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RACP 2022 Written > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Which genetic defect is associated with MODY 3?

A

Hepatocute nuclear factor-1-alpha

Most common form of MODY

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2
Q

Which forms of MODY are highly sensitive to sulfonylureas?
Which genetic defects are they associated with

A

MODY 1 and MODY 3

Associated with defect in hepatocyte nuclear factor 4a (MODY 1) and Hepatocyte nuclear factor 1a (MODY 3)

MODY 3 is most common

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3
Q

Which of the following is not a criteria for ordering auto-antibodies in diabetes?

A. Personal or family history of autoimmune disease
B. BMI <30
C. Age <50
D. Acute symptoms

A

B. BMI <25

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4
Q

Which of the following patients would be most likely to respond to a CRH stimulation test?
A. Psuedo cushings
B. Cushings disease
C. Adrenal adenoma
D. Phaeochromocytoma

A

B. Cushings disease

Corticotroph tumors respond to CRH, ectopic (i.e. non pituitary) ACTH producing tumors do not

Positive result - ACTH rise >40% within 15-30 mins and cortisol rise >20% within 45-60 mins

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5
Q

Which form of MODY is not associated with microvascular complications? Genetic defect?

A

MODY 2 - mild fasting hyperglycemia, genetic defect in glucokinase gene, not typically associated with microvascular disease

Managed with diet only

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6
Q

Which forms of MODY need insulin?

A

Mody 5 and 6, defect in hepatocyte nuclear factor 1a (MODY 5) and neurogenic diffferentiation factor-1 (MODY 6)

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7
Q

Which patients should be screened for OP on steroids?

A

Steroids for 3 months at >7.5mg/day

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8
Q

How does hyperthyroidism occur in pregnancy? What is it associated with?

A

BHCG stimulates TSH receptor –> TSH supression with associated high fT3 + fT4

Associated with hyperemesis gravidum due to high BHCG

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9
Q

Drugs causing hyperthyroidism?

A

Iodine
Amiodarone
Interleukin 2
Interferon alpha

Lithium can cause thyroiditis and hyperthyroidism before hypothyroidism

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10
Q

Immunotherapy associated with hypothyroidism

A

Anti-CTLA4 - ipilimumab, trepilimumab

Anti-PD1 - nivolumab, prembrolizumab

TKI

Bexarotene

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11
Q

Factors that increase TBG?
Drugs that decrease TBG?

A

Increase:
- estrogen/pregnancy
- hepatitis
-drugs (opioids, fluorouracil, perphenazine)
- acute intermittent porphyria

Decrease:
- high dose androgens
- cortisol/cushings syndrome
- acromegaly
- neprhotic syndrome (loss of TBG)
- danazol
- niacin

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12
Q

Features of MEN 1,

A

MEN1

Triple Ps - Parathyroid adenomas
Pancreatic tumors
Pituitary adenomas

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13
Q

Features of MEN2a vs MEN2b

A

MEN2 = PARATHYROID

MEN2a
Medullary thyroid carcinoma
Pheochromocytomas
Parathyroid adenomas

MEN2b (rare skinny men with weird tongues)

Medullary thyroid carcinoma
Pheochromocytomas
Mucosal neuromas
Marfanoid habitus

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14
Q

Which diabetic drugs are contraindicated with a past history of pancreatitis?

A

DDP4 inhibitors (-gliptins, i.e. linagliptin) + GLP1 agonists (-tides, i.e. exenatide)

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15
Q

Which diabetic drugs are associated with weight loss?

A

Metformin
SGLT2 inhibitiors
GLP1 agonists

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16
Q

Mechanism of action and effects of GLP1 agonists?

A

Mimics effects of GLP1 by effects on GLP1 receptor –> increased insulin secretion, decreased glucagon secreation, delayed gastric emptying (inhibits peristalsis of the stomach while increasing tonic contraction of the pyloric region.

Results in reduced appetite, weight loss

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17
Q

Mechanism of action of acarbose?

A

Alpha-glucosidase inhibitor - a-glucosidase normally converts CHO to monosaccharides, inhibition leads to reduced GI glucose absorption and reduced postprandial BSLs

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18
Q

Most common cause of asymptomatic hyperprolactinemia

A

Macroprolactin - ask lab to pre-treat samplex with polyethylene glycol

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19
Q

4 causes of increased thyroid uptake on technetium scan

A

TSHoma
HCG secreting tumor
Graves disease
Toxic multinodular goitre or adenoma

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20
Q

Treatment of hyperthyroidism in trimester 1?
Treatment in trimester 2 and beyond?

A

Trimester 1 - propylthiouracil
Trimester 2 - carbimazole

1p2c

21
Q

3 hormones that inhibit food intake

A

Leptin
CCK
Adiponectin

22
Q

3 hormones that stimulate food intake

A

Grehlin
Neuropeptide Y
Agouty-related peptide

23
Q

Most common genetic cause of obesity

A

MC4R mutations

24
Q

Which hormones are deficient in congenital adrenal hyperplasia? Which are in excess?

A

Deficient - aldosterone, cortisol
Excess - androgens (hirsuitism and amibuous genitalia in women)

Due to alpha-21 dyhydroxylase deficiency

25
Q

Hormone released from the zona glomerulosa

A

Aldosterone

26
Q

Hormone released from the zona fasciulata

A

cortisol

27
Q

Hormones released from the zona reticularis

A

Androgen precursors - DHEAS, androstenedione

28
Q

Hormones released from the medulla

A

Adrenaline/norad, dopamine

29
Q

Romosuzumab mechanisms of action

A

Inhibits sclerostin –> enhances Wnt signalling –> increased osteoblast matuation

30
Q

Which steroid is innappropriate for treatment of Addisons?

A

Dexamethasone, betamethasone - no mineralocorticoird activity (need to prescribe fludrocortisone with it)

31
Q

PBS criteria for anabolic agents

A

high fracture risk
BMD -3.0
2 or more minimal trauma fractures
1 symptomatic fracture 12 months after treatment with an antiresorptive

+ no romosuzumab treatment previously

32
Q

Type 1 amiodarone induced thyrotoxicosis - what is it and treatment

A

Increased synthesis of T4 and T3
More common in unerlying Graves
Treat with thionamides (methimazole)
Goitre
High uptake on scan/colour flow dopper changes
no response to steriods.

33
Q

Type 2 amiodarone induced thyrotoxicosis - what is it and treatment

A

Increased release of T4 and T3 due to toxic effect of amiodarone on thyroid follicular epithelial cells.
More common in euthyroid people
Treat with pred
No or small goitre
low uptae on radioactive scan, decreased colour flow doppler
TPO negative
But raised IL-6 and thyroglobin levels.

34
Q

Markers of bone formation and resorption

A

Osteocalcin = formation
C-telopeptide = resorption

35
Q

BSL targets during pregnancy (pre-exisitn diabetes)

A

HbA1c <6.5 T1, <6.0 T2 - check once per trimester

Pre prandial BSL 4.0 - 5.3
1hr post prandial 5.5 - 7.8
2hr post prandial 5.0 - 6.7

36
Q

Factors that increase FGF-23
Action of FGF-23

A

Secreted by osteocytes

Factors that increase it:
- PTH
- Phosphate
- calcium
- calcitriol (activated vitamin D)

Actions:
- increase phosphate excretion by reducing reabsorption
- inhibit vitamin D activation - reduced calcium _ hosphate gut/renal reabsorption
- inhibit PTH

37
Q

Co-factor of FGF23

A

Klotho

38
Q

Sick euthryoid TFTs

A

Normal TSH
Low T3
Normal T4

39
Q

Antibodies in type 1 diabetes
Which is specific for beta cells?

A

Anti-GAD65
ZnT8
IA21
Insulin auto-antibodies (IAA)

Insulin antibodies = specific for beta cells
?maybe islet cell antiboides also

40
Q

What is it fi you suppress cortisol after low dose dexa, but not after high dose dex test?

A

Cushings Disease

41
Q

What if cortisol supression in both low and high dose dexa test?

A

Adrenal neopalsm or ectopic ACTH syndrome

42
Q

Carbimazole inhibits which pathway?

A

THyroid peroxidase activity

43
Q

Targets of these drugs
Romozozumab
Densomab
Odanacatib

A

Romo: sclerostin
Den: RANKL
Oda: Cathepsin K

44
Q

Ultrasound features of Malignant nodule

A

Solid, hypoechogenecity, intranodular vascuarlity, absence of halo, irregular margin, central microcalcifications, LN, >4cm single cold nodule

Even if negative FNA and greater then 4cm, still take out lobe of thyroid.

Not cystic

45
Q

How does pred cause hyperglycemia”?

A

Increased glucose production from protein

Stimulation of gluconeogenesis

Increased pancreatic insulin production

46
Q

Pred Mechanism for osteoporosis?

A

Inhbition osteoblast function
enchance bone resorption
inhbito GI Ca absorption
Increase urine calcium loss
inhbition of sex steriods

47
Q

Level of SHBG in exogneous testosterone? What increases the level?

A

SHBG goes down in exogenous, if you are hyperthyroid it goes UPPP, so too does testoser and free test.

48
Q

Which way to SHBG go in exogenous testosterone

A

RACP 2022 Written (21 decks)

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