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Misc. Notes Year 2 > Endocrine notes > Flashcards

Endocrine notes Flashcards

1
Q

What kind of receptors do hormones bind to in order to bring about a specific response

A

Cognate receptors

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2
Q

How is hormone action typically terminated

A

By enzyme-mediated inactivation in the liver

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3
Q

What is the rate-limiting step in synthesis of steroid hormones

A

Conversion of Cholesterol to Pregnenolone

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4
Q

Name 3 important carrier proteins and what they bind

A

Cortisol-binding-globulin (CBG)
Thyroxine-binding-globulin (TBG)
Sex steroid-binding-globulin (SSBG) - testosterone/ estradiol

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5
Q

Name 2 general carrier proteins and what they bind

A

Albumin - many steroids + thyroxine

Transthyretin - thyroxine

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6
Q

Name the 3 classes of nuclear receptor and what activates them

A

Class 1 - Steroids
Class 2 - Lipids
Hybrid class - T3

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7
Q

What do PP cells of the pancreas islets release

A

Pancreatic Polypeptide

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8
Q

What is Leprechaunism-Donohue syndrome

A

Mutations in the gene for insulin receptor

Cause growth retardation, muscle loss and fat loss

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9
Q

Which three things are seen in Rabson Mendenhall syndrome

A

Severe insulin resistance
Hyperglycaemia
Hyerinsulinaemia

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10
Q

Which derm condition can be seen in Rabson Mendenhall

A

Acanthosis Nigricans

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11
Q

What chemical excess is converted to ketone bodies

A

Acetyl-CoA

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12
Q

What are three useful tests to differentiate between Type 1 and Type 2 diabetes

A

Anti-GAD/ islet cell antibody test
Ketones
Plasma C-peptide

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13
Q

Children diagnosed under the age of 6 are more likely to have which form of diabetes

A

Monogenic

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14
Q

What is Bardet-Beidl syndrome

A

Genetic disorder with diabetes, obesity, retinitis pigmentosa, polydactyly, hypogonadism

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15
Q

What are the 4 types of neuropathy

A

Peripheral
Autonomic
Proximal
Focal

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16
Q

What is Kimmelstiel-Wilson syndrome

A

Diffuse scarring of glomeruli seen in long-standing diabetes

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17
Q

What ratio is used to screen for nephropathy

A

Albumin-creatinine ratio (ACR)

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18
Q

What is the main cause of death in children, secondary to DKA

A

Cerebral Oedema

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19
Q

How is Hyperglycaemic Hyperosmolar syndrome

A

Hypovolaemia
Hyperglycaemia (BG > 30)
Hyperosmolar (osmolarity > 320)

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20
Q

Where does GLP-1 act on in the brain

A

Hypothalamus

To reduce appetite

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21
Q

What normally binds to the SUR1 subunit in a beta cell to open the K+/ATP channel

A

ADP-Mg2-

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22
Q

How many micrograms of T3 equal 100 ug of T4

A

20

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23
Q

What is struma ovarii

A

A teratoma containing thyroid tissue

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24
Q

What is the treatment for thyroid storm

A

Lugol’s iodine
Steroids
B-blockers
Fluid

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25
Q

Which drug can cause agranulocytosis

A

Carbimazole

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26
Q

Which cardio drug can cause thyroiditis

A

Amiodarone

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27
Q

When should you always treat subclinical hypothyroidism

A

In pregnancy

If TSH > 10

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28
Q

Which cells of the anterior pituitary release Prolactin

A

Lactotroph cells

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29
Q

What does AMES stand for with regard to thyroid cancer

A

Ages
Mets
Extent of primary tumour
Size of primary tumour

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30
Q

What are the side effects of thyroid remnant ablation

A

Increased risk of AML(acute myelogenous leukaemia)

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31
Q

What drug treatments are available for Cushing’s

A

Metyrapone (adrenal suppression)

Pasireotide (somatostatin analogue)

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32
Q

How is Diabetes Insipidus diagnosed

A

Water Deprivation test

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33
Q

How is diabetes insipidus treated

A

Desmopression (synthetic vasopressin)

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34
Q

What are some side effects of somatostatin analogues

A

Flatulence
Diarrhoea
Abdominal pain

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35
Q

Where is most Na in the body

A

Extra-cellular fluid

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36
Q

What values of sodium can be classed as hyper and hyponatraemia

A

<120 mmol/L = Hyponatraemia

>155 mmol/L = Hypernatraemia

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37
Q

What is the anterior pituitary derived from

A

Rathke’s Pouch

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38
Q

Name the acidophil cells of the anterior pituitary

A

Somatotrophs (GH)

Mammotrophs (PRL)

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39
Q

Name the basophil cells of the anterior pituitary

A

Corticotrophs (ACTH)
Thyrotrophs (TSH)
Gonadotrophs (FSH/LH)

40
Q

What are Zellballen

A

Tumour cells forming nests in a phaeochromocytoma

41
Q

What are the tubular components of the testes

A

Sertoli cells

Germ cells

42
Q

What are the interstitial components of the testes

A

Leydig cells

Capillaries

43
Q

What is the treatment of Polycystic Ovarian Syndrome

A

Oral pill

Regulates cycle & decreases androgens

44
Q

What is the scan used to image the parathyroid glands

A

Sestamibi scan

45
Q

What values for serum calcium & eGFR indicate a need for parathyroidectomy

A

Calcium - > 2.85mmol/L

eGFR - < 60mL/min

46
Q

What hypertension pattern would make you think of phaeochromocytoma

A

Labile hypertension - resistant to treatments

Postural hypotension

47
Q

How does orlistat work

A

Pancreatic lipase inhibitor

48
Q

Name an oral steroid with a relatively low mineralocorticoid activity

A

Dexamethasone

49
Q

What does mineralocorticoid activity mean

A

Na retention in exchange for K+/H+ ions

50
Q

What is the threshold for HbA1c which indicates adding a second oral therapy

A

58mmol/L

51
Q

Which diabetes drug should be avoided in severe renal failure

A

Metformin

52
Q

Which triad of symptoms suggests an Addisonian crisis

A

Hyponatremia
Hyperkalaemia
Hypoglycaemia

53
Q

What should you think of if a patient presents with a tender goitre and thyrotoxicosis

A

De Quervain’s thyroiditis

54
Q

What is the 1st line treatment for cerebral metastases and why

A

Dexamethasone to decrease cerebral oedema

55
Q

What are some side effects of radioiodine therapy for thyrotoxicosis

A

Hypothyroidism

Exacerbation of thyroid eye disease

56
Q

What are the blood pressure targets for someone with diabetes ± end-organ damage

A

< 140/80

< 130/80 if end-organ damage

57
Q

Pioglitazone is contraindicated in heart failure, over 65’s and which other PMH

A

History of bladder cancer

58
Q

What is the most common cause of Addison’s

A

Autoimmune Adrenalitis

59
Q

How often should blood glucose be monitored in a type 1 diabetic

A

At least 4 times a day

Before each meal and before bed

60
Q

Which thyroid pathology can have a ‘rich lipid core’

A

Benign adenoma

61
Q

Cushing’s can put the body into what biochemical state

A

Hypokalaemic Metabolic Alkalosis

62
Q

Which 3 hormones are decreased as part of the stress response

A

Insulin
Testosterone
Estrogen

63
Q

What should be done to hydrocortisone and fludrocortisone doses on admission to hospital for an Addison’s patient

A

Double Hydrocortisone

No change to Fludrocortisone

64
Q

Which heart failure medication can cause hypercalcaemia

A

Thiazide diuretics

65
Q

What does a High T4 and a High TSH suggest in a person on levothyroxine

A

Poor compliance -> they have taken extra levothyroxine before the review but the TSH hasn’t had time to change

66
Q

What is the pathology of Nelson’s syndrome

A

Rapid enlargement of an ACTH producing pituitary adenoma following a bilateral adrenalectomy

67
Q

Why would an arrhythmia arise in DKA

A

Hyperkalemia

68
Q

What kind of iodine uptake is seen in De Quervain’s thyroiditis

A

Decreased

69
Q

What is the recommended insulin regime for a newly diagnosed type 1 diabetic

A

Basal-Bolus regime + long-acting insulin(detemir) twice daily

70
Q

What should you think of when hypocalcaemia remains resistant to replacement therapy

A

Magnesium deficiency

71
Q

What is the commonest cause of hypercalcaemia (and thus renal calculi)

A

Dehydration

72
Q

What are the waking and pre-meal blood glucose targets for type 1 diabetics

A

4-7mmol/l for pre-meal

5-7mmol/L for waking

73
Q

3 Antibodies associated with type 1 diabetes

A

Anti GAD
Anti IA2
Anti islet cell

74
Q

Adrenaline, Cortisol and Glucagon are increased as part of the stress response. What two things are they trying to prevent

A

Hypoglycaemia

Hypokalaemia

75
Q

How many ATP molecules can be produced from one glucose molecule

A

36 ATP molecules

76
Q

What is the threshold after which beta cells physiologically begin releasing insulin

A

blood sugar over 5mmol/L

77
Q

Which condition presents with severe insulin resistance and acanthosis nigricans

A

Rabson-Mendenhall syndrome

78
Q

Insulin can be a hexamer or a monomer - which is the active form

A

Monomer

79
Q

Which syndrome classically presents with very low muscle mass, growth retardation and severe insulin resistance

A

Donohue Syndrome

80
Q

What is the normal level of 2-hour blood glucose for an oral glucose tolerance test

A

Less than or equal to 7.7mmol/l

81
Q

What blood glucose after 2 hours will be diagnostic of diabetes in an Oral Glucose Tolerance Test

A

Greater than or equal to 11.1mmol/l

82
Q

How might biochemistry results look like in anaemia in diabetes

A

Low albumin

Low Calcium

83
Q

What are the two types of basal insulins

A

Isophane

Analogue

84
Q

What is the target blood sugar level when a patient is on IV insulin and how often should this be checked

A

5-12mmol/l

Checked hourly

85
Q

What happens to the efficacy of sulphonylureas as you increase the dose

A

Decreases

86
Q

Metformin can interfere with the absorption of which two substances

A

Vit B12

Folic Acid

87
Q

What is the name given to the weakening of the legs seen in proximal neuropathy

A

Amyotrophy

88
Q

What is the 1st line treatment for painful neuropathy

A

Duloxetine

89
Q

What is the fluid treatment pathway for DKA

A

0.9% NaCl saline until glucose drops to 15

then switch to dextrose

90
Q

What should you give for alcohol-induced ketoacidosis

A

Pabrinex (high-dose vitamins)

91
Q

What does carbimazole inhibit

A

Thyroid Peroxidase

prevents iodine binding to tyrosine residues to form MIT and DIT

92
Q

Which hypothalamic secretion requires thyroid hormones to be present

A

GnRH

93
Q

What kind of receptor is the TSH receptor

A

G-coupled

94
Q

How does deiodinase work

A

Removes or adds an iodine atom from the outer ring of T3/4

95
Q

What do T3 and T4 become after the action of deiodinase

A

T3 -> T2

T4 -> rT3 (reverse)

96
Q

What is the most active/abundant deiodinase and where are the others found

A

D2
(D1 -> kidneys & liver)
(D3 -> placenta & brain)

97
Q

What is a satisfactory level of serum GH after surgery

A

< 0.4 ug

Misc. Notes Year 2 (30 decks)

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