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Life Maintenance > Week 14 - Thyroid, Endocrinology > Flashcards

Week 14 - Thyroid, Endocrinology Flashcards

1
Q

Role of oestrogen and progesterone

A

Oestrogen

xxxx

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2
Q

What does testosterone turn into in females? by what enzyme?

A

Oestrogen

By aromatase

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3
Q

What does testosterone turn into in men?

A

xxx

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4
Q

CARDS ON FLOW CHART SLIDE

A

xxx

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5
Q

On what day does menstrual cycle start?

A

Day 25

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6
Q

What happens at three months?

A

Corpus liteum -> placenta

Placenta is now mature and it takes over

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7
Q

What are the actions of oestrogen? (4 categories)

A

Development
Menstrual
Pregnancy
Cellular

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8
Q

What are the menstrual actions of oestrogen?

A

Menstrual - Endometrial proliferation, watery cervical mucus, maturation of vaginal epithelium, female sex behaviour

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9
Q

What are the developmental actions of oestrogen?

A

Development - secondary sex characterstics, breast development, fat distribution, uterine development, bone deposition

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10
Q

What are the pregnancy actions of oestrogen?

A

Pregnancy - Breast ductal development, fluid retention, increased uterine blood flow

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11
Q

What are the cellular actions of oestrogen?

A

Cellular - acts via a nuclear receptor, expression of progesterone receptor, decrease plasma cholesterol, hepatic enzyme inducers

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12
Q

What are the actions of progesterone? (3 categories)

A

Menstrual
Pregnancy
Cellular

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13
Q

Causes of female infertility

A

Anovulatory - Central and ovarian

Ovulatory

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14
Q

Anorexia nervosa and infertility - outline

A

Lack of adipose tissue, body can tell you are not storing enough fat through lack of leptin

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15
Q

Central causes of anovulatory female infertility

A

xx

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16
Q

Ovarian causes of anovulatory female infertility

A

xxx

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17
Q

Ovulatory causes of female infertility

A

xxx

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18
Q

Test for female infertility (5)

A 
Karyotype
Gonadaotrophins oestradiol
Progesterone
LHRH test
Pelvic ultrasound
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19
Q

What does LH being much higher than FSH indicate?

A

Ovulatory surge

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20
Q

OUTLINE FSH and INHIBIN

A

xxx

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21
Q

Luteinising hormone and testosterone

A

xxx

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22
Q

Testosterone production in women (3)

A 
Ovarian synthesis (granulosa cell)
Peripheral conversion of precursor androgen
Adrenal synthesis (zon reticularis)
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23
Q

How to measure testosterone

A

Very unreliable in women

9am fasted sample
Patient in good physical health
Repeated measure (at least 2, 6 weeks apart)

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24
Q

Actions of testosterone

A

XXXX

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25
Q

Why are men taller?

A

Later and longer puberty

Heavier bones

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26
Q

Causes of male infertility

A

Central
Testicular
Post-testicular

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27
Q

Tests for male infertility (4)

A

Karyotype
Gonadotrophins testosterone
LHRH test
Testicular ultrasound

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28
Q

Describe Cushing’s syndrome

A

EXCESS of glucocorticoids (cortisol)
Obesity
Facial plethora (redness)
Male pattern hair in female

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29
Q

Describe Addison’s syndrome

A

SHORTAGE of glucocorticoids (cortisol)

Tiredness, weight loss, postural hypotension

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30
Q

Causes of Addison’s syndrome

A 
Autoimmune
Steriod use
TB
Metastases
Infiltration
Infection
Enzyme defect
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31
Q

Describe 21-hydroxylase deficiency (Classical CAH)

A

Commonest form of CAH
1:10000 births
Autosomal recessive
HLA linked

Excess sex steroids
No aldosterone, salt-losing crisis

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32
Q

Outline 11B-hydroxylase deficiency (Non-classical)

A

About 5% of reported 5%
0.5: 100,000 live births
Increased in Moroccan Jews (1:6000)
HLA linked

Salt retention
Excess sex steriods
No aldosterone but HIGH DOC (agonist at NC receptors) - hypertension and hypokalaemia

33
Q

In what case do you treat with fludocortisone?

A

21-hydroxylase deficiency to replace absent mineralcorticoid activity

34
Q

Where is renin produced?

A

Juxtaglomerular cell

35
Q

Outline primary and secondary excess of aldosterone

A

xxx

36
Q

Outline Conn’s syndrome and treatment

A

xxx

37
Q

Outline phaeochromocytoma - what is it? symptoms?

A

Tumour of the enterochromaffin cells of the adrenal medulla
(can be outside adrenal gland, but is a tumour of the nerve ganglion)
Produces adrenaline (nor adrenaline, dopamine)
Rule of 10% (10% bilateral, malignancy, extra adrenal, inherited)

Causes sweating, anxiety, fever, abdominal pain, headache, angor aminii

38
Q

Management of phaechromocytoma

A

Emergency
Alpha blockade - non-competitive alpha antagonist
Beta blockade - non-selective beta blocker
Fluid resuscitation
Surgery

39
Q

Management of phaechromocytoma

A

Emergency
Alpha blockade - non-competitive alpha antagonist - FIRST
Beta blockade - non-selective beta blocker - 24 hours after alpha
Fluid resuscitation
Surgery

40
Q

What is shock?

A

Reduction of effective blood flow and inadequate tissue perfusion with decreased delivery of oxygen to the capillary exchange beds

41
Q

What are the common things that change with inadequate O2? (4)

A

Heart rate
Blood pressure
Respiratory rate
Urine output

42
Q

What is ABCDE?

A

Approach to examination in sick patient - must prioritise crucial issues

Airway and oxygenation
Breathing and ventilation
Circulation and management of shock
Disability due to neurological deterioration 
Exposure and examination
43
Q

How do you assess breathing / ventilation?

A

Is the chest clear?
Is ventilation bilateral / equal?
Cyanosis?
SaO2? On room or O2?

44
Q

What are management options of acute breathing issues?

A

Oxygen
Treat with nebulisers of wheeze - steriods, magnesium
Decompression for pneumothorax / haemothorax
NIV for hypercapnic respiratory failure

45
Q

Assessing circulation and management of shock in very sick patient

A 
HR
BP
Cap refill
Temp of limbs
Heart sounds
Urine output
Oedema
46
Q

Impact of a fluid challenge

A

Helps improve preload

Heart rate decreases
Mean arterial pressure / arterial pulse pressure increase
Urine output increases
Lactate clearance increases
Cardiac output or strike volume increase
47
Q

Assessment of disability due to neurological deteriotation

A

GCS
AVPU
Blood glucose

48
Q

How do you communicate your findings?

A

S - Situation
B - Background
A - Assessment
R - Recommendation

49
Q

Total vs free hormone assay

A

Total - dependent on binding protein levels so NOT always reflective of the free hormone level, cheap
Free - representative of the active hormone fraction, complex and expensive, can have poor reproducibility

50
Q

Overview of immunoassay

A

xxx

51
Q

Thyroid investigations

A

xxx

52
Q

Describe release of cortisol

A

xxx

53
Q

Investigations of Cushing’s (3 stages)

A

Screening - urinary free cortisol, diurnal rhythm
Confirmation of diagnosis - Low dose dexamethasone suppression test
Differentiation of the cause - ACTH, high dose dexamthasone suppression, localisation

54
Q

When best to measure cortisol levels for Cushings diagnosis?

A

At night (it should be low)

55
Q

What is dexamethasone?

A

So similar to cortisol, brain can’t tell difference

BUT won’t come up on assay

56
Q

Outline the types of dexamethasone suppression test

A

Low dose - 0.5 six hourly complete suppression in normal subject
High dose - 2mg six-hourly, suppresses cortisol up to 50% in Cushings
DOES NOT suppress in ectopic ADTH or adrenal neoplasia

57
Q

Outline synacthen tests

A

xxx

58
Q

Outline insulin tolerance test

A

xxx (insulin or glucagon)

59
Q

Outline oral glucose tolerance test

A

xxx acromegaly, anorexia nervosa

60
Q

Describe acromegaly

A

xxx

61
Q

Outline syndrome of inappropriate ADH (SIADH)

A

Too much ADH

Brain infection / injury, lung cancer / infection, pneumonia, metabolic (hypothyroidism / addison’s)

62
Q

What is diabetes insipidus?

A

Underproduction of ADH
Can be cranial or nephrogenic

Polyuria, polydipsia

63
Q

Outline water deprivation test

A

xxx

64
Q

If you can do one investigation with neck lump what do you do? and why?

A

Ultrasound

Can do biopsy at the same time

65
Q

Identifying benign vs. malignant neck lumps

A

xxx

66
Q

Neck lumps in different age groups

A

xxx

67
Q

Thyrotoxicosis vs hyperthyroidism

A

Thyrotoxicosis is excess thyroid hormones in blood due to any reason( outside source).

Hyperthyroidism is excess thyroid hormones only due to increased synthesis from thyroid gland.

68
Q

Signs of T3 toxicosis

A

xxx

69
Q

Describe diagnosis of hyperthyroidism in patient with overt opthalmopathy

A

xxx

70
Q

Describe diagnosis of hyperthyroidism in patient without overt opthalmopathy

A

xxx

71
Q

Treatment of hyperthyroidism

A 
Antithyroid drug (ATD)
B-blockers
Glucocorticoids 
Radioiodine
Subtotal thyroidectomy
72
Q

Outline types of thionomides

A

Carbimaxole, propythiouracil, methimizole

73
Q

Which patients are unlikely to undergo remission following hyperthyroidism treatment

A 
Large goitre
Positive TSH receptor antibodies
Thyroid disease
Opthalmopathy
Smoking
Men
74
Q

Indications and contraindications of radio-iodine

A

Safe and appropriate treatment in nearly all types of hyperthyroidism, especially in elderly
Contraindicated in children, pregnancy and women who are breast feeding
Women of childbearing age should wait for 4 months after 131I before becoming pregnant
Should be used with caution in patients with opthalmopathy
Use prophylactic steroids and avoid hypothyroidism

75
Q

Side effects of radio-iodine (4)

A

Radiation induced thyroiditis.
Transient worsening of thyrotoxicosis.
Hypothyroidism.
Cancer risk.

76
Q

Describe thyroid hormone resistance

A

May present as hypo or hyper - may not require treatment

77
Q

Developing hyper or hypo when on Amiodrone

A

Hypo - will likely go away when you stop treatment so you can just treat with T4 in the meanitime

Hyper - two types
Type 1 - XXX

78
Q

Increase of thyroxine dose during pregnancy

A

50mcg

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