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2A - Stuff i just cannot remember > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What antibody to Grave’s and Hashimoto’s have in common?

A

Anti-TSH Receptor antibodies

  • Grave’s: activate receptor
  • Hashimoto’s: inhibit receptor
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2
Q

Pt presents with sweating and wt loss despite increased appetite. On examination, you note diffuse goitre + bruit, pretibial myxoedema (shin rash) and their eyes gritty. They smoke.

Likely diagnosis? Investigations?

Management?

A

Grave’s disease

Investigations:
TFT - low TSH, high T3

Serology - TRAb, Anti-TPO

Management:
1. Propanolol - immediate relief

  1. Carbimazole
    • titrate down if healthy
    • titrate up if elderly

OR Block & Replace with Carbimazole + Thyroxine

  1. 131_I
  2. Thyroidectomy

+ Stop smoking! (big RF for Grave’s eye disease)

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3
Q

Pt presents with constipation, wt gain and numbness in their hands. Their hair appears brittle and their skin dry/. Examination reveals cardiomegaly and bradycardia, as well as a large tongue. They also have a positive Hertoghe sign.

Likely diagnosis, investigations, management + risks

A

Hypothyroidism

TFT - high TSH, low T3

Serology - Hashimoto’s?

Management:
LEVOTHYROXINE
(Risks = osteoporosis, arrhythmia)

+ annual TSH check

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4
Q

Pt presents with constipation, wt gain and numbness in their hands. Their hair appears brittle and their skin dry/. Examination reveals Goitre, hypertrophy and hyperplasia.

Likely diagnosis, risk factors, investigations, management + risks

A

Hashimoto’s thyroiditis

RF: Turner’s/ Down’s syndrome; HLA-DR5; T1DM, SLE, etc

Inv: TFT - high TSH, low T3
GOLD: High Anti-TPO (Anti-thyroid Peroxidase Ab).
Low Thyroglobulin Ab. Anti-TSH_R Ab

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5
Q

Pt arrives from the Middle East complaining of fatigue, constipation and neck swelling.

Exam reveals large, diffuse, non-tender goitre.

TFT shows hypothyroidism. Serology is negative. Likely cause?

A

IODINE DEFICIENCY

  • most common world-wide cause
  • Middle-East, Nepal, South-America
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6
Q

What drugs interfere with levothyroxine absorption?

A

IRON - Ferrous Sulphate
- take Levothyroxine THEN iron 2-4 hrs apart

Calcium chloride
Digoxin
Hormone Replacement Therapy

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7
Q

Half life of levothyroxine

A

4-6 weeks

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8
Q

Pt presents with heat intolerance, sweating and palpitations. She is 11 weeks pregnant. TFT reveals raised T3 and low TSH.

Management?

A

PROPYLTHIOURACIL (PTU)

Carbimazole is contraindicated in 1st trimester of pregnancy (crosses placenta > aplasia cutis)

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9
Q

Painful goitre

A

De Quervain’s thyroiditis

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10
Q

Secondary causes of Hyperthyroidism

A 
Amiodarone 
Lithium 
TSH-adenoma 
Choriocarcinoma (B-hCG activates TSH receptor)/ gestational 
Struma ovarii
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11
Q

Thyroid storm management

A

IV Propanolol
IV digoxin

Propylthiouracil via NG tube THEN Lugol’s Iodine 6hrs later

Prednisolone/ HC

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12
Q

Grave’s disease cardinal features

A 
Diffuse goitre + bruit 
Pretibial myxoedema (shin rash) 
Infiltrative eye disease
- exophthalmos 
- periorbital oedema 
- opthalmoplegia
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13
Q

Pt diagnosed with thyrotoxicosis and is started on Carbimazole + Propanolol. She initially felt better but now complains of a sore throat.

Management?

A

STOP CARBIMAZOLE + FBC

SE: Agranulocytosis > Neutropenia > sepsis

*also a side-effect of PTU

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14
Q

Pt is 7 weeks into pregnancy and has a Hx of hypothyroidism. It is well managed with levothyoxine.

TFT shows:

  • fT4 = 18 (11-22)
  • TSH = 2.1 (0.17-3.2)

Management?

A

Increase Levothyroxine by 25 mcg + Repeat TFT in 4 weeks

EVEN IF IN EUTHYROID STATE

  • in preg, there is ^fT4 until week 12 :: foetus is dependant on maternal T4 until their foetal T4 develops at wk12.
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15
Q

Pharmacology + SE of Carbimazole

A

Inhibits Thyroid Peroxidase in Follicular cells > inhibits iodination of tyrosine residues in thyroglobulin > stops T3/4 production.

SE: Rash, pruritus, agranulocytosis (> neutropenia > sepsis)

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16
Q

Acromegaly investigations + management

A

Investigations
1L: IGF-1?

GOLD: Oral Glucose Tolerance Test - GH not suppressed

MRI - prolactinoma?

Management
1L TRANS-SPHENOIDAL SURGERY

2L

a) Somatostatin receptor ligands - OCTREOTIDE
b) GH Antagonist - PEGVISOMANT
c) Dopamine agonist - CABERGOLINE
d) Radiotherapy

Repeat IGF-1 + random GH 3 months after

17
Q

Acromegaly is a RF for which GI disturbance?

A

Colonic polyps - can become malignant

Require colonoscopy every 5 years

18
Q

Hypothalamic-pituitary-adrenal axis

A

Hypothalamus&raquo_space; CRH > Pituitary&raquo_space; ACTH > Adrenals&raquo_space; Adrenocorticoids (cortisol, aldosterone, testosterone)

CRH = Corticotropin-releasing hormone

ACTH = Adrenocorticotropic Hormone

19
Q

Hypothalamic-pituitary-ovary axis

A

Hypothalamus&raquo_space; GnRH > Anterior Pituitary&raquo_space; LH, FSH > ovaries

LH - stimulates oestrogen
FSH - stimulates inhibin

20
Q

Growth hormone axis

A

Hypothalamus&raquo_space; Somatostatin (-) or GHRH (+) on GH.

Stomach&raquo_space; Ghrelin (+) on GH

GHRH/ Ghrelin(+) > Ant Pit&raquo_space; GH > Liver&raquo_space; IGF-1 > cells, muscles, bones

21
Q

Raised PTH
Hypocalcaemia
Hypophosphatemia

A

Secondary Hyperparathyroidism

Causes: CKD, vit D deficiency

Mx: Give calcium

22
Q

Raised PTH
Hypercalcaemia
Hypophosphatemia

A

Primary Hyperparathyroidism
(Parathyroid adenoma)

Mx: Remove adenoma

23
Q

Raised PTH
Hypercalcemia
Hyperphosphatemia

A 
Tertiary hyperparathyroidism 
(autonomous hyperplasia)

Mx: Parathyroidectomy

24
Q

Hypertension
Hyperkalaemia
Metabolic acidosis

A

Conn’s Syndrome (adrenal adenoma) - Primary hyperaldosteronism

25
Q

Addison’s disease presentations

Investigations, management

A

Tanned, tired, tearful, thin, throwing up + hypotension

= adrenal insufficiency

  • low cortisol
  • low aldosterone

Mx: Hydrocortisone + Fludrocortisone (replacement)

26
Q

Long-term steroid use complications

A
  • Diabetes Mellitus
  • Immunosuppression
  • Osteoporosis
  • Proximal weakness
  • Thin skin
27
Q

Pt presents with a 2 day history of vomiting and fatigue. She is disorientated and looks clinically dry.

Her BP is 92/50. Pulse 105. RR 20. Sats 98%. Temp 36.4.

ABG: PaO2 13kPa, pH 7.3, PaCO2 4.1 kPa, HCO3 13mmol/L.

Capillary blood glucose is 32mmol/L and urine dispstick shows Glucose +++, ketones +++

Likely diagnosis? Pathophysiology?

A

Diabetic Ketoacidosis

No insulin = hyperglycaemia…

  • Osmotic diuresis > polyuria, dehydration, polydipsia (to get rid of glucose)
  • Glucose not utilised :. lipolysis upregulated for energy source > ketoacidosis > metabolic acidosis
  • respiratory compensation for MA > hyperventilation to blow off CO2

= Kussmaul respiration

2A - Stuff i just cannot remember (19 decks)

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