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METABOLISM: Endocrine System

Index

• General Outcomes for Endocrine System
• Diabetes Mellitus
• 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 (TD 8.1)
    • The Adrenal Glands
      1. Describe the blood supply to the adrenal gland and the functional relationship between the adrenal medulla and the nervous system (GEP/DGM)
  • Medical knowledge: PHYSIOLOGY (TD 8.2)
    • Parathyroid Glands and Calcium Balance
      1. Describe the transformation of vitamin D3 into an active hormone and explain how this is regulated
      2. Explain the relationship between the various forms of circulating calcium in blood
      3. Recognise the structure of vitamin D3 and describe the sources of this vitamin in the body
      4. Describe the source of parathyroid hormone and explain how its secretion is regulated
      5. 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
      6. Briefly explain how the body excretes excess calcium
    • Thyroid Gland
      1. Outline the synthesis, storage and release of thyroid hormones (GEP/DGM)
      2. Describe the effects of thyroid stimulating hormone on the thyroid gland (GEP/DGM)
      3. Outline the actions of thyroid hormones (GEP/DGM)
      4. Outline the source and actions of calcitonin and explain its role in calcium metabolism
  • Medical knowledge: BIOCHEMISTRY (inc. Metabolism) (TD 8.3)
    • Glucose and Glycogen Metabolism
      1. Describe the actions of glucagon on glucose and lipid metabolism in the post absorptive and fasting states
  • Medical knowledge: PATHOLOGY (TD 8.7)
    • General Outcomes for Endocrine Disorders
      1. Recognise and describe specific disease processes that affect the glands of the endocrine system (GEP/DGM)
  • Medical knowledge: NUTRITION (TD 8.11)
    • Vitamins and Minerals
      1. Recognise the structure of vitamin D3 and describe the sources of this vitamin in the body
• Diabetes Mellitus
  • General Outcomes for Diabetes
    1. 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
    2. Describe the acute effects of insulin deficiency or glucagon excess
    3. Be able to classify the types of Diabetes Mellitus (DM) and list the causes of secondary DM
    4. List the long-term complications of diabetes mellitus
    5. Describe the principles of management of the newly diagnosed diabetic patient including the role of diet
    6. Outline the changes in glucose and insulin during an oral glucose tolerance test in normal and diabetic subjects
    7. Outline the macrovascular complications of diabetes mellitus
    8. Describe the principal forms of diabetes mellitus
    9. Summarise the effects of inadequate insulin secretion or action upon carbohydrate and fat metabolism, including the aetiology of diabetic ketoacidosis
    10. Define the terms glucose tolerance and insulin resistance in relation to type 1 and type 2 diabetes mellitus
    11. Outline the influence of the liver on circulating insulin levels
    12. Outline the potential abnormalities of glucose homeostasis in diabetes
    13. Understand the indications of the various classes of oral hypoglycaemic agents and insulin therapies and first aid advice to the diabetic patient
    14. Describe the diagnostic criteria for Diabetes Mellitus (DM), impaired fasting glycaemia (IFG), and impaired glucose tolerance (IGT)
    15. Know the presentation and management of Diabetes
    16. Recognise the contribution of genetic and environmental factors in the aetiology of Type 1 and Type 2 Diabetes Mellitus
    17. Be aware of the fungal infections that may present in patients who have diabetes
  • Diabetic Emergencies
    1. Be able to distinguish between the following terms and conditions: hypoglycaemia; diabetic ketoacidosis; hyperglycaemia; hyperosmolar hyperglycaemic state
    2. Outline the consequences of ketoacidosis
    3. Know how to manage a hypoglycaemic patient
    4. Know how to manage a patient with diabetic ketoacidosis
    5. Know how to manage a patient in a hyperosmolar hyperglycaemic state
    6. Understand the precipitating factors in hyperglycaemic states
    7. Know how to choose, give and monitor the following medication for Hypoglycaemia: 20% Glucose; Glucagon
    8. Apply BRAINS&AIMS when choosing, giving and monitoring the following medication for Hyperglycaemia: Insulin; IV Fluids; IV Potassium; Low Molecular Weight Heparin (LMWH)
• Metabolic Syndrome
  • General Outcomes for Metabolic Syndrome
    1. Understand the pathophysiology of obesity and metabolic syndrome
    2. Understand the relationship between hepatic steatosis with obesity, metabolic syndrome and diabetes
    3. Understand the following terms: insulin resistance; glucose tolerance; metabolic syndrome
• Disorders of the Thyroid
  • General Outcomes for Disorders of the Thyroid
    1. Define the role of isotope scanning, ultrasound and fine needle cytology in the investigation of thyroid lesions
    2. Describe the position and anatomical relationships of the thyroid gland (MET2)
    3. Briefly explain the pathophysiology of hypo- and hyperthyroidism
    4. Distinguish thyroid enlargement from other lesions in the neck by examination
    5. List the possible causes of thyroid enlargement in a euthyroid patient
    6. Be able to define the various benign and malignant tumours of the thyroid
    7. Be aware of the surgical and non-surgical treatment options for thyroid tumours
  • Thyroiditis
  • Goitre
    1. Define goitre, list the causes and briefly describe the pathology
  • 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;
  • Calcium Homeostasis
    1. List the causes of hypercalcaemia and outline the diagnostic investigations
    2. Apply BRAINS & AIMS when choosing, giving and monitoring the following medication for Hypercalcaemia: Saline; Furosemide; Bisphosphonates - Pamidronate; Prednisolone
    3. Describe the clinical features of acute hypercalcaemia and its initial management
    4. Describe the clinical features and initial management of hypocalcaemia
• Adrenal Disease
  • General Outcomes for Adrenal Disease
    1. Describe other unwanted effects arising from long-term therapy with glucocorticoids
    2. Describe the clinical syndromes underlying causes and pathology associated with adrenocortical hypofunction
    3. Describe the regulation of hormone secretion by each zone
    4. Describe the structure of the adrenal gland and relate the zones to production of hormones
    5. Clinical uses of corticosteroids (GEP/DGM)
    6. Distinguish between adrenal failure and pituitary-adrenal failure by means of clinical features assissted by laboratory investigations
    7. Clinical uses of corticosteroids (GEP/DGM)
    8. Explain how long-term corticosteroid therapy disrupts endogenous corticosteroid secretion (GEP/DGM)
    9. Describe the physiological actions of the adrenal hormones
    10. Outline the maintenance treatment of adrenal insufficiency including precautions for intercurrent illness
    11. Explain the effects of both excess and deficiency of adrenal hormones
    12. Describe the emergency management of acute adrenal insufficiency
  • Endocrine Hypertension
    1. Know the strategy for investigation of endocrine hypertension
    2. Describe the blood supply to the adrenal gland and the functional relationship between the adrenal medulla and the nervous system
    3. Outline the laboratory and radiological investigation of suspected Conn's syndrome, phaeochromocytoma and acromegaly
    4. Describe the presenting clinical features of Conn's Syndrome and phaeochromocytoma
    5. Describe the possible mechanisms of endocrine mediated hypertension with reference to phaeochromocytoma, Conn's Syndrome and renal artery stenosis
  • Cushing's Disease
    1. To see the role of different therapeutic interventions in Cushing's disease and their rationale
    2. Discuss the clinical features, causes and pathology of Cushing's Syndrome
    3. Outline the laboratory and radiological investigations which help to distinguish pituitary, adrenal and ectopic causes of Cushing's Syndrome
• Pituitary Disorders
  • General Outcomes for Pituitary Disorders
    1. To see the role of different therapeutic interventions in Cushing's disease and their rationale
    2. To be able to relate diagnostic tests for Cushing's disease to normal physiology
    3. To understand the genetic basis of familial acromegaly
    4. Know the physiology of the Hypothalamo-pituitary-ovarian axis
    5. Be able to describe the structural and functional relationships between the hypothalamus and the pituitary gland
    6. Use the concept of negative feedback to explain the principles underlying clinical tests for pituitary hormone secretion (GEP/DGM)
    7. 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)
    8. Effect of a pituitary mass on normal pituitary physiology
    9. To understand the rationale and mode of action of somatostatin analogues in acromegaly
    10. Origin and natural history of pituitary adenomas
    11. Physiology of the growth hormone axis and the pathophysiology of over-secretion of growth hormone
    12. To relate anatomy to specific tumoral secretory syndromes
    13. Signs and symptoms of acromegaly (consequences of growth hormone over-secretion)
    14. Principles of diagnostic endocrine and radiological tests for Acromegaly
    15. Social and emotional impact of pituitary disease
    16. Principles, benefits and risks of medical, surgical and radiotherapy treatments for Acromegaly
    17. 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
    18. Describe the clinical features of hypopituitarism, outline the treatment required.
  • Diabetes Insipidus and Hyponatraemia
    1. Understand the causes of hypernatraemia and hyponatraemia
    2. List the causes of thirst and polyuria
    3. Describe the initial investigations which help to distinguish cranial and nephrogenic diabetes insipidus and psychogenic polydipsia
    4. Understand the principles of treating hypernatraemia and hyponatraemia
    5. Understand the principles of diagnosing and treating hyponatraemia
• Breast Disease (inc. Breast Cancer)
  • General Outcomes for Breast Diseases
    1. Recognise normal and physiological findings
    2. Recognise the features of benign breast disease eg fibroadenoma, multi-duct nipple discharge, breast cysts, cyclical mastalgia
    3. Appreciate the need for clinical trials
    4. Take a history of breast symptoms
    5. Take a history to assess the risk factor for breast disease
    6. Be able to carry out an examination of the breasts including examination of the axillary lymph nodes and lymph node drainage sites
    7. Appreciate the mammographic appearance of impalpable lesions
    8. Assess potential sites of distant disease
    9. Be able to discuss in detail in professional and layman's terms, surgical approaches to breast disease in order to provide informed consent
    10. Be able to propose a diagnosis from clinical findings and plan mangement
    11. Recognise the role of ultrasound, mammography and cytology
    12. Be able to interpret a bone scan with supervision
    13. Be able to interpret mammograms (with supervision)
    14. Be able to carry out an examination of the breasts using a systematic approach and including preparing and positioning the patient appropriately
  • Breast Cancer
    1. Evaluate the role of breast screening programmes.
    2. Take a history of breast symptoms
    3. Take a history to assess the risk factor for breast disease
    4. Choose and justify the alternative adjuvant modalities eg radiotherapy, chemotherapy and hormone therapy
    5. Recognise and justify the differing methods of surgical treatment of breast cancer
    6. Know the relevance and role of tissue diagnosis eg cytology, trucut biopsy of a breast tumour
    7. Be able to identify features of breast cancer, eg, skin attachment, peau d'orange, deep muscle attachment
    8. Recognise the role of ultrasound, mammography and cytology
    9. Evaluate the role of Nurse Counsellors, pain control and terminal care; appreciate the role of a multi-disciplinary team approach to breast cancer
    10. Recognise the principles of and the need for staging disease prior to treatment
    11. Recognise the rationale of follow-up, and identify the symptoms and signs of recurrent or metastatic disease
    12. Recognise the role of biopsy in equivocal cases
    13. Recognise the role of biopsy in equivocal cases
    14. Recognise the role of breast reconstruction after mastectomy

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