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PAR3011 - MEDICAL > Week 6 > Flashcards

Week 6 Flashcards

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USMLE® Step 1 flashcards
1
Q

what is hyperthyroidism

A

overproduction of thyroid hormones

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2
Q

what is another name for hyperthyroidism?

A

graves disease

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3
Q

WHat causes hyperthyroidism?

A
  • Thyroid Stimulating Hormone (TSH) immunoglobulin antibodies that bind to TSH receptors, which may develop as a result of autoimmune reaction against thyroid tissue.
  • Thyroid tumours, (most common cause of hyperthyroidism)
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4
Q

What are the S&S of hyperthyroidism?

A 
Intolerance to heat
Graves Disease
Fine, straight hair
Bulging eyes
Facial flushing
Enlarged Thyroid
Tachycardia
Increased systolic BP
Breast enlargement
Weight loss
Muscle wasting
Localised edema
Finger clubbing
Tremors
Diarrhoea
Menstrual Changes
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5
Q

What is a thyroid storm?

A

an exaggerated or florid state of thyrotoxicosis, it is a life threatening sudden onset of thyroid hyperactivity.

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6
Q

How common is a thryoid storm?

A

Thyroid storm may occur in 1% of patients with hyperthyroidism

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7
Q

WHat is hypothyroidism?

A

underproduction of thyroid hormones

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8
Q

WHat causes hypothyroidism?

A
  • Autoimmune reaction that destroys the gland;
  • Iodine deficiency (goiter) where uninhibited TSH production leads to increase in precursor molecule (thyroglobulin) but without iodine T3 and T4 cannot be formed.
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9
Q

What are the S&S of hypothyroidism?

A 
Intolerance to coldhypothtroidism
Receding hairline
Facial and eyelid edema
Dull-blank expression
Extreme fatigue
Thick tongue
Slow speech
Anorexia
Brittle nails and hair
Menstrual disturbances
Hair loss
Apathy
Lethargy
Dry skin
Muscle aches and weakness
Constipation
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10
Q

What is addisons disease?

A

aused by insufficient amounts of hormones from your adrenal glands.

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11
Q

WHat are the causes of addisons disease?

A
  • Primary cause is autoimmune destruction (Addison’s Disease).
  • Secondary adrenocortical insufficiency from ACTH deficiency from pituitary and hypothalamic disease.
  • Other causes include hypothalamic – pituitary – adrenal gland suppression from exogenously administered corticosteroid
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12
Q

What are the S&S of addisons disease?

A 
Bronze pigmentation to skin
Changes in distribution of body hair
GI disturbances
Hypoglycemia
Postural hypotension
Weight loss
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13
Q

What is pre-hospital treatment for addisons disease?

A

Supportive care
Oxygen if required
Fluids
Some systems - Hydrocortisone / dexamethasone

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14
Q

What is Cushing’s syndrome?

A

caused by high levels of the hormone cortisol.

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15
Q

What causes cushings syndrome?

A
  • tumour

- steroid use side effect

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16
Q

what are the S&S of cushings syndrome?

A 
Personality changes
Moon face
Increased susceptibility to infection
Males – gynecomastia
Fat deposits on face and back of shoulders
Osteoporosis
Hyperglycemia
CNS irritability
NA and fluid retention (edema)
Thin ectremities
GI distress
Females – Amenorrhea, hirsutism
Thin skin with purple striae
Bruises and petechiae
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17
Q

What is and what causes Phaechromocytoma?

A

caused by benign tumour releasing hormones in an adrenal gland.

Adrenomedullary hyper function caused by tumour of adrenal medulla (chromaffin cells), which secretes catecholamines (adrenaline/ noradrenaline) on a continual or episodic basis.

18
Q

What are the S&S of Phaechromocytoma?

A 
Persistent hypertension
Severe headache
Diaphoresis
Tachycardia
Palpitations
Pallor
Nausea and vomiting
Epigastric / chest pain
19
Q

What is Hyperpituitarism?

A

Hyperpituitarism causing overproduction of pituitary hormones.

20
Q

What causes hyperpituitarism?

A

Caused by Pituitary adenoma (benign tumour)

  • Gigantism - young - epiphyseal / grown plates open > enlarged long bones
  • Acromegaly - older - epiphyseal / grown plates fussed > enlarged face, hands & feet.
  • Prolactinoma - overproduces prolactin, decrease in levels of some sex hormones.
  • > S&S - Female - breast discharge, irregular menstrual periods.
  • > S&S - Male - Decreased sexual drive, breast enlargement.

Syndrome of inappropriate antidiuretic hormone secretion
-Cause increased levels of ADH > electrolyte in balance

21
Q

What are S&S of hyperpituitarism?

A

Water retention, N&V, headache, confusion, weakness and / or fatigue.

22
Q

WHat is hypopituitarism?

A

caused by low levels of certain hormones made by the pituitary gland.

23
Q

What are the S&S of hypopituitarism?

A 
Fatigue
weight loss
sensitivity to cold
decreased appetite
facial puffiness
anemia
irregular or no periods
short stature in children.
24
Q

What is diabetes Insipidus?

A

Diabetes Insipidus caused by decreased levels of vasopressin (antidiuretic hormone) which is made by the hypothalamus and stored in the posterior pituitary gland.

25
Q

What are the S&S of diabetes insipidus?

A

large amount of dilute and odourless urine
increased thirst
large fluid intake

26
Q

What are the organs and glands of the endocrine system?

A 
Hypothalamus
pituitary gland
pineal gland
throid gland
parathyroid gland
Thymus
Pancreas
Adrenal gland
Gonads
27
Q

WHat hormones does the thyroid gland produce?

A

Tyroid gland secretes thyroxine (T4) and
triiodothyronine (T3), under the influence of
TSH.

28
Q

What effect on metabolism does T4 and T3 from the thyroid gland have?

A

-lack of thyroid secretion can reduce basal
metabolic rate by 50%,

-whereas increased levels of hormone can
increase metabolism by 100%.

29
Q

How do thyroid hormones affect carbohydrate metabolism?

A

 Rapid uptake of glucose by the GIT and by cells;
 Increased glycolysis;
 Increased insulin secretion.

30
Q

How do thyroid hormones a=increase fat metabolism?

A

 Reduced fat stores;
 Increased free fatty acid levels, while decreasing plasma
cholesterol, triglycerides and phospholipids.

31
Q

What does hyperthyroidism (graves disease) cause in the body?

A

 Decreased body weight;
 Increased cardiac output (to meet metabolic needs);
 Increased minute volume;
 CNS stimulation leading to nervousness, anxiety and
paranoia.

32
Q

What are some differentials for a thyroid storm?

A
  • Hypoxia
  • Sepsis
  • Encephalitis / meningitis
  • Hypertensive encephalopathy
  • Alcohol withdrawal
  • Benzodiazepine / barbiturate withdrawal
  • Opioid withdrawal
  • Heat stroke
33
Q

WHat is the mortality rate of a thyroid storm?

A

90% if untreated

5% if treated

34
Q

What is the clinical presentation of a thyroid storm?

A

 Abrupt onset.
 Restlessness.
 Confusion.
 Fever.
 Tachycardia (rate 200-300), atrial fib common.
 Vomiting and diarrhea
 Altered LOC, leading to delirium, coma and seizures.

35
Q

What can a thyroid storm be precipitated by?

A
  • surgery
  • trauma
  • infection
  • thyroxine ingestion
36
Q

What hormones are made by adrenal gland?

A
  • Medulla – adrenaline/noradrenaline
  • Cortex – corticosteroids:
    -> Mineralocorticoids (aldosterone)
    —–> Cause the conservation of sodium, secretion of potassium,
    increased water retention, and increased blood pressure.
    -> Glucocorticoids (cortisol)
    —-> Primary functions:
    —–> To increase blood sugar through gluconeogenesis
    —–> Aid in fat, protein and carbohydrate metabolism
    ->Androgens
37
Q

What are the clinical symptoms of adrenocortical insufficiency? (addisons disease)

A

 Hypotension (unresponsive to fluid therapy) – due to lack
of aldosterone and consequent polyuria;
 Dehydration – Abdominal pain & vomiting;
 Weakness, anorexia, altered mentation

38
Q

When do you sustpect adrenocorticol insufficiency (addisons disease)

A

Sudden hypotension in response to precipitating factors,

and does not correct with initial IV fluids +/- raising legs

39
Q

What are some of the precipitating factors for addisonian crisis?

A 
 Acute infection, especially pneumonia
 Acute MI
 Pulmonary embolus
 Trauma / burns
 Surgery
 Heat exposure
 Vomiting / diarrhea
 Dehydration
 Blood loss
 Rapid cessation or reduction of chronic steroid therapy
40
Q

What are 4 pituitary diseases?

A
  • syndrome of inappropriate antidiuretic hormone secretion
  • Hyperpituitarism
  • hypopituitarism
  • diabetes insipidus

PAR3011 - MEDICAL (32 decks)

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