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hard questions endo Flashcards

1
Q

what gene is mutated in congenital hypopituitarism? how is this seen on MRI?

A

PROP1

Hypoplastic gland

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2
Q

5 causes of acquired hypopituitarism

A 
tumour 
trauma
apoplexy
infection
pituitary surgery
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3
Q

which 2 conditions is radiotherapy given near pituitary?

A

acromegaly

nasopharyngeal tumour

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4
Q

which pituitary cells are most susceptable to rx damage>

A

somatotrophs and gonadotriohins

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5
Q

6 symptoms of sheehan’s

A 
amehorrhea 
fatigue 
inability to breastfeed 
weight loss
anorexia
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6
Q

how does apoplexy often present?

A

thunderclap headache

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7
Q

what may precipitate apoplexy?

A

anticoagulant use

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8
Q

what is the half life of t4

A

6 days

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9
Q

what condition is pulsatile GH/ACTH sensitive to?

A

Stress

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10
Q

how is hypopituitarism diagnoses?

A

history
dynamic pituitary function test
pituitary mri

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11
Q

what happens in a normal insulin stress test given to determine pit dysfunction?

A

cortisol and gh rise

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12
Q

what does a normal anterior pituitry loo like on mri

A

empty sella

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13
Q

how is cortisol replaced?

A

prednisolone

hydrocortosone 10 5 5

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14
Q

outline the 5 actions of vasopressin

A 
vasoconstriction via v1
aquaporins via v2
upregulates uta1 and uta3
stimulates acth release 
concentrates urine
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15
Q

how does hte posterior putuitary look on MRI

A

white C shape

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16
Q

how do stretch receptors inhibit vasopressin release?

A

detect stretch and inhibit via vagus nerve. less stretch, less inhibition

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17
Q

5 causes of CDI?

A

BRAIN INJURY, BRAIN SURGERY, CONGENITAL, PIT TUMOUR, TB SARCOIDOSIS, AUTOIMMUNE

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18
Q

3 signs of diabetes insipidus?

A

hypernatraemia
dehydration
large vol of urine

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19
Q

which things are measured in the h2o deprivation test?

A

urine volume
urine osmolarity
plasma osmolarity
weight

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20
Q

what is the difference in plasma osmolarity in DI vs psychogenic polysipsia?

A

DI - high osmolarity

PP - low

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21
Q

4 signs of SIADH?

A

LOW VOLUME OF CONCENTRATED URINE
HIGH URINE OSMOLARTY,
LOW BLOOD OSMOLARITY - SIADH IS ESSENTIALLY SALT LOSS. HYPONATRAEMIA

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22
Q

Causes of SIADP?

A

HEAD INJURY, STROKE, TUMOUR, PHNEUMONIA, LUNG CANCER,

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23
Q

2 drugs causing siadh?

A

carbemazepine, SSRIs

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24
Q

what is a tumour of each anterior pituitary cell type called?

A

CUSHINGS, ACROMEGALY, PROLACTINOMA, TSHOMA, GONADOTROPHOMA

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25
Q

4 features which help classification of tumours radiologically?

A

SIZE, INTRA/SUPRASELLAR, AFFECTS OPTIC CHIASM? CAVERNOUS SINUS?

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26
Q

pathological causes of hyperprolactinaemia?

A

PCOS

CHRONIC RENAL FAILURE (NO SECRETION OF PROLACTIN), PRIMARY HYPOTHYROIDISM (TRH STIMULATES LACTOTROPHS)

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27
Q

5 drugs that may cause hyperprolactinaemia

A 
antipsychotics 
ssris 
antiemetics 
oestrogen 
opiates
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28
Q

2 causes of false positive high prolactin?

A

macroprolactin (igG complex) and needle stress

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29
Q

what drug treats prolactinoma?

A

caberlogine - D2 receptor agonist

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30
Q

how is acromegaly screened for?

A

elevated IGF1

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31
Q

how is the glucose suppression test used to diagnose acromegaly? what may also be seen?

A

GIVE glucose , SHOULD SEE A FALL IN GH.

PARADOXICAL RIE IN GH. RAISED PROLACTIN TOO

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32
Q

1st line treatment for acromegaly?

A

transphenoidal surgery

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33
Q

medical treatments for acromegaly?

A

somatostatin (octreotide)

caberlogine

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34
Q

how does a non-functioning pituitary adenoma present?

A

PRODUCES NO HORMONES. STOPS ALL ANTERIOR PIT HORMMONES WORKING SOMETIMES HIGH PROLACTIN AS LESS DOPAMINE IF OBSTRICTED PIT STALE.
BITEMPORAL HEMIANOPiA

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35
Q

outline how thyroid follicular cells make thyroid hormone

A

TSH BINDS AND CAUSES PRODUCTION OF THYROGLOBULIN (TG). THIS GOES INTO THE COLLOID
NA/I ENTER VIA COTRANSPORTER. I INTO COLLOID
I UNDERGOES IODINATION
THE IODINATION OF I ACTIVATES TPO. TPO AND H2O2 MOVE INTO COLLOID. CATALYSIS OF IODINATION REACTIONS.
IODINE + THYROGLOBULIN UNDERGO IODINATION VIA TPO. MIT AND DIT. BOUND TO TG UNTIL RELEASED.

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36
Q

features of grave’s disease?

A 
EXOPTHALMOS. 
WEIGHT LOSS. 
INCREASED APPETITE. 
HAIR THINNING. 
HEAT INTOLERANCE. PALPITATIONS. 
SMOOTH GOITRE WITH THRILL AND BRUIT. 
TREMOR. DIARRHOEA. TIREDNESS
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37
Q

what is another name for plummer’s disease?

A

hyperfunctioning adenoma

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38
Q

what is the effect of thyroxine on the sns?

A

THYROXINE STIMULTES THE SNS. SENSITISES BETA ADRENERGIC RECEPTORS TO CATECHOLAMINES

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39
Q

Why does lid lag occur in plummers?

A

ACTIVATION OF BETA RECEPTORS HOLDS LIDS OPEN

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40
Q

5 features of a thyroid storm

A

HYPER PYREXIA, ARRYTHMIA/TACHYCARDIA, CARDIAC FAILURE,
DELIRIUM,
JAUNDICE

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41
Q

which 3 drug types reduce thyroid hormone synthesis?

A

thionamides
KI
radioiodine

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42
Q

2 examples of thionamides

A

PTU

CARBIMAZOLE

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43
Q

what beta blockers are given to treat symptoms of hyperthyroidism?

A

propanonol

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44
Q

how is thyroid storm treated?

A

KI

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45
Q

when is KI given?

A

KI GIVEN BEFORE SURGERY. STOPS BLEEDING AFTER SURGERY AND STOPS THYROID PRODUCTION VIA WOLFF CHAIKOFF. KI BLOCKS IODINATINO OF THYROGLOBULIN ANS INHIBITS TPO AND TH SYNTHESIS

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46
Q

side effects of thionamides?

A

agranulocytosis

rashes

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47
Q

how is viral thyroiditis showin on iodine imaging scan?

A

no uptake at all

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48
Q

which 5 enzymes does angiotenisin 2 activate?

A

21, 11, 18 hydroxylases
side chain cleavage enzyme
3 hydroxysteriod dehydrogenase

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49
Q

which 5 hormones are swithced on in cortisol production?

A

11,17,21 hydroxylase
side chain cleavage
3 hydroxysteriod dehydrogenase

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50
Q

3 main causes of primary adrenal failure?

A

immune
congenital adrenal hyperplasia
tb

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51
Q

2 causes of addisons

A

tb autoimmune

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52
Q

features of adrenal crisis?

A 
LOW BP.
 SYNCOPE, 
VOMITING, 
DIARRHOEA, 
HYPOGLYCAEMIA, 
FEVER, 
HYPONATRAEMIA
53
Q

what are the consequences of adrenocortical failure?

A

HYPOTENSION, DEATH

LOW GLUCOSE DUE TO GLUCOCORTICOID DEFICIENCY

54
Q

what drug is given to replace aldosterone?

A

flurocortisone

55
Q

why do babies with complete 21 hydroxylase deficiency need IV fluids asap?

A

because they can have an addisonian crisis

56
Q

when and how does partial 21 HD present?

A

GIRLS - VIRILUSIATION.AND HIRSUTISM

BOYS PRECOCOOUS PUBERTY

57
Q

how is partial 21 HD treated?

A

prednisolone

58
Q

why does 11 hydrocylyase deficiency cause hypertension?

A

low aldosterone but the precursor 11 deoxycorticosterone acts like aldosterone

59
Q

which hormones are deficient in 11hd?

A

cortisol and aldosrerone

60
Q

what is seen in 17hd?

A

no puberty
hypertension
hyperaldosteronism
low glucose (low glucocorticoids)

61
Q

first investigation to find cause of cushing’s?

A

24h free cortisol

62
Q

what test is key for cushing’s diagnosis?

A

dexamethosone suppression test

63
Q

2 drug classes used to control steriod levels?

A

enzyme inhibitors

receptor blockers

64
Q

how does metryapone work?
when is it given (hyperadrenalism)?
side effects?

A

INHIBITS 11-B-HYDROXYLASE. PRIOR TO SURGERY/AFTER RADIOTHERAPY.
HIRSUTISM, SALT RETENTION

65
Q

how does ketoconazole work?

A

inhibits 17 hydroxylase

66
Q

how is cushings treated surgically?

A

TRANSPHENOIDAL PITUITARY SURGERY, BILATERAL ADRENALECTOMY

67
Q

how is spironolactone used to treat conn’s (primary hyperaldosteronism)

A

CONVERTED TO CANRENONE. COMPETATIVE ANTAGONIST OF MINERALOCORTICOID RECEPTOR.
can cause:
GYNECOMASTIA, MENSTERAL IRREGULARITIES (PROGESTERONE INHIBITOR)\

68
Q

why is epleronone better than spironolactone?

A

less gynecomastia as less binding to sex steroid receptors

69
Q

how are phaos managed

A

SURGERY,
ALPHA BLOCERS,
BETA BLOCKERS (PREVENT TACHY),
IV FLUID TO STOP BP CRASH

70
Q

outline the process of calcitriol formation in the body

A

UVB - PRE D3 - DR
LIVER: D3 - 25 HYDROXYLASE - 25 OH CHOLECHALCIFEROL
KIDNEY: 1- ALPHA - HYDROXYLASE - CALCITRIOL

71
Q

effect of calcitriol on bone

A

osteoblastic

72
Q

effect of pth on bone

A

osteoclastic

73
Q

effects of pth?

A

INCREASE BREAKDOWN OSTEOCLASTS!!!!
B)INCREASE REUPTALE OF CALCIUM, INCREASED EXCRETION OF PO43-
SIMULATES ALPHA HYDROXYLASE SYNTHESIS (for calcitriol)
C) INCREASE REABSORPTION OF BOTH

74
Q

how does fgf 23 regulate phosphate?

A

INHIBITS NA/PO43- COTRANSPORTER IN PCT

INHIBITS CALCITRIOL SYNTHESIS

75
Q

symtpms of hypocalcaemia

A

Convulsions
Arrythmia
Tetany
numbness and tingling

76
Q

what is chvosteck’s sign?

A

tap zygomatic arch see spasm

77
Q

what is trosseaus sign

A

carpopedal spasm

78
Q

4 causes of low pth related hypoparathyroidism

A

IMMUNE DESTRUCTION OF PT GLANDS
THYROIDECTOMY
MAGNESUUM DEFICIENCY
CONGNEISAL - AGENESIS OF PTH

79
Q

symptoms of hypercalcaemia

A 
LETHARGY, 
STONES, 
DEPRESSION, 
CONSTIPATION, 
PANCREATITIS, 
DYSPEPSIA, 
FATIGUE
80
Q

3 main causes of hypercalacemia?

A

primary hyperparathyroidism
adenoma of pth gland
bone mets (and sccs make pth related peptide)
excess vit d

81
Q

why is primary hyperparathyroidism have low phospahte?

A

pth increases remocal in kidney

82
Q

what is seen in tertiary hyperparathyroidism?

A

PTH and calcium high

due to lack of kidney fucntion so lack of cholecalciferol

83
Q

what is given as a vit d replacement in a) nromals and b ) renal failue

A

a) 25 hydroxyvitamin D

b) alfacalcidol (1-alpha hydrozycholecalciferol)

84
Q

5 Testicular causes of infertility

A

TRAUMA, TUMOUR, INFECTION, CONGENITAL ANATOMICAL ABNORMALITY (CRIPORCHIDISM, VARICOELE, TOXINS)

85
Q

5 post testicular causes of infertility

A

CONGENITAL ABSENCE OF VAS DEFERENS,

OBSTRUCTIVE ASOSPERMIA, ERECTILE DYSFUNCTION, VASECTOM

86
Q

2 causes of of ovarian infertility

A

PCOS, ANNOVULATION, CORPUS LUTEUM ISUFFICIENCY

87
Q

3 tubal causes of infertility

A

endometriosis, infection, tumour

88
Q

2 cervical causes of infertility?

A

ineffective sperm pepetration due to chronic cervicitis and antisperm antibodies

89
Q

4 treatment options for endometriosis

A

OESTROGEN, LAPAROSCOPIC ABLATION* HYSTERECTOMY

90
Q

what are fibroids

A

benign tumours of myometrium

91
Q

3 hormonal treatments for fibroids?

A

oestrogen, progesterone, gnrh agonist

92
Q

what happens in kallmann sydrome

A

KALLMANN - ANOSMIA AND INFERTILITY DUE TO FAILURE OF GNRH NEURONES TO MIGRATE FROM OLFACTORY PLACODE TO HYPOTHALLAMUS

93
Q

symptoms of kallmanns

A

ANOSMIA, UNDESCENDED TESTES,
LACK OF TESTICLE DEVELOPMENT,
MICROPENIS, PRIMARY AMENNHOREA,
INFERTILITY

94
Q

describe klinefelters

A

hypergonadotrophic hypogonadism

95
Q

what imaging is done for male infertility

A

scrotal uss

mri pit

96
Q

what i the diagnostic criteria for pcos called?

A

rotterdam

97
Q

what is turners?

A

hypergonadotrophic hypogonadism

98
Q

what scorring system is used for hisutism

A

ferimann gallway

99
Q

what heart deformity cn occur in turners syndrome>

A

coarctition of aorta

100
Q

how is male hypogonadism initially diagnosed?

A

2 morning measurements of testosterone

101
Q

what are three weekly and 3 monthly testosterone injections

A

3 weekly - sustanon

3 monthly - nebido

102
Q

2 drawbacks of testosterone replacement

A

increases haematocrit

measure psa for cancer

103
Q

how does FSH increase sperm production

A

acts on sertolic cells casuing spermatogenesis

104
Q

how are gonadotrophins given to induce spermatogenesis

A
  1. hcg

2. fsh

105
Q

treatment for ovulation induction?

A
  1. weight loss/metformin
  2. letrozole
  3. clomiphene
106
Q

how does letrazole work

A

aromatase inhibitor (less e2 more fsh negative feedback) fsh needed for ovulation induction

107
Q

how does clomiphene work

A

e2 receptor modulator

108
Q

wht happens in the oocyte retrieval stage of IVF

A

large dose of fsh to grow follicles

give gnrh modulator to prevent LH surge

109
Q

what is given to cause LH exposure to mature eggs? what is the 2nd choice available?

A
  1. HCG GIVEN TO MATURE EGGS

2. gnrh agonists

110
Q

how is fertilization done if male factor infertility

A

ICSI

111
Q

how does the ius work

A

secretes progesteone into the uterus

112
Q

what is ellaone and what does it do

A

ulipristol acetate

inhibits progesterone receptor

113
Q

how does levonelle work

A

synthetic progesterone prevents ovulation

114
Q

why is transdermal e2 safer than oral in HRT?

A

due to liver metabolites - increases crp, triglycerises

115
Q

when is cvd risk not elecated on pill?

A

if started before 60

116
Q

2 benefits of hrt

A

better symptoms

less osteoporisos

117
Q

what hormones are given to transgender women

A

gnrh agonist
antiandrogens
oestrogen

118
Q

2 examples of antiandrogens

A

spironolactone

cyproteone acetate

119
Q

what is the name of the model depicting the decrease in beta cell mass in the disease course?

A

eisenbach model

120
Q

outline what happens immunologically in t1dm?

A

PRESENTATION TO CD4 CELLS
ACTIVATION OF CD8 CELLS WHICH LYSE B CELLS
CYTOKINES MAKE IT WORSE.
T REGS DEFECTIVE

121
Q

which areas of genes are responible for t1dm susceptibilty

A

hla

122
Q

4 examples of hits causing diabetes

A

enteroviral infection
cows milk
seasonal variation
microbiota

123
Q

what is found in serum of t1dm?

A

anti b cell antibodies

124
Q

3 beta cell proteins which antibodies attack?

A

gada
ia-2a
znt8

125
Q

describe the physiological insulin production?

A

BASELINE AND SPIKES AFTER MEALS THEN SPIKES AGAIN - 2ND PHASE INSULIN PRODUCTION

126
Q

how is insulin altered to make it long acting?

A

bound to zinc

127
Q

how does insulin pump therapy work?

A

delivers fixed units of short actin constantly. must bolas themselves.

128
Q

4 types of problematic hypoglyarmia

A

excessive frequency
impaired awareness
nocturnal
recurrent

129
Q

how is a hypo treatted in unconcious patients?

A

IV glucose

GI cancers (18 decks)

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