Endocrine Flashcards
what are the 4 diagnostic criteria for Diabetes?
you need 1 diagnostic test with symptoms or you need 2 diagnostic tests.
OGTT - glucose greater than 11.1
HbA1c which is over 48
random greater than 11.1
fasting greater than 7
what are the signs of ALS - motor neurone disease
weakness
LMN - wasting and fasciculation
UMN - brisk reflexes, positive babinski, clonus
treatment with riluzole
distinguish between myopathy and neuropathy
myopathy - muscle problems
gradual onset of symmetrical proximal weakness
hypertrophies affect specific muscle groups and preserved reflexes
neuropathy -
paraesthesia, bladder problems and distal weakness
what is the main presentation of myasthenia gravis?
fatigue diplopia ptosis on counting to 50 the voice fades reflexes are normal
what are the tests for acromegally?
check for increased glucose
check for an increased calcium and phosphate
If the basal serum GH is above 0.4 then a OGTT is needed.
IGF1 will be elevated
treatment is with excision (transphenoidal surgery is first line) if this doesnt work then do give somatostatin analogues and growth hormone antagonists
what are the presentations of a LN lesion
negative babinski
muscle wasting
fasciculations
no/weak reflexes
what are signs of acromegally?
amenorrhoea decreased libido increased sweating arthralgia increased size of jaws feet and hands
what are the symptoms of hyperprolactinaemia
- erectile dysfunction
- increased weight
- amenorrhoea
- galactorrheoa
- decreased libido
management is with dopamine agonist
what is diabetes insipidus?
passage of large volumes of urine because of decreased resorption from the kidney - less ADH. there is a central and peripheral DI.
symptoms of
polyuria, polydipsia, dehydration and hypernatraemia
tests is the 8 hour deprivation test where the body is forced into dehydration and then to see if the kidneys are still producing mass amounts of diluted urine.
give desmopressin and find the cause - do an MRI. if nephrogenic then treat the cause by giving NSAIDs (lower urine and plasma sodium)
what are 3 types of cells in anterior pituitary gland?
acidophil - mammotrophs and somatotrophs
basophil - ACTH, gonadotrophins, thyrotrophs
chromophobes
what is the most common visual clinical result of a pituitary adenoma
bitemporal hemianopia
homonymous hemianopia is caused by the damage to the optic tract
what is hirsutism?
growth of hair in inappropriate places in men and women.
consciousness depends on what two major systems of the brain?
Ascending reticular activating system (to act as the alerting awakening element of consciousness) cerebral cortex (determines the content of the consciousness)
what is locked in syndrome?
paralysis below the level of CN III. the patients can open, elevate and depress the eyes with no horizontal eye movement and no other voluntary eye movement.
what is the lowest GCS score someone can have?
3
if a patient has a GCS of less than 8 then intubate and give ventilation
what nerves are responsible for the occulocephalic and oculovestibular reflex?
3, 4, 6, 8.
what are the causes of coma without lateralising signs but meningism?
SAH
Meningism
Encephalopathy
CT, LP(appearance, WCC, Glc and capsular antigen test)
what are the causes of a coma with focal brainstem or lateralising cerebral signs?
tumour, cerebral haemorrhage, infarction and abscess
investigate with a CT/MRI and investigate for other causes of coma such as metabolic screens, LP and EEG
Name a typical first line anti-convulsant that is used to treat generalised primary seizures that may cause spina bifida in children?
sodium valproate is extremely teratogenic
for screening check for increased AFP in maternal blood and with amniocentesis and you can do an USS from 16-20 weeks
what are the 3 primary vesicles which are found in embryological brain?
prosencephalon - telencephalon and diencephalon
mesencephalon - mesencephalon - midbrain
rhombencephalon - metencephalon and myencephalon
which two nerves pass through the posterior triangle of the neck
phrenic
accessory
choroid plexus are made of vascular endothelium - TF?
true
what causes craniorachischisis?
failure of the anterior and caudal neuropore to close
what is anencephaly?
failure of the anterior neural tube to close
- the skull will fail to form so brain tissue will degenerate - incompatible with life
what is encephalocoele?
herniation of the cerebral brain tissue through a defect in the skull - failure of the rostral neuropore to close
mainly affects the occipital lobe
what neural tube defect results in spina bifida?
defective closure of the caudal neural tube
can be either occulta or cystica
occulta is the minor form affecting mainly L5/L6. usually no clinical symptoms
cystica can be meningocele or meningomyelocoele
meningocele is just a sac of meninges with CSF.
meningomyelocoele is with involved nerve roots and neurological deficits and loss of sensation with paralysis. also associated with hydrocephalus
myeloschisis is when the spinal cord is open due to the failure of the neural fold to fuse - there will be sensory loss and paralysis
where do microglia originate from?
they arise from the mesenchyme and then go into CNS
what do neural crest cells form?
they are responsible for forming the PNS - they will also form the melanocytes, adrenal medulla and meninges
how does the spinal cord terminate?
conus medullaris - cauda equina and filum terminalis
there are four main phases of a migraine what are they?
- premonitory phase
- muscle pain, urinary retention, mood swings and cognitive changes - aura phase
- reversible neurological changes to the brain - CSD (cortical spreading depression) - acephalgic migraine is where there is no headache pain which follows the migraine
- aura will have a slow evolution of symptoms
3. headache phase - nausea, photo/phonophobia and pain
4. postdrome - disability will last for 1-2 days.
what are tension type headaches?
not disabling
not aggravated by routine activity
abortive treatment is with - NSAIDs/paracetamol (limit to 10/month or 2/week to prevent MOH)
preventive treatment is with amitriptyline and nortriptyline
describe 3 main symptoms of a migraine
unilateral throbbing headache.
headache
photo/phonophobia
nausea/vomiting
there is a sensitisation of the trigeminal system
migraines have to last from 4-72 hours. the headache must be unilateral, pulsatile and avoidance of normal physical activity.
describe the pain seen in a cluster headache
orbital and temporal
unilateral and rapid onset and cessation
ipsilateral with autonomic symptoms (tearing)
premonitory - yawning and tired
associated - nausea, vomiting, photophobia and phonophobia
CLUSTER HEADACHES HAVE CIRCADIAN RHYTHM
what are paroxysmal hemicranias?
sharp and throbbing pain
last around 30 minutes and occur about 40 times a day
45% circadian rhythm
treat with topiramate and indometacin
no cutaneous triggers
what is prophylaxis is cluster headaches?
- verapamil
2. lithium
what is prophylactic treatment of a SUNCT
gabapentin
topiramate
describe the presentation of a SUNCT
unilateral
supraorbital and temporal
cutaneous triggers
there is no refractory period
what is the presentation of optic neuritis?
reduced visual acuity monocular vision loss pain on eye movements reduced colour vision swollen optic disc
what is gliosis?
the equivalent of fibrosis
