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Y3 CORE CONDITIONS > ENDOCRINE SYSTEM > Flashcards

ENDOCRINE SYSTEM Flashcards

1
Q

what percentage of all diabetes sufferers have diabetes type 1?

a) 5%
b) 10%
c) 50%
d) 100%

A

b) 10%

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2
Q

which immune complexes is diabetes type 1 associated with?

A

HLA

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3
Q

what occurs to the pancreas in type one diabetes?

A

beta cell destruction

absolute insulin deficiency

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4
Q

what enzyme is used in diagnostic antibody testing for DMT1?

A

Glutamate acid dehydrogenase

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5
Q

give 2 risk factors for diabetes type 1

A

family history

other autoimmune conditions

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6
Q

what 2 substances will be present in the urine of a patient with DMT1?

A

ketones

glucose

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7
Q

how do DMT1 patients normally first present?

A

Diabetic ketoacidosis

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8
Q

give 2 physiological features of a DKA

A

ketones used for gluconeogenesis
hyperglycaemia
metabolic acidosis

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9
Q

what will be present to smell on the breath of someone with DMT1?

A

ketones on breath

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10
Q

what causes polydipsia/polyuria in DMT1?

A

osmotic diuresis

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11
Q

what diagnostic test would you use to test for DMT1?

A

HBA1C

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12
Q

what would be first line treatment for a DKA and DMT1 in general?

A

insulin

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13
Q

why would you give potassium in treatment for a DKA?

A

to prevent rebound hypokalaemia in response to hyperkalemia in DKA

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14
Q

why don’t DMT1 patients get AKI as soon as expected in a DKA?

A

polyuria is a protective factor for the kidney

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15
Q

why does caution have to be exercised in giving fluids in a DKA?

A

to avoid cerebral overload as brain hydration is maintained

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16
Q

in relation to insulin, what two things can cause DMT2?

A

increased resistance

decreased secretion

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17
Q

name 2 drugs that are associated with DMT2

A

glucocorticoids
thyroxine
olanzepine (antipsychotic can increase weight)
Diazoxide

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18
Q

give 4 symptoms of DMT2

A 
polydipsia
polyuria
weight loss
blurred vision/visual disturbances
fatigue
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19
Q

name 2 diagnostic tests used for DMT2

A

fasting glucose
random glucose
HBA1C
Glucose tolerence test

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20
Q

what is first line treatment for DMT2?

A

metformin

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21
Q

what time of drug is metformin?

A

biguanide

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22
Q

how does metformin work?

A

increases insulin sensitivity

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23
Q

give 2 side effects of metformin

A

anorexia (can be good thing in obese patients)
D&V
reduced B12 absorption

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24
Q

what is second line treatment for DMT2?

A

sulfonylureas

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25
Q

how do sulphonylureas work?

A

increase insulin secretion from beta cells

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26
Q

give 2 examples of sulphonylureas

A

gliclazide
glibenclamide
tolbutamide

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27
Q

give a side effect of sulfonylureas

A

weight gain and hypoglycaemia

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28
Q

what is third line treatment for diabetes?

A

thiazolidinedione (glitazone)

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29
Q

what does glitazone do?

A

increases insulin sensitivity

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30
Q

who does cushion’s syndrome most commonly affect?

a) middle aged women
b) middle aged men
c) old women
d) old men

A

a) middle aged women

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31
Q

what causes cushing’s syndrome?

A 
hyperadrenocorticolism
over production of glucocorticoids
long term corticosteroid treatment e.g. autoimmune/inflamm
adrenal carcinoma/adenoma
Carney Complex 
Cushings disease
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32
Q

what causes 90% of cushings cases?

A

ACTH over production from pituitary gland & adrenal hyperplasia

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33
Q

where in the body except the pituitary can ACTH be produced?

A 
Ectopic ACTH production due to tumour formation ( benign and malignant)
Thyroid
Lung= small cell lung cancer
Pancreas
Thymus glands
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34
Q

what 5 things make up Carney Complex ?

Multiple Endocrine Neoplasia (men)

A 
adrenal hyperplasia
pituitary adenoma
myopia
schwannoma
testicular tumour
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35
Q

what is the point of an overnight dexamethasone suppression test in the diagnosis of Cushing’s?

A

giving body steroids should cause serum levels to decrease in a normal patient. If don’t can be cushings

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36
Q

why might you suggest a CT/MRI in the diagnosis of Cushing’s?

A

of adrenal glands to check for hyperplasia

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37
Q

give 2 types of weight gain that are characteristic of Cushing’s

A

central obesity

moon face

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38
Q

give 2 skin symptoms of Cushing’s

A

purple abdominal striae
thin bruising skin
poor wound healing

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39
Q

give two genitor-reproductive symptoms of Cushing’s

A

amenorrhoea
impotence
libido loss

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40
Q

give 2 bone symptoms of Cushing’s

A

osteoporosis

fractures

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41
Q

what is hirtuism? (symptom of Cushing’s)

A

hair growth on face

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42
Q

give 2 drugs that can be given in treatment of Cushing’s by decreasing plasma cortisol

A

aminoglutethimide
ketoconazole
metyrapone

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43
Q

excess of what can cause pseudo-cushings?

A

alcohol

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44
Q

which gender is thyroid problems most common in?

A

females

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45
Q

what causes 2/3 of hyperthyroidism?

A

grave’s disease

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46
Q

what causes Grave’s disease?

A

IgG antibodies bind to TRH receptors and cause excess hormone and thyroid hyperplaseia

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47
Q

give 3 triggers of grave’s

A

infection
stress
childbirth

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48
Q

what other conditions is Grave’s associated with?

A

Addisons, DMT1 and Vitiligo

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49
Q

give 4 other causes of hyperthyroidism

A

toxic multi nodular goitre
toxic adenoma of thyroid gland
follicular carcinoma
sub acute (de-quervain’s) thyroiditis (self limiting)
choriocarcinoma (ocarina teratoma w thyroid tissue)

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50
Q

Out of these 3 hormone,TSH/T3/T4 which would be low and which would be high in hyperthyroidism?

A

low TSH

high T3, T4

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51
Q

give 3 symptoms characteristic of Grave’s disease

A 
exophthalmus
pretibial myxoedema
thyroid acropatchy
thyroid bruis
Clubbing
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52
Q

what is a risk of thyroidectomy surgery?

A

recurrent laryngeal nerve damage

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53
Q

give 5 complications of hyperthyroidism

A 
HF
Atrial fibrillation
thyroid eye disease
osteoporosis
gynaecomastia
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54
Q

what is hashimoto’s thyroiditis?

A

autoimmune destruction of thyroid gland

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55
Q

give 2 drugs which can cause hypothyroidism

A

amiodarone
lithium
iodine
carbimazole

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56
Q

Name 2 genetic syndromes that can cause hypothyroidism

A

Pended’s

Turner’s

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57
Q

what is pendred’s syndrome?

A

thyroid problems & bilateral sensorineural deafness

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58
Q

what is Turner’s syndrome?

A

female missing one sex chromosome (45X)

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59
Q

what is the cause of secondary hypothyroidism?

A

pituitary failure

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60
Q

which of these indicates thyroid failure and which indicates pituitary failure?

a) high TSH, low T3/4
b) low TSH, low T3/4

A

a) thyroid failure

b) pituitary failure

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61
Q

Give 5 limb-related symptoms of hypothyroidism

A 
myxoedema
myalgia
arthralgia
paraesthesia in hands 
neuropathy (carpal tunnel)
Slow reflexes due to cerebellar ataxia
62
Q

give 2 facial symptoms of hypothyroidism

A

face swelling

hair loss outer 1/3 of eyebrow

63
Q

give 2 complications of hypothyroidism in pregnancy

A

pre-eclampsia
low birth weight
premature birth

64
Q

What are the causes of thyroid nodules?

A 
cyst
thyroiditis
tumour
overgrowth of normal tissue
Iodine deficiency
65
Q

how many of the population have palpable goitres?

a) 1%
b) 9%
c) 30%
d) 70%

A

b) 9%

66
Q

how can smoking cause a goitre

A

thiocyanate in cigarettes interferes with body’s use of iodine

67
Q

how many goitres are thyroid cancer?

a) 1 in 10
b) 1 in 20
c) 1 in 100
d) 1 in 200

A

b) 1 in 20

68
Q

give 5 differential diagnoses for goitre

A 
pharyngeal pouch
tumour
cyst
submandibular stones
carotid aneurysm/tortuous (pulsatile)
69
Q

What are the ranges of HB1ac for DMT1?

Normal, pre diabetic and diabetic?

A 
<42mmol/ml = normal
42-47mmol/ml = pre diabetic
>48mmol/ml = diabetic
70
Q

How can you diagnose diabetes other than using the HB1ac?

A

2 out of 3 on 2 separate occasions
Fasting glucose >7
Random glucose >11
Glucose tolerance test

71
Q

What does the HB1ac test look at?

A

The average amount of glucose in your blood in the last 2 to three months

72
Q

What is DKA?

A

When you body lacks insulin it breaks down fat to produce and high level of glucose also causes hyperglycemia. Can be fatal

73
Q

What are the physical symptoms a DMT1 patient might get?

A 
Blurred vision
Fatigue
Weight loss
Feel very thirsty
Increase urine output especially at night
Takes longer for cuts and grazes to heal
Itchiness around the genital area
74
Q

Differential diagnosis of DMT1?

A

Type 2

Maturity onset diabetes of the young

75
Q

What is MODY?

A

It is caused by single gene passing through family

Diabetes under 25 with parents having diabetes

76
Q

What lifestyle factors should you consider with DMT1?

A 
Reduce weight
Healthy eat
No smoking
Exercise
Reduce BP
77
Q

What are risk factors of DMT2?

A 
Age
Obesity
Diabetes or pre diabetes while pregnant 
5 * more common if South asian or African Carribean (over 25)
First degree relative with DMT2
78
Q

Before you have medical treatment what should you advice patients to do who have DMT2?

A

Reduce weight
More exercise
Eat healthier= less sugar and fat. More fibre

79
Q

What should you monitor regularly in a patient with DMT?

A

Eyes and feet

80
Q

What treatment do you give if the first 3 lines of treatment for DMT2 don’t work?

A

Insulin

81
Q

What are thyroid nodules?

A

Solid/fluid filled lumps in thyroid gland

82
Q

What are the risk factors for thyroid nodules?

A

Smocking
FHx
Amiodarone and lithium side effects

83
Q

What are the symptoms of thyroid nodules

A

Often asymptomatic

Release thyroxine which is a causes by hyperthyriodism

84
Q

What are the signs of thyroid nodules?

A

On swallowing see movement of nodules

Enlarged thyroid

85
Q

How can you diagnose thyroid nodules and goitre?

A 
Often incidental
Physical examination
US
TFT's and autoantibodies
Fine needle aspiration
Radioactive iodine scan
86
Q

What is red flag symptom of thyroid nodule?

A

Stridor with thyroid mass

87
Q

What developments of thyroid would indicate urgent referral?

A

Child with thyroid nodule
Painless thyroid mass that has enlarged rapidly
Hoarseness or change in voice with goitre
Palpable cervical lymphadenopathy

88
Q

What is treatment for thyroid nodule?

A

Treat underline cause
Excision if malignant
Treat hyperthyroidism

89
Q

What are the two type of goitre?

A

Diffuse smooth goitre

Nodular goitre

90
Q

What are the causes of diffuse smooth goitre?

A

Iodine deficiency

Graves disease

91
Q

What is a goitre?

A

Abnormal swelling of thyroid gland

92
Q

What are the causes of goitre?

A 
Pregnancy
Menopause
Hypo/hyperthyriodism
thyroid cancer (1 in20 of goitres)
smoking
Iodine deficiency
Drugs: lithium and immunosuppressors
93
Q

What can be a serious side effect of goitre?

A

Can compress trachea or esophagus

94
Q

What is cushings syndrome?

A

When the body produces to much cortisol

95
Q

What type of hormone is cortisol and what is its main aim?

A

It’s the stress hormone and maintains homeostasis

96
Q

What is cushings disease and how does it cause cushings syndrome?

A

It is hyperplasia and tumour growth on the pituitary gland causing excess production of ACTH which leads to excess production of cortisol

97
Q

How does Corticotroponin releasing hormone from the hypothalamus cause Cushing’s?

A

While rare it can cause excessive production of ACTH by the pituitrary gland

98
Q

What does ACTH stand for?

A

Adrenocorticotropic hormone

99
Q

What are non ACTH causes of cushings syndrome?

A

Excessive glucocorticoid
Adrenal adenoma and carcinoma
Long term corticosteroids use

100
Q

What is the ratio of female to male in cushings?

A

5:1

101
Q

What group of people have high incidence of cushings?

A

Diabetics
Osteoporsis group
Hypertension
Obese people

102
Q

How long free does the urine have to be of cortisol to not have cushings?

A

24hours

103
Q

What happens to your mood in cushings?

A

Depression and fatigue

104
Q

What happens to your BP and glucose levels in cushings?

A

Hypertension

Hyperglycaemia

105
Q

What is sub acute (de-quervain’s) thyroiditis (self limiting)?

A

Self limiting painful goitre

Causes rise in erythrocyte sedimentation rate and no radio iodine uptake

106
Q

What are the risk factors of hyperthyriodism?

A 
Fhx
Pregnancy
Female
High iodine uptake
HAART
Child birth
Trauma and surgery to thyroid
smoking
107
Q

Why does high uptake of iodine increase chance of hyperthyriodism?

A

Increases production of thyroxine

108
Q

What are the physical signs and symptoms of hyperthyroidism?

A 
Weight loss
Heat intolerance
Hair loss
Goitre
Sweaty
Over active
Diarrohea 
Labile emotions
109
Q

What happens sexually in hyperthyroidism?

A

Oligomenorrhoea

Infertility

110
Q

What heart related symptoms do you get in hyperthyroidism?

A

Palpitations (AF, SVT) and tremor

111
Q

What rare signs and symptoms do you get in hyperthyroidism?

A

Alopecia
Uriticaria
Physiocosis
itch

112
Q

What drugs would you give to prevent thyroid production?

A

Propanolol

Carbimaazole

113
Q

What are common side effects of hypothyriodism?

A 
Weight gain
Constipation
Lethargy
Cold intolerance
Amenorrhoea
Hair loss in outer 1/3rd of eyebrow
114
Q

How mentally does hypothyriodism effect a patient?

A

Depression
Lipid loss
Difficulty concentrating

115
Q

What heart complications can you get in hypothyriodism?

A

Pericardial effusion

116
Q

What is the treatment of hypothyriodism?

A

Levothyroxine

117
Q

What drugs does Levothyroxine interact with?

A

Carbamexapine
Phenytoin
Rifampicin
Iron tablet

118
Q

What complication of hypothyriodism increases chance of CVD?

A

High cholesterol levels

119
Q

What is the role of TSH and what organ is it released from?

A

It is released from the anterior pituitary gland and it controls the production of T3 and T4 from the thyroid gland

120
Q

What is TRH and what organ is it released from?

A

Thyrotropin-releasing hormone (TRH) from the hypothalamus causes the release of TSH

121
Q

In response to TSH how much T3/T4 is produced by the thyroid gland?

A

More T4 to T3

122
Q

Where is T4 activated to T3?

A

Peripherals in the kidney and liver

123
Q

Is all of the T4 and T3 in a active state?

A

No only the hormones that are free are in the active state. Most of T4 and T3 are bounded to proteins (thyroglobulin)

124
Q

What is the effect of circulating T4 and T3 on the TSH and TRH?

A

Circulating T4/3 depresses the release of TRH and TSH from hypothalamus and anterior pituitary respectively

125
Q

What is the function of the parathyroid gland?

A

4 tiny glands that sit behind the neck and controls the level of calcium by releasing parathyroid hormone (PTH)

126
Q

How does the release of PTH increase the levels of calcium in the body?

A

Breaks down bone and releases the body
Increases the ability to absorb calcium from food
Increase the kidney’s ability to hold onto calcium instead of it being excreted via urine

127
Q

What in parathyroid adenoma?

What does it cause

A

Benign tumour of the parathyroid gland

Increase release of Calcium from the bones causing hypercalcaemia

128
Q

What are the symptoms of parathyroid adenoma?

A 
Primary hyperparathyroid symptoms
Kidney stones
Depression due to hormone imbalance
Constipation
Fatigue
129
Q

What is the diagnosis of Pt adenoma?

A

Blood: PTH and calcium levels

130
Q

What is the treatment of PT adenoma and how effective is it?

A

Surgery for removal of affected gland and 95% successful

131
Q

What is hyperparathyroidism?

A

Inappropriate activity of the parathyroid gland causing ^^PTH

132
Q

What is primary hyperparathyroidism and what is the cause?

A

PTH levels is not determined by calcium serum levels. hypercalcaemia is the outcome
Caused by PT adenoma or dysfunction of the PT

133
Q

What is secondary hyperparathyroidism and what is the cause?

A

It is when calcium levels do not respond to changes in PTH, causing hypocalcaemia
Parathyroid try to respond by increase the production of PTH
Caused by vitamin D3 deficiency

134
Q

What causes Vitamin D3 deficiency?

A

CKD
Lack of sunshine
Dietary
Inability to convert from cholesterol

135
Q

What is tertiary hyperparathyroidism?

A

It is long term secondary that leads to hyperplasisa and lowered response

136
Q

What are symptoms of primary hyperparathyroidism?

A 
Osteoporosis
Bone deformity
Bone fracture
Bone, muscle and abdo pain
Kidney stones
Urinary calculi
Cognitive impairment
137
Q

What are symptoms of secondary hyperparathyroidism?

A

Rickets
Osteomalacia–> soften bone
Renal osteodystrophy

138
Q

what is renal osteodystrophy?

A

It is weekend bones due to kidney inability to maintain normal calcium and phosphate levels

139
Q

What is the diagnosis of a blood test if their is either :

a) high PTH and Calcium
b) high PTH but low Calcium

A

a) priamry

b) secondary

140
Q

What is the treatment for

a) primary
b) secondary

A

a) surgery

b) treat the Vitamin D3 deficiency

141
Q

What is addisons?

A

Adrenal gland insufficiency

Do not produce enough cortisol or aldosterone

142
Q

What are the causes of addisons disease?

A

Developed world = autoimmune disease
Developing = TB
Sepsis and bleeding into the gland

143
Q

What are the 4 main functions of cortisol?

A

Help to regulate BP, immune system
Help to balance insulin regulatory effects on blood glucose level
Help to control bodies response to stress

144
Q

What is the function of aldosterone?

A

Helps to regulate salt levels in blood and control BP

145
Q

What are the signs and symptoms of addisons disease?

A 
Weight loss and loss of apeptite 
Weakness 
Light headness 
Low blood pressure
Skin hyperpigmintation 
Abdo pain and fatigue 
Anxiety and low mood changes
the need to urinate frequently
increased thirst
craving for salty foods
Dehydration
146
Q

What is adrenal crisis?

A

Low BP and syncope
Low back pain
Hyponatremia, hypokalaemia, hypercalcaemia, hypoglycaemia
Triggered by stress (injury, surgery, infection etc.)

147
Q

What do you see in ABG for addisons patients?

A

Metabolic acidosis

148
Q

What is treatment for addisons disease?

A

Hormone replacement e.g. hydrocortisone, prednisolone, fludrocortisone
o Normally oral
o Can have injection & dextrose in crisis
High salt diet

149
Q

What are normal glucose levels in the

a) urine
b) blood?

A

A) 0-0.8mmol/L

b) 3.9-5.5 mmol/L

150
Q

What is diabetes insipidus?

A

When you produce large amounts of urine and are very thirsty. Not linked to DM

151
Q

When is oral glucose tolerance test normally used?

A

Diabetes in pregnancy

Y3 CORE CONDITIONS (15 decks)

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