Endocrine

Question 1

Treatment of DKA

Answer 1

 Sodium chloride 0.9%
 Sometimes potassium chloride.
 Intravenous insulin infusion

Question 2

Treatment of hyperosmolar non-ketotic coma

Answer 2

 Sodium chloride 0.9%
 Sometimes potassium chloride.
 Intravenous insulin infusion

Question 3

Causes of SIADH

Answer 3

Small cell lung cancer

Question 4

Results of SIADH

Answer 4

Hyponatraemia

Question 5

Subacute thyroiditis features

Answer 5

Phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR.  Globally reduced uptake on technetium thyroid scan.
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to normal

Question 6

Features of diabetic ketoacidosis

Answer 6

abdominal pain
polyuria, polydipsia, dehydration
Kussmaul respiration (deep hyperventilation)
Acetone-smelling breath (‘pear drops’ smell

Question 7

Diagnosis of diabetic ketoacidosis

Answer 7

glucose > 11 mmol/l or known diabetes mellitus

pH 3 mmol/l or urine ketones ++ on dipstick

Question 8

Complications of DKA and its treatment

Answer 8

gastric stasis
thromboembolism
arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia
iatrogenic due to incorrect fluid therapy: cerebral oedema, hypokalaemia, hypoglycaemia
acute respiratory distress syndrome
acute kidney injury

Question 9

Commonest cause of thyrotoxicosis

Answer 9

Graves’ disease - accounts for 50-60%

Question 10

Causes of thyrotoxicosis

Answer 10

Graves’ disease
toxic nodular goitre
acute phase of subacute (de Quervain’s) thyroiditis
acute phase of post-partum thyroiditis
acute phase of Hashimoto’s thyroiditis (later results in hypothyroidism)
amiodarone therapy

Question 11

Diagnostic test for Addison’s disease

Answer 11

ACTH stimulation test

Question 12

Symptom’s of addison’s disease

Answer 12

Pigmentation of skin
Tired, lean, weak, dizzy, faints, myalgias and arthralgias.
Nausea and vomiting, constipation, abdo pain.
Postural hypotension