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Year 2 RE SCP > Endocrinology Clinical Reasoning > Flashcards

Endocrinology Clinical Reasoning Flashcards

1
Q

When a patient enters the consultation room, following introductions and consent, generally what is the first part of a medical history?

A
  • presenting problem
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2
Q

Once a patient has told us why they have come in to see the clinician with the presenting problem, what is the next part of the medical history?

A
  • history of presenting problem
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3
Q

Once a patient has told us why they have come in to see the clinician with the presenting problem, and we know about the history of the presenting problem, what is the next part of a medical history?

A
  • ask about past medical history
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4
Q

Once we have asked about the following, what is the next questions we would ask:

  • presenting complaint
  • presenting complaint history
  • medical history

What is the next thing we should ask about?

A
  • medication history
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5
Q

Once we have asked about the following, what is the next questions we would ask:

  • presenting complaint
  • presenting complaint history
  • medical history
  • medication history

What is the next thing we should ask about?

A
  • social history
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6
Q

Once we have asked about the following, what is the next questions we would ask:

  • presenting complaint
  • presenting complaint history
  • medical history
  • medication history
  • social history

What is the next thing we should ask about?

A
  • family history
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7
Q

Once we have asked about the following, what is the next questions we would ask:

  • presenting complaint
  • presenting complaint history
  • medical history
  • medication history
  • social history
  • family history

What is the next thing we should ask about?

A
  • systems history
  • additional symptoms that may not seem relevant to presenting problem
  • commonly closed ‘yes’ or ‘no’ questions
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8
Q

What are the 3 main questions that should be asked if a patient is presenting with cardiovascular issues, which would be part of a system review (symptoms that may appear not to be relevant)?

A

1 - Do you ever have chest pain or tightness?
2 - Do you ever wake up during the night feeling short of breath?
3 - Have you ever noticed your heart racing or thumping?

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9
Q

What are the 4 main questions that should be asked if a patient is presenting with respiratory issues, which would be part of a system review (symptoms that may appear not to be relevant)?

A

1 - Are you ever short of breath?
2 - Have you had a cough? If so, do you cough anything up?
3 - What colour is your phlegm/ sputum?
4 - Have you ever coughed up blood?

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10
Q

What are the 3 main questions that should be asked if a patient is presenting with gastrointestinal issues, which would be part of a system review (symptoms that may appear not to be relevant)?

A

1 - Are you troubled by indigestion or heartburn?
2 - Have you noticed any change in your bowel habit recently?
3 - Have you ever seen any blood or slime in your stools?

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11
Q

What are the 4 main questions that should be asked if a patient is presenting with genitourinary issues, which would be part of a system review (symptoms that may appear not to be relevant)?

A

1 - Do you ever have pain or difficulty passing urine?
2 - Do you have to get up at night to pass urine? If so, how often?
3 - Have you noticed any dribbling at the end of passing urine?
4 - Have your periods been quite regular? Has there been a change?

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12
Q

What are the 2 main questions that should be asked if a patient is presenting with musculoskeletal issues, which would be part of a system review (symptoms that may appear not to be relevant)?

A

1 - Do you have any pain, stiffness or swelling in your joints?
2 - Do you have any difficulty walking or dressing?

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13
Q

What are the 2 main questions that should be asked if a patient is presenting with endocrine issues, which would be part of a system review (symptoms that may appear not to be relevant)?

A

1 - Do you tend to feel the heat or cold more than you used to?
2 - Have you been feeling thirstier or drinking more than usual?

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14
Q

What are the 2 main questions that should be asked if a patient is presenting with neurological issues, which would be part of a system review (symptoms that may appear not to be relevant)?

A

1 - Have you ever had any fits, faints or blackouts? (also CVS screen)
2 - Have you noticed any numbness, weakness or clumsiness in your arms or legs?

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15
Q

What are constitutional features, also known as constitutional symptoms?

A
  • symptoms affect the sense of well-being of a patient

- may or may not be linked directly to presenting problem

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16
Q

Constitutional features, also known as constitutional symptoms are symptoms that affect the sense of well-being of a patient, and may or may not be linked directly to presenting problem. What are the 5 common constitutional features we should ask about?

A 
1 - Fatigue/ energy levels
2 - Sleep quality/ Change in sleep
3 - Loss of appetite
4 - Weight loss
5 - Fevers
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17
Q

Label the key endocrine glands that need to be considered when performing an endocrine assessment numbered 1-7:

  • hypothalamus and pituitary gland
  • thymus
  • thyroid and parathyroid
  • gonads
  • ovaries
  • pancreas
  • adrenals
A 
1 - hypothalamus and pituitary gland
2 - thyroid and parathyroid
3 - thymus
4 - pancreas
5 - adrenals
6 - gonads
7 - ovaries
18
Q

If a patient has failed at IVF on three separate occasions, what are likely to be the 2 most common differentials related to hormones?

A

1 - pituitary gland or hypothalamus problem (low gonadotrophin releasing hormone and LH and FSH will therefore be low)
2 - reproductive organs are not producing oestradiol and progesterone

19
Q

If a patient has failed at IVF on three separate occasions, what could be some common differentials related to pelvic area?

A

1 - anatomical issues (blocked fallopian tubes)
2 - polycystic ovary syndrome
3 - premature ovarian failure

20
Q

What are 5 of the most common differentials that can cause severe headaches?

A

1 - migraine
2 - subarachnoid haemorrhage (causes by trauma)
3 - meningitis (associated rashes)
4 - stroke
5 - cavernous sinus thrombosis (blood clot)
6 - pituitary apoplexy

21
Q

What is pituitary apoplexy?

A
  • apoplexy = greek for bleeding into or loss of blood flow to an organ
  • pituitary apoplexy is commonly due to a noncancerous (benign) tumor of the pituitary
22
Q

Apoplexy is bleeding into or loss of blood flow to an organ. Pituitary apoplexy is commonly due to a noncancerous (benign) tumour of the pituitary. Due to its anatomical position in the brain, which of the following is it likely to impede?

1 - parietal lobe (loss of sensations)
2 - optic chiasm (double vision, eye deviation, bitemporal hemianopia)
3 - pons (impaired ability to regulate breathing)
4 - thalamus (impaired consciousness and alertness)

A

2 - optic chiasm (double vision, eye deviation, bitemporal hemianopia)
- pituitary gland is very close to optic chiasm

23
Q

When we talk about a patients headaches we need to try to identify the cause, and to do this we can categorise different aspects of the headache. So what 2 things might we consider for onset/characteristics?

A

1 - duration and things that accentuate the headache

2 - severity out of 10

24
Q

When we talk about a patients headaches we need to try to identify the cause, and to do this we can categorise different aspects of the headache. If a patient has migraines, what should we ask that is commonly associated with a migraine?

A
  • was an aura present (flashes of light, blind spots, and other vision changes_
  • history of migraines (if one before then likely top re-occur)
25
Q

When we talk about a patients headaches we need to try to identify the cause, and to do this we can categorise different aspects of the headache. There are can be some commonly associated symptoms. What are the 4 we might expect to see in someone with pituitary apoplexy?

A

1 - visual field defects (optic chiasm affected)
2 - cranial nerve involvement (nerves of the eyes)
3 - vomiting
4 - photophobia

26
Q

Adrenocorticotropic hormone (ACTH) is produced by the anterior pituitary gland, which then goes on to stimulate the adrenal gland. If there is an issue with the pituitary gland and it is secreting excessive levels of ACTH, this can result in excessive levels of what hormone?

A
  • cortisol

- ACTH stimulates the zona fasiculata of the adrenal cortex

27
Q

Adrenocorticotropic hormone (ACTH) is produced by the anterior pituitary gland, which then goes on to stimulate the adrenal gland. If there is an issue with the pituitary gland and it is secreting excessive levels of ACTH, this can result in excessive levels of cortisol. What is this condition called?

A
  • cushings syndrome
28
Q

Adrenocorticotropic hormone (ACTH) is produced by the anterior pituitary gland, which then goes on to stimulate the adrenal gland. If there is an issue with the pituitary gland and it is secreting excessive levels of ACTH, this can result in excessive levels of cortisol. Although cortisol is required and generally peaks early in the morning, we can have peaks as required during stressful events, like fight or flight. How can reduced ACTH and cortisol cause fatigue and weakness?

A
  • reduced gluconeogenesis (glucose formation from non carbon molecules
  • maintains sufficient blood glucose
29
Q

Adrenocorticotropic hormone (ACTH) is produced by the anterior pituitary gland, which then goes on to stimulate the adrenal gland. If there is an issue with the pituitary gland and it is secreting excessive levels of ACTH, this can result in excessive levels of cortisol. Although cortisol is required and generally peaks early in the morning, we can have peaks as required during stressful events, like fight or flight. How can reduced ACTH and cortisol cause depression?

A
  • impaired brain function
30
Q

Adrenocorticotropic hormone (ACTH) is produced by the anterior pituitary gland, which then goes on to stimulate the adrenal gland. If there is an issue with the pituitary gland and it is secreting excessive levels of ACTH, this can result in excessive levels of cortisol. Although cortisol is required and generally peaks early in the morning, we can have peaks as required during stressful events, like fight or flight. How can reduced ACTH and cortisol cause reduced libido?

A
  • cortisol can inhibit release of gonadotrophin releasing hormone
31
Q

Adrenocorticotropic hormone (ACTH) is produced by the anterior pituitary gland, which then goes on to stimulate the adrenal gland. If there is an issue with the pituitary gland and it is secreting excessive levels of ACTH, this can result in excessive levels of cortisol. Although cortisol is required and generally peaks early in the morning, we can have peaks as required during stressful events, like fight or flight. What are the 5 keys signs of adrenal insufficiency due to low ACTH?

A 
1 - fatigue/weakness
2 - weight loss
3 - depression
4 - GI symptoms
5 - reduced libido
32
Q

What are the 2 conditions that can be caused by low or elevated levels of thyroid stimulating hormone?

A
  • hypothyroidism

- hyperthyroidism

33
Q

If there are deficiencies in sexual hormones LH, FSH or prolactin, what are the 4 most common symptoms we might see in men?

A

1 - galactorrhoea (milky discharge from nipples)
2 - reduced libido
3 - erectile dysfunction
4 - reduced shaving frequency

34
Q

If there are deficiencies in sexual hormones LH, FSH or prolactin, what are the 3 most common symptoms we might see in women?

A

1 - galactorrhoea (milky discharge from nipples)
2 - reduced libido
3 - menstrual changes

35
Q

If there are deficiencies in growth hormone, what are the 3 most common symptoms we might see?

A

1 - mood changes

2 - muscle atrophy

36
Q

If a patient presents with suspected pituitary problems, and we know that cortisol levels, thyroid stimulating hormone (TSH), T4, LH and FSH are low, would you offer any steroid treatments?

A
  • yes

- provide intravenous hydroxycorticosteroids

37
Q

If we suspect an issue within the pituitary gland that may be impacting upon the optic chiasm, what imaging may be useful to confirm?

A

1 - MRI

2 - CT scan

38
Q

If we suspect an issue within the pituitary gland that may be impacting upon the optic chiasm, what 4 blood tests might we do?

A

1 - pituitary gland profile
2 - inflammatory markers (rule out other conditions)
3 - electrolytes (Na+, K+ etc..)
4 - blood glucose

39
Q

Apoplexy is bleeding into or loss of blood flow to an organ. Pituitary apoplexy is commonly due to a noncancerous (benign) tumour of the pituitary. These can occur in 2-12% of patients with pituitary adenomas. What are the 5 most common symptoms?

A 
1 - severe frontal headache
2 - visual impairment
3 - ocular palsy
4 - altered mental state
5 - meningsm
40
Q

Apoplexy is bleeding into or loss of blood flow to an organ. Pituitary apoplexy is commonly due to a noncancerous (benign) tumour of the pituitary. These can occur in 2-12% of patients with pituitary adenomas. This can cause bitemporal hemianopia, which is essentially where we lose vision in the lateral sides of both eyes. Why do we have this visual loss?

A
  • pituitary apoplexy impairs optic chiasm

- impairs cranial nerve II the optic nerve that crosses the chiasm

41
Q

Apoplexy is bleeding into or loss of blood flow to an organ. Pituitary apoplexy is commonly due to a noncancerous (benign) tumour of the pituitary. These can occur in 2-12% of patients with pituitary adenomas. This can cause bitemporal hemianopia, which is essentially where we lose vision in the lateral sides of both eyes due to impeding the optic chiasm where cranial nerve II (optic nerve) crosses the chiasm. If the pituitary adenoma continues to grow into the cavernous sinus, what other cranial nerves could be affected?

A
  • cranial nerve I opthalamic nerve
  • cranial nerve III occulomotor nerve (medial, superior and inferior rectus and inferior oblique muscles)
  • cranial nerve IV trochlear nerve (superior oblique muscle)
  • cranial nerve VI abducesn nerve (lateral rectus muscle)
42
Q

Apoplexy is bleeding into or loss of blood flow to an organ. Pituitary apoplexy is commonly due to a noncancerous (benign) tumour of the pituitary. These can occur in 2-12% of patients with pituitary adenomas. What are the 4 major effects of this on hormone levels?

A

1 - LH/FSH impaired in 100% of cases
2 - growth hormone impaired in 80% of cases
3 - adrenocorticotropic hormone impaired in 66% of cases
4 - thyroid stimulating hormone impaired in 42% of cases

Year 2 RE SCP (8 decks)

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