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CMS > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

3 basic problems with endocrine system?

A
  • excess hormones - widespread effect
  • reduced hormones - widespread effect
  • physical gland enlargement - mass pressure/effect
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2
Q

pituitary gland produces what hormone that encourages the thyroid to produce T4/T3?

A

TSH

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3
Q

Thyroxine excess is a disease of the thyroid causing?

A

hyperthyroidism

thyrotoxicosis

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4
Q

Thyroxine lack is a disease of the thyroid causing?

A

hypothyroidism

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5
Q

Thyroid mass changes is a disease of the thyroid causing?

A

Goitre

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6
Q

incidence of hyperthyroidism?

A

2-3% of women
0.2% men
age common = 20-40 years

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7
Q

most common causes of hyperthyroidism?

A

autoimmune e.g graves disease = most common
goitre or toxic adenoma
pituitary driven

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8
Q

symptoms of hyperthyroidism?

A

sweating, heat intolerance
irrtable, poor sleep, anxiety, palpitations
excess appetite, weight loss, diorrhea
breathlessness

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9
Q

signs of hyperthyroidism?

A 
warm moist skin
tachycardia - irregular heart rate
increased blood pressure, heart failure
fine tremor
goitre
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10
Q

what is graves disease?

A 
eye disease
exopthalmus
opthalmaplegia
lid lag/retraction
loss of visual activity
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11
Q

signs of graves disease?

A

pretibial myxoedema

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12
Q

diagnose graves disease?

A

clinical
blood tests - thyroid function - low TSH, high T3/4, autoantibodies
radiology sometimes

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13
Q

management of graves disease?

A

anti thyroid drugs - carbimazole, propylthiouracid
beta blockers - control symptoms while other tx
surgery - control disease first, poss eye surgery
radioactive iodine - caution if youner/pregnant/breastfeeding

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14
Q

incidence of hypothyroidism?

A

2% women
0.2% men
mean age of diagnosis = 60 yrs

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15
Q

causes of hypothyroidism?

A

autoimmune most common = destructive
iatrogenic - surgery, radioiodine
iodine deficiency - rare - iodised salt/fish, poor mountainous areas
rarely pituitary disease

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16
Q

symptoms of hypothyroidism?

A 
cold intolerance
weight gain
constipation
hoarse voice
puffed face/extremities
mental slowness/poor memory
hair loss
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17
Q

signs of hypothyroidism?

A 
slow pulse
large tongue
deep voice
thin/dry hair
loss of eyebrows
goitre
coarsening of features
acute - rare - coma - hypothermia
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18
Q

diagnosis of hypothyroidism?

A

clinical
blood tests - thyroid function tests - high TSH, low T4/T3
auto antibodies
radiology

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19
Q

management of hypothyroidism?

A

replacement
thyroxine
levothyroxine

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20
Q

what is goitre?

A

thyroid masses

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21
Q

types of goitre?

A
  • no association with intrinsic thyroid disease - simple cysts/adenomas - iodine deficiency
  • associated with intrinsic thyroid disease - autoimmune, toxic multi nodular goitre/adenoma
  • Malignant = rare
22
Q

Goitres can cause?

A

retro sternal extension = dysphagia/breathing difficulties

23
Q

what is an ominous sign of goitre?

A

look for lymph node enlargement

24
Q

goitre investigations?

A

radiology - ultrasound/radioisotope scans
fine needle aspiration
blood tests

25
Q

treatment of goitre?

A

remove underlying cause

may need surgery

26
Q

anti thyroid drug carbimazole can cause what orally?

A

neutropenia

taste distrubances

27
Q

types of adrenal disease?

A
  • excess corticosteroid - Cushings

- deficient corticosteroid production - Addisons

28
Q

what is Cushings syndrome?

A

excess ACTH caused by pituitary adenoma

or ectopic production by lungs = cancer

29
Q

excess corticosteroids caused by?

A

adrenal adenomas
carcinomas
iatrogenic

30
Q

Cushings syndrome has what systemic risk factors?

A

can cause high bp
diabetes
pt prone to infection

31
Q

what is Addison’s disease?

A
  • caused iatrogenically by withdrawl of steroids after long term use
  • hypopituitarism - b/c cancer, infection, vascular, trauma
  • adrenal destruction - b/c autoimmune disease
32
Q

what is chronic addisons?

A

general malaise

33
Q

what is acute addisons?

A

response to stress
infection/trauma/surgery
life threatening
=> shock, hypoglycaemia, vomiting, abdominal pain

34
Q

signs of addisons?

A

hyperpigmentation

buccal mucosa scars, pressure points, skin creases

35
Q

treatment of addisons?

A

replacement therapy = baseline tx
hydrocortisone - glucocorticoid 20mg am 20mg pm
flufrocortisone - mineralcorticoid

36
Q

what is an acute addisonian crisis?

A 
medical emergency
need fluid replacement
glucose
hydrocortisone injection
treat if infection is present
hospital
37
Q

dentally look out for what with addisons pt? cushings?

A

addisons - hyperpigmentation

cushings - oral infections/poor wound healing

38
Q

what is an excess of growth hormone?

A

acromegaly

caused by pituitary adenoma - rare = 2-3/million

39
Q

signs of acromegaly?

A 
large tongue
excess hair
spade like hands/feet - myopathy/arthritis 
pronounced supraorbital ridge
broad nose
prognathism
inderdental seperation
thick greasy skin
diabetes
high bp
heart failure
40
Q

treatment of acromegaly?

A

medically - somatostatin analouges

surgery - compressing nearby structures, also radiotherapy

41
Q

types of diabetes?

A

type 1 - IDDM 10% autoimmune young pts

type 2 - NIDDM 90% - insulin resistance/deficiency - more likely if obese >40 yrs. 10% are over 70

42
Q

what does diabetes cause an increased risk of?

A

increased risk of all infections

43
Q

what is seen on skin/mouth with diabetes?

A

boils, abscesses, cellulitis, candidosis

44
Q

what kind of diseases are seen commonly with diabetic pt’s?

A

diabetic retinopathy
diabetic nephropathy
diabetic neuropathy - loss of sensation, loss of bowel/bladder/sexual function, muscle weakeness/pain

45
Q

what type of heat condition is common with diabetic pts?

A

atherosclerosis

46
Q

foot problems with diabetes?

A

atherosclerosis
neuropathy
infections

47
Q

treat type 1 with?

A

insulin

48
Q

type 2 treat with?

A 
sometimes insulin
initially dietary
sulphonylureas
biguanides
glitazones
49
Q

emergencies with diabetes - high blood sugar?

A

DKA

HONK - hyperosmolar non ketotic coma

50
Q

low blood sugar?

A

hypoglycaemia

51
Q

what is DKA?

A

insulin not taken in because no food intake

inadequate insulin in acute physiological stress = infection/surgery

52
Q

what is dka often a combo with?

A

gastroenteritis

impaired consciousness, dehydration, ketones on breath

CMS (42 decks)

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