Endocrine

Question 1

What HbA1C level is diagnostic of diabetes mellitus?

Answer 1

48mmol/L or more

Question 2

What is the immediate treatment for thyrotoxic storm?

Answer 2

Beta-blockers, PTU and Hydrocortisone

Question 3

What is the investigation of choice for suspected Cushing’s?

Answer 3

Overnight dex suppression test

Question 4

Where are sex hormones produced?

Answer 4

Zona reticularis of adrenal gland

Question 5

Where is cortisol produced?

Answer 5

Zona fasciculata of adrenal gland

Question 6

Where is aldosterone produced?

Answer 6

Zona glomerulosa of adrenal gland

Question 7

Which adrenal condition may lead to Cushing’s syndrome?

Answer 7

Adrenocortical tumour

Question 8

What is Addison’s disease?

Answer 8

Primary adrenocortical failure

Question 9

Give causes of Addison’s disease.

Answer 9

90% due to autoimmune destruction

Others: Infection, adrenal haemorrhage/infarct, metastatic invasion

Question 10

What are the features of Addison’s disease?

Answer 10

Cortisol deficiency: Fatigue, weight loss, orthostatic dizziness and anorexia
ACTH over-secretion: Skin hyperpigmentation

Question 11

Give causes of Addisonian Crisis.

Answer 11

Can occur in increased cortisol req. Eg. infection, surgery
Adrenal haemorrhage
Inadequate cortisol dosing

Question 12

Which biochemical abnormalities may be found in Addisonian Crisis?

Answer 12

hyponatraemia, hyperkalaemia, raised urea

Question 13

What is the maintenance therapy for Addison’s disease?

Answer 13

Hydrocortisone & Fludrocortisone

Question 14

What is Conn Syndrome?

Answer 14

Primary Hyperaldosteronism - excess aldosterone production

Question 15

What is the most common cause of Conn’s syndrome?

Answer 15

unilateral adrenocortical adenoma

Question 16

What is the key feature of Conn Syndrome?

Answer 16

Resistant hypertension +/- hypokalaemia

Question 17

What is the investigation of choice in Conn Syndrome?

Answer 17

paired renin and aldosterone serum levels

Question 18

What is the treatment for pheochromocytoma?

Answer 18

alpha blocker then beta-blocker, then surgery

Question 19

What is the most common form of Congenital Adrenal Hyperplasia?

Answer 19

21-hydroxylase deficiency

Question 20

How may CAH present?

Answer 20

failure to thrive or ambiguous genitalia in females

Question 21

How can serum osmolality be estimated?

Answer 21

2 * Na+ + glucose + urea

Question 22

How do gliptins work?

Answer 22

Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1

Question 23

What should diabetics patients who are on insulin do if they are unwell?

Answer 23

Continue with normal insulin regimen but check blood sugars more frequently

Question 24

What is the first-line agent for Grave’s disease?

Answer 24

Carbimazole

Question 25

What glucose level is diagnostic of diabetes?

Answer 25

fasting > 7.0, random > 11.1 - if asymptomatic need two readings

Question 26

High glucose and normal C-peptide would suggest...

Answer 26

T2DM

Question 27

Glicazide is an example of which class of medication?

Answer 27

Sulphonylurea

Question 28

Sitagliptin is an example of which medication class?

Answer 28

DDP-4 inhibitor

Question 29

Dapagliflozin is an example of which drug class?

Answer 29

SGLT2 inhibitor

Question 30

Which diabetic medications can cause weight loss?

Answer 30

GLP-1 agonists, SGLT2 inhibitors

Question 31

Which diabetic medications are associated with hypoglycaemia?

Answer 31

Insulin, SUs, TZDs

Question 32

What is the investigation of choice for phaeochromocytoma?

Answer 32

24 hour urine collection of metanephrines

Question 33

painful thyroid swelling, usually triggered by a viral infection suggests...

Answer 33

De Quervain’s thyroiditis

Question 34

Which auto-antibodies are associated with Grave's disease?C

Answer 34

Anti-TSH and anti-TPO

Question 35

What is the first-line agent for Grave's disease?

Answer 35

Carbimazole

Question 36

How is Grave's disease treated in pregancy?

Answer 36

1st trimester = PTU | 2nd and 3rd = Carbimazole

Question 37

Reduced uptake on thyroid uptake scan suggests...

Answer 37

Thyroiditis

Question 38

Which complication can occur with Carbimazole?

Answer 38

Agranulocytosis

Question 39

Hashimoto's thyroiditis is associated with which auto-antibodies?

Answer 39

anti-TPO and anti-thyroglobulin

Question 40

What is the most common type of thyroid cancer?

Answer 40

Papillary

Question 41

Thyroid mass and raised calcitonin suggests...

Answer 41

Medullary thyroid cancer

Question 42

What is the rarest and most aggressive form of thyroid cancer?

Answer 42

Anaplastic

Question 43

What is the treatment for myxoedema coma?

Answer 43

IV Thyroxine & Hydrocortisone

Question 44

What is the first-line treatment for prolactinoma?

Answer 44

Dopamine agonist such as Cabergoline/Bromocriptine

Question 45

In DKA, should patients continue their normal insulin?

Answer 45

Continue long-acting but stop short-actin

Question 46

How many readings are needed to diagnose diabetes?

Answer 46

2 if asymptomatic, 1 if symptomatic

Question 47

What is the treatment for HHS?

Answer 47

Saline solution

Question 48

Which HbA1C level indicates that another anti-diabetic agent should be considered?

Answer 48

> 58 mmol/L

Question 49

What is the diagnostic test for Addison's disease?

Answer 49

Short synacthen test

Question 50

Which medication should always be initiated in diabetic patients with CVD?

Answer 50

SGLT2 inhibitor

Question 51

Which anti-diabetic medications promote weight loss?

Answer 51

SGLT2 inhibitor and DDP4-inhibitors

Question 52

Which anti-diabetic agents promote weight gain?

Answer 52

Insulin, SUs, TZDs, glinides

Question 53

Which anti-diabetic agents are associated with hypoglycaemia?

Answer 53

Insulin, SUs, TZDs, glinides