Endocrine

Question 1

Management of gastroparesis in T1D

Answer 1

Motility agents e.g. metoclopramide/domperidone
Or gastric pacemaker

Question 2

Management of severe hypoglycaemia

Answer 2

200ml 10% dextrose IV
1mg/kg glucagon

Question 3

WHich of the drugs for T2D can cause lactic acidosis?

Answer 3

Metformin

Question 4

Autonomic neuropathy presents with

Answer 4

Nocturnal diarrhoea
Erectile dysfunction/impotence
Poor BP and temp regulation

Question 5

Initial management of moderate DKA in kids

Answer 5

V 0.9% sodium chloride

Question 6

How are thyroid hormones secreted into bloodstream?

Answer 6

Colloid containing thyroid hormone is pinocytosed by follicular cells. Lysosomes then fuse with this intracellular vesicle to digest thyroglobulin and release T3 and T4. T3 and T4 are secreted into the bloodstream by diffusion and membrane transporters

Question 7

How thyroid hormone secretion regulated?

Answer 7

High levels of thyroid stimulating hormone (TSH), T3 and/or T4 are detected by the hypothalamus, which inhibits release of thyrotropin-releasing hormone (TRH) which decreases secretion of TSH and therefore also T3, T4

Question 8

How does pituitary compress optic chiasm?

Answer 8

From below

Question 9

Thiazides cause what electrolyte abnormality?

Answer 9

Hypercalcaemia, hypokalaemia

Question 10

Where is ADH secreted from?

Answer 10

Posterior pituitary

Question 11

Anti-diabetic drug assoc with incr risk of bladder cancer

Answer 11

Pioglitazone (TZD)

Question 12

What condition of pregnancy is associated with high hCG and abnormal TSH/fT4?

Answer 12

Hyperemesis gravidarum
- usually resolves by 20 weeks, no TRab
- manage with H1 antagonist

Question 13

Describe negative feedback loop of thyroid hormones

Answer 13

High levels of thyroid stimulating hormone (TSH), T3 and/or T4 are detected by the hypothalamus, which inhibits release of thyrotropin-releasing hormone (TRH) which decreases secretion of TSH and therefore also T3, T4

Question 14

Pubertal delay and poor secondary sexual development, combined with the anosmia and cleft palate suggests?

Answer 14

Kallmann syndrome

Question 15

Brown bone tumours are assoc with?

Answer 15

Hyperparathyroidism

Question 16

Mechanism of ADH

Answer 16

Antidiuretic hormone promotes water reabsorption by the insertion of aquaporin-2 channels

Question 17

MEN1 clinical manifestations

Answer 17

Parathyroid (hyperpara)
Pancreas
Pituitary
(adrenal and thyroid)
Presents with hypercalcaemia

Question 18

MEN2a clinical manifestations

Answer 18

Parathyroid
Phaeochromocytoma
(medullary thyroid)

Question 19

MEN2b clinical manifestations

Answer 19

Phaeochromocytoma
(marfanoid, neuroma)

Question 20

What changes should be made to hypothyroidism management in pregnancy?

Answer 20

Levothyroxine - dose increased by at least 25-50 microgram
Monitor TSH very closely

Question 21

When can insulin be used outwith diabetic management?

Answer 21

To reduce hyperkalaemia

Question 22

Management of phaeochromocytoma pre-surgery

Answer 22

Alpha blocker
e.g. phenoxybenzamine

Question 23

What is DKA in absence of acidosis?

Answer 23

Diabetic ketosis

Question 24

Diagnostic test for insulinoma

Answer 24

72 hour fast

Question 25

Pathophysiology of Graves' disease

Answer 25

Formation of IgG antibodies to TSH receptors on thyroid gland

Question 26

Which electrolyte must you be most aware of in DKA as it may become depleted in the body even though plasma concentrations may seem normal?

Answer 26

Potassium

Question 27

What is a psammoma?

Answer 27

Clusters of calcium buildup - characteristic of papillary thyroid cancer

Question 28

Most common bacterial cause of Waterhouse-Friderichsen syndrome

Answer 28

Neisseria meningitides

Question 29

Most common deficiency cauding CAH

Answer 29

21-hydroxylase deficiency

Question 30

Newly diagnosed diabetic child is managed on 1 unit of insulin a day - why such a low dose?

Answer 30

Patient still has some residual beta cell function - honeymoon phase

Question 31

Loss of lateral 1/3 of eyebrow can be a sign of which endocrine condition?

Answer 31

Hypothyroidism - Hertoghe sign

Question 32

Worst prognosis thyroid cancer

Answer 32

Anaplastic = awful

Question 33

Impaired glucose tolerance on fasting and 2h glucose

Answer 33

Fasting: <6.1 (normal) 2h: 7.8-11 (impaired)

Question 34

Which visual symptom suggests severe thyroid eye disease?

Answer 34

Diplopia/proptosis

Question 35

First line investigation of suspected panhypopituitarism?

Answer 35

Insulin tolerance test - will illicit stress response and can measure ACTH/cortisol and GH

Question 36

Most common cause of hyperparathyroidism

Answer 36

Parathyroid adenoma

Question 37

Management of neuropathic pain in patients not able to tolerate oral medications

Answer 37

Capsaicin cream (0.075%)

Question 38

Young person, hyperthyroid features, swollen and painful goitre but tired and rundown?

Answer 38

Subacute DeQuervain's thyroiditis

Question 39

Which heart condition can be a complication of hyperthyroidism?

Answer 39

Atrial fibrillation

Question 40

Drug that can impair absorption of thyroxine

Answer 40

Ferrous sulphate - for anaemia

Question 41

Management of post-partum thyrotoxiosis

Answer 41

Propanolol - symptom control

Question 42

How to differentiate between hyperthyroid phase of DeQuervain's and Grave's disease?

Answer 42

DeQuervain's - reduced uptake on radioiodine isotope scan Grave's - increased uptake on radioiodine isotope scan

Question 43

Gestat

Question 44

Most common cause of cellulitis in diabetes

Answer 44

Strep pyogenes

Question 45

When would you give zolendronate rather than alendronate?

Answer 45

If oral bisphosphonate can't be tolerated

Question 46

Management of hypoglycaemic patient who is alert and able to swallow water

Answer 46

Oral glucose tablets

Question 47

Which medications should be stopped while T2 diabetic patient is fasting for surgery?

Answer 47

Meds causing hypoglycaemia e.g. gliclazide

Question 48

Recurrent candidiasis indicates the need for which blood test?

Answer 48

HbA1c - recurrent infection is suggestive of diabetes

Question 49

What should always be ruled out before water deprivation test in suspected diabetes insipidus?

Answer 49

Hypercalcaemia - measure serum clacium

Question 50

First line investigation in suspected thyroid cancer/thyroid nodule

Answer 50

Thyroid ultrasound

Question 51

Investigation of diabetic patient unable to weight bear with history of foot ulcers

Answer 51

MRI foot and ankle - suspect Charcot's arthropathy

Question 52

Persistent hyperglycaemia in patients on enteral feeding - what anit-diabetic drug?

Answer 52

Insulin

Question 53

Management of steroid induced diabetes

Answer 53

Gliclazide

Question 54

What is required to confirm diabetes diag with one HbA1c?

Answer 54

Repeat HbA1c