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Endocrinology > Revision Tutorial > Flashcards

Revision Tutorial Flashcards

1
Q

why does hand and foot size increase in acromegaly

A

due to soft tissue expansion

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2
Q

what is the gold standard test for acrogmegaly

A

GTT (GH should decrease with glucose but in acromegaly it increases)

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3
Q

what tests can you do for acromegaly

A

GTT, IGF- 1

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4
Q

what happens if a pituitary tumour grows into the sphenoid sinus

A

CFS leak- clear drops coming from node

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5
Q

what happens if a pituitary tumour grows laterally into cavernous sinus

A

squint due to compression on cranial nerve 6

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6
Q

why is cranial nerve 6 the most prone to injury

A

is the longest

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7
Q

what additional tests should you do in acromegaly

A

Visual fields, TSH (hypothyroid from pituitary tumour), T4, prolactin, sodium (hypoadrenal), BG for diabetes, U and Es

(helps tell if there is a tumour)

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8
Q

what is the clinical sign name for excessive or inappropriate milk production

A

galactorrhoea

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9
Q

what are 5 causes of galacctorhoea

A

prolactinoma, pregnancy, drugs: antipsychotics/dopamine antagonists/metaclopramide, pituitary tumour, RTA

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10
Q

what is the round dark object on either side of the pituitary

A

carotid artery

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11
Q

what nerves are in the cavernous sinus

A 
oculomotor 
trochlear 
opthalmic branch of trigeminal 
maxillary branch of trigeminal 
abducens nerve 
trocheal nerve
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12
Q

damage to what nerve causes the eye to be pulled inwards

A

abducents

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13
Q

damage to what nerve will cause a squint when the eye can only move outwards

A

oculomotor

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14
Q

what is the venous system of the cavernous sinus

A

superior and inferior petrosal sinuses- ultimately into the internal jugular vein via the sigmoid sinus

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15
Q

what is metabolic syndrome

A

obesity, hypertension, increased blood glucose and cholesterol- puts you at risk of diabetes and CVD disease

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16
Q

why do you get thin skin in cushings

A

mobilisation of protein, protein degradation

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17
Q

what screening test for cushings

A

overnight DT

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18
Q

what eye signs in cushings

A

conjunctival oedema (chemosis)

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19
Q

how does high cortisol weaken bones

A

increases osteoclasts activity, reduces osteoblasts, collagen formation and calcium absorbtion

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20
Q

what should dexomethasone do

A

decrease ACTH and cortisol levels

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21
Q

what can causes a glucocorticoid deficiency

A

addisons disease

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22
Q

what can cause addison

A

CAH, haemorrhage of the adrenal glands (acute hypoadrenalism), menigococcal septicaemia, exogenous steroid use, adrenal TB, hypopituitarism

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23
Q

what can be see in the mouth in addisons disease

A

buccal pigmentation

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24
Q

what could cause a man to havel short stature, high pitch voice, infantile genitalia, no pubic or axillary hair

A

hypogonadism (happened pre puberty)

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25
Q

name 3 things that can cause hypogonadism

A

hypopituitarism, anabolic steroid (long term), tumour

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26
Q

what investigations should you do in hypogonadism

A

testosterone and LG/FSH, GH, IGF-1, prolactin, ACTH and cortisol

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27
Q

what can cause amenorrhoea

A

pregnancy, hyper and hypothyroidism

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28
Q

what likely caused this: 24 y/o women, amenorrhoea, hirustism

A

PCOS

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29
Q

what drugs can you give in PCOS

A

metformin, combined contraceptive pill, anti andorgens (cyclotyrone, spironolactone, elphloathine)

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30
Q

what caused this: boy with marfanism, mum had thyroid cancer, tongue has small neuromata, larger neuromata on gums, slightly raised calcium

A

MEN 2 (thyroid cancer and neuroma)

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31
Q

what causes this: middle aged women, hypertensive- intermittent attacks, cafe-au-late, lumps below skin

A

MEN 2 causing a phaeochomocytoma (too much adrenaline causing the paradoxical HPX attacks)

32
Q

A 24 year old female notices a lump in her neck. Her GP thinks it might be a thyroid swelling and send her to the clinic for assessment. What tests should be done to confirm the diagnosis?

A

blood tests for T3, T4, TSH, thyroid antibodies
ultrasound (U1-5)- above 3 needs FNA
thyroid uptake scan

33
Q

what is the prognosis for thyroid cancer

A

80-85% follicular or papillary, good prognosis, dont metastasise, present early, thyroidectomy to remove it

34
Q

who need FNA always for thyroid lump

A

under 30s, esp teens

35
Q

what usually accompanies medullary thyroid cancers

A

MEN 2 (a and b) or family history

36
Q

what can cause hyperthyroidism

A

toxic nodule/ goitre, graves or autoimmune, thyroiditis (autoimmune/ viral),

37
Q

how do you use blood tests to distinguish toxic goitre from graves

A

toxic goitre increased conversion to T3, graves all thyroid hormones raised

38
Q

what is the treatment for graves

A

antithyroid drugs, surgery, radioactive iodine

39
Q

what is the treatment for a toxic nodule

A

beta blockers, radioiodine

40
Q

what is the risk in carbimazole

A

agranulocytosis- check white blood count if sore throat or dry cough

41
Q

what should you do in patients needing levothyroxine with CVD

A

might exacerbate symptoms so start with low dose and titrate up

42
Q

what can cause cushings syndrome

A

Pituitary adenoma (cushings disease), exogenous steroid use, ectopic tumour secreting ACTH, small cell carcinoma, pseudo cushings (appearances of cushings without biochemical markers- commonest cause alcohol)

43
Q

what test to diagnose cushings

A

1mg overnight DTT suppression test (at 10 oclock, check cortisol at 9am- can get false positive in chronic stress and depression), 48 hr low dose DTT suppression test, if this negative do a high dose DTT suppression. In cushings lose diurnal variation, have high cortisol production so have raised 24 hr cortisol urinary secretion. If from pituitary CT pituitary, if not CT chest.

44
Q

when not fit for surgery what drug can help with cushings syndrome

A

metyraprone

45
Q

what can cause amenorrhoea

A

hypothyroidism, hyperthyroidism, pregnancy, low body weight/ excessive exercise (hypothalamic dysfunction), hyperprolactinaemia (iatrogens (dopamine antagonists, stressed, prolactinoma)), premature ovarian failure.

46
Q

what drugs can cause galactprrhoea

A

metoclopramide, anti convulsants, dopamine antagonists, anti depressants. Anti pyschotics, thenofiazine, oestrogens, opiates (all cause lack of dopamine).

47
Q

what are the signs of panhypopituitarism

A

tiredness, weight gain, thirst, amenorrhoea, slowness of thought, reduced exercise tolerance, pale skin, hairlessness, diarrhoea, vomiting, postural hypotension, pigmentation increased- in Addisons

48
Q

how can you confirm a diagnosis of panhypopituitarism

A

IGF-1, thyroid function test (TSH), ACTH and cortisol, GTT, water deprivation for ADH, PRL. Need to do stimulation tests

49
Q

name causes of pituitary failure

A

pituitary adenoma, carcinoma, haemorrhage (pituitary apoplexy), hyperplasia, trauma (RTA/surgery), sheenans syndrome, radiotherapy/ chemotherapy, infective (post meningitis), auto immune, sarcoidosis

50
Q

name 4 endocrine conditions that can cause hypertension

A

cushings, diabetes, phaeochromocytoma, conns (primary hyperaldosterism), acromegaly

51
Q

what can be diagnosed with an MIBG scan

A

phaeochromocytoma

52
Q

what receptor for:

insulin

A

tyrosine kinase receptor

53
Q

what receptor for:

growth hormone

A

cytokine receptor

54
Q

what receptor for:

caclium

A

GPCR

55
Q

what is the main role of insulin

A

increases hepatic glycogen synthesis

56
Q

what nerves pass through the right cavernous sinous

A

III, IV, V1, V2, VI

57
Q

what structure is most at risk during a total thyroidectomy

A

recurrent laryngeal nerve

58
Q

how often should people with insulin who drive check their insulin

A

every time they drive

59
Q

what is the target of the drug dapagliflozin

A

sodium glucose co transporter

60
Q

what is insulitis

A

inflammatory infiltrate around a pancreatic islet

61
Q

what is this thyroid uptake scan appearance:

uptake reduced

A

thyroiditis

62
Q

what is this thyroid uptake scan appearance:

increase uptake of whole thyroid

A

graves

63
Q

what is this thyroid uptake scan appearance:

patchy uptake

A

multinodule

64
Q

what is a colloid nodule

A

benign thyroid lumps which can be solitary or found in a multinodular goitre

65
Q

what is the treatment for a microprolactinoma

A

cabergoline (dopamine agonists)

66
Q

why might you have raised prolactin in a NON functioning pituitary adenoma

A

as tumour might block dopamine getting through the stalk

67
Q

what is the FIRST thing you should treat in hypopituitarism

A

hydrocortisone

68
Q

what will prolactin levels be like in a macroprolactinoma

A

> 5000

69
Q

what is the treatment for a phaeochromocytoma

A

alpha then beta blocker (a before b)

70
Q

how do you diagnose conns

A

paired renin and aldosterone measurement

71
Q

what syndrome is hyperaldosteronism

A

conns

72
Q

what do you loose in conns

A

potassium

73
Q

what is the treatment for an addisons crisis

A

IV saline and hydrocortisone

74
Q

what is the gold standard for acromegaly diagnosis

A

glucose tolerance test

75
Q

what are the 6 p’s of acute limb ischaemia

A 
pale 
painless
pulseless
paralysed 
paraesthesia 
perishing cold

Endocrinology (46 decks)

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