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Year 3 - Medical Block Workbooks > Endocrine > Flashcards

Endocrine Flashcards

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USMLE® Step 1 flashcards
1
Q

Thyroid embryology

- Remnants

A

Thyroid remnants

  1. Thyroglossal cysts
  2. Lingual thyroid
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2
Q

Thyroid

  1. Tissue
  2. Cell types
A

Thyroid tissue

  1. Colloid
    - Iodinated thryoglobulin

2 Follicular cells
- Produce thyroglobulin

2 C-cells
- Secrete calcitonin

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3
Q

Thyroid hormones

- Metabolism

A

Thyroid hormones

  1. Thyroxine
    - Made from thyroglobulin
    - Main circulating hormone
  2. Tri-iodothyronine
    - Potent
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4
Q

Hypo-thyroidism

- Primary vs Secondary

A

Hypothyroidism

  1. Primary
    - High TSH, low T4
  2. Secondary
    - Low/norm TSH, low T4
    - Pituitary disease
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5
Q

Hyperthyroidism serology

  1. Primary
  2. Secondary
A

Hyperthyroidism

  1. Primary
    - Increased T3,T4
    - Suppressed TSH
  2. Secondary
    - Low/normal TSH
    - TSHoma/TH resistance/interference
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6
Q

Hyperthyroidism

- Causes

A

Hyperthyroidism causes

  1. Graves’ (commonest)
    - Young women
    - Relapsing-remitting
  2. Nodular thyroid disease
    - Autonomous secretion
  3. Thyroiditis
    - Inflammation
    - Viral/medication/post-partum
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7
Q

Hyperthyroidism

- Presentation

A

Hyperthyroidism HPx

  1. Sympathetic action
    - Resting tachycardia/HTN
    - Warm peripheries
    - Weight loss
    - Insomnia
    - Irritability/anxiety
    - Resting tremor
  2. Other symptoms
    - Lid-lag (upper lid tone)
    - Hyperreflexia
    - Pruritus
    - Bowel frequency
    - Menstrual disturbance/reduced fertility
  3. Elderly
    - Reduced energy
  4. Children
    - Accelerated growth
    - Behaviour disturbances
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8
Q

Graves’ Disease

- Pathognomonic signs

A

Graves’ Pathognomonics

  1. Lid retraction and proptosis
  2. Tibial myxoedema
    (and skin changes)
  3. Thyroid acropachy (nail changes)
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9
Q

Hyperthyroid

- Management

A

Hyperthyroid Mx

  1. Thionamides
    (Reduce T3/4 synthesis, ADR agranulocytosis)
    - Carbimazole
    - Propylthiouracil
  2. Beta-blockers
  3. Definitive
    - Radiactive iodine
    - Thyroidectomy and replacement
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10
Q

Hypothyroid

- Primary Causes

A

Primary Hypothyroidism

  1. Autoimmune
    - Enlargement is called Hashimoto’s
  2. Post-partum
  3. Iodine deficiency
  4. Drugs
    - Amiodarone
    - Lithium
  5. Iatrogenic
    - Surgical
    - Radiation
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11
Q

Hypothyroid

- Secondary causes

A

Secondary hypothyroidism

  • TSH deficiency
    1. Rare
    2. Investigate hypothalmic-pituitary disease
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12
Q

Hypothyroidism

- Presentation

A

Hypothyroid HPC

Often incidental blood result

  1. Weight gain
  2. Cold intolerance
  3. Fatigue
  4. Constipation
  5. Bradycardia
  6. Myxoedema
    - Skin thickening
    - Eye puffiness
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13
Q

Autoimmune hypothyroidism

- Ix

A

Hypothyroidism Ix

  1. Thyroid antibodies
  2. Hashimoto’s
    - TPO antibodies
    (Thyroid peroxidase)
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14
Q

Hypothyroidism

- Tx

A

Hypothyroidism Tx

1. Thyroxine replacement
50-100 MCG OD

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15
Q

Cortisol

- Transport

A

Cortisol transport

  1. 80-90% CBG
    - Cortisol binding globulin
  2. 5-10% albumin
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16
Q

Addison’s

- Pathology

A

Addison’s Pathology

  1. Destruction of adrenal (autoimmune)
  2. Genetic defects in steroid synthesis
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17
Q

Addison’s Disease (primary)

- S&S

A

Addison’s S&S
(Primary)

  1. Fatigue and weakness
  2. Anorexia and weight loss
  3. Abdo-pain and nausea
  4. Dizziness and postural hypotension
  5. Increased pigmentation
    - ACTH excess from negative feedback
  6. Female low libido and hair
    - androgens
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18
Q

Addison’s

- Ix

A

Addison’s Ix

Bedside
1. Hypoglycaemia

Bloods

  1. Hyperkalaemia
  2. Hyponatraemia.
  3. Uraemia
  4. Mild anaemia

Screening
- SynthACTHen

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19
Q

Addison’s

- Mx

A

Addison’s Mx

  1. Steroid emergency card
  2. Lifelong replacement
    - Hydrocortisone for gluco (prednisolone)
    - Fludrocortisone for mineral
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20
Q

ACTH deficiency

- Management

A

ACTH deficiency Mx

  1. Hydrocortisone
  2. No need for fludrocortisone
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21
Q

Phaeochromocytoma

- Complications

A

Phaochromocytoma complications

  1. HTN crisis
  2. Arrhythmias
  3. Death
  4. Encephalopathy
  5. Hyperglycaemia
  6. Pulmonary oedema
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22
Q

Phaeochromocytoma

  1. Tests
  2. Imaging
A

Phaeochromocytoma

  1. 24hr Urinary catecholamines
    Plasma metanephrines
  2. Ct Abdo
    MRI Abdo or body
    PET scans
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23
Q

Phaeochromocytoma

-	Management
A

Phaeochromocytoma Mx

  1. Surgery
    - Open or lap
  2. Alpha block (HTN crisis)
    - Phenoxybenzamine (or doxazosin)
    - Beta blockade
24
Q

Pituitary

-	Five Axes

- Stimulatory
- Resultant
A

Pituitary Axes

  1. Growth - GH
    Hyp: GHRH and somatastatin Liver: IGF-1
  2. Adrenal - ACTH
    Hyp: CRH
    Adrenal: cortisol
  3. Gonadal - FSH & LH
    Hyp: GnRH
    Ovulation & Corpus luteum
    Leydig Testosterone
  4. Thyroid - TSH
    Hyp: TRH
    T3&T4

5: Prolactin
Control: Dopamine & TRH

25
Q

Pituitary tumours

-	Four functional syndromes
A

Pituitary syndromes

  1. Acromegaly (GH)
  2. Cushings (ACTH)
  3. Hyper-prolactinaemia
    - Prolactinoma
  4. TSHoma
26
Q

Pituitary tumour

- Visual field defect
- Significance
A

Pituitary tumour
- Visual field defect

  1. Bi-temporal hemi-anopia
  2. Indication for surgery in non-functional
27
Q

ACTH Pituitary Reserve

- Severity Assessment

A

SynACTHen Test

Failure to respond to ACTH
- Two week ACTH deficiency
- Atrophy of adrenal cortex

28
Q

ACTH and GH reserve

- Gold standard test

A

ACTH and GH Reserve Test

  1. Insulin Tolerance Test
  2. Induce hypoglycaemia below 2.2mmol/l
29
Q

Hyperprolactinaemia

  • 6 DDx
A

Hyperprolactinaemia

  1. Pregnancy
  2. PCOS
  3. Prolactinoma
  4. Dopamine antagonists
    - Anti-emetics
    - Anti-psychotics
  5. Hypothyroidism
  6. Renal failure
30
Q

Micro-prolactinoma

- Presentation

A

Micro-prolacinoma

  1. Menstral disturbance
  2. Galactorrhoea
  3. Infertilerty
  • Male hypogonadism
31
Q

Macro-prolactinoma

- Presentation

A

Macro-prolactinoma

  1. Men
  2. Very high prolactin levels
32
Q

Prolactinoma

- Mx

A

Prolactinoma Mx

Dopamine agonists (D2)
1 Cabergoline
2 Bromocriptine

33
Q

Prolactinoma Mx

- ADRs

A

Prolactinoma Mx ADRs

  1. D2 agonists
    - Nausea
    - Postural hypertension
    - Psychiatric disturbance
  2. Rapid reduction
    - Meningitis
  3. Parkinsons doses
    - Valve abnormalities
34
Q

Acromegaly

- Ix

A

Acromegaly Ix

  1. OGTT
    - Failure to suppress GH
  2. IGF-1
    - High levels
35
Q

Acromegaly

- Tx

A

Acromegaly Tx

Medical

  1. Monthly somatostatin analogues
    - Octreotide
  2. Dopamine agonists
  3. Definitive Surgery
  4. Gamma knife (external beam/stereotactic radiotherapy)
36
Q

Hypo-pituitarism

-	DDx
A

Hypo-pituatarism DDx

  1. Pituitary tumour
  2. Inflammatory/infiltrative disorders
    - Ass. with D. Insipidus
  3. Braintrauma
  4. Radiotherapy
37
Q

Hypo-pituitarism

- Sx

A

Hypo-pituitarism Sx

  1. Lethargy
  2. Weight gain
  3. Sexual dysfunction
  4. Acute hypo-adrenal crisis
  5. Short stature in children
38
Q

Hypopituitarism

- Investigative aim

A

Hypopituitarism Investigations

- Exclude adrenal insufficiency

39
Q

Hypopituitary

-	Treatment pathways
A

Hypo-pituitary treatments

  1. ACTH
    - Hydrocortisone
  2. TSH
    - Thyroxin
  3. Gonadotropin in men
    - Testosterone
  4. Gonadotropin in women
    - Ostrogen and progesterone (COCP or HRT)
  5. GH
    - Subcut GH
40
Q

Cushing’s syndrome

- Presentation (six elements)

A

Cushing’s presentation

  1. Central obesity
  2. Dorso-cervical fat pad
  3. Round, red face (plethora)
  4. Thin skin and easy bruising
  5. Proximal myopathy
  6. Hypertension
41
Q

Cushing’s syndrome

- Investigations

A

Cushing’s syndrome Ix

  1. Pseudocushings
    - Alcoholism
    - Severe depression
  2. 24hr UFC
    - Urine cortisol
  3. LDDST
    - Low dose dexamethasone supression test
  4. DST
    - Dexamethasone suppression test
    (overnight)
42
Q

Cushings

- DDx

A

Cushing’s DDx

  1. Pituitary
    - Very responsive to CRH
  2. Adrenal
    - Hirsuitism
    - Low ACTH
  3. Ectopic
    - Smoking Hx
    - Weight loss
    - Unresponsive to CRH
43
Q

Cushing’s Management

  1. Pit
  2. Adr
  3. Ect
A

Cushings Mx

  1. Trans-sphenoidal removal
    — Pituitary adenoma
    - Metyrapone and Ketoconazole
  2. Laparascopic adrenalectomy
  3. Underlying ectopic malignancy
44
Q

Hyponatraemia Sx

  1. Early
  2. Late
A

Hyponatraemia

  1. Early Sx
    - Headache
    - N&V
    - Malaise
  2. Late Sx
    - Confusion
    - Agitation
    - Drowsiness
    - Resp depress, coma, death
45
Q

SIADH

- Three Exclusions

A

SIADH exclusions

  1. Hypothyroidism
  2. Salt depletion
  3. ACTH deficiency
46
Q

SIADH

-	6 Causes
A

SIADH Causes

  1. Idiopathic
  2. CNS pathology
  3. Lung cancer
  4. Respiratory Pathology
  5. Non-lung cancer
  6. Drugs
    - Anticonvulsants
47
Q

Hypervolaemic hyponatraemia

-	Mx
A

Hypervolaemic hyponatraemia Mx

  • Specialist
    1. Cirrhosis
    2. Nephrotic syndrome
    3. CCF
  • Fluid restriction
  • Drug treatment
    1. Demeclocycline
    2. ADH antagonists
48
Q

DI

- Two types

A

DI

  1. Cranial DI
    - ADH insufficiency
  2. Nephrogenic DI
    - Vasopressin resistance
49
Q

DI

- Diagnostic criteria

A

DI criteria

  1. Urine volume >3l/24 hours
  2. High serum osmolality (>295mosmol/Kg)
  3. Low urine osmolality (<300 mosmol/Kg)
50
Q

DI

- Mx

A

DI Mx

Cranial

  1. Pituitary disease managmenet
  2. DDAVP
    - Desmopressin

Nephrogenic
1. Underlying cause

51
Q

Hypercalcaemia

- Ix for Malignancy

A

Malignant hypercalcaemia Ix

  1. PTH
    - Low in malignant
  2. Normal/high in non-malignant
52
Q

Hypercalcaemia with suppressed PTH

- DDx

A

Hypercalcaemia with suppressed PTH

- SCC until proven otherwise

53
Q

Hypercalcaemia with non-suppressed PTH

- DDx

A

Hypercalcaemia with non-suppressed PTH

  1. Primary PTH
  2. MEN
  3. HPT-Jaw tumour syndrome
54
Q

Hypocalcaemia

- DDx

A

Hypo-calcaemia DDx

  1. Postsurgical
  2. Vitamin D
    - Neonate
    - High PTH, low phosphate
  3. Hypomagnesaemia
    - Normal or low PTH
    - GI loss
    - Alcohol/drugs (PPIs)
55
Q

Hypocalcaemia

-	Mx
A

Hypocalcaemia Mx

  1. Vit D Deficiency
    - Cholecalciferol replacement
  2. Hypoparathyroid replacement
    - Alfacalcidol
    - Calcitriol
  3. Magnesium deficiency
    - Stop precipitating drugs (PPIs)
    - IV MgSO4

Year 3 - Medical Block Workbooks (7 decks)

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