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METABOLISM: Endocrine System

Index

• General Outcomes for Endocrine System
• Diabetes
• Metabolic Syndrome
• Disorders of the Thyroid
• Disorders of the Parathyroid
• Adrenal Disease
• Pituitary Disorders
• Breast Disease (inc. Breast Cancer)

• General Outcomes for Endocrine System
  • Medical knowledge: ANATOMY
    • Pancreas
      1. Describe the general organisation of endocrine tissues in the Islets of Langerhans of the pancreas (GEP/DGM, MET2, MET2, MET2)
      2. Understand the position and relations of the pancreas (MET2, MET2)
    • The Adrenal Glands
      1. Describe the general organisation of endocrine tissues in the adrenal glands (GEP/DGM, MET2, MET2)
      2. Understand the position and relations of the adrenal glands (MET2, MET2)
      3. Describe the blood supply to the adrenal gland and the functional relationship between the adrenal medulla and the nervous system (GEP/DGM, MET2, MET2)
    • Hepatobiliary System
      1. Describe the components, course and relations of the biliary tree, and the termination of the bile and pancreatic ducts (MET2)
    • Pituitary Gland
      1. Describe the general organisation of endocrine tissues in the pituitary gland (GEP/DGM, MET2, MET2)
      2. Describe the structural and functional relationships between the hypothalamus and the pituitary gland (MET2, MET2, MET2)
      3. Describe the blood supply to the pituitary gland and its relevance to anterior pituitary function (GEP/DGM, MET2, MET2)
    • Thyroid and Parathyroid Glands
      1. Describe the general organisation of endocrine tissues in the thyroid and parathyroid glands (GEP/DGM, MET2, MET2, MET2, MET2)
      2. Understand the position and relations of the thyroid gland (MET2, MET2)
    • Epithelia and Glands
      1. Recognise and name the cell types found in these endocrine tissues - pituitary gland, thyroid and parathyroid glands, adrenal glands and pancreas (GEP/DGM, MET2, MET2, MET2)
  • Medical knowledge: PHYSIOLOGY
    • Parathyroid Glands and Calcium Balance
      1. Describe the transformation of vitamin D3 into an active hormone and explain how this is regulated (GEP/DGM, MET2)
      2. Explain the relationship between the various forms of circulating calcium in blood (GEP/DGM, MET2)
      3. Recognise the structure of vitamin D3 and describe the sources of this vitamin in the body (GEP/DGM, MET2)
      4. Describe the actions of parathyroid hormone and 1,25-dihydroxyvitamin D3 and account for the effects of vitamin D3 deficiency, and for hypo- and hyper-secretion of parathyroid hormone (GEP/DGM, MET2)
      5. Briefly explain the relationship between calcium and phosphate metabolism (GEP/DGM, MET2)
      6. Outline the source and actions of calcitonin and explain its role in calcium metabolism (GEP/DGM, MET2)
      7. Describe the source of parathyroid hormone and explain how its secretion is regulated (GEP/DGM, MET2)
      8. Briefly explain how the body excretes excess calcium (GEP/DGM, MET2)
    • Thyroid Gland
      1. Outline the synthesis, storage and release of thyroid hormones (GEP/DGM, MET2)
      2. Describe the effects of thyroid stimulating hormone on the thyroid gland (GEP/DGM, MET2)
      3. Outline the actions of thyroid hormones (GEP/DGM, MET2)
    • Hypothalamus and Pituitary Gland
      1. Describe the structural and functional relationships between the hypothalamus and the pituitary gland (MET2, MET2, MET2)
  • Medical knowledge: BIOCHEMISTRY (inc. Metabolism)
    • Glucose and Glycogen Metabolism
      1. Describe the actions of glucagon on glucose and lipid metabolism in the post absorptive and fasting states (GEP/DGM, MET2)
  • Medical knowledge: PATHOLOGY
    • General Outcomes for Endocrine Disorders
      1. Recognise and describe specific disease processes that affect the glands of the endocrine system (GEP/DGM, MET2)
  • Medical knowledge: CLINICAL FEATURES of DISEASE
    • Thyroid and Parathyroid Disorders
      1. Describe the actions of parathyroid hormone and 1,25-dihydroxyvitamin D3 and account for the effects of vitamin D3 deficiency, and for hypo- and hyper-secretion of parathyroid hormone (GEP/DGM, MET2)
  • Medical knowledge: NUTRITION
    • Vitamins and Minerals
      1. Recognise the structure of vitamin D3 and describe the sources of this vitamin in the body (GEP/DGM, MET2)
• Diabetes
  • General Outcomes for Diabetes
    1. Describe the principles of management of the newly diagnosed diabetic patient including the role of diet (MET3B)
    2. Outline the changes in glucose and insulin during an oral glucose tolerance test in normal and diabetic subjects (MET2)
    3. Be able to classify the types of Diabetes Mellitus (DM) and list the causes of secondary DM (MET3B)
    4. Outline the macrovascular complications of diabetes mellitus (MET2)
    5. List the long-term complications of diabetes mellitus (MET2)
    6. Describe the principal forms of diabetes mellitus (MET2)
    7. Describe the acute effects of insulin deficiency or glucagon excess (MET2)
    8. Describe the long term complications of diabetes and recognise the importance of education, preventative medicine, early recognition and treatment of hypertension, retinopathy and other vascular risk factors (MET3B)
    9. Outline the influence of the liver on circulating insulin levels (MET2)
    10. Define the terms glucose tolerance and insulin resistance in relation to type 1 and type 2 diabetes mellitus (GEP/DGM, MET2)
    11. Summarise the effects of inadequate insulin secretion or action upon carbohydrate and fat metabolism, including the aetiology of diabetic ketoacidosis (GEP/DGM, MET2)
    12. Outline the potential abnormalities of glucose homeostasis in diabetes (MET2)
    13. Describe the diagnostic criteria for Diabetes Mellitus (DM), impaired fasting glycaemia (IFG), and impaired glucose tolerance (IGT) (MET3B)
    14. Understand the indications of the various classes of oral hypoglycaemic agents and insulin therapies and first aid advice to the diabetic patient (MET3B)
    15. Be aware of the fungal infections that may present in patients who have diabetes (MET3B)
    16. Know the presentation and management of Diabetes (MET3B)
    17. Recognise the contribution of genetic and environmental factors in the aetiology of Type 1 and Type 2 Diabetes Mellitus (MET3B)
    18. Explain the links between obesity, insulin resistance and diabetes (MET2)
  • Diabetes Insipidus and Hyponatraemia
    1. Understand the causes of hypernatraemia and hyponatraemia (MET3B)
    2. List the causes of thirst and polyuria (MET3B)
    3. Describe the initial investigations which help to distinguish cranial and nephrogenic diabetes insipidus and psychogenic polydipsia (MET3B)
    4. Understand the principles of treating hypernatraemia (MET3B)
    5. Understand the principles of diagnosing and treating hyponatraemia
  • Diabetic Emergencies
    1. Outline the consequences of ketoacidosis (MET2)
    2. Be able to distinguish between the following terms and conditions: hypoglycaemia; diabetic ketoacidosis; lactic acidosis; hyperglycaemia; hyper-osmolar non-ketoacidotic state (MET3B)
    3. Know how to manage a hypoglycaemic patient (MET3B)
    4. Know how to manage a patient with diabetic ketoacidosis (MET3B)
    5. Know how to manage a patient in a hyper-osmolar non-ketoacidotic state (MET3B)
    6. Understand the precipitating factors in hyperglycaemic states (MET3B)
    7. Apply BRAINS&AIMS when choosing, giving and monitoring the following medication for Hypoglycaemia: 50% Glucose; Glucagon (MET3B)
    8. Apply BRAINS&AIMS when choosing, giving and monitoring the following medication for Hyperglycaemia: Soluble Insulin; IV Fluids; IV Potassium; Low Molecular Weight Heparin (LMWH) eg Enoxaparin (MET3B)
• Metabolic Syndrome
  • General Outcomes for Metabolic Syndrome
    1. Understand the pathophysiology of obesity and metabolic syndrome (MET3B)
    2. Understand the relationship between hepatic steatosis with obesity, metabolic syndrome and diabetes (MET3B)
    3. Understand the following terms: insulin resistance; glucose tolerance; metabolic syndrome (MET3B)
• Disorders of the Thyroid
  • General Outcomes for Disorders of the Thyroid
    1. Describe the position and anatomical relationships of the thyroid gland (MET2, MET3B)
    2. Define the role of isotope scanning, ultrasound and fine needle cytology in the investigation of thyroid lesions (MET3B)
    3. Briefly explain the pathophysiology of hypo- and hyperthyroidism (GEP/DGM, MET2)
    4. Distinguish thyroid enlargement from other lesions in the neck by examination (MET3B)
    5. List the effects of excess and deficiency of thyroid hormones (GEP/DGM, MET2)
    6. List the possible causes of thyroid enlargement in a euthyroid patient (MET3B)
    7. Be able to define the various benign and malignant tumours of the thyroid (MET3B)
    8. Describe the detection and treatment of hyperthyroidism and hypothyroidism (GEP/DGM, MET2)
    9. Be aware of the surgical and non-surgical treatment options for thyroid tumours (MET3B)
  • Thyroiditis
  • Goitre
    1. Define goitre, list the causes and briefly describe the pathology (MET3B)
  • Thyroid Cancer
• Disorders of the Parathyroid
  • General Parathyroid Disease
    1. Be able to distinguish between the following terms and conditions: Hypercalcaemia; Primary hyperparathyroidism; Secondary hyperparathyroidism; Tertiary hyperparathyroidism; (MET3B)
  • Calcium Homeostasis
    1. Describe the clinical features of acute hypercalcaemia and its initial management (MET3B)
    2. List the causes of hypercalcaemia and outline the diagnostic investigations (MET3B)
    3. Apply BRAINS & AIMS when choosing, giving and monitoring the following medication for Hypercalcaemia: Saline; Furosemide; Bisphosphonates - Pamidronate; Prednisolone (MET3B)
• Adrenal Disease
  • General Outcomes for Adrenal Disease
    1. Explain how long-term corticosteroid therapy disrupts endogenous corticosteroid secretion (MET2)
    2. Describe the clinical syndromes underlying causes and pathology associated with adrenocortical hypofunction (MET3B)
    3. List some synthetic steroids with mainly glucocorticoid activity. Explain the reason for the development of such compounds (MET2)
    4. Clinical uses of corticosteroids (MET2)
    5. Describe other unwanted effects arising from long-term therapy with glucocorticoids (MET2)
    6. Describe the structure of the adrenal gland and relate the zones to production of hormones (GEP/DGM, MET2, MET3B)
    7. Describe the regulation of hormone secretion by each zone (GEP/DGM, MET2)
    8. Describe the mechanisms of action contributing to anti-inflammatory and immunosuppressive effects of corticosteroids (MET2)
    9. Distinguish between adrenal failure and pituitary-adrenal failure by means of clinical features assissted by laboratory investigations (MET3B)
    10. Outline the maintenance treatment of adrenal insufficiency including precautions for intercurrent illness (MET3B)
    11. Describe the physiological actions of the adrenal hormones (GEP/DGM, MET2)
    12. Explain the effects of both excess and deficiency of adrenal hormones (GEP/DGM, MET2)
    13. Describe the emergency management of acute adrenal insufficiency (MET3B)
  • Endocrine Hypertension
    1. Describe the blood supply to the adrenal gland and the functional relationship between the adrenal medulla and the nervous system (MET3B)
    2. Know the strategy for investigation of endocrine hypertension (MET3B)
    3. Outline the laboratory and radiological investigation of suspected Conn's syndrome and phaeochromocytoma (MET3B)
    4. Describe the possible mechanisms of endocrine mediated hypertension with reference to phaeochromocytoma, Conn's Syndrome and renal artery stenosis (MET3B)
    5. Describe the presenting clinical features of Conn's Syndrome and phaeochromocytoma (MET3B)
  • Cushing's Disease
    1. To see the role of different therapeutic interventions in Cushing's disease and their rationale (MET2)
    2. Discuss the clinical features, causes and pathology of Cushing's Syndrome (MET3B)
    3. Outline the laboratory and radiological investigations which help to distinguish pituitary, adrenal and ectopic causes of Cushing's Syndrome (MET3B)
• Pituitary Disorders
  • General Outcomes for Pituitary Disorders
    1. Principles, benefits and risks of medical, surgical and radiotherapy treatments for Acromegaly (MET2)
    2. Principles of diagnostic endocrine and radiological tests for Acromegaly (MET2)
    3. Signs and symptoms of acromegaly (consequences of growth hormone over-secretion) (MET2)
    4. Social and emotional impact of pituitary disease (MET2)
    5. To relate anatomy to specific tumoral secretory syndromes (MET2)
    6. To understand the genetic basis of familial acromegaly (MET2)
    7. To understand the rationale and mode of action of somatostatin analogues in acromegaly (MET2)
    8. To be able to relate diagnostic tests for Cushing's disease to normal physiology (MET2)
    9. Origin and natural history of pituitary adenomas (MET2)
    10. Physiology of the growth hormone axis and the pathophysiology of over-secretion of growth hormone (MET2)
    11. Be able to describe the structural and functional relationships between the hypothalamus and the pituitary gland (MET3B)
    12. To see the role of different therapeutic interventions in Cushing's disease and their rationale (MET2)
    13. Describe the structure and origins of the pituitary gland and explain the relationship between the hypothalamus and both the anterior and posterior pituitary (GEP/DGM, MET2)
    14. Know the physiology of the Hypothalamo-pituitary-ovarian axis
    15. List the hormones secreted by both the anterior and posterior pituitary and in each case explain the role of the hypothalamus in regulating their secretion (GEP/DGM, MET2)
    16. Effect of a pituitary mass on normal pituitary physiology (MET2)
    17. Use the concept of negative feedback to explain the principles underlying clinical tests for pituitary hormone secretion (GEP/DGM, MET2)
    18. Be able to list the hormones secreted by both the anterior and posterior pituitary and in each case explain the role of the hypothalamus in regulating their secretion (MET3B)
    19. Be able to briefly outline the actions of the hormones of the posterior and anterior pituitary (GEP/DGM, MET2, MET3B)
    20. Describe the clinical features of hypopituitarism, outline the treatment required. (MET3B)
• Breast Disease (inc. Breast Cancer)
  • General Outcomes for Breast Diseases
    1. Appreciate the mammographic appearance of impalpable lesions (MET3B)
    2. Appreciate the need for clinical trials (MET3B)
    3. Assess potential sites of distant disease (MET3B)
    4. Be able to discuss in detail in professional and layman's terms, the alternative surgical approaches in order to provide informed consent (MET3B)
    5. Be able to carry out an examination of the breasts including examination of the axillary lymph nodes and lymph node drainage sites (MET3B, MET3B)
    6. Be able to interpret a bone scan with supervision (MET3B, MET3B)
    7. Be able to interpret mammograms (with supervision) (MET3B)
    8. Be able to propose a diagnosis from clinical findings and plan mangement (MET3B)
    9. Recognise the features of benign breast disease eg fibroadenoma, multi-duct nipple discharge, breast cysts, cyclical mastalgia (MET3B, MET3B)
    10. Recognise normal and physiological findings (MET3B)
    11. Recognise the role of ultrasound, mammography and cytology (MET3B, MET3B)
    12. Take a history of breast symptoms (MET3B, MET3B)
    13. Take a history to assess the risk factor for breast disease (MET3B, MET3B)
    14. Be able to carry out an examination of the breasts using a systematic approach and including preparing and positioning the patient appropriately (MET3B, MET3B)
  • Breast Cancer
    1. Choose and justify the alternative adjuvant modalities eg radiotherapy, chemotherapy and hormone therapy (MET3B)
    2. Evaluate the role of breast screening programmes. (MET3B)
    3. Evaluate the role of Nurse Counsellors, pain control and terminal care; appreciate the role of a multi-disciplinary team approach to breast cancer (MET3B, MET3B)
    4. Be able to identify features of breast cancer, eg, skin attachment, peau d'orange, deep muscle attachment (MET3B, MET3B)
    5. Know the relevance and role of tissue diagnosis eg cytology, trucut biopsy of a breast tumour (MET3B)
    6. Recognise and justify the differing methods of surgical treatment of breast cancer (MET3B, MET3B)
    7. Recognise the principles of and the need for staging disease prior to treatment (MET3B, MET3B)
    8. Recognise the rationale of follow-up, and identify the symptoms and signs of recurrent or metastatic disease (MET3B, MET3B)
    9. Recognise the role of biopsy in equivocal cases (MET3B, MET3B)
    10. Recognise the role of biopsy in equivocal cases (MET3B, MET3B)
    11. Recognise the role of breast reconstruction after mastectomy (MET3B, MET3B)
    12. Recognise the role of ultrasound, mammography and cytology (MET3B, MET3B)
    13. Take a history of breast symptoms (MET3B, MET3B)
    14. Take a history to assess the risk factor for breast disease (MET3B, MET3B)

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