Endo

Question 1

What are the low and high dose Dex suppression test findings for Cushing’s disease

Answer 1

Does not suppress with low dose

Suppresses with high dose

Question 2

Patient with Zollinger-Ellinson syndrome and Whipple’s presents with polyuria and constipation?

Answer 2

Parathyroid adenoma causing hyperPTH and hypercalcaemia

Question 3

Acarbose MoA and common side effect

Answer 3

inhibits alpha glucosidases in SI, delaying digestion of starch
SEs: diarrhoea/flatulence, (hepatoxicity)

Question 4

Antihypertensive that can increase insulin requirement

Answer 4

Bendroflumethiazide

Question 5

Grave’s ophthalmopathy treatment

Answer 5

High dose steroids

Surgical orbital decompression if refractory or vision threatened

Question 6

SEs/important contraindication of sulphonylureas

Give examples

Answer 6

Hypo
Weight gain ie. not recommended in obese
Glibenclamide, Glimepiride

Question 7

Prolactin level 9000, macro or micro adenoma?

Answer 7

If Prolactin >2000, likely macroadenoma

Question 8

Nelson’s syndrome

Answer 8

hormone secreting pituitary macroadenoma following adrenalectomy for Cushing disease

Question 9

Most commonly occurring thyroid cancer

Answer 9

Papillary thyroid cancer (70%)

Question 10

Octreotide indications and important SE

Answer 10

Indications:
VIPomes
Carcinoid tumours
Acromegaly
Glucagonomas

SE: gallstones (in long term use)

Question 11

Karyotype of Turners

Answer 11

45 X0

Question 12

Kallman’s syndrome

Answer 12

hypothalamic gonadotrophin deficiency and hypo/anosmia

Other features: craniofacial feature eg. cleft palate, nerve deafness, colourblindness

Question 13

If fasting glucose shows IFG
AND
OGTT shows IGT
what is the diagnosis?

Answer 13

Impaired glucose tolerance

Question 14

Which features are more specific for Grave’s disease than other causes of hyperthyroidism?

Answer 14

Exopthalmos
Ophthalmoplegia
Thyroid acropachy
Pretibial myxoedema

NB. NOT lid lag

Question 15

Indications for islet translplant

Answer 15

T1DM + >2 severe hypos in last 2 years + impaired awareness/warning of hypo

Question 16

Precocious puberty causes and treatment (early onset puberty)

Answer 16

Idiopathic
Harmartomas of posterior hypothalamus

Treat idiopathic with long term GnRH analogues

Question 17

Troisier’s sign

Answer 17

Palpable left supraclavicular node
~GI malignancy

Not to be confused with Trousseau’s sign (hypocalcaemia): carpopedal spasm if brachial artery occluded with BP cuff

Question 18

Pseudohypoparathyroidism presentation

Answer 18

Same blood panel as secondary hyperparathyroidism (low Ca, high PTH) but with high PO4

BUT also round face and short 4th and 5th fingers

ie. PTH Resistance

Question 19

Dumping syndrome

Answer 19

Nerve supply to stomach damage ie. fast transit into SI -> pancreas over produces insulin = hypo symptoms post-meals

Usually a complication to GI surgery. eg. fundoplication

Question 20

Karyotype and features of Klinefelters

Answer 20

47 XXY

Hypogonadism ie. little body hair, slight, gynaecomastia

Question 21

Most common hormonally active pituitary tumours

Answer 21

Eosinophilic GH secreting adenoma
Basophilic ACTH secreting adenoma
Prolactin secreting adenoma

Question 22

Persistent hyperprolactinaemia despite no symptoms, dx?

Answer 22

Macroprolactinaemia

Macroprolactin = auto-antibody complex with no biological activity

Question 23

Endo cause of hyperglycaemia + hepatosplenomegaly

Answer 23

Acromegaly (not hypoglycaemia!)

Question 24

Wolfram syndrome triad

Answer 24

T1DM (Dx <16yo) + optic atrophy + deafness

Question 25

Most likely diabetes meds to cause hypoglycaemia

Answer 25

Gliclazide

Question 26

CAH pathology and Rx

Answer 26

Excess production of androgens - little cortisol Increased ACTH causes hyperplasia Rx: Hydrocortisone

Question 27

Most common cause of secondary hypertension

Answer 27

Conns | Suspect if <40yo hypertensive

Question 28

Probable second most common cause of secondary hypertension

Answer 28

Renal disease | eg. GN, RAS (asymmetrical kidneys on scan), PKD

Question 29

Chronic fatigue syndrome definition, features, Rx

Answer 29

at least 4mo disabling fatigue affecting mental and physical functionmore than 50% of the time ``` Female>male Exertion (physical or mental) makes symptoms WORSE Palpitations PAINFUL LNs, no enlargement Muscle/joint pain Sore throat Sleep disturbance Nausea Dizziness ``` ``` Rx: CBT Graded exercise therapy "pacing" Pain team referral if dominant Low dose amitryptilline for sleep ```

Question 30

DM Dx

Answer 30

Random glucose or 2h OGTT >11.1 Fasting glucose >7 HbA1c >48 (but does not exclude if less) Asymptomatic: need above criteria twice Symptomatic: once (IFG: 6.1-7 IGT: 7.8-11.1)

Question 31

How does treatment differ for osteoporosis if on long term steroids

Answer 31

Treat if t-score <1.5 as opposed to <2.5

Question 32

Example of GLP-1 mimetic | Indication

Answer 32

Exenatide | Latter Rx for T2DM

Question 33

Skin manifestation of DM

Answer 33

Necrobiosis lipoidica Shiny painless yellow/red/brown skin on shins ~telangiectasia (unlike EN)

Question 34

Which DM med should you monitor LFT

Answer 34

Pioglitazone

Question 35

When to start primary prevention statin in T1DM

Answer 35

Nephropathy had T1DM for 10 years >40yo Other CVD RFs

Question 36

When to start primary prevention statin in T2DM

Answer 36

As per QRISK

Question 37

Commonest cause of male hypogonadism | Rx

Answer 37

Klinefelter's 47XXY (Low testosterone + gynaecomastiae) Rx: testosterone

Question 38

Pituitary tumour causing thyrotoxicosis, TFTs?

Answer 38

``` NORMAL TSH (inappropriately) High fT4 ```