Endocrinology

Question 1

pain in thumb, index finger and forearm
tingling in the arm
what is it ?

Answer 1

carpal tunnel syndrome

hypothyroidism

Question 2

what is bilateral adrenal hyperplasia

Answer 2

common form of secondary hypertension
patient will be hypertensive but have a low k+ level

Question 3

features of SIADH

Answer 3

1. low serum osmolarity
2. high urine osmolarity
3. high urine sodium

Question 4

parathyroidism

Answer 4

the parathyroid hormone PTH is released by the parathyroid gland
has calcium and vitamin D receptors

when PTH is released
- renal phosphate exertion increases
- plasma calcium increases
- absorption of calcium in the gut increases

Question 5

hyperparathyroidism - impacts

Answer 5

major cause of hypercalacaemia
primary hyperparathyroidism - mainly due to cancer
secondary - CKD causes calcium levels to drop so PTH gets raised to compensate for this

Question 6

what is the most common cause of hypokalaemia?

Answer 6

hypothermia

• causes low levels of potassium due to a trans cellular shift of potassium when body temperature is low
• it is the most common reversible cause of cardiac arrest
• give patient potassium

Question 7

what is antiphospholipid syndrome

Answer 7

when the immune system accidentally makes antibodies which attack tissues

this causes blood clots in the arteries and veins
can cause miscarriage in pregnancy

Question 8

which medications can cause Cushings syndrome

Answer 8

corticosteroids like prednisolone can cause too much cortisol

Question 9

which medication can cause hyperkalaemia

Answer 9

spironolactone - it is a potassium sparing diuretic

Question 10

which medication can cause hyponatraemia

Answer 10

omeprazole
PPI
PPIs can affect the normal function of the kidneys and therefore affect the electrolytes
they can also affect ADH

Question 11

what are the side effects of carbimazole - a hyperthyroidism drug

Answer 11

it can cause neutropenic sepsis
so always check FBC

Question 12

what is hyperaldosteronism

Answer 12

it is when the adrenal glands release too much aldosterone
it presents with high blood pressure and low potassium

Question 13

symptoms of worsening palpitations and tremors. He is found to have a goitre with a bruit and is referred to the Endocrinologists. His blood test reveal that he has developed thyrotoxicosis

what is the drug?

Answer 13

amiodirone

it has a high iodine content

Question 14

what is serotonin syndrome

Answer 14

it is when there is too much serotonin in the blood
this can cause symptoms such as diarrhoea
tremors
mental state changes eg confusion

Question 15

what is addinosinan crisis

Answer 15

when someone takes steroids long term and then suddenly stops - the body naturally stops making steroids because of the external input of it

when steroids are stopped, there is a sudden decrease in steroids

causes the crisis

low aldosterone
low sodium
high potassium

Question 16

what is the management for addisonian crisis

Answer 16

IV hydrocortisone - increase glucocorticoids which increase serum cortisol

Question 17

What is the investigation for Cushing’s disease?

Answer 17

Low-dose dexamethasone suppression test

Question 18

what are the symptoms of Addisons disease

Answer 18

GI symptoms
hypotension
fatigue

Question 19

What infections can be a cause of Addisons disease

Answer 19

TB

Question 20

which hypertension medication can cause hyper and hypothyroidism

Answer 20

amiodarone

Question 21

why does amiodarone cause hypo and hyperthyroidism

Answer 21

Amiodarone contains high amounts of iodine - interferes with the production of thyroid hormones - hypothyroidism (Wolf Chailkoff)

amiodarone can cause hyperthyroidism - structural similarity of amiodarone to thyroid hormones, which can result in overstimulation of the thyroid gland (Jodd Basedow)

Question 22

most common cause of hyperthyroidism in pregnancy

Answer 22

graves disease

Question 23

symptoms of Cushings disease

Answer 23

1. bruising
2. obesity
3. hypertension

Question 24

investigation of Cushings disease

Answer 24

to identify if there is an excess of cortisol

24 hour urinary free cortisol
Low-dose Dexamethasone suppression test

Localisation:

Plasma ACTH
High-dose dexamethasone suppression test

Question 25

investigation for Addisons disease

Answer 25

9am cortisol having low levels in the morning means adrenal insufficiency

Question 26

what is the investigation for Conns disease (hyperaldoesterone)

Answer 26

aldosterone/renin ratio it can present with weakness, thirst and low potassium

Question 27

what is the cause of primary hyperparathyroidism

Answer 27

this is when the hyperparathyroid gland produces more PTH - causes hypercalcaemia

Question 28

what is the cause of secondary hyperparathyroidism

Answer 28

there is increased secretion of PTH in response to low calcium because of kidney, liver, or bowel disease.

Question 29

what is the cause of tertiary hyperparathyroidism

Answer 29

there is autonomous secretion of PTH, usually because of chronic kidney disease (CKD).

Question 30

what changes does hypothyroidism cause to the voice

Answer 30

causes voice hoarseness

Question 31

T4 and T3 normal function

Answer 31

increases metabolism so everything speeds up dry skin hair loss anxiety palpitations menstrual cycles - amennoreha

Question 32

examination findings od hyperthyroidism

Answer 32

tachycardia - vital signs general insectpion - will be thin and wearing less clothes as they will be feeling hot hands - dry skin, tremor, swelling of the hands and sweaty hands eyes - bulging eyes - exopthamlosis opthalmaplegia - one eye lags behind

Question 33

hypertension medication that can cause hyperthyroidism

Answer 33

amiodarone it contains iodine can cause toxicity - as it increases the acidity of thyroid gland

Question 34

first line treatment of hyperthyroidism

Answer 34

symptomatic - propanol prophylactic - carbimazole - common side effect is lower neutrophils curative - surgery

Question 35

hypothyroidism features

Answer 35

everything slows down decreased basal metabolic rate periods become heavier

Question 36

hypothyroidism examinations

Answer 36

bradycardia wear a lot of clothes will feel cold be heavier goitre in the neck and oedema in the legs

Question 37

what is myxoedema coma

Answer 37

extreme symptoms of hypothyroidism usually in the elderly very long standing hypothyroidism due to physiological stress hyponatreamia and hypoglycaemia very cold temp

Question 38

management of myxoedema coma

Answer 38

iv levothyroixine rise glucose levels corticosteroids

Question 39

what is thyroid storm

Answer 39

extreme symptoms of hyperthyroidism high temp high glucose high levels of sodium sweaty tachycardia

Question 40

clinical presentation of hyperaldosteronism

Answer 40

poorly controlled hypertension hypokalaemia metabolic alkalosis

Question 41

how do ace inhibitors affect aldosterone

Answer 41

they block aldosterone so less aldosterone therefore hyperkalaemia

Question 42

testing for hyperaldosteronins

Answer 42

bloods urea and elerolyets ABG renin:aldoserone ratio imaging - CT abdo

Question 43

management of primary hyperadostrone

Answer 43

give potassium sparing diuretic like spironolactone

Question 44

what is Addisons disease

Answer 44

primary adrenal insufficiency low production of aldosterone and cortisol can be autoimmune or TB causes

Question 45

presentation of Addisons disease

Answer 45

salt craving due to low sodium high potassium - muscle weakness reduced cortisol - reduced appetite and weight loss hyperpigmentation - deu to increased ACTH

Question 46

presentation of Addisons disease

Answer 46

salt craving due to low sodium high potassium - muscle weakness reduced cortisol - reduced appetite and weight loss hyperpigmentation - deu to increased ACTH

Question 47

presentation of Addisons disease

Answer 47

salt craving due to low sodium high potassium - muscle weakness reduced cortisol - reduced appetite and weight loss hyperpigmentation - deu to increased ACTH

Question 48

presentation of Addisons disease

Answer 48

salt craving due to low sodium high potassium - muscle weakness reduced cortisol - reduced appetite and weight loss hyperpigmentation - deu to increased ACTH