endocrinology

Question 1

What are the diagnostic criteria for DKA

Answer 1

ketonaemia>3mmol/l (or significant ketonuria)
Bloog glucose >11 (or known DM)
serum bicarbonate<15 or venous pH<7.3

Question 2

when should 10% dextrose be added to rescutaition/replacemetn fluid in DKA?

Answer 2

when BM<14

Question 3

what is the initial rate of fixed rate insulin in DKA?

Answer 3

0.1units per KG per hour

Question 4

WHat are the diagnostic criteria for HHS?

Answer 4

clinical hypovolaemia
BM>30mmol/l without significant keonaemia or acidosis
serum osmolarity>320mmol/l

Question 5

how is serum osmolality calculated?

Answer 5

2xNa +glucose +urea

Question 6

what is the normal osmolar gap

Answer 6

10msom/kg

Question 7

when should insulin infusion be started in HHS?

Answer 7

once BM is no longer falling with IV fluids alone

Question 8

dose of glucagon in hypoglycaemia

Answer 8

1mg IM

Question 9

which patients have reduced glycogen stores

Answer 9

alcoholics, sulphynourea, liver failure, malnourished

Question 10

what is produced by the zona glomerulosa?

Answer 10

mineralocorticoids e.g aldosterone

Question 11

what is produced by the zona fasciculata?

Answer 11

glucocorticoids e.g cortisol

Question 12

what is produced by the zona reticularis?

Answer 12

androgens

Question 13

what is produced by the adrenal medulla

Answer 13

catecholamines e.g. adrenaline/noradrenaline

Question 14

biocehmical markers of adrenocortical insufficiency

Answer 14

hyponatraemia
hyperkalaemia
high urea/creatinine
hypoglycaemia
metabolic acidosis

Question 15

low cortisol and low acth indicates?

Answer 15

secondary adrenal insufficinecy

Question 16

low corstiol and high ACTH

Answer 16

primary adrenal insufficincy (addison’s disease)

Question 17

principal cause of addision’s disease?

Answer 17

idiopathic/likely automimmune destuction

Question 18

management of acute adrenocortical insufficiency

Answer 18

a to E resucitation, fluids as guided by cardiovascular status
hydrocorisone 100mg IV
fludrocorisone only in primary insufficneccy
monitor for hypoglycamia and treat if needed
treat any underlying infection

Question 19

biochemical markes of cushing’s syndrpome

Answer 19

hypergy;ycaemia
hypokalaemia
hypernatraemia

Question 20

most common cause of cushing’s syndorme

Answer 20

chronic glucocorticoid administration

Question 21

cause of cushing’s disease

Answer 21

ACTH secreting pituitary tumour

Question 22

treatement of cushing’s disease

Answer 22

removal of pituitary adenoma, if can’t be located, bilateral adrenalectomy

Question 23

phaechromocytomas arise in?

Answer 23

adrenal medulla

Question 24

diagnosis of phaeochoromocytoma?

Answer 24

24 hour urinary free catecholamine level

diagnostic imaging to localise tumour

Question 25

best agents for BP control in phaeochromocytoma

Answer 25

phenoxybenzamine, (alpha blocade) then propranolol to treat tachycardia

Question 26

how to calculate anion gap

Answer 26

sodium-chloride-bicarb

Question 27

treatment of thyroid storm

Answer 27

high dose carbimazole/PTU then potassium iodide - inhibit synthesis and release
betablockers (80mg propanolol po) - stop peripheral conversion t4 to t3
sedation wwith benzos
glucocorticoid - stop peropherial conversion and prevent adc insufficinecy
-treat underlying cause, eg antibtics
supportive managemnt , e.g fluids or NGT

Question 28

3 main features of myxoedema coma

Answer 28

altered mental state
hypothermia (or abscence of fever despite severe infection
presence of a precipitating event

Question 29

managmetn of myxoedema coma

Answer 29

thyroid replacment
treat preciptant
100mg hydrocrotsone 8 hourly
supportive therapy

Question 30

managment of pituitary apoplexy

Answer 30

hydrocortisone 100mg 6 hourly
supportive measures
neurosurgeons

Question 31

features of diabetes insipidus

Answer 31

polyuria
poydipsia
dilute urine
dehydration

Question 32

biochemical markers of DI

Answer 32

high plasma osmolality
low urine osmolality
high serum sodium
(deranged pituitary function tests and remember CT head)

Question 33

treatment of cranial DI

Answer 33

desmopressin/DDAVP

Question 34

ECG changes in hypocalcamiatreatment of hypocalcaemia

Answer 34

calcium gluconate, low thershold for magnesium sulphate