Endocrine

Question 1

Anti-thyroid peroxidase antibodies raised in what? clinical presentation?

Answer 1

Hashimotos- often a goitre too

Question 2

Very low tsh high T4?

Answer 2

Thyrotoxicosis (with symptoms)

Question 3

High tsh normal T4

Answer 3

Poor compliance or sub clinical

Question 4

Sick euthyroid results? And in who?

Answer 4

Low TSH low T4, Tsh May be normal however T3 particularly low often hospital inpatient

Question 5

Secondary hypothyroidism?

Answer 5

Low tsh low t4

Question 6

What can give falsely low hba1c?

Answer 6

Sickle cells

Question 7

Thiazides can cause what electrolyte problem?

Answer 7

Hypercalcaemia, hypokalaemia and natraemia

Question 8

Very low TSH, high T4 and painful goitre? Scan shows?

Answer 8

De quervains (subacute hyperthyroidism) Can follow viral illness often become hypo after a short while, globally reduced uptake on radioisotope scan

Question 9

Very low TSH, high T4 painless goitre?

Answer 9

Graves’ disease

Question 10

TSH, T3 and T4 low? Often following hospital

Answer 10

Sick euthyroid

Question 11

Primary Hyperparathyroidism bloods?

Answer 11

PTH high normal or high, calcium high

Question 12

Patient presents with high PTH and low Ca2+? Usual cause?

Answer 12

Secondary hyperparathyroidism usually CKD often low vit D also

Question 13

Conn’s syndrome symptoms?

Answer 13

Hypokalaemia, Hypertension, polyuria, confusion/difficulty concentrating, lethargy

Question 14

Symptoms of Addison’s disease?

Answer 14

Anorexia, weight loss, hyperpigmentation, fatigue, uncommonly salt craving, hypotension.

Question 15

Bloods in Addison’s?

Answer 15

Hyperkalaemia, Hyponatraemia, can be elevated urea, sometimes anaemia.

Question 16

Addisonian crisis and treatment?

Answer 16

Hyponatraemia, Hyperkalaemia, Hypoglycaemia, Hypotension, headache, fatigue, confusion vomiting. Hydrocortisone and saline with dextrose do not delay treatment for bloods (FBC, UE, LFT, glucose, cortisol ACTH) consider ECG for potassium

Question 17

What differentiates graves from other hyperthyroid disease?

Answer 17

Eye signs, TSH antibodies and high uptake on radio scan

Question 18

Bloods in Hypercalcaemia due to malignancy?

Answer 18

High calcium, Low phosphorous, appropriately low PTH

Question 19

Hypercalcaemia symptoms?

Answer 19

Polydipsia, polyuria, nausea, confusion, constipation, bone pain.

Question 20

Common hypoglycaemia symptoms?

Answer 20

Confused, sweating, hunger, tremor, drowsiness, hunger, anxiety

Question 21

Type of addisons in people who were receiving steroids?

Answer 21

Secondary- and no pigmentation

Question 22

TSH antibodies in what disease?

Answer 22

Graves’

Question 23

Graves symptoms?

Answer 23

Tremor, palpitation, goitre, tachy, murmur, sweating, heat intolerance- eye signs

Question 24

Hypothryroid symptoms?

Answer 24

Weakness, weight gain, cold intolerance, constipation, menstrual irregularity, brady, coarse hair, delayed relaxing of tendon reflex.

Question 25

Most common cause of hypothyroidism western world?

Answer 25

Autoimmune, thyroid antiperoxidase antibodies

Question 26

Graves' treatment?

Answer 26

Carbimazole, steroids, beta blockers

Question 27

Treatment of hypoglycaemia IV?

Answer 27

75ml or 20% glucose 150ml of 10% glucose

Question 28

When would glucagon be inappropriate to use?

Answer 28

Liver disease, alcohol, malnourished

Question 29

Symptoms of DKA?

Answer 29

Weight loss, confusion, dehydration, abdo pain, nausea, headache and vomiting, weakness, tachy, hypotension.

Question 30

Low Ca2+ High PO4- Low or normal PTH

Answer 30

Primary hypoparathyroidism

Question 31

Hypocalcaemia symptoms?

Answer 31

Diarrhoea, muscles twitches and cramps, numbness and tingling, poor memory or slowed thinking.

Question 32

Toxic multinodular goitre scan?

Answer 32

Patchy uptake

Question 33

Common infections and drugs that may cause DKA?

Answer 33

UTI and pneumonia thiazides, antipsychotics, steroids

Question 34

In DKa when to introduce gucose again?

Answer 34

Introduction of 10% glucose is recommended when the blood glucose falls below 14.0mmol/L. It is important to continue 0.9% sodium chloride solution to correct circulatory volume

Question 35

Rate of insulin in DKA?

Answer 35

Fixed 0.1 units/kg/hr

Question 36

What should you do with SC insulin in DKA?

Answer 36

Continue as normal

Question 37

When to replace potassium in DKA and how much?

Answer 37

After first litre of fluid providing the potassium is 3.5-5.5 not needed if \>5.5 Give as 40mmol per additional litre of fluid

Question 38

Along with fluids, insulin and potassium what else is given in DKA as per NICE?

Answer 38

LMWH

Question 39

Aim for what HBa1c in type 1 diabetes?

Answer 39

48 or less

Question 40

How many times a day to test blood glucose in type 1?

Answer 40

at least 4 before meals and before bed too

Question 41

Diagnosis of type 1 diabetes random and fasting?

Answer 41

Random \>11.1 or fasting \>7 with symptoms

Question 42

Differentiate between type 1 and 2 diabetes blood test?

Answer 42

C-peptide or GAD (90%) not measured routinely

Question 43

Diagnose type 1 in who with hyperglycaemia?

Answer 43

ketosis rapid weight loss age of onset below 50 years BMI below 25 kg/m2 personal and/or family history of autoimmune disease

Question 44

Diagnosis of diabetes based upon :

Answer 44

Diabetes symptoms + a random venous plasma glucose concentration ≥ 11.1 mmol/l or a fasting plasma glucose concentration ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l) or

Question 45

If no symptoms what do you need to do to diagnose diabetes?

Answer 45

Have two elevated readings

Question 46

Type 2 diabetes educational program?

Answer 46

DESMOND

Question 47

Recommended target HbA1c for type 2 managed by lifestyle and or metformin?

Answer 47

48mmol

Question 48

If HbA1c not controlled below 48 on one drug and rises to 58 or more, new target?

Answer 48

53mmol and intensify antidiabetic treatment

Question 49

When to stop metformin egfr?

Answer 49

\<30ml

Question 50

Course for type 1 diabetics?

Answer 50

DAFNE

Question 51

What is shown why has it happened? Treatment?

Answer 51

Diabetic neuropathy causes unstable gait and bone deformity, can be casted

Question 52

Statin therapy in type 1 diabetes?

Answer 52

All adults with type 1 diabetes who are aged over 40 years or have had diabetes for more than 10 years, or have established nephropathy or have other cardiovascular risk factors.

Question 53

Ck in statin therapy with muscle pains?

Answer 53

Normal continue if tolerated give at night \>x10 upper limit is rhabdomyolysis

Question 54

Target in cholesterol reduction?

Answer 54

Target should be a greater than 40% reduction in non-HDL cholesterol.

Question 55

What endocrine condition is this associated with? What is it?

Answer 55

Thyroid acropachy, Graves' disease