Endocrine

Question 1

Modifiable risk factor for Grave’s?

Answer 1

Smoking

Question 2

Management of an asymptomatic patient with raised HbA1c?

Answer 2

Repeat test to confirm diagnosis

Question 3

Management of fluids in SIADH?

Answer 3

Fluid restriction

Question 4

What 3 endocrine parameters decrease in stress response?

Answer 4

Insulin
Testosterone
Oestrogen

Question 5

ABG in Cushing’s?

Answer 5

Hypokalaemia metabolic alkalosis

Question 6

Which diabetic drug has increased risk of bladder cancer?

Answer 6

Pioglitazone (thiazolidinediones)

Question 7

Management of Grave’s disease in pregnancy?

Answer 7

Propylthiouracil

Question 8

Biochemistry in primary hyperparathyroidism?

Answer 8

Raised ALP, PTH
Low PO4

Question 9

Cause of tertiary hyperparathyroidism?

Answer 9

Ongoing hyperplasia of parathyroid glands following correction of underlying cause

Question 10

Differentiation between primary and secondary hyperaldosteronism?

Answer 10

Primary = normal renin
Secondary = raised renin

Question 11

Thyroxine in osteoporosis ?

Answer 11

Increase replacement dose

Question 12

Uptake of iodine-131 on thyroid scintigraphy in De Quervian’s (subacute) thyroiditis?

Answer 12

Decreased

Question 13

TFTs in sick euthyroid syndrome?

Answer 13

TSH: normal
T3&4: low

Question 14

SIADH urine osmolality and urinary sodium?

Answer 14

Raised urinary osmolality
Raised urinary sodium
(management with fluid restriction)

Question 15

TFTs in nephrotic syndrome?

Answer 15

May be isolated low total thyroxine level

Question 16

Type of diabetes that Lithium causes?

Answer 16

Nephrotic Diabetes Insipidus

Question 17

In DM with CVD, high risk of CVD or CHF, what 2 drugs should be prescribed initially?

Answer 17

Metformin and SGLT-2 inhibitors (empagliflozin)

Question 18

SGLT2 inhibitors example?

Answer 18

Gliflozins

Question 19

SE of SGLT2 inhibitors?

Answer 19

Thrush
Noroglycaemic ketoacidosis
Fournier’s gangreen

Question 20

SE of pioglitazone and therefore when is it contraindiacted?

Answer 20

Fluid retention in HF

Question 21

Where do antibodies target in pemphigus vulgarism?

Answer 21

Desmosomes (connect cells)
Easily ruptured vesicles
Common in Ashkenazi Jewish population

Question 22

False raised HbA1c?

Answer 22

Splenectomy (due to increased lifespan on RBCs)

Question 23

Thyroid cancer with excellent prognosis?

Answer 23

Papilliary (even though early spread to cervical lymph nodes)

Question 24

Initial therapy in DM2 with metformin an SGLT2?

Answer 24

Ensure metformin is titrated up first, then start SGLT2 regardless of glycemic control

Question 25

Example of DPP4 inhibitor?

Answer 25

Sitagliptin Saxagliptin

Question 26

Diagnostic marker for carcinoid syndrome (24 hour urinary collection)?

Answer 26

5 HIAAA (5-hydroxyindolacetic acid)

Question 27

Use of ocreotide?

Answer 27

Acromegaly Symptom control (diarrhoea) of carcinoid tumours

Question 28

When do you treat sub-clincal hypothyroidism?

Answer 28

When TSH is > 10 on 2 separate occasions, 3 months apart

Question 29

Trousseau's sign?

Answer 29

Carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic

Question 30

Chvostek's sign?

Answer 30

Tapping over parotid causes facial muscles to twitch

Question 31

What causes patchy uptake on scintigraphy?

Answer 31

Toxic multinodular goitre

Question 32

Addison's patient with intercurrent illness?

Answer 32

Double hydrocortisone Same fludricortisone

Question 33

Why do you get a postural drop in DM?

Answer 33

Autonomic dysfunction

Question 34

When should insulin-dependent diabetic check their blood glucose with regards to driving?

Answer 34

Before driving and every 2 hours regardless of whether they have eaten or not

Question 35

Levothyroxine and pregnancy?

Answer 35

Women with hypothyroidism may need to increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy

Question 36

Inheritance of MODY?

Answer 36

Autosomal dominant

Question 37

Acropatchy?

Answer 37

Clubbing with hyperthyroidism (Grave's disease)

Question 38

Iodine uptake in Grave's disease?

Answer 38

Increased homogenous uptake

Question 39

Increased IGF-1 on bloods, what investigation do you do next to confirm diagnosis?

Answer 39

OGTT with serial GH measurement

Question 40

DVLA and dm patient with 2 hypoglycaemic episodes requiring help?

Answer 40

Need to surrender their driving licence

Question 41

Impaired fasting glucose definition?

Answer 41

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG) Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Question 42

What should people with impaired glucose tolerance receive?

Answer 42

Oral glucose tolerance test to rule out a diagnosis of diabetes A result below 11.1 mmol/l but above 7.8 mmol/l indicates that the person doesn't have diabetes but does have IGT

Question 43

Whipple's triad?

Answer 43

Insulinoma 1. Hypoglycaemia with fasting or exercise 2. Reversal of symptoms with glucose 3. Recorded low CBG at time a symptoms

Question 44

C-peptide raised?

Answer 44

Insulin produced by own pancreas If c-peptide not raised = exogenous insulin

Question 45

Sevelamer?

Answer 45

Non-calcium based phosphate binder, used in CKD mineral bone disease

Question 46

Platelets in alcoholics?

Answer 46

Decreased

Question 47

Men I

Answer 47

3 p's Pituitary Pancreas Parathyroid

Question 48

Men 2

Answer 48

Phaeochromocytoma Parathyroid Medullary thyroid cancer