Endocrine

Question 1

Addisons has reduced output of what two hormones

Answer 1

Cortisol and aldosterone (steroid hormones)

Question 2

What colour can skin go in addisons

Answer 2

bronze

Question 3

electrolyte imbalances in addisons

Answer 3

low na
high k

Question 4

test of choice for adrenal insufficiency (addisons)

Answer 4

short synacthen (synacthen is synthetic ACTH- expect cortisol to rise >double baseline in normal)

Question 5

Cotton wool sign on XR

Answer 5

pagets

Question 6

Addisons rx

Answer 6

Steroid replacement:
-hydrocortisone to replace cortisol as a glucocorticoid
-fludrocort to replace aldosterone as mineralocort

Double in acute illness - generally glucocorticoid dose should be doubled, with the fludrocortisone dose staying the same

Question 7

Addisonian crisis rx

Answer 7

IV hydrocort 100mg stat then 6 hourly

Question 8

Phaeochromocytoma is assoc with which inherited disease

Answer 8

MEN2

Question 9

Phaeochromocytoma Rx

Answer 9

alpha blockers eg phenoxybenzamine

beta blockers once established on alpha blockers otherwise can cause HTN crisis

Adrenalectomy is definitive but should be medically managed first to reduce risks in surgery/anaesthetic

Question 10

Isolated ALP rise with normal ca, phos and vit D suggests what

Answer 10

Pagets disease of bone

Question 11

Pagets Rx

Answer 11

bisphos
Calcitonin (endogenously inhibits PTH)
Surgery if symptomatic

Question 12

Most common type of thyroid ca

Answer 12

papillary

Question 13

Monitoring of previous thyroid ca

Answer 13

thyroglobulin levels

Question 14

MEN1 cancers

Answer 14

parathyroid
pituitary
pancreas

Question 15

MEN 2 gene

Answer 15

RET oncogene

Question 16

MEN 2a cancers

Answer 16

Phaeochromocytoma
Parathyroid
Medullary thyroid ca

Question 17

Men 2b cancers

Answer 17

Phaeochromocytoma
Medullary thyroid ca

Question 18

What happens to testosterone, aldosterone and cortisol in congenital adrenal hyperplasia

Answer 18

Aldosterone and cortisol are low
Testosterone is high
This is because progesterone’s conversion to A and C is blocked so all the excess becomes T.

Question 19

congenital adrenal hyperplasia mx

Answer 19

replace steroid hormones with hydrocort and fludrocort
?surgery for female genitalia

Question 20

When to offer statin for T1dm

Answer 20

-Aged over 40 years.
-Has had diabetes for more than 10 years.
-Has established nephropathy.
-Has other CVD risk factors (such as obesity and hypertension).

Question 21

Diabetes insipidus symptoms

Answer 21

Polyuria and polydipsia

Question 22

2 types of diabetes insipidus

Answer 22

cranial (deficiency of ADH) and nephrogenic (insensitivity to ADH)

Question 23

Diabetes insipidus has _____ blood and _____ urine

Answer 23

Concentrated blood
Dilute urine

Question 24

Sodium high or low in Diabetes insipidus

Answer 24

High

Question 25

Test for diabetes insipidus

Answer 25

Water deprivation test Desmopressin suppression test

Question 26

Treatment for diabetes insipidus

Answer 26

Nephrogenic- thiazides, low salt/protein diet, high dose desmopressin Cranial- desmopressin

Question 27

Tender thyroid goitre

Answer 27

De quervains

Question 28

Goitre plus thyroid eye signs, pretibial myxoedema, acropachy

Answer 28

Grave's disease

Question 29

Increased TSH and bitemporal visual defect

Answer 29

TSHoma (pituitary)

Question 30

High TSH normal T4

Answer 30

subclinical hypothyroid

Question 31

Preceding systemic illness, low T4, TSH normal, clinically euthyroid

Answer 31

sick euthyroid

Question 32

De Quervains rx

Answer 32

supportive can give B blockers or NSAIDs for sx

Question 33

Hyperthyroid medical management

Answer 33

Carbimazole Propylthiouracil second line, risk hepatic reaction Radioactive iodine

Question 34

Anti TPO antibodies are present in what

Answer 34

autoimmune thyroiditis (hashimotos) and graves

Question 35

myxoedema is in hyper or hypo thyroid

Answer 35

hypo (severe)

Question 36

Treatment for myxoedema

Answer 36

IV liothyronine IV hydrocort until co-existing adrenal insufficiency is excluded

Question 37

What is the issue with levothyroxine in suspected adrenal insufficiency

Answer 37

can precipitate an addisonian crisis

Question 38

When do you give levothyroxine in subclinical hypothyroid?

Answer 38

Pregnancy Serum TSH >10 Goitre Symptomatic High serum antithyroid peroxidase Ab

Question 39

Cushings DISEASE rather than sydrome is what

Answer 39

excess ACTH from pituitary (eg adenoma) (stimulates adrenals to release excess cortisol)

Question 40

Cushings investigations

Answer 40

urinary free cortisol dex suppression test (give at night then measure morning cortisol- should be low if healthy)

Question 41

What happens to potassium in cushings

Answer 41

low

Question 42

Medical management of cushings

Answer 42

metyrapone ketoconazole mitotane

Question 43

Fasting glucose ranges for IGT and diabetes

Answer 43

6.1-6.9 impaired >7 diabetes

Question 44

OGTT ranges for IGT and diabetes

Answer 44

Impaired 7.8-11.1 Diabetes >11.1

Question 45

Which oral diabetes drugs have hypo risk

Answer 45

pioglitazones if used in combo Sulfonylureas (gliclazide)

Question 46

Oral diabetes meds to be cautious in renal impairment

Answer 46

metformin Sulphonylureas (gliclazide)

Question 47

oral diabetes meds that risk wt gain

Answer 47

pioglitazones Sulfonylureas

Question 48

SGLT2 inhibitors example and side effect

Answer 48

flozins wee out sugar UTI, thrush, frequency Euglycaemic DKA!!

Question 49

Oral diabetes med to avoid in heart failure

Answer 49

pioglitazone

Question 50

What is a drawback of gliptins (DPP-4 inhibs)

Answer 50

Often stop working Headache,URTI and sinus infection SEs

Question 51

What diabetes med has cardiovascular benefit

Answer 51

SGLT-2 inhibitor eg dapagliflozin

Question 52

When do you start SGLT-2 inhibitors (flozins) in diabetics regardless of regime

Answer 52

If the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%) the patient has established CVD or develops it the patient has chronic heart failure

Question 53

can you get galactorrhoea in acromegaly

Answer 53

yes in 1/3

Question 54

drug to improve gastric paresis in diabetes

Answer 54

metoclopromide

Question 55

what is the single most important blood test to assess a patient's response to treatment with levothyroxine for Hashimoto's thyroiditis.

Answer 55

TSH

Question 56

HONK is characterised by

Answer 56

1.) Severe hyperglycemia 2.) Dehydration and renal failure 3.) Mild/absent ketonuria

Question 57

First line treatment for prolactinomas

Answer 57

Dopamine agonists (eg cabergoline, bromocriptine)

Question 58

What electrolyte imbalance do thiazides cause

Answer 58

hypercalcaemia

Question 59

Calcitonin is a tumour marker in what type of thyroid cancer

Answer 59

medullary thyroid cancer

Question 60

would hyper or hypoparathyroidism cause raised ALP

Answer 60

hyper