Endocrine

Question 1

Acromegaly investigations

Answer 1

IGF-1 (initial)
confirmation (growth hormone and glucose tolerance test, glucose should inhibit growth hormone)

Question 2

MOA alendronic acid

Answer 2

Inhibits osteoclasts

Question 3

Non classical congenital adrenal hypoplasia

Answer 3

Presents similarly to PCOS but also will have raised 1-17 OH progesterone

Question 4

Signs of Graves disease only

Answer 4

lid lag and lid retraction
periorbital oedema
exopthalmos
opthalmoplegia
optic nerve compression

Question 5

Is carbimazole safe in pregnancy

Answer 5

yes

Question 6

Addisons, hormone

Answer 6

Cortisol and aldosterone

Question 7

Main cause of Addisons?

Answer 7

autoimmune destruction of adrenal glands

Question 8

Cause of skin hyperpigmentation in Addisons

Answer 8

XS ACTH

Question 9

Cause of amenorrhoea in Addisons

Answer 9

High levels of prolactin

Question 10

Conns disease

Answer 10

XS aldosterone

Question 11

Diabetes drug that doesn’t need to be adjusted in renal impairnment

Answer 11

Linagliptin

Question 12

Diabetes meds that cause weight loss

Answer 12

GLP-1 analogue (-glutide)
SGLT-2i (-flozin)

Question 13

Diabetes meds that cause weight gain

Answer 13

Insulin
Pioglitazone
Sulfonylurea

Question 14

Diabetes med that is at risk of hypoglycaemia

Answer 14

Insulin

Question 15

Diabetes meds that cause ketoacidosis

Answer 15

DPP-4i (-gliptin)
GLP-1 analogue (-glutide)
SGLT-2i (-flozin)

Question 16

Diabetes medication to be avoided in HF

Answer 16

Pioglitazone

Question 17

Diabetes medication to be avoided in bladder cancer

Answer 17

Pioglitazone

Question 18

Diabetes medication to be avoided in gastro disease

Answer 18

GLP-1 (-glutide)

Question 19

How does an insulinoma present

Answer 19

Hypoglycaemia
Rapid weight gain may be seen
high insulin, raised proinsulin:insulin ratio
high C-peptide

Question 20

What is an insulinoma

Answer 20

Neuroendocrine tumour deriving mainly from pancreatic Islets of Langerhans cells

Question 21

Management of insulinoma

Answer 21

Surgery (if not fit for somatostatin)

Question 22

Where are insulinomas normally found

Answer 22

Pancreas - requires a CT pancrease

Question 23

Familial hypocalciuric hypercalcaemia

Answer 23

moderately high calcium with low calcium excretion (autosomal dominant)

Mx:

Question 24

Management of acromegaly

Answer 24

Transphenoidal surgery (can use somatostatin analogue to reduce the size)

Question 25

Dopamine analogue example

Answer 25

Pramipexole Ropinirole

Question 26

MODY 2

Answer 26

Fasting glucose is normal and increase when given glucose only increases very slightly If patients relatives have remained well for a while MODY type 2 > type 3

Question 27

MODY 3

Answer 27

Present very similarly to type 1

Question 28

MODY 5

Answer 28

Renal cysts and diabetes Treated with insulin

Question 29

Cushing's investigation

Answer 29

24 hour urinary cortisol Dexamethasone suppression test

Question 30

Tamoxifen MOA

Answer 30

Mixed oestrogen receptor antagonist and partial agonist

Question 31

Post menopausal breast cancer

Answer 31

Letrozole (aromatase inhibitor)

Question 32

Pre menopausal breast cancer

Answer 32

Tamoxifen

Question 33

Hormone that stops growth and fuses the epiphyseal plates

Answer 33

Oestrogen

Question 34

How to measure the volume of the thyroid gland

Answer 34

USS

Question 35

Hyperemesis and thyroid bloods

Answer 35

Appears to have hyperthyroidism but this is driven by BHCG, can observe and wait to normalise if no symptoms

Question 36

Thyroid lymphoma management

Answer 36

RCHOP + external beam radiotherapy

Question 37

Medullary carcinoma

Answer 37

Calcitonin

Question 38

Type of cancer causing stridor and regional lymphadenopathy

Answer 38

Anaplastic carcinoma

Question 38

Thyroid lymphoma

Answer 38

Seen in over 60s

Question 39

Acromegaly cancer link

Answer 39

Colorectal cancer

Question 40

How is denosumab given

Answer 40

SC 6 monthly

Question 41

How is teriparatide given

Answer 41

Daily injection

Question 42

When is metformin CI

Answer 42

eGFR <30

Question 43

Why does metaclopramide cause galactorrhoea

Answer 43

It is a dopamine antagonist that binds to the D2 receptors on pituitary lactotrophs stimulating prolactin. Prolactin causes galactorrhoea (also inhibits GnRH so can cause amenorrhoea)

Question 44

Diabetic amyotrophy presentation

Answer 44

Proximal muscle weakness

Question 45

Hashimotos antibodies

Answer 45

HYPOTHYROIDISM anti-TPO or anti-Tg

Question 46

Graves disease

Answer 46

HYPERTHYROIDIDM anti TSH or anti-TPO

Question 47

What is prolactin controlled by

Answer 47

Under negative control of dopamine

Question 48

Nelsons syndrome

Answer 48

Cushings and development of an ACTH producing tumour --> causes skin pigmentation and bitemporal hemianopeia

Question 49

Acromegaly hormone and ix

Answer 49

XS GH, serum IGF-1/OGTT

Question 50

Cushings hormone and ix

Answer 50

XS cortisol, dexamethasone suppression test or 2x 24 hour urinary cortisol levels

Question 51

Addisons hormone and ix

Answer 51

Decrease in cortisol SynACTHen test

Question 52

Conns hormone and ix

Answer 52

XS aldosterone aldosterone:renin MRI/renal vein sampling

Question 53

Early pregnancy hyperthyroid management

Answer 53

Propyluracil

Question 54

Late pregnancy hyperthyroid management

Answer 54

Carbamazapine as propyluracil has an increased risk of hepatic toxicity

Question 55

Insulinoma investigation

Answer 55

72 hour supervised fast