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CSP1 YR5 > Human Disease YR3 #3 > Flashcards

Human Disease YR3 #3 Flashcards

1
Q

What drug is best for TI diabetes for HBP?

A

ACE-I

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2
Q

What drug is best for TII diabetes for HBP?

A

ARBs

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3
Q

What are the results of taking ACE/ARBs?

A

Prevent progression of neuropathy and promote regression to normoalbuminuria

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4
Q

What type of care does a SI/II CKD patient need?

A

Assessment and shared care

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5
Q

What type of care does a SIII CKD patient need?

A

Renal clinic and shared care

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6
Q

What type of care does a SIV/V CKD patient need?

A

Pre-dialysis| Low clearance clinic

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7
Q

What is the GS treatment for HT in CKD?

A

Converting enzyme inhibitor or AllA

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8
Q

Which stages of CKD is HT usually present?

A

SII/III/IV| Common

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9
Q

Which stages of CKD does anaemia usually present?

A

SII - rareSIII - uncommonSIV - common

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10
Q

Which stages of CKD does divalent ion metabolism usually present?

A

SII - rareSIII - rareSIV - uncommon

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11
Q

Name the 5 causes of anaemia of renal disease?

A 
Iron deficiencyBlood lossHaemolysisInhibitor of erythropoiesisRelative erythropoietin deficiency
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12
Q

What are the disordered haemostasis diseases present with renal disease and how to treat it?

A 
Uraemic platelet dysfunction- increased bleeding timeDesmopressin:- releases vWF multimers from endothelium- promote platelet aggregation
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13
Q

Name 4 examples of renal bone disease?

A

HyperparathyroidismOsteoporosisOsteomalaciaAdynamic bone disease

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14
Q

Why does renal bone disease occur in renal disease?

A

Reduced GFR leads to hyperphosphatemiaLoss of renal tissues leads to lack of active Vit DIndirect reduction in Ca absorption

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15
Q

What are the signs that renal bone disease is present in renal disease?

A

Low CaRaised PO4Secondary hyperparathyroidism (elevated PTH)Can progress to teritary

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16
Q

How to manage renal bone disease?

A 
Control PO4:- diet- PO4 binders (Ca acetate)Normalise Ca and PTH:- active Vit D (calcitriol)Parathyroidectomy
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17
Q

Name the 4 types of ahemodialysis access?

A

Arteriovenous fistulaAV prosthetic graftTunnelled venous catheterTemporary venous catheter

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18
Q

What are the fluid and dietary restrictions for dialysis?

A 
Fluid:- dictated by residual urine output- interdialytic weight gainDietary:- K- Na- PO4
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19
Q

Explain the process of peritoenal dialysis?

A

A balanced dialysis solution is instilled into the peritoneal cavity via a tunnelled, cuffed catheter, using the peritoneal mesothelium as a dialysis membraneAfter a dwell time the fluid is drained out and fresh dialysate is instilled

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20
Q

What are the modalities of peritoneal dialysis?

A

Continuous ambulatory peritoneal dialysisAutomated peritoneal dialysisHybrid

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21
Q

What is contained in a dialysis fluid?

A

Balanced concentration of electrolytesGlucose is a osmotic agent for ultrafiltration of fluidPeritoneal transport can be high or low transporterDwell times can be adjusted according to transport characteristics

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22
Q

What are the complications for peritoneal dialysis?

A 
Gram +ve:- skin contaminantGram -ve:- bowel originMixed:- suspected complicated peritonitis (perforation)Exit site infectionUltrafiltration failureEncapsulating peritoneal sclerosis
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23
Q

Name the 4 oral complications of end stage renal disease?

A

ParotitisStomatitisUraemic factorOesophagitis

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24
Q

Explain the process of renal transplantation?

A

Placed into the iliac fossa and anastomosed to the iliac vesselsNative kidney stays

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25
Q

When would the native kidney be removed?

A

Size (polycystic)| Infection (pyelonephritis)

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26
Q

Name the 4 complication for renal transplantation?

A

RejectionInfectionCVMalignancy

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27
Q

Name the CV complication after renal transplantation?

A 
Underlying renal diseaseCRFHTHyperlipidaemiaPT diabetes
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28
Q

Name 5 types of immunosuppressants in renal transplantation?

A 
Non specificT cellmTOR inhibAnti-IL2 receptor absT cell abs
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29
Q

Name 2 example of non-specific immunosuppression for renal transplant?

A

Prednisone| Azathioprine

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30
Q

Name 3 example of T cell activation immunosuppression for renal transplant?

A

CyclosporineTacrolimusMMF

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31
Q

Name 1 examples of mTOR inhibitor immunosuppression for renal transplant?

A

Rapamycin

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32
Q

Name 2 T cell abs immunosuppression for renal transplant?

A

AKG| OKT3

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33
Q

WHat are the risk factors for CKD?

A 
GeneticsHTRASLipidsSmokingDietExercise
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34
Q

Name 4 examples of conventional infection after renal transplantation?

A

HepBUTI (bacteremia)PneumoniaHSV

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35
Q

Name 6 examples of unconventional infection after renal transplantation?

A 
TBCMVEBVAspergillus HepACryptococcus
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36
Q

What are the oral complications following renal transplantation?

A 
Gingival hyperplasiaAphthous ulcerationHerpes simplex virus (cold sore)Leukoplakia (can become squamous carcinoma)Candidiasis (co with HSV)Kaposi's sarcoma
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37
Q

What drugs can cause gingival hyperplasia?

A 
CyclosporinePhenytoinNifedipineDiltiazem (Ca antag)
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38
Q

What is post transplant lymphoproliferative disease?

A

1-2% of all transplanteesIncidence risingAfter primary or reactivation of EBV infection

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39
Q

What type of cancers can occur after renal transplantation and their RR

A 
Relative risk2 - colon, lung and breast3 - testes and bladder5 - melanoma, leukaemia and cervical15 - renal20 - non-melanoma skin, Kaposi, carcom, NHL and PTLD
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40
Q

Where is the liver positioned?

A

RUQ

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41
Q

How many lobes does the liver have?

A

2

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42
Q

What is the blood flow rate to the Liver?

A

5L per min

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43
Q

What type of blood does the portal vein carry?

A

Nutrient rich blood from GI| 50% O2 and 75% BF

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44
Q

What are kupffer cells?

A

Special white blood cells (macrophages) which help regulate molecules entering the sinusoids. The phagocytose molecules

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45
Q

What is the function of stellate cells?

A

Around sinusoid and help with structural integrity

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46
Q

Which zone of the liver acinus has more O2?

A

Zone 1 most| Zone 3 least

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47
Q

What are the metabolic functions the liver?

A 
Biotransformation of:- drugs- toxins- hormonesNilfe formation and excretionhaem metaIntermediate meta of:- glycogen and lactate- plasma port- clot factor- ammonia removalLipids
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48
Q

What would happen if a patient had no bile?

A

Weight loss| Vitamin deficiency

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49
Q

Explain the basic process of RBC destruction?

A 
In spleen:- converted to haem and globinGlobin recycledHaem oxidised forming iron and biliverdinBiliverdin converted to bilirubin
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50
Q

What happens to bilirubin?

A

Travels to liver via albuminUndergoes phase 2 reaction to become unconjugatedHelps form bile acid

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51
Q

What is the most common cause of unconjugated hyperbilirubinemia?

A

Haemolysis| Increased RBC breakdown

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52
Q

What causes conjugated hyperbilirubinemia?

A

Obstructive jaundice:- no bile release, not enter bowel- due to gallstones

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53
Q

What causes non-obstructive or hepatocellular jaundice?

A

Dysfunction or death of hepatocytes, resulting in release into circulation

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54
Q

What is a key plasma protein the liver produces?

A

Albumin

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55
Q

Which vitamin is essential cofactor for II VII IX and X

A

D

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56
Q

How can liver disease impact clotting?

A

Vit D absorption| Clotting factor synthesis

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57
Q

Name the 6 common causes of Liver diesease?

A 
AlcoholNon-alcoholic steatohepatitisViralDrugsAutoimmunity/geneticCancer
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58
Q

Name 6 symptoms of liver disease?

A 
FatigueNauseaWeight lossDrowsinessJaundiceAbnormal bleeding
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59
Q

Name 6 signs for liver disease?

A 
Jaundiced scleraGeneral jaundiceAscitesHepatomegalySplenomegalyBruising
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60
Q

Name the 4 dental considerations for a patient with liver disease?

A

Oral and gingival hygieneBleeding tendencyAltered drug metabolism (local anaesthetic, sedation)Risk of viral hepatitis for the dental practitioner

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61
Q

Name 6 oral signs for liver disease?

A 
Angular cheilitisHaematomas, petechiaeGingival bleedingXerostomia, sialadenitisLichen planus – associated with HCVGlossitis – associated with alcoholism and nutritional deficiencies
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62
Q

What is necessary to check before any dental procedure of a patient with liver disease?

A

Check that the patient’s clotting and platelet count is normal. Where any derangement is seen, seek medical advice prior to proceeding.During the dental procedure, minimise mucosal trauma and keep any procedure to the minimum required.No NSAIDsIf difficult send to hospital setting

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63
Q

Should sedation be avoided for liver disease patient?

A 
YesAltered excretion functionAmmonia excretionOverdosingHospital for GA
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64
Q

Name the 6 the signs for LA toxicity?

A 
Peri-oral tinglingDrowsiness, confusionUnconsciousnessSeizuresArrhythmiasCardiac arrests
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65
Q

How can liver disease impact LA?

A

Reduced amount for LA toxicity

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66
Q

Name the 5 drugs contraindicated for liver disease patients?

A 
BenzodiazepinesAspirinAntifungals e.g. miconazoleAntibiotics e.g. erythromycin, metronidazole, tetracyclineStrong opiates e.g. morphine
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67
Q

Name the 4 drugs to be wary about prescribing for a liver disease patient?

A

Amide local anaestheticsNSAIDsParacetamolMild opiates e.g. codeine

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68
Q

What is considered to be the foregut?

A

Mouth-mid duodenum

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69
Q

What is considered to be the midgut?

A

mid-duodenum to mid-transverse colon

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70
Q

What is considered to be the hindgut?

A

Mid-transverse colon to anus

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71
Q

What are the symptoms for gastroesophageal reflux disease?

A 
HeartburnRegurgitationDysphagiaChest painHypersalivationGlobus sensationOdynophagia
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72
Q

What treatment can be used for GI disease?

A

Lifestyle changesProton pump inhibitorsH.pylori testing (CLO test)Anti-reflux surgery

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73
Q

What drugs are avoided for GI disease patients?

A

Ca ch blockersNSAIDsAnticholinergics

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74
Q

What alarming symptoms of GI disease should suggest a urgent referral?

A 
DysphagiaPersistent vomUnintentional weight lossGi bleedingAbdominal swelling
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75
Q

Dental implications of GI disease?

A

Tooth erosionHalitosisMucosal erythemaBurning mucosal sensation

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76
Q

What drug should be avoided for GI disease patients?

A

Aspirin

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77
Q

What preventative action can be taken for patients with GI disease?

A

Dietary adviceTreatment of reflux with PPIENhancing tooth surface integrityPlace adhesive physical barrier on susceptible tooth surfaces

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78
Q

Name the 5 general symptoms of Liver disease?

A 
JaundiceFever Loss of body hairCoagulopathyBruising
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79
Q

Name 11 causes of jaundice?

A 
Viral BacterialHepatomaMetastatic diseaseDrugsAlcoholWilson's diseaseIschaemiaObstructionSepsisAutoimmune Congestive
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80
Q

Symptoms for pre-hepatic jaundice?

A

Haemolytic anaemia or excessive prod of blood cells

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81
Q

Name 3 causes for hepatic jaundice?

A

PoisonsInfectionsTumours

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82
Q

WHat is the definition of post-hepatic jaundice?

A

Obstruction to the drainage of bile from liver

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83
Q

Name 7 antibiotics contraindicated for liver disease patients?

A

Erythromycin estolate - causes cholestasisTetracycline - dose related hepatotoxicityChloramphenicol - markedly increased half lifeAntituberculous therapy in combinations, pyrazinamideGriseofulvin - contraindicatedNalidixic acidNitrofurantoin prolonged use

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84
Q

What should a dentist do in situations a patient becomes acutely unwell?

A

Ensure adequate airwayBreathing: central cyanosis or fetorCirculation: tachy, pale or suggestion of other complications

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85
Q

Name 4 causes of IBD?

A

IschemiaInfectionDegenerativeInflammatory

86
Q

What are the signs and symptoms of Crohn’s?

A

Lesions may be found anywhere between the mouth and the anusThickened bowel wall with cobblestone appearanceDeep ulcers that cross the muscularis mucosaeGranulomas are common

87
Q

What are the signs and symptoms of UC?

A

Disease is confined to the colonThin bowel wallDisease is continuousUlcers do not cross the muscularis mucosaeGranulomas are uncommon and associated with crypts

88
Q

Name 7 oral manifestations for patient with IBD?

A

Periodontitis Aphthous lesions/stomatitis (typically labial/buccal mucosa) Pyoderma (pyostomatitis) vegetans Nodular granulomatous submucosal lesions Cobblestone mucosal swelling Oral tags Swollen lips (orofacial granulomatosis)

89
Q

Name 5 types of immunomodulators for treatment of IBD?

A 
Thiopurines, for example, azathioprineMethotrexateCalcineurin inhibitors, for example, cyclosporin A, tacrolimusCorticosteroidsAnti-TNFa, for example, infliximab
90
Q

What oral symptoms do iron deficiency anaemia patient show?

A

Angular cheilitis and aphthous ulcers| But this anaemia may be of greater concern such as bowel cancer

91
Q

Name 2 enzymes present in the mouth?

A

Salivary amylase| Lingual lipase

92
Q

What does the terminal ileum absorb?

A

B12| Bile acid

93
Q

How does the SI have a large SA?

A

Folds of the bowel surface covered by villi and microvilli

94
Q

Function of cheif cells?

A

Secretes pepsinogen and converted to pepsin

95
Q

Function of parietal cell?

A

Secrete HCl and intrinsic factor (bind B12)

96
Q

What is the function of the colon?

A

Water reabsorption| 200g into the stool

97
Q

What are the macroscopic pathology of Crohn’s disease?

A

Deep ulcers and fissures in the mucosaStricturesFistulae, for example between bowel and bladder/vagina (in women)Areas of affected mucosa that are not continuous, called ‘skip lesions’

98
Q

What are the symptoms of Crohn’s disease?

A

Abdominal painWeight lossDiaarhoea

99
Q

What are the oral manifestations for Crohn’s disease?

A

Diffuse facial and lip swellingCobblestoning of the mucosaUlcerationMucosal tags

100
Q

What tests can be done to investigate Crohn’s disease?

A

Blood testBarium enemaGI endoscopy

101
Q

What drug treatment can be undertaken for a Crohn’s patient?

A

Oral steroidsAnti-inflammatoryImmunosuppressive drugsHigh fibre low fat diet

102
Q

What surgical treatment can be undertaken for a Crohn’s patient?

A

Complications such as strictures and fistulas intervention

103
Q

What are the macroscopic pathology of ulcerative colitis?

A

Affects only the colonStarts in the rectum and then extends backwards (proximally) by varying amountsContinuously involves bowel (NO skip lesions, unlike Crohn’s)Produces ulcers and pseudo-polyps

104
Q

What are the extraintestinal features for UC and Crohn’s?

A 
Anaemia (due to blood loss)ArthritisClubbingSkin conditionsUveitis
105
Q

What are the oral manifestations for UC?

A

Aphthous ulcers| Angular cheilitis

106
Q

What tests can be done to investigate ulcerative colitis?

A

Blood testStool cultureBarium enemaGI endoscopy

107
Q

What drug treatment can be undertaken for a ulcerative colitis?

A

Oral steroidsAnti-inflammatoryImmunosuppressive drugsHigh fibre low fat diet

108
Q

What surgical treatment can be undertaken for a Crohn’s patient?

A

Colectomy| Stoma

109
Q

What are the symptoms of Coeliac disease?

A 
Feeling generally tired and weakWeight lossDiarrhoea +/- steatorrhoeaAbdominal distension and painAnaemia
110
Q

What tests can be done to investigate coeliac disease?

A

Blood test| GI endoscopy

111
Q

What are the oral presentations for Coeliac disease?

A 
Features of anaemiaOral ulcerationGlossitisAngular cheilitisEnamel defects
112
Q

What is the definition of TI diabetes?

A

Autoimmune destruction of Beta cells leads to reduced insulin production

113
Q

What is the definition of TII diabetes?

A

Body becomes increasingly resistant to effects of insulin| Pancreas works harder to control plasma glucose levels

114
Q

Name 8 diseases that cause 2nd diabetes?

A 
Chronic pancreatitisHaemochromatosisCystic fibrosisAcromegalyCushing'sGlucagonomaPheochromocytomaSteroids
115
Q

What is the definition monogenic diabetes?

A

Maturity onset diabetes of the youngNot TI or TIIAutosomal dominantGlucokinase, HNF1A and NHF4A

116
Q

What is the treatment for monogenic diabetes?

A

HNF1A and HNF4A responds to sulfonylurea| Glucokinase no treatment

117
Q

Describe the signs and symptoms of undiagnosed diabetes?

A 
ThirstPolyuriaPolydypsiaWeight changeLethargySKin changesBlurred visionRecurrent candida infections
118
Q

What is the normal value for fasting plasma glucose?

119
Q

What is the diabetic valve for fasting plasma glucose?

120
Q

What is the intermediate valve for fasting plasma glucose?

121
Q

What is the normal value of 2hr OGTT?

122
Q

What is the intermediate value of 2hr OGTT?

123
Q

What is the diabetes value of 2hr OGTT?

124
Q

What are the requirements for a clinical diabetes diagnosis?

A

1 typical symptom + 1 diagnostic blood test| 2 diagnostic blood test

125
Q

When should HbA1c should be used?

A

True fasting blood sampling is not possible OR| following identification of impaired fasting plasma glucose

126
Q

Explain how the HbA1c test works?

A

Glucose binds irreversibly to haem in RBCs forming Hb1AcHigher glucose, Higher Hb1AcCan reflect the blood glucose over 2-3 months

127
Q

Name low, medium and high levels of the Hb1Ac test?

A

Low: 48Medium: 64High: 97Lowering your Hb1Ac by 10 mmol/mol reduces your risk of complications by 20%

128
Q

Name the 3 macrovascular complications for diabetes?

A

Coronary artery diseaseCerebrovascular diseasePeripheral vascular disease

129
Q

Name the 4 microvascular complications for diabetes?

A

Peripheral neuropathyRetinopathyNephropathyAutonomic neutropathy

130
Q

How do diabetics monitor their blood glucose?

A

Capillary blood glucosePrick fingersDevices available

131
Q

What should the blood glucose targets be over the day?

A

Before breakfast: 5-6 mmol/LBefore meals: 4-7 mmol/L2 hrs after meal: 5-9 mmol/LBedtime: 6-8 mmol/L

132
Q

How can ketone monitoring be useful for diabetics?

A

Presence of ketones indicates lack of insulinUrine or blood testLevels change much faster

133
Q

What are the normal, rapid action and immediate action for ketone monitoring?

A

Normal: <0.6Rapid: 0.6-1.5Immediate: >1.5

134
Q

What is the definition of Flash CGM?

A

Freestyle libre sensor contains a small filament underneath the disk that is inserted into the back of the armFilament measures the glucose level of the interstitial tissue under your skinSensor lasts up to 14 days and needs to be scanned at least every 8 hours - continuous glucose infoWater resistant up to 1m for 30 minsMeasures interstitial rather than blood glucose

135
Q

Name the 4 categories for treatment of TII diabetes?

A

DietExerciseDrugsInsulin

136
Q

Name the oral manifestations for diabetes?

A

Xerostomia; burning sensation in the mouthImpaired/delayed wound healing; increased incidence and severity of infections; Secondary infection with candidiasis; Parotid salivary gland enlargement; Gingivitis; and/or periodontitis.

137
Q

Name 7 drug treatment options for diabetes?

A 
MetforminSulfonylureasPioglitazoneDPP-4 inhibitorsSGLT-2 inhibitorsGLP-1Insulin
138
Q

How successful is counterweight plus to aid TII diabetes?

A

Counterweight Plus: 53/149 achieved remissionControl diet: 5/149 achieved remissionRemission defined as Hb1Ac <48 mmol/mol

139
Q

How can exercise impact TII diabetes?

A

Compared to a very low control| Exercise can help

140
Q

Why should we treat diabetes?

A

Reduce hyperglycaemia and CVD

141
Q

Describe 2 types of regimes for insulin taking?

A

Basal, basal bolus or basal plus| Twice daily mixed

142
Q

Name the 4 requirements for an insulin pump therapy?

A

TI diabetesTesting at least 4 times a dayEducated on carb countingsignificant hypos or poor control despite optimal basal bolus therapy

143
Q

Explain how the closed loop device works?

A 
Artificial pancreasLow user inputAccurate and reliable glucose monitoringAlgorithms incorp glucose data to adjust doseInternal or external
144
Q

Name 2 types of hypoglycaemia?

A

Mild| Severe

145
Q

Name 2 causes of hypoglycaemia?

A 
Insulin therapySulfonylurea therapy (glipizide and gliclazide)
146
Q

What is the frequency of hypos for a T1 diabetes patient?

A

2 mild hypos per week| 1 severe hypo per year

147
Q

Name the 11 clinical features of a hypoglycaemic attack?

A 
ConfusionDrowsinessOdd behaviourSpeech difficultyIncoordinationMalaiseHeadachePalpitationsHungerTremblingSweating
148
Q

Explain glucose metabolism?

A

Oral intakeGluconeogenesis + glycogen breakdownGlucose use in brain, muscle and adipose tissue

149
Q

Name the 6 adverse effects of hypoglycaemia?

A 
ComaSeizureHemiplegiaFractureArrhythmiaMyocardial ischaemia
150
Q

Describe S1 of immediate management of conscious patient?

A

Give 15-20g quick acting carbs patient choice:e. g. - 150-200 mL of pure fruit juice- 5-7 Dextrosol tablets or 4-5 glucotabs- 3-4 heaped teaspoons of sugar dissolved in water

151
Q

Describe S2 of immediate management of conscious patient?

A

Repeat capillary blood glucose measurement 10-15 minutes later.If less than 4.0 mmol/L repeat step 1 up to 3 times

152
Q

Describe S3 of immediate management of conscious patient?

A

Blood glucose remains less than 4.0 mmol/L after 45 mins contact doctorConsider 1mg of glucagon IM or IV 10% glucose infusion at 100ml/hr

153
Q

Describe S4 of immediate management of conscious patient?

A

Once blood glucose above 4.0mmol/L and recovered, then give long acting carb e.g.- 2 biscuits- sliced bread

154
Q

Describe S1 of immediate management of conscious patient whom is confused and disorientated?

A

Uncoop but able to swallow:- 1.5-2 tubes glucogel/dextrogel- glucagon 1mg IMGlucagon may not be effective for sulfonylurea or malnourished

155
Q

Describe S1 of immediate management of unconscious patient?

A

Check ABCGive IV glucose over 15 mins as 75ml 20% or 150ml 10%Or 1mg glucagon IMRecheck after 10 mins to see above 4 mmol/L

156
Q

What are the sick day rules for TI diabetes?

A

Body stressed = blood glucose higherDon’t stop insulinDrink plentyCheck levels of glucose and ketones

157
Q

What are the consequences of missing insulin?

A 
Increased resp rateKetones on breathAbdominal painNauseaVomiting
158
Q

What are the sick day rules for TII diabetes?

A 
Rest FLuidsTreat associated symptomsAntibiotics indicatedCheck levels more regAdjust meds:- stop metformin if risk of dehydration- stop SGLT-2 inhibitor if very unwell
159
Q

What is the definition of diabetic ketoacidosis?

A

Characterised by hyperglycaemia, acidosis and ketonaemiaBG >11Ketones > 3pH < 7.3 (HCO3 <15)

160
Q

If DKA is detected, what should you do?

A

1L IV NaCl 0.9% over 1 hr within 30 mins| Sol IV insulin of 6 units/hr within 30 mins

161
Q

How to detect DKA clinically?

A 
H+ > 45HCO3 <18pH <7.3Check U and Es Lab blood glucoseCheck urine and blood ketones
162
Q

What pH, HCO3 and H+ is severe DKA?

A

pH <7.1HCO3 < 5mmol/LH+ > 80mEq/L

163
Q

Name the 10 endocrine organs?

A 
TestesOvariesPancreasAdrenal glandThymusParathyroidThyroidPituitaryHypothalamusPineal gland
164
Q

WHat hormones are required for repro?

A

LH and FSH

165
Q

What hormones are required for metabolish?

166
Q

What hormone is required for lactation?

167
Q

What hormone is required for growth

168
Q

What hormones is required for stress?

169
Q

WHat hormones is required for water balance?

170
Q

What hormones is required for parturition?

171
Q

What are some endocrine conditions?

A 
HypothyroidismAmyloidosisLymphomaSyphilisSecondary macroglossia from benign or malignant space occupying lesions
172
Q

Name 6 endocrinopathies?

A 
Adrenal insufficiencyCushing'sHypothyroidismThyrotoxicosisGoitreAcromegaly
173
Q

What does the glomerulosa produce in the adrenal gland?

A

Mineralocorticoids

174
Q

What does the fasciculata produce in the adrenal gland?

A

Glucocorticoids

175
Q

What does the reticularis produce in the adrenal gland?

176
Q

What do the adrenal glands produce?

A

Adrenaline| Noradrenaline

177
Q

Name the 2 types of adrenal insufficiency?

A

Primary - High ACTH| Secondary - Low ACTH

178
Q

What is the definition of primary adrenal insufficiency?

A

Autoimmune (tuberculous adrenalitis)| ACTH not able to interact with Adrenal gland

179
Q

What is the definition of secondary adrenal insufficiency?

A

Tumour in the hypothalamic-pituitary region| No form of ACTH

180
Q

What is the definition of tertiary adrenal insufficiency?

A

WIthdrawal of exogenous glucocorticoid admin

181
Q

Name the 4 discriminatory diagnostic features for adrenal insufficiency?

A

Skin hyperpigmentationAlabaster-coloured pale skinLow BPPostural hypotension

182
Q

Name a test for adrenal insufficiency?

A

Short synacthen test

183
Q

Explain how the short synacthen test works?

A 
Assess renal reserveAny time of day without fastingInj synthetic ACTHTake baseline cortisol before and one 30 mins laterOnly for adrenal gland
184
Q

For a dental patient with adrenal insufficiency what must they take addition to their current medication before a dental extraction?

A

20mg (double/triple of normal dose) hydrocortisone or double usual dose of prednisolone before procedureResume normal dose after

185
Q

Name the 4 clinical features that best discriminate Cushing’s syndrome?

A

Easy bruisingFacial plethoraProximal myopathy or proximal muscle weaknessStriae - especially if reddish purple and >1cm wideMoon faced

186
Q

What is the definition of Cushing’s syndrome?

A

ACTH dependent - Cushing’s or Ectopic ACTH secreteACTH independent - Adrenal adenoma/carcinomaExogenous steroids

187
Q

What investigation can aid in the diagnosis for Cushing’s?

A

Demonstrate excess cortisol:- 24 hr urinary free cortisol- overnight dexamethasone suppression test

188
Q

Name 4 conditions associated with hypercortisolism without cushing’s syndrome?

A

PregDepression/other psy conditionsAlcohol dependenceMorbid obesity

189
Q

What is the definition of hypothyriodism?

A

Negative feedback loop| Low thyroid hormone Low T4/3 but high TSH

190
Q

Name the 2 types of thyroid hormone?

A

T4 - thyroxineT3 - triiodothyronineDeiodinase enzymes convert T4 to T3

191
Q

What is the normal range for TSH?

192
Q

What is the normal range for free t3?

193
Q

What is the normal range for free t4?

194
Q

What is the definition of thyrotoxicosis?

A

High T4/T3 and low TSH

195
Q

What is the treatment for hypothyroidism?

A

Levothyroxine

196
Q

How to test for hypothyroidism?

A

TFT testing interval| GAFUR

197
Q

WHat are the main causes for hypothyrodism?

A

Atrophic autoimmune thyroiditisHashimoto’s thyroiditisPost-treat thyrotoxicosis

198
Q

Name 4 diseases that have thyrotoxicosis common as a symptom?

A

GravesToxic multinodular goitreAutonomously functioning adenomaThyroiditis

199
Q

What are the discriminatory signs for thyrotoxicosis?

A

GoitreTremorOcular signs

200
Q

What investigations help for thyrotoxicosis diagnosis?

A

TSH, T4 and T3| TPO and TRABs

201
Q

What treatment options are there for thyrotoxicosis?

A 
Carbimazole:- once daily- gives rashPropylthiouracil:- 2 daily- rashBeta blockerLow dose radioiodine:- can cause hypothyroidismThyroid surgery:- recurrent laryngeal nerve- Ca issue
202
Q

What are the 3 differential diagnoses for thyroid nodules?

A

Multinodular goitre with a dominant noduleThyroid cystThyroid cancer

203
Q

What is the aetiology for goitre?

A 
Autoimmune thyroid diseaseSporadicEndemicPregDrug inducedThyroiditis
204
Q

What can a ultrasound signify for thyroid lumps?

A

3cm mass in R lobe of thyroid suggestive but not diagnostic of follicular thyroid cancerR diagnostic hemithyroidectomy

205
Q

What is the definition of acromegaly?

A

An increased secretion of growth hormone causing changes in appearance

206
Q

What could acromegaly be caused by?

A

Growth hormone secreting tumour

207
Q

Name 9 complications associated with acromegaly?

A 
Visual field defectHeadachesDiabetesDecreased libidoSleep apnoeaHypertensionCardiomyopathyArthritisCarpal tunnel
208
Q

Give 5 tests that can aid acromegaly diagnosis?

A

Blood test:- IGF1- Glucose- Thyroid hormone- Oestrogen- FSH

209
Q

Explain how the oral glucose tolerance test is carried out?

A

Baseline blood sampleMeasured dose of glucoseBlood drawn at intervalsDetermine how quickly blood can be clearedFor acromegaly, check growth hormone levelsCan do MRI after

210
Q

What are the treatment options for acromegaly?

A

Removal of tumourSandostatin analogue if surgery failsGH inhibition (Pegvisomant)Dopamine can suppress GH secretion

CSP1 YR5 (10 decks)

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