Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CC2 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Which hormones are released by anterior pit

A 
FLAT GP
FSH
LH
ACTH
TSH
GH
Prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which hormones are released by post pit

A

Oxytocin

ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the thyroid axis

A

Hypothalamus releases TRH
Ant pit releases TSH
Thyroid releases T4-> T3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Symptoms of hypothyroidism

A
  1. Weight gain
  2. Fatigue/weakness
  3. Cold
  4. Depression
  5. Hair loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of hypothyroidism

A
  1. Autoimmune (hashimotos, atrophic)
  2. Treatment of hyper (iodine, surgery)
  3. Natural course of thyroiditis and graves
  4. Drug (amiodorone, lithium, phenytoin)
  5. Central - hypopituitarism

WORLDWIDE = iodine deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Diagnosis of hypothyroidism

A
  1. TSH high
  2. T4 and T3 low
    MAY SEE
    TPO antibodies raised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Treatment of hypothyroidism

A

100-150mcg Levothyroxine or 25 for elderly/IHD
Rare SE
interacts with warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Symptoms of hyperthyroidism

A 
Weight loss/inc appetite
Heat intolerance/sweating
Fatigue/cant seep
tremor
Palpitations/nervousness
Irregular periods
Eye problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of hyperthyroidism

A
  1. Graves disease
  2. TNG
  3. Thyroiditis (autoimmune or viral)
  4. Drug induced (amiodarone)
  5. Iodine induced Jod basedow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Diagnosis of hyperthyroidism

A
  1. Low TSH
  2. High T4/3
    MAY SEE
    anti TSH antibodies (TRab)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment of hyperthyroidism

A 
GRAVES
- long course carbimazole 20mg 1 daily
- radioiodine
TNG
- radioiodine 
- surgery
-long term carbimazole
BRIDGE = beta blocker for 1st month
propanolol = mild
nadolol = severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Graves disease natural history, presentation and assd conditions

A

strong genetic asscn
Spontaneous remission 1-2 yrs common. then long term remission, R+R, hypo (TRab)
Can present with dermopathy, smooth diffuse goitre, eye signs assd with smoking
ASSD with addisons, pernicious anaemia and vitiligo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

RF for hyperthyroidism to elicit in history

A
  1. FH of autoimmunity
  2. Female
  3. Smoking
    if post partum thyroiditis suspected ask about t1 diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe hypothalamic- adrenal axis (EDIT)

A

hypothalamus releases ARH
Ant pit releases ACTH
Adrenal glands release cortisol and androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Functions of cortisol

A
  1. Stress response- alert
  2. Inc blood glucose
  3. Inc metabolism
  4. Suppress immune response
  5. Suppress bone formation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Causes of primary adrenal insufficiency

A
  1. Autoimmune = Addison’s disease
  2. Infective = TB, HIV
  3. Congenital = CAH
  4. Neoplastic = adrenal, mets from RCC, lung
  5. Non malignant infiltration = sarcoidosis, amyloidosis, haemochromatosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Symptoms of primary adrenal insufficiency

A 
Low aldosterone:
- fatigue, weakness
- orthostatic hypo
Abdo signs:
- weight loss
- N/V
- abdo pain

XS ACTH = hyperpigmentation

TANNED TIRED TEARFUL TUMMY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of Cushing syndrome

A
  1. Cushing disease = acth secreting pituitary adenoma
  2. Exogenous steroids= long term tx
  3. Ectopic source = paraneoplastic syndrome eg SCLC ACTH secreting
  4. Cancer- Adreno-cortical carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Growth hormone axis

A

Hypothalamus releases GHRH
ant pit releases GH
Liver releases insulin like growth factor 1 IGF1
IGF1 acts everywhere - bone density, muscle mass, cell turnover and organ growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is function of somatostatin

A

Growth hormone inhibiting hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is ghrelin

A

Hormone released by digestive organs onto Ant pit to stimulate GH release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe PTH axis

A
  1. Low calcium, low magneisum and high P04 cause PTH release from 4 glands on thyroid
  2. Inc in number and activity of osteoclasts -> Ca release
  3. Kidneys reabsorb calcium
  4. Kidneys activate vit D -> inc calcium absorption from food in gut
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe PTH axis

A
  1. Low calcium, low magneisum and high P04 cause PTH release from 4 glands on thyroid
  2. Inc in number and activity of osteoclasts -> Ca release
  3. Kidneys reabsorb calcium
  4. Kidneys activate vit D -> inc calcium absorption from food in SI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe RAAS

A
  • low circ volume detected
  • renin released from kidney
  • acts on angiotensin 1 (liver)-> 2
  • angiotensin 2-> angitoensinogen by ACE
  • angiotensinogen causes vasoconstriction and aldosterone release (adrenal)
  • aldosterone = water and Na reaborsption DT and H,K secretion?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Carbimazole indication, SE and alternative

A

Used to control Graves, TNG
Works by blocking TPO from organifying the iodine
RISK = agranulocytosis = low neutrophils = check fbc in pxs on this drug when ill
SE- rash, GI
Teratogenicity
Alternative in preg esp 1st trimester: propylthiouracil
SE: hepatotoxicity and fulminant hepatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does thyroid cancer present, diagnosis, treatment

A

Asymptomatic, palpable nodule in 30-40 year old women
risk - previous head /neck radiation
Diagnose: USS and FNAC
Tx: thyroidectomy, radioiodine ablation, TSH suppressing dose of levothyroxine
rare but good prognosis for most types

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Role of steroids in thyroid problems

A

If treating px with thyroid eye disease with radioactive iodine need to give prophylactic steroids
Can give prednisolone in severe thyroiditis symptom management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is T1 diabetes

A

Autoimmune or idiopathic destruction of beta cells that result in complete loss of insulin
So there is no uptake of glucose from blood, no glyconeogenesis, no inhibition of glycogenolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Diagnosis of diabetes

A

HbA1c > 48
Fasting bgc > 7
Random bgc or OGTT > 11

If T1 symptomatic = 1 test is enough
if T2 need 2 tests

30
Q

Diagnosis of pre-diabetes

A

HBA1c > 38
Fasting > 5.5
Random > 7.8

31
Q

Treatment of T1 diabetes

A

Insulin injection or subcut infusion
Never stop, inc when ill (hyperglycaemic)
Take a mixture of long and short acting

Monitor 3 monthly with Hba1c or fructosamine if blood disorder

32
Q

What is DKA

A
  1. Hyperglycaemic or known diabetic
  2. Ketonaemia >3 bloods or urine >2
  3. Metabolic acidosis VBG > 7.3 pH or Hc03 <15

Cause
- forgot to take insulin/infection

33
Q

Presentation of DKA

A 
ACUTE < 24 HOURS
T1 DIABETIC
Usual t1 symptoms + 
N+V
Abdo pain 
Reduced conciousness,low bp, excessive tiredness, headache
Hyperventilation
Hot dry skin
Hypothermic
34
Q

Presentation of DKA

A 
ACUTE < 24 HOURS
T1 DIABETIC
Usual t1 symptoms + 
N+V
Abdo pain 
Reduced conciousness,low bp, excessive tiredness, headache
Hyperventilation
Hot dry skin
Hypothermic
35
Q

Treatment of DKA

A
  1. 500ml of 0.9% NaCL
  2. FRII 0.1unit/kg/hour of insulin
  3. Potassium if <5.5 because insulin lowers K risk of hypokalaemia
  4. VTE prophylaxis
  5. Glucose if bgc <14
36
Q

What is T2 diabetes

A

Beta cell of pancreas dysfunction = reduced sensitivity to and production of insulin

37
Q

Presentation of T2 diabetic

A

Asymptomatic

Chronic fatigue, may have blurred vision

38
Q

RF for T2 diabetes

A

Non modifiable:

  • age
  • ethnicity
  • FH
  • PCOS
  • exisitng CVD

Modifiable:

  • activity, weight status (BMI 25-30 over, 30+ obese)
  • hypertension
  • hyperlipidaemia
39
Q

Management of T2 diabetes other than OHA

A 
Conservative: 
activity = reduce cv risk, directly use glucose, inc glycogen stores, directly inc sensitivity to insulin 
change diet 
stop smoking = cvd
alcohol = risk hypo

DRUGS

  • BP
  • Lipid
  • Antiplatelet asprin, clopidogrel CV risk
40
Q

What is HHS

A
  1. Hyperosmolar ( >320 mosmol/kg)
  2. Marked Hyperglycaemic (>30)
  3. Hypovolemic
  4. non ketotic

Causes - old diabetic who is ill or poorly controlled
Present - confused, dehydrated over a few days

41
Q

Treat HHS

A

SLOW fluid replacement, naturally lowers glucose
if not -> insulin
Watch for hypernatraemia with saline replacement
Watch for hypokalaemia
VTE and ulcer protection

42
Q

OHA for T2 diabetes

A
  1. Metformin
  2. SU eg gliclazide
  3. Pioglitazone
  4. Incretin based - gliptins, exenatide
  5. Acarbose
  6. SGLT2 inhibitors
43
Q

How does metformin work, benefits and SE

A

Increases insulin sensitivity by
- inc glucose uptake into muscle
- reduce gluconeogensis
- decrease gut absorption of glucose
Benefit: cannot cause hypo or weight gain
BUT risk of lactic acidosis so check LFT and U+E before.
SE- GI, impaired B12 absorption

44
Q

How do SU’s work, examples, side effects.

Name a similar drug

A

Change electrochemical gradient accross B cells via K = MORE INSULIN secreted
EG gliclazide, tolbutamide (s), glibenclamide (l)
SE- hypo, weight gain
CI- pregnancy/breastfeeding
SIMILAR- REPAGLINIDE
but shorter half life, less risk of hypo

45
Q

What is pioglitazone an example of, how does it work and what are its SE

A

Thiazolidinediones
Increases lipid metabolism -> secondary glucose uptake
SE- weight gain, peripheral oedema, inc risk bladder cancer, reduce bone density

46
Q

How do gliptins work, examples, SE

A 
Gliptins = inhibit DPP4 = inhibit incretin(GLP1) breakdown 
= inc glucose mediated insulin release
SE- pancreatitis 
CANT cause hypo
Eg
Linagliptin, Alogliptin, Saxagliptin
47
Q

What kind of drug is exanatide, how does it work for diabetes and SE

A

Exanatide is a GLP1 analogue (mimetic) = glucose mediated insulin release increases
also : impaired glucagon secretion, slow gastric emptying
Benefit = only one good for obese px except acarbose
SE- subcut injection, N+V, pancreatitis

48
Q

How do SGLT2 inhibitors work for diabetes, examples, SE

A

Reduce renal resorption of glucose
Gliflozins
SE- DKA, peripheral vasc disease
Eg dapagliflozin, clanagliflozin

49
Q

Risk factors/associations of primary adrenal insufficiency

A
  1. Hypothyroidism
  2. Female
  3. Hypercoaguable state
50
Q

Symptoms of Cushing’s syndrome

A
  1. Central adiposity, buffalo hump
  2. Purple striae
  3. Think skin, bruising
  4. Facial plethora
  5. Diabetes symptoms
  6. Prem osteoporosis
51
Q

How to investigate cushing syndrome

A

PMH: steroid use, cancers
DEXAMETHASONE suppression test
Low dose = fails to suppress axis, cortisol still high
High dose = lowers cortisol in cushings disease. Ectopic or endogenous = stay high.

MRI pituitary for disease

52
Q

How is cushings syndrome treated

A

DISEASE: trans-sphenoidal hypophysectomy, radiotherapy

SYNDROME: metyrapone, ketoconazole, etomidate ICU, mitotane (ACC)

53
Q

How is primary adrenal insufficiency diagnosed

A

Low sodium, high potassium
SHORT SYNACTHEN TEST
primary = low or no cortisol response

54
Q

How is secondary adrenal insufficiency diagnosed

A

high suspicion -> treat
Early morning cortisol
May do a synacthen if stable later

55
Q

How is adrenal insufficiency treated

A
  1. Replace aldosterone if primary = fludrocortisone

2. Replace cortisol = hydrocortisone

56
Q

What is an adrenal crisis and how is it prevented

A 
Emergency situation where a patient has insufficient cortisol response to stress
They will be 
- hypotensive, tachycardic
- hypoglycaemic
- hyponatraemic -> confused
hyperkalaemic

PREVENT = sick day rules, pxs on cortisol should take more when ill

57
Q

Causes of secondary adrenal insufficiency

A
  1. Exogenous steroid use
  2. Ectopic ACTH secretion
  3. Hypopituitarism
58
Q

What are the causes of primary hyperaldosteronism/Conn’s syndrome?

A
  1. Aldosterone secreting adenoma of adrenals

2. Idiopathic (familial)

59
Q

How does Conn’s present

A
  1. Hypertensive (always consider)
    - headaches
    - retinopathy
    - weakness/tired
  2. Hypokalaemic (can be normal, but they can end up swapping H,K for Na)
    risk of met acidosis

could also present with hypertensive complications eg stroke

60
Q

Diagnosis of conn’s

A
  1. Plasma aldosterone: renin ratio= increased

2. Fludrocortisone suppression test = would expect aldosterone to drop but it doesn’t

61
Q

How is conn’s treated

A
  1. Excise adenoma

2. Spironolactone (gynae SE), triamterene for K preservation + amiloride diuretic for fluid overload

62
Q

What is phaeochromocytoma

A

Excess catecholamines (ad,nad, dop) due to adrenal medullary tumour

63
Q

Symptoms of phaeochromocytoma

A

random

  • sweating
  • palpitation
  • headache

-tremor
-pallor
- weakness
hypertension

64
Q

How is phaeochromocytoma diagnosed + tx

A

No consensus for diagnostic test

Tx- alpha and beta blockers, excise tumour

65
Q

Causes of secondary hyperaldosteronism

A
  • Benign JMA growth = inc renin

- RAS = false activation

66
Q

Causes of primary hyperparathyroidism and blood results

A
  1. benign PT adenoma
  2. Hyperplasia
  3. Cancerous tumour

PTH high
Calcium high
Phosphate low
vit d high

67
Q

Causes of secondary hyperparathyroidism and blood results

A
  1. renal disease
  2. vit d deficiency
  3. malabsorption eg pancreatitis

PTH high
calcium low
Phosphate high
low vit d (renal fail)

68
Q

Causes of tertiary hyperparathyroidism and blood results

A 
Continued secondary, px given tx but axis doesnt respond
PTH high 
calcium high
phosphate high
vit d low
69
Q

Symptoms of hypercalcaemia

A

Stones
Bones
Abdo moans
Pyschic groans(confusion)

70
Q

Symptoms of hypocalcaemia

A 
CATs go numb
convulsions
arrhythmias
tetany 
numb hands, feet, around mouth
= chvosteks sign 
= trosseau sign

CC2 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions