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Endocrinology Flashcards

1
Q

Effect of dopamine on prolactin secretion

A

Dopamine inhibits prolactin secretion

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2
Q

Effect of somatostatin on GH release

A

Somatostatin inhibits GH release

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3
Q

Effect of TRH on TSH

A

TRH promotes TSH release

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4
Q

Effect of TRH on prolactin release

A

TRH promotes prolactin release

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5
Q

Effect of GnRH on FSH and LH

A

GnRH promotes FSH and LH release

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6
Q

Effect of CRH on ACTH

A

CRH augments ACTH release

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7
Q

Effect of CRH on beta lipotrophin release

A

CRH augments betalipotrophin release (cleaved from ACTH)

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8
Q

Anterior pituitary acidic chromophils

A

Somatotrophs (GH) and Mamotrophs (PRL)

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9
Q

Anterior pituitary basophlic chromophils

A

Thyrotrophs, Corticotrophs, gonadotrophs

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10
Q

Do chromophobe adnomas induce hypo or hyperpituitarism?

A

Chromophobe adenomas induce hypopituitarism

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11
Q

Diebetes insipidus suggests suprasellar extension- true or false

A

True

DI suggests suprasellar extension of a pituitary adenoma

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12
Q

Cushing’s disease caused by acidophilic or basophilic macroadenoma?

A

Chushing’s disease can be caused by a basophilic macroadenoma

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13
Q

Acromegaly caused by an acidophilic or basophilic macroadenoma?

A

Acromegaly may be caused by an acidophilic macroadenoma

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14
Q

Presentation of pituitary macroadenoma with expansion of pituitary fossa

A

Headache

Bilateral hemianopia/superior quadrantanopia

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15
Q

Features of acromegaly

A 
Thoracic kyphosis
Myopathy
Hypertension
DM
Goitre
Cardoimegaly
Hyperhydrosis
Non-suppression of GH on glucose tolerance test
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16
Q

Fearures of Cushing’s disease (Pituitary dependent)

A 
Amenorrhea
Depression
Proximal mypoathy
DM
Hypertension
Hypokalaemia
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17
Q

Causes of hyperprolactinaemia

A 
Oestrogen therapy
Chlorpromazine
Haloperidol
Hypothyroidism
Hypoadrenalism
Cushing's disease
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18
Q

Childhood growth hormone deficiency is likely to feature panhypopituitarism (T/F)

A

False

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19
Q

Common cause of childhood growth hormone deficiency

A

Genetic deficiency of GH releasing factor

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20
Q

Causes of short stature in childhood

A

Turner’s syndrome (45 XO)
Emotional deprivation
Cushing’s syndrome

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21
Q

Causes of hypopituitarism

A

Post partum haemorrhage (Sheehan’s syndrome)
Acromegaly
Autoimmune hypophysitis
Sarcoidosis

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22
Q

Features of hypopituitarism

A

Loss of libido, menstruation and secondary sexual hair
Hypoglycaemia
Coma, water intoxication

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23
Q

Features of cranial DI

A

Increased polyuria after corticosteroid therapy for hpopituitarism
Caused by basal meningitis or hypothalamic trauma
Normal response to ADH (unlike psychogenic polydipsia)

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24
Q

Causes of nephrogenic NI

A

Lithium tx
Heavy metal poisoning
Congenital recessive sex-linked disorder

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25
Causes of SIADH
``` Meningitis Head injury Lobar pneumonia SCC of lung Phenothiazine tx Amitriptyline ```
26
T3 and T4 in thyroid tissue
Stored in colloif vesicles as thyroglobulin
27
Main source of circulating T3
Peripheral conversion of T4 to T3
28
Action of rT3
Inhibits conversion of T4 to T3
29
Low total T3, T4 and TSH | DDx
Hypopituitarism Nephrotic syndrome Liver failure
30
Low T4 and TSH | Where is the cause of the problem?
Thyroid disease
31
Low T4 and TSH with TSH receptor Abs | Where is the cause of the problem?
Thyroid disease (Hashimoto's)
32
Low T4 and high TSH | Where is the cause of the problem?
Thyroid disease
33
Features of thyrotoxicosis
``` AF Collapsing pulse Weight loss Oligomenorrhoea Proximal myopathy Exophthalmos Increased insulin requirements in DM1 ```
34
Managing thyrotoxicosis | AF?
Beta blocker eg propanolol
35
MOA Carbimazole
Prevents thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin Reduced production of T3 and T4
36
Surgery for thyrotoxicosis more likely in young men or women
Men
37
Consequences of 131 radio-iodine tx in thryotoxicosis
50% develop hypothyroidism in 7 years | 50% thyroid isotope uptake is still present after 8 days (8 d half life)
38
Regimens for Grave's disease
Propanonlol and carbimazole Subtotal thyroidectomy after thyroid control Prednisolone, KI, propanolol
39
Complications of subtotal thyroidectomy
Transient hypothyroidism Recurrent laryngeal nerve palsy Hypoparathyroidism Recurrent thyrotoxicosis
40
Clinical features of primary hypothyroidism
``` Carpal tunnel syndrome Proximal myopathy Cold sensitivity Merhorrhagia Deafness Dizziness Puffy eyelids Malar flush Delayed relaxation of reflexes ```
41
Biochemical findings in primary hypothyroidism
High Prolactin Inappropriate ADH secretion High cholesterol Low T3/4, high TSH
42
Clinical findings of primary hypothyroidism in children
Precocious puberty Retardation of growth and sexual development Epyphyseal dysgenesis
43
Causes of goitre
``` Lithium and amiodarone tx Acromegaly Hashimoto's thyroiditis OCP or pregnancy Pendred's syndrome (thyroidal dyshormonogenesis) ```
44
Features of de Quervain's subacute thyroiditis
Giant cells on histopathology | Goitre regresses after thyroxine tx
45
Simple colloid goitre is associated with
Dietary iodine deficiency Excess dietary calcium Turner's syndrome
46
Management of papillary thyroid carcinoma
Total thyroidectomy
47
Presentation of medullary type thyroid carcinoma
Episodic flushing | Diarrhoea
48
List 2 diabetic emergencies in DM1
DKA | Hypoglycaemia
49
List 2 metabolic emergencies that can result from DM or its treatment
``` HONK Lactic acidosis (Metformin) ```
50
Capillary blood glucose 25.7 mol/L. | What 5 investigations?
ABG for lactate and pH U&E for renal impairment/hyperkalaemia FBC for infection Urine ketones for ketoacidosis Plasma glucose to confirm capillary meaasurement ECG for evidence of hyperkalaemia
51
Management of DKA
2 venous cannulae ECG monitoring IV fluids- 1L 0.9% saline in 1 h Insulin: 12 units soluble insulin bolus then IV 6units/hour. When plasma glucose
52
causes of male infertility
Primary (Testicular failure): - Anabolic steroid abuse, cannabis, alcohol - Kleinfelter's syndrome (47XXY), SRY translocation (46XX with short length of paternal Y) - Haemochromatosis Secondary: - Haemochromatosis - Exogenous androgens - Hyperprolactinaemia secondary to drugs/prolactinoma - Hypothalamic/Pituitary tumour - Kallman's syndrome
53
Diagnosis of oligozoospermia
Hx Ex Bloods: fasting plasma glucose, FBC, prolcatin, LH, FSH, testosterone, iron, LFTs Urine steroid profile and check urine steroids/cannabis
54
``` DDx of 22YO female: Acne, hirsutism Oligomenorrhoea Overweight Acanthosis nigricans Pigmented hair ```
PCOS | Late onset 21-hydroxylase deficiency
55
Investigations for PCOS
Serum LF, FSH, Oestrogen, testosterone profile, prolactin, sex-hormone-binding-globulin, 17-hydroxyprogesterone USS ovaries
56
Symptoms of hypothyroidism
``` Cold intolerance Lethargy Constipation Reduced appetite Weight gain ```
57
Causes of hypothyroidism
Autoimmune thyroiditis (Hashimoto's, atrophic) Other thyroiditis (de Quervain's, Reidel's) Drugs (Carbimazole, PTU, amiodarone, lithium) Iatrogenic (thyroidectomy, radioiodine, external beam radiotherapy of neck) Iodine deficiency Congenital (Thyroid dysgenesis, dyshormonogenesis)
58
Management of hypothyroidism
Thyroxine for life Start at 50ug/day and titrate every 4-6 weeks until at 100-150u/day Titrate at 25g increments in elderly who are at risk of arrhythmia and AF Aim: restore TSH to low-normal
59
Management of myxoedematous coma
IV triiodothyronine and thyroxine until able to have oral thyroxine Mechanical ventilation Circulatory support Reverse hypothermia
60
Histological and biochemical features of Hashimoto's thyroiditis
Lymphocytic infiltration of thyroid gland causing goitre formation High anti-thyroglobulin and Anti-TPO Abs
61
Histological and biochemical features of atrophic thyroiditis
Fibrosis, reducing the size of the thyroid gland High anti-thyroglobulin and Anti-TPO Abs TSH receptor Abs
62
Features of de Quervain's thyroiditis
Subactute thyroiditis tender thyroid enlargement transient thyrotoxicosis early in illness followed by hypothyroidism Resolves spontaneously afte a few months
63
Features of hyperthyroidism
``` Heat intolerance/sweating Fatigue Palpitations Weight loss Increased appetite Tremor Exophthalmos, lid lag, lid retraction Change in vision, diplopia, ophthalmoplegia, chemosis, proptosis Goitre with bruit Sinus tachycardia/AF Proximal myopathy Pretibial myxoedema Acropachy ```
64
Pathology of grave's disease
Autoimmune thyrotoxicosis | TSH receptor antibodies stimulate follicular cells of thyroid gland to release T3/T4
65
Options for management of thyrotoxicosis
Block and replace: Carbimazole/PTU and thyroxine. Is agranulocytosis. Radio iodine treatment Subtotal thyroidectomy
66
Drugs that elevate prolactin
Anti-psychotics: Chlopromazine, haloperidol, risperidone Anti-emetics: Metoclopramide, domperidone Anti-depressants: Amitriptyline, fluoxetine, venlafaxine Oestrogens Methyldopa
67
Features of acromegaly
``` Joint pain Coarse facial features DMII Larger hands and feet Sweating Macroglossia Prognathism Interdental separataion HT Carpal tunnel OSA Kyphosis Headache Bitemporal hemianopia Hypopituitarism ```
68
Main cause of acromegaly
Somatotroph-secreting pituitary tumour
69
Diagnosis of Somatotrophic pituitary adenoma
Oral glucose tolerance test with inability to suppress GH
70
Management of acromegaly
Hypophysectomy then radiotherapy Somatostatin analogue (octrelotide, lanreotide) Dopamine agonist (Cabergoline, bromocriptine) GH receptor antagonist
71
Causes of Cushing's syndrome
Exogenous steroids ACTH dependent: Pituitary adenoma (disease), ectopic ACTH release ACTH independent: Adrenal adenoma, adrenal carcinoma, adrenal hyperplasia
72
Clinical features of Cushing's syndrome
``` Proximal myopathy Bruising HT Central obesity Buffalo hump Striae Pigmentation (if ACTH dependent) Hypokalaemia Moon face Facial plethora Hirsutism/hair loss Menstrual disturbance, loss of libido Lethargy, depression, psychosis Osteoporosis Impaired glucose tolerance ```
73
Tests to establish presence of Cushing's syndrome
Short synacthen test/Long synacthen test | Urine cortisol
74
Tests to establish cause of Cushing's disease
``` Plasma ACTH at 9am Serum K and bicarb Long synacthen test CRH test Bilateral inferior petrosal sinus sampling ```
75
Causes of Addison's disease
``` Infection: TB, fungal Autoimmune Neoplasia Bilateral adrenal haemorrhage (Waterhouse Freiderichsen syndrome in sepsis) Trauma Burns Coagulopathy Impaired steroidogenesis (21 hydroxylase or 11ßhydroxylase deficiencies) ```
76
Clinical features of Addison's disease
``` Weight loss Malaise Weakness Skin hyperpigmentation Hyperkalaemia, hyponatraemia Dehydration Nausea, vomiting Anorexia Postural hypotension Diarrhoea Vitiligo ```
77
Biochemical tests to confirm Addison's disease
9am cortisol and ACTH | Short synacthen test
78
Pathology of primary hyperaldosteronism
Conn's disease Adrenal (cortex) hyperplasia or adenoma releasing aldosterone Results in Na+ resporption, K+ and H+ loss and HT
79
Biochemical findings of hyperaldosteronism
``` NOT Hypernatraemia Hypokalaemia Metabolic alkalosis high urine potassium Low plasma renin High plasma aldosterone ```
80
Management of hyperaldosteronism
Remove any adenoma Aldosterone antagonist (Spironolactone) Amiloride
81
Appropriate response to desmopressin
Action at V2 receptors in renal tubules Increased water resporption Increased urine osmolality to >750mOsmol/L
82
Management of cranial DI
Desmopressin (oral, nasal spray, injection)
83
Causes of cranial DI
``` Trauma Neoplasia Inflammatory/infiltrative Infarction Pregnancy ```
84
Causes of nephrogenic DI
Defective V2 receptor or aquaporin gene Chronic renal disease e.g. polycystic Drugs (lithium) Osmotic (hypercalcaemia)
85
Causes of hypercalcaemia
``` Hyperparathyroidism (1/2/3) Vitamin D toxicity Hypoalbuminaemia Dehydration malignancy Granulomatous disease Paget's disease Thyrotoxicosis Addison's disease ```
86
Symptoms of phaechromocytoma
``` Headach Palpitations Vomiting Weakness Dyspnoea Pale Hypertension ```
87
Management of phaechromocytoma
Surgical excision | a and ß blockade with phenoxybenzamine and propanolol
88
Diagnosis of phaechromocytoma
Do an a and ß blockade CT/MRI adrenal glands Scinctigraphy Selective venous sampling of adrenal vein
89
Classification of DM retinopathy
Background Preproliferative Proliferative
90
Features of background retinopathy
Microaneurysms, retinal haemorrhage, exudates
91
Features of pre proliferative retinopathy
Venous beading/looping, extensive haemorrhage, intra-rentinal microvascular abnormalities
92
Features of proliferative retinopathy
New vessels, pre-retinal/vitreous haemorrhage, pre-retinal fibrosis, tractional retinal detachment

Medicine (15 decks)

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