Endocrinology

Question 1

What is the most common side effect of metformin?

Answer 1

GI disturbance

Question 2

Which diabetic medication should be stopped in AKI?

Answer 2

Metformin

Question 3

Which class of T2DM drug is useful in bringing down glucose quickly?

Answer 3

Sulphonylureas
- glimepiride, gliclazide, glipizide

Question 4

Which T2DM drug is useful if insulin resistance is significant?

Answer 4

Pioglitazone

Question 5

Which class of T2DM drug is useful in cardiovascular risk?

Answer 5

SGLT2 inhibitors
- canagliflozin, dapagliflozin, empagliflozin

Question 6

SGLT2 inhibitors carry risk of what type of infection?

Answer 6

Urinary tract infection, thrush
- due to mode of action of increasing glucose excretion in urine

Question 7

Which class of T2DM medications are commonly used for weight loss?

Answer 7

GLP1 analogues
- liraglutide, semaglutide, exenatide

Question 8

Which class of T2DM drugs is useful in protecting kidneys if there is albumin or protein in the urine?

Answer 8

SGLT2 inhibitors
- canagliflozin, dapagliflozin, empagliflozin

Question 9

What is the recommended cut off HbA1c for diagnosing diabetes?

Answer 9

48mmol/mol

Question 10

When should we not utilise HbA1c testing for diabetes diagnosis?

Answer 10

Children, suspected type 1, pregnancy, acute illness, symptomatic for less than 2 months

Question 11

Which test is used for detecting microvascular kidney complications in diabetes?

Answer 11

ACR

Question 12

What is the upper limit of normal for ACR in men and women?

Answer 12

2.5mg/mmol men
3.5mg/mmol women

Question 13

When replacing insulin in DKA, which electrolyte is important to monitor?

Answer 13

Potassium
- Insulin decreases blood potassium

Question 14

What are the three main things to administer in a DKA patient?

Answer 14

Fluids + insulin + potassium

Question 15

Steroids can have what effect on blood glucose?

Answer 15

Increase

Question 16

Type 3c diabetes can be caused by what conditions?

Answer 16

Acute/chronic pancreatitis, pancreatic cancer, cystic fibrosis, haemochromatosis

Question 17

How may Cushing’s disease/syndrome lead to diabetes?

Answer 17

Elevated cortisol leads to increased insulin resistance

Question 18

Excessive growth hormone may lead to what effect on insulin?

Answer 18

Resistance

Question 19

Name 4 hormones that can increase insulin resistance/impede it’s secretion

Answer 19

Cortisol, adrenaline, thyroid, growth hormone

Question 20

What is target blood pressure for those with diabetes?

Answer 20

<140/90mmHg
- NB same as those without diabetes

Question 21

Which painkiller is first line in painful peripheral neuropathy in diabetics?

Answer 21

Amitriptyline
- note cannot use in glaucoma

Question 22

During puberty what do we usually need to do to insulin dosages?

Answer 22

Increase them
- due to increasing insulin resistance at puberty

Question 23

Alcohol does what to glucose levels?

Answer 23

Hypoglycaemia
- due to alcohol inhibiting the livers ability to regulate blood glucose

Question 24

How many grams of quick acting carbohydrate should we give to those who we suspect hypoglycaemia who are conscious and talking?

Answer 24

15-20g

Question 25

In hypercalcaemia, what happens to PTH levels?

Answer 25

Reflexively decreased

Question 26

What is the most common cause of primary hyperparathyroidism?

Answer 26

Parathyroid adenoma

Question 27

Subarachnoid haemorrhage is associated with which electrolyte abnormality?

Answer 27

Hyponatraemia

Question 28

Thiazide diuretics can cause a triad of what electrolyte abnormalities?

Answer 28

Hyponatraemia + hypokalaemia + hypercalcaemia

Question 29

Choose high/low: Addisons disease has what effect on sodium, potassium and glucose?

Answer 29

Sodium - low Potassium - high Glucose - low

Question 30

How should hydrocortisone dose in Addison’s disease be split throughout the day?

Answer 30

Split with more in the morning, less in the evening Note - to mimic the bodies natural cortisol production

Question 31

Fill in the blanks: To be able to consider trial of levothyroxine in asymptomatic subclinical hypothyroidism patients, TSH levels must be over __ on __ separate occasions, __ months apart.

Answer 31

1. 10 2. 2 3. 3

Question 32

Fill in the blanks: In symptomatic subclinical hypothyroidism patients, TSH levels must be between ___ - ___ on 2 occasions more than 3 months apart to consider levothyroxine trial.

Answer 32

5.5 - 10

Question 33

How should a patient over 65 with subclinical hypothyroidism be managed?

Answer 33

Watchful waiting

Question 34

Which antithyroid treatment should be avoided in thyroid eye disease?

Answer 34

Radioiodine

Question 35

Metformin carries risk of which metabolic abnormality?

Answer 35

Lactic acidosis

Question 36

What is the most common side effect of bisphosphonates?

Answer 36

Oesophagitis

Question 37

Osteonecrosis of which bone may occur with bisphosphonate therapy?

Answer 37

Jaw

Question 38

Deficiency of what 2 parameters should be corrected before initiating bisphosphonate therapy?

Answer 38

Calcium and vitamin D

Question 39

What is the appropriate management in a patient: 1. 75+ with a fragility fracture? 2. Under 75 with a fragility fracture?

Answer 39

1. Initiate bisphosphonates without DEXA 2. Conduct DEXA

Question 40

Over correction with levothyroxine increases risk of developing what?

Answer 40

Osteoporosis

Question 41

Recent myocardial infarction should prompt the cessation of what diabetes drug?

Answer 41

Metformin

Question 42

Prolonged diarrhoea results in a metabolic acidosis associated with what levels of: 1. Potassium 2. Chloride

Answer 42

1. Hypokalaemia (low potassium) 2. Hyperchloraemia (high chloride)

Question 43

Name the 2 contraindications to statin therapy

Answer 43

Macrolide therapy (clarithromycin, erythromycin) and pregnancy

Question 44

Fill in the blank: Statins should be stopped if ALT rises to and persists to __ times upper limit

Answer 44

3

Question 45

In primary prevention of hyperlipidaemia, what is the target percentage reduction in non-HDL cholesterol?

Answer 45

> 40%

Question 46

Total cholesterol level over what should prompt suspicion of familial hypercholesterolaemia?

Answer 46

Over 7.5mmol/l