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MRCP Part 1 > General Medicine: Endocrine (excl diabetes) > Flashcards

General Medicine: Endocrine (excl diabetes) Flashcards

1
Q

Outline the basic pathway of thyroid hormone production

A

(Ant pituitary) –> TSH –> (thyroid) –> T3/4

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2
Q

How do hypo and hyperthyroidism compare with
Systemic symptoms
Cardiac
Skin
Gastrointestinal
Gynaecological
Neurological

A

Hypothyroidism // hyperthyroidism
weight gain, lethargy, cold intolerance // weight loss, restless, heat intolerance
none // palpitations
Dry, non hairy, non-pitting oedema // sweaty, bubbly tibia
constipation // diarrhoea
reduced reflex, carpal tunnel // tremor

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3
Q

Interpret the following
TSH: Low
T4: High
What are the causes of the following

A

Thyrotoxicosis
Causes
- Graves (60%)
- Toxic multinodular goitre
- Acute subacute thryoiditis/ acute hashimoto’s (before it goes hypo)
- Amiodarone therapy

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4
Q

In addition to TFTs, what clinical and lab tests would point towards

Grave’s disease

Toxic multinodular goitre

A

Grave’s

Clinical: big and palsied eyes, pre-tibial myxoedema, digital clubbing
Labs: anti-TSHR, anti-TPO, diffuse homogenous intake of radio-iodine

TMN

Nuclear scintigraphy reveals patchy uptake

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5
Q

Interpret the following TFT results
T4 // TSH
low, high
low, low
normal, high

A

Hashimoto’s
2ary cause, sick euthyroid
subclinical, poor compliance

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6
Q

How do you treat thyrotoxicosis?

A

Propranolol for tremor
Carbimazole to block T4 production
Radioiodine/surgery to remove if persistent

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7
Q

What is the treatment for hypothyroidism?

A

levothyroxine

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8
Q

How do you check if levothyroxine treatment is working/being complied with?

A

Check TSH in normal range

TSH high because low T4 so therapy should cause negative feedback

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9
Q

How does thryoid storm and myoedema coma compare in terms of

Hx

Presentation

A

TS // MC

Overactive thyroid // underactive

Confusion, fever, N+V (+/-jaundice) // Confusion and hypothermia

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10
Q

How do you manage myoxedema coma?

A

IV thyroxine

IV fluids

IV corticosteroids while adrenal insufficiency ruled out

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11
Q

How do you treat thyroid storm?

A

IV propranolol

Methimazole, PTU

Dexamethasone to reduce conversion

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12
Q

How can thyroid cancer be distinguished from other thyroid lumps

A

Lacks the features of hyper/hypothyroidism

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13
Q

What investigations are performed in suspected thyroid cancer?

A

1st line: Ultrasound

GS: Fine needle aspiration

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14
Q

‘mixture of papillary and colloidal filled follicles, tumour has papillary projections and pale empty nuclei’

Which thyroid cancer is this and how does it spread?

A

Papillary

Lymph node spread

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15
Q

‘encaspulated tumour with microscopic capsular invasion’

What thyroid cancer is this and how does it spread?

A

Follicular carcinoma

Vascular invasion predominates

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16
Q

How are papillary and follicular thyroid cancers treated?

A

Thyroidectomy + radioiodine 131 to kill residue cells

Yearly thyroglobulin levels

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17
Q

What endocrine disorders give you a high BP and outline their distinguishing characteristics

A

Hyperaldosteronism: hypokalaemia (muscle wasting), alkalosis

Phaeochromocytoma: intermittent headaches, palps, sweating, anxiety

Cushing’s syndrome: moon face, pigmented skin

Congenital adrenal hyperplasia: female virilisation

Acromegaly: Big head, hands and feet, headaches, bitemporal hemianopia, sweaty

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18
Q

Bronzed skin, thin, fatigue and salt craving indicates which endocrine disorder

A

Addison’s disease

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19
Q

What do the following aldosterone renin ratios suggest

high/high

high/low

A

2ary (renal artery stenosis)

1ary: Conn’s syndrome

20
Q

If primary hyperaldosteronism is suspected from A:R testing, what further test should be performed?

A

Adrenal CT to visualise adeomas

if -ve adrenal venous sampling for unilateral adenoma vs bilateral hyperplasia

21
Q

What is the most common cause of hyperaldosteronism?

A

Renal artery stenosis

chonic underperfusion of kidney leads to increased aldosterone production

22
Q

How do you manage renal artery stenosis?

A

Antihypertensives, statin + antiplatelets

Stenting of renal artery

23
Q

How do you manage primary hyperaldosteronism?

A

unilateral adenoma: surgery

Bilateral hyperplasia: spironolactone

24
Q

How would you investigate and treat a patient with addison’s?

A

1st: 9am cortisol = 100-500

GS: short synACTHen test, cortisol does not double

+ APS 1/2 autoantibodies

+ CT for adrenals, MRI for pituitary

25
Q

What is the management of Addison’s disease?

A

Hydrocortison 2-3 daily for cortisol

fludrocortisone for aldosterone

26
Q

If someone with addison’s is ill what should they do regarding their meds

A

Double hydrocortisone

Keep fludrocortisone the same

27
Q

Addison’s patient very unwell post-op; their notes show they have not received their hydrocortisone, what is the diagnosis and management?

A

Addisonian crisis

IV hydrocortisone 100mg

1 litre saline over 30-60 mins

6hrly hydrocortisone until stable. No fludrocortisone

Oral replacement after 24hrs, reduce to maintenance over 304 days

28
Q

How do you investigate cushing’s syndrome to

confirm the syndrome

reveal the cause

A

Diagnosis

low dose dexamethasone: undampened cortisol confirms syndrome

high dose dexamethasone:

no suppression: ectopic ACTH

ACTH: Adrenal adenoma

ACTH +cortisol : pituitary (Cushing’s disease)

*dexamethesone dampens ACTH

29
Q

How do you treat cushing’s syndrome?

A

Surgical removal of source

Where not possible, remove adrenals and replace steroid hormones for life

30
Q

What investigation result confirms phaeochromocytoma?

A

24 hr urinary metanephrines will be raised

+ cathecolamines but these are less reliable

31
Q

What is the management of phaeochromocytoma?

A
  1. Alpha blockers
  2. Add beta blockers

Def: adrenalectomy

32
Q

What are the investigation findings in acromegaly?

A
  1. IGF-1 levels raised
  2. OGTT to confirm if raised; shows no impairment of GH

+ pituitary MRI to look for tumour

33
Q

What is the treatment of acromegaly?

A

1st line: TS surgery

unresectable:

  1. Octreotide (Somatostatin analogue) to inhibit GH
  2. Pegvisomant (GHR antagonist) but doesnt shirnk size
  3. Bromocriptine (dopamine agonist) to compete with GH
34
Q

Bones, stones, abdo groans and psychic moans refers to what endocrine disorder?

A

Hyperparathyroidism

Bones: Pain, fractures due to calcium release

Stones: Renal stones due to increaesd calcium

Abdominal groans: pancreatitis, constipation + ulcers due to increased calcium

Psychic moans: anxiety, depression

35
Q

What do the following PTH and Ca2+ readings show

PTH, Ca2+

high, high

high, low/normal

A

Primary (PTH tumour) tertiary (hyperplasia following 2ary)

secondary (vit D, CKD)

36
Q

What is the treatment for hyperparathyroidism?

A

1ary, 3ary: surgery

2ary: Correct vit D, CKD

37
Q

What are the clinical features of hypoparathyroidism?

A

Muscle aches

Depression

Cataracts

+ Prolonged QT

38
Q

How do the following differ from hypoparathyroidism?

Pseudohypoparathyroidism

Pseudopseudohypoparathyroidism

A

HPT

Impaired stimulation/synthesis of calcium release

BOTH urinary cAMP + phosphate high after PTH infusion

PSEUDO

Imparired G protein causing calcium insensitivity to PTH

Assoc: low IQ, short height and 4th/5th fingers

ONLY ONE/NEITHER of cAMP+phosphate high after PTH infusion

PSEUDOPSEUDO

Above phenotype but normal biochemistry

39
Q

Since PCOS and POF mess with periods and fertility how can you tell them apart by

Symptoms

FSH/LH

Oestrogen

Testosterone

A

PCOS // POF

Hairy // Night sweats, vaginal dryness

High // high

Normal // low

High // normal

40
Q

How do you treat PCOS

A

COC/Co-pyprindol/elflornithine for acne

Clomifene, metformin for infertility

41
Q

How do you treat POF?

A

HRT

COC pill if <50yrs as reduces breast cancer and VTE risk

42
Q

Outline the main steroids from most to least glucocorticoid activity (reverse direction for mineralocorticoid)

A

Dexamethasone/betamethasone

Prednisilone

Hydrocortisone

Fludrocortisone

43
Q

What is the effect of corticosteroids on

Glucose levels

Immune cells

Physical appearance

Mental health

A

high glucose due to impaired insulin function

High neutrophils, low others

Cushingoid features

psychosis, depression, insomnia

44
Q

What are the side effects of mineralocorticoids

A

Fluid retention, hypertension

45
Q

Who should have gradual withdrawal of corticosteroids?

A

>=40mg daily for over a week

Received more than 3 weeks treatment

Repeat courses

MRCP Part 1 (32 decks)

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