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UL Final Year OSCE's & Short Cases > RCSI: Endocrine Disorders > Flashcards

RCSI: Endocrine Disorders Flashcards

1
Q

What is the anatomical structure of the thyroid gland?

A

Formed from two triangular lobes connected by a central isthmus overlying the 2nd and 3rd tracheal rings.

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2
Q

Where is the thyroid gland located?

A

Between the levels of C5-T1, invested within the pretracheal fascia.

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3
Q

What are the arterial supplies to the thyroid gland?

A
  • Inferior thyroid artery
  • Superior thyroid artery
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4
Q

What is the venous drainage of the thyroid gland?

A
  • Superior thyroid vein
  • Middle thyroid vein
  • Inferior thyroid vein
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5
Q

What are the lymphatic drainage nodes for the thyroid gland?

A
  • Prelaryngeal nodes
  • Pretracheal nodes
  • Paratracheal nodes
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6
Q

How many pairs of parathyroid glands are generally found?

A

Two pairs.

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7
Q

What is the function of the external laryngeal nerve?

A

Innervates the cricothyroid muscle.

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8
Q

What is the significance of the recurrent laryngeal nerve?

A

It supplies all other intrinsic laryngeal muscles and is vulnerable during thyroid and parathyroid surgery.

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9
Q

What hormones are involved in the central control of thyroid hormones?

A
  • TRH (Thyrotropin-releasing hormone)
  • TSH (Thyroid-stimulating hormone)
  • T3 (Triiodothyronine)
  • T4 (Thyroxine)
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10
Q

What are the thyroid function test results for hyperthyroidism?

A

TSH: ↓, T4: ↑

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11
Q

What are the clinical presentations of hyperthyroidism?

A
  • Hyperactivity
  • Tachycardia
  • Mood swings
  • Protruded eyes
  • Insomnia
  • Irregular menstruation
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12
Q

What are the symptoms of hypothyroidism?

A
  • Fatigue
  • Sluggishness
  • Bradycardia
  • Irregular uterine bleeding
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13
Q

What is Graves’ disease?

A

Hyperthyroidism, goitre, eye disease, and pretibial/localised myxoedema.

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14
Q

What characterizes Hashimoto’s thyroiditis?

A

Chronic autoimmune thyroiditis with high TPO and thyroglobulin antibodies, typically resulting in hypothyroidism.

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15
Q

What is the effect of iodine deficiency on the thyroid?

A

May present with a diffuse goitre, usually painless and slow growing.

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16
Q

What is a cystic thyroid nodule?

A

Also known as a ‘simple cyst’, may lead to thyroid pain and dysphagia.

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17
Q

What is the Sistrunk procedure?

A

Surgical excision technique used for thyroglossal cysts.

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18
Q

What is the primary imaging method for thyroid pathology?

A

Ultrasound (US) is non-invasive and does not expose the patient to radiation.

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19
Q

What defines thyrotoxicosis?

A

A hypermetabolic syndrome due to elevated thyroid hormone levels.

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20
Q

What are the clinical signs of thyrotoxicosis?

A
  • Sweats
  • Tremors
  • Weight loss despite increased appetite
  • Anxiety
  • Heat intolerance
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21
Q

What is the management for Graves’ disease?

A

Carbimazole for 18 months, consider radioiodine treatment or surgery if refractory.

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22
Q

What are the indications for thyroidectomy?

A
  • Cancer
  • Compression of adjacent structures
  • Cosmesis
  • Carbimazole failure
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23
Q

Which antibodies are associated with Graves’ disease?

A
  • TSH receptor antibodies
  • TPO antibodies
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24
Q

What is the relationship between TSH and thyroid disease severity?

A

TSH correlates well with the severity of the disease.

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25
Q

What are the causes of thyrotoxicosis?

A
  • Graves’ disease
  • Toxic multinodular goitre
  • Solitary toxic nodule
  • Thyroiditis
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26
Q

What is the typical age range for Graves’ disease onset?

A

Commonly occurs in women aged 20–40 years old.

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27
Q

What is the main complication associated with hyperthyroidism?

A

Increased risk of atrial fibrillation.

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28
Q

What are the common symptoms of thyroiditis?

A
  • Pain
  • Fever
  • Fatigue
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29
Q

What does a fine needle aspiration cytology (FNAC) help determine?

A

It is used for evaluating thyroid nodules for malignancy.

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30
Q

True or False: Amiodarone can cause both hyperthyroidism and hypothyroidism.

A

True

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31
Q

What is Ophthalmoplegia?

A

A condition where eye movement is impaired due to muscle or nerve issues.

Look up to stretch inferior rectus to provoke as the inferior rectus muscle becomes fibrous and tight.

32
Q

What are the key findings in TFTs for Graves’ disease?

A

High fT4, low TSH.

TSH correlates well with the severity of disease.

33
Q

Which autoantibodies are positive in Graves’ disease?

A
  • TSH receptor antibodies
  • TPO antibodies (up to 80%)
  • Thyroglobulin antibodies (up to 70%)
34
Q

What does scintigraphy demonstrate in Graves’ disease?

A

Increased uptake.

35
Q

What is the first-line medical treatment for Graves’ disease?

A

Beta blocker for symptom relief.

36
Q

What is the mechanism of action for Carbimazole?

A

Blocks the action of TPO, preventing the formation of thyroid hormone.

37
Q

What is the typical duration of Carbimazole treatment for Graves’ disease?

A

18 months.

38
Q

What is the less potent alternative to Carbimazole?

A

Propylthiouracil (PTU).

39
Q

What are the risks associated with radioactive iodine treatment?

A
  • Hypothyroidism
  • Transient thyroiditis
  • Transient worsening of Graves’ ophthalmopathy
40
Q

What are the indications for surgical intervention in Graves’ disease?

A
  • Cancer
  • Compression of adjacent structures
  • Carbimazole failure
  • Cosmesis/severe ophthalmopathy
41
Q

What is the most common type of thyroid cancer?

A

Papillary carcinoma (80%).

42
Q

What are the epidemiological risk factors for papillary thyroid cancer?

A
  • Incidence of 12.5 per 100,000
  • Female:male ratio of 2.5:1
  • Most common in ages 30–50
43
Q

What are the pathological features of papillary thyroid cancer?

A
  • Not encapsulated
  • May be partially cystic
  • Papillae consist of tumour cells surrounding a fibro-vascular core
44
Q

What percentage of patients with papillary thyroid cancer have metastatic disease at presentation?

A

2–10%.

45
Q

What are the negative prognostic factors for medullary thyroid cancer?

A
  • Soft tissue invasion
  • Distant metastases
46
Q

What characterizes anaplastic thyroid cancer?

A

Undifferentiated tumours with aggressive behavior and near 100% disease-specific mortality.

47
Q

What is the mainstay of treatment for thyroid cancer?

A

Thyroidectomy.

48
Q

What is the incidence of primary hyperparathyroidism?

A

3/1000 in the general population; 21/1000 in women aged 55–75.

49
Q

What are the diagnostic criteria for primary hyperparathyroidism?

A
  • High corrected calcium
  • High PTH
  • Increased 24-hour urinary calcium excretion
50
Q

What is the most common presentation of primary hyperparathyroidism?

A

Mostly asymptomatic; often found incidentally.

51
Q

What are the symptoms associated with primary hyperparathyroidism?

A
  • Renal stones
  • Psychiatric symptoms (MOANS)
  • Bone pain
  • Gastrointestinal issues (GIT GROANS)
  • Generalized fatigue (OVERTONES)
52
Q

What is the classic triad of symptoms for pheochromocytoma?

A
  • Episodic headache
  • Sweating
  • Tachycardia
53
Q

What is the mainstay treatment for pheochromocytoma?

A

Total adrenalectomy.

54
Q

What is the Rule of 10s in pheochromocytoma?

A
  • 10% bilateral
  • 10% extra-adrenal
  • 10% malignant
  • 10% recur
  • 10% normotensive
  • 10% calcify
  • 10% children
  • 10% familial
55
Q

What are the common imaging techniques used to investigate pheochromocytoma?

A
  • CT
  • MRI
  • MIBG scan for metastatic disease
56
Q

What is the primary purpose of alpha-adrenergic blockade before surgery?

A

To control hypertension and encourage volume expansion.

57
Q

When should beta-adrenergic blockade be initiated before surgery?

A

2–3 days prior to surgery, once sufficient alpha-blockade is achieved.

58
Q

What percentage of patients can undergo laparoscopic resection?

A

Approximately 90%.

59
Q

How can malignant tumors be identified?

A

By their metastatic activity, commonly involving local organs.

60
Q

What is a notable risk following resection of malignant tumors?

A

Distant metastases may occur up to 20 years following resection.

61
Q

What are common clinical features of Cushing’s disease?

A
  • Weight gain (buffalo hump; truncal obesity)
  • Muscle wasting (lemon on a stick)
  • Striae
  • Facial plethora (moon facies)
  • Thinning of the skin, easy bruising
  • Mood changes: lethargy, depression, suicidal ideation, psychosis
  • Menstrual irregularities
  • Hirsutism in women, hair loss in men
  • Glucose intolerance, diabetes
62
Q

List the causes of Cushing’s disease.

A
  • Iatrogenic
  • Primary adrenal disease
  • Secondary adrenal disease
  • Ectopic ACTH secretion
63
Q

What is the significance of high cortisol levels in Cushing’s disease?

A

Morning peak and midnight nadir pattern is lost; 24-hour urinary cortisol is elevated.

64
Q

What does the overnight dexamethasone suppression test measure?

A

If morning cortisol will be low in normal patients after administration of 1 mg dexamethasone.

65
Q

What distinguishes pituitary from ectopic sources of ACTH in high-dose dexamethasone suppression test?

A

Pituitary will still show some inhibition; ectopic will not.

66
Q

What are the ACTH levels in different types of Cushing’s disease?

A
  • High in patients with pituitary adenomas and ectopic production
  • Low in primary adrenal disease.
67
Q

What is the initial treatment for iatrogenic Cushing’s disease?

A

Taper and stop exogenous glucocorticoids.

68
Q

What is the surgical treatment for adrenal adenoma?

A

Surgical excision, unilateral adrenalectomy.

69
Q

What is the required post-operative management after adrenal gland resection?

A

Patients will require cortisol replacement.

70
Q

What lifelong treatment is required after bilateral adrenalectomy for Conn’s syndrome?

A

Lifelong cortisol and mineralocorticoid replacement.

71
Q

Define Conn’s syndrome.

A

Usually autonomous aldosterone secretion by adrenocortical tissue (zona glomerulosa).

72
Q

What are common clinical features of Conn’s syndrome?

A
  • Hypertension
  • Hypokalemia (not always)
  • Hypernatremia (not always)
  • Metabolic alkalosis (not always)
  • Fluid retention
  • Reduced plasma renin activity (PRA)
73
Q

List the complications associated with Conn’s syndrome.

A
  • Hypertension
  • Cardiac arrhythmias
  • Cardiac fibrosis
  • Increased cardiac mortality
74
Q

What biochemical tests are used to investigate Conn’s syndrome?

A
  • Failure of aldosterone suppression with sodium load or fludrocortisone suppression test
  • Plasma aldosterone: Renin ratio.
75
Q

What is the surgical treatment for classic Conn’s syndrome with a solitary adenoma?

A

Laparoscopic or retroperitoneoscopic adrenalectomy.

76
Q

True or False: Aldosterone-secreting cancer is common in Conn’s syndrome.

A

False.

UL Final Year OSCE's & Short Cases (107 decks)

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