Endo

Question 1

Flushing, diarrhoea, bronchospasm, tricuspid stenosis, hypotension, pellagra →
Ix?
Tx?

Answer 1

CARCinoid:
- Cutaneous flushing
- Asmathic wheezing
- RHF (tricuspid valve)
- Cramping & diarrhoea

carcinoid with liver mets
urinary 5-HIAA
somatostatin analogues e.g. octreotide

Question 2

Acromegaly is associated with which heart condition

Answer 2

cardiomyopathy

Question 3

In type 1 diabetics, recommend monitoring blood glucose __________ (frequency)______

Answer 3

at least 4 times a day, including before each meal and before bed

Question 4

liraglutide, exenatide are

Answer 4

GLP-1

Question 5

___(drug)______ reduces cerebral oedema

Answer 5

dexamethasone

Question 6

elderly man admitted to hospital with pneumonia
TSH normal, T4 reduced
what do you do?

Answer 6

nothing, sick euthyroid is common in the elderly and unwell

Question 7

Headaches, amenorrhoea, bitemporal superior quadrantanopia–>

Answer 7

polactinoma

Question 8

Addisonian crisis- tx?

Answer 8

IV hydrocortisone

Question 9

how often must T1 diabetics monitor their blood glucose?

Answer 9

at least 4 times a day, including before each meal and before bed

Question 10

tx for bilateral adrenocortical hyperplasia?

Answer 10

aldosterone antagonist e.g. spironolactone (cant do surgery as cant completely remove pts ability to produce aldosterone and cortisol)

Question 11

Endocrine parameters reduced in stress response:

Answer 11

Insulin
Testosterone
Oestrogen

Question 12

triad of sweating, headaches, and palpitations in association with severe hypertension - Ix?

Answer 12

Phaeochromocytoma - plasma and urinary metanephrines

Question 13

pioglitazone is C/I in

Answer 13

HF

Question 14

The early stages of diabetic nephropathy are associated with________, in contrast to most other causes of CKD

Answer 14

enlarged kidneys

Question 15

what BMI does someone have to be to qualify for GLP memetic tx?

Answer 15

35

Question 16

what can you use to differentiate between the different types of diabetes?

Answer 16

• c-peptide levels
• diabetic specific antibody levels (ab to glutamic acid decarboxylase or anti-GAD)

Question 17

Thyrotoxic storm is treated with ___________________________________

Answer 17

beta blockers, propylthiouracil and hydrocortisone

Question 18

clues that it’s secondary HTN and not primary

Answer 18

• persistently high or malignant blood pressure
• labile blood pressure measurements
• young age and electrolyte abnormalities

Question 19

what is tertiary hyperparathyoidism?

Answer 19

Tertiary hyperparathyroidism usually occurs after prolonged secondary hyperparathyroidism – the
glands become autonomous, and so produce excessive PTH even after the cause of hypocalcaemia (in this case, CKD 4) has been corrected; this then causes the hypercalcaemia that typifies tertiary hyperparathyroidism.

Question 20

Hyperparathyroid: which disease presents with

1. Raised PTH, raised Ca, low phosphate
2. Raised PTH, low/normal Ca, raised Phosphate, low vitamin D
3. Raised/normal Ca, raised PTH, low/normal phosphate, normal/low vit D, raised ALP

Answer 20

primary
secondary
tertiary

Question 21

1. complication of treating hyperNa
2. complication of treating hypoNa

Answer 21

1. cerebral oedeoma
2. Central pontine myelinolysis

Question 22

how to distinguish between unilateral adenoma and bilateral hyperplasia in Conn’s?

Answer 22

adrenal venous blood sampling

Question 23

Boerhaave’s syndrome

Answer 23

transmural oesophageal perforation secondary to an episode of forceful emesis

This condition typically presents with a triad of vomiting/retching; severe retrosternal chest pain, typically radiating to the back and subcutaneous emphysema

Question 24

what abx increases risk of cranial HTN?

Answer 24

doxycycline

Question 25

All proximal scaphoid pole fractures require ________

Answer 25

surgical fixation

Question 26

The PTH level in primary hyperparathyroidism may be ___________

Answer 26

normal

Question 27

features of acromegaly

Answer 27

- coare facial apperance - spade-like hands - increase in shoe size - large tongue, prognathism, interdental spaces - excessive sweating and oily skin - features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia - galactorrhoea

Question 28

complications of acromegaly

Answer 28

hypertension diabetes cardiomyopathy colorectal cancer

Question 29

Ix for acromegaly

Answer 29

1. IGF-1 + OGTT 2. OGTT should suppress GH but won't

Question 30

Tx options of acromegaly

Answer 30

1st line: acromegaly 2nd line: somatostatin analgoue (octreotide), GH receptor antagonist (pegivisomant)

Question 31

causes of hyperprolactinoma

Answer 31

- pituitary adenoma - hypothyroidism - PCOS - SE of haloperidol

Question 32

SGLT2 inhibitors should be given in addition to metformin if:

Answer 32

- pt has high risk of developing CVD (QRISK>10%)/CHF

Question 33

T2DM sick-day rules with medications

Answer 33

- don't stop insulin - stop metformin/sulfonylureas

Question 34

Pathophysiology of DKA

Answer 34

uncontrolled lipolysis which results in an excess of free fatty acids that are ultimately converted to ketone bodies

Question 35

Hashimoto's thyroiditis is associated with ________

Answer 35

MALT lymphoma

Question 36

endo syndromes that can cause hyperCa

Answer 36

acromegaly, thyrotoxicosis, Addison's

Question 37

following a change in thyroxine dose thyroid function tests should be checked after

Answer 37

8-12 weeks

Question 38

what reduces the absorption of levothyroxine?

Answer 38

iron, calcium carbonate give at least 4 hours apart

Question 39

investigation of hypopituitarism

Answer 39

insulin stress test IV insulin given, GH and cortisol levels measured with normal pituitary function GH and cortisol should rise

Question 40

what medications can reduce hypoglycaemic awareness?

Answer 40

beta-blockers

Question 41

3 types of MEN + inheritence pattern

Answer 41

AD MEN1: 3Ps - hyperparathyroid, pituitary (prolactinoma), pancreas (insulinoma, gastrinoma --> peptic ulcer) MEN2: parathyroid, phaeochromocytoma MEN3: phaeochromocytoma

Question 42

myxoedema coma - Px and Tx?

Answer 42

Px: confusion, hypothermia Tx: IV fluids, levothyroixine, corticosteroids [to cover for ?Addisons]

Question 43

alpha-blocker example

Answer 43

phenoxybenzamine

Question 44

Ix if you suspect a pituitary adenomna

Answer 44

- MRI head with contrast - formal visual field testing - pituitary blood profile (incl GH, prolactin, ACTH, FSH, LH, TFTs)

Question 45

Most common cause of primary hyperaldosteronism

Answer 45

bilateral adrenal hyperplasia

Question 46

Tx for primary Conn's?

Answer 46

spironolactone

Question 47

how does sick euthyroid syndrome present

Answer 47

TSH inappropriately normal, thyroxine and T3 low No tx, recover when recover from systemic illness

Question 48

sublinical hyperthyroidism: Ix findings and Px? Why is it bad?

Answer 48

Ix: LOW TSH, normal free thyroxine Px: multiondular goitre in elderly females Bad bc AF, osteoporosis

Question 49

sublinical hypothyroidism: Ix findings and Px? Why is it bad?

Answer 49

Ix: TSH raised, T3 and T4 normal risk of progressing to over hypothyroidism

Question 50

thyroid cancers - P-FMAL

Answer 50

Papillary (most common, young females) Follicular Medullary (secrete calcitonin, part of MEN2) Anaplastic Lymphoma (associated with Hashimoto's thyroiditis)

Question 51

what do you replace first in secondary hypothyroidism?

Answer 51

steroids before the thyroxine

Question 52

thyrotoxic storm: in addition to beta-blockers and anti-thyroid drugs, what do you give?

Answer 52

dexamethasone

Question 53

toxic multinodular goitre - Ix and Tx

Answer 53

Ix: nuclear scintigraphy reveals patchy uptake Tx: radioodine therapy

Question 54

________ is the key parameter to monitor in patients with hyperosmolar hyperglycaemic state

Answer 54

Serum osmolality

Question 55

causes of prolactin - all 'Ps'

Answer 55

pregnancy prolactinoma physiological polycystic ovarian syndrome primary hypothyroidism phenothiazines, metoclopramide, domperidone

Question 56

Patients with type I diabetes and a BMI > 25 should be considered for ______ in addition to insulin

Answer 56

metformin

Question 57

Over-replacement with thyroxine increases the risk for _________

Answer 57

osteoporosis

Question 58

Asymptomatic patients with an abnormal HbA1c or fasting glucose

Answer 58

must be confirmed with a second abnormal reading before a diagnosis of type 2 diabetes is confirmed

Question 59

_______________ is a cause of cranial diabetes insipidus

Answer 59

Hereditary haemochromatosis

Question 60

The diagnosis of type 2 diabetes mellitus (T2DM) can only be made if

Answer 60

there is one elevated glucose measurement and the presence of symptoms, or if two glucose measurements at separate time points show elevated glucose.

Question 61

Glitazones - associated with what SE

Answer 61

fractures

Question 62

_______ (diabetic drug) ____ should be stopped following a myocardial infarction

Answer 62

Metformin (risk of lactic acidosis)

Question 63

IGT itself can be defined by OGTT 2h glucose of

Answer 63

between 7.8 and 11.1mmol/L alone.

Question 64

A fasting glucose greater than or equal to_____________ implies impaired fasting glucose (IFG)

Answer 64

6.1 but less than 7.0mmol/l