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MedEd Path > MedEd Chem 1 > Flashcards

MedEd Chem 1 Flashcards

1
Q

describe the endocrine axis in the body

A

hypothalamus –> pituitary –> end organ
(tertiary) (secondary (primary)
- negative feedback from each to the one above
- external factors control the negative feedback

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2
Q

where is thyroid

A

inferior to larynx

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3
Q

vascular supply to thyroid

A

3 arteries (superior, inferior, thyroid ima) and veins (superior, middle, inferior)

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4
Q

2 functions of thyroxine and the R it acts on

A

acts on intranuclear receptor
regulates BMR
potentiating reponses to catecholamines

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5
Q

describe histology of thyroid gland

A

stroma (pale) with colloid (pink) surrounded by follicular cells (dark purple) and parafollicular cells between follicular cells

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6
Q

production of thyroxine

A

stimulated by TSH
thyroglobulin secreted by follicular cells
moved into colloid
oxygenation and iodination of thyroglobulin by thyroid peroxidase
makes t4
moves back into follicular cells
secreted into blood

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7
Q

what is free thyroxine

A

t4

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8
Q

t4 to t3 by which enzyme

A

deiodinase enzymes

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9
Q

how many iodine molecules does t4 have

A

2

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10
Q

what do parafollicular cells secrete

A

calcitonin

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11
Q

what does calcitonin do

A

regulates (reduces) calcium

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12
Q

sx of too much thyroxine

A

tremor
sweating
weight loss
palpitations
heat intolerance
goiter
anxiety

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13
Q

sx of hypothyroidism

A

weight gain
puffiness
reduced heart rate
constipation
depression

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14
Q

describe period dysfunction in hypo/hyperthyroidism & why

A

hypo = heavy periods
hyper = oligomenorrhoea with light periods
thyroxine has anti oestrogen effects - too much = blocks ovulation, too little = endometrial proliferation

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15
Q

what actually causes a goitre

A

high TSH causing proliferation

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16
Q

what types of thyroid issues cause goitre

A

primary hypothyroidism - TSH produced in response to low t4
secondary / tertiary hyperthyroidism - too much TSH produced

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17
Q

buzzword clinical features of specific thyroid diseases

A

pretibial myxoedema = graves
exopthalmus = hyperthyroidism (esp graves)
myxoedema coma = hypothyroidism

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18
Q

what scan is done in thyroid disease

A

radio iodine technetium scan

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19
Q

radio iodine scan of graves

A

butterfly thyroid - diffuse uptake through whole of thyroid

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20
Q

radio iodine scan of toxic multinodular goitre

A

discrete patches of uptake where the nodules are

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21
Q

radio iodine scan of toxic adenoma

A

single very dark spot showing intense uptake in one area over cancer

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22
Q

causes of hyperthyroidism

A

graves
de quervains
thyroid adenoma / ectopic
drug induced
toxic multinodular goitre
PP
iodine / jon basedow reaction

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23
Q

what is graves

A

AID hyperthyroidism due to auto ABs to TSH R

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24
Q

reaction to what drug can cause hyperthyroidism

A

amiodarone

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25
Q

causes of hypothyroidism

A

congenital /cretinism
primary atrophic
hashimotos
iodine deficiency
surgery / radio ablation
hypopituitarism
drugs
wolf chaikoff effect

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26
Q

what drugs can cause hypothyroidism

A

amiodarone, lithium, carbimazole

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27
Q

process of de quervain’s thyroiditis inc thyroidism level

A

infection / cancer / surgery / ITU stay etc –> inflammation of thyroid –> breakdown of gland –> release of all the hormones

hyper –> hypothyroid as hormones run out

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28
Q

why does amiodarone cause thyroid issues

A

amiodarone is a source of iodine

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29
Q

what is jon basedow reaction

A

chronic low thyroxine then given iodine causes hyperthyroidism due to body being used to low thyroxine

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30
Q

what is wolff chaikoff effect

A

give someone loads of iodine –> overloads the thyroid cells –> kills them off –> hypothyroidism

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31
Q

why is wolff chaikoff effect clinically relevant

A

explains why radio iodine in high doses can be used to treat toxic multinodular goitre etc

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32
Q

what is hashimotos thyroiditis

A

AID with ABs against TPO
(hypothyroidism)

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33
Q

what does ABs against TPO in hashimotos actually cause

A

inability to oxygenate and iodinate that thyroglobulin into t4 so no thyroxine produced

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34
Q

causes of cretinism

A

thyroid agenesis
thyroid dysgenesis

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35
Q

from where does the thyroid form embryologically

A

foramen caecum
(also forms part of tongue which is why if you have a thyroglossal cyst, it will move when you stick your tongue out)

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36
Q

features of cretinism

A

LDs
oedematous - puffy face, distended abdo
protruding tongue
stunted growth
hypothyroidism sx

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37
Q

Ix of thyroid issues

A

bedside - ECG, examination
bloods - FBC, U&Es, TFTs, ABs, lipids, BM, LFTs
imaging - USS, thyroid uptake / isotope scan, CT, MRI

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38
Q

ABs to screen for in ?thyroid issues

A

anti TSH
anti TPO

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39
Q

TSH low or high, free t4 high , t3 high. Dx?

A

hyperthyroidism

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40
Q

TSH high or low, free t4 low, t3 low. Dx?

A

hypothyroidism

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41
Q

TSH low or normal, free t4 low, t3 low. Dx?

A

sick euthyroid

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42
Q

TSH low, free t4 high or low, t3 high or low. Dx?

A

subacute thyroid

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43
Q

TSH normal or high, free t4 low, t3 low. Dx?

A

subclinical hypothyroid

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44
Q

TSH normal or low, free t4 high, t3 high. Dx?

A

subclinical hyperthyroid

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45
Q

mx of hyperthyroid and reason why for each

A

propanolo - sx control
thioamides - inhibit TPO
radioiodine - wolf chaikoff effect
surgical resection

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46
Q

mx of hypothyroidism

A

oral levothyroxine

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47
Q

mx of myxoedema coma

A

IV liothyronine

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48
Q

how is levothyroxine titrated

A

to normal TSH with 6 weekly check ups until stable
ensuring not over replacing –> palpitations
higher in preg / nephrotic syndrome etc

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49
Q

what is sick euthyroid

A

severe illness causes body to try and shut down metabolism to conserve energy so low t3/4 –> initially high TSH then low

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50
Q

most common type of thyroid tumour

A

papillary 70%

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51
Q

which thyroid tumour has best prognosis

A

papillary

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52
Q

3 buzzwords for papillary thyroid tumour

A

psammoma bodies
orphan annie nuclei
lymphatic invasion

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53
Q

2nd most common thyroid tumour

A

follicular 20%

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54
Q

what is prognosis of follicular tumour (good / bad / very bad)

A

good

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55
Q

2 buzzwords for follicular tumour

A

encapsulated
vascular invasion

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56
Q

2 associations of medullary thyroid cancer (buzzwords)

A

c-cells that produce calcitonin
MEN2

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57
Q

what thyroid condition is a risk factor for developing lymphoma

A

hashimotos

58
Q

2 buzzword gene associations of lymphoma with thyroid

A

DLBCL
CD20

59
Q

who gets anaplastic thyroid tumour

A

elderly people

60
Q

prognosis of anaplastic thyroid tumour (good / bad / very bad)

A

very bad

61
Q

histology of anaplastic thyroid tumour

A

rapid growth
giant and spindle shaped cells

62
Q

Mx of papillary and follicular thyroid tumours

A

surgery +/- radio-iodine
replace thyroxine to completely suppress TSH
monitor thyroglobulin / calcitonin

63
Q

50F with recent coryzal Sx. Now has hyperthyroidism sx with tender neck. low TSH and high T4. poor uptake on technetium scan. Dx?

A

de quervain’s thyroiditis

64
Q

which blood marker is used to monitor for recurrence of medullary thyroid cancer

A

calcitonin

65
Q

Mx for thyrotoxic crisis

A

beta blocker, steroid, thioamide

66
Q

why is steroid given in thyrotoxic crisis

A

prevents peripheral conversion of t4 to t3

67
Q

where does pituitary sit

A

sella turcica

68
Q

list anterior pituitary hormones

A

growth hormone
FSH / LH
ACTH
TSH

69
Q

list hypothalamic hormones which act on AP

A

TRH
VP
CRH
GnRH
GHRH
somatostatin

70
Q

how is GnRH released

A

pulsatile wave forms

71
Q

2 types of pituitary masses with definition of each

A

macroadenoma >1cm (non functional)
microadenoma <1cm (functional)

72
Q

sx related to macroadenoma in pituitary

A

bitemporal hemianopia - superior quadrantopia
headache
hormone related - mainly prolactin

73
Q

clinical features of acromegaly

A

soft tissue growth - large hands / feet / tongue
organomegaly
HF / HTN
DM
carpal tunnel

74
Q

Ix of acromegaly

A

plasma IGF-1 1st line
OGTT
GH measurement
MRI pituitary

75
Q

Mx of acromegaly

A

trans sphenoidal surgical resection - 1st line
somatostatin analogue
CVD risk factor modification
monitor serum GH
colonoscopy surveillance

76
Q

what is gigantism

A

acromegaly before puberty (epiphysis haven’t fused so get rlly tall)

77
Q

clinical features of prolactinoma

A

galactorrhoea
gynaecomastia
oligo / amenorrhoea
loss of libido
impotence

78
Q

ix of prolactinoma with key result

A

serum prolactin (>6000)
MRI pituitary

79
Q

mx of prolactinoma

A

dopamine agonist - 1st line
trans sphenoidal resection
serum prolactin for monitoring

80
Q

causes of hypopituitarism

A

cancer - pituitary adenoma, craniopharyngioma
infection - TB / syphillis
infiltration - sarcoid / lymphoma
iatrogenic - surgery / trauma / radiation
infarct - Sheehan’s / apoplexy
tertiary - kallman’s

81
Q

signs / sx of hypopituitarism

A

generic - lethargy, weight gain, low BP, hair loss, myalgia
sex hormones - impotence, loss of libido, no periods (GnRH)
addisons crisis (ACTH)
myxoedema coma (TSH

82
Q

in what order are the hormones lost in SOL compressing pituitary

A

(kind of the order of how important they are except prolactin)
GH first to go
FSH / LH
ACTH
TSH
prolactin last to go (TRH stimulates prolactin, so when TSH goes then prolactin goes up)

83
Q

screening of hypopituitarism

A

9am cortisol
TFTs
serum testosterone / oestrogen

84
Q

Ix of hypopituitarism and what this involves

A

combine pituitary function test
- administer LHRH, TRH and induce hypoglycaemia (give insulin)
- measure LH, FSH, TSH, ACTH and GH for 2 hours every 30 mins.

CT / MRI

85
Q

mx of hypopituitarism

A

replace end hormones - cheaper and easier
- hydrocortisone
- thyroxine
- oestrogen / testosterone
give steroids if infiltration cause

86
Q

which hormone needs to be replaced first and why in hypopituitarism

A

hydrocortisone - can precipitate a thyrotoxic crisis otherwise

87
Q

BV supply to adrenals

A

3 arteries
1 vein

88
Q

3 layers of adrenal cortex and what does each secrete

A

glomerulosa = aldosterone
fasicularta = cortisol
reticularis = sex hormones
medulla = catecholamines
(remember it as GFR outer to inner)

89
Q

3 layers of adrenal cortex and what does each secrete

A

glomerulosa = aldosterone
fasicularta = cortisol
reticularis = sex hormones
medulla = catecholamines
(remember it as GFR outer to inner)

90
Q

what does 21 hydroxylase do

A

progesterone –> deoxycorticosterone (ald pathway)
AND
17 OH progesterone –> 11 deoxycortisol (cortisol pathway)

91
Q

what does 17a hydroxylase do

A

progesterone –> 17 OH progesterone
AND
pregnenolone –> 17 OH prognenolone
(both in aldosterone to cortisol pathway shunt)

92
Q

21a hydroxylase deficiency clinical picture

A

CAH

93
Q

clinical features of 11 beta hydroxylase deficiency

A

HTN
hypernatraemia
hypokalaemia

94
Q

clinical features of 21 hydroxylase deficiency

A

hypotensive addisons crisis
low Na, high K

95
Q

causes of adrenal insufficiency

A

primary
- iatrogenic
- Addisons (AID)
- TB
- waterhouse friedrichson syndrome
- infarct
- malignancy
- AIPE syndromes 1&2
secondary
- hypopituitarism

96
Q

what is waterhouse friedrichson syndrome

A

septicaemia causing haemorrhagic adrenals infarcts

97
Q

which bug / condition most commonly causes waterhouse friedrichson syndrome

A

neisseria meninigitidis meningitis

98
Q

clinical features of adrenal insufficiency

A

postural sx
weight loss, anorexia
abdo pain, N&V
fatigue
vomitting, salt craving
skin / mucosal pigmentation
decreased arm / pubic hair
addisonian crisis

99
Q

Ix for adrenal insufficiency

A

9am cortisol
U&Es - Na, K
serum ACTH
glucose
CT abdomen
SynthACTHen test

100
Q

how is synthACTHen test done

A

IV/IM ACTH given
check cortisol at 0,30,60 mins

101
Q

what 9am cortisol reading would exclude Addisons

A

> 350

102
Q

in which type of adrenal insufficiency cause would synthACTHen test be positive (cortisol rises)

A

secondary disease

103
Q

Mx of adrenal insufficiency

A

hydrocortisone (glucocorticoid + weak mineralo)
fludrocortisone (mineralocorticoid)

104
Q

causes of hyperaldosteronism

A

primary
- bilateral idiopathic hyerplasia
- adrenal adenoma
- familial GRA
secondary
- RAS
- FMD
- CCF

105
Q

sx / signs of hyperaldosteronism

A

HTN
low K
high Na
polyuria and polydipsia

106
Q

ix of hyperaldosteronism

A

bloods - U&Es, plasma ald:renin ratio
CT abdo
adrenal vein sampling

107
Q

mx of hyperaldosteronism

A

aldosterone antagonists (spironolactone)
surgical resection

108
Q

causes of cushing syndrome

A

primary
- adrenal tumour
secondary
- pituitary adenoma (cushings DISEASE)
- ectopic / paraneoplastic ACTH - SCC lung Ca
iatrogenic
- xs steroids
mccune albright syndrome

109
Q

cushings sx

A

moon face
red face
buffalo hump
lemon on sticks etc

110
Q

ix of cushings

A

24hr urinary cortisol / 9am cortisol
low dose dex suppression test
high dose dex suppression test
CT CAP / MRI pituitary

111
Q

purpose of 24hr urinary cortisol / 9 am cortisol for ?cushings

A

confirms raised cortisol

112
Q

purpose of low dose vs high dose dex suppression test for ?cushings

A

low dose = confirms true cushings syndrome (ie not exogenous steroids)
high dose = confirms cushings DISEASE

113
Q

mx of cushings due to exogenous steroids

A

gradual tapering

114
Q

mx of cushings disease

A

trans sphenoidal resection

115
Q

mx of cushings due to adrenal tumour

A

monitoring
resection
radiotherapy

116
Q

mx of cushings due to ectopic tumour

A

radio / resection
ketoconazole / metyrapone / mifepristone

117
Q

what are phaeos associated with

A

MEN2
NF 1
VHL

118
Q

what is the clinical rule of phaeos

A

10%
malignant
extra adrenal
bilateral
normotensive

119
Q

clinical features of phaeo

A

episodes of panic / impending doom
resistant HTN
triad: throbbing headache, palpitations, sweating

120
Q

ix of phaeo

A

BP, ECG
** urinary metanephrins ** buzzword
U&Es, LFTs, catecholamines
CT abdo / MIBG scan

121
Q

what can cause false positives in urinary metanephrins test

A

TCAs
CCBs
beta blockers

122
Q

mx of phaeo

A

alpha blockade - phenoxybenzamine
beta blockade
surgery
chemo
labelled MIBG

123
Q

phaeos are tumours of what

A

adrenal medulla

124
Q

what is conns syndrome

A

adrenal hyperplasia / tumour causing HTN, high Na and low K

125
Q

what Ix is high in conns

A

aldosterone:renin ratio

126
Q

tx of conns

A

spironolactone
adrenalectomy

127
Q

features of MEN1

A

pituitary adenoma
parathyroid hyperplasia
pancreatic tumour
3Ps

128
Q

features of MEN2a

A

parathyroid hyperplasia
medullary thyroid cancer
phaeo
2Ps 1M

129
Q

features of MEN2b

A

mucosal neuromas
marfanoid body habitus
medullary thyroid cancer
phaeo
1P 3Ms

130
Q

Dx of pre DM with values for each

A

fasting BG 6.1-6.9
OGTT 7.8 - 11
HbA1c 42 - 47
random BM 7.8 - 11

131
Q

Dx of DM with values for each

A

Sx + one of these // no Sx + 2 of these:
fasting BG >7
OGTT >11.1
HbA1c >48 (6.5%)
random BM >11.1

132
Q

mx of t1dm

A

lifestyle advice - inc alcohol
DM nurse review
dietary advice
insulin
metformin if BMI >25
surgical - pancreas kidney transplant

133
Q

outline tx ladder of t2dm (7)

A

diet and lifestyle
exercise
metformin
+ sulphonylurea / DPP4 agonist / SGLT2 inhibitor
+ GLP1 antagonist or 2 of above
insulin
surgical - bariatric

134
Q

buzzword for DKA breathing

A

kussmals breathing

135
Q

enzyme deficiency in acute intermittent porphyria

A

PBG deaminase

136
Q

Ix of acute intermittent porphyria

A

urinary / serum levels of PBG and ALA

137
Q

sx of acute intermittent porphyria

A

acute abdo pain
GI Sx
neuropsych Sx - confusion, hallucinations, sensory loss / weakness

138
Q

what is PCT

A

porphyria cutanea tarda

139
Q

enzyme deficiency in PCT

A

uroporphyrinogen decarboxylase

140
Q

Ix of PCT

A

urinary uroporphyrinogen III is raised

141
Q

sx of PCT

A

photosensitive rashes and blisters

MedEd Path (10 decks)

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