endo

Question 1

DPP-4 inhibitors (gliptans) MoA

Answer 1

reduce peripheral breakdown of incretins (such as GLP-1)

Question 2

metformin moa

Answer 2

increases peripheral insulin sensitivity and reduces hepatic gluconeogenesis

Question 3

sulfonylureas moa

Answer 3

increase pancreatic insulin secretion

hence can lead to hypoglycaemia

Question 4

GLP mimetics, e.g. exenatide, moa

Answer 4

increase pancreatic insulin secretion
suppress glucagon release
slow gastric emptying and promote satiety

Question 5

best diabetic med for overweight patients

Answer 5

DPP-4 inhibitors (they do not cause weight gain, e.g. Sitagliptin)
SGLT-2 inhibitors (-flozins)
GLP1 analogues (only in BMI>35)

Question 6

important glucocorticoid side effects

Answer 6

osteoporosis and osteonecrosis
impaired glucose regulation
neutrophilia
immunosuppression
psychosis
avascular necrosis

Question 7

Graves’ autoantibodies

Answer 7

TSH receptor stimulating antibodies (90%)

anti-TPO (75%)

Question 8

features of Graves’ but not other causes of hyperthyroidism

Answer 8

eye signs - exophthalmos and ophthalmoplegia
pretibial myxoedema
digital clubbing

Question 9

hyperthyroidism with painful goitre

Answer 9

most likely subacute (De Quervain’s) thyroiditis

Question 10

HHS vs DKA

Answer 10

HHS does not cause hyperketonaemia and metabolic acidosis but can have much higher glucose
HHS more common in old and fat T2DM
DKA more common in young, skinny T1DM

Question 11

mx of thyroid storm

Answer 11

beta blocker - propranolol
propylthiouracil
hydrocortisone

Question 12

LADA vs MODY

Answer 12

LADA - no fhx, 30-50 years

MODY - <25 years, no ketones

Question 13

Addison’s crisis mx

Answer 13

only IV hydrocortisone

Question 14

OGTT cut offs

Answer 14

fasting ≥ 7.0 mmol/L

random or after glucose tolerance test ≥ 11.1 mmol/L

Question 15

blood glucose targets T1DM

how often to measure

Answer 15

on waking - 5-7
before meals (except breakfast) - 4-7
measure 4 times per day

Question 16

HbA1c target in T2DM

Answer 16

48 mmol/mol if lifestyle (+/- metformin) mx
53 mmol/mol if taking any drug that causes hypoglycaemia
at 58 mmol/mol consider adding a second agent

Question 17

impaired fasting glucose

Answer 17

blood glucose 6.1-7.0

Question 18

Kallman’s bloods

Answer 18

low-normal FSH and LH

low testosterone

Question 19

hypothyroidism TFTs

Answer 19

high TSH

low T4

Question 20

hyperthyroidism TFTs

Answer 20

low TSH

high T4

Question 21

drug causes of gynaecomastia

Answer 21

spironolactone
GnRH agonists (goserelin)

Question 22

what conditions is Pioglitazone CI in

Answer 22

HF

bladder cancer

Question 23

most common cause of Cushing’s syndrome

Answer 23

ACTH dependent causes - Cushing’s disease (pituitary tumour secreting ACTH producing adrenal hyperplasia)

Question 24

how to interpret dexamethasone suppression testing

Answer 24

lack of cortisol suppression by low dose dexamethasone - excess glucocorticoid
high dose testing used to localise the problem
if both ACTH and cortisol are suppressed by high dose - pituitary cause
if only cortisol is suppressed by high dose - adrenal cause
if neither are suppressed - ectopic ACTH secretion

Question 25

features of Addison's

Answer 25

vague symptoms of lethargy, weakness, anorexia hyperpigmentation, vitiligo *hypoglycaemia* hyponatraemia and hyperkalaemia

Question 26

what should be done with steroid replacement for Addison's patients with illness, e.g. gastroenteritis

Answer 26

double hydrocortisone | same fludrocortisone

Question 27

most common cause of primary hyperaldosteronism

Answer 27

bilateral idiopathic adrenal hyperplasia

Question 28

mx of myxoedemic coma

Answer 28

thyroxine | hydrocortisone

Question 29

ix for acromegaly

Answer 29

1. serum IGF-1 (insulin growth factor-1) | 2. OGTT

Question 30

most common cause of primary hyperparathyroidism

Answer 30

solitary adenoma

Question 31

bloods in primary hyperparathyroidism

Answer 31

high PTH (can be inappropriately normal) high Ca low phosphate

Question 32

bloods in secondary hyperparathyroidism

Answer 32

high PTH low/normal Ca high phosphate low vitamin D

Question 33

bloods in tertiary hyperparathyroidism

Answer 33

``` extremely high PTH normal/high Ca low/normal phosphate low/normal vitamin D high ALP ```

Question 34

which thyroid cancer produces calcitonin

Answer 34

medullary

Question 35

commonest thyroid cancer

Answer 35

papillary (65%) | follicular (20%)

Question 36

mx of DKA

Answer 36

0.9% NaCl IV 0.1 unit/kg/hr insulin infusion, once blood glucose <15 mmol/l start 5% dextrose correct electrolyte disturbances cont long acting insulins, stop short acting

Question 37

cause of hyperthyroidism then hypothyroidism

Answer 37

De Quervain's thyroiditis

Question 38

results of water deprivation test in cranial DI

Answer 38

low urine osmolality after fluid deprivation | high urine osmolality after desmopressin

Question 39

results of water deprivation test in nephrogenic DI

Answer 39

low urine osmolality after both fluid deprivation and desmopressin

Question 40

electrolyte abnormality seen in Cushing's

Answer 40

hypokalaemic metabolic alkalosis

Question 41

adverse effects of thryoxine therapy

Answer 41

hyperthyroidism due to over treatment reduced bone mineral density AF worsening of angina

Question 42

which type of hyperparathyroidism in CKD

Answer 42

most likely tertiary

Question 43

causes of lower than expected HbA1c

Answer 43

anything that causes higher turnover of red cells, e.g. spherocytosis, sickle cell, G6PD deficiency

Question 44

causes of higher than expected HbA1c

Answer 44

anything that causes red cells to be held onto for longer, e.g. iron deficiency anaemia, splenectomy, vitamin B12/folate deficiency

Question 45

HbA1c that indicates prediabetes

Answer 45

42-47 mmol/mol

Question 46

ix for Addison's

Answer 46

short synacthen (ACTH) test

Question 47

Klinefelter vs Kallmanns

Answer 47

both cause infertility Klinefelter's - above average height, small testes, gynaecomastia Kallman's - anosmia, no gyanecomastia

Question 48

mx of primary hyperaldosteronism

Answer 48

Spironolactone if bilateral adrenal hyperplasia | Surgery if adrenal adenoma

Question 49

features of MEN1

Answer 49

3 Ps parathyroid - hyperparathyroidism pancreas - insulinoma, gastrinoma (leading to peptic ulceration) pituitary - prolactinoma

Question 50

insulin infusion rate in DKA

Answer 50

0.1 unit/kg/hr

Question 51

how to differentiate between causes of Cushing's

Answer 51

dexamethasone suppression test adrenal cause - cortisol is not suppressed by high-dose dexamethasone pituitary cause - cortisol is suppressed by high dose dexamethasone

Question 52

mx of acromegaly

Answer 52

1. trans-sphenoidal surgery 2. if surgery not appropriate or unsuccessful - somatostatin analogue (Octreotide), GH receptor antagonist (Pegvisomant), dopamine agonist (Bromocriptine)

Question 53

what should be done to metformin dosing during intercurrent D&V

Answer 53

suspend during illness as it increases risk of lactic acidosis

Question 54

orlistat moa

Answer 54

pancreatic lipase inhibitor

Question 55

mx of hypoglycaemia in drowsy patient

Answer 55

IV 20% glucose is first line | if drowsy there may be risk of aspiration with gluco-gel

Question 56

best diabetic med for patients w CKD

Answer 56

Sitagliptin (DPP-4 inhibitor)

Question 57

mx of prediabetes

Answer 57

refer to Diabetes Prevention Programme

Question 58

low TSH and low T4

Answer 58

suggests secondary hypothyroidism which needs and MRI pituitary to confirm dx

Question 59

which medications may reduce absorption of levothyroxine

Answer 59

iron/calcium carbonate

Question 60

results of water deprivation test in psychogenic/primary polydipsia

Answer 60

high urine osmolality after fluid deprivation and after desmopressin

Question 61

complication of papillary thyroid cancer

Answer 61

spread to cervical lymph nodes

Question 62

mx of hypoglycaemia if person is alert and able to swallow

Answer 62

glucose tablets

Question 63

CI to testosterone therapy

Answer 63

PSA >4 hx of or active prostate/breast cancer haematocrit >0.55

Question 64

drug cause of hyperthyroidism

Answer 64

amiodarone

Question 65

adverse effects of glitazones

Answer 65

``` ELBOW Edema fluid retention Liver dysfunction Bladder cancer Osteoporosis - fractures Weight gain ```

Question 66

mx of prolactinoma

Answer 66

``` dopamine agonists (e.g. Cabergoline or Bromocriptine) surgery is only performed for those who cannot tolerate/fail to respond to medical therapy ```