Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Embryologically, where does the Thyroid originate from?

A

Back of the tongue, then descends down the midline to sit anteriorly to the Thyroid Cartilage in the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Anatomically, what does the Thryoid gland consist of?

A

Right and Left lobes connected by a central Isthmus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which nerves lie in close proximity to the Thyroid Gland?

A

Recurrent Laryngeal nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What relation do the Parathyroid glands have to the Thyroid?

A

4, located on the posterior aspect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where does the blood supply of the Thyroid come from?

A

Superior and Inferior Thyroid arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Thyroid tissue made of?

A

Colloid which contains iodinated thyroglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where is Iodinated Thyroglobulin synthesised?

A

Follicular cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which neuroendocrine cells does the Thryoid contain, and what do they secrete?

A

C cells, which secrete Calcitonin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Simply, what do Thyroid hormones do?

A

Increase Basal metabolic rate
Influence growth in children
Act on CV, CNS and Reproductive systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which hormone does the Hypothalamus release for thyroid function?

A

Thyrotropin Releasing Hormone (TRH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which gland does TRH influence, and which hormone does this gland release?

A

Anterior Pituitary, which releases Thyroid Stimulating Hormone (TSH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is another name for Hyperthyroidism?

A

Thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some causes of Hyperthyroidism?

A

Graves Disease (Autoimmune)
Nodular Thyroid disease
Thyroiditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Graves’ Disease?

A

An autoimmune hyperthyroid condition due to the presence of TSH receptor stimulating antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does Graves’ Disease present?

A

Lid Retraction
Proptosis
Thyroid eye disease
Skin Changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What Is Nodular Thryoid disease?

A

A condition due to 1/many toxic nodules on the Thyroid. Leads to autonomous secretion of T3/T4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Thyroiditis?

A

Inflammation of the Thyroid leading to a thyroxine release. Can be viral, medication related or following childbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some generalised symptoms of Hyperthyroidism?

A 
Weight loss and increased appetite
Insomnia
Irritability
Anxiety
Heat intolerance
Palpitations
Tremor
Pruritis
Altered Bowel habits
Menstrual distubances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some clinical signs of Hyperthyroidism?

A 
Resting Tachycardia
Warm peripheries
Resting tremor
Hyper-reflexia
Lid Lag
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does Hyperthyroidism present in thyroid function tests?

A

Raised T3/T4

Reduced/Absent TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What treatment options are there for Hyperthyroidism?

A

Medical
Radioactive Iodine
Surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What medical treatments are available for Hyperthyroidism?

A

Thionamides (Carbimazole), which reduce T3/T4 synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is Radioactive Iodine used to treat Hyperthyroidism?

A

Iodine 131 damages Thyroid tissue, leading to Hypothyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What surgical options are available for Hyperthyroidism?

A

Thyroidectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How can Hypothyroidism be sub-classified?

A

Primary Hypothyroidism - Thyroid issue

Secondary Hypothyroidism - HPA issue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are some causes of Primary Hypothyroidism?

A 
Autoimmune - Hashimoto's Thyroiditis
Pregnancy
Iodine deficiency
Drugs - Amiodarone, Lithium
Iatrogenic - Surgery, Radioactive Iodine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are some causes of Secondary Hypothyroidism?

A

TSH deficiency due to HPA disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does Secondary Hypothyroisim present?

A

Reduced T4

Normal TSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are some symptoms of Hypothyroidism?

A 
Weight Gain
Cold Intolerance
Fatigue
Constipation
Bradycardia
Myxoedema - Thickening of Skin, Puffy eyes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What other condition can present very similarly to Hypothyroidism?

A

Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does Hypothyroidism present in Thyroid Function Tests?

A

Reduced T4
Raised TSH
+ve Thyroid Peroxidase antibodies in Hashimoto’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the recommended treatment for Hypothyroidism?

A

50-100microgram/day Thyroxine

If elderly/IHD - 25microgram/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Following treatment for hypothyroidism, what does a persistently elevated TSH suggest?

A

Under-replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Following treatment for hypothyroidism, what does an undetectable TSH suggest?

A

Over-replacement - HPA suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How can sub-clinical hypothyroidism present?

A

Normal T4
Elevated TSH
Only treat if symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How is Diabetes Mellitus characterised?

A

Chronically elevated glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What levels of plasma glucose are seen in Diabetes Mellitus?

A

Fasting Glucose =>7.0mmol/L

Random Glucose =>11.1mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What value of HbA1c indicates diabetes in a symtomatic patient?

A

> 6.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is the cause of Type 1 Diabetes Mellitus?

A

Pancreatic Islet Beta Cell Deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How does Type 1 Diabetes Mellitus present?

A

Rare
Presents in younger patients (<30)
Absolute insulin deficiency due to autoimmune Beta cell destruction
Patient requires insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the cause of Type 2 Diabetes Mellitus?

A

Defective insulin action or secretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How does Type 2 Diabetes present?

A

Common, particularly in middle-aged/older patients

Primarily due to an increased peripheral resistance to insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What are some rarer causes of diabetes?

A 
Exocrine pancreas failure
Endocrine disease
Gestational diabetes
Malnutrition-related diabetes
Maturity Onset Diabetes in Young (MODY) - Genetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are some symptoms of Type 1 Diabetes?

A 
Rapid onset weight loss, polyuria and polydypsia
Ketoacidosis is possible
Age <30
Elevated venous plasma glucose
Presence of Ketones due to Lipolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the generalised treatment for Type 1 Diabetes?

A

Subcut Insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What are some symptoms of Type 2 Diabetes?

A

Overweight

Insidious polyuria and polydypsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are some complications of Type 2 Diabetes?

A 
Ischaemic Heart Disease
Cerebrovascular disease
Renal failure
Foot ulcers
Visual impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the generalised treatment for Type 2 Diabetes?

A

Oral hypoglycaemic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are some generalised symptoms of diabetes?

A

Tiredness
Weakness
Lethargy
Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How can complications of diabetes be subclassified?

A

Microvascular

Macrovascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Why does diabetes have macrovascular complications?

A

Increases risk of atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What conditions do diabetics have an increased risk of?

A

Stroke - 2x
MI - 3-5x
Amputation of a foot due to Gangrene - 50x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How are the macrovascular risks of diabetes best managed?

A

Risk stratification of:
Hypertension
Smoking
Lipid Abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are some microvascular complications of diabetes?

A 
Diabetic Retinopathy
Diabetic Nephropathy
Diabetic Neuropathy
Diabetic Foot
Infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What is Diabetic Retinopathy?

A

Metabolic consequences of poorly controlled diabetes leads to thickening of basement membrane of small blood vessels of the eye.

These then occlude causing retinopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is Diabetic Nephropathy?

A

Diabetes increases GFR due to poor glycaemic control. This gives renal hypertrophy and eventual glomerular sclerosis.

This gives Proteinuria and can lead to end-stage renal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What types of Diabetic Neuropathy are there?

A

Symmetrical mainly distal polyneuropathy
Acute painful neuropathy
Mononeuropathy
Autonomic neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the gross anatomical areas of the adrenal glands?

A

Outer Cortex

Inner Medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the zones of the adrenal cortex called and what do they produce?

A

Zona Glomerulosa - Aldosterone
Zona Fasciculata - Cortisol
Zona Reticularis - Androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How can the hormones produced by the adrenal glands be classified?

A

Glucocorticoids
Mineralocorticoids
Androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the primary role of Glucocorticoids?

A

Primarily affect Carbohydrate metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the primary role of Mineralocorticoids?

A

Effect extracellular balance of Sodium and Potassium in the DCT of the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the primary role of Androgens?

A

Important role in adult females and developing humans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What actions do Glucocorticoids increase/stimulate?

A 
Gluconeogenesis
Glycogen deposition
Protein catabolism
Fat deposition
Sodium retention
Potassium loss
Free water clearance
Uric acid production
Circulating neutrophils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What actions do Glucocorticoids decrease/inhibit?

A 
Protein synthesis
Host response to infection
Lymphocyte transformation
Delayed hypersensitivity
Circulating lymphocytes
Circulating eosinophils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the Adrenal Medulla made of?

A

Tissue of the SNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the Adrenal Medulla responsible for releasing?

A

Adrenaline
Noradrenaline
Dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is Primary Adrenal insufficiency also known as?

A

Addison’s Disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What causes Addison’s Disease?

A

Destruction of the entire adrenal cortex leads to reduced hormone production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are some causes of Addison’s disease?

A

Autoimmune disease
TB
Surgical removal of adrenals
Haemorrhage/infarct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are some symptoms of Addison’s disease?

A 
Weight loss + Anorexia
Malaise + Weakness
Fever
Depression
Impotence/Amenorrhoea
Nausea + Vomiting
Diarrhoea
Confusion
Postural Hypotension
Abdo Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are some clinical signs of Addison’s disease?

A 
Hyperpigmentation
Buccal pigmentation
Loss of weight
General wasting
Dehydration
Loss of body hair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What will investigations demonstrate in Addison’s disease?

A 
Hyponatraemia
Hyperkalaemia
Raised urea
Hypoglycaemia
Mild anaemia
Reduced 9am Cortisol 
Raised ACTH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the management for Addison’s disease?

A

Glucocorticoid replacement - Hydrocortisone/Fludrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Which hormone is released by the Hypothalamus in response to stress/circadian stimuli?

A

Corticotrophin Releasing Hormone (CRH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What does the anterior pituitary release in response to raised CRH?

A

Adrenocorticotrophin Hormone (ACTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What does ACTH make the adrenal glands release?

A

Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What effects does Cortisol have on the Anterior Pituitary + Hypothalamus?

A

-ve Feedback

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

When does circadian release of ACTH/Cortisol peak?

A

Between 8-9am

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is an Addisonian Crisis?

A

A medical emergency due to an acute deficiency of Cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What are some symptoms of an Addisonian crisis?

A 
Abdo pain
Confusion, LOC or Coma
Dehydration
Dizziness
Fatigue
Headache
Fever
Loss of Appetite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What will biochemistry demonstrate in an Addisonian crisis?

A 
Hypotension
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Dehydration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is the recommended immediate management of an Addisonian crisis?

A

1 litre of 0.9% Saline over 30-60 minutes with 100mg IV Hydrocortisone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What can cause secondary hypoadrenalism?

A

Hypothalamic-Pituitary Disease - Inadequate ACTH

Long term steroid therapy leading to hypothalamic-pituitary-adrenal suppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Why are adrenal medullary tumours concerning?

A

They are Catecholamine (Adrenaline/Noradrenaline) secreting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Where are the majority of Phaeochromocytomas found?

A

90% are from the Adrenal Medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Where else can catecholamine secreting tumours be found?

A

Elsewhere in the chain

10 % - called Paraganglioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are some symptoms of a Phaeochromocytoma?

A 
Anxiety
Palpitations
Tremor
Sweating
Headache
Flushing
Nausea and Vomiting
Weight loss
Chest Pain
Polyuria
89
Q

What are some clinical signs of a Phaeochromocytoma?

A 
Hypertension
Tachycardia/arrhythmias
Bradycardia
Orthostatic hypotension
Pallor
Glycosuria
Fever
90
Q

What investigations are appropriate for a suspected Phaeochromocytoma?

A

Raised Catecholamines on biochemistry

CT/MRI/PET

91
Q

What is the recommended treatment for Phaeochromocytoma?

A

Surgical excision

92
Q

What medication should be started once Phaeochromocytoma is confirmed?

A

Alpha Blocker - Hypertension

Beta Blocker - Arrhythmias

93
Q

What value of serum sodium is considered the lower limit of normal?

A

135mmol/L

94
Q

In terms of blood volume, how can hyponatraemia be classified?

A

Hypovolaemic
Euvolaemic
Hypervolaemic

95
Q

How can causes of hyponatraemia be generally classified?

A

Renal

Extra-renal

96
Q

What are some early signs of Hyponatraemia?

A

Headache
Nausea
Vomiting
General malaise

97
Q

What are some late signs of Hyponatraemia?

A

Confusion
Agitation
Drowsiness

98
Q

What can acute severe hyponatraemia lead to?

A

Seizures
Respiratory depression
Coma
Death

99
Q

If a patient is confirmed to have hypotonic hyponatraemia, what should be checked next?

A

Urine Osmolality

100
Q

In hyponatraemia, what does a Urine Osmolality of <100mOsmol/kg suggest?

A

Primary polydypsia
Inappropriate IV fluid prescription
Inadequate intake

101
Q

In hyponatraemia, what does a Urine Osmolality of >100mOsmol/kg suggest?

A

Cause unknown, check urine sodium

102
Q

In hyponatraemia, what does a Urine Sodium value of <30mmol/L suggest?

A

Low effective arterial volume (Dehydration, CCF, Nephrotic syndrome)

103
Q

In hyponatraemia, what does a Urine Sodium value of >30mmol/L suggest?

A

?SIADH
?Addison’s
?Hypothyroidism

104
Q

What is SIADH?

A

A condition characterised by excessive/inappropriate secretion of ADH

105
Q

Which tumours can cause SIADH?

A 
SCC of Lung
Prostate
Thymus
Pancreas
Lymphomas
106
Q

Which Pulmonary Lesions can cause SIADH?

A

Pneumonia
TB
Lung Abscesses

107
Q

What are some CNS causes of SIADH?

A 
Meningitis
Tumours
Head injury
SLE
Vasculitis
108
Q

What are some metabolic causes of SIADH?

A

Alcohol withdrawal

Porphyria

109
Q

What are some common symptoms of SIADH?

A

Dilutional hyponatraemia
Euvolaemia
Low plasma osmolality with inappropriate urine osmolality
Continued urinary sodium excretion >30mmol/L
Absence of Hypokalaemia
Normal renal and thyroid function

110
Q

What is the generalised treatment for Hyponatraemia?

A

Identify and Correct cause

Consider fluid restriction if dilutional hyponatraemia

111
Q

What controls most peripheral hormone systems?

A

The Hypothalamus and Pituitary

112
Q

Where is the Pituitary gland located?

A

The pituitary fossa at the base of the brain

113
Q

What lies in close anatomical relation to the Pituitary gland?

A

Optic Chiasm superiorly

Cavernous sinuses laterally

114
Q

What is the anterior pituitary formed from?

A

Upgrowth of Rathke’s Pouch

115
Q

What is the posterior pituitary formed from?

A

The floor of the third ventricle

116
Q

Which hormones are released from the posterior pituitary?

A

ADH

Oxytocin

117
Q

Which hormones act upon the anterior pituitary?

A 
Gonadotrophin Releasing Hormone (GnRH)
Growth Hormone Releasing Hormone (GHRH)
Dopamine
Thyrotrophin Releasing Hormone (TRH)
Corticotrophin Releasing Hormone (CRH)
118
Q

Which hormones are synthesised by the anterior pituitary, and which hormone triggers their release?

A 
LH + FSH - GnRH
Growth Hormone - GHRH
Prolactin - Dopamine
TSH - TRH
ACTH - CRH
119
Q

Which hormonal axes is the pituitary gland a key member of?

A 
Growth Axis
Adrenal Axis
Gonadal Axis
Thyroid Axis
Prolactin
120
Q

What is the physiological process in the growth axis?

A

Growth hormone is secreted in a pulsatile manner.
It acts on the liver to produce insulin-growth factor 1.
GH is important in MSK growth in children, and has a role in adults

121
Q

Which hormone increases activity of the growth axis?

A

GHRH

122
Q

Which hormone decreases activity of the growth axis?

A

Somatostatin

123
Q

Which hormone increases activity of the adrenal axis?

A

CRH

124
Q

Which hormone decreases activity of the adrenal axis?

A

Cortisol

125
Q

What is FSH reponsible for?

A

Ovarian follicle development in women

Sperm production in men

126
Q

What is LH responsible for?

A

Ovulation in women

Testosterone secretion from Leydig cells in men

127
Q

Which hormone increases activity of the gonadal axis?

A

GNRH

128
Q

Which hormones decrease activity of the gonadal axis?

A

Testosterone
Oestrogen
Prolactin

129
Q

Which hormone increases activity of the Thyroid axis?

A

TRH

130
Q

Which hormone decreases activity of the Thyroid axis?

A

Thyroxine

131
Q

What does Prolactin do?

A

Causes lactation

Has a direct inhibitory effect on LH and FSH

132
Q

Which hormone increases Prolactin activity?

A

TRH

133
Q

Which hormone decreases Prolactin activity?

A

Dopamine

134
Q

How can Pituitary tumours present?

A

Due to the mass defect

Due to hormonal excess

135
Q

What may functional pituitary tumours present with?

A

Acromegaly (GH)
Cushings (ACTH)
Prolactinoma (Prolactin)
TSHoma (TSH)

136
Q

How do non-functional pituitary tumours present?

A

Hypopituitarism

Compression of Local structures

137
Q

How are hormone levels affected in hypopituitarism?

A

All hormones except prolactin decrease

138
Q

What other effect can a pituitary tumour lead to?

A

Alteration of visual fields

139
Q

When can Prolactin and TSH levels be measured?

A

Any time

140
Q

When should LH and FSH be measured in women?

A

Within the first 5 days of the menstrual cycle

141
Q

When should LH and FSH be measured in men?

A

At 9am with the patient in a fasting state

142
Q

When should Cortisol be measured?

A

9am

143
Q

What does the Synacthen test measure?

A

Adrenal failure

144
Q

How does the Synacthen test work?

A

After 2 weeks of ACTH deficiency, the adrenal cortex atrophies. It therefore doesn’t respond well to synthetic ACTH

145
Q

How does the Insulin Tolerance Test work?

A

Insulin-induced hypoglycaemia is a physiological stress that should lead to ACTH and GH risis. If it doesn’t, it suggests a Pituitary axis problem

146
Q

What imaging modalities are appropriate for a suspected pituitary lesion?

A

MRI/Functional MRI
PET
CT if unable to have MRI

147
Q

When does physiological hyperprolactinaemia occur?

A 
Pregnancy
Lactation
Severe stress
Sleep
Coitus
148
Q

What is considered a mild elevation of Prolactin?

A

400-600mU/L

149
Q

What do Prolactin levels of 5000mU/L or above suggest?

A

Prolactin-secreting Pituitary tumour

150
Q

What are some causes of Hyperprolactinaemia?

A 
Prolactinoma
Co-secretion of Prolactin in Acromegalous tumours
Stalk compression by pituitary adenomas
PCOS
Primary Hypothyroidism
Dopamine antagonists
151
Q

How does Hyperprolactinaemia present clinically?

A

Galactorrhoea
Oligomenorrhoea/Amenorrhoea
Decreased libido
Subfertility

152
Q

What is the recommended treatment for Hyperprolactinaemia?

A

Dopamine (D2) Agonist, Cabergoline/Bromocriptine

153
Q

What are Non-Functioning Pituitary Adenomas?

A

Biologically inactive pituitary tumours that can present with visual field defects, headaches or hypopituitarism

154
Q

When is surgical intervention recommended with non-functioning pituitary adenomas?

A

If visual loss is a risk

155
Q

How can common causes of hypopituitarism be classified?

A

Congenital

Acquired

156
Q

What are some causes of hypopituitarism?

A

Pituitary tumour
Inflammatory/Infiltrative disorders
Traumatic brain injury
Radiotherapy

157
Q

What are some symptoms of hypopituitarism?

A

Lethargy
Weight gain
Sexual dysfunction

158
Q

What is the recommended treatment for an ACTH deficiency?

A

Hydrocortisone

159
Q

What is the recommended treatment for a TSH deficiency?

A

Thyroxine

160
Q

What is the recommended treatment for a Gonadotropin deficiency in men?

A

Testosterone

161
Q

What is the recommended treatment for a Gonadotropin deficiency in women?

A

Oestrogen and Progesterone

162
Q

What is the recommended treatment for a Growth Hormone deficiency?

A

Daily Growth Hormone injections

163
Q

What causes Acromegaly?

A

A growth-hormone secreting pituitary tumour

164
Q

What is the equivalent of Acromegaly in children?

A

Gigantism

165
Q

What are some symptoms of Acromegaly?

A 
Increased size of hands and feet
Headaches
Excessive sweating
Tiredness
Weight gain
Impotence/poor libido
Goitre
Deep voice 
Breathlessness
166
Q

What are some physical signs of Acromegaly?

A 
Prominent Supraorbital ridge
Large tongue
Hirsuitism
Thick greasy skin
Hypertension
Heart Failure
Arthropathy
167
Q

What investigation is appropriate with suspected Acromegaly?

A

Oral Glucose Tolerance test

168
Q

What is found with the Oral Glucose Tolerance test in Acromegaly?

A

Failure to suppress GH levels after OGTT, raised IGF-1

169
Q

What will an MRI show in Acromegaly?

A

Pituitary tumour

170
Q

What is the management steps of confirmed Acromegaly?

A

Surgery - Treatment of choice
Somatostatin analogues may improve symptoms
Radiotherapy

171
Q

After treatment, what should be monitored regularly in acromegalous patients?

A

Sleep apnoea
Diabetes
CV Risk

172
Q

What is Cushing’s Syndrome?

A

Term used to describe the clinical state of increased circulating free glucocorticoid

173
Q

How can the conditions causing Cushings be subdivided?

A

ACTH-Dependent Cushings

Non-ACTH Dependent Cushings

174
Q

What are some ACTH dependant causes of Cushings syndrome?

A

Pituitary Dependent - Cushings Disease
Ectopic ACTH-Producing tumours
ACTH Administration

175
Q

What are some Non-ACTH dependant causes of Cushings syndrome?

A

Adrenal adenomas/carcinomas
Glucocorticoid administration
Alcohol-induced pseudo-cushings

176
Q

What are some common physical signs of Cushings Syndrome?

A 
Plethoric, moon-shaped face
Thin Skin
Central obesity
Bruising
Poor wound healing
Purple/Red striae
Dorsal Fat Pad - "Buffalo Hump"
177
Q

Which investigations are appropriate with suspected Cushings Syndrome, and what will they show if positive?

A

24h Urine Cortisol - Raised

Low Dose Dexamethasone Suppression Test - Fails to suppress to <50nmol/L

178
Q

What are some differentials of causes of Cushings syndrome, and which symptoms suggest each cause?

A

Pituitary tumour
Adrenal tumour - Hirsuitism
Ectopic ACTH - Hypokalaemia, weight loss

179
Q

What is the recommended management for confirmed Cushings syndrome?

A

Adrenal tumour - Laparoscopic removal
Ectopic ACTH - Manage/Treat causative tumour
Cushings Disease - Trans-sphenoidal pituitary removal

180
Q

Which 2 things can both lead to Diabetes Insipidus?

A

Deficiencies of Vasopressin (ADH)

Insensitivity to the actions of ADH

181
Q

What symptoms does Diabetes Insipidus present with?

A

Polyuria - 10-15L/day in some cases
Nocturia
Compensatory Polydypsia

182
Q

What is a real risk in patients with Diabetes Insipidus?

A

Severe dehydration

183
Q

What are the two broad classes of causes of Diabetes Insipidus?

A

Cranial

Nephrogenic

184
Q

What are some Cranial causes of Diabetes Insipidus?

A 
Familial
Idiopathic
Tumours - Hypothalamic/Pituitary
Hypothalamo-Pituitary surgery
Infections
Trauma
185
Q

What are some Nephrogenic causes of Diabetes Insipidus?

A

Renal Disease
Hypokalaemia
Hypercalcaemia
Drugs

186
Q

How does Diabetes Insipidus present biochemically?

A

High Serum Osmolality
Low Urine Osmolality
High Urine Volume

187
Q

What are the diagnostic criteria for Diabetes Insipidus?

A

Urine Volume >3L in 24h with:
Serum Osmolality >295mOsmol/Kg
Urine Osmolality <300mOsmol/Kg

188
Q

What can the Water Deprivation test be useful in diagnosing?

A

Suspected Diabetes Insipidus

189
Q

How will patients with Diabetes Insipidus respond to the Water Deprivation test?

A

Unacceptable thirst

Weight loss

190
Q

What is given during the water deprivation test?

A

WDT Synthetic Vasopressin (DDAVP)

191
Q

How does Cranial DI respond to DDAVP during the water deprivation test?

A

Reduced urine output

192
Q

How does Nephrogenic DI respond to DDAVP during the water deprivation test?

A

Unaffected urine output

193
Q

What are the generalised management steps for confirmed Diabetes Insipidus?

A

Manage underlying/causative disease

DDAVP/Desmopressin administration

194
Q

Ordinarily, how many Parathyroid glands are there, and where are they located?

A

4, posterior aspect of thyroid

195
Q

Where can additional Parathyroid glands sometimes be found?

A

In the neck/mediastinum

196
Q

Which cells of the Parathyroid secrete PTH?

A

Chief cells

197
Q

When is PTH secreted by the Parathyroid glands?

A

When serum Ca falls

198
Q

How does PTH increase serum calcium?

A

Increases osteoclastic resorption of bone
Increases intestinal Ca2+ absorption
Increased synthesis of 1,25-(OH)2D3 - Vit D Precursor
Increase renal tubular resorption of Calcium
Increased excretion of Phosphate

199
Q

What is Hypercalcaemia?

A

Serum Ca >2.6mmol/L

200
Q

What are the most common causes of Hypercalcaemia?

A

Primary Hyperparathyroidism

Malignancies

201
Q

What does Hypercalcaemia + a reduced PTH suggest?

A

Malignancy until r/o

202
Q

What does Hypercalcaemia + a normal PTH suggest?

A

Hyperparathyroidism until r/o

203
Q

What are some non-specific symptoms of hypercalcaemia?

A 
Tiredness
Generalised aches and pains
Polyuria + Polydypsia - Nephrogenic DI
Abdo pain and constipation
Kidney stones
204
Q

What is a useful rhyme to remember hypercalcaemia symptoms?

A

Moans, Stones, Groans and Bones

205
Q

What biochemical markers will be present in primary hyperparathyroidism?

A

Hypercalcaemia
Raised/Normal PTH
Reduced Phosphate
Raised ALP

206
Q

When is surgery recommended in Hypercalcaemia?

A

If Serum Ca >2.85mmol/L or symptoms are debilitating

207
Q

What is Hypocalcaemia?

A

Serum Calcium <1.9mmol/L

208
Q

What are some causes of Hypocalcaemia?

A

Post-surgical Hypoparathyroidism
Vitamin D Deficiency
Hypomagnesia

209
Q

Why does Post-surgical Hypoparathyroidism occur?

A

Post thyroidectomy, can be temporary or can be due to removal of parathryoid glands

210
Q

What are some clinical features of acute hypocalcaemia?

A

Laryngospasm
Prolonged QT
Seizures

211
Q

What are some clinical features of sub-acute hypocalcaemia?

A

Muscle cramps
Carpo-pedal spasm
Peri-oral and peripheral paraesthesia
Neuropsychiatric signs

212
Q

What is Chvostek’s Sign?

A

Facial spasm when the cheek is gently tapped with a finger. Seen in hypocalcaemia

213
Q

What is Trousseau’s Sign?

A

Carpo-pedal spasm induced after inflating a BP cuff. Seen in hypocalcaemia

214
Q

What is the recommended treatment for Vit. D deficiency?

A

Cholecalciferol - 20 000 IU for 7 weeks loading

1-2000 IU for maintenance

215
Q

What is the recommended treatment for Hypoparathryoidism?

A

1-alphacalcidol

Calcitrol

216
Q

What can be a risk with excessive treatment of hypocalcaemia?

A

Nephrocalcinosis

217
Q

What is Pseudohypoparathyroidism?

A

Rare G-Protein mutation leading ot PTH resistance

218
Q

How does Pseudohypoparathyroidism present?

A

Hypocalcaemia + Raised Phorphate
High PTH
Normal Vitamin D

219
Q

What is the characteristic appearance suggestive of Pseudohypoparathyroidism?

A

Short stature
Round Face
Short 4th and 5th Metacarpals

Year 3 Medicine (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions