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Medicine > Endocrinology > Flashcards

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
Q

Causes of SIADH

A 
Meningitis
Head injury
Lobar pneumonia
SCC of lung
Phenothiazine tx
Amitriptyline
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26
Q

T3 and T4 in thyroid tissue

A

Stored in colloif vesicles as thyroglobulin

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27
Q

Main source of circulating T3

A

Peripheral conversion of T4 to T3

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28
Q

Action of rT3

A

Inhibits conversion of T4 to T3

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29
Q

Low total T3, T4 and TSH

DDx

A

Hypopituitarism
Nephrotic syndrome
Liver failure

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30
Q

Low T4 and TSH

Where is the cause of the problem?

A

Thyroid disease

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31
Q

Low T4 and TSH with TSH receptor Abs

Where is the cause of the problem?

A

Thyroid disease (Hashimoto’s)

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32
Q

Low T4 and high TSH

Where is the cause of the problem?

A

Thyroid disease

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33
Q

Features of thyrotoxicosis

A 
AF
Collapsing pulse
Weight loss
Oligomenorrhoea
Proximal myopathy
Exophthalmos
Increased insulin requirements in DM1
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34
Q

Managing thyrotoxicosis

AF?

A

Beta blocker eg propanolol

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35
Q

MOA Carbimazole

A

Prevents thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin
Reduced production of T3 and T4

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36
Q

Surgery for thyrotoxicosis more likely in young men or women

A

Men

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37
Q

Consequences of 131 radio-iodine tx in thryotoxicosis

A

50% develop hypothyroidism in 7 years

50% thyroid isotope uptake is still present after 8 days (8 d half life)

38
Q

Regimens for Grave’s disease

A

Propanonlol and carbimazole
Subtotal thyroidectomy after thyroid control
Prednisolone, KI, propanolol

39
Q

Complications of subtotal thyroidectomy

A

Transient hypothyroidism
Recurrent laryngeal nerve palsy
Hypoparathyroidism
Recurrent thyrotoxicosis

40
Q

Clinical features of primary hypothyroidism

A 
Carpal tunnel syndrome
Proximal myopathy
Cold sensitivity
Merhorrhagia
Deafness
Dizziness
Puffy eyelids
Malar flush
Delayed relaxation of reflexes
41
Q

Biochemical findings in primary hypothyroidism

A

High Prolactin
Inappropriate ADH secretion
High cholesterol
Low T3/4, high TSH

42
Q

Clinical findings of primary hypothyroidism in children

A

Precocious puberty
Retardation of growth and sexual development
Epyphyseal dysgenesis

43
Q

Causes of goitre

A 
Lithium and amiodarone tx
Acromegaly
Hashimoto's thyroiditis
OCP or pregnancy
Pendred's syndrome (thyroidal dyshormonogenesis)
44
Q

Features of de Quervain’s subacute thyroiditis

A

Giant cells on histopathology

Goitre regresses after thyroxine tx

45
Q

Simple colloid goitre is associated with

A

Dietary iodine deficiency
Excess dietary calcium
Turner’s syndrome

46
Q

Management of papillary thyroid carcinoma

A

Total thyroidectomy

47
Q

Presentation of medullary type thyroid carcinoma

A

Episodic flushing

Diarrhoea

48
Q

List 2 diabetic emergencies in DM1

A

DKA

Hypoglycaemia

49
Q

List 2 metabolic emergencies that can result from DM or its treatment

A 
HONK
Lactic acidosis (Metformin)
50
Q

Capillary blood glucose 25.7 mol/L.

What 5 investigations?

A

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
Q

Management of DKA

A

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
Q

causes of male infertility

A

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
Q

Diagnosis of oligozoospermia

A

Hx
Ex
Bloods: fasting plasma glucose, FBC, prolcatin, LH, FSH, testosterone, iron, LFTs
Urine steroid profile and check urine steroids/cannabis

54
Q 
DDx of 22YO female:
Acne, hirsutism
Oligomenorrhoea
Overweight
Acanthosis nigricans
Pigmented hair
A

PCOS

Late onset 21-hydroxylase deficiency

55
Q

Investigations for PCOS

A

Serum LF, FSH, Oestrogen, testosterone profile, prolactin, sex-hormone-binding-globulin, 17-hydroxyprogesterone
USS ovaries

56
Q

Symptoms of hypothyroidism

A 
Cold intolerance
Lethargy
Constipation
Reduced appetite
Weight gain
57
Q

Causes of hypothyroidism

A

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
Q

Management of hypothyroidism

A

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
Q

Management of myxoedematous coma

A

IV triiodothyronine and thyroxine until able to have oral thyroxine
Mechanical ventilation
Circulatory support
Reverse hypothermia

60
Q

Histological and biochemical features of Hashimoto’s thyroiditis

A

Lymphocytic infiltration of thyroid gland causing goitre formation
High anti-thyroglobulin and Anti-TPO Abs

61
Q

Histological and biochemical features of atrophic thyroiditis

A

Fibrosis, reducing the size of the thyroid gland
High anti-thyroglobulin and Anti-TPO Abs
TSH receptor Abs

62
Q

Features of de Quervain’s thyroiditis

A

Subactute thyroiditis
tender thyroid enlargement
transient thyrotoxicosis early in illness followed by hypothyroidism
Resolves spontaneously afte a few months

63
Q

Features of hyperthyroidism

A 
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
Q

Pathology of grave’s disease

A

Autoimmune thyrotoxicosis

TSH receptor antibodies stimulate follicular cells of thyroid gland to release T3/T4

65
Q

Options for management of thyrotoxicosis

A

Block and replace: Carbimazole/PTU and thyroxine. Is agranulocytosis.
Radio iodine treatment
Subtotal thyroidectomy

66
Q

Drugs that elevate prolactin

A

Anti-psychotics: Chlopromazine, haloperidol, risperidone
Anti-emetics: Metoclopramide, domperidone
Anti-depressants: Amitriptyline, fluoxetine, venlafaxine
Oestrogens
Methyldopa

67
Q

Features of acromegaly

A 
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
Q

Main cause of acromegaly

A

Somatotroph-secreting pituitary tumour

69
Q

Diagnosis of Somatotrophic pituitary adenoma

A

Oral glucose tolerance test with inability to suppress GH

70
Q

Management of acromegaly

A

Hypophysectomy then radiotherapy
Somatostatin analogue (octrelotide, lanreotide)
Dopamine agonist (Cabergoline, bromocriptine)
GH receptor antagonist

71
Q

Causes of Cushing’s syndrome

A

Exogenous steroids
ACTH dependent: Pituitary adenoma (disease), ectopic ACTH release
ACTH independent: Adrenal adenoma, adrenal carcinoma, adrenal hyperplasia

72
Q

Clinical features of Cushing’s syndrome

A 
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
Q

Tests to establish presence of Cushing’s syndrome

A

Short synacthen test/Long synacthen test

Urine cortisol

74
Q

Tests to establish cause of Cushing’s disease

A 
Plasma ACTH at 9am
Serum K and bicarb
Long synacthen test
CRH test
Bilateral inferior petrosal sinus sampling
75
Q

Causes of Addison’s disease

A 
Infection: TB, fungal
Autoimmune
Neoplasia
Bilateral adrenal haemorrhage (Waterhouse Freiderichsen syndrome in sepsis)
Trauma
Burns
Coagulopathy
Impaired steroidogenesis (21 hydroxylase or 11ßhydroxylase deficiencies)
76
Q

Clinical features of Addison’s disease

A 
Weight loss
Malaise
Weakness
Skin hyperpigmentation
Hyperkalaemia, hyponatraemia
Dehydration
Nausea, vomiting
Anorexia
Postural hypotension
Diarrhoea 
Vitiligo
77
Q

Biochemical tests to confirm Addison’s disease

A

9am cortisol and ACTH

Short synacthen test

78
Q

Pathology of primary hyperaldosteronism

A

Conn’s disease
Adrenal (cortex) hyperplasia or adenoma releasing aldosterone
Results in Na+ resporption, K+ and H+ loss and HT

79
Q

Biochemical findings of hyperaldosteronism

A 
NOT Hypernatraemia
Hypokalaemia
Metabolic alkalosis
high urine potassium
Low plasma renin
High plasma aldosterone
80
Q

Management of hyperaldosteronism

A

Remove any adenoma
Aldosterone antagonist (Spironolactone)
Amiloride

81
Q

Appropriate response to desmopressin

A

Action at V2 receptors in renal tubules
Increased water resporption
Increased urine osmolality to >750mOsmol/L

82
Q

Management of cranial DI

A

Desmopressin (oral, nasal spray, injection)

83
Q

Causes of cranial DI

A 
Trauma
Neoplasia
Inflammatory/infiltrative
Infarction
Pregnancy
84
Q

Causes of nephrogenic DI

A

Defective V2 receptor or aquaporin gene
Chronic renal disease e.g. polycystic
Drugs (lithium)
Osmotic (hypercalcaemia)

85
Q

Causes of hypercalcaemia

A 
Hyperparathyroidism (1/2/3)
Vitamin D toxicity
Hypoalbuminaemia
Dehydration
malignancy
Granulomatous disease
Paget's disease
Thyrotoxicosis
Addison's disease
86
Q

Symptoms of phaechromocytoma

A 
Headach
Palpitations
Vomiting
Weakness
Dyspnoea
Pale
Hypertension
87
Q

Management of phaechromocytoma

A

Surgical excision

a and ß blockade with phenoxybenzamine and propanolol

88
Q

Diagnosis of phaechromocytoma

A

Do an a and ß blockade
CT/MRI adrenal glands
Scinctigraphy
Selective venous sampling of adrenal vein

89
Q

Classification of DM retinopathy

A

Background
Preproliferative
Proliferative

90
Q

Features of background retinopathy

A

Microaneurysms, retinal haemorrhage, exudates

91
Q

Features of pre proliferative retinopathy

A

Venous beading/looping, extensive haemorrhage, intra-rentinal microvascular abnormalities

92
Q

Features of proliferative retinopathy

A

New vessels, pre-retinal/vitreous haemorrhage, pre-retinal fibrosis, tractional retinal detachment

Medicine (15 decks)

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