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endocrine > Qs :/ > Flashcards

Qs :/ Flashcards

1
Q

associated with hypothyroidism, painful goitre and raised ESR

A

de quervains thyroiditis (subacute)

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2
Q

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

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3
Q

Autonomously functioning thyroid lesions that secrete excess thyroid hormones

A

toxic multinodular goitre

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4
Q

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

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5
Q

most comon type of thyroid cancer

A

papillary

*also has best prognosis

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6
Q

Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma in a question is most likely to indicate

A

MEN IIa

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7
Q

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:

A

MEN 2a

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8
Q

Medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus in a question is most likely to indicate:

A

MEN IIb

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9
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 is a stereotypical history of:

A

men 2b

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10
Q

Thyroid lymphoma is most associated with:

A

hashimotos thyroiditis

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11
Q

27 y/o with neck lump + assoc lymphadenopathy, biopsy shows psammoma calcification

A

papullary thyroid carcinoma

-> typically spread lymph nodes first

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12
Q

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?

A

inhibition of dopamine activity

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13
Q

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.

A

medullary carcinoma

(phaeochromocytoma may also be present, may be inherited in autosomal dominant fashion + affected family members may be offered prophylactic thyroidectomy)

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14
Q

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.

A

papillary carcinoma
most common type, more likely to develop lymphatic spread than follicular
excellent prognosis

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15
Q

which cancer is thyroglobulin a good tumour marker for?

A

papillary + follicular

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16
Q

papillary thyroid cancer

A 
commonest
young females
metastasis to cervical lymph nodes
thyroglobulin tumour marker
good prognosis
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17
Q

follicular thyroid cancer

A

women >50
mestastasis to lung + bones
thyroglobulin tumour marker
moderate prognosis

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18
Q

medullary

A

sporadic or part of MEN2

from parafllicular cells which produce calcitonin

19
Q

management of papillary + follicular cancer

A

total thyroidectomy
radioiodine for residual cells
yearly thyroglobulin levels

20
Q

which hormone is resposible for stimulating uterine muscle to contract in labour?

A

oxytocin

21
Q

electrolytes in addisons

A

hyperkalaemia, hypOnatraemia, reduced cortisol, hypoglycaemia

(cortisol consumption increases during times of stress - surgical procedures)

22
Q

electrolytes in cushings

A

hypokalaemia + hypernatraemia, hyperglycaemia

opposite to addisons

23
Q

electrolytes in Conns (primary hyperaldosteronsim)

A

hypokalaemia, hypernatremia, hypertension

same as cushings

24
Q

serum + urine osmolality in SIADH

A

serum = low (dilutional hyponatraemia)

urine = high (retention of water in kidneys)

25
Q

iodines effect on thyroid hormones

A

less iodine = less thyroid hormone

–> causes pituitary to release more TSH and thyroid hypertrophy/hyperplasia

26
Q

changes to hypothyroidim medication during pregnancy

A

wome with hypothyroidism need to increase their thyroid replacement dose by 50%

27
Q

when would a total thyroidectomy not be necessary in differentiated thyroid cancer?

A

low risk group (<50, tumour <4cm)
–> lobectomy, keep TSH low, monitor thyroglobulin

(differentiated = papillary + follicular, TSH driven)

28
Q

what type of cells are involved in phaeochromocytoma?

A

tumour of chromaffin cells that secretes unregulated + excessive amounts of catecholamine (adrenaline)
–> in adrenal medulla

29
Q

management of phaeochromocytoma

A

first = alpha blockers - phenoxybenzamine
then - beta blockers - propanolol

adrenalectomy = definitive (symptoms must be medically controlled prior to surgery

30
Q

why is there bronze hyperpigmentation in addisons?

A

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)

31
Q

inheritance pattern of congenital adrenal hyperplasia

A

autosomal RECESSIVE

–> deficiency of 21-hydroxylase enzyme = underproduction of cortisol and aldosterone + OVERproduction of androgens

32
Q

what aldosterone + cortisol underproduced and testosterone over produced in congenital adrenal hyperplasia?

A

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

33
Q

electrolyte disturbances in congenital adrenal hyperplasia

A

hyponatraemia, hyperkalaemia, hypoglycaemia

34
Q

other than addisons what other condition may present with skin hyperpigmentation?

A

congenital adrenal hyperplasia

–> high ACTH response to low cortisol

35
Q

ambiguous genitalia, hyponatraemia, arrhythmias and hypoglycaemia could indicate what?

A

congenital adrenal hyperplasia

–> tall, absent periods, deep voice, early puberty

36
Q

what can cause confusion in a patient?

A

hypercalcaemia
hypoglycaemia
hypothyroidim
B12/folate deficiency

37
Q

management of hyperaldosteronism

A

eplerenone, spirnolactone

treat underlying - remove adenoma, (fix genitals in CAH), angioplasty for renal artery stenosis

38
Q

causes of primary aldosteronism (Conns)

A

adrenal adenoma secreting aldosterone (commonest)
bilateral adrenal hyperplasia
familial hyperaldosteronism
adrenal carcinoma

renin = LOW

39
Q

causes of secondary hyperaldosteronism

A

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

40
Q

investigation for congenital adrenal hyperplasia

A

17-OH progesterone - high

hyponatraemia, hyperkalaemia, hypoglycaemia

(presents after birth - poor feeding, vomiting, dehydration, arrhythmias)

41
Q

conservative management of hyperparathyroidism

A

cinacalcet

increases sensitiviry of calcium receptors on parathyroid cells, reducing PTH levels –> decrease in Ca levels

42
Q

alendronate

A

bisphosphonate

  • -> mx osteoporosis, paget
  • –> inhibits osteoclast mediated bone reabsorption
43
Q

what is trousseaus sign?

A 
carpal spasm (wrist flexing + fingers adducting) on inflation of BP cuff to pressure above systolic
--> hypOcalcaemia
44
Q

what is Chvostek’s sign?

A

tapping over parotid (CN VII) causes facial muscles to twitch
–>hypocalcaemia

endocrine (15 decks)

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