Endocrinology 1

Question 1

Longest acting insulin

Answer 1

Degludec followed by Glargine/ Determir

Question 2

Most rapid acting onset insulin

Answer 2

Fiasp

Question 3

Urea cycle disorder -X linked = deficiency in what?

What the deficient enzyme does?

Answer 3

Ornithine transcarbamylase - final act in converting Ammonium to urea

Question 4

What test highly suggestive of Urea cycle disorder?

Answer 4

High Plasma ammonia + Normal blood glucose and lactate

Question 5

Hypokalemic periodic paralysis - what channel mutation?

Answer 5

Voltage gated CALCIUM channel

Question 6

Wolffian ducts differentiate into?

Mullerian ducts differentiate into?

Answer 6

Wolffian = Male internal tract + genitalia

Mullerian = female internal tract + genitalia

Question 7

Androgen resistance what happens?

Answer 7

External phenotype feminised but no internal reproductive tracts at all

Question 8

Testicular dysgenesis what happens?

Answer 8

Testes development in utero is poor
-decreased androgen and mullerian regression factor secretion

SO Mullerian duct may differentiate -female internal tract

Question 9

Wolffian duct requires what hormone to differentiate - internal tract and external male genitalia?

Answer 9

Internal male tract = Testosterone

External male genitalia (scrotum,penis) = Dihydrotestosterone

Question 10

‘Penis-at-twelve’ syndrome - deficient of what hormone?

Answer 10

congenital 5a reductase syndrome

Question 11

Graves disease with orbitopathy - what treatment is contraindicated?

Answer 11

Radioiodine - it worsens it

Question 12

Octreotide known to cause what?

Answer 12

Gallstones

Question 13

GRA pathophysiology and treatment?

Answer 13

Glucocorticoid remediable aldosteronism - rare cause of primary hyperaldosteronism
High aldosterone due to stimulation by ACTH

• steroids given to suppress ACTH - if work then it is GRA

Question 14

Cortisol inhibits what and vice versa?

Answer 14

ADH

Question 15

1st line treatment in nephrogenic DI?

2nd line treatment in nephrogenic DI?

Answer 15

1st - low sodium diet

2nd - Thiazide - paradoxical - Anti diuretic effect but mechanism unknown

Question 16

Angular cheilitis/glossitis commonest cause?

Answer 16

Fungal candida (commonest)
2nd is Vit B2 deficiency (riboflavin)

Question 17

Nuclear receptor are?

Answer 17

Receptor that binds to steroid hormone or thyroid hormones - regulates gene transcription and translation

Question 18

Classical complication of hemochromatosis

Answer 18

hypogonadotrophic hypogonadism

Question 19

what hormones promotes satiety?

Answer 19

Leptin
CCK
Amylin
Insulin
GLP-1

Question 20

Biotin causes what?

Answer 20

False positive Graves picture

-Low TSH and high T3/T4

Question 21

Deiodinases 1 is found in which organ

Deiodinases 3 is found where?

Answer 21

D1 = liver/kidney/thyroid
D3 is widespread
D2 is other organs apart from D1

Question 22

SERM shown to?

Answer 22

ONLY REDUCE VETEBRAL FRACTURES

Question 23

Pseudohypoparathyroidism main problem?

Answer 23

CaSR mutation - doesn’t sense CA

Question 24

Acromegaly versus gigantism?

Answer 24

Acromegaly - GH excess before epiphyses fused

Gigantism - GH excess after epiphyses fused

Question 25

Water deprivation test measure what?

Answer 25

Copeptin (derived from arginine vasopressin aka ADH) | - failure to rise >5 = partial or complete Diabetic insipidus

Question 26

Apart from GLP1-agonist, what else use to reduce weight?

Answer 26

Topiramate Phentermine - suppresses appetite

Question 27

Changes to which type of Ca will affect PTH?

Answer 27

ionised Calcium

Question 28

G protein - what turns it on and off? G protein function?

Answer 28

Turn on = GTP Turn off = GDP 1.molecular switch within cells -Gas - cAMP = signal transduction for many hormones +GNRH/CRH/ACTH/TSH/LH/FSH -Gaq -stimulate ACEII = blood control -Gai -inhibit cAMP from ATP

Question 29

HyperParathyroid = surgery indications?

Answer 29

``` Ca > 2.8 24 hours urine > 10 Age < 50 eGFR < 60 BMD < 2.5 / fragility # ``` BORED - BMD 24 hours CAGE

Question 30

Pseudohypoparathyroidism Type 1A Type 1B

Answer 30

Type 1A - GNAS mutation Mom- TSH/PTH hormone resistance Dad - Short stature - osteodystrophy Type 1B - GNAS normal + imprinting/methylation Hypocalcemia