelvic mass
Tenderness
Whirlpool sign on USS
40
Sheehan's syndrome
Complication following PPH
PPH = low blood volume = low BP = low perfusion of pituitary = AVN
41
Sx Sheehan's syndrome
lack of milk production + amenorrhea
42
Most common type of ovarian cancer
serous
43
Sx Grave's disease
Weight loss
Heat intolerance
Anxiety and tremor
Smooth, painless goitre
Exophthalmos
44
ABs in Grave's
Anti-TSH
45
Tx Hashimoto
Levothyroxine
46
What is De Quervain's syndrome?
Viral infection causes painful goitre
47
Function of adrenal medulla
Chromaffin cells to make catecholamines - adrenaline etc
48
Treatment pathway for t2 diabetes
first line: metformin
second line: metformin + gliclazide
third line: metformin + 2x gliptins/sulfonylureas/pioglitazone/gliflozins
48
Treatment pathway for t2 diabetes
first line: metformin
second line: metformin + gliclazide
third line: metformin + 2x gliptins/sulfonylureas/pioglitazone/gliflozins
49
treatment for t1 diabetes
Insulin
50
S/e insulin
Hypoglycaemia and weight gain
51
MOA metformin
Decreases hepatic gluconeogenesis
52
MOA sulfonylureas
Stimulate B cells to make insulin
53
S/e sulfonylureas
Weight gain and hyponatraemia
54
E.g. sulfonylureas
Gliclazide
55
MOA thiazolidinediones
Activate PPAR = adipogenesis and fatty acid uptake
56
S/e thiazolidinediones
Weight gain and fluid retention
57
MOA DPP-4 inhibitors
Increases incretin levels = inhibited glucagon
58
MOA SGLT-2 inhibitors
Inhibits glucose reabsorption in kidney
59
Management Graves's disease
Carbimazole
60
Treatment for Hashimoto's
Levothyroxine
61
Sx primary hyperparathyroidism
Goitre, exophthalmos
62
Tx primary hyperparathyroidism
Parathyroidectomy
63
Sx secondary and tertiary hyperparathyroidism
Fractures, salt and pepper skull
64
Sx primary hypoparathyroidism
Chvostek and Trousseau sign
65
Investigations primary hypoparathyroidism
low PTH and calcium, high phosphate
66
How to treat hypoparathyroidism
Calcium and vit D
67
Sx acromegaly
Large hands and feet
Frontla bossing
ED
Galactorrhoea
68
Management of acromegaly
Transsphenoidal surgery and ocreotide
69
What is SIADH?
Too much ADH made - more water reabsorbed
70
Sx SIADH
Headache, myalgia, N+V, coma
71
Tx SIADH
Treat underlying condition
ADH antagonist
72
What are the three parts of the fallopian tube?
Isthmus (closest to uterus), ampulla, infundibulum
73
Where does fertilisation most commonly occur:
Ampulla (middle third of Fallopian tube)
74
What is secondary amenorrhoea?
Periods have started but stop for 6+ months - due to stress etc
75
What is primary amenorrhoea?
Periods haven't started but breast development etc has - by age 15
76
Absent vas deferens cause
Cystic fibrosus
77
Sheehan syndrome
severe blood loss or extremely low blood pressure during or after childbirth. Lack of blood flow to the pituitary gland, can cause damage to the gland and lead the pituitary dysfunction
78
receptor on theca cell
LH
79
Receptor on granulose cell
FSH
80
Ulipristal acetate
EllaOne - used as emergency contraception
Take within 120 hours
Selective progesterone receptor modulator - inhibits ovulation
81
How long before POP is effective?
48h
82
What are the two hormones involved in milk and their functions?
Oxytocin = milk ejection
Prolactin = milk production
83
The testicular artery is a branch of the ...
Abdominal aorta
84
Treatment for hypermeesis gravidarum
Antihistamines (cyclising or promethazine)
Ondansetron and metoclopramide are second line
85
Most common cause of PID
Chlamydia
86
Most common cause od neonatal sepsis
GBS
87
most common type of ovarian cancer
Serous carcinoma
88
Risk factors for ovarian cancer
BRCA1/2 mutation
Early menarche, late menopause, nulliparity (all increase ovulations)
89
Sx ovarian cancer
Abdo distension/bloating
Abdo/pelvic pain
Urinary urgency
Early satiety
Diarrhoea
90
Diagnosing ovarian cancer
CA125 screen and US if raised
91
Into which layer of the uterus does an embryo implant?
Submucosal
92
Major arterial supply to breast
Internal mammary
93
How to treat hypertension in pregnancy
Aspirin 75mg from 12 weeks pregnant
94
Describe the process of fertilisation
Sperm penetrates corona radiata
Sperm head binds to zone pellucid
This triggers acrosome reaction - hydrolytic enzymes digest zone pellucid and create pathway to ovum
Sperm enter ovum
Sperm and ovum fuse
Sperm releases calcium ions to prevent polyspermy
95
Where is onuf's nucleus found
Anterior horn of s2 nerve roots
96
Which hormone reduced BP in pregnancy?
Progesterone
97
Advantages of breast feeding
Involution of uterus, protecting against breast and ovarian cancer
IgA and lactoferrin (ensures iron absorption) to baby, reduced incidence of ear infections and eczema, reduced T1DM
98
Disadvantages of breast feeding
Jaundice
Vit d/k deficiency
Transmission of disease
99
How do you differentiate between primary and primordial follicles?
Primordial contain oocyte and granulose cells
Primary marked by development of zone pellucida
100
Up to what stage of oogenesis do cells develop in utero
Prophase I
101
U; until what stage are oocytes held before fertilisation
Metaphase ii
102
Skin layers of scrotum
skin
dartos muscle
external spermatic fascia
cremasteruc muscle
internal spermatic fascia
parietal layer of tunica vaginalis
103
How do you extract fluid from pouch of Douglas?
Needle through posterior vaginal fornix
104
What causes asymmetrical intrauterine growth reduction
Placental insufficiency
105
Hormonal changes menopause
Cessation of estradiol and progesterone production
106
What is an amniotic fluid embolism
Foetal cells enter mother's bloodstream
107
Sx amniotic fluid embolism
Chills, shivering, sweating, coughing, cyanosis, hypotension, tachycardia, MI
108
What is acromegaly ?
Excess growth hormone due to pituitary adenoma
109
Sx acromegaly
- Spade-like hands
- Coarse facial appeartance
- Large tongue
- Excessive sweating
- Pituitary tumour sx - headaches, hypopituitarism, bi-temporal hemianopia
ED
galactorrhea
110
Tx acromegaly
trans-sphenoidal surgery and somatostatin analogue - ocreotide
111
Diagnosing acromegaly
OGTT
Glucose normally suppresses growth hormone. In normal OGTT, GH levels will be undetectable but in acromegaly they remain elevated
112
Treatment for acute and chronic Addison's
acute = hydrocortisone
Chronic = glucocorticoids and mineralocorticoid
113
What is Bartter's syndrome
Autosomal recessive cause of hypokalaemia following defective NaKCC transporters in aLOH
Like taking lots of furosemide
114
Sx Bartter's
Weakness
Polyuria/polydipsia
Hypokalaemia
Normotension
115
most common cause of congenital adrenal hyperplasia
21-hydroxylase
116
What is DKA
Complication of T1DM, uncontrolled lipolysis makes FFA that are converted to ketones
Caused by infection, missed insulin dose and MI
117
Sx DKA
Abdo pain
Polyuria, polydipsia and dehydration
Kussmaul breathing
Acetone smelling breath
118
Tx DKA
fluid bolus and insulin infusion
119
Blood results for DKA
Glucose >11 or known diabetes
PH<7.3
bicarb <15
Ketones >3
120
What is Klinefelter's
An example of primary hypogonadism with high LH and low testosterone
Karyotype 47 XXY
121
Sx Klinefelter's
- Very tall
- Lack of secondary sexual characteristics
- Small, firm testes
- Infertility
- Gynaecomastia
122
What is Kallman's syndrome
Delayed puberty due to hypogonadotrophic hypogonadism - failure of GnRH neurons in hypothalamus
A type of secondary hypogonadism
X-linked recessive
123
Sx Kallman's syndrome
- Delayed puberty
- Anosmia
- LH and FSH levels are low
- Cleft lip/palate
- Normal/above average height
124
drug causes of gynaecomastia
SPIRONOLACTONE, digoxin
125
most common type of thyroid cancer
papillary
126
treatment thyroid cancer
thyroidectomy and iodine
127
which compound indicates thyroid cancer recurrence
thyroglobulin
128
causes of primary hyperaldosteronism
unilateral can be by adrenal adenoma - Conn's syndrome
129
Sx primary hyperaldosteronism
hypertension and hypokalaemia
130
Ix hyperaldosteronism
aldosterone:renin
CT
AVS
131
Mx hyperaldosteronism
unilateral: surgeru
bilateral: aldosterone antagonist - spironolactone
132
Water deprivation results for cranial DI
Low after deprivation, high after ADH
133
Water deprivation tests for nephrogenic DI
Low after deprivation, high after ADH
134
Which drug causes both hypo and hyper thyroidism
Amiodarone
