Endocrinology

Question 1

what does hypokalaemia associated with hypertension indicate?

Answer 1

primary hyperaldosteronism

Question 2

which 2 tests are most commonly used to diagnose cushing’s? which is the most sensitive?

Answer 2

overnight dexamethasone suppression test (most sensitive)

24h urinary free cortisol

Question 3

2 conditions that can cause diabetes

Answer 3

chronic pancreatitis
haemochromatosis

damage pancreas’s insulin-producing cells

Question 4

name a drug that causes raised glucose levels

Answer 4

glucocorticoids

Question 5

what is a glucose tolerance test?

Answer 5

fasting BG taken, then 75g glucose taken

2hrs later - BG taken again

Question 6

diagnosis of DM by blood glucose

Answer 6

if symptomatic:
fasting glucose of 7+
random glucose of 11+ (or after 75g OGTT)

if asymptomatic, these must apply on 2 occasions

6.1-6.9 fasting - prediabetes

Question 7

HbA1c in diagnosis of DM

what can cause misleading results?

Answer 7

42-47 - prediabetes
48+ - diagnostic
less than 48 doesn’t exclude
if asymptomatic, repeat test to confirm

increased red cell turnover - misleading

Question 8

how does metformin work?

Answer 8

increases insulin sensitivity

decreases hepatic gluconeogenesis

Question 9

2 SEs metformin

Answer 9

GI upset

lactic acidosis

Question 10

when can you not use metformin?

Answer 10

eGFR < 30

Question 11

what type of drug is gliclazide?

Answer 11

sulfonylurea

Question 12

how do sulfonylureas (gliclazide) work?

Answer 12

stimulate beta cells to produce insulin

Question 13

3 SEs of sulfonylureas (eg gliclazide)

Answer 13

hypoglycaemia
weight gain
hyponatraemia

Question 14

3 SEs of thiazolidinediones

name the thiazolidinedione used

Answer 14

weight gain
fluid retention
liver impairment

pioglitazone

Question 15

how to distinguish DM 1 from other types?

Answer 15

c-peptide - low in DM1

Question 16

DVLA - rules if on insulin/sulfonylureas for HGV drivers

Answer 16

no severe hypo in last year

monitor BG 2x daily

Question 17

DVLA - rules for drivers on insulin (group 1)

Answer 17

not more than 1 hypo needing others’ help in last year

Question 18

3 things that can precipitate DKA

Answer 18

infection
missed insulin
MI

Question 19

management of DKA

Answer 19

0.9% saline 1L over 1h
then IV insulin infusion 0.1u/kg/h
once BG <15: 5% dextrose
correction of hypokalaemia

Question 20

what are the 2 roles of ADH?

Answer 20

regulates tonicity of body fluids:
makes kidneys reabsorb water to return to blood → concentrates urine + reduces its volume
constricts arterioles → increased peripheral vascular resistance → BP raised

Question 21

how does SIADH present on blood + urine tests?

Answer 21

hyponatraemia
low plasma osmolality
high urine osmolality

Question 22

what endocrine effect can small cell lung cancer have?

Answer 22

SIADH

Question 23

BP target in diabetes

Answer 23

140/80

or 130/80 if end organ damage

Question 24

diagnosis of follicular thyroid carcinoma

Answer 24

USS + FNA + hemithyroidectomy

Question 25

papillar/follicular thyroid cancer - mgmt + monitoring

Answer 25

total thyroidectomy then radioiodine yearly thyroglobulin levels

Question 26

patients on steroids long-term - what to do with dose if get intercurrent illness?

Answer 26

double it

Question 27

what effects can glucocorticoids have on the eye?

Answer 27

glaucoma | cataracts

Question 28

2 SEs of mineralocorticoids (fludrocortisone + hydrocortisone)

Answer 28

fluid retention | HTN

Question 29

how does pioglitazone (a thiazonidiledione) work?

Answer 29

inreases insulin sensitivity (reduces peripheral insulin resistance)

Question 30

what is an adverse effect of thiazides?

Answer 30

hypercalcaemia

Question 31

what are the commonest causes of hypercalcaemia?

Answer 31

primary hyperPTH | malignancy (due to variety of processes eg bone mets, myeloma)

Question 32

what is one finding of myeloma on bloods?

Answer 32

hypercalcaemia

Question 33

how can hyperPTH present on bloods?

Answer 33

hypercalcaemia

Question 34

how can malignancy present on bloods?

Answer 34

hypercalcaemia

Question 35

what kind of drug is sitagliptin?

Answer 35

DPP-4 inhibitor

Question 36

what is a SE of exenatide?

Answer 36

weight loss

Question 37

what is deep, laboured breathing a sign of?

Answer 37

DKA or metabolic acidosis | Kussmaul's breathing - inhales excess CO2 to compensate

Question 38

whats the main issue in addisons?

Answer 38

little/no endogenous steroid production

Question 39

what happens to cortisol levels when ill?

Answer 39

increase

Question 40

addisons pt unwell - what to do with hydrocortisone + fludrocortisone doses?

Answer 40

same fludrocortisone | double hydrocortisone

Question 41

addisons - management

Answer 41

fludrocortisone + hydrocortisone

Question 42

what are the 4 insulin antagonists?

Answer 42

adrenaline glucagon growth hormone cortisol (is this why growing, stress, illness can precipitate DKA?)

Question 43

DKA - metabolic pathway

Answer 43

consider as fats + sugars: increased stress hormones + reduced insulin cause: 1) lipolysis -> ketoacidosis -> kussmaul, ketone breath, negative inotropism 2) hyperglycaemia -> osmotic diuresis -> dehydration, K depletion + renal impairment

Question 44

what causes the hypokalaemia in DKA?

Answer 44

1) osmotic diuresis 2) RAS activated to hold onto Na + fluid but causes you to excrete K. means total body K always low but serum K sometimes normal/high - 'potassium paradox' - prerenal AKI

Question 45

explain a normal-high K in DKA

Answer 45

1) acidosis - H+ in cells forces K+ out to maintain intracellular cation balance 2) no insulin - no K+ uptake until insulin replaced - then sudden drop 3) prerenal AKI - oliguria with failure of K+ excretion

Question 46

4 causes of macroglossia

Answer 46

acromegaly down's amyloid congenital hypothyroidism

Question 47

euthyroid with neck lump - what is it?

Answer 47

multinodular goitre - commonest large goitre | rarely can go thyrotoxic (toxic multi nodular goitre

Question 48

what doesn't take up radioiodine?

Answer 48

thyroid cancer or cyst

Question 49

multinodular goitre - indications for surgery

Answer 49

cosmetic | local structure compression eg voice change, stridor

Question 50

what are pemberton's test + sign?

Answer 50

test for retrosternal goitre - raise arms + pink face from SVC obstruction, can cause stridor

Question 51

neurofibromatosis - inheritance?

Answer 51

autosomal dominant condition

Question 52

neurofibromatosis - features

Answer 52

axillary freckling cafe au lait spots type 2 - acoustic neuroma