ques med Flashcards
what is sick euthyroid syndrome
Sick euthyroid syndrome
Sick euthyroid syndrome is an abnormality of the thyroid function tests that can occur in any systemic illness. The most common abnormality is that the free T3 is low with a normal to low free T4 and TSH. These patients tend to have no symptoms of thyroid disease and it is usually seen in critical illness or in starvation states. Repeat thyroid function tests should be performed in 6 weeks after the patient has recovered.
A 69 year old male presents to the general practitioner with a six week history of burning and shooting pains in both feet which is worse at night time. It is not limiting his activities of daily living and he reports the pain is 6/10 severity. His past medical history includes type 2 diabetes mellitus, hypertension and previous myocardial infarction. Clinical examination is unremarkable. His most recent HbA1c is 72 mmol/mol (target <53 mmol/l).
what is being descirbed here
diabetic neuropathy
what is the management of diabetic neuropathy
First line medications include duloxetine, gabapentin, pregabalin or amitriptyline. If one is ineffective a trial of one of the three other medications is indicated. The patient’s glycaemic control should also be addressed with a review of his lifestyle habits and oral medication for diabetes. Given the HbA1c of 72 mmol/mol he is likely to require an intensification of his diabetic medication
cranial DI is what
not enough ADH hormone
nephrogenic DI is what
when the problem is with the repsonse to ADH
what common cardiac drug can cause both hyper and hypo thyrodism
amiodarone
what cancer metastasise to the bone
BLT koshier pickle
breast lung , thyroid, kidney and prostate
differnce between hypogonadotrophic and hypergonadotrophic hypogonadism
Hypogonadotrophic hypogonadism results from a lack of serum gonadotrophin production or action, usually due to a hypothalamo-pituitary abnormality. Hypergonadotrophic hypogonadism results from gonadal insufficiency, and manifests with elevated serum gonadotrophin concentrations in the absence of pubertal signs at the appropriate age for puberty. Examples include Turner syndrome and Klinefelter’s syndrome
what test and what hormone are identified in carcinoid syndrome
24 hour urinary 5HIAA
This is the correct answer as 5HIAA is the metabolite of serotonin the neurotransmitter which mediates the effects of carcinoid syndrome. It can be detected in sufficient quantities in the urine. Carcinoid syndrome is the release of endocrine products from tumours (often within the gut) which have potent effects such as flushing, sweating and and wheezing
62%
poorly controlled diabetes in pregnancy can lead to what
Macrosomia (birthweight >4kg) and neonatal seizures are both complications.
Macrosomia is a result of excess maternal blood glucose crossing the placenta and inducing increased insulin production in the baby.
Hypoglycaemic episodes due to sustained high fetal insulin levels after birth can lead to seizures when severe
You are evaluating a 23-year-old woman who complains of malaise, fatigue, and occasional abdominal discomfort. She was diagnosed with Hashimoto’s Thyroiditis 3 years ago. She has normal serum immunoglobulin A concentrations. A tissue transglutaminase antibody study was negative 1 month before this current visit, and free thyroxine and thyroid-stimulating hormone (TSH) values were normal at that time. She reports that she has been eating poorly and has lost half a stone since you saw her at the beginning of the summer.
Which of the following is the most important initial laboratory investigation?
one autoimmune condition increases your risk of another
Measurement of 9am cortisol and Synacthen test
This is a classical presentation of Addison’s disease and highlights the importance of checking cortisol in patients with thyroid disease. In this instance given the normal serum immunoglobulin A and negative TTG this makes coeliac disease unlikely. Addison’s can present as acute emergency with circulatory collapse or more chronically with symptoms of malaise and fatigue. This patient should have a cortisol test and if this is low a synacthen test should be performed. In Addison’s this will show a lack of adrenal response and an inappropriately low cortisol. One should be considering an autoimmune polyglandular syndrome (e.g autoimmune polyendocrine syndrome type 1) given the history now of two autoimmune conditions
first line type 1 diabetic
Basal-bolus Insulin
This is the first-line treatment in type 1 diabetes. Alternatively, patients with good self-management skills may prefer to use an Insulin pump
what cardiac drug causes gynaecomastia
digoxin
does epelorone cause gynaecomastia
no
best test for phaecytochrootoma
Plasma metanephrines followed by urinary metanehprines have the best diagnostic accuracy, with 24 hour urinary catecholamines being of less value.
higher sensitivity and specificity with plasma over urine
A 70-year-old man presents to the emergency department with severe diarrhoea and abdominal pain.
On examination, he looks flushed, and on auscultation of his chest, there is a global wheeze.
He is currently under investigation for a tumour in his small intestine.
What hormone is the tumour most likely to be secreting?
serotonin
carcinoid syndrome
subclincial thyrodisim - high TSH rest normal what is the management
Assessment for features of hyperthyroidism
Exclude causes of transiently suppressed TSH such as medication (e.g. steroids, lithium, anti-Parkinson’s medications).
Repeat thyroid function tests in 3-6 months.
Endocrinology referral if persistent results.
what do you measure to test for acromegaly
Insulin growth factor (IGF-1)
hyperthyroid states such as tremour and anxiety what can you do to manage the symtpoms what type of drug
beta 2 agonist receptors
stop all hyoglycaemic causing agents at end of life
yes
what is subclinical hypothyrodism
Subclinical hypothyroidism is a high TSH with normal T3 and T4 levels. This lady is experiencing hypothyroidism symptoms.
drug cause of nephrogenic DI
lithium
what thyroid lumo rises on swallowing and tongue protrusion
thyroglossal cyst
hashitmoto goitre - not on tongu eprotrusion
intial DKA tx
Initial management of DKA involves fluid and potassium replacement in order to correct the hypovolaemia, acidosis, ketonemia and total body hypokalaemia associated with this condition. It is important to note that fluid replacement, though vital to treatment, should be cautious as there is also an increased risk of cerebral oedema with fluid overload in DKA patients. Therefore, fluid boluses should be avoided if possible and fluid should be replaced at a slightly reduced rate
remove adrenal glands what cx can occur
Nelson´s Syndrome
Nelson syndrome is where where in the setting of Cushing’s syndrome a bilateral adrenalectomy has taken place. As a consequence, there is a loss of feedback to the brain and we get increased Corticotrophin-Releasing Hormone from the hypothalamus leading to increased stimulation of the anterior pituitary and enlargement of the pituitary and formation of an adenoma. This leads to symptoms of mass effect with headaches, visual field defects but also hormonal issues with compression of the posterior pituitary. Primary treatment is transphenoidal surgery
Hypotestosteronism is associated with
osteoporosis - so need DEXA scan
PCOS rotterdam criteria
Presence of Multiple Ovarian cysts
Oligomenorrhoea or amenorrhoea
Clinical/biochemical signs of hyperandrogenism
A 33 year old female reports feeling generally unwell with fatigue, headaches, double vision and intermittent blackouts. She has been found on the latest occasion to have a random blood glucose of 2.2 mmol/l. She feels better when eating foods high in sugar.
It is suspected that she has an insulinoma. What is the best test for establishing the diagnosis?
A 72 hour fast
gold standard t
Whipple’s triad of symptomatic hypoglycaemia, glucose levels of 2.2 or lower and resolution of symptoms with glucose are all suggestive of An insulinoma (functional neuroendocrine tumour of the pancreas)
A 72 hour supervised fast is key to observing a monitored drop in blood glucose levels and then at the moment of proper hypoglycaemia taking the correct hormonal blood profile which would include plasma insulin levels, pre-insulin, pre-pro insulin and ketones amongst others
24%
hwo can you reduce risk of hypos in type 1 diabetic
Reduce the patients insulin doses and set higher than normal blood glucose targets
colosomty left side of abdomen - contains faecal stuff - cannot pass stool through anus
ilosteomy right side - liquid and msall bowel contents
