Qs :/ Flashcards
associated with hypothyroidism, painful goitre and raised ESR
de quervains thyroiditis (subacute)
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
Autonomously functioning thyroid lesions that secrete excess thyroid hormones
toxic multinodular goitre
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
most comon type of thyroid cancer
papillary
*also has best prognosis
Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma in a question is most likely to indicate
MEN IIa
A patient is diagnosed as having medullary thyroid cancer. Her past medical history includes phaeochromocytoma and she is currently undergoing investigations for hypercalcaemia is a stereotypical history of:
MEN 2a
Medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus in a question is most likely to indicate:
MEN IIb
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 is a stereotypical history of:
men 2b
Thyroid lymphoma is most associated with:
hashimotos thyroiditis
27 y/o with neck lump + assoc lymphadenopathy, biopsy shows psammoma calcification
papullary thyroid carcinoma
-> typically spread lymph nodes first
A patient with a new diagnosis of schizophrenia is started on risperidone. They discuss side effects with their doctor, who advises some of the side effects are due to increased levels of prolactin.
Through which mechanism does this occur?
inhibition of dopamine activity
34-year-old female presents with a thyroid nodule. She has a family history of thyroid disease and both her sisters have undergone total thyroidectomies. Her past medical history includes hypertension which has been difficult to manage.
medullary carcinoma
(phaeochromocytoma may also be present, may be inherited in autosomal dominant fashion + affected family members may be offered prophylactic thyroidectomy)
An 18-year-old female presents with 3 nodules in the right lobe of the thyroid. Clinically she is euthyroid and there is associated cervical lymphadenopathy. She has no family history of thyroid disease.
papillary carcinoma
most common type, more likely to develop lymphatic spread than follicular
excellent prognosis
which cancer is thyroglobulin a good tumour marker for?
papillary + follicular
papillary thyroid cancer
commonest young females metastasis to cervical lymph nodes thyroglobulin tumour marker good prognosis
follicular thyroid cancer
women >50
mestastasis to lung + bones
thyroglobulin tumour marker
moderate prognosis
medullary
sporadic or part of MEN2
from parafllicular cells which produce calcitonin
management of papillary + follicular cancer
total thyroidectomy
radioiodine for residual cells
yearly thyroglobulin levels
which hormone is resposible for stimulating uterine muscle to contract in labour?
oxytocin
electrolytes in addisons
hyperkalaemia, hypOnatraemia, reduced cortisol, hypoglycaemia
(cortisol consumption increases during times of stress - surgical procedures)
electrolytes in cushings
hypokalaemia + hypernatraemia, hyperglycaemia
opposite to addisons
electrolytes in Conns (primary hyperaldosteronsim)
hypokalaemia, hypernatremia, hypertension
same as cushings
serum + urine osmolality in SIADH
serum = low (dilutional hyponatraemia)
urine = high (retention of water in kidneys)
iodines effect on thyroid hormones
less iodine = less thyroid hormone
–> causes pituitary to release more TSH and thyroid hypertrophy/hyperplasia
changes to hypothyroidim medication during pregnancy
wome with hypothyroidism need to increase their thyroid replacement dose by 50%
when would a total thyroidectomy not be necessary in differentiated thyroid cancer?
low risk group (<50, tumour <4cm)
–> lobectomy, keep TSH low, monitor thyroglobulin
(differentiated = papillary + follicular, TSH driven)
what type of cells are involved in phaeochromocytoma?
tumour of chromaffin cells that secretes unregulated + excessive amounts of catecholamine (adrenaline)
–> in adrenal medulla
management of phaeochromocytoma
first = alpha blockers - phenoxybenzamine
then - beta blockers - propanolol
adrenalectomy = definitive (symptoms must be medically controlled prior to surgery
why is there bronze hyperpigmentation in addisons?
ACTH is secreted with MSH which stimulates melanocytes to produce melanin
–> ONLY in primary (addisons) increase ACTH from neg feedback
(secondary will have pale skin due to reduced ACTH)
inheritance pattern of congenital adrenal hyperplasia
autosomal RECESSIVE
–> deficiency of 21-hydroxylase enzyme = underproduction of cortisol and aldosterone + OVERproduction of androgens
what aldosterone + cortisol underproduced and testosterone over produced in congenital adrenal hyperplasia?
progesterone can be converted to aldosterone, cortisol + testosterone
21-hydroxylase is responsible for the aldosterone + cortisol conversion but NOT testosterone
when its deficient, extra progestone floating around gets converted to testosterone
electrolyte disturbances in congenital adrenal hyperplasia
hyponatraemia, hyperkalaemia, hypoglycaemia
other than addisons what other condition may present with skin hyperpigmentation?
congenital adrenal hyperplasia
–> high ACTH response to low cortisol
ambiguous genitalia, hyponatraemia, arrhythmias and hypoglycaemia could indicate what?
congenital adrenal hyperplasia
–> tall, absent periods, deep voice, early puberty
what can cause confusion in a patient?
hypercalcaemia
hypoglycaemia
hypothyroidim
B12/folate deficiency
management of hyperaldosteronism
eplerenone, spirnolactone
treat underlying - remove adenoma, (fix genitals in CAH), angioplasty for renal artery stenosis
causes of primary aldosteronism (Conns)
adrenal adenoma secreting aldosterone (commonest)
bilateral adrenal hyperplasia
familial hyperaldosteronism
adrenal carcinoma
renin = LOW
causes of secondary hyperaldosteronism
excessive renin stimulating adrenals to produce more aldosterone
–> bp in kidney disproportionately lower than bp in rest of body - stenosis/obstruction, heart failure
renin = HIGH
investigation for congenital adrenal hyperplasia
17-OH progesterone - high
hyponatraemia, hyperkalaemia, hypoglycaemia
(presents after birth - poor feeding, vomiting, dehydration, arrhythmias)
conservative management of hyperparathyroidism
cinacalcet
increases sensitiviry of calcium receptors on parathyroid cells, reducing PTH levels –> decrease in Ca levels
alendronate
bisphosphonate
- -> mx osteoporosis, paget
- –> inhibits osteoclast mediated bone reabsorption
what is trousseaus sign?
carpal spasm (wrist flexing + fingers adducting) on inflation of BP cuff to pressure above systolic --> hypOcalcaemia
what is Chvostek’s sign?
tapping over parotid (CN VII) causes facial muscles to twitch
–>hypocalcaemia
