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Question 1

Pioglitazone side effects

Answer 1

Weight gain
Fractures
Fluid retention (C.I HF)
bladder cancer
Liver impairment

Question 2

Ix Cushings syndrome

Answer 2

24h urinary cortisol

Overnight dexamethasone suppression test
Pitadenoma-high dose -> reduced.cortisol,highACTH

ACTH low, cortisolnoteffected ->adrenal adenoma, (cushings syndrome)

high acth, unaffected cortisol -> ectopic acth

Question 3

Raised prolactin effect

Answer 3

Impotence, libido loss, galactorrhea

women : amenorrhea, galactorrhea

Question 4

Causes of raised prolactin

Answer 4

Prolactinoma
pregnancy
oestrogens
stress, exercise, sleep
acromegaly
PCOS
Hypothyroid
Metoclopramide, domperidone
phenothiazines
haloperidol
SSRIs, opioids

Question 5

drug cause of hypercalcaemia

Answer 5

thiazide

Question 6

Levothyroxine in pregnancy

Answer 6

increase dose by 50% at 4-6w

increase in TBG
measure TSH in each trimester.
breastfeeding safe.

Question 7

dx HHS

Answer 7

hypovolaemia
glucose>30
serum osmolality >320

Question 8

Mx HHS

Answer 8

Fluid replace0.9% saline
positive balance of 3-6 L by 12h

monitor serum osmolarity, glucose, sodium .

Question 9

Addisons causes

Answer 9

sepsis
surgery -> exacerbations
adrenal haemorhage
steroid withdrawal

Question 10

Mx addisons

Answer 10

100mg Hydrocortisone IM /IV
1 litre saline + dextrose 30-60m
continue steroids 6hly until stable
continue maintainence after 24h

Question 11

tx prolactinoma

Answer 11

bromocriptine

Question 12

pituitary adenoma ix

Answer 12

bloods - GH, prolatin, ACTH, FSH, LH, TFTs
formal visual field testing
MRI brain

Question 13

de quervains phases

Answer 13

1. hyperthyroid. painful goitre ESR
2. euthyroid
3. hypothyoid
4. normal

Question 14

thyroid globally reduced uptake

Answer 14

de quervains

Question 15

Thyrotoxic storm

Answer 15

b blocker
propothyouracil
hydrocortisone

Question 16

Causes of bitemporal hemianopia

Answer 16

Neoplastic 
- pituitary macroadenoma
-suprasellar meningioma
craniopharyngioma
chiasmatic glioma

Non neoplastic
aneurysm /ectatic carotid artery
epidermoid cyst
sarcoid
dermoid cyst

Question 17

Causes of carpal tunnel syndrome

Answer 17

Idiopathic
soft tissue swelling
pregnancy
menopause
gout
acromegaly
rheumatoid
myxoedmea
amyloidosis

Question 18

Features of acromegaly

Answer 18

Prognathism
cardiomegaly
Colonic polyps
macroglossia
hepatosplenomegaly
30-50

Question 19

Ix acromegaly

Answer 19

OGTT + measure GH
-failure of normal suppression of GH to < 2 in response to glucose load.

MRI pituitary adenoma

Question 20

Mx acromegaly

Answer 20

Bromocriptine, cabergoiline
somatostatin analogues

External beam irradiation (older)

Younger, pressure sx. Transsphnoidal hypophysectomy.

Question 21

Ix cushings

Answer 21

24 h urinary free cortisol
Overnight dex suppression test.
(1mg at midnight) then check 9am cortisol
mRI pituitary, petrosal venous sinus samploing - confirm pituitary source

Question 22

Ix secondary HTN

Answer 22

CT adrenals
Renal USS
Dexsuppression test
plasma metanephrines
Renin: aldosterone ratio
MIBG scan

Question 23

Mx phaeo

Answer 23

alpha blockers - phenoxybenzamine

Question 24

SIADH ix

Answer 24

urine osmolality >100
Urine Na >40
plasma osmolality <290

Question 25

SIADH causes

Answer 25

``` Stroke, cancer lung abscess sepsis neuro disease ```

Question 26

SIADH tx

Answer 26

Mild: fluid restriction Severe: specialist - hypertonic NaCl 1.8% , controlled. Demeclocycline if resistant.

Question 27

Mx malignancy related hypercalcemia

Answer 27

IV fluids | Bisphosphonates (oral/IV)

Question 28

Growth hormone deficiency in adults symptoms

Answer 28

``` Anxiety and depression body fat waist increase low libido fatigue isolation heat and cold sensitivity ``` Ix: AGHDA questionarre Blood tests.

Question 29

Thyroid storm precipitants

Answer 29

``` Thyroid/non thyroid surgery trauma infection acute iodine load (ct contrast media) DKA MI ```

Question 30

thyroid storm features

Answer 30

``` fever tachy confusion N+V HTN HF LFTs Abdo pain ```

Question 31

Thyroid storm Mx

Answer 31

``` IV fluids analgesia IV/oral propranolol Propothyouracil Hydrocortisone IV Cardiac monitoring Urgent endo review ``` Hyperthyroid mx: Carbimazole 40mg OD

Question 32

Addisons features

Answer 32

``` Mouth pigmentation tiredness SOB Wt loss Polyuria Headaches Dizziness. postural hypotension ``` Hyponatremia Hyperkalaemia raised urea. (mineralocorticoid deficiency)

Question 33

Addisons ix

Answer 33

random cortisol + matched ACTH Short synacthen test. <550 if secondary, could be normal if onset within 4weeks. if longstanding lack of ACTH, adrenals will atrophy.

Question 34

Causes of primary addisons

Answer 34

``` Autoimmune. 70% post infectous (TB, fungal, HIV) 20% ```

Question 35

Tx addisons

Answer 35

Hydrocortisone | Fludrocortisone.

Question 36

Carcinoid syndrome features

Answer 36

``` Abdo pain Diarrhoea Weight loss Flushing (worse w Etoh/exercise) Hyper/hypotension Bronchospasm Dizziness Wheezing on exercise can get cushings. ``` ``` Tumour in argentaffin cells produces 5HT. Most commonly appendix/distal ileum, 1/3 Mets (most to liver) Syndrome = Mets Asw MEN1. Tricuspid regurg/stenosis. 50-60%. ```

Question 37

Carcinoid syndrome ix

Answer 37

Plasma serotonin 24h urine 5 HIAA (check diet/drugs before) CT CAP Endoscopic ultrasound. Somatostatin receptor scintigraphy.

Question 38

Complications of Carcinoid syndrome

Answer 38

Vit B3 malabsorption (Pellagra)- diarrhoea, dementia, dermatitis. Pulmonary stenosis Hepatic mets Desmoplastic tumours in mesentery.

Question 39

Carcinoid syndrome mx

Answer 39

Antihistamines - itching and flushing. Octreotide - block release of mediateors, diminishing effect tho, Alpha interferon - reduce tumour size. Surgical resection. Ablation. Chemo. Loperamide.

Question 40

DKA features

Answer 40

``` Anorexia lethargy polydipsia polyuria dehydration abdo pain vomiting coma Hyperventilation ```

Question 41

Salicylate OD features

Answer 41

``` Dehydration Vomiting Hyperventilation Vertigo Sweating tinnitus hypokalaemia. ```

Question 42

HHS features

Answer 42

longer deterioration dehydration glucose >35 Osmolality >340

Question 43

DKA dx criteria

Answer 43

``` Glucose >11.1 /Known DM Ketonuria ++ bicarb <15 pH <7.3 metabolic acidosis with raised AG. ```

Question 44

Causes of raised AG:

Answer 44

``` phosphate lactate ketones urate salicylate/biguanides poisoning. ```

Question 45

AG equation

Answer 45

Na + K - (Cl + Hco3) = 10-18mmol/L

Question 46

Mx DKA

Answer 46

1. FLUIDS 14 G cannula in 2 ACFs 0.9% sodium chloride (1L bolus) -> 1L over 1h. then 1L over 2-4h then 1L over 4-6h. 2. INSULIN If glucose >20 + delay, IM 10U insulin. otherwise 50U insulin 50ml 0.9% Sodium chloride (0.1u/kg/h) 3. Replace Potassium .e.g. 40 mmol in 1L over 6h if <3.5 -> HDU. Cardiac monitor Monitor GCS get MSU, blood ketones, blood cultures, CXR, monitor U+Es, gucose, bicarb. at 2h, and then 4h intervals. Catheterise if no urine. aim 0.5ml/kg/h. NGT if vomiting. LMWH. aim to reduce glucose 4-6/h, and bicarb >15. and correct acidosis. once glucose <14 -> 10% dextrose. 125ml/h. Resolution Blood ketones <0.3 pH>7.3 bicarb >18. once eating, 1+ less ketonuria -> SC insulin.

Question 47

Causes of hypomagnesemia

Answer 47

GI - Diet, malabsorption, diarrhoea/vomiting, pancreatitis, alcohol. MI Renal failure, DM, DKA - insulin. Diuretics, aminoglycosides, adrenergics Symptoms: arrythmias, weakness, asthma. coma.

Question 48

Osmolality equation

Answer 48

2 (na + K) + (urea + glucose) | 280-300.

Question 49

Phaeo sx

Answer 49

``` Sweats, anxiety restlessness chest tightness palpitations HTN ``` ``` Precipitants: Stress, surgery parturition Smoking alcohol TCAs Cheese. ``` Tx: Alpha then B blockade.

Question 50

Thyroid eye disease

Answer 50

Lid lag, lid retraction More common in smokers. Graves: proptosis, periorbital oedema, diplopia, grittines, increased tears. Tx: artificial tears, eye ointment, dark glasses. Diuretics, radiotherapy for oedema visual acuity loss, colour loss -> optic nerve compression -> pred, surgery.

Question 51

Tx Hyperthyroid

Answer 51

Carbimazole 30-60mg OD -> reducing according to t4. for 12-18months/PTU. or can give block replace 40mg/day for 6months plus thyroxine if hypothyroid. B blockers - tremor, palps, agitation. Surgery - total/subtotal thyroidectomy complications: Recurrent laryngeal nerve palsy, hypoparathyroid, haematoma. Radioiodine 1311.

Question 52

Carbimazole SE

Answer 52

Agranulocytosis 0.1% Maculopapular rash 5% Pruritus Jaundice

Question 53

DM: definitions

Answer 53

``` Diabetes: Fasting glucose > 7 Glucose tolerance test (75g glucose) Plasma glucose >11.1 at 2h. ``` 2h : 7.8-11.1 = impaired glucose tolerance. impaired fasting glucose 6-7.

Question 54

Diabetic retinopathy

Answer 54

BG: Venodilation Microaneurysms Hard exudates Preproliferative: soft exudates Proliferative: new vessels.

Question 55

hypertensive

Answer 55

Silver wiring AV nipping cotton wool spots/flame haemorrhages papilloedema