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JL Endocrinology > Week 3 > Flashcards

Week 3 Flashcards

1
Q

Name two macrovascular complications of diabetes?

A

IHD

Stroke

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2
Q

What percentage of patients with diabetes will develop some degree of neuropathy?

A

60 - 70%

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3
Q

What type of neuropathy involves pain/loss of feeling in feet, hands?

A

Peripheral

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4
Q

What type of neuropathy involves changes in bowel, bladder function, sexual response, sweating, heart rate, BP and hypoglycaemic unawareness?

A

Autonomic

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5
Q

What type of neuropathy involves pain in the thighs, hips or buttocks leading to weakness in the legs (amyotrophy)?

A

Proximal

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6
Q

What type of neuropathy involves sudden weakness in one nerve or a group of nerves causing muscle weakness or pain e.g. carpal tunnel, ulnar mono neuropathy, foot drop, bells palsy and cranial nerve palsy?

A

Focal neuropathy

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7
Q

Which type of diabetes is more prone to neuropathy?

A

type I

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8
Q

Name a cream that may help treat painful neuropathy?

A

Capsaicin cream

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9
Q

For treating painful neuropathy - what might be started after paracetamol?

A

TCA’s (amitryptiline)
Gabapentin
dULOZETINE/PRE-GABALIN
Oxycodone/tramadol

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10
Q

Name a digestive complication of diabetes that can make blood glucose levels fluctuate widely, due to abnormal food digestion?

A

Gastroparesis

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11
Q

A gastric pacemaker can be used to treat gastroparesis - name three drugs that can also be trialed?

A
  1. Metoclopramide
  2. Domperidone
  3. Erythromycin
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12
Q

What might happen to blood pressure in a diabetic complication?

A

May drop sharply after sitting or standing, causing a person to feel light-headed

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13
Q

What does nodular glomerulosclerosis occur in?

A

Diabetic nephropathy

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14
Q

What should you use to screen for diabetic kidney disease?

A

Urinary albumin creatinine ratio (ACR)

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15
Q

In diabetic nephropathy what signals impending doom?

A

Microalbuminuria

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16
Q

What should be screened and treated aggressively in a patient with microalbuminuria?

A

Hypertension

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17
Q

What does exercise, protein load and fluid load vary?

A

Microalbuminuria

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18
Q

Name a few other false positives for microalbuminuria?

A

Menstruation, vaginal discharge, UTI, pregnancy etc

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19
Q

What class of drugs reduce progression on diabetic nephropathy?

A

ACE inhibitors

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20
Q

Give four effects of ACE inhibitors or ARBS in diabetic nephropathy?

A
  1. Dilatation of renal arterioles
  2. Decrease filtration pressure
  3. Decrease proteinuria
  4. Decrease GFR
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21
Q

In all patients with diabetes - what should their blood pressure be maintained at?

A
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22
Q

Name four diabetic eye pathologies that people with diabetes get?

A
  1. Retinopathy
  2. Cataract
  3. Glaucoma
  4. Acute hyperglycaemia - visual blurring
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23
Q

What part of the eye is involved in fine vision?

A

Fovea

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24
Q

What is the area around the fovea?

A

Macula

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25
Q

What three ways can retinopathy be treated?

A

Laser, vitrectomy and anti-VEGF injections

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26
Q

What two anti-hypertensive drugs can commonly cause erectile dysfunction?

A

Thiazides and beta blockers

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27
Q

Name a few CNS drugs that can commonly cause erectile dysfunction?

A
  1. Antidepressants, tricyclics
  2. Tranquilisers
  3. Sedatives
  4. Analgesics
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28
Q

Name two drugs which can be used to treat ED in diabetes?

A

Sildenafil

Vardenafil

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29
Q

What therapy should be commensed in all patients with diabetes over age 40?

A

Statin for cholesterol lowering

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30
Q

What is the most diverse hormone subtype?

A

Proteins and peptides

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31
Q

What are steroids derived from?

A

Cholesterol

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32
Q

Name two cytokine receptors?

A

Prolactin and growth hormone receptors

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33
Q

In steroid hormone receptors, once steroid complex binds DNA response elemtns what occurs?

A

Change in gene transcription

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34
Q

What is the major determinant of hormone concentration?

A

Rate of secretion

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35
Q

What does a raised TSH suggest?

A

Hypothyroidism

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36
Q

What does a suppressed TSH suggest?

A

Hyperthyroidism

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37
Q

When might TSH not be a reliable marker of thyroid status?

A

Pituitary dysfunction

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38
Q

What does ACTH released from anterior pituitary work on?

A

Adrenal cortex

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39
Q

What measurement may give indication of HPA axis function?

A

9am cortisol

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40
Q

What indicates GH hypersecretion?

A

IGF-1 measurement

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41
Q

What does evaluation of female sex hormones depend on?

A

Timing in menstrual cycle

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42
Q

What is prolactin (PRL) secreted by>?

A

Lactotroph cells of the anterior pituitary

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43
Q

What is Prolactin secretion under tonic inhibition by?

A

Hypothalamic dopamine

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44
Q

What are the effects of prolactin mediated by?

A

Prolactin receptor

45
Q

What disease involves primary adrenal failure?

A

Addison’s disease

46
Q

What condition is associated with cortisol excess?

A

Cushings syndrome

47
Q

Name a steroid stimulation test?

A

Synacthen test

48
Q

Name a steroid suppression test?

A

Dexamethasone suppression test

49
Q

What condition involves chushingoid facies, acne, hirsutism, abdo striae & centripetal obesity, interscapular and supraclavicular fat pads, proximal myopathy, osteoporosis, hypertension and impaired glucose tolerance?

A

Cushings syndrome

50
Q

What is cushings disease?

A

Pituitary cushing’s - tumour arising from the corticotroph cells of anterior pituitary

51
Q

Is the adrenal cause of cushings syndrome ACTH-independent or ACTH-dependent?

A

Independent

52
Q

Is the pituitarty cause of cushings syndrome ACTH dependent or independent?

A

Dependent

53
Q

Is the ectopic ACTH cause of cushings syndrome ACTH dependent or independent?

A

Dependnet

54
Q

What sort of test is used for cushings?

A

Suppression

55
Q

Name three screening tests for cushings?

A
  1. 1mg overnight dexamethasone suppression test
  2. 24 hour urinary free cortisol
  3. Midnight cortisol
56
Q

What is the formal diagnostic test for Cushings?

A

Low dose dexamethasone suppression test

57
Q

If the ACTH is low - what does it suggest about the cushings?

A

It is adrenal origin

58
Q

If the ACTH is raised - what does it suggest about cushings?

A

Need to distinguish between cushings disease and ectopic ACTH

59
Q

In relation to cushings - what does a rise in cortisol and ACTH on CRH test indicate?

A

Pituitary source

60
Q

What is the gene type of multiple endocrine neoplasia MEN1?

A

Autosomal dominant - MEN1 gene 11q

Classic tumour suppressor

61
Q

What is the gene type of multiple endocrine neoplasia MEN2?

A

Autosomal dominant, RET gene 10q

Classic proto-oncogene

62
Q

In the thyroid - what do parafollicular C cells secrete?

A

Calcitonin

63
Q

What is the main fuel of thyroid gland?

A

Iodine

64
Q

What are the four steps in synthesis and storage of T3 and T4?

A
  1. Iodine taken up by follicle cells
  2. Iodine attached to tyrosine residues on thyroglobulin to form MIT and DIT
  3. Coupling of MIT + DIT (T3) & 2 DITs (T4)
  4. Stored in colloid thyroglobulin till required
65
Q

What makes up 90% of thyroid hormones secreted?

A

t4

66
Q

What is T4 converted to T3 by?

A

LIver and kidney

67
Q

What is the major biologically active thyroid hormone?

A

T3

68
Q

What allows T3 and T4 to bind to plasma proteins?

A

Hydrophobic/lipophilic

69
Q

Name three plasma proteins which bind to T3 and T4?

A
  1. Thyroxine binding globulin
  2. Thyroxine binding prealbumin
  3. Albumin
70
Q

What do you get decreased TBG in?

A

Cushings S

71
Q

What hormones increase responsiveness to adrenaline and sympathetic NS neurotransmitter, noradrenaline, by increasing numbers of receptors?

A

Thyroid hormones

72
Q

What class of drug is used to treat symptoms in initial stages of hyperthyroidism?

A

Propranolol - beta-blocker

73
Q

What hormone from the hypothalamus stimulates thyroid stimulating hormone?

A

Thyrotrophin release hormone (TRH)

74
Q

What stimulates TRH release?

A

LOW TEMPERATURES

75
Q

what inhibits TRH and TSH release?

A

Stress

76
Q

What is the most common type of thyroid cancer?

A

Papillary 76% then follicular 17%

77
Q

What do most differentiated thyroid cancers take up and secrete?

A

Take up iodine and secrete thyroglobulin

78
Q

What types of cancers are TSH driven?

A

Differentiated thyroid cancer

79
Q

Does thyroid cancer have an association with diet, smoking etc?

A

No only nuclear exposure

80
Q

What do most thyroid cancer patients present with?

A

Palpable nodules

81
Q

How does papillary thyroid cancer spread?

A

Via lymphatics

82
Q

What is papillary thyroid cancer associated with?

A

Hashimoto’s thyroiditis

83
Q

How does follicular cancer spread?

A

Haematogenously

84
Q

How is thyroid cancer usually investigated?

A

Via ultrasound guided FNA of the lesion

85
Q

What age groups for new thyroid nodules suggest malignancy?

A

less than 20 or over 50

86
Q

Is male or female more likely for malignant nodules on thyroid?

A

Male

87
Q

What is treatment of choice for thyroid cancer?

A

Surgery

88
Q

What surgery would you do for papillary microcarcinoma, MININALLY INVASIVE follicular carcinoma with capsular invasion only and patients in AMES low risk group?

A

Thyroid lobectomy with isthmusectomy

89
Q

What surgery would you do for DTC with extra-thyroidal spread, bilateral/multifocal DTC, DTC with distant metastases, DTC with nodal involvement and patients in AMES high risk group?

A

Sub-total or total thyroidectomy

90
Q

What is checked within 24 hours after thryoid cancer surgery?

A

Calcium - calcium replacement initiated if corrected or calcium falls below 2 mmol/l

91
Q

What is a patient discharged on after thyroid cancer surgery?

A

T3 and T4

92
Q

What technique is used in patients who have undergoe sub-total or total thyroidectomy?

A

Whole body iodine scanning

93
Q

What needs to rise to greater than 20 before whole body iodine scanning?

A

TSH

94
Q

If iodine is taken up in thyroid on whole body scan after surgery what occurs?

A

Thyrpid remnant ablation

95
Q

What indicates a cured thyroid cancer patient?

A

Undetectable thyroglobulin levels

96
Q

What bounds the anterior triangle superiorly and what makes up the anterior border laterally?

A

Bounded by mandible superiorly and anterior border of SCM laterally

97
Q

What makes up the boundaries of posterior triangle in neck?

A

Posterior border SCM anteriorly
Anterior border trapezius laterally
Clavicle inferiorly

98
Q

Give three examples of superficial swellings?

A
  1. Sebaceous cysts
  2. Lipomas
  3. Neurofibromas
99
Q

Give three examples of midline swellings in the neck?

A
  1. Thyroid
  2. Thyroglossal cyst
  3. Dermoid cyst - suprasternal notch
100
Q

Name four anterior triangle swellings?

A
  1. lymph nodes
  2. branchial cyst
  3. salivary glands
  4. carotid body tumour
101
Q

Name two posterior triangle swellings?

A
  1. Lymph nodes

2. Cystic hygroma

102
Q

Give three investigations for cervical lumphadenopathy?

A
  1. CXR
  2. ENT
  3. Fine needle aspiration
103
Q

What moves with the tongue, presents in teenage years and contains lymphatics which may become infected?

A

Thyroglossal cyst

104
Q

What is a rare congenital cyst, usually presents in teenage years and is soft, nonfluctuant?

A

Dermoid cyst

105
Q

What is persisting second branchial arch, arises in upper part of ant. triangle, usually presents in teenage years, ‘haklf filled water bottle’, FNA-cholesterol crystals and can fistulate?

A

Branchial cyst

106
Q

What normally presents in first year of life and can cause pressure symptoms, lymph filled and transilliuminate?

A

Cystic hygroma - posterior triangle

107
Q

What salivary gland are stones most common in?

A

Submandibular

108
Q

What is a swelling in the parotid salivary gland more likely to be?

A

Tumour

JL Endocrinology (12 decks)

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