Endocrine Flashcards
1
Q
Describe the presentation of a patient with thyrotoxicosis
A
A nervous, heat-intolerant individual with poor sleep, possibly with pretibial myxedema
2
Q
What is the most common cause of thyrotoxicosis?
A
Grave’s disease
3
Q
What is the most common arrhythmia associated with thyrotoxicosis?
A
Atrial fibrillation (AF)
4
Q
What is the first investigation to be done for a patient with AF suspected to have thyroid involvement?
A
Thyroid functions test
TSH
5
Q
Define primary thyrotoxicosis
A
Elevated T3 and T4 levels, decreased TSH levels
6
Q
Define secondary thyrotoxicosis
A
Elevated TSH levels, elevated T3 and T4 levels (due to pituitary adenoma)
7
Q
What is the initial test for a patient with a thyroid nodule?
A
Thyroid function test (TFT)
8
Q
What is the recommended action if thyroid nodule is found to be elevated on TFT?
A
Proceed to ultrasound (U/S)
9
Q
How should hoarseness of voice in a patient raise suspicion be investigated? suspect ₵
A
Fine needle aspiration biopsy (FNAB) guided by ultrasound
10
Q
Irradiation to children…..
A
carcinogenic
11
Q
Surgery —-Total thyrodiectomy (SE
A
hypothyrodism and recurrence, recurrent nerve injury)
12
Q
What is the most common treatment for thyrotoxicosis in Australia?
A
Radioactive iodine therapy (side effect: hypothyroidism)
13
Q
What is contraindicated in children with thyroid issues due to the risk of after surgery?
A
recurrence
14
Q
What is the best treatment if recurrence occurs after thyroid surgery?
A
Radioactive iodine therapy (avoiding repeated neck surgeries)
15
Q
Describe the side effects of antithyroid drug carbimazole
A
Agranulocytosis, caution in pregnancy
16
Q
What is the preferred drug combination for pregnant women with thyroid issues experiencing palpitations?
A
Propylthiouracil + propranolol
17
Q
When is surgery considered the definitive treatment for thyroid issues in pregnant women?
A
Second trimester
18
Q
Drugs for pregnant woman —–→
A
fetal hypothyroidism
19
Q
Hypothyroidism and pregnancy:
A
Thyroxine…..safe, ↑requirements
20
Q
Children…Hypothyroidism tx
A
Hypothyroidism - Investigation and management
Royal Australian College of General Practitioners (RACGP)
https://www.racgp.org.au › afp › august › hypothyroidi…
Thyoxine replacement therapy is the mainstay of treatment for hypothyroidism and is usually lifelong
.drugs
21
Q
What is the recommended test for monitoring thyroid function during pregnancy?
A
T4 levels
thyroid stimulating hormone and free t4 are useful to guide diagnosis and monitoring of thyroid conditions in pregnancy. As free t3 does not cross the placenta, ordering of free t3 levels is usually limited to specific circumstances such as t3 predominant thyrotoxicosis (discussed below).
https://www.racgp.org.au › …PDF
Thyroid disease in the perinatal period - RACGP
22
Q
What is the safest treatment for hypothyroidism during pregnancy?
A
Thyroxine (T4)
hypothyroid states should be treated with thyroxine aiming for a tsh <2.5 prior to conception and in the first trimester and tsh <3.0 for the second and third trimesters. it is important to separate thyroxine intake from preparations that may reduce absorption.
https://www.racgp.org.au › …PDF
Thyroid disease in the perinatal period - RACGP
23
Q
What is the treatment approach for children with thyroid issues?
A
Medication
Management
Thyoxine replacement therapy is the mainstay of treatment for hypothyroidism and is usually lifelong. However, it is important to recognise when the cause of the hypothyroidism is transient or drug induced because this may require no treatment or only short term thyroxine supplementation
24
Q
What is the recommended treatment for a thyrocardiac patient?
A
Surgery
Initial Management:
1. Beta-blockers (e.g., propranolol, atenolol, metoprolol) for symptomatic relief in moderate-to-severe symptomatic thyrotoxicosis.
Definitive Treatment Options:
1. Antithyroid Medications (Thionamides):
- Favored as initial treatment to achieve euthyroidism.
- Common drugs: Carbimazole (less hepatotoxicity) or Propylthiouracil (PTU) in the first trimester of pregnancy and thyroid storm.
-
Radioactive Iodine Ablation (I-131):
- Considered if thionamide therapy fails or in recurrent Graves’ disease.
-
Thyroidectomy:
- Preferred in cases with moderate-to-severe Graves’ orbitopathy or for women planning pregnancy within 6-12 months.
For more detailed information, refer to the RACGP guidelines oai_citation:1,RACGP - Thyroid disease Long term management of hyperthyroidism and hypothyroidism.
25
What is the standard treatment for thyroid cancer?
Total thyroidectomy
26
What is the initial step when dealing with a patient with exophthalmos and thyroid issues?
Ensure the patient is euthyroid before further management
27
Describe sub-acute thyroiditis (De Quervain's thyroiditis)
Inflammation of the thyroid gland, often viral in origin, characterized by thyroid tenderness
28
Describe sub-acute thyroiditis (De Quervain's thyroiditis)
Viral etiology, Thyroid TENDRNESS (only type(
RAIU -> ……..vimp.
All thyrotoxicosis ….
Tx ->
Viral etiology, Thyroid TENDRNESS (only type(
RAIU -> LOW……..vimp. All thyrotoxicosis high….
Tx -> ASPIRIN to relieve pain…..vv imp.
29
Pituitary adenoma: Causes
only cause of hyperthyroidism with ++ T4 & ++ TSH
30
What is the diagnostic test for pituitary adenoma causing hyperthyroidism with elevated T4 and TSH?
Brain MRI
31
What is the recommended treatment for pituitary adenoma causing hyperthyroidism?
Surgical removal via transsphenoidal route
32
What are the consequences of exogenous thyroid hormone abuse on TSH and gland size?
Elevated T4, decreased TSH, gland atrophy - key word
33
Define sick euthyroid syndrome
A condition with low T3 levels often seen in acute severe illnesses, especially in ICU patients
↓T3 …… vvvvvvvvvv imp …..High, low or normal T4 & TSH
34
Describe the most common cause of hypothyroidism known as myxedema.
Hashimoto's thyroiditis
35
Do patients with myxedema (hypothyroidism) typically experience loss of the outer 2/3 of their eyebrows?
Yes
36
Define exophthalmos and its association with thyrotoxicosis.
Exophthalmos is bulging of the eyes and is associated with thyrotoxicosis.
37
How is myxedema coma characterized in older patients?
It is characterized by hypothermia, hypoventilation, hypoglycemia, and heart failure.
38
Describe the treatment for myxedema coma.
Treatment includes IV hydrocortisone and IV thyroxine, following the order of treating an Addisonian crisis.
39
Myxedema coma:
old patients + Predisposing factors…..infections or cold weather
Hypothermia, Hypoventilation, Hypoglycemia, HF
TTT:
Myxedema coma:
old patients + Predisposing factors…..infections or cold weather
Hypothermia, Hypoventilation, Hypoglycemia, HF
TTT: Iv hydrocortisone + iv thyroxine (by order ff adesonian crisis). ↓T3 and T4
40
TSH: 1ry……
--- 2ry…..
---- Iodine uptake…..
TTT…
Average maintenance..
TSH: 1ry……increased --- 2ry…..decreased ---- Iodine uptake…..decreased
TTT… L-THYROXIN Start with 50 MG/day Average maintenance..200 MG / day
41
In old patient and CVD patients; Start with 25 and increase gradually 25 per time
Monitoring by …
When ?.....
the ttt..vvvv imp
Pregnant with hypothyroidism….
In old patient and CVD patients; Start with 25 and increase gradually 25 per time
Monitoring by TSH … When ?.....4 weeks after starating the ttt..vvvv imp
Pregnant with hypothyroidism….increase dose of thyroxine
42
What are the changes in T3 and T4 levels in primary hypothyroidism?
Decreased T3 and T4 levels
43
Hashimoto's thyroiditis: Hypothyroidism symptoms.
….. hormone
TTT:
Hashimoto's thyroiditis: Hypothyroidism symptoms.
Thyroid peroxidase antibodies….. ↓T4 …… ↑TSH
TTT: thyroxine replacement
44
Define the treatment for primary hypothyroidism.
Treatment involves L-thyroxine replacement therapy, starting with 50 mg/day.
45
How often should TSH levels be monitored during hypothyroidism treatment?
TSH levels should be monitored 4 weeks after starting treatment, especially in older and cardiovascular disease patients.
46
Describe the recommended approach for adjusting thyroxine dose in pregnant women with hypothyroidism.
The dose of thyroxine should be increased in pregnant women with hypothyroidism.
47
Differentiate between subclinical hypothyroidism and subclinical thyrotoxicosis based on TSH levels.
Subclinical hypothyroidism is characterized by high TSH levels, while subclinical thyrotoxicosis has low TSH levels.
48
MCC hypothyrodismin in Newly born…….
Children / Adult……………..
Developing countries…..
MCC hypothyrodismin in Newly born…….congenital dysgenesis
Children / Adult……………..hashimoto's
Developing countries…..iodine deficiency
49
Most imp thyroid marker in pregnant…..
Most imp marker to follow patients with thyroid disorders….
Most imp marker in euthyroid sick syndrome……….
Most imp thyroid marker in pregnant…..T4
Most imp marker to follow patients with thyroid disorders….TSH
Most imp marker in euthyroid sick syndrome……….T3
50
What are the key symptoms of hypothyroidism that can help differentiate it from depression and dementia?
Constipation is a common manifestation of hypothyroidism.
How to differentiate???.. Other manifestation of hypothyrosim esp. constipation
51
Subclinical hypothyroidism vs subclinical thyrotoxicosis:
Both of them…….. …… symptoms
Subclinical hypothyroidism……
Subclinical thyrotoxocisis……
Subclinical hypothyroidism vs subclinical thyrotoxicosis:
Both of them……..normal T3 and T4 …… NO symptoms
Subclinical hypothyroidism……High TSH
Subclinical thyrotoxocisis……low TSH
52
Describe the characteristics of retrosternal goiter.
Retrosternal goiter presents with neck swelling and obstructive symptoms, often indicated by Pemberton's sign.
53
What is the recommended investigation of choice for retrosternal goiter?
CT chest is the preferred investigation, and surgery is the treatment of choice.
54
How is diabetes mellitus diagnosed based on fasting blood sugar (FBS) and postprandial/random blood sugar (PP/RBS) levels?
Diabetes mellitus is diagnosed if FBS is >7 mmol/L and PP/RBS is >11 mmol/L, or if HbA1c is >6.5%.
55
What is the primary test recommended for follow-up in diabetes mellitus patients?
HbA1c test every 3-6 months is the best for follow-up.
56
Describe the initial steps in managing diabetes mellitus.
Initial steps include weight loss and dietary modifications, focusing on complex carbohydrates.
57
What is the first-line medication for diabetic patients, especially those who are thin and obese?
Metformin is the first-line medication, particularly in obese diabetic patients.
Metformin is the drug of first choice for glucose lowering in patients with type 2 diabetes. A sulphonylurea is an appropriate second option. GLP-1 agonists and SGLT-2 inhibitors provide some benefits for weight loss.
https://www.racgp.org.au › may
Glucose-lowering medicines for type 2 diabetes - RACGP
58
What is the most common side effect associated with metformin use?
Lactic acidosis is the most common side effect of metformin.
check RFTs
59
What should be done with metformin before surgical operations?
Stop 1-2 days before.
before surgical operations
60
Describe the initial insulin dose and its adjustment.
Start with 20 units per day, then increase gradually.
61
What are the possible complications of insulin therapy?
Hypoglycemia, Weight gain, Allergic reaction.
62
How should the insulin injection position be changed to avoid allergic reactions?
Change the position of the injection site.
63
What is the common issue with wrong insulin doses?
Usually overdose leading to nocturnal sweating.
64
What action should be taken for morning hypoglycemia?
Decrease long-acting insulin at night.
65
What should be done for morning hyperglycemia?
Increase long-acting insulin at night.
66
Describe the relationship between statins and diabetes mellitus in the presence of cardiovascular risk factors.
In type 2 DM with any CVS risk factors or absolute CVS risk >15%.
1-any CVS risk factors ( smoker, hyperlipidemia, HTN, obesity)
2- absolute CVS risk more than 15%
67
What are the main causes of diabetic ketoacidosis?
1st: Infection, 2nd: Missed insulin, 3rd: Newly diagnosed DM.
68
What are the clinical presentations of diabetic ketoacidosis?
Abdominal pain, Kussmaul's breathing, Nausea, Vomiting, Dehydration, Confusion then Coma.
69
What are the initial steps in managing diabetic ketoacidosis?
First: ABG, then Urine: glucose and acetone.
70
How is hyperglycemia and hyperkalemia initially managed in DKA?
First step: IV fluid (normal saline), Second step: Insulin (regular short-acting).
IV fluid (dehydration/Acidosis), normal saline, 4-8 liters
Second step…..insulin (regular short acting)
Acidosis: self corrected after giving the fluid
71
Why does hypokalemia occur in DKA treatment?
Intracellular shift after giving insulin.
72
When should potassium be administered in DKA treatment?
Only after passing urine.
73
When should glucose be given in DKA treatment?
If glucose is <250 mg/dl, give glucose 5%.
74
What is the most common complication during DKA treatment?
Hypoglycemia.
75
What is the most serious complication causing mortality during DKA treatment?
Cerebral edema.
76
Describe the management of hypoglycemia.
IV or oral glucose; in severe cases, IM glucagon.
77
Hypoglycemia:
MCC:
Cp………
TTT…….…
In severe cases….
Hypoglycemia:
MCC: Overdose of the insulin
Cp………sympathetic overactivity:
TTT…….iv or oral glucose (impaired consciousness …only IV glucose)
In severe cases….IM glucagon
78
Acathosis nigricans:
Hyperpigmented velvety patches over neck, axilla dt….
Acathosis nigricans: DM / PCO
Hyperpigmented velvety patches over neck, axilla dt….insulin resistance
79
What is acanthosis nigricans associated with?
Diabetes mellitus or PCOS.
80
What are the characteristic features of acromegaly?
Increased growth hormone, pituitary adenoma, coarse facial features.
81
What is the best screening test for acromegaly?
Insulin-like growth factor.
82
What is the best confirmatory test for acromegaly?
GH suppression by glucose.
83
MRI -> Acromegaly
MRI -> Pituitary lesion.
84
MCC of death….. CHF. Acromegaly
MCC of death….. CHF
85
Acromegaly-
Cancer with acromegaly….. colon cancer
Cancer with acromegaly….. colon cancer
86
How is acromegaly typically treated?
Surgical resection with trans-sphenoidal removal.
87
Describe the first step in the treatment of hypoparathyroidism.
First step is to administer calcium gluconate.
TTT: First step ---→ Ca+2 gluconate…. Long term ----→ vitamin D and Ca
88
Primary hypo-parathyroidism
MCC:
Ca ->
MCC: Post-surgical……….. after thyroidectomy & removal of of 4 parathyroids
↓Ca -> perioral Numbness (1st sign), carpopedal spasms , Seizures.
TTT: First step ---→ Ca+2 gluconate…. Long term ----→ vitamin D and Ca
89
What are the common signs of hypocalcemia?
Common signs include perioral numbness, carpopedal spasms, and seizures.
90
Define primary hyperparathyroidism.
It is most commonly caused by a parathyroid adenoma and is characterized by high levels of calcium, low levels of phosphate, and high levels of PTH.
91
Primary hyper-para-thyroidism:
MCC Parathyroid adenoma (90%)
Cp: Abdominal groans, renal stones, bones #s & psychic moans.
First inv for hyperparathyrosim ……parathyroid scan (MCC of ↑Ca ---→ ↑PTH)
↑Ca ……. ↓ PO4……. ↑PTH……
92
How is primary hyperparathyroidism typically treated?
It is usually treated with parathyroidectomy.
93
Only type of hyperpathyrosim with low ca+2 level….
Only type of hyperpara with low PTH ...
TTT:
TTT of asymptomatic hypercalcemia…..none
Only type of hyperpathyrosim with low ca+2 level…..secondary to RF
Only type of hyperpara with low PTH ...pseudo( malignancy)
TTT: Parathyroidectomy
TTT of asymptomatic hypercalcemia…..none
94
Describe the differences between hyperparathyroidism and familial hypercalcemia hypocalciuria.
In hyperparathyroidism, serum calcium and urine calcium are both increased, while in familial hypercalcemia hypocalciuria, serum calcium is increased but urine calcium is decreased.
95
Mother with ↑Ca, son presented with ↑Ca: 1st inv:
urin Ca (the ↑Ca not 1st PTH)
96
What are the common physical manifestations of Cushing's syndrome?
Common manifestations include truncal obesity, moon face, buffalo hump, thin arms and legs, hypertension, hirsutism, and skin pigmentation.
97
Define adrenal insufficiency (Addison's disease).
It is characterized by insufficient production of adrenal hormones and can lead to various symptoms such as fatigue, weight loss, and low blood pressure.
98
What is the cause of striae in Cushing's syndrome?
Striae are caused by the rupture of subcutaneous tissue.
99
How is Cushing's syndrome differentiated from polycystic ovary syndrome (PCOS)?
Both conditions present with obesity, hirsutism, and menstrual disorders, but Cushing's syndrome can also cause psychiatric manifestations.
100
ACTH_Levels_and_Specific_Tests
Tx ------------> Removal - Removal - Removal.
101
Describe the treatment for Cushing's syndrome.
Treatment usually involves the removal of the source of excess cortisol production, which can be from the pituitary, adrenal glands, or ectopic sources.
102
Cause of striae…..
Cause of striae…..rupture of subcutaneous tissue
103
Only type of cushing with low ACTH…..
Inv of choice for cushing…..
Only type that is suppressed by dexamethasone…
Only type of cushing with low ACTH…..adrenal
Inv of choice for cushing…..suppresion test
Only type that is suppressed by dexamethasone…pituitary
104
Adrenal insuffeciency = addison disease :
Mcc….. …..
Cl/P:
Scars (only recent only) ……
TTT…..
Adrenal insuffeciency = addison disease :
Mcc….. Auto immune…..
TB in developing countries
Cl/P: Pigmentation←----- key word + همدان بيرجع
Scars (only recent only) ……vvvvvvv imp
TTT…..oral cortisone
105
Addisonian crisis:
Aggressive iv fluid…N saline if not improve… nest step/ DOC iv hydrocortisone
Any pt with vomiting ---
is adisson
Patient with lung cavitation now complaining of weakness and pigmentation…..
Addisonian crisis: Hypotensive + Pigmentation + همدان بيرجع
Aggressive iv fluid…N saline if not improve… nest step/ DOC iv hydrocortisone
Any pt with vomiting --- ↓K…. the only one ↑K is adisson
Patient with lung cavitation now complaining of weakness and pigmentation…..TB affected adrenal gland
106
Describe the management of an accidental discovery of a suprarenal mass less than 4 cm in size with no other hormonal changes.
Follow-up is recommended.
107
Describe the management of an accidental discovery of a suprarenal mass more than 4 cm in size.
Biopsy or adrenalectomy is indicated.
108
Define metabolic syndrome and list its common features.
Metabolic syndrome is characterized by increased fasting blood sugar, abdominal obesity, elevated triglycerides, low HDL cholesterol, and hypertension.
109
What are the symptoms of pheochromocytoma?
Symptoms include panic attacks, headaches, and hypertension.
110
How is pheochromocytoma initially evaluated?
Best initial test is measuring VMA levels.
111
What is the most accurate diagnostic test for pheochromocytoma?
MIBG scan of the adrenal glands.
112
What is the first-line treatment to control blood pressure in pheochromocytoma?
Phenoxybenzamine (Alpha blocker) is used first. Surgical resection.
113
Erectile dysfunction:
MCC…. Anxiety (psychiatric)
Erectile dysfunction: Failure of spontaneous erection.
MCC…. Anxiety (psychiatric)
114
Describe the treatment approach for erectile dysfunction.
First-line treatment is Sildenafil, but caution is advised in patients taking nitrates due to risk of severe hypotension.
115
Define nocturnal penile tumescence and its significance in diagnosing erectile dysfunction.
It helps differentiate psychogenic causes (positive result) from organic causes (negative result) of erectile dysfunction.
116
What is the most common cause of erectile dysfunction in diabetics?
Anxiety is the most common cause.
117
What is the most common organic cause of erectile dysfunction in diabetics?
Neuropathy is the most common organic cause.
118
Erectile dysfunction in D.M Due to vascular complications & neuropathy.
1st line of ttt. Sildenafil (SE PRIAPISM)… # with nitrate ---→
Erectile dysfunction in D.M Due to vascular complications & neuropathy.
1st line of ttt. Sildenafil (SE PRIAPISM)… # with nitrate ---→ sever hypotension
119
What is the most common cause of erectile dysfunction after a heart attack (MI)?
Anxiety is the most common cause.
120
Most common cause after pelvic injury….
nerve lesion
121
Most imp question in history…..
night erection
122
What is the most common cause of erectile dysfunction after pelvic injury?
Nerve lesion is the most common cause.
123
What is the most common drug causing erectile dysfunction?
Alcohol is the most common drug.
124
What is the most important question in the history of a patient with erectile dysfunction?
Nighttime erections are crucial to assess.
125
What is the most important investigation for evaluating erectile dysfunction?
Nocturnal penile tumescence testing is essential.
126
What should be checked in an elderly cancer patient with constipation?
Check calcium levels.
