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PRIYA ENDO > summary doc > Flashcards

summary doc Flashcards

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
Q

describe transient neonatal diabetes

A

diganosed< 1 weeks
resolves at 12 weeks
stop insulin

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26
Q

describe permanent NDM

A

diagnosed 0-6 weeks
lifelong insulin
SURs can be used

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27
Q

which channels are affected in NDM

A

K+

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28
Q

what kind of receptors are TSH receptors

A

G protein receptors

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29
Q

which genetics cause autoimmune thyroiditis eg hashimotos and graves

A

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

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30
Q

antibodies in graves?

A

TSH receptor, TPO and Tg

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31
Q

which disease is pretibial myxoedema associated with?

A

graves

it itself causes hyperthyroidism

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32
Q

how is the thyroid described as in graves?

A

smooth

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33
Q

biochem of graves

A 
decreased TSH 
increased T3/4
hypercalcaemia 
high ALK PHOS
leucopenia 
TSH receptor antibody
34
Q

how to treat graves

A

antithyroid drugs eg carbimazole

12-18 months dose titration

35
Q

what are the 3 causes of hypothyroidism

A

HLA DR3 + DR5
iodine deficiency
lithium

36
Q

what are the risks of hashimotos?

A

non-hodgkins lymphoma of thyroid

37
Q

what causes a goitre?

A

lack of iodine

38
Q

decsribe a follicular adenoma

A

encapsulated by a surrounding colalagen cuff
mutant RAS or PIK3CA
functional adenoma

39
Q

in which carcinoma are psoamma bodies found?

A

papillary carcinomas

40
Q

what should you do if you find a psomma body?

A

search occiput

41
Q

what are the genetics behind papillary carcinoma

A

activate MAP kinase pathway
rearrangement of RETOR NTK R1
activating point mutation in BRAF
mutation of RAS

42
Q

which other thyroid condition is papillary carcinoma associated with

A

hashimotos

43
Q

how do papillary carcinomas spread

A

via lymph

44
Q

what are the mutations in follicular carcinoma

A

mutation in D13K1AKT pathway
mutation in RAS pathway
transcription including PAX8 and PPARY1

45
Q

which age do people get follicular carcinoma

A

40-50 year olds

46
Q

how do follicular carcinomas spread

A

haematogenous spread

47
Q

what casues follicular carcinoma

A

iodine deficiency

48
Q

what are the mutations for anaplastic carcinoma

A

P53 + B-catenin mutation

49
Q

genetics of medullary carcinoma

A

MEN 2 (germline RET mutation)

50
Q

histology of medullary carcinoma

A

c cells - secrete calcitonin

composed of spindle or polygonal cells arranges in nests, trabeculae or follicles

51
Q

what causes non-goitrous hypothyroidism?

A

atrophic thyroiditis

52
Q

temperature symptoms of hypotyroidism

A

cold intolerance - cant feel cold

53
Q

who gets myxoedema coma?

A

elderly women with long standing hypothyroidism

54
Q

what are the symptoms of myxoedema coma?

A

brady cardia + T wave inversion + Long QT

type 2 resp failure

55
Q

how to treat myxoedema coma?

A

broad spec AB eg ciprofloaxin

thyroxine continuously

56
Q

symptoms of thyrotoxicosis?

A

proximal muscle weakness (thighs and upper arms)

intolerance to heat

57
Q

symptoms of nodular thyroid disease?

A 
older patients 
asymmetric goitre 
increased T4/3 + decreased TSH 
negative TRAb
high scintigraphy uptake
58
Q

symptoms of thyroid storm?

A

severe hyperthyroidism
resp + cardiac failure
exaggerated reflexes

59
Q

how to treat thyroid storm?

A

lugol’s iodine

60
Q

hyperthyroid treatment

A
  1. carbimazole

2. PTU (first line in first trimester of pregnancy)

61
Q

side effects of anti-thyroid drugs?

A

rash
jaundice
agranulocytosis (highest risk in first 6 weeks) - fever, infection of mouth + throat + can never take the drugs again

62
Q

how do betablockers and amiodarone work?

A

inhibits DiO1 (converts T4 to T3)

63
Q

what is the graves relapse rate?

A

50%

64
Q

when to do a lobectomy?

A

<50 years
tumours <4cm
low TSH

65
Q

when to do a thyroidectomy?

A

> 50 years
tumour >4cm
TSH <1
T3 or more

66
Q

how to classify tumours?

A 
T1 = <1cm 
T2 = 2-4cm (limited to thyroid) 
T3 = >4cm 
T4a = extending beyond thyroid capsules 
T4b = very advanced
67
Q

what is the TNM classification

A 
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
Q

who gets thyroid lymphoma and what is it

A

occurs as a result of long term thyroxine

women 70-80

69
Q

how to treat thyroid lymphoma

A

steroids + RCHOP chemo

70
Q

what to do if you suspect medullary carcinoma

A

always check 24 hours urinary metanephrine and genetics

71
Q

Men 2 x3

A

MTC
phaeochoromocytoma
hyperparathyroidism

72
Q

what do you see on CT in multinodular goitre?

A

retrosternal expansion

tracheal compression

73
Q

what do differentiated thyroid cancers do

A

take up iodine and secrete Th (Tg is used as a marker because it is produced by papillary / follicualr carcinoma thyroxine precursor)

74
Q

what does AMES stand for

A

age
mets
extent of primary tumour
size of primary tumour

75
Q

what is low risk ames

A

younger patients
men < 40 or women <50
no evidence of mets

76
Q

what is high risk ames

A

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
Q

when to do a thyroid lobectomy with isthmusectomy?

A

papillary microadenoma <1cm in diameter
minimially invasive fllicular carcinoma with capsular invasion only
AMES low group

78
Q

when to do subtotal / total thyroidectomy

A 
DTC with extrathyroidal spread 
bilateral / multifocal DTC 
DTC with distant mets 
DTC with nodal involvement 
AMES high risk group
79
Q

what to check post thyroid op?

A

Ca checked within 24 hours
replace is <2mmol
IV Ca if <1.8mmol / symptomatic
patient discharged on thyroxine

80
Q

what is whole body iodine scanning

A

checks for metabolically active cells ie cancer
3-6 months post op
T4 stopped 4 weeks prior
T3 stopped 2 week prior

81
Q

what shoudl TSH be at for whole body iodine scanning?

A

> 20

82
Q

when is thyroid remnant ablation used?

A

if thyroid cancer is still active after surgery

TSH must be raised

PRIYA ENDO (8 decks)

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