Passmedicine/Pastest

Question 1

test to monitor for disease recurrence in medullary thyroid cancer

Answer 1

calcitonin

Question 2

mechanism of action of orilistat

Answer 2

pancreatic lipase inhibitor

Question 3

genetic mutation in MODY

Answer 3

hepatic nuclear factor 1 alpha

Question 4

treatment of MODY

Answer 4

sulphonylureas

Question 5

treatment of pagets

Answer 5

Bisphosphonate

either IV zoledronate or oral risedronate

Question 6

complication of pagets

Answer 6

deafness (cranial nerve entrapment)
bone sarcoma (1% if affected for > 10 years)
fractures
skull thickening
high-output cardiac failure

Question 7

contraindications to pioglitozone

Answer 7

liver failure
heart failure
bladder cancer

Question 8

antibody in hashimotos thyroiditis

Answer 8

anti thyroid peroxidase antibodies

Question 9

biggest modifiable risk factor for thyroid eye disease

Answer 9

smoking

Question 10

inications for parathyroidectomy in primary hyperthyroidism

Answer 10

Elevated serum Calcium > 1mg/dL above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations below peak bone mass (T score lower than -2.5)

Question 11

80 year old female, hip fracture, calcium normal, no evidence of osteoprosis. how should she be managed

Answer 11

bisphosphonates and calcium supplements
no need for dexa

guidelines are if post menopausal and fracture - treat

Question 12

most common cause of hypoadrenalism in the uk

Answer 12

addisons

Question 13

other causes of hypoadrenalism

Answer 13

Primary causes
tuberculosis - most common cause worldwide
metastases (e.g. bronchial carcinoma)
meningococcal septicaemia (Waterhouse-Friderichsen syndrome)
HIV
antiphospholipid syndrome

Secondary causes
pituitary disorders (e.g. tumours, irradiation, infiltration)

Exogenous glucocorticoid therapy

Question 14

what is important about diabetes diagnosis

Answer 14

is asymptotic - must have two blood tests to confirm diagnosis
if symptomatic then one is all you need

Question 15

mode of inheritance of MODY

Answer 15

autosomal dominant

Question 16

what are DKA high risk of

Answer 16

thromboembolism

often given heparin

Question 17

what drug can cause hypercalcaemia

Answer 17

thaizide diuretics

Question 18

what are the main causes of hypercalcaemia

Answer 18

hyperparathyroidism and malignancy

others : sarcoidosis*
vitamin D intoxication
acromegaly
thyrotoxicosis
Milk-alkali syndrome
drugs: thiazides, calcium containing antacids
dehydration
Addison's disease
Paget's disease of the bone* - usually normal but can be high

Question 19

what is Waterhouse- Friderichsen syndrome

Answer 19

adrenal gland failure due to bleeding into the adrenal glands, commonly caused by severe bacterial infection:

Question 20

what is nelsons syndrome

Answer 20

rapid enlargement of a pituitary corticotroph adenoma (ACTH producing adenoma) that occurs after the removal of both adrenal glands (bilateral adrenalectomy) which is an operation used for Cushing’s syndrome

Question 21

give reasons for hypoglycaemia in a non diabetic

Answer 21

EXPLAIN
Exogenous drugs such alcohol, aspirin poisoning, pentamidine, quinine sulfate, ACE-inhibitor
Pituitary insufficiency
Liver failure
Addison's disease
Islet cell tumours eg insulinoma
Non-pancreatic neoplasms

Question 22

first line insulin regime

Answer 22

basal–bolus using twice‑daily insulin detemir

Question 23

what is the DVLA guidance on insulin

Answer 23

if on insulin then patient can drive a car as long as they have hypoglycaemic awareness, not more than one episode of hypoglycaemia requiring the assistance of another person within the preceding 12 months and no relevant visual impairment. Drivers are normally contacted by DVLA

if on insulin for less than 3 months or for gestational diabetes up to 3mths post partum then can keep driving and no need to inform the DVLA

Question 24

describe the sick day rules for insulin dependent diabetics

Answer 24

patients should be encouraged to drink at least 3L of fluid over 24 hours.
Patients should continue their normal insulin regimen but check their blood glucose more regularly
Main meals should not be substituted for sugary foods, if a patient is struggling to eat then they may take sugary drinks.
Ketones should also be measured every 3-4 hours or even more frequently depending on the readings