Endocrinology

Question 1

Sulfonylurea

Answer 1

Increase stimulation of insulin secretion by pancreatic B-cells and decrease hepatic clearance of insulin

e.g. Gliclazide

Question 2

SGLT-2 inhibitors

Answer 2

Inhibits sodium-glucose co-transporter-2 in early proximal convoluted tubule to stop glucose reabsorption causing excretion in urine

Dapagliflozin, canagliflozin, empagliflozin

Question 3

DPP-4 inhibitors

Answer 3

Inhibits enzyme that breaks down GLP-1 a incretin hormone that increases insulin secretion and suppresses glucagon secretion

Sitagliptin

Question 4

Metformin

Answer 4

Reduces hepatic gluconeogenesis, increases peripheral glucose uptake and reduces the absorption of glucose in the gut

Question 5

Pioglitazone (thiazolidinediones)

Answer 5

Insulin sensitiser

Agonists to the PPAR-gamma receptor and reduce peripheral insulin resistance

Question 6

Cholesterol control in hypothyroidism

Answer 6

Start levothyroxine

Question 7

Papillary thyroid cancer

Answer 7

Most common type
Young women
Good prognosis

Question 8

Anaplastic carcinoma of thyroid

Answer 8

Pressure problems
Elderly
Not responsive to treatment

Question 9

Paget’s disease

Answer 9

Calcium normal
Phosphate normal
ALP raised
PTH normal

Question 10

Osteoporosis

Answer 10

Calcium
Phosphate
ALP
PTH
-> all normal

Question 11

Osteoamalacia

Answer 11

Calcium low
Phosphate low
ALP high
PTH high

Question 12

Primary hyperparathyroidism

Answer 12

Calcium high
Phosphate low
ALP high
PTH high

Question 13

Secondary hyperparathyroidism

Answer 13

Calcium
Phosphate
ALP
PTH

Question 14

Osteopetrosis

Answer 14

Calcium
Phosphate
ALP
PTH

-> all normal

Question 15

Nephrogenic DI

Mutation cause

Answer 15

1. Mutation in vasopressin (ADH) receptor
2. Mutation in gene that encodes aquaporin 2 channel

Question 16

Hyperaldotsteronism -> most common cause

Answer 16

Bilateral adrenal hyperplasia

Question 17

Physiological response to hypoglycaemia

Answer 17

1. decreased insulin secretion
2. increased glucagon secretion
3. increased growth hormone and cortisol

Question 18

Management of hypoglycaemia - unconscious patient

Answer 18

SC or IM glucagon OR
IV 20% glucose

Question 19

Management of levothyroxine in pregnancy

Answer 19

Increase by 50% at 4-6 weeks pregnancy

Question 20

Significant weight gain
Sweating (particularly early morning)
Double vision

Diangosis?

Answer 20

Insulinoma

Question 21

Treatment of diabetic ketoacidosis

Answer 21

1. Fluid resuscitation
2. Fixed rate insulin at 0.1unit/kg/hour
3. Once glucose <14 add 10% dextrose
4. Add K+ to fluids if <5.5

Question 22

Treatment of thyrotoxicosis

Answer 22

Beta-blockers
Propylthiouracil
Hydrocortisone