whore moans Flashcards
1
Q
what is hypocalcaemia
A
low serum calcium
2.2-2.6mmol/L
2
Q
what can cause hypocalcaemia
A
hypoparathyroidism vitamin D deficiency diarrhoea liver and kidney disease PPI blood transfusions
3
Q
how does hypocalcaemia present
A
muscle twitches seizures fractures poor blood clotting ventricular tachycardia tetany
4
Q
what are clinical tests for hypocalcaemia
A
chovstek’s - tap skin 1cm below zygomatic process, will cause facial twitch/spasm
trousseaus - use blood pressure band to compress arm, flexors will be activated and hand will twitch
5
Q
what investigations should you do for hypocalcaemia
A
ECG
serum Ca, albumin and phosphate
PTH
6
Q
how can you manage hypocalcaemia
A
oral Ca tablets
oral VD tablets if deficient
if serum Ca is below 1.9 this is an emergency
treat with IV calcium gluconate
7
Q
what is hypoparathyroidism
A
when the parathyroid gland does not produce enough PTH resulting in low serum Ca
8
Q
what causes hypoparathyroidism
A
thyroid/parathyroidectomy
autoimmune destruction of gland
9
Q
how does hypoparathyroidism present
A
symptoms of hypocalcaemia
10
Q
what is hypercalcaemia
A
increased serum calcium
3-3.5mmol/l above 3.5 is an emergency
11
Q
what can cause hypercalcaemia
A
hyperparathyroidism renal failure acromegaly MEN syndromes TB sarcoidosis
12
Q
how does hypercalcaemia present
A
polyuria nausea vomiting constipation bone pain fatigue pancreatitis coma osteoporosis
13
Q
what investigations could you do for hypercalcaemia
A
serum Ca, albumin, phosphate
U&Es
DEXA for osteoporosis
14
Q
how do you treat hypercalcaemia
A
rehydrate with 4-6l of 0.9% saline over 4-6hrs IV bisphosphonates glucocorticoids calcitonin cinacalcet
15
Q
what is primary hyperparathyroidism
A
gland makes PTH uncontrollably
high serum PTH and high Ca
16
Q
what causes primary hyperparathyroidism
A
adenoma
hyperplasia of gland
carcinoma
17
Q
how does primary hyperparathyroidism present
A
stones, thrones, bones, moans, psychiatric overtones Ca kidney stones polyuria constipation sore bones muscle weakness depression confusion
18
Q
how can you manage hyperparathyroidism
A
remove tumour
19
Q
what is secondary hyperparathyroidism
A
when renal failure or VD deficiency causes low absorption of Ca resulting in hypocalcaemia
the parathyroid gland reacts to this by releasing more PTH and undergoes hyperplasia
serum calcium is normal but PTH is high
20
Q
what can cause secondary hyperparathyroidism
A
vitamin D deficiency
chronic kidney failure
21
Q
how does secondary hyperparathyroidism present
A
symptoms of chronic renal failure
calcification of vessels
22
Q
how can you manage secondary parathyroidism
A
correct VD deficiency
manage renal failure
23
Q
what is tertiary hyperparathyroidism
A
when secondary hyperparathyroidism becomes primary over a long period of time
treat by surgical removal of part of the gland
24
Q
what is primary adrenal insufficiency
A
hyposecretion of adrenal hormones
most commonly aldosterone and cortisol, can be sex steroids too
25
what can cause primary adrenal insufficiency
waterhouse-friederschein disease
| sudden increase in BP causing rupture of vessels causing ischaemia
26
how does primary adrenal insufficiency present
hypotension
nausea
vomiting
confusion coma
27
what is Addison's disease
chronic primary renal insufficiency due to destruction of adrenal cortex
28
how does addison's disease present
```
lethargy
sore muscles, abdomen, joints
depression
diarrhoea
vomiting
```
29
what can cause addison's
autoimmune destruction
TB
metastatic carcinoma
30
what investigations would you do in addison's
synacthen test
31
what are clinical signs of addison's
hyperpigmentation (CRH is a precursor of melalin) - of buccal membrane, palmar creases
acanthesis nigricans
postural hypotension
weight loss
32
how can you manage addisons
hydrocortisone
fludrocortisone
increase dose when patient has infection or minor surgery
patient given emergency ID tag
33
what is addisonian crisis
sudden increased need for hormones causes acute symptoms
34
what can cause addionian crisis
sudden stopping of steroids/hormone therapy
| bilateral adrenal haemorrhage
35
how does addisionian crisis present
```
hypotension
nausea, vomiting
pain in back abdomen and legs
dehydration
weakness
psychosis
coma
```
36
what investigations could you do in addisonian crisis
bloods for cortisol and ACTH
37
how could you manage addisonian crisis
Hydrocortisone Sodium succinate 100mg IV
IV saline
monitor BG
find underlying cause
38
what is graves disease
autoimmune disease where antibodies are formed that mimic TSH and bind to receptors causing an increase in T3 and T4
TRH and TSH levels are low
the increased demand for TH causes hyperplasia (increased number of follicular cells) and hypertrophy of the gland
the antibodies also stimulate fibroblasts in eyes and skin causing them to make more glycosaminoglycans
causes hyperthyroidism
39
what is toxic multinodular goitre
nodules develop on the gland that act independently of the TRH and TSH negative feedback and produce lots of TH (some TSH receptors are turned on constantly - like megan)
causes hyperthyroidism
usually caused by iodide deficiency - hypothalamus increases TRH and therefor TRH causing hypertrophy and hyperplasia of the gland - goitre develops
40
what is the effect of a thyroid adenoma
the adenoma produces TH regardless of TH level in the blood
41
what can happen when the thyroid gland is inflamed or damaged?
the hormones can all spill out causing hyperthyroidism
42
how does hyperthyroidism present
```
increased basal metabolic rate
heat intolerance
sweating
fever
anxiety
muscle weakness
osteoporosis if chronic
loose stools
hyperreflexia
palpitations
```
43
what is thyroid storm/ thyrotoxic crisis
severe hypermetabolism
| life threatening
44
what can cause thyrotoxic crisis
sudden stopping of therapy
infection
surgery
45
how does thyrotoxic crisis present
pyrexia
tachycardia
delirium
arrhythmia
46
what are specific clinical signs of graves disease
enlarged thyroid - goitre
exophthalmos (bulging of eye)
pretibial myxoedema
oedema
47
what are specific clinical signs of toxic multinodular goitre
```
enlarged thyroid
hoarse voice
airway obstruction
dysphagia
SVC syndrome - facial and arm swelling
```
48
how can you treat hyperthyroidism
Carbimazole - 1st line
propylthiouracil
radioactive iodine ablation (+ levothyroxine if needed)
beta blockers
surgical removal
for thyroid storm - beta blockers, thionamides, glucocorticoids
49
what investigations can you do in hyperthyroidism
TFTs
| ECG
50
what is primary hypothyroidism
thyroid gland doesn't make enough hormones
51
what can cause primary hypothyroidism
hashimoto's thyroiditis - autoimmune destruction of thyroid gland
iatrogenic - thyroidectomy or iodine ablation
chronic iodine deficiency
congenital
52
what is secondary hypothyroidism and what can cause it
there is not enough TSH to release TH
| tumour of pituitary or hypothalamus
53
how does hypothyroidism present
```
weight gain
loss of appetite
cold intolerance
lethargy
constipation
myxoedema - swelling of tongue and skin
```
54
what is myxoedema coma and how does it present
extreme hypothyroidism due to surgery, infection
hypothermia
loss of consciousness
confusion
55
what investigations could you do in hypothyroidism
blood hormone levels - TH will always be low, TSH only raised in primary disease (and low in secondary disease).
thyroid peroxidase antibodies for autoimmune disease
56
how do you treat hypothyroidism
levothyroxine long term - start with a high dose and gradually reduce
TFTs every month
57
what is acromegaly
extra GH after growth plates have closed
58
what is gigantism
excess GH in kids before growth plates have closed
59
what can cause acromegaly
pituitary adenoma secreting GH
| MEN 1 syndrome
60
how does acromegaly present
```
large hands and feet
large jaw
gaps between teeth
large forehead
soft tissue swelling
large tongue
carpal tunnel syndrome
diabetes (GH increases insulin resistance)
```
61
what investigations could you do in acromegaly
blood GH levels
MRI for pituitary adenoma
GH suppression test
oral glucose tolerance test
62
how do you treat acromegaly
```
somatostatin analogues
GH receptor antagonists
dopamine agonists
pituitary tumour removal
removal of any other causative tumour
```
63
what is hyperprolactinemia
high levels of prolactin in the blood
64
what can cause hyperprolactinemia
```
prolactinoma
pregnancy
polycystic ovary disease
tumour in hypothalamus secreting prolactin releasing hormone or in pituitary secreting prolactin
lactation
stress
dopamine depleting drugs
```
65
how can hyperprolactinaemia present in women
menstrual irregularity
lactating when not pregnant
infertility
66
how can hyperprolactinaemia present in men
```
gynecomastia
impotence
visual disturbances
headache
decreased facial hair
```
67
what investigations could you do in hyperprolactinaemia
blood prolactin level > 550mu/l
| pregnancy and polycystic ovary test
68
how can you treat hyperprolactinaemia
dopamine agonists
| increase calcium and vitamin D uptake because risk of osteoporosis
69
What is the first presentation of thyroid cancer?
A solitary hard painless lump on the thyroid gland. it can cause hoarseness and trouble swallowing if it gets too big.
70
what does non functional thyroid cancer mean?
They don't produce signs of hyperthyroidism or hypothyroidism.
71
What is the diagnosis of thyroid cancer made with?
Thyroid ultrasound. Radioiodine scan - where radio iodine is injected and taken up by cells which make thyroid hormone, usually thyroid tumours don't make thyroid hormone so they are 'cold nodues'
72
what is the definitive diagnostic test for thyroid cancer?
Fine needle aspiration.
73
what is the treatment for thyroid cancer?
partial or total thyroidectomy followed by thyroid hormone replacement.
74
what is primmery hyperaldosteronism?
aldosterone s a mineralocirtocoid. it increases sodium reabsorption, and increases hydrogen secretion and potassium secretion.
Conns syndrome - when the adrenal gland produces too much aldosterone, the renin is low because of the high blood pressure entering the kidneys.
75
Where does stage 2 of the RAAS system occur? (mediated by ACE hormones)
In the lungs.
76
which hormone stimulates the release of aldosterone?
Angiotensin II
77
what is the cause of Conns syndrome?
adrenal adenoma - most common cause.
bilateral adrenal hyperplasia
familial hyperaldosteronism.
adrenal carcinoma
78
What is secondary hyperaldosteronism?
where renin is causing the increase in aldosterone - renin will be high.
79
what is the main cause of secondary hyperaldosteronism?
when theres reduced blood flow to the kidneys, tricking them into thinking the blood pressure is too low:
renal artery stenosis, heart failure, atherosclerosis.
80
what is the investigation for hyperaldosteronism?
to check the renin:aldosterone ratio
- high aldosterone : low renin (primary hyperaldosteronism)
- High aldosterone : high renin (secondary hyperaldosteronism).
Blood pressure, hypokalaemia, alkalosis.
81
treatment of aldosteronism?
aldosterone antagonists - spironolactone, eplenerone.
surgery - remove adenoma.
percutaneous angioplasty - to stent the renal artery.
82
what does hyperaldosteronism cause?
it is the leading cause of secondary hypertension.
83
when is radioactive iodine for hyperthyroidism contraindicated?
```
pregnant women (can't get pregnant within 6 months)
can be around pregnant women or children for 3 weeks
must have limited contact with anyone for days after receiving the dose.
```
84
which mood stabilising drug can cause hypothyroidism?
Lithium - inhibits production of thyroid hormone.
