Endocrine

Question 1

What drug worsens Thyroid Eye Disease?

Answer 1

Carbimazole

Question 2

Pathophysiology of Thyroid Eye Disease?

Answer 2

1) Fibrobasts stimulated by anti-TSH receptor antibodies & activated T-cells
2) Fibroblasts deposit GAG (Glycosaminoglycans)
3) GAG is hydrophilic so water drawn in from surrounding tissues –> oedema & pressure on optic nerve –> vision changes.

Question 3

Treatment of thyroid eye disease?

Answer 3

Immune modulation with corticosteroids = initial intervention of choice

Mycophenolate motefil.

Teprotumumab (IGF-1) inhibitor

Question 4

Symptoms of excess prolactin?

Answer 4

Galactrrhoea, amenorrhoea and low libido.

Question 5

Treatment of a prolactinoma?

Answer 5

Cabergoline

Question 6

Micro vs macroprolactinoma?

Answer 6

Micro = <1cm

Question 7

MOA of SGLT-2 inhibitors e.g dapagliflozin?

Answer 7

SGLT2= low-affinity, high capacity glucose transporter in proximal renal tubules. Responsible for 90% of glucose reabsorption.

Thus inhibition= glucose excretion.

Dependent on GFR thus not recommended in significant renal impairment.

Question 8

Which factor is associated with poor pregnancy outcome in type 1 or type 2 diabetes?

Answer 8

High HbA1c is associated with increased risk of anencephaly, microcephaly, congenital heart disease and miscarriage.

Question 9

Recommended glycaemic controls for diabetes during pregnancy?

Answer 9

Pre-meal, bedtime and overnight glucose 3.3–5.4 mmol/l

Peak postprandial glucose 5.4–7.1 mmol/l

A1c < 6.0%

Question 10

Underlying pathophysiology in diabetic foot?

Answer 10

Neuropathy –> trauma –> exaggerated local inflammatory response

Question 11

MOA of sulfonylureas e.g gliclazide?

Answer 11

Aninsulin secretagogue.

Associated with hypoglycaemia.

Frequent hypoglycaemia= increased cardiovascular events