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MRCP > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is hyperuricaemia associated with?

A

Hyperlipidaemia, hypertension, metabolic syndrome

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2
Q

What are the enzyme abnormalities in Gitelman’s syndrome?

A

hypokalaemia, hypocalciuria, hypomagnesaemia

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3
Q

What are the diagnostic thresholds for gestational diabetes?

A

FG >= 5.6, 2-hr glucose >= 7.8

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4
Q

What threshold for FG should insulin be started in gestational diabetes?

A

FG >= 7.0

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5
Q

What causes predominantly hypercholesterolaemia rather than hypertriglyceridaemia?

A

nephrotic syndrome, cholestasis, hypothyroidism

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6
Q

What causes predominantly hypertriglyceridaemia rather than hypercholesterolaemia?

A

diabetes, obesity, alcohol, chronic renal failure, drugs, liver disease

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7
Q

What is the MOA of meglitinides?

A

bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells

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8
Q

What are the three symptoms of Pendred’s syndrome?

A

bilateral sensorineural deafness, mild hypothyroidism and goitre

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9
Q

What is the MOA of evolocumab?

A

prevents PCSK9-mediated LDL receptor degradation

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10
Q

What is the MOA of fibrates?

A

Increase lipoprotein lipase activity via PPAR-alpha agonism

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11
Q

What is the MOA of ezetimibe?

A

reduces intestinal absorption of cholesterol

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12
Q

What is cholesterol a precursor to?

A

steroids, bile acids, vitamin D

also used to maintain cell membranes

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13
Q

What defect leads to familal hypercholesterolaemia?

A

Mutations in the LDL receptor gene (these are used for LDL clearance and breakdown to free cholesterol in the liver)

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14
Q

Which medication can increase fertility in PCOS?

A

Clomifene

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15
Q

Which medication is used to treat hyperthyroidism in the first trimester?

A

Propylthiouracil

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16
Q

Which medication is used to treat hyperthyroidism in the second and third trimester?

A

Carbimazole

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17
Q

What helps to determine the risk of fetal hypothyroidism when a mother is being treated for thyrotoxicosis in pregnancy?

A

thyrotrophin receptor stimulating antibodies at 30-36 weeks gestation

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18
Q

What is the treatment of myxoedemic coma?

A

Hydrocortisone and levothyroxine

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19
Q

Which type of MODY is most common and what gene is responsible?

A

MODY3 - HNF-1 alpha gene

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20
Q

Which gene is responsible for MODY2

A

glucokinase gene

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21
Q

Which gene is responsible for MODY5

A

HNF-1 beta gene

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22
Q

What is the diagnostic test for gastroparesis in DM

A

Isotrope gastric motility scintigraphy scan

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23
Q

What causes asymmetrical quadriceps wasting in DM

A

Diabetic amyotrophy (motor neuropathy)

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24
Q

What is the MOA of carbimazole

A

Blocks thyroid peroxidase from coupling and iodinating tyrosine residues on thyroglobulin - reducing thyroid hormone production

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25
Q

What antiglycaemic agent is linked with severe pancreatitis

A

exenatide

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26
Q

Which drugs cause SIADH

A

carbamazepine, sulphonylureas, SSRIs, TCAs

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27
Q

What condition describes lack of blood flow to the pituitary after blood loss during childbirth

A

Sheehan’s syndrome

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28
Q

what is seen in sick euthyroid syndrome

A

Low TSH, low thyroxine, low T3

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29
Q

what is the action of metformin in PCOS

A

increases peripheral insulin sensitivity

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30
Q

Which antibodies can be used to test for LADA

A

GAD

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31
Q

What is the first line investigation of Conn’s syndrome

A

Plasma aldosterone/renin ratio

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32
Q

What is the HbA1c target for a patient with T2DM on metformin

A

48

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33
Q

What is the HbA1c target for a patient with T2DM on a drug that may cause hypoglycaemia

A

53

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34
Q

Which insulin should a patient with T2DM start with

A

NPH insulin (intermediate-acting)

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35
Q

What is the first line treatment for remnant hyperlipidaemia

A

Fibrates

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36
Q

Which anti-diabetic medication is associated with increased risk of foot amputations

A

Canagloflozin

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37
Q

What levels of FSH and LH are seen in Kallmann syndrome

A

Low/normal

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38
Q

What levels of FSH and LH are seen in Klinefelter syndrome

A

Raised FSH and LH

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39
Q

What is the inheritance of Kallmann’s syndrome

A

X-linked recessive

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40
Q

When should statins be started in T1DM

A

age over 40yrs, had diabetes >10 years, established nephropathy, or has other CVD risk factors

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41
Q

What is the management of subclinical hypothyroidism in an asymptomatic person with TSH < 10

A

Watch and wait

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42
Q

What is the management of subclinical hypothyroidism in an asymptomatic person aged less than 70 with TSH >10

A

start levothyroxine

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43
Q

Which steroids have the lowest mineralocorticoid activity

A

dexamethasone, betmethasone

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44
Q

what are the endocrine deficiencies seen in autoimmune polyendocrinopathy syndrome (APS) type 2

A

Addisons + T1DM or autoimmune thyroid disease

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45
Q

what are the endocrine deficiencies seen in autoimmune polyendocrinopathy syndrome (APS) type 1

A

2 of: Addisons, chronic mucocutaneous candidiasis, primary hypoparathyroidism

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46
Q

What is the treatment of liddle’s syndrome

A

amiloride or triamterene

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47
Q

What is the central feature of MEN1

A

hyperparathyroidism

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48
Q

What is the difference between MEN2a and MEN2b

A

MEN2a has hyperparathyroidism, MEN2b has marfanoid body. (both have medullary thyroid cancer and phaeochromocytoma)

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49
Q

When should metformin be considered in T1DM

A

BMI > 25

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50
Q

What does nuclear scintigraphy show in toxic multinodular goitre

A

Patchy uptake

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51
Q

What causes excessive sweating in acromegaly

A

Sweat gland hypertrophy

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52
Q

What are the symptoms of MEN1

A

Peptic ulcer (from insulinomas/gastrinomas), hyperparathyroidism, pituitary disease

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53
Q

Which MEN gives a marfanoid body habitus

A

MEN 2b

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54
Q

Which MEN Types cause hyperparathyroidism

A

MEN1, MEN2a

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55
Q

What condition is associated with tendon and tuberous xanthoma

A

Familial hypercholesterolaemia

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56
Q

What is the treatment of familial hypercholesterolaemia

A

Max dose statins

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57
Q

Which condition is associated with palmar xanthoma

A

Remnant hyperlipidaemia

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58
Q

What is associated with eruptive xanthoma

A

Familial hypertriglyceridaemia, lipoprotein lipase deficiency

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59
Q

What features are diagnostic of metabolic syndrome

A

Central obesity + 2 of: raised triglycerides, low HDL, hypertension, raised fasting glucose

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60
Q

Where is leptin produced

A

Adipose

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61
Q

Where is ghrelin produced

A

Stomach/pancreas

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62
Q

Which condition is due to inhibition of lipoprotein lipase leading to raised triglycerides and recurrent abdominal pain

A

Chylomicronaemia syndrome

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63
Q

How is insulinoma diagnosed

A

72 hr fast - if symptoms develop check insulin and c-peptide

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64
Q

What is the MOA of fibrates

A

Activate PPAR alpha receptors - increases LPL activity

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65
Q

What percentage of insulinomas are malignant

A

10%

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66
Q

Which malignancy is necrolytic migratory erythema associated with

A

Glucagonoma

67
Q

What is Wolfram’s syndrome

A

DIDMOAD - DI, DM, optic atrophy and deafness

68
Q

What is the usual inheritance of nephrogenic DI

A

X-linked recessive

69
Q

What is the treatment of nephrogenic DI

A

Indomethacin, thiazide, low sodium diet

70
Q

What is the treatment of cranial DI

A

Fluids, vasopressin

71
Q

What is the inheritance of Liddle’s syndrome

A

Autosomal dominant

72
Q

Which inherited condition causes severe hypokalaemia due to defective Cl absorption at the Na-K-2Cl co-transporter in ascending loop of henle

A

Bartter’s syndrome

73
Q

What is the treatment of Bartter’s syndrome

A

Spironolactone/Indomethacin

74
Q

What is the inheritance of Bartter’s syndrome

A

Autosomal recessive

75
Q

What electrolyte abnormalities are seen in Gitelman’s syndrome

A

Hypokalaemia, hypomagnesaemia and hypocalciuria

76
Q

Where is the transport defect located in Gitelman’s syndrome

A

DCT (thiazide-sensitive Na-Cl transporter)

77
Q

What is the main cause of hyperaldosteronism

A

Bilateral idiopathic adrenal hyperplasia

78
Q

How do corticosteroids cause osteoporosis

A

Inhibit osteoblast activity and increase osteoblast apoptosis

79
Q

What is the most accurate way to test for pituitary source of cushing’s

A

Inferior petrosal sinus sampling

80
Q

Which antibodies are typically seen in Addison’s disease

A

Anti-2l hydroxylase antibodies

81
Q

What are the causes of SIADH

A

Sulphonylureas, SSRIs, TCAs, antipsychotics, carbamazepine, thiazides, omeprazole, porphyrias

82
Q

Where does phaeochromocytoma arise from

A

Chromaffin cells in medulla

83
Q

Which conditions are associated with phaeochromocytoma

A

MEN2, neurofibromatosis, VHL

84
Q

What causes increased IGF-1

A

Acromegaly, pregnancy

85
Q

What complications are associated with acromegaly

A

Hypertension, diabetes, colorectal cancer, cardiomyopathy

86
Q

What is the diagnostic test for GH deficiency

A

Insulin tolerance test - <10mg/L of GH released confirms diagnosis

87
Q

What is the most important treatment in pituitary apoplexy

A

IV hydrocortisone

88
Q

What test can be used to diagnose factitious hyperthyroidism

A

Low thyroglobulin

89
Q

What are the most common antibodies in Grave’s disease

A

Anti-TSH receptor stimulating Abs (90%) (50% have TPO Abs)

90
Q

What is toxic multinodular goitre

A

Thyroid gland contains multiple autonomously functioning thyroid nodules

91
Q

What is the biggest risk factor for developing thyroid eye disease

A

Smoking

92
Q

What pattern of thyroid disease does De Quervain’s have

A

Post viral: hyperthyroid -> hypothyroid -> euthyroid

93
Q

Which HLA is associated with De Quervain’s thyroiditis

A

HLA B35

94
Q

What is the treatment of De Quervain’s thyroiditis

A

Self limiting, no treatment required

95
Q

What are the complications of subclinical hyperthyroidism

A

SVT, osteoporosis

96
Q

Which antibodies are positive in Hashimoto’s thyroiditis

A

Anti-TPO, Anti-TG

97
Q

Which drugs interfere with thyroxine absorption

A

Rifampicin, amiodarone, calcium, iron tablets, cholestyramine, sevelamer, PPIs

98
Q

Which syndrome describes increased reverse T3, low T3 and T4 seen in ITU patients

A

Sick euthyroid syndrome

99
Q

Which thyroid cancer is associated with FAP

A

Papillary

100
Q

Which cancer associated with MEN2 secretes calcitonin

A

Medullary thyroid cancer

101
Q

Which thyroid cancer is associated with local invasion and metastases

A

Anaplastic thyroid cancer

102
Q

What does PTH do to calcium and phosphate

A

Increases plasma calcium, decreases plasma phosphate (by decreasing renal PO4 absorption)

103
Q

What else causes hypercalcaemia other than PTH and malignancy

A

Thiazides, thyrotoxicosis, addisons

104
Q

Which electrolyte abnormalities can cause nephrogenic diabetes insipidus

A

Hypercalcaemia, hypokalaemia

105
Q

What is the pathophysiology of pseudohypoparathyroidism

A

Target cells insensitive to PTH

106
Q

Which electrolyte disturbance results in hypocalcaemia

A

Hypomagnesaemia

107
Q

Which inherited condition is characterised by impaired PO4 reabsorption in the renal tubules

A

Vitamin D resistant rickets

108
Q

Which is more sensitive and specific for hypocalcaemia out of trosseau’s and chvostek’s sign

A

Trosseau’s sign ( carpal spasm with brachial artery occlusion)

109
Q

Which neurotransmitter constantly inhibits prolactin

A

Dopamine

110
Q

What are the causes of gynaecomastia

A

Testicular failure, liver cirrhosis, hyperthyroidism, spironolactone, cimetidine, omeprazole, goserelin

111
Q

What is the treatment of hirsutism and acne in PCOS that doesn’t respond to COCP

A

Topical eflornithine

112
Q

Which anti-hyperglycaemics can cause weight gain

A

Sulphonylureas, TZDs

113
Q

What is the treatment of choice for toxic multinodular goitre

A

Radioiodine therapy

114
Q

What are the causes of hyperprolactinaemia

A

Pregnancy, prolactinoma, physiological, PCOS, primary hypothyroidism, phenothiazines, metoclopramide, domperidone

115
Q

What is the MOA of orlistat

A

Pancreatic lipase inhibitor

116
Q

What BMI is orlistat indicated for

A

BMI >28 with RFs or >30

117
Q

What is measured during dynamic pituitary function tests

A

GH, glucose, cortisol, TSH, LH, FSH

118
Q

What is the starting plasma osmolality in a water deprivation test in a patient with psychogenic polydipsia

A

Low

119
Q

What is the pattern of results seen in a water deprivation test in a patient with cranial diabetes insipidus

A

High starting plasma osmolality, low starting urine osmolality (<300), high urine osmolality after ADH (>600)

120
Q

When should gestational diabetes be screened for in a women who has had GD in a previous pregnancy

A

As soon as possible after booking and at 24-28 weeks if first test is normal

121
Q

What are the glucose targets for self-monitoring in pregnancy

A

Fasting 5.3; 1 hour after meals 7.8; 2 hours after meals 6.4

122
Q

Which foods have a high glycaemic index

A

White rice, baked potato, white bread

123
Q

How should metformin be adjusted for Ramadan

A

1/3 before sunrise, 2/3 after sunset

124
Q

What are the adverse effects of pioglitazone

A

Weight gain, liver impairment, fluid retention (CI in HF, worse with insulin), bladder cancer, increased risk of fractures

125
Q

What causes higher-than-expected levels of HbA1c

A

Vit B12/folate deficiency, IDA, splenectomy

126
Q

What are the clinical features of pseudohypoparathyroidism

A

Low IQ, short stature, shortened 4th and 5th metacarpals, low calcium, high phosphate, high PTH

127
Q

What indicates that a patient with T2DM might benefit from meglitinides

A

Erratic lifestyle - taken shortly before a meal

128
Q

What are the contraindications to an insulin stress test for investigation of hypopituitarism

A

Epilepsy, IHD, adrenal insufficiency

129
Q

What is the Simon Broome criteria

A

Used to diagnose familial hypercholesterolaemia: TC >7.5 and LDL >4.9, tendon xanthoma in pt or 1st/2nd degree relatives, FHx of MI <60 in 1st degree relative

130
Q

What is the medical management of stress incontinence that doesn’t respond to pelvic floor exercises

A

Duloxetine

131
Q

When is hypertonic saline indicated in hyponatraemia

A

Acute, severe, symptomatic hyponatraemia (<120)

132
Q

Where are chylomicrons produced

A

GI tract - contain mostly triglycerides

133
Q

Where are VLDLs produced

A

The liver - contain mainly triglycerides but some cholesterol

134
Q

What is the main function of triglycerides

A

Energy source for tissues

135
Q

What should a patient with hypothyroidism do with their thyroxine dose in pregnancy

A

Increase thyroxine dose by up to 50% as early as 4-6 weeks of pregnancy

136
Q

What is the definitive diagnosis of remnant hyperlipidaemia (dysbetalipoproteinaemia)

A

Lipoprotein electrophoresis or genotyping of apo-protein E

137
Q

What is the first test to do when excluding anyone with hyperprolactinaemia

A

Pregnancy test

138
Q

What is Von Hippel Lindau syndrome

A

Phaeochromocytoma, renal cell carcinoma, retinal and cerebellar haemangioblastomas

139
Q

What can lead to a false positive dexamethasone suppression test

A

Enzyme inducers (CYP450)

140
Q

What is the best treatment of venous ulcers

A

Multi layer bandaging

141
Q

What is the preferred anti-thyroid drug therapy in late pregnancy

A

Carbimazole

142
Q

What is the initial follow up for patients with microprolactinomas

A

Yearly MRI

143
Q

What is the treatment of Kallman’s syndrome

A

Pulsed GnRH

144
Q

What disease is characterised by precocious puberty, cafe-au-lait skin pigmentation, polyostotic fibrous dysplasia and hyperthyroidism

A

McCune-Albright syndrome

145
Q

What is the commonest cause of primary hyperthyroidism

A

Benign adenoma

146
Q

What is the most common electrolyte abnormality in anorexia

A

Hypokalaemia

147
Q

What is the treatment of ABPA

A

Oral corticosteroids + prolonged course of itraconazole

148
Q

What is the treatment of DI after trans-sphenoidal surgery

A

IV desmopressin whilst matching fluid output with appropriate replacement (only a few will go on to need DDVAP long term)

149
Q

What causes raised c peptide with low glucose

A

Sulfonylurea abuse (most common), insulinoma (very rare)

150
Q

Which type of amiodarone-induced thyrotoxicosis has normal radioiodine uptake and normal IL-6

A

AIT type 1

151
Q

What is the treatment of AIT type 1

A

Anti-thyroid drugs (e.g. carbimazole) and potassium perchlorate

152
Q

Which AIT causes high IL-6

A

AIT type 2

153
Q

What is the treatment of AIT type 2

A

Prednisolone 40mg/day

154
Q

What is the treatment of amiodarone-induced hypothyroidism

A

Continue amiodarone and add levothyroxine

155
Q

What is the treatment of grave’s ophthalmology with sight-threatening features

A

IV corticosteroids

156
Q

What is the equation for plasma osmolarity

A

2(Na+K) + urea + glucose

157
Q

What are the plasma osmolarity and glucose levels usually seen in HHS

A

Osmolarity >320

Glucose >30

158
Q

What is the most useful marker of tumour recurrence of thyroid carcinomas after total thyroid ablation

A

Thyroglobulin

159
Q

What can be used to diagnose medullary thyroid cancer

A

Pentagastrin stimulation test (measures calcitonin at 2 and 5 minutes - rise suggests cancer)

160
Q

What joint condition is associated with T1DM due to HLA-DR4

A

Rheumatoid arthritis

161
Q

What is present on 75% of MRI brain scans in Kallman’s syndrome

A

Absent olfactory bulbs (no sense of smell)

162
Q

What is the management of insulin-related fluid retention

A

Furosemide

163
Q

What is the initial treatment of a macroprolactinoma

A

Dopamine agonist - bromocriptine

164
Q

Which condition can present with modest CK rise and muscle symptoms when untreated

A

Hypothyroidism

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