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MC > Thyroid and other endocrine DO > Flashcards

Thyroid and other endocrine DO Flashcards

1
Q

The clinical diagnosis of ______disease
is usually obvious with the features of exophthalmos,
hyperkinesis and a large goitre but if the eye and
neck signs are absent it can be misdiagnosed as an
anxiety state

A

classical Graves

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2
Q

_______ often
has a gradual onset with general symptoms such as
constipation and lethargy.

A

Hypothyroidism

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3
Q

If with suspected thyroid problems, serum ____ and ______should be requested

A

thyroid stimulating hormone

(TSH) or thyrotropin

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4
Q 
The \_\_\_\_\_level is the most sensitive index of thyroid
function and is the preferred test for suspected thyroid
dysfunction.
A

serum TSH

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5
Q

How often to repeat TSH

A

If necessary repeat TSH in 3–6 months

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6
Q

Serum tri-iodothyronine (T 3 ) measurement and
serum free thyroxine (T 4 ) can be useful in suspected
T 3 toxicosis where ______ level may be normal,
and for monitoring patients with treated thyroid
dysfunction

A

serum T 4

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7
Q 
Raised autoantibodies (antimicrosomal or antithyroid
peroxidase) are suggestive of \_\_\_\_\_\_
A 
Hashimoto thyroiditis
(autoimmune thyroiditis
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8
Q

_____, _______, _______ are
elevated in Graves disease, the TSH receptor antibody
being very specific for Graves disease

A

Antithyroglobulin, antithyroid

peroxidase and TSH receptor antibodies

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9
Q

This is the single most cost-effective investigation in the
diagnosis of thyroid nodules. It is the best way to assess
a nodule for malignancy

A

FNAB

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10
Q

The scan may help in the differential diagnosis of

thyroid nodules and in hyperthyroidism

A

Thyroid isotope scan

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11
Q

A functioning nodule is said to be less likely to be _______ than a non-functioning nodule

A

malignant

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12
Q

A _______is usually more sensitive in the

detection of thyroid nodules

A

thyroid ultrasound

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13
Q

T or F

A multinodular goitre is said to be less likely to be malignant than
a solitary thyroid nodule.

A

T

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14
Q

_____ of the thyroid may be used particularly to
determine if there is significant compression in the
neck from a large multinodular goitre with retrosternal
extension

A

CT scan

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15
Q

________ which is relatively common, is

more prevalent in elderly women (up to 5%).

A

Hypothyroidism,

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16
Q

The
term _____ refers to the accumulation of
mucopolysaccharide in subcutaneous tissues

A

myxoedema

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17
Q

Dx?

tiredness + husky voice + cold
intolerance

A

myxoedema

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18
Q

Pts at risk for hypothyroidism

1
2
3
4

A 
• previous Graves disease
• autoimmune disorders (e.g. rheumatoid arthritis,
type 1 diabetes)
• Down syndrome
• Turner syndrome
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19
Q

Drugs that may cause hypothyroidism

A

lithium, amiodarone, interferon

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20
Q

Other conditions that may cause hypothyroidism

A

• previous thyroid or neck surgery
• previous radioactive iodine treatment of the
thyroid

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21
Q

_______, which is an autoimmune
thyroiditis, is the commonest cause of bilateral nonthyrotoxic
goitre in Australia

A

Hashimoto thyroiditis

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22
Q

Clinical features of Hashimoto:

  • bilateral _____
  • classically described as____ and ____
A

goitre

firm and rubbery

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23
Q

T or F

In patients with Hashimoto:

patients may be hypothyroid or euthyroid with a
possible early period of thyrotoxicosis

A

T

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24
Q

Hashimoto:

Diagnosis is confirmed by a strongly positive
_______ titre and/or fine
needle aspiration cytology.

A

antithyroid microsomal antibody

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25
Q

Hashimoto thyroiditis may present as _______

The hypothyroidism may resolve in
____ months or may be permanent.

A

postpartum hypothyroidism.

6–12

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26
Q

Laboratory diagnosis of hypothyroidism

  • T 4 —______
  • TSH—______
A

subnormal

elevated (>10 is clear gland failure)

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27
Q

If T 4 is low and TSH is low or normal, consider

____ and _____

A 
pituitary dysfunction (secondary hypothyroidism)
or sick euthyroid syndrome.
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28
Q

A raised TSH
and T 4 in normal range denotes______ and treatment is appropriate albeit
controversial.

A

‘subclinical’

hypothyroidism

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29
Q

Other diagnostics for Hashimoto:

  • Serum cholesterol level elevated
  • Anaemia: usually _____
  • ECG: _____
A

normocytic; may be macrocytic

sinus bradycardia, low voltage, flat T waves

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30
Q

Tx of Hashimoto:

Exclude coexisting _____ and _____before T 4 replacement.

A

hypoadrenalism and ischaemic

heart disease

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31
Q

Tx of Hashimoto:

Treatment as primary hypothyroidism when
hypopituitarism is the cause may precipitate ____

A

adrenal

crisis

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32
Q

How to give Thyroxine

A

Thyroxine 100–150 mcg daily (once daily)

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33
Q

Thyroxine:

Start with low doses (25–50 mcg daily) in
____ and ________and
50–100 mcg in others

A

elderly and those with ischaemic heart disease

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34
Q

TSH level in Hashimoto to say its treated:

A

Aim to achieve TSH levels of 0.5–2 mU/L.

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35
Q

How long is the tx for Hashimoto

A

When stable on
optimum dose of T 4 , monitor every 2–3 years.
Treatment is usually lifelong.

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36
Q

Hashimoto Tx:

Ischaemic heart disease. Rapid thyroxine
replacement can precipitate _______ especially in the elderly

A

myocardial infarction,

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37
Q

Hashimoto Tx:

Pregnancy and postpartum. Continue thyroxine
during pregnancy; watch for ______ (an
increased dose of T 4 is often required).

A

hypothyroidism

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38
Q

Elective surgery. If euthyroid, can stop thyroxine
for ______ If subthyroid, defer surgery until
euthyroid

A

one week.

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39
Q

____. Urgent hospitalisation under
specialist care is required. Intensive treatment
is required, which may involve parenteral T 4
or T 3 .

A

Myxoedema coma

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40
Q

Misdiagnosing this serious condition leads to failure to

thrive, retarded growth and poor school performance.

A

Neonatal hypothyroidism

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41
Q

If neonatal hypothy (NH) is not treated, what is the cx?

A

If untreated it leads to permanent intellectual damage

(cretinism

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42
Q

Dx of NH

A

It is detected by routine neonatal heel prick blood

testing.

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43
Q

Clinical features of NH

A

The clinical features of the newborn
include coarse features, dry skin, supra-orbital oedema,
jaundice, harsh cry, slow feeding and umbilical hernia

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44
Q

In NH, Thyroxine replacement should be started as
soon as possible, at least before _____weeks of age to avert
intellectual retardation.

A

2

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45
Q

_____ is also relatively common and may
affect up to 2% of women, who are affected four to
five times more often than men

A

Hyperthyroidism

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46
Q

_____ is the most common cause Hyperthyroidism followed closely by
_____

A

Graves disease

nodular thyroid disease

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47
Q

Other causes of hyperthyroidism

  1. Autonomous functioning nodules
  2. Subacute thyroiditis or ________—
    viral origin
    3.Excessive intake of thyroid hormones—
    _______
  3. Iodine excess
  4. ______(beware of this drug)
A

(de Quervain thyroiditis)

thyrotoxicosis factitia

Amiodarone

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48
Q

T or F, in patients with hyperthyroidism:

The classic symptoms may be lacking in elderly
patients who may have only cardiovascular
manifestations (e.g. unexplained heart failure or
cardiac arrhythmias).

A

T

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49
Q

Care has to be taken not to dismiss hyperthyroidism

as severe _____

A

anxiety.

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50
Q

anxiety + weight loss + weakness

A

thyrotoxicosis

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51
Q

4 eye signs of hyperthyroidism

A 
• Lid retraction (small area of sclera seen
above iris)
• Lid lag
• Exophthalmos
• Ophthalmoplegia in severe cases
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52
Q

Investigation for thyrotoxicosis

  • T 4 (and T 3 ) _____
  • TSH level ____
  • Radioisotope scan
  • Antithyroid peroxidase
A

elevated

suppressed

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53
Q

The isotope scan enables a diagnosis of Graves

disease to be made when the scan shows ___

A

uniform increased uptake

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54
Q

Isotope scan:

Increased irregular uptake would
suggest a ______, while there is
poor or no uptake with _____ and ______

A

toxic multinodular goitre

Quervain thyroiditis and
thyrotoxicosis factitia.

55
Q

Management of thyrotoxicosis

• Establish the precise cause before initiating
treatment.
• Educate patients and emphasise the possibility
of development of _____ and _____ and the need for lifelong
monitoring.
• Monitor for _____ and _____

A

recurrent hyperthyroidism
or hypothyroidism

cardiovascular complications and
osteoporosis

56
Q

Therapy of thyrotoxicosis

  1. _____
  2. Thionamide antithyroid drugs
A

RAI

57
Q

Initial doses of antithyroid drugs

— \_\_\_\_\_\_ 10–45 mg (o) daily in divided
doses
or
—\_\_\_\_\_\_ 200–600 mg (o) daily in
divided doses
A

carbimazole

propylthiouracil

58
Q

Adjunctive drugs for thyrotoxicosis

— beta blockers (for symptoms in acute
florid phase, e.g. propranolol 10–40 mg,
6 to 8 hourly); \_\_\_\_\_ and \_\_\_\_\_\_are
alternatives
— \_\_\_\_\_\_(rarely used when there is
intolerance to thionamides)
— \_\_\_\_\_\_\_ mainly used prior to surgery
A

diltiazem or atenolol

lithium carbonate

Lugol’s iodine:

59
Q

Type of surgery for thyrotoxicosis

A

• Surgery
— subtotal thyroidectomy
or
— total thyroidectomy

60
Q

Guidelines for Mx of Graves

Younger patients with small goitres and mild
case—_______

Older patients with small goitres—as above or
_____ (preferably when euthyroid)

A

18-month course antithyroid drugs

radioiodine

61
Q

Large goitres or moderate-to-severe cases—

antithyroid drugs until euthyroid, then ____ or _____

A

surgery

or 131 I

62
Q

Hyperthyroidism is usually transient and follows
a surge of thyroxine after a viral-type illness.
Symptoms include pain and/or tenderness over the
goitre (especially on swallowing) and fever

A

subacute thyroiditis

63
Q

Tx of acute phase of subacute thyroiditis

A

In the

acute phase treatment is based on rest, analgesics (aspirin 600 mg (o) 4–6 hourly) and soft foods.

64
Q

What to give if with severe pain in subacute thyroiditis

A

Rarely, when pain is severe, corticosteroids may be

used.

65
Q

Clinical features are marked anxiety, weight
loss, weakness, proximal muscle weakness,
hyperpyrexia, tachycardia (>150 per minute),
heart failure and arrhythmias. It is usually
precipitated by surgery or an infection in an
undiagnosed patient

A

Thyroid crisis (thyroid storm

66
Q

A _______ is defined as a discrete lesion on
palpation and/or ultrasonography that is distinct
from the rest of the thyroid gland.

A

thyroid nodule

67
Q

Etiology of thyroid nodules

A

• Dominant nodule in a multinodular goitre (most
likely)
• Colloid cyst
• True solitary nodule: adenoma, carcinoma
(papillary or follicular

68
Q

Dxtics for thyroid nodule

1
2
3

A
  • Ultrasound imaging
  • Fine-needle aspiration cytology
  • Thyroid function tests
69
Q

________ is the most common malignancy.
Although rare compared with non-malignant lesions
(such as colloid nodules, cysts, haemorrhage and
benign adenomas), it is important not to miss
carcinoma because of the very high cure rate with
treatment.

A

Papillary carcinoma

70
Q

Dx of thyroid CA

A

Fineneedle

aspiration is the investigation of choice.

71
Q

Pituitary tumors:

These are invariably benign _____ They can
present with hormone deficiencies, features of
_______ syndromes (e.g. prolactin, GH, ACTH)
or by local tumour mass symptoms (e.g. headache,
visual field loss

A

adenomas.

hypersecretory

72
Q

The main causes (of many) are a pituitary adenoma
(micro- or macro), pituitary stalk damage, drugs—
such as antipsychotics, various antidepressants,
metoclopramide, cimetidine, oestrogens, opiates,
marijuana—and physiological causes such as
pregnancy and breastfeeding

A

Hyperprolactinaemia

73
Q

SSx of hyperprolactinemia

• Symptoms common to males and females:
reduced libido, subfertility, ______ (mainly
females)
• Females: ______
• Males: erectile dysfunction, reduced facial hair

A

galactorrhoea

Amenorrhoea/oligomenorrhoea

74
Q

hyperprolactinemia

  • Serum ____ and _____ assays
  • MRI: consider if headache, etc
A

prolactin and macroprolactin

75
Q

Hyperprolactinemia

Refer for management, which may include
a dopamine agonist such as _____ and _____

A

cabergoline or

bromocriptine

76
Q

Dx

nasal problems + fitting problems ( e. g.
rings, shoes ) + sweating

A

acromegaly

77
Q

Dx of acromegaly

  • Plasma ____ excess
  • Elevated ____—the key test
  • X-ray skull and hands
  • MRI scanning pituitary
  • Consider associated __________
A

growth hormone

insulin-like growth factor 1 (IGF-1)
(somatomedin)

impaired glucose tolerance/
diabetes

78
Q

Impaired secretion of vasopressin (antidiuretic
hormone) from the posterior pituitary leads to
polyuria, nocturia and compensatory polydipsia
resulting in the passage of 3–20 L of dilute urine per
day

A

DI

79
Q

In ______the kidney

tubules are insensitive to vasopressin

A

nephrogenic DI

80
Q

DDx for nephrogenic DI

A

compulsive (psychogenic) water

drinking

81
Q

The______ is caused by cancer
(e.g. lung, lymphomas, kidney, pancreas), pulmonary
disorders, various intracranial lesions and drugs such
as carbamazepine and many antipsychotic agents

A 
syndrome of secretion of inappropriate
antidiuretic hormone (SIADH)
82
Q

Tx of SIADH

A

Management of SIADH is essentially fluid restriction

83
Q

weakness + polyuria + polydipsia

A

diabetes insipidus

84
Q

What is the dx?

  • a history of postpartum haemorrhage
  • symptoms of hypothyroidism
  • symptoms of adrenal insufficiency
  • symptoms suggestive of a pituitary tumour
  • thin, wrinkled skin: ‘monkey face’
  • pale ‘alabaster’ skin/hairlessness
A

Hypopituitarism 7

85
Q

( female ): amenorrhoea + loss of

axillary and pubic hair + breast atrophy

A

Hypopituitarism

86
Q

( male ): ↓ libido + impotence + loss of

body hair

A

Hypopituitarism

87
Q

Hypopituitarism:

Investigate with serum pituitary hormones,
imaging and ____

A

triple stimulation test

88
Q

Uncommon disorders of the adrenal cortex

_______ deficiency of cortisol and aldosterone
________—cortisol excess
• primary hyperaldosteronism

A

chronic adrenal insufficiency (Addison disease)

• Cushing syndrome

89
Q

Autoimmune destruction of the adrenals is the most

common cause.

A

Addison disease

90
Q

What is the dx?

Clinical features

• Lethargy/excessive fatigue/weakness
• Anorexia and nausea
• Diarrhoea/abdominal pain
• Weight loss
• Dizziness/funny turns, syncope: hypoglycaemia
(rare); postural hypotension (common)
• Hyperpigmentation, especially mucous
membranes of mouth and hard palate, skin
creases of hands
A

Addison Disease

91
Q

If Addison disease remains undiagnosed, wasting
leading to death may occur. _________can
be a feature

A

Severe dehydration

92
Q

fatigue + a / n / v + abdominal pain

± skin discolouration

A

Addison disease

93
Q

Dx of Addison

Elevated serum ____, low serum____
• Low plasma ______level (fails to respond to
synthetic adrenocorticotropic hormone [ACTH])

A

potassium, sodium

cortisol

94
Q

Dx of Addison

• The short_______test is the
definitive test
• Consider adrenal autoantibodies and imaging
calcification of adrenals

A

synacthen stimulation

95
Q

Tx of Addison

A

corticosteroid replacement—

hydrocortisone/fludrocortisone acetate

96
Q

An______ develops because of an inability
to increase cortisol in response to stress, which may
include intercurrent infection, surgery or trauma.

A

Addisonian crisis

97
Q

SSx of Addisonian crisis

A
  • Nausea and vomiting
  • Acute abdominal pain
  • Severe hypotension progressing to shock
  • Weakness, drowsiness progressing to coma
98
Q 
The five main causes of Cushings are:
\_\_\_\_\_\_—chronic corticosteroid
administration
\_\_\_\_\_\_ excess (Cushing disease)
• bilateral adrenal hyperplasia
• adrenal tumour (adenoma, adenocarcinoma)
\_\_\_\_\_\_\_ or (rarely) corticotrophin-releasing
hormone (CRH) from nonendocrine tumours
(e.g. oat cell carcinoma of lung)
A
  • iatrogenic
  • pituitary ACTH
  • ectopic ACTH
99
Q

plethoric moon face + thin extremities +

muscle weakness

A

Cushing syndrome

100
Q

Diagnosis (apart from iatrogenic cause) of Cushing

• Cortisol excess (plasma or 24-hour urinary
cortisol)
• \_\_\_\_\_\_\_test
• \_\_\_\_\_\_\_ sampling
• Serum ACTH
• Radiological localisation: MRI for ACTHproducing
pituitary tumours; CT scanning for
adrenal tumours
A

Dexamethasone suppression

Inferior petrosal sinus

101
Q

Primary hyperaldosteronism is usually from?

A

Most commonly due to an adrenal adenoma

102
Q

Usually asymptomatic but any symptoms are features
of hypokalaemia

  • weakness
  • cramps
  • paraesthesia
  • polyuria and polydipsia
A

Conn syndrome

103
Q

A dangerous tumour of the adrenal medulla

A

Phaeochromocytoma

104
Q

Ssx of Phaeochromocytoma

A 
• hypertension
• headache (throbbing)
• sweating
• palpitations
• pallor/skin blanching
• rising sensation of tightness in upper chest and
throat (angina can occur
105
Q

Phaeochromocytoma
• Series of three 24-hour ___ and inc in ______
• Abdominal CT or MRI scan

A

free catecholamines

↑ VMA

106
Q

Tx of Phaeochromocytoma

Excise tumour, cover with ___ and ____

A

alpha and beta

blockers

107
Q

An AR condition with 21-hydroxylase deficiency
being the most common of several forms. There is
inadequate synthesis of cortisol and aldosterone with
increased androgenisation

A

Congenital adrenal hyperplasia

adrenogenital syndrome

108
Q

In CAH,

Major problem is adrenal
failure ± _____

A

salt-losing state (SLS).

109
Q

CAH in females:

In females, ____ and ______ before puberty
usually occurs.

A

ambiguity

of external genitalia and hirsutism

110
Q

CAH in males

Males may have normal urogenital development but ______ is a concern

A

SLS

111
Q

CAH in infants

Infants of either
sex may present with_____ and _____ and
dehydration (SLS).

A

failure to thrive or vomiting

112
Q

Tx of CAH

A

Lifelong glucocorticoid treatment

is required.

113
Q

Other term for adrenal tumors

A

‘incidentalomas’

114
Q

example of adrenal tumors

A

adrenal carcinoma,
phaeochromocytoma, neuroblastoma, glucocorticoid
or a mineral corticoid secreting tumour

115
Q

Suspect___________if there is weakness, tiredness,
malaise, anorexia, nausea or vomiting, abdominal
pain, constipation, thirst, polyuria, drowsiness,
dizziness, personality changes, muscle aches and
pains, visual disturbances

A

hypercalcaemia

116
Q

MC causes of primary hyperparathyroidism

A

familial hypercalciuric hypercalcaemia and neoplasia,

117
Q

Other causes of primary hyperparathyroidism

A

include Paget disease,

sarcoidosis and milk-alkali syndrome

118
Q

Investigations for primary hyperparathyroidism

A 
ESR, 
serum parathyroid hormone (N: 1.0–7
pmol/L), 
serum ACE levels, 
serum alkaline phosphatase,
chest X-ray,
119
Q

What scans are used in primary hyperparathyroidism

A

Sestamibi scan and bone scan

120
Q

weakness + constipation + polyuria

A

hypercalcaemia

121
Q

cramps + confusion + tetany

A

hypocalcaemia

122
Q

Hyperparathyroidism is caused by an excessive
secretion of parathyroid hormone and is usually due
to a _____

A

parathyroid adenoma.

123
Q

The classic clinical features
of hyperparathyroidism are due to the effects of
_______

A

hypercalcaemia.

124
Q

Rarely, a_________ in a
misdiagnosed patient may result in death from severe
hypercalcaemia.

A

parathyroid crisis

125
Q

Dx of Primary hyperparathyroidism
1
2

A
  • Serum parathyroid hormone (elevated)

* TC-99m Sestamibi scan to detect tumour

126
Q

This usually presents with tetany or more
generalised neuromuscular hyperexcitability and
neuropsychiatric manifestations

A

Hypocalcaemia

127
Q

The sensory
equivalents are paraesthesia in the hands, feet and
around the mouth (distinguish from tetany seen in
the_________).

A

respiratory alkalosis of hyperventilation

128
Q

Hypocalcemia

The diagnosis is by
measurement of serum total calcium concentration in
relation to serum ____

A

albumin

129
Q

Two important signs of hypocalcemia are:
• ______ occlusion of the brachial artery
with BP cuff precipitates carpopedal spasm (wrist
flexion and fingers drawn together)
• ________ tapping over parotid (facial nerve)
causes twitching in facial muscles

A

Trousseau sign:

Chvostek sign:

130
Q

Tx of Hypocalcemia

A

Treatment involves careful adjustments in dosage
of calcitriol and calcium to correct hypocalcaemia and
avoid hypercalcaemia and hypercalciuria

131
Q

Hypoparathyroidism is the most common cause

of ______

A

hypocalcaemia

132
Q

Causes of Hypoparathyroidism

A
  1. postoperative thyroidectomy and parathyroidectomy,
  2. congenital deficiency (DiGeorge syndrome) and
  3. idiopathic (autoimmune) hypoparathyroidism
133
Q

Main ssx of Hypoparathyroidism

1
2
3

A

neuromuscular hyperexcitability, tetany

and neuropsychiatric manifestations

MC (90 decks)

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