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Medicine > Endocrine > Flashcards

Endocrine Flashcards

1
Q

The 10 signs of HYPERTHYROIDISM

A

WWE GB TAP DL

Weight loss
Warm Skin/ HEAT INTOLERANCE
Exophthalmos

Goitre (+/- bruit heard via stethoscope)
BRISK REFLEXES

TREMOR
ANXIETY
PALPITATIONS

DIARRHOEA
LID LAG

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2
Q

The three causes of HYPERTHYROIDISM

A

Graves’- autoimmune- distinguishable from others via OCULAR changes and PRETIBIAL MYXOEDEMA

Toxic Multinodular Goitre/ Toxic Solitary Nodule Goitre- Higher risk in old people and females

DE QUERVAIN’s THYROIDITIS- develops after viral infection

  • Transient hyperthyroidism
  • Period of hypothyroidism may follow
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3
Q

Investigations for Hyperthyroidism (4 things)

A

TFTs (LOW TSH, HIGH T3/T4)
US scan of nodules
FNA of solitary nodules to exclude malignancy
Isotope scan to assess hot and cold thyroid nodules

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4
Q

Treatment of Hyperthyroidism (4 things)

A

Symptomatic control-

  • Palpitations and tremors- BETA BLOCKERS
  • Eye symptoms- EYE DROPS for LUBRICATION

Anti-thyroid medication-

  • CARBIMAZOLE
  • PROPYLTHIOURACIL
  • Side effects- AGRANULOCYTOSIS (monitor bloods carefully)

Radioactive iodine ablation-

  • Definitive treatment
  • Patient MUST BE EUTHRYOID before commencing

Surgical- subtotal tyroidectomy

  • Patient MUST BE EUTHYROID before commencing
  • Give patient POTASSIUM IODIDE before surgery as it decreases thyroid gland vascularity
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5
Q

Complications of Hyperthyroidism (4 things)

A

Atrial fibrillation
Cardiomyopathy
High Output Cardiac Failure
OSTEOPOROSIS

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6
Q

Two types of Hypothyroidism and 4 things about each

A

Primary hypothyroidism

  • Iodine deficiency
  • Hashitmoto’s autoimmune
  • Post-thyroidectomy/ radioactive iodine therapy
  • Drug-induced (Lithium/ overtreatment of hyperthyroidism)

Secondary hypothyroidism

  • Dysfunction of hypothalamus-pituitary axis
  • Pituitary ADENOMA
  • Sheehah’s Syndrome (ischaemic necrosis of the pituitary gland after child birth)
  • Inflitrative disease (TB/ Haemochromatosis)
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7
Q

8 Signs and Symptoms of Hypothyroidism

A
  • Weight GAIN
  • Cold skin/ Cold intolerance
  • Constipation
  • DELAYED reflexes
  • Bradycardia
  • Depression
  • THINNING of SKIN
  • DRY SKIN
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8
Q

Investigations for Hypothyroidism

A

FBC (anaemia)

TFTs (HIGH TSH, LOW T3/T4)

Guthrie Test for congenital screening

Cholesterol (as it is a complication)

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9
Q

Treatment for Hypothyroidism

A

Lifelong treatment with LEVOTHYROXINE

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10
Q

Complications of Hypothyroidism

A

Hypercholesterolaemia
Hyperthyroidism from overtreatment
MYXOEDEMA COMA

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11
Q

4 types of Thyroid Carcinomas

A

Papillary-

  • Most common
  • Spreads to CERVICAL LYMPH NODES
  • GOOD prognosis

Follicular-

  • More common in LOW IODINE areas
  • Spreads to BONES and LUNGS
  • GOOD prognosis

Medullary-

  • Arises from PARAFOLLICULAR CELLS
  • CALCITONIN is a biochemical marker
  • Associated with M.E.N.
  • Spreads to LYMPH NODES

Anaplastic-

  • Affects older patients
  • AGGRESSIVE
  • Spreads to LYMPH NODES as well
  • POOR PROGNOSIS
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12
Q

Investigations of Thyroid Carcinoma

A
  • Bloods to assess TFTs
  • FNA Cytology
  • Diagnostic Lobectomy
  • Thyroid isotope scan (hot nodules less likely to indicate malignancy)
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13
Q

Treatment for the 4 Thyroid Carcinomas

A

Papillary/ Follicular-
- Lesion<1cm- Thyroid Lobectomy then lifelong LEVOTHYROXINE and ANNUAL THYROGLOBULIN measurements

  • Lesion>1cm- Total Thyroidectomy/ Radio-iodine ablation then lifelong LEVOTHYROXINE and ANNUAL THYROGLOBULIN measurements

Medullary-
- Same as lesion>1cm and SCREEN FAMILY for M.E.N.

Anaplastic- Debulking surgery and palliative care unfortunately

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14
Q

Complications of Thyroid Carcinoma

A

HYPOTHYROIDISM

Complications of surgery-

  • Damage to Recurrent Laryngeal Nerve
  • HYPOPARATHYROIDISM
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15
Q

The two textbook risks of Diabetes Type 1 and Type 2

A

Type 1- KETOACIDOSIS

Type 2- HYPEROSMOLAR STATE

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16
Q

3 extra causes of DIabetes

A

CHRONIC Pancreatitis
Gestational Diabetes
Cystic Fibrosis

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17
Q

6 signs of GENERAL DIABETES and 4 signs of TYPE 1

A
  • Polyuria
  • Polyphagia
  • Polydipsia
  • Blurred Vision
  • Glycosuria
  • Sign of MICROVASCULAR and MACROVASCULAR disease
  • Acetone breath
  • WEIGHT LOSS
  • KUSSMAUL BREATHING
  • Nausea and Vomiting
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18
Q

Investigations of Diabetes

A

HbA1c>6.5%
Fasting Plasma glucose>7mmol/L

FOR borderline cases-
- Impaired glucose tolerance test- Fasting plasma glucose <7mmol/L

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19
Q

Treatment of Diabetes

A
  • Dietary advice
  • Smoking Cessation
  • Decrease alcohol intake
  • Regular blood glucose and HbA1c monitoring
  • Encourage exercise

ANTIDIABETIC AGENTS

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20
Q

4 Microvascular and 4 Macrovascular Complications of diabetes

A

Microvascular-

  • Nephropathy
  • Peripheral neuropathy
  • Retinopathy
  • Erectile dysfunction

Macrovascular-

  • Hypertension
  • Increased risk of STROKE
  • MI
  • Diabetic foot
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21
Q

7 Antidiabetic Agents

A

Biguanides (Metformin)

Sulfanylureas

Meglitinides

Thiazolidinediones

Incretins (Exenatide)

Incretins (Saxagliptin)

Alpha-glucosidase

Amylin analogues

22
Q

Biguanides

  • Mechanism
  • Uses
  • Side effects
  • Contraindications
  • Drug interactions
A

Mechanism-

  • Increase in PERIPHERAL insulin resistance
  • Increase in GLUCOSE UPTAKE into skeleton
  • Decrease in HEPATIC GLUCOGENESIS
  • Decrease in INTESTINAL GLUCOSE ABSORPTION

Uses-

  • POI
  • T2 DM

Side effects-

  • Lactic ACIDOSIS
  • GI DISTURBANCES
  • Nausea/ Vomiting

Contraindications-
- Renal/ Cardiac/ Hepatic/ Respiratory Failure

Drug Interactions-

  • ACE inhibitors
  • Alcohol
  • NSAIDs
  • Steroids
23
Q

Sulphonylureas and Meglitinides (-glinides)

  • Mechanism
  • Uses
  • Side effects
  • Contraindications
  • Drug interactions
A

Mechanism-
- Block POTASSIUM CHANNELS on PANCREATIC BETA CELLS- stimulating INSULIN RESISTANCE

Uses-
- T2 DM

Side effects-

  • Hypoglycaemia (extreme glucose control)
  • Weight gain
  • GIT disturbances (SULPHONYLUREAS)

Contraindications-

  • Hepatic failure
  • Pregnancy and Breastfeeding
  • Renal failure/ Porphyria (SULPHONYLUREAS)

Drug interactions (SULPHONYLUREAS (same as BIGUANIDES))-

  • ACE inhibitors
  • Alcohol
  • NSAIDs
  • Steroids

Drug interactions-

  • CICLOSPORIN
  • TRIMETHOPRIM
  • CLARITHROMYCIN
24
Q

Thiazolidinediones (-glitazones)

  • Mechanism
  • Uses
  • Side effects
  • Contraindications
  • Drug interactions
A

Mechanisms-
- Activates NUCLEA PPAR (receptor)

Uses-T2 DM

Side effects-

  • Hypoglycaemia
  • Weight gain
  • HEPATOTOXICITY

Contraindications-

  • TYPE 1 DM
  • LIVER DISEASE
  • HEART FAILURE
  • BLADDER CANCER

Drug interactions-

  • RIFAMPICIN
  • Paclitaxel
25
Q

Exenatide (INCRETIN)

  • Mechanism
  • Uses
  • Side effects
  • Contraindications
  • Drug interactions
A

Mechanism-
- Analogue of GLP-1 (glucagon-like peptide)

Uses- T2 DM

Side effects-

  • GIT disturbances
  • Acute PANCREATITIS

Contraindications-

  • –> M.E.N.
  • –> Thyroid cancer

Drug interactions-
- Bexarotene

26
Q

Saxagliptin (INCRETIN)

  • Mechanism
  • Uses
  • Side effects
  • Contraindications
  • Drug interactions
A

Mechanism-
- Inhibits DPP-4 (dipeptidul peptidase

Uses- T2 DM

Side effects-

  • GIT disturbances
  • UTI/ Respiratory infection
  • HEPATOTOXICITY
  • Peripheral oedema

Contraindications-
- History of HYPERSENSITIVITY REACTIONS

Drug interactions-
- THIAZOLIDINEDIONES

27
Q

Only one of the seven drugs that can be used in T1 DM

A

Amylin analogues (Pramlintide)

28
Q

Antidiabetics that don’t cause GI disturbances

A

Thiazolidinediones (glitazones)

Meglitinides (glinides)

29
Q

Antidiabetics that shouldn’t be used in:

  • Heart failure
  • Renal failure
  • Respiratory failure
  • Hepatic failure
A

Heart failure-

  • Biguanides
  • Thiazolidinediones (glitazones)

Renal failure-

  • Biguanides
  • Sulphonylureas

Respiratory failure-
- Biguanides

Hepatic failure-

  • Biguanides
  • Sulphonylureas
  • Meglitinides (glinides)
30
Q

Insulin Types

Rapid acting-
Short acting-
Intermediate acting-
Long acting-
Biphasic-
A

LSIGI

Insulin LISPRO
SOLUBLE Insulin
ISOPHANE Insulin
Insulin GLARGINE
Biphasic ISOPHANE Insulin
31
Q

The two Tyrosine Kinase receptors (involved in insulin action)

A

MAP KINASE- cell growth/ proliferation

PI-3K- transport of GLUT-4 to cell surface membrane- responsible for protein, lipid and glucose synthesis

32
Q

4 side effects of Insulin

A

Weight gain
Hypoglycaemia
LOCALISED LIPOATROPHY
HYPOKALAEMIA

33
Q

5 drug interactions of INSULIN

A

LEVOTHYROXINE- decreases effects of insulin

THIAZIDE DIURETICS- decreases effects of insulin

CORTICOSTEROIDS- decreases effects of insulin

REPAGLINIDE (anti-diabetic)- increases risk of HYPOGLYCAEMIA and MYOCARDIAL INFARCTION

MAO INHIBITORS- may increase insulin secretion

34
Q

Causes of Cushing’s- ACTH independent, ACTH dependent and one other

A

Prescription of GLUCOCORTOIDS for ASTHMA

ACTH DEPENDENT-

  • Occurs when ACTH produced from a pituitary ADENOMA
  • Use low dose DEXAMETHASONE test to confirm
  • ECTOPIC ACTH production - like from SMALL CELL CANCER

ACTH INDEPENDENT (CARS)

  • Cancer (adrenal carcinoma)
  • Adrenal nodular hyperplasia
  • Rare cause (McCune-Albright Syndrome)
  • Steroid use
35
Q

Signs and Symptoms of Cushing’s (10 things)

A
  • Moon face
  • Purple striae
  • Buffalo hump
  • Central obesity
  • Proximal muscle wasting
  • Vertebral collapse
  • Acne
  • HYPERTENSION
  • HYPERGLYCAEMIA
  • PSYCHOSIS
36
Q

Investigations for Cushing’s

A
  • URINARY FREE CORTISOL
  • LOW and HIGH DEXAMETHASONE suppression test
  • CXR to look for LUNG CANCER and VERTEBRAL COLLAPSE
  • Dual Energy X-ray (DEXA) scan
37
Q

Treatment of Cushing’s

A
  • DECREASE ALCOHOL

Medical-

  • KETOCONAZOLE
  • METYRAPONE
  • MITOTANE
  • Treat complications such as hypertension and diabetes mellitus

Surgery-
- TRANS-SPHENOIDAL SURGERY to remove PITUITARY ADENOMA

  • BILATERAL ADRENALECTOMY to remove ADRENAL ADENOMA
38
Q

7 Complications of Cushing’s

A
  • Diabetes mellitus
  • Hypertension
  • Striae formation
  • Cataracts
  • Osteoporosis
  • ULCERS
  • IMMUNOSUPPRESSION
39
Q

3 Functions of Cortisol

A
  • mAke glucose in liver
  • Anti-stress pathway
  • Anti-inflammatory pathway
40
Q

Causes of PRIMARY ADRENAL DEFICIENCY (ADDISON’s DISEASE)

A

MAIL-

  • Metastases from breasts, lungs and renal cancers
  • Autoimmune
  • Infections (TB most common) and CMV in HIV patients)
  • Lymphomas

+ Postadrenalectomy

41
Q

Causes of SECONDARY ADRENAL DEFICIENCY

A

Prolonged PREDNISOLONE use

Pituitary adenoma

SHEEHAN’s SYNDROME

42
Q

7 Signs and Symptoms of Adrenal Deficiency

A
  • BODY HAIR LOSS
  • SKIN PIGMENTATION
  • POSTURAL HYPOTENSION (BP drops when standing up)
  • Unintentional weight loss
  • Myalgia
  • DEPRESSION
  • Nausea/ Vomiting
43
Q

Investigations in Adrenal Deficiency

A
  • ACTH and cortisol measurements
  • Insulin tolerance tests
  • SHORT SYNACTHEN TEST

Blood Tests-

  • LOW Na/ HIGH K
  • SERUM CALCIUM

Radiology-

  • CXR- look for LUNG CANCER
  • CT and MRI scan of adrenal glands
44
Q

Complications of Adrenal Deficiency

A
  • ALOPECIA
  • HYPOGLYCAEMIA
  • HYPERKALAEMIA
  • EOSINOPHILIA
45
Q

Conditions that Addison’s disease is associated with

A

3PGH

  • Pernicious anaemia
  • Premature ovarian failure
  • Polyglandular syndrome
  • GRAVES’
  • HASHIMOTO’s
46
Q

5 parts of ADRENAL CORTEX and MEDULLA (from outside to inside)

A

CAPSULE-
- In= mesoderm

ZONA GLOMERULOSA-
- Out= ALDOSTERONE

ZONA FASCICULARIS-
- Out= CORTISOL

ZONA RETICULARIS-
- Out= ANDROGENS

MEDULLA-

  • In= neural crest
  • Out= ADRENALINE/ NORADRENALINE
47
Q

Causes of Acromegaly (results from excessive growth hormone)

A
  • PITUITARY ADENOMA- most common

- GHRH production from BRONCHIAL CARCINOID

48
Q

Signs and Symptoms of ACROMEGALY

A
  • LOWER PITCH OF VOICE
  • CARPAL TUNNEL SYNDROME
  • Increased Jaw/ Hand/ Tongue size
  • Ask to see old photos to compare appearances
49
Q

Investigations in Acromegaly

A
  • –> Bloods-
  • GH levels
  • IGF 1 levels (raised in acromegaly)
  • HIGH PROLACTIN

ECG and ECHO to assess for cardiac complications

—> Visual field testing to test for BILATERAL HEMIANOPIA

50
Q

Treatment for Acromegaly

A
  • Inform patients bone changes will NOT REVERT after TREATMENT

Medical-

  • Somatostatin analogues (OCTREOTIDE)
  • Dopamine agonists (CABERGOLINE)
  • –> GH antagonists (PEGVISOMANT)

—>Surgery- TRANS-SPHENOID surgical excision of the ADENOMA

51
Q

Complications of Acromegaly

A
  • Hypertension
  • Diabetes
  • Increased risk of colon cancer
  • Increased risk of cardiovascular disease
  • Erectile Dysfunction
  • Postsurgical complications (infection/ CSF leak)

Medicine (15 decks)

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