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A 33-year-old man presents complaining of visual disturbance. Examination reveals a bitemporal hemianopia with predominately the upper quadrants being affected. What is the most likely lesion?
Brainstem lesion
Pituitary macroadenoma
Frontal lobe lesion
Right occipital lesion

disturbance to optic chasm - pituitary lies above this and so tumour could compress this


what attaches the hypothalamus to the pituitary gland



where is the antioer pituitary derived from

rathkes pouch

superior hypophyseal artery- internal carotid and hypophyseal portal system


rathkes cysts causing what

chronic headaches


67-year-old female goes to the GP for routine blood tests. The abnormality below is noted in the thyroid function test (TFT).
TSH is 7.8 normal is 0.5-5.5
Free T4 14 normal is 9-18

What condition does she have?

Secondary hypothyroidism
Subclinical hypothyroidism
Hashimoto’s thyroiditis
Graves’ disease

subclinical hypothyroidism

Tsh is higher than usual but T4 normal meaning patient has not gone to full blown hypo yet


thyroid what germ layer

thyroglossal bud from the endoderm


A 33-year-old woman presents with weight loss and excessive sweating. Her partner reports that she is 'on edge' all the time and during the consultation you notice a fine tremor. Her pulse rate is 96/min. A large, non-tender goitre is noted. Examination of her eyes is unremarkable with no evidence of exophthalmos. Her blood results are below. What is the most likely diagnosis?

TSH is less than 0.05 when normal is 0.5-5.5
T4 free is 26 normal is 9-18
anti-tsh is positive

Toxic multinodular goitre
De Quervain’s thyroiditis
Hashimoto’s thyroiditis
Graves’ disease
Iodine deficiency


Can immediately rule out Hashimoto’s, De Quervain’s and Iodine deficiency as they all cause hypothyroidism

wight loss
heat intolerance
smooth painless goitre

Pretibial myxoedema is erythematous pitting oedema usually found around the tibia above the malleoli


treatment of graves

propanolol then carbimazole


hasimoto treatment and symptoms

weight gain
cold intolerance
dry skin
non pitting oedema
hair loss
brief thryotix period



de quervains thyroiditis


treated with nsaids


painful goitre
raised ESR
iodine uptake is global reduced on scintigraphy


iodine deficiency cause hypothyroidism

same as hashimoto

dietary iodine replacement


60-year-old woman has presented to her GP with fatigue and constipation. She has a history of hypertension and depression and normally takes amlodipine, venlafaxine and over-the-counter vitamin D supplements. She has a 30-pack-year smoking history. Blood test results show the following:
calcium high
phosphate low
sodium and potassium normal
urea and creatinine normal
PTH normal
VIt D normal

What is causing her hypercalcaemia?
Lung cancer
Primary hyperparathyroidism
Secondary hyperparathyroidism
Tertiary hyperparathyroidism

primary hyperparathyroidism

PTH normal but calcium up and phosphate low

secondary is excess PTH due to low calcium

not tertiary as due to high PTH and enlarged glands and kidney derangement show in urea and elctrylotyes


embryology of parathryoid glands

Superior glands derived from 4th pharyngeal arch
Inferior glands derived from 3rd pharyngeal arch


embryology of the pancreas

ventral and dorsal pancreatic buds of the foregut


arterial supply of pancreas

splenic artery to body and to head is sup and inf pancreaticodudoednal arteries

venis is hepatic portal vein to body and splenic vein

All Autonomic
Parasympathetic: CN X
Induce secretion from acinar cells and Islets of Langerhans
Sympathetic: Splanchnic nerves
Limit exocrine secretion


A 47-year-old-female presents to her normal diabetic outpatient appointment as part of her regular check up. She is a type two diabetic with a body mass index of 24kg/m². She is currently on full dose metformin monotherapy. Her HbA1c is 59mmol/mol. She reports that she is compliant with her medications. After discussion the patient feels there is not much more she can do with lifestyle modification or diet and is willing to add extra therapeutics to her management as needed. Which of the following would be the most appropriate management options?
Continue metformin only

Gliclazide is the preferred option when there is no concern about weight gain
If there was concern, sitagliptin (DPP-4 inhibitor) would be used as it does not cause weight gain
Insulin is not used until very far down the treatment pathway


56 year-old gentleman has a known pituitary adenoma causing excessive secretion of ACTH. Which part of his adrenal gland will be excessively stimulated?
Zona glomerulosa
Zona fasciculata
Zona reticularis
Adrenal medulla

cortisol release from the bona fasciculatata


the adrenal cortex comes from the mesoderm but where does the medulla come from

neural crest from the ectoderm


three layers GFR

Salt, sugar, sex – the deeper you go the sweeter it gets
Mineralocorticoids – aldosterone, production stimulated by angiotensin 2 as part of the RAAS
Glucocorticoids – cortisol
Androgens – dehydroepiandrosterone (DHEA) which is the precursor to testosterone (reticularis does synthesise a nominal amount of the others as well)


HPA axis

CRH - ACTH - glucocorticoids and catecholamines


You review a 52-year-old man who is being investigated for weight gain (particularly around his face), impotence and hypertension. On examination you record a blood pressure of 180/110 mmHg and notice purple striae around his abdomen. He also has some difficulty getting up from a chair and you observe generalised decreased muscle strength. What is the most likely diagnosis?
Cushing’s syndrome
Addison’s disease
Conn’s syndrome
Type 2 diabetes

Cushing syndrome

striae of skin - moon face, obesity , weight Gain
easy brusing and diabetes


Addison's is autoimmune normal

vitiligo , anorexia and weakness and hyper pigmentation in palms as excessive acth produces

bloods show low sodium and low glucose but high potassium

hydrocortisone and fludrocortisone to replace he aldosterone

criisis is when hypovolaemic , hyponatraemic and hyperkalaemic


what nerve lies infront of the parotid gland

facial nerve


A 75-year-old man presented with a 2-month history of dysphagia and regurgitation of undigested food. He also complains of halitosis and a chronic cough. Examination shows a small neck swelling which gurgles on palpation. Barium studies show a diverticulum or pouch forming at the junction of the pharynx and the oesophagus.

Based on the likely diagnosis, this diverticulum ( hidden canal or tube) commonly occurs between which of the following muscles?

Thyropharyngeus and cricopharyngeus muscles


what artery supplies the prostate gland

he arterial supply to the prostate gland is from the inferior vesical artery, it is a branch of the prostatovesical artery. The prostatovesical artery usually arises from the internal pudendal and inferior gluteal arterial branches of the internal iliac artery.