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JUST4MED clinical cases > Medicine- Hypothyroidism + Pancreatic Ca > Flashcards

Medicine- Hypothyroidism + Pancreatic Ca Flashcards

1
Q

Which of these is a cause of hypothyroidism?

a) Hashimoto’s disease
b) Grave’s disease
c) Levothyroxine excess
d) Iodine excess

A

a) Hashimoto’s disease

Hashimoto’s is a type of autoimmune hypothyroidism

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2
Q

Which of these signs would you expect to see in hypothyroidism?

a) Palmar erythema
b) Tachycardia
c) Ascites
d) Brisk reflexes

A

c) Ascites

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3
Q

What would you expect to see in secondary/central hypothyroidism?

a) TSH raised, T4 raised
b) TSH raised, T4 reduced
c) TSH normal, T4 raised
d) TSH reduced, T4 reduced

A

d) TSH reduced, T4 reduced

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4
Q

What is ‘Hypothyroidism?

A

• Hypothyroid disease/hypothyroidism: a clinical state resulting from underproduction of the thyroid hormones T3 and T4

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5
Q

Primary hypothyroidism can be caused by?

A
  • Autoimmune thyroiditis (Hashimoto’s disease)
  • Iodine deficiency - (major cause worldwide)
  • Primary atrophic hypothyroidism (autoimmune)
  • Post-thyroidectomy/radioiodine treatment
  • Drug-induced : Amiodarone, lithium, over-treatment of hyperthyroidism
  • Subacute thyroiditis
  • Malignancy
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6
Q

Secondary hypothyroidism can be caused by?

A
  • lack of TSH production usually due to hypopituitarism (pituitary adenoma or necrosis)
  • Infiltrative disease such as tuberculosis or hemochromatosis
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7
Q

Symptoms of hypothyroidism?

A
  • Weakness
  • Lethargy
  • Cold sensitivity
  • Weight gain
  • Goitre development
  • Depression/psychosis
  • Menstrual irregularity, pain
  • Myalgia, cramps
  • Constipation
  • Decreased libido
  • Dry skin or hair
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8
Q

History of hypothyroidism patient

A
  • For hypothyroidism the patient will usually present with fatigue, low mood and maybe a few more specific symptoms
  • In the history it is important to then ask about specific symptoms of hypothyroidism to try to determine if this is the most probable diagnosis.
  • Such as asking about specific symptoms/signs in hypothyroidism
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9
Q

Epidemiology of hypothyroidism

A
  • Family history of autoimmune thyroiditis
  • Female sex
  • Middle age
  • Other autoimmune conditions (type 1 DM, Addison’s, pernicious anaemia)
  • Iodine deficiency
  • Grave’s disease
  • Amiodarone/lithium use
  • Radiotherapy
  • Turner’s and Down’s syndrome
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10
Q

Ix for hypothyroidism

A
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11
Q

Differentials for hypothyroidism?

A
  • Primary hypothyroidism
  • Secondary hypothyroidism
  • Depression
  • Alzheimer’s dementia
  • Anaemia
  • Malignancy
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12
Q

Conservative and medical management for hypothyroidism

A
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13
Q

Clinical examination

what is the pneumonic for hypothyroidism

A
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14
Q

A 50 year old female presents with increasing fatigue and low mood. On examination she is bradycardic, has cold hands and a goitre.

Which other signs might you expect to see in this lady?

a) Increased reflexes
b) Ascites
c) Unsteady stature
d) Tremor

A

b) Ascites
c) Unsteady stature

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15
Q

A 50 year old female presents with increasing fatigue and low mood. On examination she is bradycardic, has cold hands and a goitre

A TSH and T4 blood tests are sent and confirm primary hypothyroidism, what results would you expect to see?

a) TSH raised, T4 raised
b) TSH decreased, T4 raised
c) TSH decreased, T4 decreased
d) TSH raised, T4 decreased

A

d) TSH raised, T4 decreased

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16
Q

A 50 year old female presents with increasing fatigue and low mood. On examination she is bradycardic, has cold hands and a goitre

What would be your initial management and treatment?

a) Give levothyroxine
b) FNA and ultrasound to exclude malignancy
c) Lifestyle advice d

) Thyroid antibodies screen and FBC/LFTS/U+Es

A

ALL

17
Q

What is the function of the pancreas?

a) Secrete bile
b) Secrete pepsinogen
c) Secrete insulin and glucagon
d) Secrete trypsinogen

A

c) Secrete insulin and glucagon
d) Secrete trypsinogen

18
Q

Chief cells produce

A

chief cells produce pepsinogen

19
Q

What cells secrete enzymes in the pancreas?

a) Ductal cells
b) Chief cells
c) Acinar cells
d) Parietal cells

A

c) Acinar cells

20
Q

What hormone stimulates the release of enzymes in the pancreas?

a) Secretin
b) Cholecystokinin
c) GIP
a) Somatostatin

A

b) Cholecystokinin

21
Q

What is Pancreatic Cancer?

A
  • Cancer of the pancreas
  • Ductal adenocarcinoma (most common)
  • 60% arise in the head, 25% body, 15% tail
22
Q

Majority of individuals with pancreatic ca will have mutations in the _____ __

A

Majority of individuals with pancreatic ca will have mutations in the KRAS2 gene

23
Q

Symptoms for pancreatic cancer?

A
24
Q

History of pancreatic ca patient?

A
  • Unexplained non-specific upper abdominal pain
  • Persistent back pain (retroperitoneal metastases

) • (tail and body tumours may present with epigastric pain) Relieved on sitting forward

  • Signs of pancreatic insufficiency (e.g. steatorrhoea)
  • Smoking
  • Family history
  • Other hereditary cancer syndromes (e.g. Peutz-Jeghers syndrome, BRCA1/2 mutations)
25
Q

Epidemiology for pancreatic cancer

A

65-75 y/o • Median age diagnosis – 70 years

26
Q

Ix for pancreatic ca

A

• Bloods • Abdominal Ultrasound • CT • ERCP

27
Q

Differentials for pancreatic cancer?

A
  • Pancreatitis
  • Choledocolithiasis (gall stones in the common bile duct)
  • Ampullary carcinoma
  • Cholangiocarcinoma
28
Q

What bloods would you do for suspected pan ca

A
  • FBC
  • LFTs – demonstrates a degree of obstructive jaundice (does not differentiate)
  • Coagulation screen – vit K dependent clotting à prolonged
  • CA19-9 – Elevated
29
Q

What can be in seen in abdominal ultrasound for pan ca

A
  • Pancreas, bile duct and liver
  • Does not exclude pancreatic cancer if normal
  • Shows: pancreatic mass, dilated bile ducts, liver metastases
30
Q

OSCE tips for suspected pancreatic ca

A
  • Check the left supraclavicular lymph node (Virchow’s node)
  • Pancreatic cancer is staged using tumour nodes metastasis (TNM)
  • Management:
  • Surgery (eg Whipple’s; curative)
  • Creon (pancreatic enzyme replacement)
  • Surgery (palliative)
  • Chemotherapy (for survival)
  • Radiotherapy (for pain)
31
Q

What would differentiate pancreatic cancer from cholelithiasis (gallstones in the gall bladder)

a) Epigastric pain
b) Palpable gallbladder
c) Steatorrhoea
d) Increased prothrombin time

A

b) Palpable gallbladder

Pain from gallstones usually present in the right upper quadrant but may radiate to the epigastric region

32
Q

Pancreatic insufficiency would result in a deficiency in

a) Vitamin B12
b) Vitamin C
c) Vitamin K
d) Riboflavin

A

c) Vitamin K

33
Q

Red flag sign of pancreatic cancer?

a) Portal hypertension
b) vomiting
c) Epigastric pain
d) Painless jaundice

A

d) Painless jaundice

34
Q
A

JUST4MED clinical cases (15 decks)

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