Endocrine

Question 1

How is diabetes mellitus suspected at bedside?

Answer 1

Capillary glucose test, urinary ketones

Question 2

How is diabetes mellitus diagnosed?

Answer 2

Random plasma glucose ≥ 11.1 mmol/l

Fasting plasma glucose ≥ 7.0 mmol/l

Question 3

Symptoms of diabetes mellitus type 1

Answer 3

Polyuria
Polydipsia
weight loss
blurred vision
nausea and vomiting

Question 4

Treatment of diabetes mellitus type 1

Answer 4

Basal bolus insulin

Premeal corrective insulin

Question 5

Symptoms of diabetes mellitus type 2

Answer 5

asymptomatic
candidal/skin infections
fatigue
blurred vision
polydipsia
polyuria

Question 6

Treatment of diabetes mellitus type 2

Answer 6

First line; diet and exercise

Second line; metformin

Third line; sulphonylurea

Next can add thiazolidinedione, DPP4 inhibitor, SGLT2 inhibitor, GLP1 receptor agonist

Question 7

In which patients is thiazolidinedione contraindicated?

Answer 7

Those with heart failure

Question 8

How does DKA present?

Answer 8

nausea or vomiting
abdominal pain
confusion
polydipsia
polyuria

Question 9

How is DKA diagnosed?

Answer 9

plasma glucose
ABGs
capillary/serum ketones
urinalysis

Question 10

Treatment of DKA

Answer 10

IV fluids, supportive care, potassium, insulin once potassium at 3.3mmol/l

May give vasopressors, bicarbonate therapy, phosphate therapy

Question 11

Symptoms of Conn’s disease

Answer 11

nocturia
polyuria
lethargy
mood disturbance

HYPERTENSION

Question 12

Diagnosis of Conn’s disease

Answer 12

plasma potassium; normal/low
aldosterone/renin ratio
Fludrocortisone suppression test

Question 13

Treatment of Conn’s disease

Answer 13

unilateral adrenectomy

bilateral adrenectomy

aldosterone antagonists

IF FAMILIAL; glucocorticoids

Question 14

Symptoms of cushing’s syndrome

Answer 14

hypertension
weight gain
striae
thin skin
bruise easily

Question 15

Diagnosis of Cushing’s syndrome

Answer 15

• raised serum glucose
• late night salivary cortisol raised
• 1mg overnight dexamethasone suppression test
• 24hr urinary free cortisol

Question 16

Treatment of cushing’s syndrome

Answer 16

Primary adrenal; unilateral/bilateral adrenectomy

Disease; transphenoidal pituitary adrenectomy

Question 17

symptoms of addison’s disease

Answer 17

fatigue
anorexia
weight loss
nausea
vomiting
hypotension
buccal pigmentation
hyperpigmentation

Question 18

Diagnosis of addison’s disease

Answer 18

serum electrolytes
blood urea
FBC
synACTHen test

Question 19

Ongoing treatment of addison’s

Answer 19

Gluco and mineralocorticoid replacement

• hydrocortisone, prednisolone
• fludrocortisone

Question 20

Treatment of acute adrenal crisis

Answer 20

glucocorticoid + supportive therapy

• corticosteroids
• saline to correct hypotension and dehydration
• glucose to correct hypoglycaemia (avoid worsening hyponatraemia)

Question 21

Symptoms of Grave’s disease

Answer 21

heat intolerance
sweating
lid retraction
opthalmopathy
weight loss 
irritability

Question 22

Diagnosis of Grave’s disease

Answer 22

TSH
Free T3 T4
TSH receptor antibodies

Question 23

Treatment of Grave’s disease

Answer 23

First line; prolonged antithyroid i.e. carbimazole
ameliorate symptoms
radioactive iodine
corticosteroid
thyroid surgery

Question 24

When is radioactive iodine contraindicated?

Answer 24

Pregnancy and planning pregnancy

Question 25

Symptoms of hypothyroidism

Answer 25

``` weakness lethargy cold sensitivity weight gain constipation ```

Question 26

Diagnosis of hypothyroidism

Answer 26

``` TSH Free T3/T4 raised cholesterol possible FBC anti thyroid peroxidase antibodies ```

Question 27

Treatment of hypothyroidism

Answer 27

levothyroxine low dose in CAD bc can aggravate angina

Question 28

Hashimoto's symptoms

Answer 28

``` fatigue weight gain pale/puffy face cold intolerance joint/muscle pain ```

Question 29

Hashimoto's diagnosis

Answer 29

``` TSH Free T3 T4 TPO antibodies TSH receptor antibodies radioiodine/technetium scan (minimal uptake) ```

Question 30

Treatment of Hashimoto's

Answer 30

Levothyroxine During thyrotoxicosis ameliorate hypertension with bblockers and CCBs

Question 31

Symptoms of hyperparathyroidism

Answer 31

``` Osteoporosis nephrolithiasis bone pain poor sleep fatigue ```

Question 32

Diagnosis of hyperparathyroidism

Answer 32

serum calcium serum PTH Vit D level ALP (may be raised)

Question 33

Treatment of hyperparathyroidism

Answer 33

parathyroidectomy +/- vit d supplementation

Question 34

Hypoparathyroidism symptoms

Answer 34

muscle spasms anxiety brittle nails dry hair

Question 35

Diagnosis of hypoparathyroidism

Answer 35

serum calcium serum albumin (normal) ECG (prolonged QT) PTH

Question 36

Treatment of hypoparathyroidism

Answer 36

severe hypocalcaemia <1.88 ; IV calcium gluconate ongoing = oral calcium and calcitriol

Question 37

Symptoms of pheochromocytoma

Answer 37

``` headache palpitations orthostatic hypotension hypertension hypercalcaemia cushing syndrome ```

Question 38

Diagnosis of pheochromocytoma

Answer 38

24hr urinary collection catecholamines | plasma catecholamines

Question 39

Treatment of pheochromocytoma

Answer 39

Hypertensive crisis; antihypertensive agents First line; alpha blockers + bblockers after alpha blockade + volume expansion Tumour surgical excision