Endocrine

Question 1

Primary vs Secondary vs tertiary hyperparathyroidism causes and calcium levels

Answer 1

Primary - primary parathyroid adenoma. High PTH, High Ca
Secondary - low vit d or CKD. High PTH, low ca
Tertiary - prolonged untreated CKD, High PTH, High ca

Question 2

Sx of hypoglycaemia

Answer 2

Pallor
Sweating
Restless
Tremor
Tachycardia
Anxiety
Confusion
Drowsiness

Question 3

Rf for hypoglycaemia in hospital/ post admission

Answer 3

Change in diet during stay
Missed or delayed meals
Elderly pts
Mobilisation and physio regimes after illness
Prev ep of hypos

Medication changes
Medication errors
Comirbidities eg sepsis

Question 4

Mild vs moderate vs severe hypoglycaemia features

Answer 4

Mild - <4, conscious, orientated, can swallow
Moderate - <4, conscious, able to swallow. Disorientated
Severe - <2.6 unconscious/agressive. Can not swallow

Question 5

Rx of mild. If doesnt work what do you do

Answer 5

Give 5-7 dextrose tablets
Or glucojuice
Or lift juice shots

Stop any insulin in situ

Repeat x3 times, checking bm every 10-15mins. If still hypo, consider 1mg glucagon IM or 50/ml/hr of 20% iv glucose

Question 6

Rx of moderate hypoglycaemia

Answer 6

If capable and cooperative treat like mild. If not, but can swallow, give 2 tubes of glucogel.

Max 3 times then IM glucagon or 50ml/hr 20% glucose

Question 7

What should you do once bm rise above 4 in hypoglycaemia rx and why
What if glucagon has been administered

Answer 7

Give a long acting carbohydrate (20g) such as a slice of toast, glass of milk, 2 biscuits to replenish glycogen stores
If glucagon has been used, double the carbs (40g)

Question 8

Presentation of DKA

Answer 8

Nausea vomiting
Sweet smelling breath
Abdo pain
Kussmaul breathing

Question 9

What should you wait for before stopping IV insulin infusion

Answer 9

30mins after SC short acting insulin has been administered

Question 10

Complications of HHS

Answer 10

MI, stroke, thrombosis
Seizures
Cerebral oedema
Central pontine myelinolysis

Question 11

3 main features of HHS

Answer 11

Marked hypovolaemia/dehydration
Marked hyperglycaemia (>30)
Raised serum osmolarity >320

Question 12

Calculate osmolarity

Answer 12

2(Na)+glucose+urea

Question 13

Rx of HHS

Answer 13

Fluids
Insulin once glucose is no longer being reduced by fluids alone
Correct electrolyte imbalances - particularly potassium
VTE prophylaxis

Question 14

Which diabetes drug can rarely cause mourners gangrene

Answer 14

SLGLT2 inhibitors (gliflozin)

Question 15

ix for acromegaly

Answer 15

MRI head
Serum IGF 1 levels (GH not accurate enough as released in pulsatile manner)
OGTT - rapid increase in blood glucose should supress GH but GH levels not supressed

Question 16

rx of acromegaly

Answer 16

transphenoidal surgery

Question 17

what is Sheehans
rf for it

Answer 17

necrosis of pituitary after birth
PPH increases risk

Question 18

causes of hypopituitarism

Answer 18

pituitary apoplexy
sheehans
tumour
trauma
radiotherapy

Question 19

hyperprolactinaemia causes

Answer 19

anti psychotics
pituitary adenomas
prolactinomas
liver cirrhosis
pregnancy
acromegaly
Domperidone (common! used to induce lactation in breastfeeding)

Question 20

rx of hyperprolactinaemia

Answer 20

dopamine agonists eg bromocriptine, cabergoline

side effects of the dopamine is addiction! and risky behaviours

Question 21

ix results in diabetes insipidus

Answer 21

hypernatraemia
low urine osmolality
high serum osmolarity

Question 22

diagnostic ix for DI
results for craniotomy and nephrogenic

Answer 22

water deprivation test (desmopressin stimulation test)
crania low urine osmolality before and high after
nephrology low urine osmolality before but also low afterwards

Question 23

causes of nephrogenic DI

Answer 23

genetic
hypercalcaemia
lithium
pyelonephritis
sickle cell

Question 24

causes of cranial DI

Answer 24

head injury
pituitary adenoma
sarcoidosis
sheehan

Question 25

ix results in SIADH

Answer 25

dilutional hyponatraemia high urine osmolality low serum urine osmolality

Question 26

which lung cancer causes SIADH

Answer 26

small cell lung cancer

Question 27

causes of SIADH

Answer 27

Post-operative after major surgery Lung infection, particularly atypical pneumonia and lung abscesses Brain pathologies, such as a head injury, stroke, intracranial haemorrhage or meningitis Medications (e.g., SSRIs and carbamazepine) Malignancy, particularly small cell lung cancer Human immunodeficiency virus (HIV) top 3 - SSRI, small cell lung cancer, post surgery

Question 28

rx SIADH and what to monitor for

Answer 28

fluid restrict demiclocycline ADH antagonists central pontine myelinisis - rx slowly, do not correct sodium levels too quickly

Question 29

rx of cranial DI

Answer 29

desmospressin

Question 30

rx of nephrogenic DI

Answer 30

thiazides and low salt diet

Question 31

features of hyperthyroidism

Answer 31

Rapid heartbeat (palpitations). Feeling shaky and/or nervous. Weight loss. Increased appetite. Diarrhea and more frequent bowel movements. Vision changes. Thin, warm and moist skin. Menstrual changes. Intolerance to heat and excessive sweating. Sleep issues. Swelling and enlargement of the neck from an enlarged thyroid gland (goiter). Hair loss and change in hair texture (brittle). Bulging of the eyes (seen with Graves’ disease). Muscle weakness.

Question 32

antibodies in hyperthyroidism

Answer 32

TSH stimulating hormone anti tpo

Question 33

rx of hyperthyroid

Answer 33

propanolol for adrenegeric effects then carbimazole and thyroxine (block and replace) radioactive iodine

Question 34

what drug not to give with methotrexate

Answer 34

trimethoprim!! risk of agranulocytosis!!

Question 35

someone come in with sore throat on carbimazole, what should you do

Answer 35

urgent FBC!!

Question 36

thyroid storm triad

Answer 36

fever, tachycardia, delirium

Question 37

what is the most common type of thyroid cancer

Answer 37

papillary

Question 38

what is AIN and features

Answer 38

hypersensitivity reaction causing inflammation of the space between the cells and the tubules of the kidney. It occurs in response to drugs (often antibiotics, including penicillin), infection (including staphylococcal infection) and systemic disease (such as systemic lupus erythematosus or systemic sclerosis). The presentation involves an allergic-type response, with an acute kidney injury (AKI) and hypertension. rash, fever, arthralgia and aki

Question 39

what other endocrine condition should people with acromegaly be screened for

Answer 39

Diabetes mellitus due to insulin resistance

Question 40

features of acromegaly

Answer 40

frontal bossing, macroglossia, hypertension, bitemporal hemianopia, voice changes, sleep disturbance due to OSA, large hands and feet, prognathism