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Medicine > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What antibodies are associated with Graves disease?

A

TSH receptor antibodies

Also, to a lesser extent
Anti-thyroid peroxidase antibodies

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2
Q

Symptoms of hyperthyroidism

A 
Anxiety and irritability 
Sweating and heat intolerance 
Tachycardia 
Weight loss
Fatigue
Diarrhoea 
Sexual dysfunction
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3
Q

Management of hyperthyroidism

A 
Carbimazole 
Propylthiouracil
Radioactive iodine 
Beta blockers 
Surgery
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4
Q

Subacute (de quervains) thyroiditis presentation and management

A

Typically follows a viral infection
Typically causes hyperthyroidism

  • painful goitre
  • raised ESR

Usually self-limited

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5
Q

Presentation of hypothyroidism

A 
Tiredness, lethargic 
Low mood 
Cold-disliking 
Weight gain 
Constipation 
Menorrhagia 
Decreased cognition and memory 
Dry skin 
Fluid retention
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6
Q

Presentation of hyperparathyroidism

A

Bones - painful
Stones - kidney
Abdominal moans - constipation, nausea and vomiting
Psychiatric groans - fatigue, depression and psychosis

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7
Q

a low dexamethasone test indicates no suppression of cortisol, what does this mean?

A

Cushing’s syndrome

  • dexmeth exerts negative feedback (hypothalamus) reduces CRH and pituitary reduces ACTH in normal response.
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8
Q

Patient has cushings syndrome, on a high dose dex test, cortisol is suppressed, ACTH is suppressed to

A

Cushings disease

Some negative feedback

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9
Q

Patient has cushings syndrome, on a high dose dex test, ACTH suppressed but cortisol isn’t. What does this mean?

A

Shows an adrenal adenoma

Cortisol is independent of the pituitary

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10
Q

Patient has cushings syndrome, high dose dex test reveals that cortisol is not suppressed and neither is ACTH

A

Reveals ectopic ACTH production (SCLC), as production of both is independent of pituitary and adrenal glands

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11
Q

What type of ABG disturbance might be seen in cushings syndrome

A

Hypokalaemic metabolic alkalosis

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12
Q

Management of cushings

A

Trans-sphenoid removal of pituitary adenoma
Surgical removal of adrenal tumour
Surgical removal of tumour producing ectopic ACTH

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13
Q

What is primary adrenal insufficiency

A

Where adrenal glands have been damaged and don’t produce cortisol and mineralcorticoid
- commonly autoimmune

  • Addisons
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14
Q

What is secondary adrenal insufficiency?

A

Result of a loss of ACTH and so cortisol is release from adrenals is less
- pituitary damage

Also chronic steroids - if withdrawn, hypothalamus does not wake up quick enough to release CRH

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15
Q

Electrolyte disturbance in addisons

A

Hyponatraemia and Hyperkalaemia

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16
Q

Is ACTH high or low in primary adrenal insufficiency?

A

High

  • trying to compensate for lack of negative feedback on cortisol
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17
Q

Is ACTH high or low in secondary adrenal insufficiency?

A

Low

  • reason arsenal glands are not producing cortisol is due to lack of ACTH
18
Q

Causes of primary aldosteronism

A

Solitary aldosterone-producing adenoma - CONNS syndrome
Bilaterally adrenal hyperplasia
Rare - adrenal cancer

19
Q

Features of hyperaldosteronism

A 
HTN 
Hypokalaemia
- muscle weakness, cramps, palpitations 
Alkalosis
Polyuria 
Polydypsia
20
Q

Is renin high or low in primary hyperaldosteronism

A

Low - suppressed by high BP

21
Q

Is renin high or low in secondary hyperaldosteronism

A

High - high renin is the cause

22
Q

Causes of secondary hyperaldosteronism

A

Where excessive renin stimulates the adrenal gland produces more aldosterone.

Causes of high renin:

  • renal artery stenosis
  • renal artery obstruction
  • heart failure
23
Q

Does acidosis or alkalosis occur in hyperaldosteronism

A

Alkalosis (excretion of potassium)

24
Q

Features of insulinoma

A

Fasting hypoglycaemia with whipple’s triad:

  • symptoms with fasting or exercise
  • recorded hypoglycaemia with symptoms
  • symptoms relieved with glucose
25
Q

Tests for insulinoma

A

Glucose (fasting)
Suppressive test - IV insulin and measure C-peptide production - C-peptide suppressed by insulin normally, does not occur in insulinoma
CT / MRI - pancreas

26
Q

What should be prescribed in patients awaiting surgery for phaeocytochroma?

A

Phenoxybenzamine

(Alpha blocker)

Then a beta blocker

27
Q

Painful goitre, hyperthyroidism following an infection and raised ESR and increased iodine uptake on scan would indicate what?

A

Subacute thyroiditis

28
Q

Hypertension and muscle weakness, alkalosis should point towards what?

A

Hyperaldosteronism

Muscle weakness = hypokalaemia

29
Q

What diabetic medication causes fluid retention?

A

Pioglitazone

30
Q

First line test in acromegaly

A

IGF-1 levels raised

Then OGTT and GH measurement (no suppression of GH) also impaired glucose tolerance associated with acromegaly

31
Q

What is diabetes insipidus?

A

Lack of ADH production (cranial) or

Lack of response to ADH (nephrogenic)

32
Q

Causes of diabetes insipidus

A

Nephrogenic:

  • drugs - lithium
  • mutations in the X chromosome
  • intrinsic kidney disease

Cranial:

  • idiopathic
  • brain infections or surgery or radiotherapy
  • head injury
33
Q

Test for diabetes insipidus

A

Water deprivation test

34
Q

What is the osmolality of serum and urine in diabetes insipidus?

A

Low urine osmolality

High serum osmolality

35
Q

After 8 hour water deprivation, someone’s urine osmolality is low, then after desmopressin the urine osmolality is high. What does this mean?

A

Cranial diabetes insipidus

Can still respond to ADH (but don’t produce any)

36
Q

After 8 hour water deprivation, someone’s urine osmolality is low, then after desmopressin the urine osmolality is low still. What does this mean?

A

Nephrogenic diabetes insipidus

Kidneys do not respond to ADH

37
Q

After 8 hour water deprivation, someone’s urine osmolality is high, what does this mean?

A

Normal

38
Q

Electrolyte and osmolality abnormalities in syndrome of inappropriate ADH

A

Hyponatraemia (excessive fluid retention)

High urine osmolality

39
Q

Peptic ulceration, galactorrhoea, hypercalcaemja should make you think of what?

A

Multiple endocrine neoplasia type 1

40
Q

Features of MEN1

A

Parathyroid - hypercalcaemia
Pituitary- prolactinoma
Pancreas- insulinoma or gastronoma (peptic ulceration)

41
Q

Features of MEN2a

A

Parathyroid- hypercalcaemia

Phaeochromocytoma

Medicine (25 decks)

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