Endocrinology/metabolic

Question 1

What biochemical abnormality does vitamin D deficiency lead to?

Answer 1

Low calcium
Low phosphate
Secondary hyperparathyroidism
Raised ALP

Question 2

Give an example of a long acting insulin

Answer 2

Glargine (Lantus)

Question 3

What is the treatment for acute symptomatic hyponatraemia?

Answer 3

Hypertonic saline

Question 4

What are the causes of a low TSH and normal T4?

Answer 4

Sublcinical hyperthyroidism
Thyroxine ingestion

Question 5

What is the normal anion gap range?

Answer 5

12-17 mmol/l

Question 6

What is pseudohypoparathyroidism caused by?

Answer 6

Resistance to PTH
Results in low calcium, high PTH and high phosphate
Skeletal abnormalities including short stature, rounded face, shortened fourth metacarapals

Question 7

Describe the thyroid morphology in Hashimoto’s thyroiditis

Answer 7

Large, firm and lobulated due to lymphocytic infiltration and fibrosis

Question 8

Describe the thyroid morphology in Riedel’s thyroiditis

Answer 8

Replacement of the normal thyroid parenchyma by dense fibrosis extending beyond the capsule

Most patients are euthyroid but 1/3rd become hypothyroid

Question 9

What is the most common type of thyroid cancer?

Answer 9

Papillary - affecting 20-55 year olds

Question 10

How does ACTH work?

Answer 10

Activates the 20,22 desmolase enzyme which catalyses the rate limiting step in adrenal steroidogenesis

Question 11

How do you diagnose diabetes mellitus?

Answer 11

HbA1c > 48mmol/mol
Fasting glucose >7 mmol/l
Random glucose >11.1 mmol/l

Question 12

What is POEMs syndrome?

Answer 12

Polyneuropathy, organomegaly, endocrinopathy and m-protein band from a plasmacytoma & skin pigmentation/tethering

Question 13

What is milk-alkali syndrome?

Answer 13

Triad of hypercalcaemia, renal failure and metabolic alkalosis secondary to ingestion of large amounts of calcium and absorbable alkali

Question 14

What is the most common cause of subclinical hypothyroidism?

Answer 14

Chronic autoimmune thyroiditis

Question 15

How should you further investigate subclinical hypothyroidism?

Answer 15

Repeat measurement after 3 months

Question 16

In which groups should HbA1C not be used to diagnose DM?

Answer 16

<18y
Pregnant women or women who are <2m postpartum
Symptoms of diabetes <2m
Acutely ill
Medication that may cause hyperglycaemia
Acute pancreatic damage
HIV infection
ESRD

Question 17

How do you calculate plasma osmolarity?

Answer 17

2xNa + Ur + glucose

Question 18

What is the normal range for plasma osmolarity?

Answer 18

285-295 mmol/l

Question 19

Name some clinical features of Grave’s disease

Answer 19

Exophthalmos
Ophthalmoplegia
Thyroid acropatchy
Pretibial myxoedema

Question 20

What is the genetic defect in MEN1?

Answer 20

Mutations in the tumour suppressor gene MEN1

Question 21

What is the genetic defect in MEN2?

Answer 21

Mutations in the RET proto-oncogene

Question 22

Name some causes of hypoglycaemia

Answer 22

Exogenous
Pituitary insufficiency
Liver failure
Addison’s disease
Islet cell tumours
Non-pancreatic neoplasms

Question 23

How do you biochemically diagnose acromegaly?

Answer 23

IGF-1 is better than GH due to more consistent serum levels

Question 24

What is a ‘medical’ III nerve palsy?

Answer 24

III palsy with pupillary sparing as fibres for sphincter pupillae run on the outside

Question 25

What is the HbA1C target if taking a drug associated with hypoglycaemia?

Answer 25

52mmol/mol

Question 26

Name some secondary causes of DM

Answer 26

Drugs: steroids, thiazides Pancreatic disease: pancreatitis, Ca, haemoschromatosis, CF Endocrine: Cushing's, thyrotoxicosis, phaeo, acromegaly Others: glycogen storage diseases, insulin receptor antibodies

Question 27

What are the clinical features of toxic multinodular goitre?

Answer 27

Also known as Plummer's disease Most patients are over 50 Consists of a thyroid gland with autonomously functioning thyroid nodules

Question 28

Which genetic mutations are implicated in hereditary haemochromatosis?

Answer 28

C282Y & H63D HFE mutations commonly tested

Question 29

In which conditions may you find lanugo?

Answer 29

Premature newborns Anorexia nervosa

Question 30

How does Danazol work?

Answer 30

It inhibits pituitary gonadotrophins

Question 31

Name some clinical features of medullary thyroid carcinoma

Answer 31

Diarrhoea and facial flushing due to excessive calcitonin Malignancy of parafollicular C-cells

Question 32

Name some clinical features of papillary thyroid carcinoma

Answer 32

Occurs more frequently in women Presents in 30-40yr age group