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1
Q

what is the stimulation and inhibition of KATP channels?

A

stimulation - diazoxide

inhibition - SURs

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2
Q

which biological effects does insulin turn on?

A

lipogenesis in adipose tissue and liver

glycogen synthesis in liver and muscles

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3
Q

which biological effects does insulin turn off?

A

lipolysis

gluconeogenesis

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4
Q

what are ketone bodies derived from?

A

acetyl-coA which if from B oxidation of fats

ketone bodies are found in liver mitochondria

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5
Q

what is the basic pathway behind ketone body production?

A
  1. fatty acid oxidation
  2. acetyl - co A
  3. TCA cycle if fat and carb degradation are balanced
  4. ketone body production
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6
Q

true or false

hormones are activated when they bind to receptors in the liver?

A

false

they are deactivated

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7
Q

what are the general carriers for steroids + thyroid hormones?

A

albumin and transthyretin

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8
Q

when are thyroid hormones highest?

A

at night

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9
Q

what are the symptoms of T1DM?

A

blurred vision
recurrent UTIs
tiredness
polyuria

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10
Q

how do you treat a hypo?

concious and unconcious?

A

concious - 15-20mg of carbs, recheck in 15 mins

unconcious - IV glucagon + IV insulin

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11
Q

how do you treat nephropathy?

A

ACE / ARB

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12
Q

what are cotton wool spots?

A

areas of ischaemia

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13
Q

what is the biochem of DKA?

A

ketonaemia >3
BG >11
Bicarbonate <15 or pH <7.3

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14
Q

what do you monitor for blood ketones?

A

betahydroxybutyrate

<0.6 normal

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15
Q

what do you monitor for urine ketones?

A

acetoacetate

indicates levels of ketones 2-4 hours previously

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16
Q

how is HHS classified?

A

hyperglycaemia, hyperosmolarity with no ketoacidosis

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17
Q

how do you calculate osmolarity?

A

2Na + urea + glucose

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18
Q

what is the management of HHS?

A

0.9% saline without insulin

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19
Q

what is type 1 MODY?

A

HNF 4a

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20
Q

what is type 2 MODY?

A

glucokinase

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21
Q

how to treat T2DM

A

> 40 years = 40mg simvastatin or 10mg atorvastatin

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22
Q

biochem for HHS

A 
hypovolaemia 
hyperglycaemia >30 
mild / no ketonaemia <3
bicarbonate >5
osmolarity >320
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23
Q

describe glucokinase muatiton in MODY

A 
onset at birth 
stable hperglycaemia 
diet treatmnet 
complications rare
fastnig glucose >7
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24
Q

describe transcription factor muations in MODY

A

young adult onset
progressive hyperglyccaemia
complications frequent

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25
describe transient neonatal diabetes
diganosed< 1 weeks resolves at 12 weeks stop insulin
26
describe permanent NDM
diagnosed 0-6 weeks lifelong insulin SURs can be used
27
which channels are affected in NDM
K+
28
what kind of receptors are TSH receptors
G protein receptors
29
which genetics cause autoimmune thyroiditis eg hashimotos and graves
CTLA4 - negative regulator of T cell responses, polymorphisms with reduced protein level / function increasse risk of autoimmune disease (T cells regulate immunity) PTPN22 - inhibits T cell function
30
antibodies in graves?
TSH receptor, TPO and Tg
31
which disease is pretibial myxoedema associated with?
graves | it itself causes hyperthyroidism
32
how is the thyroid described as in graves?
smooth
33
biochem of graves
``` decreased TSH increased T3/4 hypercalcaemia high ALK PHOS leucopenia TSH receptor antibody ```
34
how to treat graves
antithyroid drugs eg carbimazole | 12-18 months dose titration
35
what are the 3 causes of hypothyroidism
HLA DR3 + DR5 iodine deficiency lithium
36
what are the risks of hashimotos?
non-hodgkins lymphoma of thyroid
37
what causes a goitre?
lack of iodine
38
decsribe a follicular adenoma
encapsulated by a surrounding colalagen cuff mutant RAS or PIK3CA functional adenoma
39
in which carcinoma are psoamma bodies found?
papillary carcinomas
40
what should you do if you find a psomma body?
search occiput
41
what are the genetics behind papillary carcinoma
activate MAP kinase pathway rearrangement of RETOR NTK R1 activating point mutation in BRAF mutation of RAS
42
which other thyroid condition is papillary carcinoma associated with
hashimotos
43
how do papillary carcinomas spread
via lymph
44
what are the mutations in follicular carcinoma
mutation in D13K1AKT pathway mutation in RAS pathway transcription including PAX8 and PPARY1
45
which age do people get follicular carcinoma
40-50 year olds
46
how do follicular carcinomas spread
haematogenous spread
47
what casues follicular carcinoma
iodine deficiency
48
what are the mutations for anaplastic carcinoma
P53 + B-catenin mutation
49
genetics of medullary carcinoma
MEN 2 (germline RET mutation)
50
histology of medullary carcinoma
c cells - secrete calcitonin | composed of spindle or polygonal cells arranges in nests, trabeculae or follicles
51
what causes non-goitrous hypothyroidism?
atrophic thyroiditis
52
temperature symptoms of hypotyroidism
cold intolerance - cant feel cold
53
who gets myxoedema coma?
elderly women with long standing hypothyroidism
54
what are the symptoms of myxoedema coma?
brady cardia + T wave inversion + Long QT | type 2 resp failure
55
how to treat myxoedema coma?
broad spec AB eg ciprofloaxin | thyroxine continuously
56
symptoms of thyrotoxicosis?
proximal muscle weakness (thighs and upper arms) | intolerance to heat
57
symptoms of nodular thyroid disease?
``` older patients asymmetric goitre increased T4/3 + decreased TSH negative TRAb high scintigraphy uptake ```
58
symptoms of thyroid storm?
severe hyperthyroidism resp + cardiac failure exaggerated reflexes
59
how to treat thyroid storm?
lugol's iodine
60
hyperthyroid treatment
1. carbimazole | 2. PTU (first line in first trimester of pregnancy)
61
side effects of anti-thyroid drugs?
rash jaundice agranulocytosis (highest risk in first 6 weeks) - fever, infection of mouth + throat + can never take the drugs again
62
how do betablockers and amiodarone work?
inhibits DiO1 (converts T4 to T3)
63
what is the graves relapse rate?
50%
64
when to do a lobectomy?
<50 years tumours <4cm low TSH
65
when to do a thyroidectomy?
>50 years tumour >4cm TSH <1 T3 or more
66
how to classify tumours?
``` T1 = <1cm T2 = 2-4cm (limited to thyroid) T3 = >4cm T4a = extending beyond thyroid capsules T4b = very advanced ```
67
what is the TNM classification
``` N0 - no lymph node mets N1 = regional lymph node mets N1a - mets to level VI N1b - more mets M0 - no distant mets M1 - distant mets ```
68
who gets thyroid lymphoma and what is it
occurs as a result of long term thyroxine | women 70-80
69
how to treat thyroid lymphoma
steroids + RCHOP chemo
70
what to do if you suspect medullary carcinoma
always check 24 hours urinary metanephrine and genetics
71
Men 2 x3
MTC phaeochoromocytoma hyperparathyroidism
72
what do you see on CT in multinodular goitre?
retrosternal expansion | tracheal compression
73
what do differentiated thyroid cancers do
take up iodine and secrete Th (Tg is used as a marker because it is produced by papillary / follicualr carcinoma thyroxine precursor)
74
what does AMES stand for
age mets extent of primary tumour size of primary tumour
75
what is low risk ames
younger patients men < 40 or women <50 no evidence of mets
76
what is high risk ames
older patients distant mets extrathyroidal disease in patients with papillary cancer significant capsular invasion with follicular carcnioma primary tumour >5cm in older patients 20 year survival @ 61% recieve RAI post o p
77
when to do a thyroid lobectomy with isthmusectomy?
papillary microadenoma <1cm in diameter minimially invasive fllicular carcinoma with capsular invasion only AMES low group
78
when to do subtotal / total thyroidectomy
``` DTC with extrathyroidal spread bilateral / multifocal DTC DTC with distant mets DTC with nodal involvement AMES high risk group ```
79
what to check post thyroid op?
Ca checked within 24 hours replace is <2mmol IV Ca if <1.8mmol / symptomatic patient discharged on thyroxine
80
what is whole body iodine scanning
checks for metabolically active cells ie cancer 3-6 months post op T4 stopped 4 weeks prior T3 stopped 2 week prior
81
what shoudl TSH be at for whole body iodine scanning?
>20
82
when is thyroid remnant ablation used?
if thyroid cancer is still active after surgery | TSH must be raised

PRIYA ENDO (8 decks)

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