Endocrinology

Question 1

What do the beta cells of the Islets of Langerhans secrete?

Answer 1

Insulin

Question 2

What do the alpha cells of the Islets of Langerhans secrete?

Answer 2

Glucagon

Question 3

What do the delta cells of the Islets of Langergans secrete?

Answer 3

Somatostatin

Question 4

What is the function of insulin?

Answer 4

To lower blood glucose levels

Question 5

How does insulin lower glucose levels?

Answer 5

1. Stimulates glucose uptake into insulin-dependent tissues
2. Stimulates glucagon synthesis and suppresses gluconeogenesis
3. Stimulates cellular uptake of potassium

Question 6

What is the normal range for blood glucose?

Answer 6

3.5-8.0 mmol/L

Question 7

How is glucose taken into cells?

Answer 7

Via GLUT receptors

Question 8

How is hypoglycaemia defined?

Answer 8

Blood glucose levels < 3.0mml/L

Question 9

What are the symptoms of hypoglycaemia?

Answer 9

Dizziness, confusion, hunger, convulsions, coma, sympathetic activation

Question 10

What is the treatment for hypoglycaemia?

Answer 10

Rapidly absorbed carbohydrate taken orally if possible

Question 11

What is the definition of Diabetes Mellitus?

Answer 11

A disease of chronic hyperglycaemia due to insulin deficiency, resistance or both

Question 12

What is the normal level for a fasting blood glucose?

Answer 12

< 5.5 mmol/L

Question 13

What is the prediabetic level for a fasting blood glucose?

Answer 13

5.5-7.0 mmol/L

Question 14

What is the diabetic level for a fasting blood glucose?

Answer 14

> 7.0 mmol/L

Question 15

What is the cause of Type 1 DM?

Answer 15

Insulin deficiency from autoimmune destruction of beta cells of the Islets of Langerhans

Question 16

What is the inheritance pattern of T1DM?

Answer 16

Polygenic

Question 17

What are the symptoms of T1DM?

Answer 17

Polydipsia, polyuria, fatigue, weigh loss, polyphagia

Question 18

What do undiagnosed type 1 diabetics often present to hospital with?

Answer 18

Diabetic ketoacidosis

Question 19

What is the treatment for T1DM?

Answer 19

Replacement of deficient insulin and careful diet control

Question 20

What is the cause of Type 2 Diabetes Mellitus?

Answer 20

Insulin resistance and deficiency

Question 21

What are the risk factors for developing T2DM?

Answer 21

Obesity, Fhx, male sex, lack of exercise, hyperlipidaemia, hypertension, excess alcohol consumption, stress, African and Caribbean ancestry

Question 22

What are the acute symptoms of T2DM?

Answer 22

Polyuria, polydipsia, weight loss

Question 23

What are the subacute symptoms of T2DM?

Answer 23

Lethargy, visual blurring, pruritas vulus

Question 24

What are the complications of T2DM?

Answer 24

Retinopathy, polyneuropathy, ED, arterial disease

Question 25

What is the treatment for T2DM?

Answer 25

HOLISTIC - education, management of long term complications, hypoglycaemic agents

Question 26

Which drugs are used in T2DM?

Answer 26

Metformin, statins and BP lowering drugs, sulphonylureas

Question 27

What are the microvascular complications of T2DM?

Answer 27

Retinopathy, neuropathy, nephropathy

Question 28

What are the macrovascular complications of T2DM?

Answer 28

Increased risk of IHD, MI and cerebrovascular disease. Diabetic foot ulcers.

Question 29

What are the symptoms of diabetic ketoacidosis?

Answer 29

Nausea, vomiting, abdominal pain, polydipsia, polyuria, dehydration, drowsiness, ketone smell in breath, Kussmaul breathing.

Question 30

What is the treatment for diabetic ketoacidosis?

Answer 30

1. Fluid resus with 0.9% saline 2. 50u rapid action IV insulin 3. Assess for K+ replacement

Question 31

What is the aim of treatment for diabetic ketoacidosis?

Answer 31

Aim for fall of ketones by 0.5 mmol/L/hr

Question 32

What is a hyperosmolar hyperglycaemic state?

Answer 32

Severe hyperglycaemia without significant ketosis

Question 33

What are the symptoms of a hyperosmolar hyperglycaemic state?

Answer 33

Hyperglycaemia, dehydration, alteration of consciousness and serum osmolarity of > 320 mosm/kg

Question 34

What are the actions of thyroid hormone?

Answer 34

1. Increases metabolic rate 2. Beta adrenergic action on heart and gut motility 3. CNS activation 4. Bone demineralisation

Question 35

What are the signs of hyperthyroidism?

Answer 35

Tremor, sweating, restlessness, wasting, hyperreflexia, palmar erythema

Question 36

What are the symptoms of hyperthyroidism?

Answer 36

Weight loss, increased appetite, heat intolerance, palpitations, oligomenhorrea, diarrhoea, polyuria, polydipsia

Question 37

What are the causes of hyperthyroidism?

Answer 37

Grave's disease, toxic multinodular goitre, toxic adenomas, thyroiditis, TSH-secreting pituitary tumours

Question 38

Which drugs can be used to manage hyperthyroidism?

Answer 38

Carbimazole or propylthiouracil

Question 39

How is hyperthyroidism managed?

Answer 39

Drugs, radioactive iodine, thyroidectomy

Question 40

How can the risk of thyroid eye disease be reduced?

Answer 40

Smoking cessation as smoking is the main risk factor

Question 41

What are the primary causes of hypothyroidism?

Answer 41

Hashimoto's thyroiditis, primary atrophic hypothyroidism, post surgery for hyperthyroidism, congenital

Question 42

What are the secondary causes of hypothyroidism?

Answer 42

Iodine deficiency and secondary to pituitary failure

Question 43

What are the signs of hypothyroidism?

Answer 43

Dry nails and hair, bradycardia, macroglossia, hyporeflexia, hoarse voice, alopecia

Question 44

What are the symptoms of hypothyroidism?

Answer 44

Weight gain, cold intolerance, menorrhagia, fatigue, constipation and carpal tunnel syndrome

Question 45

What is used to manage hypothyroidism?

Answer 45

Thyroxine

Question 46

What is the action of vasopressin (ADH)?

Answer 46

Increase aquaporins in collecting duct, therefore increasing water retention

Question 47

What are the functions of vasopressin?

Answer 47

Decrease urine production, increase blood pressure, decrease sweating

Question 48

What increases ADH?

Answer 48

Hypovolaemia, hypotension, anaemia, nicotine and adrenaline

Question 49

What decreases ADH?

Answer 49

Hypertension, ethanol and a-adrenergic stimuli

Question 50

Cranial aetiology of DI?

Answer 50

Familial, tumours, infection, trauma post-surgical

Question 51

What is Diabetes Insipidus?

Answer 51

ADH deficiency or insensitivity

Question 52

Nephrogenic aetiology of DI?

Answer 52

Renal disease or drugs

Question 53

Investigations and positive results for DI?

Answer 53

1. Osmolality - shows low urine osmolality 2. U+E - shows hypernatraemia 3. 24h urine volumes - shows high urine volumes 4. Water deprivation tests

Question 54

What is the treatment for cranial causes of DI?

Answer 54

1st line ADH analogue

Question 55

What is the treatment for nephrogenic causes of DI?

Answer 55

Thiazide diuretics

Question 56

Symptoms of Syndrome of Inappropriate ADH?

Answer 56

Confusion, nausea and irritability then fits and coma at late stage

Question 57

Aetiology of SIADH?

Answer 57

Tumours: SCLC, prostate, thymus and lymphomas Metabolic: alcohol withdrawal, porphyria Pulmonary: TB, pneumonia, lung abscess CNS: meningitis, head injury Drugs: SSRIs, anti epileptics and sulfonylureas

Question 58

Investigations and positive results for SIADH?

Answer 58

1. U+E - shows dilutional hyponatraemia 2. Osmolality - shows low plasma osmolality 3. Urinalysis - shows urinary Na+ secretion