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Endocrinology > PassMedicine > Flashcards

PassMedicine Flashcards

1
Q

what is menorrhagia found in

A

hypothyroidism

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2
Q

what is oligomenorrhea found in

A

thyrotoxicosis

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3
Q

what is the most common cause of hypothyroidism

A

hashimotos thyroiditis

  • most common cause
  • autoimmune
  • associated with T1DM
  • more common in women
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4
Q

what is the most common cause of thyrotoxicosis

A

graves disease

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5
Q

what are the TSH and free T4 levels in thyrotoxicosis (graves)

A

low TSH

high free T4

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6
Q

what are the TSH and free T4 levels in hypothyroidism (hashimotos)

A

high TSH

low free T4

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7
Q

treatment for hypothyroidism

A

thyroxine in the form levothyroxine

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8
Q

treatment for thyrotoxicosis

A

1 propranolol to control symptoms (tremor)
2 carbimazole
3 radioiodine treatment

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9
Q

MOA for carbimazole

A

blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

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10
Q

what is thyroid acropachy and is it found in hypo or hyperthyroidism

A

clubbing

hyper

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11
Q

is non-pitting oedema in hands and face found in hypo or hyperthyroidism

A

hypothyroidism

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12
Q

anti-TPO antibodies are seen in 90% of which patients

A

hashimotos thyroiditis

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13
Q

MODY definition`

A

group of inherited genetic disorders affecting insulin production

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14
Q

is carpal tunnel syndrome commonly seen in hypothyroidism or hyperthyroidism

A

hypothyroidism

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15
Q

are thyroid disorders more common in men or women

A

women

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16
Q

what does TRH (thyrotropin releasing hormone) stimulate

A

anterior pituitary

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17
Q

how can thyroid disorders be classified

A

primary - problem with thyroid gland

secondary - problem with pituitary

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18
Q

what is the most common cause of hypothyroidism

A

hashimotos thyroiditis

-autoimmune

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19
Q

what is the most common cause of thyrotoxicosis

A

graves disease

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20
Q

what are the less common causes of hypothyroidism

A 
1 subacute thyroiditis (de quervains)
-painful goitre + raised ESR
2 riedel thyroiditis
-painless goitre
-fibrous tissue replaces thyroid tissue
3 postpartum thyroiditis
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21
Q

what are the less common causes of thyrotoxicosis

A

1 toxic multinodular goitre

-autonomously functioning thyroid nodules which secrete excess thyroid hormones

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22
Q

what drug can cause both hypothyroidism and thyrotoxicosis

A

amiodarone

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23
Q

what is the most common cause of hypothyroidism in the developing world

A

iodine deficiency

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24
Q

what two drugs can cause hypothyroidism

A

lithium

amiodarone

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25
Q

TSH-receptor antibodies are found in what condition

A

thyrotoxicosis by graves disease

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26
Q

anti-TPO antibodies are found in what condition

A

hashimoto’s thyroiditis

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27
Q

main treatment for hypothyroidism

A

levothyroxine

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28
Q

main treatment for thyrotoxicosis

A

carbimazole

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29
Q

what is the MOA of carbimazole

A

blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production

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30
Q

what is the risk of carbimazole

A

agranulocytosis

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31
Q

SEs of sulfonylureas

A

hypoglycaemia
weight gain
hyponatraemia

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32
Q

def of T1DM

A

autoimmune disorder whereby insulin-producing beta cells of the islets of langerhans in the pancreas are destroyed by the immune system
this causes an absolute deficiency of insulin leading to hyperglycaemia

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33
Q

who is T1DM common in

A

children and young adults

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34
Q

def of T2DM

A

caused by relative deficiency of insulin due to excess adipose tissue

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35
Q

who does T2DM affect

A

older adults who are fatter

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36
Q

what is MODY

A

a group of inherited genetic disorders affecting the production of insulin

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37
Q

who does MODY commonly affect

A

younger patients with similar symptoms to T2DM

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38
Q

what are is the characteristic triad of T1DM

A

weight loss
polydipsia
polyuria

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39
Q

what are characteristic symptoms of T2DM

A

polydipsia

polyuria

40
Q

why do polydipsia and polyuria occur in diabetes

A

high glucose levels cause glucose to be excreted in the urine
glucose has an osmotic effect and so pulls water into the urine causing polyuria
this in turn causes polydipsia

41
Q

what is the diagnostic criteria for diabetes

A

fasting glucose >7

random glucose >11.1

42
Q

An elderly patient presents with bone pain, depression, renal stones and recurrent peptic ulcer

A

primary hyperparathyroidism

43
Q

where is cortisol produced

A

zona fasciculata of the adrenal cortex

44
Q

what is the mneumonic for zones of the adrenals and the hormones they produce

A

Go Find Rex, Make Good Sex

Glomerulosa
Fasciculata
Reticularis

Mineralocorticoids
Glucocorticoids
Sex hormones

45
Q

what is the mneumonic for adrenal hormones and what those hormones control

A

Salt Sugar Sex: The deeper you go the sweeter it gets

salt (mineralocorticoids)
sugar (glucocorticoids)
sex (weak androgens)

46
Q

what are functions of cortisol

A 
increases:
1 BP
2 Insulin resistance
3 gluconeogenesis, lipolysis
inhibits:
1 bone formation
2 inflammatory + immune responses
47
Q

what increases levels of cortisol

A

ACTH from pituitary gland (stimulated by corticotrophin-releasing hormone of hypothalamus)
stress

48
Q

a 35-year-old woman is found to have a blood pressure of 180/110 mmHg. She complains of feeling tired and weak. Routine bloods show hypokalaemia

A

primary hyperaldosteronism

49
Q

a 30-year-old woman presents with weight gain and irregular menstruation. Her blood pressure is elevated at 170/100 mmHg and there is evidence of proximal muscle weakness

A

Cushing’s syndrome

50
Q

what are features of primary hyperaldosteronism

A

HARPS

HTN
Alkalosis + Aldosterone high
Renin low 
Potassium decreased (muscle weakness)
Sodium high
51
Q

what are the investigations for suspected primary hyperaldosteronism

A

ABCD

Adrenal scintigraphy
-differentiates between conns and bilateral adrenal hyperplasia by measuring adnrenal vein aldosterone levels
Bloods
-high aldosterone
-low renin
CT abdomen
Diurnal + postural measurements of aldosterone and renin

52
Q

what is primary hyperaldosteronism aka

A

conns syndrome

53
Q

management of adrenal adenoma

A

surgery

54
Q

management of bilateral adrenocortical hyperplasia

A

aldosterone antagonist (spironolactone)

55
Q

what (drug) has very high mineralocorticoid therapy but minimal glucocorticoid activity

A

fludrocortisone

56
Q

what (drug) has high mineralocorticoid therapy with some glucocorticoid activity

A

hydrocortisone

57
Q

what (drug) has high glucocorticoid therapy with low mineralocorticoid activity

A

prednisolone

58
Q

what (drug) has very high glucocorticoid therapy with minimal mineralocorticoid activity

A

dexamethasone

betmathasone

59
Q

what are SEs of mineralocorticoids

A

fluid retention

HTN

60
Q

what are SEs of corticosteroids

A

CORTICOSTEROID

Cushings syndrome (moon face, buffalo hump, striae)
Osteoporosis
Retardation of growth
Thin skin (Cushings)
Immunosuppression + Infection
Cataracts + glaucoma
Oedema
Suppression of HPA axis
Thinning + ulceration of gastric mucosa (peptic ulceration)
Emotional disturbance
Rise in BP
Increase in hair growth (hirsuitism)
Others (hypokalaemia)
DM precipitation
61
Q

what are features of hashimotos thyroiditis

A

features of hypothyroidism (features of hyperthyroidism will be present initially for a transient period)
goitre which is non-tender
anti-thyroid peroxidase antibodies`

62
Q

what can cause hypo and hyperthyroidism

A

amiodarone

63
Q

A middle-aged women presents with symptoms of hypothyroidism. There is a diffuse, non-tender goitre on examination. TSH is raised, T4 is low, anti-TPO is positiv

A

hashimotos

64
Q

what is subacute thyroiditis

A

de quervains thyroiditis

65
Q

how does subacute thyroiditis present

A

after a viral infection

presents with features of hyperthyroidism

66
Q

what are the phases of subacute thyroiditis

A

painful goitre, raised ESR, hyperthyroidism followed by a period of euthyroid followed by hypothyroidism
thyroid structure and function should return to normal after this

67
Q

what would be seen on an iodine 131 scan for subacute thyroiditis

A

reduced uptake

68
Q

A middle aged woman presents with a tender goitre and symptoms of hyperthyroidism. Bloods show a suppressed TSH and raised T4. There is a globally reduced uptake on iodine-131 scan

A

subacute thyroiditis

69
Q

fibrous tissue replacing the normal thyroid parenchyma with a painless goitre

A

Riedel thyroiditis

70
Q

nuclear scintigraphy reveals patchy uptake

autonomously functioning thyroid lesions that secrete excess thyroid hormones

A

Toxic multinodular goitre

71
Q

what is thyroid lymphoma related to

A

hashimotos thyroiditis

72
Q

A 45-year-old woman with a history of retroperitoneal fibrosis is found to have hypothyroidism. On examination a hard, fixed, painless goitre is noted

A

Riedel’s thyroiditis

73
Q

what is characterised by Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma

A

MENIIa

74
Q

A patient is diagnosed as having medullary thyroid cancer. Her past medical history includes phaeochromocytoma and she is currently undergoing investigations for hypercalcaemia

A

MENIIa

75
Q

A 30-year-old woman with a history of recurrent peptic ulcer disease is found to have hypercalcaemia on routine bloods

A

MENI

76
Q

A man with a history of medullary thyroid cancer and phaeochromocytoma is noted to have a tall, thin, ‘marfanoid’ habitus. A number of small lumps are noted on his eyelids and lips

A

MENIIb

77
Q

Medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus

A

MEN IIb

78
Q

Peptic ulceration, galactorrhoea, hypercalcaemia

A

MEN I

79
Q

what would raised serum calcium, low serum phosphate, raised ALP and raised PTH

A

primary hyperparathyroidism

80
Q

what would low serum calcium, raised serum phosphate, raised ALP and raised PTH

A

secondary hyperparathyroidism

81
Q

what is characteristically caused by hyperparathyroidism

A

hypercalcaemia

82
Q

An elderly patient presents with bone pain, depression, renal stones and recurrent peptic ulcer

A

primary hyperparathyroidism

83
Q

low calcium and phosphate, high ALP and PTH

A

osteomalacia

84
Q

high calcium, low phosphate, high ALP, high PTH

A

primary hyperparathyroidism

85
Q

low calcium, high phosphate, high ALP, high PTH

A

secondary hyperparathyroidism

86
Q

normal calcium, phosphate, PTH, high ALP

A

pagets disease

87
Q

what drugs cause hypothyroidism

A

amiodarone
lithium
carbimazole

88
Q

a 2-month-old baby is noted to have hypotonia, macroglossia and a puffy face. They were treated at birth for neonatal jaundice

A

congenital hypothyroidism

89
Q

what syndrome is associated with hypothyroidism

A

downs syndrome

90
Q

A middle-aged women presents with symptoms of hypothyroidism. There is a diffuse, non-tender goitre on examination. TSH is raised, T4 is low, anti-TPO is positive

A

hashimotos thyroiditis

91
Q

a 45-year-old woman with a history of retroperitoneal fibrosis is found to have hypothyroidism. On examination a hard, fixed, painless goitre is noted

A

riedels thyroiditis

92
Q

a middle aged woman presents with a tender goitre and symptoms of hyperthyroidism. Bloods show a suppressed TSH and raised T4. There is a globally reduced uptake on iodine-131 scan

A

subacute thyroiditis

93
Q

hyponatraemia is associated with hyper or hypothyroidism

A

hypothyroidism

94
Q

hypercalcaemia is associated with hyper or hypothyroidism

A

hyperthyroidism

95
Q

A middle aged woman presents with thyrotoxicosis and a goitre. On examination there is exophthalmos and pretibial myxoedema. Anti-TSH receptor stimulating antibodies are positive

A

graves

Endocrinology (29 decks)

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