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CMS > Week 11 - Endocrinology > Flashcards

Week 11 - Endocrinology Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

endocrine system - mediated by?

A

hormones

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2
Q

3 basic problems in endocrine disease?

A
  1. excess hormone
  2. reduced hormone
  3. physical gland enlargement
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3
Q

thyroid disease - manifestations?

A
  1. thyroxine excess: hyperthyroidism/thyrotoxicosis
  2. thyroxine lack: hypothyroidism
  3. thyroid mass: goitre
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4
Q

hyperthyroidism: pathophysiology?

A
  1. autoimmune: grave’s disease
  2. goitre/toxic adenoma
  3. pituitary driven
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5
Q

hyperthyroidism: symptoms?

A
  • sweating, heat intolerance
  • irritability, poor sleep, anxiety, palpitations
  • excess appetite, weight loss, diarrhoea
  • breathlessness
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6
Q

hyperthyroidism: signs?

A
  • warm, moist skin
  • tachycardia, irregular heart rate
  • increased BP, heart failure
  • fine tremor
  • goitre
  • grave’s disease
  • pre-tibial myxoedema
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7
Q

describe grave’s disease?

A

eye disease

  • exopthalmos
  • ophthalmoplegia
  • lid lag/retraction
  • loss of visual acuity
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8
Q

hyperthyroidism - diagnosis?

A
  • clinical signs
  • blood tests: thyroid function tests & auto-antibodies
  • radiology (sometimes)
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9
Q

diagnosing hyperthyroidism with blood test - what would the thyroid function test results be?

A

low TSH

high T3, T4

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10
Q

hyperthyroidism - management?

A
  1. drugs:
    - anti-thyroid drugs e.g. carbomazole, propylthiouracil
    - b-blockers: controls symptoms
  2. surgery: control disease first, occasionally eye surgery
  3. radioactive iodone: caution in young patients, do not use in pregnancy or breast-feeding
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11
Q

hypothyroidism: pathophysiology?

A
  1. auto-immune: thyroid destruction
  2. iatrogenic: from surgery or radioiodone
  3. iodine deficiency: rare
  4. rarely pituitary disease
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12
Q

hypothyroidism - symptoms?

A

reduced metabolism

  • cold intolerance
  • weight gain, constipation
  • hoarse voice, puffed face, extremities
  • mental slowness, poor memory
  • hair loss
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13
Q

hypothyroidism - signs

A
  • slow pulse
  • large tongue, deep voice
  • thin/dry hair, loss of eyebrows
  • goitre
  • coarsening of features
  • acute (rare): coma, hypothermia
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14
Q

hypothyroidism - diagnosis

A
  • clinical signs
  • blood tests: thyroid function tests & auto-antibodies
  • radiology (sometimes)
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15
Q

diagnosing hypothyroidism with blood test - what would the thyroid function test results be?

A
  • high TSH

- low T3, T4

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16
Q

hypothyroidism - management?

A

replacement

  • thyroxine (T4)
  • levothyroxine
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17
Q

goitre - thyroid mass: what are the 3 types?

A
  • those not associated with intrinsic thyroid disease: simple cysts/adenomas, iodine deficiency
  • associated with intrinsic thyroid disease: auto-immune, toxic multi-nodular goitre/adenoma
  • malignant: rare
18
Q

goitre - what type of compression effect is possible despite being rare?

A

retro-sternal extension: results in dysphagia and breathing difficulties as it compresses the mediastinum

19
Q

goitre - investigation methods?

treatment?

A
  • radiology: ultrasound/radioisotope scan
  • fine needle aspiration
  • blood tests

tx:
- treat underlying cause, may need surgery

20
Q

thyroid disease - dental aspects:

  • anti-thyroid drugs?
  • goitres?
A
  • antithyroid drugs e.g. carbimazole -> cause neutropenia and taste disturbance
  • goitres:
    evidence of lymphadenopathy or compression -> related to thyroid effects?
21
Q

adrenal disease: two types and their mechanisms?

A
  • excess corticosteroid production: cushing’s syndrome

- deficient corticosteroid production: addison’s disease

22
Q

cushing’s syndrome: pathophysiology?

A

excess ACTH:

  • pituitary adenoma
  • ectopic production by cancers

excess corticosteroids:

  • adrenal adenomas, carcinomas
  • iatrogenic
23
Q

cushing’s syndrome: characteristics?

A
  • high BP
  • diabetes
  • prone to infections
  • thinning hair
  • high visceral fat
  • thin extremities
  • buffalo hump
  • moon face
24
Q

cushing’s syndrome - management?

A

address underlying cause

  • iatrogenic: try to reduce/stop
  • non-iatrogenic: surgery (ideal)
25
Q

addison’s disease - pathophysiology?

A
  • iatrogenic: occurs after withdrawal of steroids after long term use
  • hypopituitarism: due to cancer, infection, vascular, trauma
  • adrenal destruction: due to autoimmune disease
26
Q

addison’s disease - symptoms?

A
  • chronic: general malaise
  • acute: usually in response to stress from infection, trauma, surgery
    symptoms may be life-threatening: shock, hypoglycaemia, vomiting, abdominal pain
27
Q

addison’s disease - signs?

A 
- hyperpigmentation of:
buccal mucosa
scars
pressure points
skin creases
28
Q

addison’s disease - management?

management of addisonian crisis?

A

replacement therapy: baseline

  • hydrocortisone (glucocorticoid)
  • fludrocortisone (mineralocorticoid)

increase at times of stress
- infection, trauma, surgery

acute addisonian crisis is a medical emergency

  • fluid replacement, glucose, hydrocortisone injections
  • need hospitalization
29
Q

adrenal disease - dental aspects

A
  • cushing’s: poor woulf healing, oral infections

- addison’s: increased steroid dose

30
Q

growth hormone excess: acromegaly

- due to?

A
  • excess growth hormone, usually due to a pituitary adenoma

- rare

31
Q

acromegaly: characteristic features?

A
  • large tongue
  • excess hair
  • large hands/feet
  • myopathy/arthritis
  • prominent supraorbital ridge
  • broad nose
  • prognathism
  • interdental separation
  • thick, greasy skin
  • high BP
  • heart failure
  • diabetes
32
Q

acromegaly - management?

A
  • medical management (somatstatin analogues to slow down production of growth hormone)
  • surgery
  • may also need radiotherapy
33
Q

diabetes mellitus - two forms and their pathophysiology?

A

10% type 1

  • insulin dependent
  • auto-immune disease
  • commonly seen in young people

90% type 2

  • non-insulin dependent
  • insulin resistance and deficiency
  • more likely if obese
34
Q

diabetes - diganosis?

A
  • elevated blood sugar
  • classical symptoms: high plasma glucose
  • no symptoms: from routine medical screening
35
Q

diabetes - complications?

A
  1. infections - increased risk: boils, abscesses, cellulitis in boils and mouth
  2. eye disease (diabetic retinopathy)
  3. kidney disease (diabetic nephropathy)
  4. nerve disease (diabetic neuropathy): loss of nerve function, i.e. lose sensation, bowel and bladder function, muscle weakness and pain
  5. atherosclerosis
36
Q

diabetes management: main goal? methods for type 1 and 2?

A
  • normalize blood sugar
  • type 1: insulin
  • type 2: initially dietary & lifestyle changes. if not,
    oral medication given:
  • sulphonylureas
  • biguanides
  • glitazones
37
Q

diabetes - management?

A
  • minimize other risk factors: weight control, exercise, cholesterol, smoking, high BP
  • monitor for complications: regular clinic, eyes photographed, feet examined, monitor blood sugar control (HbA1c), monitor cholesterol, kidney fn, BP
38
Q

2 types of diabetic emergencies? list each

A

high blood sugar:

  • diabetic ketoacidosis - type 1
  • hyperosmolar non-ketoic (HONK) coma - type 2

low blood sugar:
- hypoglycaemia

39
Q

diabetic ketoacidosis - causes?

A
  • insulin not taken due to no food intake
  • inadequate insulin in acute physiological stress: infection & surgery
  • often a combination of both
40
Q

DKA - symptoms & signs? diagnosis? management

A
  • impaired consciousness, dehydration, ketones on breath
  • elevated blood sugar, ketones in urine
  • hospitalization: insulin replacement, fluids, treat underlying cause
41
Q

hypoglycaemia:

  • causes?
  • clinical features?
  • diagnosis based on?
A
  • taking insulin without any glucose
  • occasionally due to tablets
  • irritability, personality change, sweating, tremor, hunger. progresses to impaired consciousness -> fits, coma
  • clinical features and blood glucose reading
42
Q

hypoglycaemia:

treatment? for awake & those with impaired consciousness

A

awake:
oral glucose: soft drinks, biscuits, milk

impaired consciousness:

  • hypostop: glucogel, squirt into buccal mucosa
  • IM glucagon
  • IV glucose
  • oral glucose as soon as able

CMS (16 decks)

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