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eMRCS questions > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Blood supply of thyroid

A

Superior thyroid- branch of external carotid

Inferior- thyrocervical

Thyroidea ima- from brachiocephalic

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2
Q

Venous supply of thyroid

A

Superior and middle- IJV
Inferior in brachiocephalic

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3
Q

Synthesis of thyroid hormones

A
  • Thyroid actively concentrates iodide( to 25 times the plasma conc.)
  • Iodide is oxidised to atomic iodine by peroxidase(in the follicular cells)
  • Atomic iodine then iodinates tyrosine residues (contained in thyroglobulin).
  • Iodinated tyrosine residues undergo coupling to either T3 or T4.
  • Process is stimulated by TSH, which stimulates secretion of thyroid hormones.
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4
Q

AB in hasimotos

A

Thyroperoxidase

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5
Q

Most sensitive tests for hyper and hypo thyroidism

A

Hyper- T3

Hypo- TSH and T4

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6
Q

Features of toxic nodule

A

Small swelling @midline/near midline; hot intolerance recently

Low TSH
High T3

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7
Q

What is suggestive of a thyroid cancer on imagine

A

Cold nodule- reduced/no uptake in radio iodine

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8
Q

Causes of hypothyroidism

A

Primary-Hashimoto
Iodine def
Radioiodine

Secondary- pituitary- surgery, tumour, radiation

Tertiary- hypothalamus

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9
Q

Pendred syndrome

A

Bilateral sensorineural hearing loss + Goitre + Hypothyroidism

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10
Q

Cause of brown tumour

A

Brown tumors are tumors of bone that arise in settings of excess osteoclast activity, such as hyperparathyroidism

They appear brown because haemosiderin is deposited at the site.

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11
Q

Mx of severe hypercalcaemia

A

Aggressive fluids
IV pamidromate
Furosemide

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12
Q

When is urgent mx of hypercalc required

A

> 3.5
Reduced consciousness
Abdo pain
Pre Renal failure

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13
Q

Causes of hypocalcaemia

A

Vit D def
Renal failure
Hypoparathyroidism
Pseudohypo (target insensitive to PTH)
Mg def

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14
Q

Sx of hypocalacaemia

A

Parasthesia
Spasm, tetany, convulsion
Psychosis
Chcosteck
Trousseau
Prolonged QT

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15
Q

Mx of severe hypocalcaemia

A

Calcium gluconate, 10ml of 10% solution over 10 minutes

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16
Q

What is Mg required for physiologically

A

Mg is required for both PTH secretion and its action on target tissues.

  • Hypomagnesaemia cause both hypocalcaemia and make patients unresponsive to treatment with calcium and
    vitamin D supplementation.
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17
Q

Most common cause of hyponatraemia in surgery

A

Over administration of dextrose

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18
Q

Causes of pseudohyponatraemia

A

Include hyperlipidaemia (increase in serum volume)
Multiple myeloma
Taking blood from a drip arm

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19
Q

Features of papillary thyroid cancer

A

Young person
Multinodular
Not capsulated
Orphan Annie nuclei
Psammoma body
TSH dependent

Spread by lymphatics !
Cold radioisotope

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20
Q

Features of follicular thyroid cancer

A

Capsulated
Solitary nodule
Spread via blood- to lung, brain, bone
Prominent oxyphil cells and scanty thyroid colloid

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21
Q

Features of medullary thyroid cancer

A

Multifocal- MEN
Diarrhoea and flushing
Potentially recurrent after surgery

High calcitonin- para C cells

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22
Q

Features of anaplastic thyroid cancer

A

Rapidly enlarging
Aggressive
Local invasion
Cold scan

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23
Q

Mx of thyroid cancer

A

Pap
<2cm lobectomy
Thyroxine life long
Yearly thyroglobulin FU

> 2cm
Total thyroidectomy
RI ablation
Suppressive thyroxine lifelong
Yearly TG FU

Follicular- total
Adenoma- hemi

Med
Total thyroidectomy
Thyroxine
Yearly FU calcitonin

Anaplastic
Debulking and radio palliation- isthmusectomy
Total + radio if capsule and no evident mets

Lymphoma
Radio +/- chemo

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24
Q

Features of lymphoma of thyroud

A

Hx of Hashimoto
Rapidly enlarging
B cell

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25
Q

Type of follicular cancer with poor prognosis

A

Hurthle cell cancer

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26
Q

Acute thyroiditis features

A

Euthyroid
Fever
High ECC

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27
Q

Sub acute thyroiditis - De querveins

A

Granulomatous
Hyperthyroidism then hypo
High WCC
High T4 low TSH
SMooth tender thyromegaly

Low uptake on scan

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28
Q

Hashimoto features

A

TPO +
TG+
Anti mito
TSH receptor

Firm hard receptor
Cold, weight gain, tired

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29
Q

Reidel syndrome

A

Hypothyroid
Hard
AB -ve
Fibrosing

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30
Q

Cold nodule with hyperthyroid symptoms

A

Thyroid Carcinoma associated with Grave’s disease is usually Papillay

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31
Q

Mx of Graves disease

A

Medical
1st Carbimazole - TPO inhibitor
2nd Propylthiouracil -use in pregnancy

Radio - small, no eye

Surgery - large, eye sign
Must be euthyroid and vocal cord exam before surgery

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32
Q

Mx of multinodular goitre

A

Total thyroidectomy

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33
Q

Mx of thyrotoxicosis with eye signs

A

Carbimazole

Then if relapse- total thyroidectomy

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34
Q

High TSH and normal/high T4

A

Poor complience of thyroxine

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35
Q

Low TSH and normal T4

A

Steroid therapy

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36
Q

Skin features of hypothyroidism

A

Dry- anhydrosis
Non pitting edema
Eczema
Xanthomata

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37
Q

Skin features of hyperthyroidism

A

Pretibial myxoedema
Acropachy- clubbing
Sweating

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38
Q

Radioiodine

A

Close contact with children not permitted for 4 weeks
15% with eye signs get worse
Symptoms improve after 6-8w
80% become hypothyroid
CI in pregnancy

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39
Q

Prolactinoma sx

A

Nipple discharge
Gynaecomastia
Visual signs

40
Q

Causes of gyanecomastia

A

Kallman
Kleinfelter
Test failure

Spironolactone- most common
Finasteride
Anabolic steroids
Oestrogens

41
Q

When is IV bisphosphante require

A

Ca >3

42
Q

FHH sx

A

Loss of PTH receptor sensitivity found in parathyroid and kidney

Parathyroid- doesn’t detect- increase/normal PTH- Mild hypercalcaemia

Kidneys- meant to inhibit reabsorption but doesn’t- hypocalciuria

High Mg

43
Q

Indications of parathyroidectomy

A

ABCS

<50 age, Asymptomatic - Ca 1 above normal
BMD <2.5 SD
Calciumstones Nephrolithiasis

Life threatening hypercalcaemia
Symptomatic

44
Q

Pseduohypoparathyroidism

A

G protein abnormailty- insensitive to PTH

Low IQ, short stature, 4/5th metacarpal short

Low Ca, high phosphate, high PTH

Measure urinary cAMP and phosphate following PTH infusion

If increases- hypoparathyroidism
If no- Pseudo

45
Q

Psuedopseduohypoparathyroidism

A

Skeletal defects similar to PHPTH
Normal biochem

46
Q

Thyroid cancer linked to prolonged irradiation exposure

A

Papillary

47
Q

Adrenal mass that has a lipid rich core

A

Adenoma

48
Q

Cells of phaeo

A

Chromaffin cells

49
Q

10% rule of phaeo

A

10% of cases are bilateral.
10% occur in children.
11% are malignant (higher when tumour is located outside the adrenal).
10% will not be hypertensive.

50
Q

Post thyroidectomy- patient becomes profoundly dyspneic and hypoxic

A

Tracheomalacia

51
Q

If ultrasound shows indeterminate mass in breast and FNA shows normal tissue what should you do

A

Excisions biopsy

CT rarely helpful in breast

52
Q

Patient presents with MSK pain and x rays show widespread osteopenia -waht ix

A

USS of neck

53
Q

Cell changes in tertiary hyperparathyroid

A

Hyperplasia of all 4 glands

54
Q

Haemorrhage in adrenal glands

A

Waterhouse - Friderichsen syndrome

55
Q

Thyrotoxicosis, proptosis- receives radiotherapy on eyes, symptoms relapse after stopping carbimaozle
Tx?

A

Total thyroidectomy

56
Q

After thyroidectomy pt develops oculogyric crisis and muscle spasm

A

hypocalcaemic tetany and will require immediate calcium supplementation.

57
Q

Psychiatric drug that can cause thyroid goitre

A

Lithium

58
Q

FNA vs core biopsy

A

Core biopsy is preferred over FNAC by most surgeons.

The reason for this is that FNAC often yielded inadequate tissue for assessment.

When FNAC demonstrated benign changes, it had to be repeated at least once to confirm this.

If it yielded cells that were indeterminate, then a core biopsy was needed.

A core biopsy removes many of these stages and is thus more reliable.

59
Q

Thyroglossal cyst removal

A

Resection of cyst
Associated track
Central portion of hyoid and wedge of tongue

Sistrunks procedure

60
Q

Thyroid mass, euthyroid Ix?

A

FNAC

61
Q

Other AB found in hashimotos

A

Anti microsomal

62
Q

Proportion of primary HPTH caused by adenoma

A

85%

63
Q

% of patient with HPTH that are symptomatic

A

30%

64
Q

Area affected in adrenals in addisions

A

Fasciculata

65
Q

Ig of Anti TSH

A

IgG

66
Q

Treatment of Graves in Pregnancy

A

PTU in first

Can do carbimazole after

67
Q

Treatment success of anti thyroid drugs in children

A

1/3 replase

68
Q

Dex suppression test results

A

Cortisol raised- adrenal adenoma or bronchial

If ACTH high small cell
If Low adrenal

If cortisol suppressed pituitary- usually with high dose

69
Q

Which thyroid cancer has best prognosis

A

Papillary

70
Q

Dx of acromegaly

A

Initially by IGF 1

Then oral glucose with lack of suppression of GH <1 measurements

71
Q

Diagnosis of diabetes and pre diabetes

A

Fasting
6.1 7.1

Random
7.8 11.1

Hba1c
42 48

72
Q

Problems with stopping antithyroid drugs

A

High recurrence rates

73
Q

Where globally is incidence higher for follicular cancer

A

Iodine deficient

74
Q

Common extra adrenal location of phaeo

A

Organ of Zuckerkandl

Aortic bifurcation

75
Q

Proportion of medullary thyroid that is familial

A

20%

76
Q

Other conditions Hashimotos is associated with

A

Coeliac and pernicious anaemia
And other AI

77
Q

FHH inheritance and electrolyte disturbances

A

AD

Hypermagnesium

78
Q

Specific imaging for phaeo

A

MIBG

79
Q

Top endogenous cause of cushings

A

Pituitary adenoma

80
Q

Proto oncogene with MEN

A

RET

81
Q

Bilateral adrenalectomy now developed bitemproal semi, pigmentation

A

Nelsons syndrome

Expanding pit tumour- high ACTH

82
Q

What electrolyte abnormality suggests chronic renal failure

A

Low Ca

83
Q

Thyroid effect on fat

A

Hypothyroid hypercholestrol

84
Q

Initial test for phaeo

A

VMA/HVA 24 hour urine

85
Q

Conditions phaeo is associated with

A

MEN 2A+B
VHL
NFM1

86
Q

Best method of localised parathyroid adenoma

A

Bilateral neck exploration

87
Q

Bilateral hilar lymphadeopathy with high Ca

A

Sarcoid

88
Q

Thyroid effects on Ca

A

Hyper high Ca

89
Q

Liddle syndrome

A

Hypokalaemia metabolic acidosis with HTN
Low renin activity
AD

Resistant HTN

90
Q

Gieltman syndrome

A

Hypokalaemia metabolic alkalosis
Hypocalciuria and hypomagnesia
BP normal or low

Def in Na/Cl in DCL

91
Q

Phaeo, medullary and itchy lesions

A

MEN 2A

Itchy lesions are cutaneous lichen amyloidosis

92
Q

Pre op parathyroid localisation

A

US
Sestamibi radionucleotide scan
Technetium

93
Q

Most useful initial ix of goitres

A

US and FNA

94
Q

Thiazides on Ca

A

Hypercalcaemia - mild

95
Q

Which thyroid cancer associated with radiation

A

Papillary

96
Q

Most common enzyme def in CAH

A

21

eMRCS questions (45 decks)

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