Physiology

Question 1

Drugs that can cause SiADH?

Answer 1

SSRI’s
Carbamazepine
Cyclophosphamide

Question 2

Drugs that can cause nephorgenic DI

Answer 2

Lithium
Demeclocycline

Question 3

Causes of nephrohenic DI

Answer 3

Hereditary
Hypercalcaemia
Hypokalaemia
Drugs (lithium, demeclocyline)

Question 4

Treatment for central Diabetes insipidis

Answer 4

Desmopressin

Question 5

What is Sheehans syndrome

Answer 5

Ischaemic infarct of pituitary following severe post partum haemorrhage (increased pituitary growth in pregnancy = more vulnerable to hypoperfusion)

Question 6

What is pituitary apopexy

Answer 6

Sudden haemorrhage of the pituitary usually in the presence of an existing pituitary adenoma

Question 7

Diagnosing acromegaly

Answer 7

Increased serum IGF- 1
Failure to suppress GH following glucose tolerance test
Pituitary MRI

Question 8

What is subacute granulomatous thuroiditis

Answer 8

DeQuervain thyroiditis
Transient Hyperthyroid - euthyroid - hypothyroid - euthyroid
Often after viral infection
Painful jaw and tender thyroid
Granulomatous inflammation

Question 9

Features of reidel thyroiditis

Answer 9

Slowly enlarging, hard (rock-like), fixed nontender thyroid

Question 10

What is Reidel thyroiditis

Answer 10

Also called invasive fibrous thyroiditis
May occur as part of IgG4 related diseases
Hypothyroidism in 1/3
Fibrosis may extend to surrounding structures

Question 11

Features of congenital hypo thyroidism

Answer 11

6 P’s
Pot bellied
Protruding tongue
Protruding umbillicus
Poor brain development
Pale
Puffy face

Question 12

Histology found in graves disease

Answer 12

Tall, crowded follicular epithelial cells, scalloped colloid

Question 13

Antibodies associated with graves disease

Answer 13

HLA-DR3, HLA-B8

Question 14

Histology of pappilary thyroid cancer

Answer 14

“Pap and mama adopted orphan annie”
Psammoma bodies
Empty nuclei with central clearing (orphan annie’s)
Grooved nuclei

Question 15

What is medullary thyroid cancer arised from?

Answer 15

Parafollicular C cells

Question 16

Histology staining of medullary thyroid Ca

Answer 16

Congo red

Question 17

Electrolyte disturbance associated with medullary thyroid Ca

Answer 17

Hypocalcium - due to increased calcitonin produced from parafollicular c cells

Question 18

Mutation associated with anaplastic thyroid cancer

Answer 18

TP53

Question 19

Lab values hypoparathyroidism vs pseudohypoparathyroidism

Answer 19

Hypopara - low Ca, increased PO, low PTH
Pseudohypopara - low Ca, increased PO, high PTH

Question 20

What condition is hashimotos thyroiditis associated with?

Answer 20

MALT lymphoma

Question 21

What is the mechanism by which ADH causes hyponattaemia

Answer 21

Insertion of aquaporin 2 channels

Question 22

How can insulin decrease K levels

Answer 22

Increases Na / K pump

Question 23

What diabetic medication is associated with UTI’s and why

Answer 23

Dabagliflozin
Sodium glucose co-transporter 2 inhibitors: increase urinary excretion of glucose which provides an environment for bacterial growth

Question 24

What diabetic medication is associated with pancreatitis?

Answer 24

Enexatide
(GLP-1 analogues)

Question 25

What diabetic medication is associated with fractures

Answer 25

thiazolidinediones i.e. pioglitazone

Question 26

What is waterhouse-frideeichsen syndrome

Answer 26

Bilateral adrenal haemorrhage in the setting of infection causing acute adrenal insufficiency

Question 27

Causes of primary secondary and teritary adrenal insufficiency

Answer 27

Primary - addisons (autoimmune adrenal atrophy) Secondary - pituitary Tertiary - exogenous removal of steroids (tertiary from treatment)

Question 28

What does a phaeochromocytoma arises from?

Answer 28

Chromaffin cells (arise from neural crest)

Question 29

Extra adrenal locations of phaeochromocytoma

Answer 29

Bladder wall Organ of zuckerkandI

Question 30

Treatment for pheochromocytoma

Answer 30

Alpha antagonist (phenoxybenazmine) before beta antagonist to prevent hypertensive crisis

Question 31

What is found in the urine due to a phaeochromocytoma

Answer 31

Catecholamines and metanephrines (E.g. homovanilic acid, vanillylamndelic acid)

Question 32

Where does a neuroblastona arise from

Answer 32

Adrenal medulla

Question 33

Histology finding in neuroblastoma and medulloblastoma

Answer 33

Homer-wright rosettes (neuroblasts surrounding a central area of neurophil) Bombedin and NSE positive

Question 34

MEN 1 features

Answer 34

MEN1 gene (codes for menin found oj chromosome 11) 3 P’s Pancrease, pituitary and parathyroid

Question 35

MEN 2A gene and features

Answer 35

RET (protooncogene, codes for tyrosine kinase receptor, chromosome 10) 2 P’s and 1 M Parathyroid, medullary thyroid cancer and phaeochromocytoma

Question 36

MEN 2B gene and features

Answer 36

Mutations in RET gene, may have marfans habitus 1 P and 2 M’s Phaeochromocytoma Medullary thyroid cancer Mucosal neuromas

Question 37

Features of glucaganoma

Answer 37

6 D’s Dermatitis Diarrhoea Depression Declining weight Diabetes DVT

Question 38

Features of somatostatinoma

Answer 38

Diabetes / impaired glucose tolerence Steattorhoea Gallstones Achlorhydria

Question 39

Where do carcinoid tumours origionate from

Answer 39

Neuroendocrine cells, most commonly intestines or lung

Question 40

What substance does carcinoid tumours secrete?

Answer 40

5-HT

Question 41

Histology of carcinoid tumours

Answer 41

Carcinoids Really Can Sting Rosettes Chromogranin A positive Synaptophysin

Question 42

Urinary feature of carcinoid tumours

Answer 42

Invreased urinary 5-HIAA

Question 43

How does carcinoid tumours cause carcinoid syndrome

Answer 43

They produce 5-HT which undergoes heparic first pass metabolism and enzymatic breakdown by MAO in the lung. If 5-HT reaches the systemic circulation (i.e. liver mets) causes carcinoid syndrome

Question 44

Features of carcinoid syndrome

Answer 44

Flushing Wheezing Diarrhoea Right sided valvular failure Niacin deficiency

Question 45

Mechanism of heat intokerence snd weight loss on hyperthyroidism

Answer 45

Increased Na/K/ATPase = increase metabolic rate = calorigenesis

Question 46

Mechanism of myxedema in hypothyroidism

Answer 46

Increase GAG’s in interstitial space = increased osmotic pressure = water retension

Question 47

Mechanism of secondary hyperparathyroidism

Answer 47

Low Ca or high PO causes parathyroid hyperplasia = increase PTH and ALP

Question 48

How does siADH cause hyponatraemia

Answer 48

Decreases aldosterone which increases Na urinary excretion

Question 49

Pathophysiology of hashimotos

Answer 49

lymphocytic infiltratation of the thyroid gland and formation of germinal centers

Question 50

CKD can cause hyperparathyoirdism, what lab values would you expect to find

Answer 50

high ca low PO4 high PTH high alk phosphatase

Question 51

medullary thyroid cancer is associated with what gene

Answer 51

RET gene sometimes associated with MEN2A and MEN2B

Question 52

radiation to the neck is a major risk factor for what type of thyroid cancer

Answer 52

papillary

Question 53

FNA of thyroid nodule shows amyloid deposits

Answer 53

medullary thyroid cancer

Question 54

how is ACE inhibitors renoprotective in diabetes

Answer 54

normalises albuminuria

Question 55

acarbose drug action

Answer 55

alpha glucosidase inhibitor used in diabetes to decrease cho absorption from GI tract

Question 56

side effects of acarbose (alpha-glucosidase inhibitor)

Answer 56

flatulence GI symtpoms

Question 57

Ca, phosphate and ALP in bone mets

Answer 57

hypercalcaemia normal P04 elevated ALP

Question 58

Ca, phosphate and PTH in chronic kidney disease

Answer 58

hypocalcaemia hyperphosphataemia elevated PTH

Question 59

role of incretins (GLP-1)

Answer 59

augment release of insulin they are secreted from the gut after eating

Question 60

thyroid biopsy showing pleomorphic spindle cells

Answer 60

anaplastic

Question 61

chronically high PTH levels + cystic lesions in bone

Answer 61

osteitis fibrosis cystica caused by chronically elevated PTH = hypercalcaemia, hypophosphataemia and high PTH