Endocrinology Flashcards

Question

how is risk of CKD managed in feline hyperthyroidism?

Answer 1

medical management before curative treatment to assess

Answer 2

bilateral thyroidectomy

Answer 3

``` inappetence weakness tremors pawing face seizures coma death ```

Answer 4

IV 10% calcium gluconate monitoring for arrhythmia and bradycardia oral therapy

Answer 5

carcinoma adenoma locally invasive with possible metastasis

Answer 6

old mass in ventral neck cough dyspnoea

Answer 7

FNA and histopathology of mass

Answer 8

surgical removal chemo radiation high dose radioactive iodine

Answer 9

poor if large invasive masses | good if surgical removal of small carcinoma

Answer 10

thyroxine/T4 and triiodothyronine/T3 from tyrosine AA by action of thyroid peroxidase oxidating iodine

Answer 11

vascular bilobed structures lateral to proximal tracheal rings

Answer 12

metabolic processes enzymes tissues

Answer 13

protein bound in circulation | biologically active unbound in circulation is fT4

Answer 14

negative feedback on TSH production

Answer 15

in thyroid cell fT4 is deiodoinated to form T3

Answer 16

hypothalamus pituitary thyroid axis TRH in hypothalamus stimulates TSH in pituitary which stimulates T4 and T3 production T4 and T3 are inhibitory for TRH and TSH

Answer 17

lymphocytic thyroiditis | thyroid atrophy

Answer 18

destructive immune mediated process where lymphocytes, macrophages, plasma and fibrous tissue infiltrate

Answer 19

degeneration and progressive replacement by adipose and connective tissue

Answer 20

pituitary hypoplasia | suppression of TSH secretion by glucocorticoids or hyperadrenocorticism

Answer 21

middle aged | breed dispositions to lymphocytic thyroiditis including setter, retriever, ridgeback, cocker, boxer

Answer 22

``` decreased metabolic rate endocrine alopecia facial oedema persistent anoestrus bradycardia NMD myxoedema coma ocular issues SIBO low intestinal peristalsis ```

Answer 23

``` history clinical sign s mild anaemia hypercholesterolaemia hypertriglyceridemia low T4 high TSH anti-thyroglobulin antibodies ```

Answer 24

synthetic T4 prohormone for T3 sodium levothyroxine

Answer 25

``` 6-8 weeks after treatment 2-4 weeks after changing doses TT4 measured after 6 hours after admin monitor fT4 if chronic prednisolone admin monitor cTSH ```

Answer 26

thyrotoxicosis | myxoedema coma

Answer 27

``` panting anxiety PUPD weight loss polyphagia ```

Answer 28

zona glomerulosa- mineralocorticoids zona fasciculata and reticularis- glucocorticoids and sex hormones adrenal medulla- catecholamines

Answer 29

mineralocorticoid | main site of action is late distal and collecting tubules

Answer 30

reabsorption of NaCl and water | secretion of K+ and H+

Answer 31

hyperkalaemia | increased angiotensin II

Answer 32

lack of MC and GC | suspected immune mediated destruction of adrenal cortex

Answer 33

``` neoplasia inflammation infection iatrogenic cause lack of GC only ```

Answer 34

``` young female breeds including poodle and great dane history lack of cortisol and aldosterone weakness vomiting anorexia diarrhoea PUPD low Na addisonian crisis ```

Answer 35

``` collapse severe dehydration hypovolaemia pre-renal azotaemia cardiac arrhythmia hyperkalaemia bradycardia ```

Answer 36

``` history clinical signs non-regenerative anaemia absent stress leukogram low neutrophils high lymphocytes and eosinophils hyperkalaemia and calcaemia pre-renal azotaemia hypoglycaemia and natraemia high liver enzymes low albumin and cholesterol ```

Answer 37

basal cortisol over 55nmol/l

Answer 38

ACTH stimulation test if has disease pre and post ACTH cortisol concentrations are below 20nmol/l cortisol is given and ACTH measured before and 1 hour after

Answer 39

IVFT hydrocortisone or dexamethasone slow correction of hyponatraemia treat hypoglycaemia and hyperkalaemia

Answer 40

GC usually prednisolone MC desoxycortone privalate fludrocortisone but cant manage MC and GC separately

Answer 41

good if managed but long term medication needed | more GC needed in stress

Answer 42

excess production of cortisol

Answer 43

pituitary tumour causing excess ACTH production and loss of negative feedback adrenal tumour causing excess cortisol so suppression of ACTH production iatrogenic

Answer 44

``` abdominal distension hepatomegaly lethargy panting alopecia polydipsia polyphagia ```

Answer 45

``` DM from insulin resistance progression of major signs pulmonary thromboembolism neuro signs pancreatitis secondary infection hypertension ```

Answer 46

``` mild erythrocytosis and thrombosis high neutrophils and monocytes low eosinophils and lymphocytes increased liver enzymes lipolysis hyperglycaemia increased bile acids USG lower than 1.015 urolithiasis ACTH stimulation test LDDST urine cortisol to creatinine ratio ```

Answer 47

probability of negative result if not affected

Answer 48

probability of positive result if affected

Answer 49

collect serum for basal cortisol inject dexamethasone IV collect samples 4 and 8 hours later

Answer 50

expensive may unmask other disease can cause pituitary lesions to expand causing CNS signs

Answer 51

``` LDDST HDDST imaging PDH- symmetrical adrenal glands AT- asymmetrical adrenal glands ```

Answer 52

trilostane hypophysectomy bilateral adrenalectomy radiation

Answer 53

adrenalectomy | trilostane

Answer 54

depends on age and health | usually survive less than few years after diagnosis

Answer 55

cachexia fragile skin syndrome alopecia

Answer 56

HDDST | ACTH stimulation test

Answer 57

adrenalectomy some success with hypophysectomy, trilostane poor prognosis

Answer 58

destruction of pancreatic beta cells due to genetics, immune mediated, pancreatitis, idiopathic beta cell exhaustion due to obesity, diet, drugs

Answer 59

insulin dependent

Answer 60

middle aged to old females breeds such as schnauzer and bichon

Answer 61

``` PUPD glucosuria polyphagia weight loss cataracts diabetic ketoacidosis ```

Answer 62

vomiting collapse dehydration

Answer 63

glycosuria hyperglycaemia fructosamine to show average glycaemia for previous 2-3 weeks

Answer 64

insulin spaying females diet

Answer 65

lenate for immediate length action, caninsulin | PZI for long action

Answer 66

store in fridge replace bottle every 4 weeks mix before use

Answer 67

progesterone causes insulin resistance

Answer 68

non simple sugar to limit hyperglycaemia post feeding calories from complex carbs and protein high fibre consistent feeding in line with insulin

Answer 69

takes weeks to months low dose insulin 2x daily first day of inulin in practice monitoring BG to avoid hypoglycaemia

Answer 70

spot monitoring | continuous glucose monitoring

Answer 71

usually mild glucosuria before insulin no glucosuria for 24 hours may suggest insulin overdose ketones may indicate poor control

Answer 72

hypoglycaemia somogyi overswing short or prolonged duration of action inadequate action

Answer 73

less than 3mmol/l

Answer 74

rebound hyperglycaemia caused by physiologic response to hypoglycaemia BG over 3.6mmol/l

Answer 75

``` hypoglycaemia cateracts diabetic neuropathy hypertension diabetic ketoacidosis ```

Answer 76

good when well managed | survival average 3-5 years after diagnosis

Answer 77

``` old age obesity male indoors burmese maine coon ```

Answer 78

non-insulin dependent

Answer 79

insulin resistance | reduced insulin secretion from beta cell damage, chronic high glucose and FAs

Answer 80

``` obesity genetics pancreatitis UTIs CKD dental disease enteropathy hyperthyroidism hypercortisolism ```

Answer 81

BG consistently over 6.5mmol/l

Answer 82

BG between 10 and 16mmol/l

Answer 83

low carb diet | weight loss

Answer 84

BG over 16 mmol/l high fructosamine glycosuria

Answer 85

``` PUPD weight loss polyphagia DKA peripheral neuropathy cataracts ```

Answer 86

hyperglycaemia glycosuria fructosamine history and clinical signs

Answer 87

insulin diet exercise consistency and commitment of owner

Answer 88

prozinc caninsulin glargine insulin

Answer 89

increases insulin secretion | used alongside diet

Answer 90

weight loss | reduce or prevent need for insulin dose

Answer 91

wet high protein low carbs

Answer 92

increased production of glucoregulatory hormones lack of insulin allows unopposed glucogenic effects of stress hormones in liver, muscle and adipose excess FFA breakdown excess ketone formation

Answer 93

``` PUPD PP weight loss lethargy anorexia strong odour of acetone on breath dehydration hypovolaemia ```

Answer 94

``` restore water and electrolytes insulin to turn off ketone production correct acidosis identify underlying disease analgesia feeding support monitoring ```

Answer 95

hard to treat often have underlying disease can become healthy diabetics or enter remission 25% dont survive

Answer 96

heart failure sepsis pancreatitis

Answer 97

decrease in production of dopamine due to decreased inhibition, pituitary adenoma, overproduction of hormones

Answer 98

``` long curly coat laminitis PUPD weight loss neurological impairment altered fat distribution infertility skin disease periodontal disease ```

Answer 99

clinical signs post mortem ACTH test TRH stimulation test

Answer 100

treat but re test in 4-6 weeks for dose | retest annually as disease progresses

Answer 101

if clinically indicated start treatment and recheck

Answer 102

``` farriery clipping parasite control dental care dopamine agonist ```

Answer 103

obesity insulin resistance or dysregulation laminitis

Answer 104

older horses mainly over 15s

Answer 105

high insulin | normal glucose

Answer 106

high insulin and glucose glucosuria type 2 diabetes

Answer 107

hardy breeds genetically predisposed poor diet so ID facilitating breakdown of glucose and fat and stimulating hepatic gluconeogenesis keeps glucose supply to vital tissue

Answer 108

plenty of food in summer so get fat and IR | loose weight over summer so restore insulin sensitivity by spring

Answer 109

dont have seasonal weight loss | have chronic obesity so stay IR and get laminitis

Answer 110

``` obesity regional adiposity laminitis lipoma hyperlipemia ```

Answer 111

resting insulin and glucose after overnight starving | IR seen by hyperinsulinemia and normoglycemia

Answer 112

``` low carb diet no grass multivitamin and mineral supplement exercise considering laminitis weight loss feeding 1/3 less metformin to block SI carb absorption so decreases IR by weight loss ```

Answer 113

stress or negative energy balance triggers fatty acid metabolism triggers catecholamine and GC release lots of fat moves into circulation

Answer 114

``` obesity ponies pregnancy excess FA stores IR ```

Answer 115

``` hepatic lipidosis liver failure not enough hormones for fat fat embolism kidney failure pancreatitis ```

Answer 116

``` identify if risk prevention better depression anorexia ataxia icterus ```

Answer 117

``` improve energy intake and balance treat hepatic disease eliminate stress treat concurrent diseases inhibit fat metabolism from adipose increase triglyceride uptake by peripheral tissues ```

Answer 118

``` manage hepatic and underlying disease wean foal tempt to eat supportive nutrition glucose infusion ```

Answer 119

60-100% mortality

Answer 120

client education identify risk glucose infusion and insulin