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Endocrine > ENT/thyroid > Flashcards

ENT/thyroid Flashcards

1
Q

neck lump features during examination

A 
site
size
consistency
edge
relationship to: muscles, trachea, hyoid
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2
Q

what nerve lies behind the superior thyroid artery?

A

external laryngeal nerve

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3
Q

hormones secreted by the posterior pituitary?

A

oxytocin

ADH

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4
Q

hormone secreted by the anterior pituitary

A 
TSH
ACTH
FSH & LH
GH
Prolactin
Endorphins
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5
Q

features of hyperthyroidism

A 
heat intolerance, sweating
weight loss, diarrhoea, increased appetite
tremor, coma
tachycardia, HF, dyspnoea
eye disease
myopathy, periodic paralysis
menstrual irregularity
gynaecomastia
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6
Q

features of hypothyroidism

A 
cold intolerance
dry nails, skin, hair
facial oedema
pallor
non-pitting oedema
constipation
psychosis, coma, death
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7
Q

examination findings in hyperthyroidism

A 
agitation
tachycardia
warm clammy hands
brisk reflexes
eye signs - proptosis, exopthamlos. lid lag, lid retraction
opthalmoplegia
thyroid acropachy
pre-tibial myxoedema
goitre
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8
Q

examination findings in hypothyroidism

A

coarse features
bradycardia
slow relaxing reflexes
goitre

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9
Q

aetiology of hyperthyroidism

A 
grave's disease - 70%
multinodular goitre - 20%
toxic adenoma - 5%
thyroiditis
amiodarone/iodine induced (Jod-Basedow phenomenon)
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10
Q

aetiology of hypothyroidism

A 
Grave's disease (toxic diffuse goitre)
thyroiditis
iatrogenic (surgery, radiotherapy)
Drugs - amiodarone, lithium
congenital
iodine excess or deficiency
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11
Q

thyrotoxic

A

TSH low

FT4 high

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12
Q

Hypothyroid

A

TSH high

FT4 low

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13
Q

risk factors for grave’s eye disease

A

smoking
Male
high initial FT4 >70

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14
Q

anti-thyroid drugs (thyrotoxicosis)

A

carbimazole, propylthiouracil

inhibit iodination of tyrosine, inhinit FT4 –> FT3 conversion

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15
Q

risks of thyroidectomy

A

hypocalcaemia

hypo/hyperthyroidism

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16
Q

features of thyroid storm

A

tachycardia, fever, encephelopathy, fits, stroke, HTN, D&V, circulatory collapse, death
(treat with propylithiouracil, iodine, steroids, beta-blockers, I.V. fluids

17
Q

treatment of hypothyroidism

A

L-Thyroxine (100-150mg OD)
tri-iodothyronine
(+ IV fluids and steroids for hypothroid coma)

18
Q

Normal FT4/FT3

Low TSH

A

subclinical hyperthyroisism

e.g. recent treatment for hyperthyroidism, drugs (steroids, dopamine), non-thyroidal illness (NTI)

19
Q

Normal FT4/FT3

High TSH

A 
subclinical hypothyroidism
e.g. poor compliance with thyroxine
malabsorption of thyroxine
drugs (amiadarone)
NTI recovery phase
TSH resistance
20
Q

adrenal disease - Cushing’s

A

illness resulting from chronic exposure to high levels of cortisol

21
Q

clinical features of cushings

A 
moon face
acne, thinnig of skin, striae, bruising
hirsuitism, thinning of scalp hair
truncal obesity
proximal muscle weakness
mood disturbances, depression
22
Q

associated features of cushings

A 
HTN (>50%)
impaired glucose tolerance/DM
osteopenia & osteoporosis
vascular disease
coagulopathy
susceptibility to infection
23
Q

endogenous causes of cushings

A

ACTH-dependent:
Pituitary adenoma, ectopic ACTH syndrome, ectopic CRH secretion
ACTH-independent (adrenal):
adenoma, carcinoma, nodular hyperplasia

24
Q

DDx for cushings

A

psuedo-cushings
alcoholism
severe depression

25
Q

Hypoadrenalism causes:

A

primary: autoimmune, secondary deposits, TB, HIV
secondary: prolonged exogenous steroids, pituitary lesions

26
Q

Hypoadrenal/addisonian crisis

A

causes: severe physical shock, e.g. car crash; severe infection; severe dehydration

27
Q

Sx of hypoadrenal crisis

A 
extreme weakness
confusion
drowiness --> coma
pronounced dizziness
nausea and/or vommiting
headache 
abnormal heart rate
low BP
feeling v. cold
possibly febrile
possible abdo tenderness
28
Q

Addisons is:

A

detruction of the adrenal cortex leading to cortisol and aldosterone deficiency.

29
Q

Aldosterone:

A

essential for Na conservation in the kidney

e.g when dehydrated, increase Na reabsorption to decrease water loss

30
Q

Cortisol:

A

released in response to stress and low blood glucose. e.g will prepare the body for activity by freeing up glucose into the blood

31
Q

renin-angiotensin system

A

In response to low sodium, or reduced renal blood flow, juxtaglomerular cells secrete renin. this converts angiotensin I into angiotensin II via the enzyme ACE.
angiotensin II triggers aldosterone release by adrenal glands, which act on the kidneys to decrease sodium and therefore water excretion (raise BP)

Endocrine (4 decks)

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