Miscellaneous Flashcards
what causes increased urination?
type 1 diabetes type 2 diabetes diabetes insipidus UTI hypercalcaemia
groans (constipation
moans (depression, fatigue)
bones (sore bones0
kidney stones
hypercalcaemia
if you suspect diabetes insipidus what test should you do and what would be the result?
fluid deprivation test
if fluid output doesnt decrease then its a positive test
at what level is HbA1c considered elevated?
> 48mmol/L
what happens to glucose in kidneys?
passively secreted then actively reabsorbed
what is the ideal glucose plasma conc?
3.6-5.8mmol/L
what is Kaussmaul breathing and where do you see it?
deep laboured breathing occurs in presence of excessive ketone bodies in blood
in type 1 diabetes only!
do babies of diabetic mothers have a larger birth weight?
yes but they are of normal length
why are babies of diabetic mother heavier ?
cause glucose can cross the placenta but insulin cant. so baby has more glucose than normal so there is increased fat
what should pregnant diabetic mother supplement theri diet with?
folic acid
what are babies of diabetic mothers are risk of?
CNS deformities e.g spina bifida
what is acromegaly?
excess growth hormone
can cause diabetes
what is cushings syndrome?
excess cortisol
can stop uptake of glucose in muscles
bag of bones appearance on X ray?
Charcot Foot
are the adrenal glands retroperitoneal structures>
yes
what are the 2 parts of the adrenal glands?
medulla
cortext
what are the 5 zones of the adrenal glands?
connective tissue zona glomerulosa zona fasciculate zona reticularis medualla
what hormones does the medulla secrete?
adrenalin and noradrenaline
what hormones does the zona reticularis secrete?
aldosteronee
dehydroepiandrosterone
what hormones does the zona fasciculate secrete?
cortisol
cortisone
corticosterone
what are adrenaline and noradrenaline derived from?
tyrosine within the chromaffin cellss
can medulla hormones be made early and stored?
yes
what stimulates the synthesis and release of aldosterone?
angiotensin 2
what does aldosterone do on the kidneys?
increases NaCl retention+reabsorption
due to osmosis, water is also reabsorbed and there is an increase in blood volume and therefore an increase in BP
name 2 types of primary aldosteronism?
conn;s syndrome
adrenal hyperplasia
what is conn’s syndrome?
excess amounts of aldosterone is secreted by a tumour in in the cells of the zona glomerulosa
increase NaCl
increase water
decrease potassium
signs of hypertension and hypokalaemia?
conn’s syndrome
how do you diagnose conn’s and adrenal hyperplasia?
aldosterone to renin ratio
if >750 then do saline suppression test
what is the treatment for Conn’s/ adrenal hyperplasia?
if unilateral-remove gland
aldosterone receptor anatgonist-spironolactone
what are the side effects of spironolactone?
nausea
rashes
gynaecomastia
what is cushings syndrome?
excess cortisol
functions of cortisol?
maintain normal plasma glucose levels
help produce fuel when stressed
increase responsiveness of adrenoreceptors to adrenaline
affect on cortisol on fat tissue?
increase lipolysis
affect of cortisol on tissue (except brain)
decrease glucose uptake
affect of cortisol on liver?
increase gluconeogenisis
affect of cortisol on muscle?
increase proteolysis
what happens to the body if there is excess cortisol?
cardiac output and blood flow increase
reduced osteoblast activity
moon face conjunctival oedema thin skin purpura prox muscle wasting central obesity easily bruised recurrent skin infections always thirsty peeing more kyphosis insomnia lethargic
looks like a lemon on sticks/
excess cortisol
cardiac output and blood flow increase
reduced osteoblast activity
moon face conjunctival oedema thin skin purpura prox muscle wasting central obesity easily bruised recurrent skin infections always thirsty peeing more kyphosis insomnia lethargic
excess cortisol
what makes the adrenal glands release cortisol?
ACTH
what is the most common type of cushings?
ACTH dependent
what can cause ACTH independent cushings?
adrenal adenoma
adrenal carcinoma
nodular hyperplasia
what controls secretion of the sex hormones?
ACTH
which part of pituitary is ACTH from?
anterior
what happens if too much dehydroepiandrosterone in females?
acne
amenorrhea
frontal balding
facial growth
because it causes increased levels of testosterone
definitive test for cushings?
low dose dexamethasone test
what is the medical /surgical therapy for cushings?
metyrapone/ketoccnazole
stop cortisol being produced
can also cut out the lesion causing hypersecretion of cortisol
what affects does adrenaline have on the heart
increase HR and SV via B1 receptors
what affect does adrenaline have on BP?
increased it
what affect does adrenaline have on skeletal muscle?
vasodilation via B2 receptors
what affect does adrenaline have on blood vessles
vasonconstriction via alpha 1 receptors
what affect does adrenaline have on insulin secretion?
decreased insulin secretion via alpha 2 receptors
what is the triad for hypersecretion of adrenaline?
hypertension
sweating
headaches
name some signs/symptoms of hypersecretion of adrenaline?
heart arrhythmias hypertension pallor excessive sweating flushing anxiety peeing alot drinking alot constipation headaches
what is phaectomocytoma caused by?
by catecholamine secreting tumours which arise from sympathetic paraganglia cells
what are paraganglia cells?
collections of adrenaline secreting chromaffin cells
10% tumour
phaechromomocytomas - 10% extra adrenal, malignant, bilateral, in children, part of an inherited syndrome
treatment of phaechromomocytomas
alpha and beta blockers
tumour removed as soon as possible!!
chemo if malignant
what do the follicular cells of the thyroid produce?
thyroglobulin
what do the parafollicular cells of thyroid produce?
calcitonin
what is taken up by follicular cells?
iodine
where is thyroglobulin stored?
colloid
what 2 hormones are produced by thyroid?
T3-trriodothyronine
T4-thyroxine
what is needed for production of thyroid hormones?
iodine
what does idodine attach to on thyroglobulin molecules and what does this produce?
attaches to tyrosine residues to produce MIT and DID which are the building blocks of the thyroid hormones
true or false
majority of secreted hormones is T4
true
true or false
T3 is more biochemically active in bodt
true
true or false
unbound thyroid hormones are in their active state
true
true or false
T4 is converted to T3 by liver and kidneys
true
true or false
T3 and T4 are hydrophilic
true
true or false
the majority of inactive thyroid hormones are bound to albumin
false
what are the thyroid hormones responsible for?
metabolsim
behaviour
reproduction
growth
development
affect of thyroid hormone son protein syntheses and glucose and lipolysis?
increase protein synthesis
increase blood glucose
increase lipolysis
affect of thyroid on heart?
increase HR and SV
what causes the thyroid to release T3 and T4?
TSH
tremor in hands excessive body movements HR and SV increase heat intolrenace-may get moist itchy skin increase BMR-lose weight but bigger appetite agitation-always on edge irregular periods loss of libido
hyperthyroidism
what does graves disease cause?
hyperthyroidism
what is graves disease?
an autoimmune disease
thyroid cant be suppressed by high levels of T3 and T4
who usually gets graves disease/
middle aged women
normal TSH value
0.4-4
normal T3 value
9.9-22
normal T4 level
0.9-2.6
what hormone is always raised in graves?
T4
what is exopthalamus?
eyes seemed pushed forward due to water build up and retro orbital swelling
“orange peel “look
preibial myxoedema
what is pretibial myxodema
bilateral plaque formation on anterior surface of leg
non pitting
complication of graves/hyperthyroidism
what is a goitre?
swelling of thyroid gland so that it is easily seen and palpated
2nd most commen cause of hyperthyroidism?
toxic multinodular goitre
what is toxic multinodular goitre?
large nodules secreting lots of thyroid hormones
what is de Quervains thyroiditis?
show to suffer from hyperthyroidism but also have
fever
malaise
local tenderness
what causes Quervains thyroiditis?
initiated by an acute inflammatory process (usually viral origin)
reduced BMR loss of appetite but weight gain slow reflexes fatigue and lethargy coarse sparse hair expressionless face cool doughy skin obstructive sleep apnoea
HYPO thyroidism
what can cause hypothyroidism?
goitre
iodine deficiency
hashimoto’s thyroiditis
what is hashimoto’s thyroiditis?
an autoimmune disease
antibodies attack thyroid peroxidase
antibodies attack thyroglobin leading to destruction of follicular cells
increased TSH decreased T4
hypothyroidism
decreased TSH increased T3 or increased T4
hyperthyroidism
decreased TSH, normal T3 and T4
subclinical hyperthyroidism
increased TSH normal T4
treated hypo
decreased TSH T3 and T4
pituitary disease
if there is goitre what should you do management wise?
fine needle aspirate
US or thryoid scan
how do you investigate thyroid disease?
thyroid function tests
anti-thyroid antibodies
what medical treatment is there for hyperthyroidism?
carbimazole and propylthiouracil
these inhibit the production of thyroid hormone
beta blockers can also be given for hyper
what is the major side effect of carbimazole
agranulocytosois
what surgical treatment is there for hyperthyroidism?
remove the gland
treatment for hypothyroidism?
replacement therapy- analogue of thyroxine is taken for life (levothyroxine)
