Endocrine Anatomy

Question 1

How does Grave’s disease present?

Answer 1

Question 2

Layers of the adrenal gland, and the hormones they produce:

Answer 2

Question 3

PTH function

Answer 3

Increase Ca2+ through bone resorption and GI uptake.

Question 4

What is the most common cause of neonatal hypothyroidism?

Answer 4

Thyroid agenesis - more common in babies with Downs.

Question 5

Goitre

Answer 5

• Enlargement of the thyroid gland
• Related to hypothyroidism

Question 6

In suspected thyroid malignancy what is first line investigation?

What can be seen?

Answer 6

Ultrasound

Calcification appearing on US suggests malignancy.

Question 7

High uptake of radioactive iodine suggests…

Answer 7

Grave’s disease

Question 8

Low uptake of radioactive iodine in the thyroid suggests…

Answer 8

Thyroiditis

Question 9

Pituitary adenoma can cause what distinct presentation?

Answer 9

Bitemporal hemianopia

Question 10

Anterior pituitary hormones:

Answer 10

• TSH
• Prolactin
• GH
• ACTH
• LH & FSH (Gonadotropins)

Question 11

LH does what?

Answer 11

Triggers ovulation / Stimulates testosterone production.

Question 12

FSH function

Answer 12

Stimulates folicle growth and controls pubertal maturation.

Question 13

Pituitary neurosecretion:

Answer 13

Question 14

What cells make up the retina?

Answer 14

Photoreceptors:

Rods - lower light photosensitivty concentrated at the periphery.

Cones - colour vision.

Question 15

What is funduscopy used for?

Answer 15

Allows for assessment of retina to assess chronic disease (mainly diabetes and hypertension), but also allows assessment of optic disc (so should be performed in every neurological examination also).

Question 16

Layers of the retina:

Answer 16

Pigmented layer - nourishes the neural layer.

Neural layer - Contains the rod and cone photoreceptors.

Question 17

Optic disc:

Answer 17

• The optic disc is the area where the optic nerve enters the retina - no photoreceptor cells at this point thus is the blindspot.

Question 18

Macula

Answer 18

• This is the area where concentration of cone cells starts to increase
• It temporal to the optic disc (lateral)
• It appears to have a lower concentration of blood vessels, to preserve visual acuity.
• The macula is responsible for central vision.

Question 19

Diagram of the eye:

Answer 19

Question 20

Digital retinal

Answer 20

• Digital picture of back of eye
• Much more accurate than traditional fundoscopy
• Eliminates user error
• Images can be reviewed by multiple clinicans at once.
• Allows permanent record of fundus.
• Useful to assess response to treatment/progression of disease
• Forms an essential component of diabetic eye screening
• If you go for an eye test in most opticians now, they will perform this. Most opticians also perform tonometry (to assess for glaucoma).

Question 21

Diabetic eye screening:

Answer 21

• All diabetic patients over the age of 12 should be invited for digital retinal photography with their local diabetic eye service.
• Aim to diagnose early retinopathy to alter diabetes management/offer early treatment.

Question 22

Diabetic retinopathy

Answer 22

Poor glycaemic control leads to arteriopathic change on the small vessels supplying the retina. Hypoxia drives neovascularisation. These new vessels are fragile and bleed, leading to further hypoxia, and eventual cell death = blindness.

Question 23

Diabetic retinopathy grading

Answer 23

Question 24

Vasculature of the thigh:

Answer 24

• Femoral artery arises from external iliac artery. Essentially becomes femoral as it passes under the inguinal ligament, as shown on the diagram here.
• Important artery comes off posterior surface of femoral artery.
• Profunda femoris (deep femoral artery)

Question 25

Profunda femoris gives off three branches what are these 3 branches and what is the clinical significance?

Answer 25

• Perforating branches - supply the adductor magnus.
• Lateral femoral circumflex - suplies lateral thigh.
• Medial femoral circumflex - supplies neck and head of the femur.
• Clinically significant as these branches are easily damaged during fractured neck of femur.

Question 26

As the femoral artery travels posteriorly to the knee it becomes…

Answer 26

Popliteal artery

Question 27

Popliteal artery branches:

Clinical significance?

Answer 27

1. Anterior tibial artery - eventually becomes dorsalis pedis - important in PVD.
2. Fibular peroneal artery.

• Dorsalis pedis can be palpated by dorsiflexing the great toe and feeling on the top of the foot, just medial to extensor hallucis longus tendon.
• Tibialis posterior can be palpated just behind medial malleolus. You can palpate these pulses on yourself, and we use them clinically to assess for peripheral vascular disease.

Question 28

Dermatomal map of the leg:

Answer 28

Question 29

Label this foot radiograph:

Answer 29

Question 30

Osteomyelitis:

Answer 30

Osteomyelitis is the inflammation and destruction of bony tissue. Normally, the inflammation is caused by bacterial infection destroying the bone. This is relevant to diabetics, as if they have peripheral neuropathy, they can easily develop an ulcer, allowing bacterial invasion. Thus, more often seen on dependent parts (i.e. feet). Poor glycaemic control also encourages bacterial growth. Of note, there must be at least 30-50% loss of bony tissue before definite radiographic change can be seen.

Question 31

Charcot arthropathy:

Answer 31

Charcot arthropathy, also known as Charcot neuroarthropathy or Charcot foot and ankle, is a syndrome in patients who have peripheral neuropathy, or loss of sensation, in the foot and ankle. Patients may experience fractures and dislocations of bones and joints with minimal or no known trauma.

Question 32

What is meant by a T and Z score on a bone density scan?

Answer 32

This measures the difference between your bone density and the expected value. The difference between your measurement and that of a young healthy adult is known as a T score, The difference between your measurement and that of someone of the same age is known as a Z score.