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OSCE - Doctor Clarke 2018 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Graves’ disease triad

A

Goitre Eye signs Thyrotoxicosis

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2
Q

Test for lid retraction

A

Visible white below eyelid Move finger up and quickly down, lid lags behind

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3
Q

Features on peripheral thyroid status

A

-lid retraction and lid lag -clubbing and onycholysis -fine tremor and moist palms -tachycardia, AF -biceps reflex, normal upstroke, slow delay -slow relaxation- hypothyroid -proximal myopathy- elbows up, chair without hands -pretibial myxoedema- thyroid dermopathy (non-pitting)

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4
Q

Graves eye signs

A

Oedema (periorbital and chemists) Pronto sis (best assessed from side) Retraction (autonomically mediated) Exposure keratopathy Opthalmoplegia (upgaze palsy)

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5
Q

Graves treatment

A

Carbimazole low dose- 18 months- agranulocytosis 1/20 get a rash Treat and block- carbimazole and iodine Surgery Radioiodine

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6
Q

Features of hypothyroidism

A

-gruff voice, slow cerebration -coarse facial features -dry, cold scaly skin -slow pulse and slow relaxation of biceps jerk -goitre- Hashimoto’s -myoedema

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7
Q

Features of cushing’s Syndrome

A
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8
Q

Cushing’s general examination

A

truncal obesity

moon face

supraclavicular fat pads

stooped posture- kyphosis

evidence of RA, asthma, A-V fistula—> steroids

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9
Q

Cushing’s hands and arms

A

Bruising

Decreased skin fold thickness

BP- high

shoulder abduction- myopathy

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10
Q

Facial features cushings

A
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11
Q

Cushing’s abdomen and legs

A

purple striae- underlying muscle

renal Transplant scar

stand from chair

leg ulcers

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12
Q

Extras in Cushing exam

A

palpate spine for tenderness- osteoporosis

interscapular fat pad

dip urine/ bedside BM

check visual fields- rare defects

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13
Q

General things to look out for in cushings

A

SWEDISH

Spinal tenderness

Weight- central obesity

Easy bruising

Diabetes

Interscapular fat pad

Striae

Hypertension

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14
Q

How to screen for hypercortisolaemia

A
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15
Q

Causes of Cushing’s syndrome

A

exogenous steroids

pituitary Adenoma- Cushing’s disease

adrenal Adenoma or carcinoma

ectopic ACTH synthesis (wasting due to Carcinoma, pigmentation Dan hypokalaemia)

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16
Q

How to distinguish adrenal from pituitary disease

A

ACTH levels are high in Cushing’s disease

Low in adrenal Cushing’s syndrome

ACTH levels are difficult as degrade quickly

high dose suppression test is unreliable

17
Q

What is acromegaly?

A
18
Q

Acromegaly hand features

A

Size- increased

wasting of thenar eminence if carpal tunnel

sensation in median nerve distribution

increased sweating

boggy palms

skin fold thickness increased in active disease

19
Q

Facial features in acromegaly

A

Prominent supraorbital ridge

big ears, nose, lips, tongue

look from side for prognathism

wide separation of teeth

raised JVP- acromegaly cardiomegaly and biventricular failure

20
Q

Features of acromegaly

A

ABCDEF

Arthropathy- accelerated OA

BP

Carpal tunnel

Diabetes

Enlarged features

Fields- bitemporal hemianopia

21
Q

Acromegaly diagnostics

A

Failure of GH suppression during oral glucose tolerance test

GH is a glucose antagonist

average of hourly growth hormone levels (single unreliable as pulsation release)

insulin-like growth factor levels

22
Q

Acromegaly examination

A
23
Q

Acromegaly management

A
24
Q

What is Addison’s?

A

Autoimmune adrenalitis

commoner in women

associated with vitiligo and other organ specific autoimmune diseases

presents insidiously

25
Q

Features of adrenal crisis

A

usually precipitated by Trauma or infection

emergency

occassionally caused by sudden withdrawal of steroids

coma and hypotension

take blood for cortisol level, but don’t wait for results

FBC, U&E and blood cultures

check for hypoglycaemia, and give IV dextrose if needed

treat with IV steroids, saline (Na depletion) and antibiotics

26
Q

Clinical findings in chronic adrenal insufficiency

A

Non-specific symptoms: lassitude, nausea, abdominal pain, diarrhoea

dizziness due to postural hypotension

pigmentation due to ACTH- hand creases, buccaneers mucosa, scars

hypoglycaemia- due to loss of one of the main insulin antagonists

27
Q

Investigations in adrenal insufficiency

A

hypocortisolaemia- basal levels may be normal or show low morning levels

may need dynamic test of adrenal reserve to prove insufficiency- synacthen test

electrolytes often normal

may show low Na, and high K especially in crisis

28
Q

Questions in acromegaly

A

Headaches

vision changes

tingling in hands

tingling in feet - diabetic neuropathy

sweat easily

difficult with getting/ maintaining an errection

increase in shoe, hat, glove size

29
Q

Extra in acromegaly

A

Visual fields

BP

urine glucose

axillary and pubic hair- hypopituitaryism

feet and heel pads

serial photographs from the past

goiter- 10% have due to increased GH

30
Q

Other causes of macroglossia

A
31
Q

Acromegaly imaging

A

lateral radiographs with tomographs of the pituitary fossa.

CT/MRI shows extent

32
Q

Symptoms of hyperthyroidism

A

Weight loss

increased appetite

heat intolerance

sweating

fatigue and weakness

irritability, nervousness, restlessness, insomnia

diarrhoea

palpitations

loss of libido

33
Q

Signs specific to graves disease

A

Exopthalmos

opthalmoplegia

conjunctival oedema

periorbital oedema

pretibial myxoedema

clubbing

34
Q

Pathophysiology of Graves’ disease

A

TSH receptor IgG antibodies binding to the TSH receptor, stimulating production of thyroid hormones

35
Q

Complications of untreated hypothyroidism

A

Short term

  • AF
  • angina
  • thyroid storm

long-term

  • osteoporosis
  • heart failure
36
Q

Indications for a thyroidectomy

A

Patient choice

pressure to local structures

drug side effects

poor compliance with drug therapy

relapse of hyperthyroidism after withdrawal of medication

37
Q

Complications of thyroidectomy

A

2 Acute, early, severe- bleeding (airway compression), thyroid crisis

2 local- recurrent laryngeal nerve (outside pre-tracheal fascia), hypoparathyroidism

2 common, late- hypothyroidism (30%), recurrent hyperthyroidism (15%)

38
Q

Causes of hypothyroidism

A

Autoimmune

iodine deficiency

thyroidectomy/radioiodine therapy

drugs (amiodarone)

congenital

OSCE - Doctor Clarke 2018 (12 decks)

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