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Finals > Endocrinology and Metabolic Medicine > Flashcards

Endocrinology and Metabolic Medicine Flashcards

1
Q

What are the hypothalamic releasing and inhibiting factors?

A 
Releasing:
GnRH
GHRH
TRH
CRH
Inhibiting:
Somatostatin
Dopamine
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2
Q

Which releasing factors act on the anterior pituitary and what do they cause to be released or downregulated?

A

GnRH - LH and FSH which acts on the gonads to produce androgens
GHRH - GH acts on liver to cause growth via Insulin-like GF
TRH - releases TSH, causing the thyroid to release thyroxine
Somatostatin - down-regulates GH and TSH release
Dopamine - down-regulates prolactin release
CRH - ACTH release causes steroid synthesis in the adrenals

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3
Q

What hormones are released by the posterior pituitary

A

vasopressin - renal tubules

oxytocin - breasts and uterus

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4
Q

Symptoms of over-production in the pituitary

A

Acromegaly - prognathism, interdental separation, large tongue, spade-like hands and feet, tight-fitting rings, or gigantism in children
Prolactin excess - galactorrhoea, gynecomastia
ACTH excess - nelson’s (hyperpigmentation, visual disturbance, headaches, menstrual cycle disturbance) or Cushing’s (weight gain, central fat distribution, abdominal striae, hirsutism, mood changes, gonadal dysfunction)

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5
Q

Local effects of pituitary tumours

A

bitemporal hemianopia
cavernous sinus infiltration - III (ptosis, lateral gaze), IV (diplopia corrected with head tilt) and VI (lateral rectus palsy) cranial nerve palsy
Bony or meninges infiltration - headaches
hypothalamus infiltration - obesity, precocious puberty
ventricular infiltration - hydrocephalus

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6
Q

what is the short synACTHen test?

A

ACTH analogue is given, which should stimulate cortisol secretion
measure plasma cortisol should rise to over 500nmol/L
A negative response suggests primary hypoadrenalism (Addison’s)

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7
Q

What is an insulin tolerance test?

2 CIs

A

measures growth hormone response
can assess pituitary reserve
CI IHD and epilepsy

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8
Q

What is a dexamethasone suppression test?

A

dexamethasone should suppress ACTH and cortisol

failure to suppress suggests cortisol excess - Cushing’s

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9
Q

symptoms of hypopituitarism

A 
gonadotrophin deficiency:
loss of libido, erectile dysfunction, amenorrhoea
Hyperprolactinaemia:
galactorrhoea, hypogonadism
GH deficiency:
Short stature in children, no effect in adults
Hypothyroidism and adrenal failure:
TATT, weight gain, slow, depression.
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10
Q

Causes of hypothyroidism (5)

A

Primary:
primary atrophic hypothyroidism (common) - no goitre
Hashimoto’s thyroiditis - immune infiltrate causes goitre
Iodine deficiency - rare in UK due to water supplementation
Iatrogenic - surgery, radioiodine treatment, amiodarone, lithium, iodine
postpartum or De Quervain’s thyroiditis - painful goitre
Secondary: v rare due to hypopituitarism

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11
Q

Causes of hyperthyroidism (6)

A

Graves - common, immune infliltrate causes goitre
toxic multinodular goitre - older, iodine deficient patients. decompressive surgery.
toxic adenoma - solitary overactive nodule
ectopic thyroid tissue - Metastatic thyroid cancer or teratoma
iodine or thyroxine excess
thyroiditis - postpartum, due to amiodarone

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12
Q

ECG changes in myoxoedemic crisis

A

heart block, prolonged QT, ST and T wave changes

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13
Q

adrenal layers and their hormones

A

zona glomerulosa - mineralocorticoids - fluids - Na retention, salivary glands, sweat, colon, BP
Zona fasiculata - glucocorticoids - anti-inflammatory, promote glouconeogenesis, lipolysis and inhbit glucose uptake
Zona reticularis - androgens - secondary to gonads
Adrenal medulla- catecholamines - sympathetic nervous system

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14
Q

Adrenal excess - name and causes (7)

A

cushing’s syndrome
ACTH dependent
-pituitary disease - cushing’s disease
-ectopic ACTH - small call and carcinoid tumours
-ACTH administration
ACTH independent causes
-adrenal adenomas
- adrenal carcinomas
- glucocorticoid administration (MOST COMMON)
Alcohol-induced psuedo-cushing’s syndrome

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15
Q

symptoms of Cushing’s (7)

A 
central obesity +/- buffalo hump
plethoric complexion
thin, easily bruising skin
striae on the abdomen, legs, breasts
proximal myopathy
pathological #
hypertension
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16
Q

what is Addison’s disease?

A

adrenal insufficiency due to autoimmune destruction of the adrenal cortex. May also be due to TB, surgical removal of adrenals or malignant infiltration.

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17
Q

Symptoms of Addison’s

A

lethargy, depression, anorexia, weight loss
postural hypotension and salt craving
hyperpigmentation in skin folds
vitiligo and hair loss in women

18
Q

symptoms of Addisonian crisis

A 
vomiting
abdominal pain
profound weakness
hypoglycaemia
hypovolaemia
19
Q

management of Addisonian crisis (5)

A 
take cortisol and ACTH, calcium and other bloods
give 100mg IB hydrocortisone
give fluids - saline
treat hypoglycaemia 
treat precipitating cause
20
Q

Primary hyperaldosteronism presentation and causes

A

hypertension, hypernatraemia, and hypokalemia
adrenal hyperplasia
adrenal adenoma
adrenal carcinoma (rare)

21
Q

diagnostic criteria for diabetes

A

present once if symptomatic, twice if asymptomatic.
Fasting BM - 6.0 to 7.0 = prediabetse, >7.0= diabetes
HBA1C 41 to 48 = prediabetes, >/=48 = diabetes

22
Q

DKA management

A

Fluids

fixed rate insulin infusion 0.1u/kg/hr and usual long-acting insulin

23
Q

Causes of thyroid storm (4)

A

thyroid or non-thyroidal surgery
trauma
infection
acute iodine load e.g. CT contrast media

24
Q

presentation of thyroid storm (7)

A 
fever > 38.5ºC
tachycardia
confusion and agitation
nausea and vomiting
hypertension
heart failure
abnormal liver function/jaundice
25
Q

management of thyroid storm (6)

A

symptomatic treatment e.g. paracetamol
treatment of underlying precipitating event
IV propranolol
anti-thyroid drugs: e.g. methimazole or propylthiouracil
Lugol’s iodine
dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3

26
Q

Phaeochromocytoma
what is it?
associations

A 
catecholamine secreting tumour
10% are familial - associated with MEN type II, neurofibromatosis and von Hippel-Lindau syndrome
10% are bilateral
10% are malignant 
10% are extra-adrenal
27
Q

symptoms of phaeochromocytoma (5)

A

hypertension

episodic palpitations, anxiety, sweating, headaches

28
Q

diagnostic test for phaeochromocytoma

A

24hr urinary metanephrines

29
Q

Mx of phaeochromocytoma

A

surgery is definitive Mx

alpha then beta-blocker to control hypertension until then

30
Q

What is SIADH?

A

hyponatraemia secondary to excessive water retention

31
Q

causes of SIADH (5 categories)

A

Brain injury - stroke, SAH, subdural, infection
Malignancy- SCLC
Infections - TB, pneumonia
Drugs - SSRIs, TCAs, carbamazepine, sulfonylureas, vincristine, cyclophosphamide
Hypothyroidism

32
Q

Mx of SIADH

A

slowly replace Na to prevent central pontine myelinolysis
Fluid restriction
drugs - ADG receptor antagonisits

33
Q

MEN I

A

Three Ps
Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
Also: adrenal and thyroid
Commonly present as hypercalcaemia

34
Q

MEN II

A 
Medullary thyroid cancer (70%)
2 P's
Parathyroid (60%)
Phaeochromocytoma
RET Oncogene
35
Q

MEN III

A

Medullary thyroid cancer
1 P
Phaeochromocytoma

Marfanoid body habitus
Neuromas
RET Oncogene

36
Q

A second drug should be added in type 2 diabetes mellitus when?

A

HbA1c is > 58 mmol/mol

37
Q

hypoglycaemia with reduced GCS Mx

A

give 100ml 20% IV Glucose if there is access

38
Q

What is gastroparesis

A

GI autonomic neuropathy often due to diabetes
erratic blood glucose control, bloating and vomiting
management options include metoclopramide, domperidone or erythromycin (prokinetic agents)

39
Q

oral hypoglycaemic choice in T2DM

A

start with metformin and titrate dose accordingly
if not adequeate
add a gliptin if obese
if not add a sulfonylurea if not (glicazide)

40
Q

ECG changes in hypocalcaemia

A

Common: Corrected QT interval prolongation
Rare: Atrial fibrillation or torsade de pointes

Finals (34 decks)

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