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Station 5 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Hand signs in thyroid dysfunction?

A 
Sweaty/cold and dry 
Palmar erythema 
Pulse ?Af vs bradycardia 
Brisk reflexes in hyper 
Tremor
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2
Q

Face and neck signs in thyroid dysfunction?

A

Eyes- lid lag (hyperthyroidism), proptosis, kemosis, ophthalmoplegia + loss of colour vision
Hair loss and periorbital oedema in hypothryoidism
Neck- goitre (describe texture and size). Test with swallow. Listen for bruit and percuss.

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3
Q

Peripheral signs of thyroid dysfunction?

A 
Pretibial myxoedema (Graves) 
Proximal myopathy (hypo)
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4
Q

Important things to ask about in a patient presenting with hyperthyroidism.

A 
Sleep and energy 
Heat intolerance and sweating 
Tremor and anxiety 
Appetite and weight loss 
Palpitations 
Plans to become pregnant 
Smoking 
Eye symptoms - 'sore or gritty eyes', 'does the colour red at the traffic lights look dull?'
Goitre
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5
Q

Treatment for severe thyroid eye disease?

A

High dose steroids, orbital irradiation or surgical decompression.

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6
Q

Investigations in hyperthyroidism?

A

TFTs
TSH receptor antibodies (+ve in Graves and thyroid eye disease)
Radioisotope scanning (increased in Graves)

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7
Q

Important things to ask about in suspected hypothyroidism?

A 
Weight gain 
Mood 
Energy levels 
Cold intolerance 
AI history
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8
Q

Neurological associations with hypothyroidism

A

Ataxia
Carpel Tunnel
Proximal myopathy

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9
Q

Causes of hypothyroidism

A

Hashimotos
Viral Thyroiditis
Iodine deficiency
Post thyroidectomy or secondary to anti thyroid drugs

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10
Q

What should you ask about in suspected Acromegaly?

A 
Change in hand and feet size 
Change in shape of face (any pictures with them) or interdental spacing 
Snoring or stopping breathing at night 
Visual problems 
Sweating 
Heart problems 
Loss of libido/menstrual changes
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11
Q

The A-M of acromegaly

A 
Acanthosis Nigricans 
BP (hypertension) 
Carpel Tunnel 
Diabetes 
Enlarged hands and feet 
Field defect 
Goitre, gastrointestinal malignancy 
Heart failure, Hirsute, hypopituitary 
IGF raised 
Joint arthropathy 
Kyphosis 
Lactation 
Myopathy and macroglossia
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12
Q

Diagnostic investigations in acromegaly?

A

Raised plasma IGF-1
Non suppression of GH with oral glucose tolerance test
CT/MRI pituitary fossa demonstrating pituitary adenoma
Also test for other pituitary functions- FSH/LH/TSH and T4/morning cortisol/Prolactin/testosterone (in men)
Also check Ca (secondary to acromegaly or hyperparathyroidism), HbA1c, lipid profile

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13
Q

What investigations might you do to look for complications of Acromegaly?

A 
CBG- diabetes 
Sleep studies- OSA 
BP - HTN 
CXR- cardiomegaly 
Echo- to assess LVF 
Pituitary function tests- compression effect
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14
Q

First line management of Acromegaly?

A

Transphenoidal surgery- post op complications include meningitis, DI, panhypopituitarism

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15
Q

Medical therapy in acromegaly?

A

Somatostatin analogues (Octreotide), Dopamine agonists (Cabergoline)

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16
Q

Any associated syndromes for Acromegaly?

A

men 1

17
Q

Common causes of acanthosis nigricans?

A 
Diabetes mellitus 
PCOS 
Acromegaly 
Obesity 
Cushings
Malignancy- gastric and lymphoma
18
Q

Presenting symptoms in Adrenal insufficiency?

A

Fatigue, weakness, low mood, nausea, weight loss, thirst.
Syncope
Hypoglycaemia

19
Q

Biochemical findings of adrenal insufficiency?

A

Hyponatraemia, hyperkalaemia, high urea, hypoglycaemia ?hypothyroidism

20
Q

Education required in Addisons?

A

Sick day rules (double dose, IM hydrocortisone if sick or unable to take usual oral meds)
Importance of compliance
Steroid card
Medic alert bracelet

21
Q

Examination findings in Adrenal insufficiency?

A

Buccal/nipple/scar/creases hyperpigmentation (Addisons)
Orthostatic hypotension
Possible bitemporal hemianopia in secondary adrenal insuffiency

22
Q

Important side effects of carbimazole?

A

Rash, Agranulocytosis, Hepatitis

23
Q

Most important issues to consider in a patient considering radioiodine treatment?

A

Up to 4 weeks with no exposure to pregnant women or children (may be occupational problem).
Short term avoidance of public transport and confined spaces with other people.
Partner to sleep in different bed for a few nights,
Risk of toxic symptoms such as tremor and palpitations.
Can worsen thyroid eye disease so should be stable before treatment.
Regular follow up.
Reliable contraception, pregnancy to be avoided for at least 4 months.
Set off alarms in airports for up to 2 months- signed letter to allow them to travel by air.

24
Q

Most common causes of goitre?

A

Idiopathic
Graves
Iodine deficiency
Puberty and pregnancy

25
Q

Drug causes of thyroid dysfunction?

A

Lithium ( typically hypo)

Amiodarone (hypo or hyper)

26
Q

What do you know about eye signs in Graves disease?

NOSPECS

A 
No signs 
Only upper lid retraction and lid lag 
Soft tissue involvment 
Proptosis 
Extraocular involvement
Corneal ulceration 
Sight loss (secondary to optic nerve damage)
27
Q

Common precipitants to DKA?

A

Infection
Missed insulin
MI
Injury

28
Q

In general management of DKA?

A

Agressive IV fluid replacement with crystalloid and K replacement if K 3-5-5mmol
Fixed rate insulin 0.1unit/kg/hour (+long acting SC insulin)
Monitoring of VBG, CBG and ketones
Treat precipitating cause.

29
Q

Investigations in DKA?

A 
FBC, UEs, LFTs, CRP, HbA1c, lab glucose 
Blood ketones 
Urine dip + culture, blood cultures 
CXR 
ABG/VBG. 
ECG
30
Q

What would you examine for in hypothyroidism?

A

Neck for goitre- ask to stick tongue out and swallow
Hands for dry skin
Pulse- bradycardia
Get off the chair without the use of arms ?proximal myopathy

31
Q

How would you treat hypothyroidism?

A

Levothyroxine 50mcg, recheck bloods at 6 weeks.

32
Q

What to examine in acromegaly?

A

Hands- size and excess soft tissue
Face- coarsening of features (look from the side), macroglossia, inderdental spacing
Visual fields and acuity and eye movements

33
Q

Which thyroid autoantibody is specific to Graves Disease?

A

TSH receptor antibodies

34
Q

What investigations should be performed in suspected adrenal insufficiency?

A

Morning cortisol
SST
FBC (may have eosinophilia), UEs (hyperkalaemia, hyponatraemia), bone profile (hypercalcaemia), glucose, thyroid function and adrenal autoantibodies

CT/MRI pituitary if secondary insufficiency suspected.

35
Q

Which 3 syndromes make up MEN1?

A

Pituitary Adenoma
Parathyroid hyperplasia
Pancreatic tumour

36
Q

Which 3 conditions make up MEN 2a?

A

Parathyroid adenoma
Medullary thyroid carcinoma
Phaechromocytoma

37
Q

Which 4 conditions make up MEN2b?

A

Medullary thyroid carcinoma
Phaechromocytoma
Marfinoid
Mucosal neuroma

Station 5 (12 decks)

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