Endocrine

Question 1

Thyrotoxicosis

Answer 1

• Preference for cooler weather
• Weight loss
• Polyphagia
• Palipitations
• Increased sweating
• Nervousness
• Irritability
• Diarrhoea
• Amenorrhea
• Muscle weakness
• Exertional dyspnoea

Question 2

Hypothyroidism

Answer 2

• Preference for warmer weather
• Lethargy
• Oedema of eyelids
• Hoarse voice
• Constipation
• Coarse skin
• Hypercarotinaemia

Question 3

Diabetes Mellitus

Answer 3

• Polyuria
• Polydipsia
• Thirst
• Blurred vision
• Weakness
• Infections
• Groin itch, rashes
• Weight loss
• Tiredness
• Lethargy
• Disturbance of conscious state

Question 4

Hypoglycaemia

Answer 4

• Morning headeaches
• Weight gain
• Seizures
• Sweating

Question 5

Primary Adrenal Insufficiency

Answer 5

• Pigmentation
• Tiredness
• Loss of weight
• Anorexia
• Nausea
• Diarrhoea
• Nocturia
• Mental changes
• Seizures (hypotension and hypoglycaemia)

Question 6

Acromegaly

Answer 6

• fatigue
• weakness
• increased sweating
• heat intolerance
• weight gain
• enlarging hands and feet
• enlarged and coarsened facial features
• headaches
• decreased vision
• voice change
• decreased libido
• impotence

Question 7

Cushing’s syndrome

Answer 7

• truncal obesity
• purple striae
• moon-like facies
• buffalo hump
• myopathy
• bruises

Question 8

Causes of Midline Neck Swellings

Answer 8

• Goitre (moves up on swallowing)
• Thyroglossal cyst (moves on stickign out tongue)
• Submental LN’s.

Question 9

Causes of Lateral Neck Swellings

Answer 9

• LN’s.
• Submandibular gland
• Parotid gland
• Skin
  
  • Sebaceous cyst
  • Lipoma
• Lymphatics
  
  • cystic hygroma
• Carotid artery
  
  • aneurysm
  • tumour
• Pharynx
  
  • pharyngeal pouch
  • branchial cyst
• Parathyroid gland (very rare)

Question 10

Differential of a thyroid nodule

Answer 10

• Carcinoma (5%) - fixed, palpable LN’s, vocal cord paralysis, hard.
• Adenoma - mobile, no local associated features
• Big nodule in a multinodular goitre

Question 11

Causes of a diffuse goitre

Answer 11

• idiopathic
• puberty or pregnancy
• thyroiditis
  
  • hashimoto’s
  • subacute(tender)
• simple goitre of iodine deficiency
• goitrogens - iodine, lithium, other drugs
• inborn errors of thyroid hormone synthesis

Question 12

Causes of a solitary thyroid nodule

Answer 12

• Benign
  
  • dominant nodule in multinodular goitre
  • degeneration or haemorrhage into a colloid cyst or nodule
  • follicular adenoma
  • simple cyst (rare)
• Malignant
  
  • carcinoma
  • Lymphoma (rare)

Question 13

Causes of exopthalmos

Answer 13

• Bilateral
  
  • graves disease
• Unilateral
  
  • Tumours of the orbit
  • cavernous sinus thrombosis
  • grave’s disease
  • pseudotumours of the orbit

Question 14

Causes of thyrotoxicosis

Answer 14

• Primary
  
  • graves disease
  • toxic multinodular goitre
  • toxic adenoma
  • Hashimoto’s thyroiditis early in its course
  • subacute thyroiditis (transient)
  • Post-partum thyroiditis (non-tender)
  • Iodine -induced (after previously deficient diet)
• Secondary
  
  • TSH hypersecretion from pituitary
  • HCG secretion from hydatiform mole or choricarcinoma(rare)
  • Struma ovarii (rare)
  • Drugs - excess TH ingestion, amiodarone

Question 15

Causes of hypothyroidism

Answer 15

• Primary
  
  • Without a goitre
    
    • idiopathic atrophy
    • treatment of thyrotoxicosis
    • agenesis or lingual thyroid
    • unresponsiveness to TSH
  • With a goitre
    
    • chronic autoimmune disease (Hashimoto’s)
    • Drugs - lithium or amiodarone
    • Inborn errors
    • Iodine defiency
• Secondary: Pituatary lesions
• Tertiary:Hypothalamic lesions
• Transient
  
  • thyroid hormone treatment withdrawn
  • subacute thyroiditis
  • postpartum thyroiditis

Question 16

Neuro of Hypothyroidism

Answer 16

• Common
  
  • Entrapment :carpal tunnel
  • Delayed ankle jerks
  • Muscle cramps
• Uncommon
  
  • peripheral nueropathy
  • proximal myopathy
  • psychosis
  • coma

Question 17

Causes of hypopituitarism

Answer 17

• Space occupying lesions
• iatrogenic (surgery or irradiation)
• Head injury
• Sheehan’s syndrome
• Empty sella syndrome
• Infarction or pitiutary apoplexy
• idiopathic

Question 18

Male Tanner Staging

Answer 18

1. Preadolescent
2. enlargement of testes and scrotum
3. lengthening of penis
4. increase penis breadth, glans development and scrotal darkening
5. adult - all of the above and pubic hair spreading to medical surface of the thighs

Question 19

Female Tanner Staging

Answer 19

• Breasts
  
  1. preadolescent
  2. breast bud - elecation of breasts and papilla
  3. enlargement of breast and areola - no separation of contours
  4. areola and papilla project above breast level -secondary mound
  5. adult - areola is recessed and papilla projects
• Pubic hair
  
  1. no pubic hair
  2. sparse growth, mainly over labia
  3. darker, coarser, more curled hairs but sparse over the junction of the pubes
  4. adult type hair but no spread to the medial thighs
  5. adult horizontal pattern and hair spread to medial thighs

Question 20

Causes of Cushing’s syndrome

Answer 20

• exogenous administration of excess steroids or ACTH
• Adrenal hyperplasia
  
  • secondary to pituitary ACTH production(Cushings disease)
  • microadenoma
  • macroadenoma
  • pituitary-hypothalamic dysfunction
  • secondary tto ACTH producing tumours
• Adrenal neoplasia, adenoma or carcinoma

Question 21

Causes of Addison’s Disease

Answer 21

• Chronic
  
  • Primary
    
    • Autoimmune adrenal disease
    • Infection (TB, HIV)
    • Granuloma
    • Follwing heparin therapy
    • Malignant infiltration
    • Haemochromatosis
    • Adrenoleucodystrophy
  • Secondary
    
    • Pituitary or hypothalamic disease
• Acute
  
  • Meningococcal septicaemia
  • adrenalectomy
  • any stress in a patient with chronic hypoadrenalism or abrupt cessation of prolonged high dose steroid therapy

Question 22

Combinations in automimmune polyglandular syndromes

Answer 22

• Type 1 (rare autosomal recessive)
  
  1. Chronic mucocutaneous candidiasis
  2. Hypoparathyroidism
  3. Addison’s disease
• Type 2 (more common)
  
  1. Type 1 DM
  2. Autoimmuine thyroid disease
  3. Addison’s disease
  4. Myasthenia gravis
  5. Pernicious anaemia
  6. Primary gonadal failure

Question 23

Causes of hypercalcaemia

Answer 23

• primary hyperparathyroidism
• carcinoma
• thiazide diuretics
• vitamin d excess
• thyrotoxicosis
• associated with renal failure
• multiple myeloma
• familial hypocalciuric hypercalcaemia
• prolonged immobilisation or space flight

Question 24

Causes of hypocalcaemia

Answer 24

• hypoparathyroidism
• malabsorption
• vitamin d deficiency
• chronic renal failure
• acute pancreatitis
• pseudohyperparathyroidism
• magnesium deficiency
• hypocalcaemia of malignant disease

Question 25

Causes of hirsutism

Answer 25

* PCOS * idiopathic * androgen secreting tumours * drugs - phenytoin, diazoxide, streptomycin, anabolic steroids * acromegaly * porphyria cutanea tarda

Question 26

Causes of pathological gynaecomastia

Answer 26

* Increased oestrogen production * leydig cell tumour * adrenal carcinoma * bronchial carcinoma (HCG) * liver disease * thyrotoxicosis * starvation * decreased androgen production * klinfelter's syndrome * secondary testicular failure * testicular feminisation syndrome * Drugs * oestrogen receptor binders - oestrogen, digoxin, marijuana * anti-androgens - spirinolactone, cimetedine

Question 27

Diagnostic critera for DM

Answer 27

* fasting plasma venous blood sugar level of 7.0mmol/L or more * 2 hour postprandial blood sugar level of 11.1mmol/L or more on more than 1 occasion

Question 28

Causes of DM

Answer 28

1. Type 1 * Type 1 A - autoimmune destruction of B cells * Adult-onset type 1 (islet cell antibodies) 2. Type 2 - insulin deficieny and resistance 3. Other types * mutations leading to abnormalities of b cell function * inherited defects of inuslin action * disease of the exocrine [ancreas * endocrine abnormalities * drug induced - steroids, COC, phenytoin, thiazide diuretics * infections like CMV, coxsackie and rubella 4. Gestational diabetes

Question 29

Cushing's

Answer 29

Signs that suggest adrenal carcinoma * palpable abdominal mass * virilisation in the female * gynaecomastia Signs that suggest ectopic ACTH production * absence of cushingoid body habitus * more prominent oedema and hypertension * marked muscle weakness Hyperpigmentation suggests and extrra adrenal tumour or enlargement of an ACTH secreting pituatary adenoma.

Question 30

MEN syndromes

Answer 30

MEN Type 1 (chromosone 11) * parathyroid tumour * pituitary tumour * tumour of pancreatic islet cells MEN Type 2 a(chromosome 10) * medullary carcinoma of the thryoid * hyperparathyroidism * phaeochromocytoma MEN Type 2 b * mucosal neuroma's * medullary thyroid ca * phaechromocytoma

Question 31

Complications of proptosis

Answer 31

* chemosis (oedema of the conjunctiva and injection of the sclera) * conjunctivitis * corneal ulceration * optic atrophy * opthalmoplegia

Question 32

Anaemia in hypothyroidism

Answer 32

* chronic disease * folate deficiency due to bacterial overgrowth * Vit B12 deficiency due to associated pernicious anaemia * Iron deficiency due to menorrhagia

Question 33

Presentation of Pituitary tumours

Answer 33

* local effects such as headaches, visual field loss and loss of acuity * changes in pituitary hormone secretion * excess GH -\> acromegaly * excess ACTH -\> cushings * excess prolactin -\> galactorrhea, secondary amenorrhea, male infertility * excess TSH -\> hyperthyroidism

Question 34

Order of loss of hormone production in panhypopituitarism

Answer 34

* GH leading to dwarfism in children and insulin sensitivty in adults * Prolactin leading to failure of lactation after delivery * Gonadotrophins leasing to loss of secondary sexual characteristics, amenorrhea in women, and loss of libido and inferitlity in men * TSH leading to hypothyroidism * ACTH leading to hypoadernalism(loss of secondary sexual hair due to androgens)