Endo Flashcards
(32 cards)
24yr woman has BMI of 35kg/m. The weight is evenly distributed. She has somewhat plethoric moon facies. Her blood pressure is 122/75mmHg. She has some non-pigmented abdominal striae. Proximal muscle power is normal. Her normal medication is the oral contraceptive pill.
An 8am cortisol measurement is 855nmol/L [125-695nmol/L]
What is the most likely explanation?
a. Laboratory measurement error
b. The contraceptive pill
c. Cushions syndrome
d. Alcohol
The contraceptive pill
A 28 yr woman presents with weigh gain, tuncal obesity and a new diagnosis of type 2 diabetes. You suspect that she may have Cushing’s syndrome.
Which one of the following is the most appropriate screening test in this woman?
a. Random serum cortisol
b. 11pm serum ACTH
c. Short synacthen test
d. 24-hour urine free cortisol
e. 8am salivary cortisol
d. 24-hour urine free cortisol
A 46hr Samoan woman with BMI of 38.2 kg presents with a polyuria and fatigue. You suspect that she might have undiagnosed diabetes. A screening HbA1c is 64mmol/L. She has normal renal function.
What is the most appropriate management?
a. Initiate insulin therapy with a basal insulin (e.g. once daily NPH insulin)
b. Initiate an SGLT2 inhibitor (e.g. empagliflozin)
c. Initiate a sulphonylurea (e.g. gliclazide)
d. Give diet and lifestyle advice and initiate a biguanide (e.g. metformin)
e. Give diet and lifestyle advice
d. Give diet and lifestyle advice and initiate a biguanide (e.g. metformin)
Which one of the following is most suggestive of a diagnosis of Addison’s disease?
a. 8am plasma cortisol of 128nmol/L [125-695 nmol/L]
b. Post synacthen cortisol of 250 nmol/L
c. 24 hour urinary free cortisol 220nmol/L [0700-1100am sample < 46 ng./L]
d. Plasma Potassium of 4.8mmol/L [3.5 – 5.0 mmol/L]
b. Post synacthen cortisol of 250 nmol/L
A 32 yr old woman is found to be hypertension with a BP of 172/92mmHg. She has excess ______ often wakes at night with numbness and tingling in her index and ring fingers on both hands.
Which one of the following tests is most likely to reveal a secondary cause of hypertension in this woman?
a. Plasma metanephrines
b. 24-hour urinary free cortisol
c. 24-hour urinary catecholamines
d. Plasma aldosterone: renin ration – screening test to detect primary aldosteronism in high risk, HTN individuals
e. Serum insulin like growth factor – 1 (IGF)
e. Serum insulin like growth factor – 1 (IGF)
A 45 yr old woman presents with a two year history of hot flushes and amenorrhoea. Physical examination is unremarkable. Her visual fields are normal to confrontation and she doesnt not describe galactorrhoea.
Free t4 11.1 (10.5-21.2)
TSH 0.10 (0.35-3.60)
LH 0.2 (1.1-11.6)
FSH 1.0 (2.8-11.3)
Oestradiol <50 (200-2000)
Prolactin 620 (40-530)
IGF-1 9.9 (30-50)
Cortisol 237 (125-695)
What is the most likely explanation of her amenorrhoea?
a. Non-functioning pituitary macroadenoma
b. PCOS
c. Premature ovarian failure
d. Macroprolactinoma
e. Hypothyroidism
In patients with pituitary apoplexy which is the most clinically important hormone deficiency?
a. Thyroid hormone
b. Cortisol
c. Aldosterone
d. Antidiuretic hormone
e. Growth hormone
Cortisol
The visual pattern shown is most in keeping with which of the following lesions?
Bitemporal hemianopia
a. Pituitary microadenoma
b. Frontal meningioma
c. Optic neuroma
d. Craniopharyngioma
e. Occipital astrocytoma
d. Craniopharyngioma = a tumour from pituitary embryonic tissue
Which one of the following is the most appropriate screening test when considering primary hyperaldosteronism?
a. Performing an intravenous saline suppression test
b. Measuring serum Potassium concentration
c. CT imaging of the adrenal glands
d. Measurement of plasma aldosterone to renin ratio
e. Measurement of plasma metanephrines
d. Measurement of plasma aldosterone to renin ratio
Which of the following tests has the greatest specificity for growth hormone deficiency?
a. 8am serum growth hormone
b. 8am serum IGF-1
c. Growth Hormone levels following oral glucose tolerance test
d. Growth hormone levels following an insulin tolerance test
e. 24-hour urinary growth hormone levels
d. Growth hormone levels following an insulin tolerance test
Which pituitary hormone is primarily regulated by an inhibitory signal from the hypothalamus?
a. GH
b. TSH
c. LH
d. Prolactin
e. Antidiuretic hormone
d. Prolactin
T score -1.24 and -1.25 at lumbar and femoral
a. Osteoporosis at both lumbar spine and femoral neck
b. Osteopenia at both lumbar spine and femoral neck
c. Osteoporosis at lumbar spine and osteopenia at the femoral neck
d. Osteopenia at lumbar spine and osteoporosis at the femoral neck
e. Normal bone density
Which of the features in her history and DEXA confers the greatest risk of a future insufficiency fracture?
a. Age
b. Smoking
c. Maternal osteroporosis
d. Existing fractured wrist
e. Bone density on DEXA
d. Existing fractured wrist
In an ovulatory cycle, which of the following hormones has the greatest elevation in the luteal phase relative to the follicular phase of the menstrual cycle?
a. Gonadotropin release hormone
b. Luteinising hormone
c. Oestrogen
d. Progesterone
e. Prolactin
d. Progesterone
A 28yr woman has an oral glucose tolerance test.
Fasting glucose 6.9
2hr glucose 10.8
Which one of the following is the most correct diagnosis?
a. Impaired fasting glucose
b. Type 2 diabetes
c. Impaired glucose tolerance
d. Gestational diabetes
e. Impaired fasting glucose and impaired glucose tolerance
e. Impaired fasting glucose and impaired glucose tolerance
A 62yr mam with type 2 diabetes has microalbuminuria and his blood pressure is 140/90 mmHg. He is intolerant of an ACE inhibitor due to cough. What antihypertensive agent would you prescribe for this patient?
a. a blocker
b. b blocker
c. Ca channel blocker
d. ARB
e. Thiazide diuretic
ARB
In which area of the brain are appetite and satiety predominantly regulated?
a. Pons
b. Amygdala
c. Hypothalamus
d. Anterior pituitary
e. Frontal lobe
Hypothalamus
If a laboratory hormone assay is repeated three times on the same blood sample and provides really similar results, which of the following can be concluded?
a. The assay is precise
b. The assay is accurate
c. The result is clinically important
d. There is low intra-individual variability of the hormone
e. There is low inter-individual variability of the hormone
a. The assay is precise
A 35yr Somalian woman who has been in NZ for 5 years is investigated for an incidental finding of low serum calcium. Her results are:
Corrected calcium 2.1 (2.15-2.55)
Phosphate 0.75 (0.78-1.43)
PTH 8.3 (1.8-5.6)
Creatinine 95 (49-90 in females)
24hr urinary calcium 1.2 (1-5)
a. Primary hyperparathyroidism
b. Familial hypocaliuric hypercalcaemia
c. Sarcoidosis
d. Renal impairment
e. Vitamin D deficiency
Vit D deficiency
A 54yr man is investigated for an incidental finding of an elevated serum calcium. His results are:
correct Ca 2.59 (up)
PTH up
Vit D very slightly low
Creatinine N
24hr urinary Ca 4.2 (1-5)
What is the most likely explanation of this pattern?
a. Primary hyperparathyroidism
b. Familial hypocaliuric hypocalcaemia
c. Sarcoidosis
d. Malignancy
e. Vit D deficiency
Primary hyper-PTH
A 24yr woman presents with palpitations and sweating. She has become increasingly anxious and not sleeping well. Her weight has reduced by 5kg down to 52kd. You suspect that she may be thyrotoxic. What is the first test you should do?
a. Thyroglobulin
b. TSH
c. Free T4
d. Thyroid ultrasound
e. Nuclear medicine thyroid scan
TSH
A 45yr man presents with a lump in his neck that he noticed when putting on his tie. An ultrasound scan reveals solitary nodule in the right lobe of the thyroid measuring 3.2cm in maximal diameter. A nuclear medicine scan is performed
Nodule does not take up iodine.
What is the most appropriate next step in management of this patient?
a. Reassure that nodule is benign
b. Perform a FNA of the nodule
c. Treat with carbimazole
d. Perform thyroidectomy
e. Treat with low dose radioactive iodine
b. Perform a FNA of the nodule
A 23yr woman presents with difficulty completing her usual 10km run. She has lost 4kg weight despite feeling hungry and increasing her food intake. She has no family history of thyroid disease. Her thyroid function tests are:
TSH <0.05 (0.35-3.6)
Free T4 57.6 (10.5-21.2)
Free T3 16.4
Thyroid antibodies negative
Uniform too much uptake across entire thyroid
The most likely explanation of her symptoms is?
a. Graves disease
b. Toxic multinodular goitre
c. Solitary toxic nodule
d. Post viral thyroiditis
e. Hashimoto’s thyroiditis
a. Graves disease
Most clinically significant hormone affected in pituitary apoplexy? Answers:
c. Cortisol
d. Prolactin
e. Growth Hormone
f. thyroid
g. oestrogen
c. Cortisol
