Endocrinology

Question 1

What is meal ratio? Formula?

Answer 1

The amount of carbohydrate one unit of fast acting insulin will ‘metabolise’ to keep BLS in optimal range.
Meal ratio = 500/Total daily dose

If total daily dose in 50, then meal ratio = 10.
Ie, one unit of insulin will cover 10g carbohydrate

Question 2

What is insulin sensitivity factor

Answer 2

The amount that the BSL will drop with 1 unit insulin

ISS = 100/Total daily dose

Question 3

growth hormone

Answer 3

increased by: sleep, exercise, stress, trauma, sepsis, protein
decreased by: age, obesity, sugar

Question 4

amiodarone induced thyrotoxicosis Rx

Answer 4

type 1: rx with carbimazole (increased vascularity)

type 2: rx with prednisolone (decreased vascularity)

Question 5

High risk HLA for T1DM

Answer 5

HLA DR2/DQ3

HLA DR4/DQ8

Question 6

What in utero infection increases the risk of T1DM

Answer 6

Congenital rubella

Question 7

Primary hyperparathyroidism - indications for surgery

Answer 7

Ca >0.25 LLN
Cx - bone disease, renal calculi
Age <50 y.o.
Want surg

Question 8

Markers of bone resorption

Answer 8

Hydroxyproline
Deoxypyridiniline
N or C telopeptide

Question 9

Markers of bone formation

Answer 9

ALP
Osetocalcin
Procollagen C terminal propeptide
Procollagen N terminal propeptide

Question 10

exenatide / byetta MOA

Answer 10

GLP1 analogue; increases glucose dept secretion of insulin

Question 11

high cholesterol

Answer 11

hypothyroid
nephrotic syndrome
cholestatic liver disease
pregnancy

Question 12

high TGL

Answer 12

alcohol
oestrogens
DM
renal disease
use fibrates? but no benefit added to statins; trend toward mortality

Question 13

SERM

Answer 13

raloxifene
decreases vertebral fractures in OP
decreases breast cancer

Question 14

MEN2

Answer 14

medullary thyroid CA + phaeo
2A: + parathyroid adenoma
2B: + neuromas + marfanoid

Question 15

MEN1

Answer 15

pituitary + parathyroid + pancreas

Question 16

Carney Syndrome

Answer 16

pituitary tumour + spotty skin pigmentation + myxomas + testicular / adrenal adenomas
PPKAR1A

Question 17

autoimmune polyglandular syndrome

Answer 17

Addisons + hypothyroid + candida + hypoparathyroidism

giving thyroxine can precipitate adrenal crisis

Question 18

Hyponatraemia

Answer 18

serum osmol (expect low unless BGL, protein)
urine osmol (> 100 unless drinking too much H2O)
urine Na ( < 20 if low volume)
urine Cl (> 20 w diuretics)

Question 19

appetite stimulants

Answer 19

ghrelin

neuropeptide Y

Question 20

appetite suppressants

Answer 20

leptin
alpha MSH
CCK
PYY3-36

Question 21

testosterone

Answer 21

morning peak
low post food, in DM
SHBG low in obesity, DM; low total testosterone but free level normal in moderate obesity
totally low in severe obesity

Question 22

GH deficiency

Answer 22

< 5 post insulin tolerance test

Question 23

brown fat

Answer 23

thermogenic; mitochrondria rich

Question 24

pregnancy thyroid

Answer 24

over hypothyroid; increase thyroxine by 30%
hyperthyroid OK: aim high normal T4
PTU 1st ™; carbimazole 2nd, 3rd
post partum thyroiditis - avoid antithyroid drugs

Question 25

atypical femoral #

Answer 25

prodromal pain, bilateral, femoral shaft, minimal trauma, delayed healing, >5-7 years bisphosphonate use, GCC, PPI, no comminution, thick cortices, transverse or short oblique, medial braking Rx: cease bisphos; teriparatide; prophylactic pinning of contralateral side

Question 26

diabetic retinopathy

Answer 26

less likely to require laser if fenofibrate used | use ranibizumab for oedema (VEGF)

Question 27

Von Hippel Lindau

Answer 27

VHL tumour suppressor gene mutation auto domt noradrenaline secreting phaeos renal cell, retinal, pancreatic, neuroendocrine tumours

Question 28

MEN2

Answer 28

ret gene mutation adrenaline secreting phaeos medullary thyroid cancer, primary hyperparathyroid

Question 29

Neurofibromatosis 1

Answer 29

neurofibromas, cafe au laid spots, CNS gliomas | adrenaline secreting phaeo

Question 30

SDHB

Answer 30

malignant paragangliomas dopamine secreting phaeos maternal imprinting

Question 31

corrected sodium

Answer 31

corr Na = Na + BGL / 3

Question 32

PCOS LH: FSH ratio

Answer 32

LH > FSH | ie: ratio > 1:1