Endocrinology Conditions A

Question 1

Diabetes Mellitus Type 1 - Description

Answer 1

decreased insulin secretion

Question 2

Diabetes Mellitus Type 1 - Causes (1)

Answer 2

1) autoimmunity (90% of HLA-DR3/HLA-DR4)

Question 3

Diabetes Mellitus Type 1 - Pathophysiology (2)

Answer 3

1) autoimmune destruction of β cells in pancreas islet of Langerhans
2) decreased insulin secretion

Question 4

Diabetes Mellitus Type 1 - Symptoms (6)

Answer 4

1) polyuria*
2) polydipsia*
3) weight loss
4) hunger
5) fatigue
6) blurred vision

Question 5

Diabetes Mellitus Type 1 - Signs (4)

Answer 5

1) acute onset (<1 month)
2) ketosis (pear drop breath)
3) Caucasian
4) child/adolescent (esp. 5-15)

Question 6

Diabetes Mellitus Type 1 - Complications (9)

Answer 6

1) vascular disease
2) nephropathy
3) neuropathy (30% painful)
4) retinopathy
5) cataracts
6) diabetic ketoacidosis (uncontrolled)
7) hypoglycaemia (iatrogenic)
8) infection (e.g. thrush, UTI)
9) autoimmune associations (e.g. Hashimoto’s thyroiditis, Addison’s disease, Coeliac disease)

Question 7

Diabetes Mellitus Type 1 - Investigations (2/2)

Answer 7

initial
1) random plasma glucose* (>11mM)
2) Hb1Ac (>48mmol/mol, >6.5%)
consider
1) fasting plasma glucose (>7mM) (follow-up)
2) glucose tolerance test (rarely used)

Question 8

Diabetes Mellitus Type 1 - Management (6/4/0)

Answer 8

conservative
1) dietary advice
2) smoking cessation
3) alcohol control
4) regular exercise
5) monitor glucose
6) monitor Hb1Ac
medical
1) basal-bolus insulin (1st line)
2) pre-meal insulin (adjunct)
3) pre-meal amylin (adjunct)
4) fixed-dose insulin (2nd line)

Question 9

Diabetes Mellitus Type 2 - Description

Answer 9

decreased insulin secretion and efficacy

Question 10

Diabetes Mellitus Type 2 - Risk Factors (10)

Answer 10

1) family history
2) Afro-Caribbean
3) Hispanic
4) Asian
5) old age
6) obesity
7) physical inactivity
8) pre-diabetes
9) gestational diabetes
10) hypertension

Question 11

Diabetes Mellitus Type 2 - Pathophysiology (4)

Answer 11

1) dysfunction of β cells in pancreas islet of Langerhans
2) decreased insulin secretion
3) peripheral resistance to insulin
4) decreased insulin efficacy

Question 12

Diabetes Mellitus Type 2 - Symptoms (3)

Answer 12

1) asymptomatic*
2) fatigue
3) blurred vision

Question 13

Diabetes Mellitus Type 2 - Complications (7)

Answer 13

1) vascular disease
2) nephropathy
3) neuropathy (30% painful)
4) retinopathy
5) cataracts
6) hypoglycaemia (iatrogenic)
7) infection (e.g. thrush, UTI)

Question 14

Diabetes Mellitus Type 2 - Investigations (2/2)

Answer 14

initial
1) random plasma glucose* (>11mM)
2) Hb1Ac (>48mmol/mol, >6.5%)
consider
1) fasting plasma glucose (>7mM) (follow-up)
2) glucose tolerance test (rarely used)

Question 15

Diabetes Mellitus Type 2 - Management (6/3/0)

Answer 15

conservative
1) dietary advice
2) smoking cessation
3) alcohol control
4) regular exercise
5) monitor plasma glucose
6) monitor Hb1Ac
medical
1) metformin*
2) statin
3) antihypertensive (e.g. thiazide diuretic)

Question 16

Diabetes Mellitus Type 2 - Management (Failed Hb1Ac Targets) (6)

Answer 16

1) pioglitazone
2) sulfonylurea
1) GLP-1 receptor agonist
4) SGLT-2 inhibitor
5) DPP-4 inhibitor
6) insulin (last resort)

Question 17

Diabetic Ketoacidosis - Description

Answer 17

increased plasma ketone bodies

Question 18

Diabetic Ketoacidosis - Risk Factors (3)

Answer 18

1) uncontrolled diabetes mellitus (esp. type 1)
2) infection
3) myocardial infarction

Question 19

Diabetic Ketoacidosis - Pathophysiology (5)

Answer 19

1) decreased insulin secretion
2) increased lipolysis
3) increased hepatic fatty acid metabolism
4) increased plasma ketone bodies
5) decreased plasma pH

Question 20

Diabetic Ketoacidosis - Symptoms (8)

Answer 20

1) polyuria
2) polydipsia
3) abdominal pain
4) nausea
5) vomiting
6) anorexia
7) weight loss
8) weakness

Question 21

Diabetic Ketoacidosis - Signs (5)

Answer 21

1) acute onset (<1 week)
2) Kussmaul’s breathing (deep, laboured breathing)
3) tachycardia
4) hypotension
5) dehydrated

Question 22

Diabetic Ketoacidosis - Complications (6)

Answer 22

1) acute respiratory distress syndrome
2) aspiration pneumonia
3) thromboembolism
4) hypoglycaemia (insulin)
5) hypokalaemia (insulin)
6) cerebral oedema (rehydration)

Question 23

Diabetic Ketoacidosis - Investigations (5/0)

Answer 23

initial

1) plasma ketones* (>3mM)
2) random plasma glucose (>13.9mM)
3) ABG (pH<7.3, HCO3-<15mM)
4) UnE
5) serum osmolality

Question 24

Diabetic Ketoacidosis - Management (1/5/0)

Answer 24

conservative
1) ICU admission
medical
1) IV fluids (3L in 1st 3 hours)
2) potassium phosphate (replace electrolytes)
3) sodium bicarbonate (metabolic acidosis)
4) insulin
5) vassopressor (DA/NA)

Question 25

Hyperosmolar Hyperglycaemic State - Description

Answer 25

highly increased plasma glucose and osmolality without ketosis

Question 26

Hyperosmolar Hyperglycaemic State - Risk Factors (3)

Answer 26

1) uncontrolled diabetes mellitus (esp. type 2) 2) infection 3) myocardial infarction

Question 27

Hyperosmolar Hyperglycaemic State - Symptoms (9)

Answer 27

1) altered mental status 2) polyuria 3) polydipsia 4) abdominal pain 5) nausea 6) vomiting 7) anorexia 8) weight loss 9) weakness

Question 28

Hyperosmolar Hyperglycaemic State - Signs (5)

Answer 28

1) acute onset (<1 week) 2) Kussmaul’s breathing (deep, laboured breathing) 3) tachycardia 4) hypotension 5) dehydration

Question 29

Hyperosmolar Hyperglycaemic State - Complications (6)

Answer 29

1) acute respiratory distress syndrome 2) aspiration pneumonia 3) thromboembolism 4) hypoglycaemia (insulin) 5) hypokalaemia (insulin) 6) cerebral oedema (rehydration)

Question 30

Hyperosmolar Hyperglycaemic State - Investigations (5/0)

Answer 30

initial 1) plasma ketones (normal) 2) random plasma glucose (>33.3mM) 3) ABG (pH>7.3, HCO3->15mM) 4) UnE 5) serum osmolality (>320mmol/kg)

Question 31

Hyperosmolar Hyperglycaemic State - Management (1/4/0)

Answer 31

``` conservative 1) ICU admission medical 1) IV fluids (1-2L in 1st 3 hours) 2) potassium phosphate (replace electrolytes) 3) insulin 4) vassopressor (DA/NA) ```

Question 32

Hypoglycaemia - Description

Answer 32

decreased plasma glucose

Question 33

Hypoglycaemia - Causes (4)

Answer 33

1) insulin 2) sulphonylurea 3) kidney disease 4) liver disease

Question 34

Hypoglycaemia - Symptoms (Autonomic) (3)

Answer 34

random plasma glucose <3.8mM 1) sweating 2) palpitations 3) tremor

Question 35

Hypoglycaemia - Symptoms (Neuroglycopenic) (5)

Answer 35

random plasma glucose <2.8mM 1) confusion 2) drowsiness 3) altered behaviour 4) dysphasia 5) incoordination

Question 36

Hypoglycaemia - Symptoms (Severe Neuroglycopenic) (2)

Answer 36

random plasma glucose <1.5mM 1) convulsions 2) coma

Question 37

Hypoglycaemia - Investigations (3/0)

Answer 37

initial 1) random plasma glucose (<3.8mM) 2) RFT 3) LFT

Question 38

Hypoglycaemia - Management (4/2/0)

Answer 38

conservative 1) adjust medications 2) patient education (recognition, treatment) 3) fast acting carbohydrate (15g) (3x 15 minute intervals) 4) long acting carbohydrate (glucose>4mM) medical 1) IV glucose (unconscious or refractory) 2) IM glucagon (unconscious or refractory)

Question 39

Hyperthyroidism - Description

Answer 39

increased T3/T4 secretion

Question 40

Hyperthyroidism - Causes (6)

Answer 40

1) Graves’ disease (2/3) 2) toxic adenoma 3) toxic multinodular goitre 4) drug induced (iodine, amiodarone) 5) post-partum thyroiditis 6) De Quervain’s (subacute) thyroiditis (post-infection)

Question 41

Hyperthyroidism - Pathophysiology (Graves’ Disease) (3)

Answer 41

1) autoimmune thyroid stimulating IgGs (TRAb) bind to TSH receptors 2) increased thyroid activation 3) increased T3/T4 secretion

Question 42

Hyperthyroidism - Symptoms (7)

Answer 42

1) weight loss 2) increased appetite 3) diarrhoea 4) heat intolerance 5) sweating 6) tremor 7) palpitations

Question 43

Hyperthyroidism - Signs (7)

Answer 43

1) goitre (diffuse-Graves’, solitary-adenoma, multinodular-MNG) 2) tachycardia 3) lid lag 4) lid retraction 5) onycholysis 6) palmar erythema 7) warm moist skin

Question 44

Hyperthyroidism - Complications (7)

Answer 44

1) angina 2) atrial fibrillation 3) heart failure 4) osteopenia—>osteoporosis 5) hypothyroidism (iatrogenic) 6) recurrent laryngeal nerve damage (thyroidectomy) 7) hypoparathyroidism (thyroidectomy)

Question 45

Hyperthyroidism - Complications (Thyroid Storm) (5)

Answer 45

severe hyperthyroidism 1) hyperthermia 2) vomiting 3) diarrhoea 4) confusion 5) coma

Question 46

Hyperthyroidism - Complications (Graves’ Disease) (3)

Answer 46

1) ophthalmology (inc. exophthalmos) 2) tibial myxoedema 3) acropachy

Question 49

Primary Hypothyroidism - Description

Answer 49

decreased T3/T4 secretion (99% of hypothyroidism)

Question 50

Primary Hypothyroidism - Causes (6)

Answer 50

1) Hashimoto’s thyroiditis 2) post-partum thyroiditis 3) iodine deficiency 4) drug induced (iodine, amiodarone) 5) iodine 131 therapy 6) thyroidectomy

Question 51

Primary Hypothyroidism - Pathophysiology (Hashimoto’s Thyroiditis) (3)

Answer 51

1) cytotoxic T cell mediated destruction of thyroid cell 2) autoantibodies to thyroid peroxidase and thyroglobulin 3) decreased T3/T4 secretion

Question 52

Primary Hypothyroidism - Symptoms (7)

Answer 52

1) weight gain 2) constipation 3) weakness 4) lethargy 5) bad mood 6) cold intolerance 7) amenorrhoea

Question 53

Primary Hypothyroidism - Signs (4)

Answer 53

1) bradycardia 2) hyporeflexia 3) hair loss 4) cool dry coarse skin

Question 54

Primary Hypothyroidism - Complications (1)

Answer 54

1) pregnancy problems

Question 55

Primary Hypothyroidism - Complications (Myxoedema Coma) (6)

Answer 55

severe hypothyroidism 1) hypothermia 2) hypoventilation 3) hypoglycaemia 4) hyponatraemia 5) seizures 6) coma

Question 56

Primary Hypothyroidism - Investigations (1/1)

Answer 56

initial 1) TFT* (high TSH, low T3/T4) consider 1) serum TPOAb (Hashimoto’s, positive)

Question 57

Primary Hypothyroidism - Management (0/1/0)

Answer 57

medical | 1) synthetic L-thyroxine

Question 58

Secondary Hypothyroidism - Description

Answer 58

decreased T3/T4 secretion (1% of hypothyroidism)

Question 59

Secondary Hypothyroidism - Causes (2)

Answer 59

1) pituitary adenoma | 2) Sheehan’s syndrome

Question 60

Secondary Hypothyroidism - Pathophysiology (2)

Answer 60

1) low thyroid stimulation | 2) low T3/T4 secretion

Question 61

Secondary Hypothyroidism - Symptoms (7)

Answer 61

1) weight gain 2) constipation 3) weakness 4) lethargy 5) bad mood 6) cold intolerance 7) amenorrhoea

Question 62

Secondary Hypothyroidism - Signs (4)

Answer 62

1) bradycardia 2) hyporeflexia 3) hair loss 4) cool dry coarse skin

Question 63

Secondary Hypothyroidism - Complications (1)

Answer 63

1) pregnancy problems

Question 64

Secondary Hypothyroidism - Complications (Myxoedema Coma) (6)

Answer 64

severe hypothyroidism 1) hypothermia 2) hypoventilation 3) hypoglycaemia 4) hyponatraemia 5) seizures 6) coma

Question 65

Secondary Hypothyroidism - Investigations (1/1)

Answer 65

initial 1) TFT* (low TSH, low T3/T4) consider 1) pituitary MRI

Question 66

Secondary Hypothyroidism - Management (0/1/0)

Answer 66

medical | 1) synthetic L-thyroxine

Question 67

Thyroid Carcinoma - Description

Answer 67

malignant proliferation of thyroid cells

Question 68

Thyroid Carcinoma - Types (4)

Answer 68

1) papillary (70%) 2) follicular (20%) 3) medullary (5%) 4) anaplastic (5%)

Question 69

Thyroid Carcinoma - Risk Factors (2)

Answer 69

1) head/neck irradiation | 2) female

Question 70

Thyroid Carcinoma - Prognosis (4)

Answer 70

1) papillary - good 2) follicular - good 3) medullary - good 4) anaplastic - poor

Question 71

Thyroid Carcinoma - Symptoms (3)

Answer 71

late presentation 1) dysphonia 2) dysphagia 3) dyspnoea

Question 72

Thyroid Carcinoma - Signs (2)

Answer 72

1) thyroid nodules | 2) cervical lymphadenopathy

Question 73

Thyroid Carcinoma - Investigations (3/0)

Answer 73

initial 1) TFT 2) fine needle biopsy cytology 3) neck ultrasound

Question 74

Thyroid Carcinoma - Management (0/2/1)

Answer 74

``` medical 1) radioactive iodine ablation (papillary, medullary) 2) levothyroxine (TSH suppression) surgery 1) thyroidectomy ```

Question 76

Hyperthyroidism - Investigations (1/1)

Answer 76

initial 1) TFT* (low TSH, high T3/T4) consider 1) serum TRAb (Graves’, positive)

Question 77

Hyperthyroidism - Management (1/4/1)

Answer 77

conservative 1) smoking cessation medical 1) carbimazole (block+replace* or titrate) 2) propyluracil (block+replace* or titrate) 3) iodine 131 (refractory) (not in pregnancy or feeding) 4) βB (thyroid storm) surgery 1) thyroidectomy

Question 78

Acromegaly - Description

Answer 78

increased GH secretion

Question 79

Acromegaly - Causes (1)

Answer 79

1) pituitary adenoma

Question 80

Acromegaly - Pathophysiology (3)

Answer 80

1) pituitary adenoma 2) increased GH secretion 3) increased IGF-1 secretion

Question 81

Acromegaly - Symptoms (6)

Answer 81

1) arthralgia 2) sweating (excessive) 3) headaches (late, 50%) gonadal dysfunction 4) low libido 5) amenorrhoea 6) erectile dysfunction

Question 82

Acromegaly - Signs (8)

Answer 82

1) acral enlargement 2) big nose 3) big tongue 4) big jaw 5) big supraorbital ridges 6) dark skin 7) skin tags 8) deep voice

Question 83

Acromegaly - Complications (9)

Answer 83

1) gigantism 2) arthritis 3) carpal tunnel syndrome 4) diabetes mellitus 5) hypertension 6) heart conditions (e.g. cardiomyopathy) 7) stroke 8) sleep apnoea 9) bitemporal hemianopia

Question 84

Acromegaly - Investigations (3/1)

Answer 84

``` initial 1) serum GH (high) 2) serum IGF-1 (high) 3) glucose tolerance test* (nadir GH>1μg/L) consider 1) pituitary MRI ```

Question 85

Acromegaly - Management (0/4/1)

Answer 85

``` medical 1) DA agonist (e.g. cabergoline) 2) SST analogue (e.g. octreotide) 3) GH receptor antagonist 4) radiotherapy (refractory) surgery 1) transsphenoidal surgery* ```

Question 86

Cushing’s Syndrome - Description

Answer 86

chronic excess cortisol exposure

Question 87

Cushing’s Syndrome - Causes (5)

Answer 87

1) Cushing’s disease 2) adrenal adenoma 3) adrenal hyperplasia 4) ectopic ACTH secretion 5) steroids (iatrogenic)

Question 88

Cushing’s Syndrome - Pathophysiology (Cushing’s Disease) (3)

Answer 88

1) pituitary adenoma 2) increased ACTH secretion 3) increased cortisol secretion

Question 89

Cushing’s Syndrome - Symptoms (8)

Answer 89

``` 1) weight gain mood 2) depression 3) lethargy 4) irritability 5) psychosis gonadal dysfunction 6) hirsutism 7) oligomenorrhoea 8) erectile dysfunction ```

Question 90

Cushing’s Syndrome - Signs (8)

Answer 90

1) central obesity 2) moon face 3) plethoric 4) acne 5) bruising 6) skin atrophy 7) muscle atrophy 8) violaceous striae

Question 91

Cushing’s Syndrome - Complications (6)

Answer 91

1) diabetes mellitus 2) hypertension 3) hypokalaemia 4) osteoporosis 5) nephrolithiasis 6) hypopituitarism (iatrogenic)

Question 92

Cushing’s Syndrome - Investigations (2/1)

Answer 92

``` initial 1) overnight low dose dexamethasone suppression + 9:00am cortisol 2) 24 hour urinary free cortisol* consider 1) pituitary MRI (70%) ```

Question 93

Cushing’s Syndrome - Management (2/1/4)

Answer 93

conservative 1) alcohol control 2) review steroids medical 1) metyrapone or mitotane (pre-op) surgery* 1) transsphenoidal surgery (Cushing’s disease) 2) unilateral adrenalectomy (adrenal adenoma) 3) bilateral adrenalectomy (adrenal hyperplasia) 4) local tumour resection (ectopic ACTH secretion)

Question 94

Hyperaldosteronism - Description

Answer 94

increased aldosterone secretion (independent of RAAS)

Question 95

Hyperaldosteronism - Causes (2)

Answer 95

1) Conn’s syndrome | 2) adrenal hyperplasia

Question 96

Hyperaldosteronism - Pathophysiology (Conn’s Syndrome) (1)

Answer 96

1) aldosterone producing adrenal adenoma (aldosteronoma)

Question 97

Hyperaldosteronism - Symptoms (4)

Answer 97

1) asymptomatic (often) 2) polyuria 3) nocturia 4) lethargy

Question 98

Hyperaldosteronism - Complications (3)

Answer 98

1) hypertension 2) hypernatraemia 3) hypokalaemia*

Question 99

Hyperaldosteronism - Investigations (3/1)

Answer 99

``` initial 1) UnE (low K+, high Na+) 2) serum renin (low) 3) serum aldosterone (high) consider 1) adrenal vein sampling* (unilateral - Conn’s syndrome, bilateral - adrenal hyperplasia) ```

Question 100

Hyperaldosteronism - (0/1/1)

Answer 100

medical 1) spironolactone (aldosterone anatgonist) surgery 1) laparoscopic adrenalectomy (Conn’s syndrome)