PassMedicine Flashcards
1
Q
what is menorrhagia found in
A
hypothyroidism
2
Q
what is oligomenorrhea found in
A
thyrotoxicosis
3
Q
what is the most common cause of hypothyroidism
A
hashimotos thyroiditis
- most common cause
- autoimmune
- associated with T1DM
- more common in women
4
Q
what is the most common cause of thyrotoxicosis
A
graves disease
5
Q
what are the TSH and free T4 levels in thyrotoxicosis (graves)
A
low TSH
high free T4
6
Q
what are the TSH and free T4 levels in hypothyroidism (hashimotos)
A
high TSH
low free T4
7
Q
treatment for hypothyroidism
A
thyroxine in the form levothyroxine
8
Q
treatment for thyrotoxicosis
A
1 propranolol to control symptoms (tremor)
2 carbimazole
3 radioiodine treatment
9
Q
MOA for carbimazole
A
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
10
Q
what is thyroid acropachy and is it found in hypo or hyperthyroidism
A
clubbing
hyper
11
Q
is non-pitting oedema in hands and face found in hypo or hyperthyroidism
A
hypothyroidism
12
Q
anti-TPO antibodies are seen in 90% of which patients
A
hashimotos thyroiditis
13
Q
MODY definition`
A
group of inherited genetic disorders affecting insulin production
14
Q
is carpal tunnel syndrome commonly seen in hypothyroidism or hyperthyroidism
A
hypothyroidism
15
Q
are thyroid disorders more common in men or women
A
women
16
Q
what does TRH (thyrotropin releasing hormone) stimulate
A
anterior pituitary
17
Q
how can thyroid disorders be classified
A
primary - problem with thyroid gland
secondary - problem with pituitary
18
Q
what is the most common cause of hypothyroidism
A
hashimotos thyroiditis
-autoimmune
19
Q
what is the most common cause of thyrotoxicosis
A
graves disease
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
21
Q
what are the less common causes of thyrotoxicosis
A
1 toxic multinodular goitre
-autonomously functioning thyroid nodules which secrete excess thyroid hormones
22
Q
what drug can cause both hypothyroidism and thyrotoxicosis
A
amiodarone
23
Q
what is the most common cause of hypothyroidism in the developing world
A
iodine deficiency
24
Q
what two drugs can cause hypothyroidism
A
lithium
amiodarone
25
TSH-receptor antibodies are found in what condition
thyrotoxicosis by graves disease
26
anti-TPO antibodies are found in what condition
hashimoto's thyroiditis
27
main treatment for hypothyroidism
levothyroxine
28
main treatment for thyrotoxicosis
carbimazole
29
what is the MOA of carbimazole
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
30
what is the risk of carbimazole
agranulocytosis
31
SEs of sulfonylureas
hypoglycaemia
weight gain
hyponatraemia
32
def of T1DM
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
33
who is T1DM common in
children and young adults
34
def of T2DM
caused by relative deficiency of insulin due to excess adipose tissue
35
who does T2DM affect
older adults who are fatter
36
what is MODY
a group of inherited genetic disorders affecting the production of insulin
37
who does MODY commonly affect
younger patients with similar symptoms to T2DM
38
what are is the characteristic triad of T1DM
weight loss
polydipsia
polyuria
39
what are characteristic symptoms of T2DM
polydipsia
| polyuria
40
why do polydipsia and polyuria occur in diabetes
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
what is the diagnostic criteria for diabetes
fasting glucose >7
| random glucose >11.1
42
An elderly patient presents with bone pain, depression, renal stones and recurrent peptic ulcer
primary hyperparathyroidism
43
where is cortisol produced
zona fasciculata of the adrenal cortex
44
what is the mneumonic for zones of the adrenals and the hormones they produce
Go Find Rex, Make Good Sex
Glomerulosa
Fasciculata
Reticularis
Mineralocorticoids
Glucocorticoids
Sex hormones
45
what is the mneumonic for adrenal hormones and what those hormones control
Salt Sugar Sex: The deeper you go the sweeter it gets
salt (mineralocorticoids)
sugar (glucocorticoids)
sex (weak androgens)
46
what are functions of cortisol
```
increases:
1 BP
2 Insulin resistance
3 gluconeogenesis, lipolysis
inhibits:
1 bone formation
2 inflammatory + immune responses
```
47
what increases levels of cortisol
ACTH from pituitary gland (stimulated by corticotrophin-releasing hormone of hypothalamus)
stress
48
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
primary hyperaldosteronism
49
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
Cushing's syndrome
50
what are features of primary hyperaldosteronism
HARPS
```
HTN
Alkalosis + Aldosterone high
Renin low
Potassium decreased (muscle weakness)
Sodium high
```
51
what are the investigations for suspected primary hyperaldosteronism
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
what is primary hyperaldosteronism aka
conns syndrome
53
management of adrenal adenoma
surgery
54
management of bilateral adrenocortical hyperplasia
aldosterone antagonist (spironolactone)
55
what (drug) has very high mineralocorticoid therapy but minimal glucocorticoid activity
fludrocortisone
56
what (drug) has high mineralocorticoid therapy with some glucocorticoid activity
hydrocortisone
57
what (drug) has high glucocorticoid therapy with low mineralocorticoid activity
prednisolone
58
what (drug) has very high glucocorticoid therapy with minimal mineralocorticoid activity
dexamethasone
| betmathasone
59
what are SEs of mineralocorticoids
fluid retention
| HTN
60
what are SEs of corticosteroids
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
what are features of hashimotos thyroiditis
features of hypothyroidism (features of hyperthyroidism will be present initially for a transient period)
goitre which is non-tender
anti-thyroid peroxidase antibodies`
62
what can cause hypo and hyperthyroidism
amiodarone
63
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
hashimotos
64
what is subacute thyroiditis
de quervains thyroiditis
65
how does subacute thyroiditis present
after a viral infection
| presents with features of hyperthyroidism
66
what are the phases of subacute thyroiditis
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
what would be seen on an iodine 131 scan for subacute thyroiditis
reduced uptake
68
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
subacute thyroiditis
69
fibrous tissue replacing the normal thyroid parenchyma with a painless goitre
Riedel thyroiditis
70
nuclear scintigraphy reveals patchy uptake
| autonomously functioning thyroid lesions that secrete excess thyroid hormones
Toxic multinodular goitre
71
what is thyroid lymphoma related to
hashimotos thyroiditis
72
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
Riedel's thyroiditis
73
what is characterised by Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma
MENIIa
74
A patient is diagnosed as having medullary thyroid cancer. Her past medical history includes phaeochromocytoma and she is currently undergoing investigations for hypercalcaemia
MENIIa
75
A 30-year-old woman with a history of recurrent peptic ulcer disease is found to have hypercalcaemia on routine bloods
MENI
76
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
MENIIb
77
Medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus
MEN IIb
78
Peptic ulceration, galactorrhoea, hypercalcaemia
MEN I
79
what would raised serum calcium, low serum phosphate, raised ALP and raised PTH
primary hyperparathyroidism
80
what would low serum calcium, raised serum phosphate, raised ALP and raised PTH
secondary hyperparathyroidism
81
what is characteristically caused by hyperparathyroidism
hypercalcaemia
82
An elderly patient presents with bone pain, depression, renal stones and recurrent peptic ulcer
primary hyperparathyroidism
83
low calcium and phosphate, high ALP and PTH
osteomalacia
84
high calcium, low phosphate, high ALP, high PTH
primary hyperparathyroidism
85
low calcium, high phosphate, high ALP, high PTH
secondary hyperparathyroidism
86
normal calcium, phosphate, PTH, high ALP
pagets disease
87
what drugs cause hypothyroidism
amiodarone
lithium
carbimazole
88
a 2-month-old baby is noted to have hypotonia, macroglossia and a puffy face. They were treated at birth for neonatal jaundice
congenital hypothyroidism
89
what syndrome is associated with hypothyroidism
downs syndrome
90
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
hashimotos thyroiditis
91
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
riedels thyroiditis
92
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
subacute thyroiditis
93
hyponatraemia is associated with hyper or hypothyroidism
hypothyroidism
94
hypercalcaemia is associated with hyper or hypothyroidism
hyperthyroidism
95
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
graves
