Endocrine Medicine

An assignment given by a person named Hassan from England. He gets his work without paying and cheats his university. 

need any help for this assignment?? contact me at amnasheikh25@hotmail.com

For questions 1-5, which of the hormone disturbances cause each endocrine disorder.

Please note that you will not need to use all of the hormone disturbances.

(i) Inhibin

(ii) Graafian follicle

(iii) Oestrogen

(iv) LH

(v) Sertoli cells

(vi) Progesterone

(vii) hCG

(viii) FSH

(ix) GnRH

(x) Uterus wall

(xii) Seminiferous tubules

(xi) Primary follicle

(xiii) Corpus luteum

(xiv) Testosterone

(i) Inhibin

(ii) Graafian follicle

(iii) Oestrogen

(iv) LH

(v) Sertoli cells

(vi) Progesterone

(vii) hCG

(viii) FSH

(ix) GnRH

(x) Uterus wall

(xii) Seminiferous tubules

(xi) Primary follicle

(xiii) Corpus luteum

(xiv) Testosterone

(i) Inhibin

(ii) Graafian follicle

(iii) Oestrogen

(iv) LH

(v) Sertoli cells

(vi) Progesterone

(vii) hCG

(viii) FSH

(ix) GnRH

(x) Uterus wall

(xii) Seminiferous tubules

(xi) Primary follicle

(xiii) Corpus luteum

(xiv) Testosterone

(i) Inhibin

(ii) Graafian follicle

(iii) Oestrogen

(iv) LH

(v) Sertoli cells

(vi) Progesterone

(vii) hCG

(viii) FSH

(ix) GnRH

(x) Uterus wall

(xii) Seminiferous tubules

(xi) Primary follicle

(xiii) Corpus luteum

(xiv) Testosterone

(vii) hCG

(vii) hCG

(vii) hCG

v. Excess thyroid hormone

ii.  Excess prolactin

ix.   Low prolactin levels

iv. No insulin produced

Q2) Hyperthyroidism

Q4) Type II Diabetes

iv

v

viii

ii

vi

Q5) Cushing’s Syndrome

Q3) Prolactinoma

Q1) Type I Diabetes

viii. Excess cortisol

vii. Insufficient thyroid hormone

iii. Insufficient cortisol

Hormone Disturbance

i. Low oestrogen levels

vi. Decreased insulin production or lack of sensitivity to insulin

 

6) According to the BNF, what range is a normal blood glucose reading?

a) 2-7 mmol/l

b) 4-9 mol/l

c) 4-9 mmol/l

d) 6-11 mmol/l

7) Which one of the following statements is TRUE?

a) Type I diabetes is more common than Type II diabetes

b) Type II diabetes is caused by an auto-immune reaction in the pancreas

c) Patients with Type II diabetes often suffer long term complications, such as having a stroke or amputation

d) Obesity is an important predisposing factor for Type I diabetes

8) Which one of the following statements is FALSE?

a) A prolactinoma is a common tumour that occurs in the anterior pituitary.

b) Destruction of the pituitary gland results in hypopituitarism

c) Diabetes Insipidus occurs due to insufficient production of antidiuretic hormone

d) Acromegaly occurs as a result of insufficient production of growth hormone

9) Which one of the following statements regarding acute pancreatitis is FALSE?

a) The main causes of acute pancreatitis are trauma and infection. 

b) Patients with acute pancreatitis experience severe upper abdominal pain

c) Acute pancreatitis can result in death

d) Heavy alcohol use is a cause of acute pancreatitis

10) Which one of the following statements about the causes of chronic pancreatitis is TRUE?

The causes of chronic pancreatitis include:

a) Diabetes, low calcium levels in the blood and prolonged heavy alcohol use

b) Prolonged heavy alcohol use, cystic fibrosis and acute pancreatitis

c) Cystic fibrosis, acute pancreatitis and low fat levels in the blood

d) Prolonged heavy alcohol use, cystic fibrosis and low calcium levels in the blood

For questions 11-16, match the symptoms in the table with an endocrine disorder (a-f) by writing the correct letter into the answer column.  You should use each endocrine disorder once. 

Symptoms	Answer
Q11) A lady with excess milk production and no periods.	c
Q12) A middle-age overweight lady suffering from thirst, increased urine output, tiredness and vaginal thrush.	d
Q13) A young man suffering from thirst, increased urine output, tiredness and weight loss.	a
Q14) A patient experiencing weakness and fainting.  They also experience nausea, vomiting and weight loss.  They have areas of hyperpigmentation on their elbows and knees.	f
Q15) A female patient with fat swellings between her shoulders and facial puffiness.  She has stretch marks and is suffering from high blood pressure.	e
Q16) A 40 year old lady experiencing weight loss, anxiety, tiredness, diarrhoea and palpitations.	b

(f) Addison’s disease

(b) Hyperthyroidism

(d) Type II Diabetes

(e) Cushing’s Syndrome

(a) Type I Diabetes

(c) Prolactinoma

 

17) What hormone changes occur at the menopause?

A decrease in estrogen and progesterone takes place at menopause while an increase in follicle-stimulating hormone (FSH) and luteinising hormone (LH) occurs in response. 

18) Describe four symptoms of the menopause.

1.       Hot flushes and sweats: These occur due to a homeostasis loss by the central thermoregulatory centre of the body and commonly affect the head, face, neck and thoracic area and normally last for only a few minutes.

2.       Menstrual irregularities:  Most of women suffer from menstrual irregularities, lasting for up to many years.

3.       Urogenital symptoms: These occur mainly because of the loss of trophic oestrogen effect and include   vaginal discomfort, dyspareunia, and dryness.

4.       Sleep and mood disturbances also occur, leading to irritability, loss of libido, etc. 

19) What hormone disturbance occurs in hypothyroidism?

In case of hypothyroidism the main hormone disturbance is mainly the thyroid hormone. An insufficient secretion of this hormone leads to hypothyroidism.

20) Describe three symptoms of hypothyroidism.

• Weight gain: This occurs due to slowing down of metabolism of the body.
• Cold intolerance: Due to low thyroid levels affecting body’s temperature haemostasis.
• Menstrual irregularities: Hypothyroidism results in alteration in the length of the menstrual cycle as well as in the amount of bleeding. 

Drug Treatments

Questions 21-25

Match the most appropriate drug treatment listed (i- viii) to the endocrine condition by filling in the boxes questions 21-25.  Please note that you will not need to use all of thedrug treatments. (P2)

Q21) Hypothyroidism

Q23) Hyperthyroidism

Q25) The Menopause

vii. Pancreatin

vi. Propylthiouracil

iv. Hydrocortisone and fludrocortisone

v. Metyrapone

iv

i

viii

vi

ii

i.  Insulin

ii.  Levothyroxine

iii. Bromocriptine

viii. Estradiol with progestogen ·

Q24) Type I Diabetes

Q22) Addison’s disease

 

26) Which of the following statements is FALSE?(P2)

a) Hormone Replacement Therapy can be used to prevent post-menopausal osteoporosis

b) Hormone Replacement Therapy is the first line treatment for long term osteoporosis prevention in women aged 50 and over

c) When Hormone Replacement Therapy is stopped, bone loss will recommence

d) Hormone Replacement Therapy is most effective at preventing post-menopausal osteoporosis if it is started early in the menopause and is taken for up to 5 years

27) Choose two possible side-effects of HRT from the list below? (P3)

a) Breast enlargement

b) Mood changes

c) Increased thirst

d) Tremors

28) Which of the following can be considered as additional health risks when taking HRT? [select all that apply] (P4)

a) Lung Cancer

b) Stroke

c) Hypotension

d) Breast cancer

29) Which answer best describes the possible side effects of acarbose? (P3)

a) Flatulence, soft stools and diarrhoea

b) Hypersensitivity reactions, and rarely a disturbance in liver function

c) Gastrointestinal disturbances and weight loss

d) Anaemia and oedema

30) Pick out the counselling points which you would recommend to a patient with Type II diabetes in order to help the management of their condition [Select all that apply] (P4)

a) Monitor your blood glucose levels regularly

b) Comply with your medication

c) Visit the doctor for checks at least twice a week

d) Stop smoking, as this increases the risk of complications

e) You are free to purchase OTC medicines, as these do not interfere with your diabetes

f) Regular exercise is not necessarily required, as it will not improve your condition that much

g) Make sure you understand the early signs of complications

For each of the endocrine disorders in questions 31-38 you will be given the name of a drug and an action. Firstly decide whether the drug can be used for the disorder. Then decide if the action described would help the disorder. Then make a decision on whether the action is a correct description of how the drug is used to help the patient. (P2)

After this, select the appropriate answer using the options below:

A – The drug can be used for this disorder and the action is a correct description of how the drug works B – The drug can be used to treat this disorder but the action is not the correct description of how the drug works C – The drug is NOT used for this disorder but the action described would help to treat a patient with this disorder D – The action is a correct description of how the drug works, however the drug is NOT used for this disorder

 

Questions 31 and 32 are concerned with type II diabetes

B

31) Drug: Gliclazide

 Action: Raises the blood sugar levels

A

32) Drug:Metformin

Action: Reduces the rate of gluconeogenesis in the body and increases the use of glucose peripherally

Questions 33 and 34 are concerned with the menopause

C

 

33) Drug: Hydrocortisone

Action: Replaces the hormones that the ovaries have stopped producing

B

34) Drug:Angeliq (a brand of HRT)

Action: Only replaces oestrogen

Questions 35 and 36 are concerned with chronic pancreatitis

A

35) Drug: Pancreatin

Action: Provides pancreatic enzyme replacement for when the pancreas is producing

 insufficient enzyme levels

D

36) Drug: Levothyroxine

Action: Provides thyroid hormone replacement for when the thyroid gland is producing insufficient amounts of thyroid hormone

Questions 37 and 38 are concerned with Addison’s disease

D

37) Drug: Finasteride

Action: Inhibits an enzyme which changes testosterone into a more potent testosterone

C

38) Drug: Insulin

Action: Replaces the cortisol that is absent from the body

Medication	Answer
Q39) Pancreatin	d
Q40) Levothyroxine	g
Q41) Metformin	a
Q42) Hydrocortisone	h
Q43) Propylthiouracil	b
Q44) Gliclazide	c
Q45) Oestrogens (for HRT)	f
Q46) Testosterone	e

For questions 39-46, match the medications (a-h) with the potential side effects in the table by writing the correct letter into the answer column. (P3)

(h) Diabetes, osteoporosis, muscle wasting and weight gain.

(a) Nausea, vomiting, diarrhoea, taste disturbance and lactic acidosis.

(d) Nausea, vomiting and abdominal discomfort.  Irritation of the skin around the mouth and the buccal mucosa can occur if the medication is held in the mouth.

(c) Nausea, vomiting, diarrhoea, constipation, abnormal liver function and jaundice.  Hypoglycaemia can occur if the dose given is too high.

(e) Prostate cancer, depression, changes in libido, irritability, hirsutism and male-pattern baldness.

(f) Bloating, weight changes, breast enlargement and an increased risk of developing blood clots.

(g) Vomiting, diarrhoea, chest pain, palpitations, tremor, heat intolerance and weight loss.

(b)Nausea, taste disturbance, fever, anaemia, hepatitis and encephalopathy.

 

Jack is a 25 year old man with Type I diabetes.  He is on a ‘multiple injection’ insulin regimen.

47) Look up the ‘multiple injection’ insulin regimen in the BNF.  What types of insulin is Jack taking?  How often is each type of insulin taken? (P2)

He is taking a long acting insulin.

Long acting: This long acting insulin can be taken once or twice daily. Multiple daily injection treatment generally needs at least 4 injections daily.

Short-acting: This type is taken after 3 to 5 hours because it affects lasts three to five hours.

Intermediate-acting:  Intermediate acting insulins are generally used together with a short acting insulin and its affect last for 7 hours.

Pre-mixed insulin:  A twice daily injections of premixed insulin is recommended.

48) Name at least three common side effects Jack could experience from his insulin injections? (P3)

1.       Pain or itching at the site of injection

2.       Hypoglycemia

3.       Lipohypertrophy 

49) Describe the counselling that you could give to Jack about his insulin treatment. Your answer should include four counselling points (P4)

Jack will be counselled, initially by showing compassion and consideration about his disease, and then he will be explained that this condition is progressive, lifelong and thus requires changes in his lifestyle, in addition to insulin use.  He will inform about the correct injection technique and use of proper depth for injecting insulin.  He will further be advised to regularly check his glucose level and use insulin injection and frequent small meals. Finally, he will ask to notify as soon as possible in case of any adverse event.

50) Jack becomes hypoglycaemic.  Briefly describe how the hypoglycaemia is treated.  (P2)

The main treatment for hypoglycaemia is glucose.  Such a person should eat frequent meals and snacks containing complex carbohydrates, particularly at night. If dietary therapy fails, then glucose is administered intravenously.

Sarah is a 40 year old lady with hyperthyroidism due to Grave’s disease.

51) Discuss Sarah’s treatment options. (P2)

After giving beta blocker, hyperthyroidism can be managed by the following ways.

• Antithyroid drugs
• Radioactive iodine
• Surgery

It is decided that Sarah will start taking carbimazole at an initial dose of 20mg daily. 

52) Explain the counselling that you would give to Sarah about this medication and the common side effects she should look out for.(P3 and P4)

She will be asked not to stop the drug abruptly or change the dose without consent of the pharmacists or health care provider. If she misses a dose, try to take it as soon as she remembers. Avoid double dose to compensate.

She should look out for itching and skin rashes and easy bruising or bleeding due to bone marrow suppression.