FFCP Endo

Question 1

What is Waterhouse-Friedrichson syndrome?

Answer 1

hypoadrenalism caused by adrenal haemorrhage usually due to meningococcal infection

Question 2

What might you see on blood test of someone with addison’s?

Answer 2

hypoglycaemia, hyponatraemia and hyperkalaemia

Question 3

What is the investigation of choice for hypoadrenalism?

Answer 3

synacthen test - short synthetic ACTH. Cortisol measures at 9am then 30 and 60 minutes

Question 4

How to treat Addisonian crisis?

Answer 4

0.9% saline in large volumes, IV hydrocortisone 100mg bolus stat then IM injections until patient able to take tablets

Question 5

Sick day rules for addison’s?

Answer 5

glucocorticoid dose should be doubled and the fludrocortisone dose should stay the same

Question 6

What are ACTH dependent causes of Cushing’s syndrome?

Answer 6

• Cushing’s disease - pituitary tumour secreting ACTH causing adrenal hyperplasia
• ectopic ACTH production most common being small cell lung cancer

Question 7

First-line investigation for Cushing’s syndrome?

Answer 7

low dose dexamethasone suppression test - failure to suppress cortisol indicates Cushing’s syndrome
also 24 hour urinary free cortisol and late night salivary cortisol

Question 8

How does high dose dexamethasone suppression test help to diagnose Cushing’s?

Answer 8

failure of the high dose to suppress cortisol suggests an ectopic sourse whilst suppression indicates a pituitary cause

Question 9

Medical management of Cushing’s syndrome?

Answer 9

ketoconazole, metyrapone

Question 10

What drug for treatment of symptoms of Grave’s disease?

Answer 10

beta blocker - propranolol

Question 11

Anti thyroid drugs?

Answer 11

Carbimazole, propylthioruacil

Question 12

What is a common cause of euvolemic hyponatraemia?

Answer 12

syndrome of inappropriate antidiuretic hormone secretion

Question 13

What kind of hyponatremia does congestive heart failure cause?

Answer 13

hypervolaemic hyponatraemia

Question 14

How do you confirm phaeochromocytoma?

Answer 14

24 hour urinary collection of metanephrines

Question 15

How should you treat hypertension linked to phaeochromocytoma?

Answer 15

first alpha blockade (phenoxybenzamine), then beta blockade (if you do beta blocker first then unopposed alpha stimulation leads to hypertensive crisis)

Question 16

Treatment of acute hypercalcaemia?

Answer 16

Aggressive rehydration (0.9% saline IV rapidly) and then consider bisphosphonate only when hydrated and calcium isnt falling

Question 17

Investigations for acromegaly?

Answer 17

first line - serum IGF-1
If IGF1 raised then oral glucose tolerance test to confirm (there will be no suppression of GH)

Question 18

What drug is ocreotide?

Answer 18

somatostatin analogue - directly inhibits release of growth homrone

Question 19

What kind of drug is pegvisomant?

Answer 19

GH receptor antagonist - stops the action of growth hormone on the growth hormone receptor to reduce the production of IGF1

Question 20

Stereotypical presentation of primary hyperaldosteronism?

Answer 20

hypertension, hypokalaemia and metabolic alkalosis. Might also have symptoms such as fatigue, muscle weakness and urination

Question 21

Plasma renin in conn’s syndrome?

Answer 21

suppressed (whereas it would be elevated in secondary hyperaldosteronism).
This is bc aldosterone is overproduced independently of the RAAS system

Question 22

Management of Conn’s?

Answer 22

Unilateral adrenal adenoma - surgery
Bilateral adrenal hyperplasia - aldosterone antagonist (eplerenone, spironolactone)

Question 23

What familial endocrine neoplasia syndromes are associated with phaeochromocytoma?

Answer 23

Von Hippel Lindau disease
MEN 2
SDH mutation

Question 24

Examples of alpha receptor blockers?

Answer 24

Doxazosin, phenoxybenzamine

Question 25

Management of hypocalcaemia?

Answer 25

<1.9 with no symptoms, oral calcium supplements <1.9 with symptoms - IV calcium gluconate, high dose 1-alfacalcidol

Question 26

How can urinary sodium help determine cause of hyponatraemia?

Answer 26

Low - hypovolaemia kidneys trying to preserve salt and water High - suggests inappropriate loss of Na ie SIADH

Question 27

What is nephrogenic diabetes insipidus?

Answer 27

failure of response of kidneys to circulating ADH

Question 28

Water deprivation test - if urine is dilute before and after desmopressin what does this suggest?

Answer 28

nephrogenic diabetes

Question 29

Water deprivation test - if urine is concentrated before and after desmopressin what does this suggest?

Answer 29

cranial diabetes inspidus

Question 30

How to treat cranial diabetes insipidus?

Answer 30

Replace ADH with desmopressin

Question 31

Serious adverse reaction to carbimazole?

Answer 31

agranulocytosis - warn patients about sore throat

Question 32

What two hormones are released from posterior pituitary?

Answer 32

vasopressin and oxytocin

Question 33

Management of prolactinoma?

Answer 33

Dopamine agonists -bromocriptine / cabergoline

Question 34

What drugs can cause high prolactin?

Answer 34

antipsychotics, antiemetics such as prochlorperazine and antacids such as ranitidine

Question 35

How do you calculate ion gap and what is a normal anion gap?

Answer 35

[Na+ + K+] - [HCO3- + Cl-). Normal is 10-18mmol/L

Question 36

first step in investigating hypercalcaemia?

Answer 36

measuring parathyroid hormone

Question 37

firstline management for a patient with hypercalcaemia?

Answer 37

IV fluids, if this fails then IV bisphosphonates may be added

Question 38

What will you see in subacute / De Quervain's thyroiditis?

Answer 38

in the initial phase hyperthyrodism, painful goitre, rasied ESR. then it settles, goes hypo and then normal. On thyroid scitigraphy, globally reduced uptake of iodine-131

Question 39

diabetes sick day rules when it comes to insulin?

Answer 39

must not stop insulin due to DKA risk, should continue with it but ensure they are checking their blood sugars frequently

Question 39

What antibodies cause Grave's disease?

Answer 39

IgG antibodies to thyroid stimulating hormone receptor

Question 40

symptoms of cushing's disease?

Answer 40

cortisol induced fatigue, weight gain and altered fat distribution, proximal muscle weakness, hypertension

Question 41

What acid base anomaly is seen alongside cushing's syndrome?

Answer 41

A hypokalaemic metabolic alkalosis

Question 42

What are the main types of tumours you find in MEN type 1?

Answer 42

The 3 P's parathryoid, pituitary, pancreas

Question 43

Treatment for myxoedemic coma?

Answer 43

Thyroxine and hydrocortisone

Question 44

How should thyroxine doses be changed during pregnancy?

Answer 44

They should be increased by up to 50%

Question 45

what kind of medications are cabergoline and bromocriptine?

Answer 45

dopamine agonists