Endo

Question 1

Most aggressive subtype of thyroid ca which is often diagnosed late?

Answer 1

Anaplastic

Question 2

Type of thyroid ca: typically upper lobe ca, typically facial flushing and diarrhoea
- what syndrome is is associated with?

Answer 2

Medullary thyroid ca
- flushing and diarrhoea due to calcitonin secretion

• MEN2!

Question 3

Most common type of thyroid ca?
Common iatrogenic cause

Answer 3

Papillary (popullary haha)
- caused by radiation to head and neck often, seen in children ++

Question 4

Top 3 causes of high prolactin

Answer 4

Prolactinoma
Hypothyroidism (TRF stimulates both TSH and prolactin)
Drugs - dopamine antagonists

Question 5

HbA1c targets in T2DM

Answer 5

For lifestyle only or + drug which doesn’t cause hypoglycaemia - aim 48

If on sulfonylurea/other hypoglycaemic drug - aim 53

Question 6

State the indications for commencing SGLT2 inhibitors in T2DM at time of diagnosis

Answer 6

1st establish metformin therapy.
Then add sglt2 if:
Established CVD
Heart failure
QRISK >10%

Question 7

TFT levels in sick euthyroid syndrome?

Answer 7

Low T4/T3
Normal TSH
- no sx of clinical hypothyroidism

Question 8

TFT levels in sick euthyroid syndrome?

Answer 8

Low T4/T3
Normal TSH
- no sx of clinical hypothyroidism

Question 9

Cause of primary haemochromatosis

Answer 9

HFE gene mutation (auto recessive)

Question 10

Diabetes mellitus
Skin pigmentation
Liver cirrhosis

Diagnosis?

Answer 10

Haemochromatosis

Question 11

Diabetes mellitus
Skin pigmentation
Liver cirrhosis

Diagnosis?

Answer 11

Haemochromatosis

Question 12

Liver disease
+ psychiatric disorder

Diagnosis?

Answer 12

Wilson’s disease

Question 13

What is cushings disease

Answer 13

Pituitary ACTH secreting tumour

Question 14

Most common cause of Cushing’s syndrome?

Answer 14

Pituitary Adenoma (Cushings disease)

Question 15

Dexamethasone suppression test
- if low dose is given, what is the result in:

• adrenal adenoma
• ectopic ACTH secreting tumour
• pituitary tumour

Answer 15

No suppression of cortisol in any of them

Question 16

High dose dexamethasone suppression test - what is the cortisol level in each scenario

• adrenal adenoma
• ectopic ACTH (aka secreting tumour)
• pituitary adenoma

Answer 16

A high dose of Dex would ordinarily exert negative feedback on PITUITARY ACTH production, and subsequent cortisol release would decrease

• adrenal adenoma: no suppression
• ectopic ACTH: no suppression
• pituitary adenoma: suppression of cortisol release

Question 17

Biochemistry abnormality in Wilson’s disease

Answer 17

Low caeruloplasmin

Question 18

What is pseudohypoparathyroidism

Answer 18

Low Ca and high PTH

Caused by an inherited resistance to PTH

Question 19

impaired fasting glucose

Answer 19

6-7

Question 20

impaired glucose tollerance

Answer 20

7.8 - 11 for 2 hour OGTT

Question 21

best blood test in suspected acromegaly?

Answer 21

IGF1

Question 22

best blood test in suspected addisons?

Answer 22

short synacthen test

Question 23

Cushings disease vs syndrome?

Answer 23

disease = pituitary tumour secreting ACTH

Question 24

1st line test in suspected cushings syndrome

Answer 24

overnight dexamethasone suppression
- Cortisol will be high the following morning in Cushings

Question 25

Fibrosis of the thyroid - rock hard neck lump

Answer 25

Riedels thyroiditis

Question 26

most common type of thyroid malignancy?

Answer 26

Papillary

Question 27

2 drugs which can cause DM

Answer 27

steroids thiazides

Question 28

milk alkali syndrome - triad of features

Answer 28

hypercalcemia metabolic alkalosis renal failure

Question 29

secondary hyperparathyroidism Ca, phosphate, PTH levels?

Answer 29

CKD --> low calcitriol + kidneys unable to excrete phosphate - low Ca - high phosphate (and this binds to Ca and uses it all up!!) - high PTH

Question 30

ECG changes in hyper and hypocalcemia

Answer 30

hypercalcemia - osborn wave hypocalcemia - QT prolongation

Question 31

vitamin D deficiency Ca, phosphate, PTH levels?

Answer 31

unable to synthesise calcitriol - low Ca - low PTH - high PTH

Question 32

secondary vs tertiary hyperparathyroidism

Answer 32

secondary is due to CKD --> lowcalcitriol and low Ca--> high PTH in response tertiary is due to prolonged secondary hyper PTH --> autonomous PTH secretion . therefore high ca and low PO4

Question 33

what is pseudohypoparathyroidism

Answer 33

resistance to PTH hormone.

Question 34

how to calculate anion gap

Answer 34

(Na+K)-bicarb - chloride

Question 35

most common cause worldwide of non toxic goitre

Answer 35

iodine deficiency

Question 36

3 top causes of high prolactin

Answer 36

1. prolactinoma 2. hypothyroidism 3. dopamine antagonist = domperidone, metoclopramide

Question 37

De Quervains thyroiditis what is it

Answer 37

Hyperthyroidism and fever followed by hypothyroidism (TSH suppressed and T4 supplies run out)

Question 38

Most common neurological manifestation of diabetes? Most serious neuro manifestation ?

Answer 38

Gustatory sweating most serious - postural hypotension

Question 39

pt is tired TSH high, T4 normal. has no thyroid autoantibodies. what do you do next?

Answer 39

i.e. subclinical hypothyroidism - repeat tests in 3 months

Question 40

congenital adrenal hyperplasia -how does it present in girls vs boys - key blood tests x2

Answer 40

girls: typically with ambiguous genitalia at birth boys: normal genitalia therefore present at 1 week old with salt losing crisis 17 hydroxyprogesterone - high if 21-a-hydroxylase deficiency short synACTHen test - will result in low cortisol if the non-salt losing form

Question 41

adrenocortical insufficiency in pt with meningitis - diagnosis

Answer 41

Waterhouse Friederichsen

Question 42

Features of MEN1

Answer 42

3Ps - PTH high - Pituitary tumour - Pancreatic islet cell tumour

Question 43

Features of MEN2a vs 2b

Answer 43

Both MEN2s have: - Medullary THYROID ca - Phaeochromocytoma 2a) - high PTH 2b) - Marfanoid