Endocrinology

Question 1

What are the causes of a false positive ARR

Answer 1

Beta Blockers
NSAIDs
Alpha agonists (central) - clonidine

Question 2

What are the causes of a false negative ARR

Answer 2

Spironolactone
ACE and ARBs
Other Diuretics
SSRI

Question 3

Which form of insulin is bound to albumin?

Answer 3

Detemir

Question 4

Which cells do bisphophonates act?

Answer 4

Osteoclasts

Question 5

How does prednisone cause osteoporosis

Answer 5

Suppression of osteoblast proliferation.

Question 6

What response would expect to see with Desmopressin after water deprivation in central DI?

Answer 6

Dramatic response to DDAVP With osmolality of >600

Question 7

What response would expect to see with Desmopressin after water deprivation in nephrogenic DI

Answer 7

Poor response (<50% increase) in urine osmolality.

Question 8

What response would expect to see with Desmopressin after water deprivation in psychogenic polydipsia

Answer 8

No response (<10% increase in urine osmolality)

Question 9

What is the treatment of lithium induced nephrogenic DI?

Answer 9

Low sodium diet
Amiloride
Indomethacin
Desmopressin (if not able to have indomethacin)

Question 10

What is the treatment of central DI?

Answer 10

Low solute diet
Desmopressin
Thiazide diuretics

Question 11

What is the treatment of nephrogenic DI?

Answer 11

Low sodium low protein diet

Thiazide diuretics

Question 12

Characteristic findings in MEN1?

Answer 12

Pituitary Adenomas
Parathyroid hyperplasia
Pancreatic neuroendocrine tumours

Question 13

What is commonly found on gastroscope in patients with Zollinger Ellison syndrome?

Answer 13

Single sub centimetre duodenal ulcer (75%)

Question 14

How do you diagnose MEN1?

Answer 14

Clinical - 2 or more primary MEN1 tumour types

Genetic - Germline mutation in someone without clinical diagnosis

Question 15

How do you investigate a high IGF-1?

Answer 15

Oral glucose tolerance test with growth hormone levels.

Question 16

What is the single best test for acromegaly?

Answer 16

Serum IGF-1

Question 17

How do you interpret an oral glucose tolerance test when diagnosing acromegaly?

Answer 17

Levels of growth hormone 2 hours post administration.

GH >1ng/ml is diagnostic of acromegaly.

Question 18

What is the treatment of acromegaly?

Answer 18

1. Trans-sphenoidal surgery
2. Long acting somatostatin analogue (if not for surgery or not controlled)
3. Addition of pegvisomant if not controlled

Question 19

Mechanism of pegvisomant?

Answer 19

Growth hormone receptor antagonist.

Question 20

Mechanism of cabergoline?

Answer 20

Dopamine receptor agonist

Question 21

What is the most common genetic cause of MODY3?

Answer 21

HNF1a

Question 22

What is the mechanism of pasireotide?

Answer 22

Somatostatin receptor 5 agonist used in acromegaly.

Question 23

Osteogenesis imperfecta is a disorder of what?

Answer 23

Type 1 collagen

Question 24

What mutation would you most often find in a patient with an autonomous thyroid module?

Answer 24

Activating TSH receptor mutation

Question 25

What is the pathophys of Graves’ disease?

Answer 25

Thyroid stimulating immunoglobulin production | Thyrotropin receptor antibodies

Question 26

Mechanism of carbimazole?

Answer 26

Inhibition of iodine oxidation

Question 27

What do you measure to monitor for recurrent medullary thyroid cancer?

Answer 27

Calcitonin

Question 28

What is the treatment of a macroprolactinoma?

Answer 28

1. Dopamine agonist therapy | 2. Surgery if does not respond

Question 29

What is the management of acromegaly in a patient who is a candidate for surgery?

Answer 29

1. Surgery 2. Long acting somatostatin analogue (octreotide) 3. Add on dopamine agonist 4. Replace DA with pegvisomant 5. Radiation or repeat surgery

Question 30

What is the most common autoimmune disease associated with type 1 DM?

Answer 30

Autoimmune thyroiditis

Question 31

What are the major antibodies associated with Hashimoto’s thyroiditis ?

Answer 31

Thyroid peroxidase | Thyroglobulin

Question 32

What is the treatment of painless thyroiditis?

Answer 32

Hyperthyroid phase - beta blockade | Hypothyroid phase - thyroxine

Question 33

What is the cell that PTH primarily acts on in bone?

Answer 33

Osteoblast

Question 34

What effect does amiodarone have on T4 and T3?

Answer 34

Inhibits peripheral conversion of T4 to T3

Question 35

What are the most likely diagnoses with a low TSH, a high T3 and a normal T4?

Answer 35

Graves’ disease | Thyroid adenoma

Question 36

What are the most likely diagnoses with a low TSH, a high T4 and a normal T3?

Answer 36

Amiodarone induced Thyroxine ingestion Non thyroidal illness

Question 37

What are the sonographic features for a thyroid nodule which necessitate FNA?

Answer 37

Subcapsular location Extra thyroidal extension Large lymph nodes Solid and >1cm