Endocrine

Question 1

What’s the mechanism and SE of SGLT2 inhibitors?

Answer 1

Inhibit SGLT2 channels in PCT, so less glucose is reabsorbed, more is excreted. End in -ozin.
SE: UTIs, necrotising fasciitis of penis, increased risk of lower limb amputation.

Question 2

Indication and SE of carbimazole

Answer 2

Mx of thyrotoxicosis. SE: agranulocytosis- FBC.

Administer in high doses for 6 weeks till euthyroid, then reduce.

Question 3

Primary hyperparathyroidism sx and cause

Answer 3

Thirst, bones (pain/#), stones, abdominal groans, psychiatric moans (depression).
Polydipsia and uria.
Associated with hypertension.
Often old thirsty ladies.
Most caused by solitary adenoma.

Question 4

Investigations for primary hyperparathyroidism

Answer 4

Raised or inappropriately normal PTH,
Raised Ca,
Low phosphate
Technetium scan (MIBI)

Question 5

Mx for primary hyperparathyroidism

Answer 5

Parathyroidectomy

Question 6

How many units of insulin in 1ml?

Answer 6

1 ml = 100 units

Question 7

How does hypothyroidism affect periods?

Answer 7

Causes menorrhagia. Whilst hyperthyroid causes amenorhoea or oligo.

Question 8

TFTs for primary hypothyroidism

Answer 8

High TSH
Low free T4

Poor compliance with meds = high TSH, normal free T4

Question 9

TFTs for secondary hypothyroidism

Answer 9

V rare

Low TSH, low free T4

Question 10

4 phases of de quervain’s thyroiditis (subacute)

Answer 10

1) painful goitre, raised esr, hyperthyroid
2) euthyroid
3) hypothyroid
4) structure and function return to normal

Question 11

Cause of subacute thyroiditis

Answer 11

Usually follows viral infection. Usually self limiting.

Question 12

Investigation for subacute thyroiditis

Answer 12

Decreased iodine uptake on scan.

Question 13

Most common drug cause of gynaecomastia

Answer 13

Spiranolactone

Question 14

Which signs on examination are specific to Grave’s?

Answer 14

Exophthalmos

Question 15

Symptoms of acromegaly

Answer 15

Glossitis and enlarged gum spaces
Prognathism (jaw extends/bulges out)
Features of pituitary tumour: headache, bitemporal hemianopia (tumour on chiasm)
Increase in hand/shoe size
Potentially galactorrhea (increased prolactin)

Question 16

What type of hemianopia would you expect in a stroke, and in acromegaly?

Answer 16

Stroke or other lesion distal to optic chiasm: homonymous

Acromegaly: bitemporal hemianopia

Question 17

Features of raised prolactin in women

Answer 17

Amenorrhoea

Galactorrhea

Question 18

Features of raised prolactin in men

Answer 18

Impotence
Reduced libido
Galactorrohea

Question 19

Causes of raised prolactin

Answer 19

Obs/gynae: PCOS, pregnancy, oestrogens
Endocrine: prolactinoma, acromegaly, primary hypothyroidism- TRH stimulates prolactin release
Physiological: stress, exercise, sleep

Question 20

Drug causes of raised prolactin

Answer 20

Anti-psychotics: haloperidol and phenothiazines

Anti-sickness: domperidone, metoclopramide

Question 21

Tx of raised prolactin and mechanism

Answer 21

Bromocriptine

Dopamine inhibits prolactin release, so use a dopamine agonist.

Question 22

Carcinoid syndrome: what is it and how does it present

Answer 22

Neuroendocrine tumour, can be GI, resp, other places. Usually occurs from mets in liver.
Secretes serotonin so causes flushing, diarrhoea, bronchospasm, abdo pain

Question 23

Cardiac associations of carcinoid syndrome

Answer 23

TIPS
Tricuspid insufficiency
Pulmonary stenosis

Question 24

Inv for carcinoid

Answer 24

Urinary 5-HIAA

Question 25

Mx for carcinoid

Answer 25

Somatostatin analogues like ocreotide. (Somatostatin inhibits release of somatotropins which are growth factors)

Question 26

How does alcoholic ketoacidosis present clinically and in investigations? Management?

Answer 26

Alcoholics who have an episode of reduced food intake. Start to metabolite fats. Nausea, vom, abdo pain. Ketones, normal or low glucose, acidotic. Saline with thiamine for wernickes.

Question 27

Presentation of Wilsons

Answer 27

Neuro: psychiatric and speech problems Liver: hepatitis, cirrhosis

Question 28

Investigating and tx Wilson’s

Answer 28

Total Serum copper is reduced as serum caeroloplasmin carries 95% and is reduced, free copper is increased, increased urinary copper excretion Penicillamine

Question 29

How do you mx hypercalcaemia?

Answer 29

IV 0.9% saline 3/4 litres then bisphosphonates later

Question 30

Causes of hypercalcaemia

Answer 30

Primary hyperparathyroidism | Malignancy like Squamous cell LC

Question 31

Antibodies in Grave's

Answer 31

TSH-receptor stimulating autoantibodies | Anti-thyroid peroxidase autoantibodies (lower %)

Question 32

Investigations for Grave's

Answer 32

Low TSH | Raised free T4

Question 33

Effects of mineralocorticoids vs glucocorticoids

Answer 33

Fluid-retention vs. anti-inflammatory

Question 34

Which mineralocorticoid exerts the highest mineralo effect but lowest gluco effect?

Answer 34

Fludrocortisone

Question 35

Which glucocorticoid exerts the highest glucocorticoid effect but lowest mineralo?

Answer 35

Dexamethasone

Question 36

What's the most important modifiable RF for thyroid eye disease?

Answer 36

Stop smoking

Question 37

How does myxoedema coma present?

Answer 37

Confusion, hypotension, bradycardia, hypothermia, profoundly hypothyroid

Question 38

Mx of myxoedema coma

Answer 38

IV thyroid hormone replacement + IV hydrocortisone (may have co-existing adrenal insufficency so must avoid precipitating a crisis)

Question 39

Sick euthyroid syndrome: cause, investigations and mx

Answer 39

Severe systemic illness causes low everything. Low or normal TSH, low thyroxine, T3. Reverses naturally upon recovery.

Question 40

Which haematological disease can produce falsely low HbA1cs?

Answer 40

Sickle cell- decreased RBC lifespan

Question 41

2 aspects of diabetic foot disease

Answer 41

1) Neuropathy- 10g filament test | 2) Ischaemia- Doppler DP pulse, ABPI is reduced

Question 42

5 types of hormones released by adrenal glands (stimulated by ACTH)

Answer 42

- Androgens - Oestrogen - Mineralocorticoid - Glucocorticoids - Catecholamines (adrenaline, noradrenaline, dopamine)