Random stuff Flashcards
(181 cards)
1
Q
What are the lab values for calcium, phosphate, ALP, and PTH in osteoporosis?
A
Calcium: Normal
Phosphate: Normal
ALP: Normal
PTH: Normal
2
Q
What are the lab findings in primary hyperparathyroidism (leading to osteitis fibrosa cystica)?
A
Calcium: Increased
Phosphate: Decreased
ALP: Increased
PTH: Increased
3
Q
How do calcium, phosphate, ALP, and PTH levels change in osteomalacia?
A
Calcium: Decreased
Phosphate: Decreased
ALP: Increased
PTH: Increased
4
Q
How does chronic kidney disease (leading to secondary hyperparathyroidism) affect calcium, phosphate, ALP, and PTH levels?
A
Calcium: Decreased
Phosphate: Increased
ALP: Increased
PTH: Increased
5
Q
What are the lab values in Paget’s disease of bone?
A
Calcium: Normal
Phosphate: Normal
ALP: Increased
PTH: Normal
6
Q
What are the expected lab values for osteopetrosis?
A
Calcium: Normal
Phosphate: Normal
ALP: Normal
PTH: Normal
7
Q
What are the thyroid function test results in primary hypothyroidism?
A
TSH: High
T3: Low
T4: Low
8
Q
What are the thyroid function test results in secondary hypothyroidism?
A
TSH: Low
T3: Low
T4: Low
9
Q
What are the thyroid function test results in sub-clinical hypothyroidism?
A
TSH: High
T3: Normal
T4: Normal
10
Q
What are the thyroid function test results in primary hyperthyroidism?
A
TSH: Low
T3: High
T4: High
11
Q
What are the thyroid function test results in secondary hyperthyroidism?
A
TSH: High
T3: High
T4: High
12
Q
What are the thyroid function test results in sub-clinical hyperthyroidism?
A
TSH: Low
T3: Normal
T4: Normal
13
Q
What is another name for sick euthyroid syndrome?
A
Non-thyroidal illness
14
Q
What happens to TSH, T4, and T3 levels in sick euthyroid syndrome?
A
TSH: Usually inappropriately normal (but can be low)
T4 (Thyroxine): Low.
T3 (Triiodothyronine): Low
15
Q
Why is TSH considered “inappropriately normal” in sick euthyroid syndrome?
A
Because TSH should be high when T4 and T3 are low, but in this condition, it remains normal or low
16
Q
What causes sick euthyroid syndrome?
A
Severe systemic illness, such as sepsis, trauma, or chronic disease
17
Q
How do thyroid function tests change after the illness resolves and what is the treatment?
A
They return to normal once the patient recovers and no treatment is needed
18
Q
What are the three zones of the adrenal cortex
A
Zona Glomerulosa
Zona Fasciculata
Zona Reticularis
19
Q
What does the zona glomerulosa of the adrenal cortex produce?
A
Mineralocorticoids, mainly aldosterone
20
Q
What does the zona fasciculata of the adrenal cortex produce?
A
Glucocorticoids, mainly cortisol
21
Q
What does the zona reticularis of the adrenal cortex produce?
A
Sex steroids (androgens) and some glucocorticoids
22
Q
Where are the adrenal glands located?
A
Superior and medial to the upper pole of the kidneys
23
Q
What is the weight of each adrenal gland?
A
Around 4-5 grams per gland
24
Q
What are the two main parts of the adrenal gland?
A
Outer cortex and central medulla
25
A 39-year-old man presents with headaches and excessive sweating. He also reports some visual loss. Visual fields testing reveal loss of temporal vision bilaterally
What is this describing?
Acromegaly
26
High insulin, High C-peptide means what?
Endogenous insulin production
= Insulinoma or sulfonylurea use/abuse
27
In hypercalcaemia secondary to malignancy what would blood results look like?
PTH is low, although PTHrP may be raised
28
What is used in the management of prostate cancer may result in gynecomastia?
GnRH agonists (e.g. goserelin)
29
A 56-year-old female is admitted to ITU with a severe pneumonia. Thyroid function tests are most likely to show
1. TSH normal/low
2. Thyroxine low
3. T3 low
No action neccarsily
30
John, 84, has been previously diagnosed with metastatic prostate cancer. He is brought to the emergency department by his family due to confusion which began approximately one day ago. John had previously been complaining of increased drowsiness, nausea, decreased appetite and aching pains in his legs before the onset of confusion.
John's medications include MST, Oramorph and co-danthramer. His last set of blood results were taken by his GP 2 months ago and showed a slight hypernatraemia. Which of the following electrolyte imbalances is the most likely cause of his current symptoms?
The mnemonic for remembering the symptoms of hypercalcaemia is stones, bones, groans, thrones and psychiatric overtones. Breaking this down we get:
1. Stones (renal)
2. Bones (bone pain)
3. Groans (abdominal pain, nausea and vomiting)
4. Thrones (polyuria)
5. Psychiatric overtones (confusion and cognitive dysfunction, depression, anxiety, insomnia, coma)
hypercalcaemia
31
What can give a falsely low HbA1c?
premature red blood cell death
= HBA1C is a form of haemoglobin
sickle-cell anaemia, GP6D deficiency and hereditary spherocytosis
32
Thyrotoxicosis with tender goitre treatment
Conservative management with ibuprofen
33
IF YOU KNOW ITS TO DO WITH MALIGNANCY WHAT THE FUCK DO YOU PRESS
ANY FORM OF FUCKING CANER, MYELOMA, LYMPHOMA ANYTHING
BENCE JONCE PROTEINS RELATED TO MYELOMA
ANYTHING RELATED TO A CANCER
34
Where does anti-diuretic hormone (ADH) promote water reabsorption in the kidneys, and how does it do so?
ADH, also known as vasopressin, is released by the posterior pituitary and promotes water reabsorption in the collecting ducts of the kidneys by stimulating the insertion of aquaporin-2 channels
35
An F1 who has just started has been asked to draw up 10 units of insulin using an insulin syringe. However, he makes the serious error of using a normal syringe to draw the insulin up and draws up 10ml of a standard insulin preparation. The nurse on the ward spots his doing this and immediately stops him before a serious error, and explains to him the vital importance of using an insulin syringe.
How many units of insulin did the F1 draw up?
1 ml of insulin = 100 units
10 ml of insulin = 100 units/ml × 10 ml = 1000 units of insulin.
36
What does Trousseau's sign indicate, and how is it tested?
Indicates hypocalcaemia
= It is tested by inflating a blood pressure cuff above the patient's systolic pressure for about 2 minutes, causing carpopedal spasm (a tightening of the hand and fingers)
36
What is Chvostek's sign, and what does a positive result indicate?
test for hypocalcaemia
= It is elicited by tapping over the parotid gland (near the facial nerve, CN VII), causing a twitch or spasm of the facial muscles if the sign is positive
37
There is decreased secretion of what hormones in response to major surgery
Insulin
Testosterone
Oestrogen
38
First-line management for prolactinomas
Dopamine agonists (e.g. cabergoline, bromocriptine)
39
Another name for primary hyperparathyroidism is what?
Parathyroid adenoma
40
What is the management for primary hyperparathyroidism?
Parathyroidectomy
41
Another name for secondary hyperparathyroidism
Parathyroid hyperplasia
42
A frail 88-year-old woman presents to her GP to discuss the results of her recent blood test. Over the past 2 months, she has been experiencing back pain and muscle weakness. She walks with a waddling gait and there is mild bony tenderness upon palpation of her spine. She is diagnosed with osteomalacia based on her blood test results.
What results would you expect to see on her bone profile?
Low serum calcium, low serum phosphate, raised ALP and raised PTH
43
What is the most common cause of secondary adrenal insufficiency
Long-term steroid use
44
The PTH level in primary hyperparathyroidism may be what
normal or increased
45
Hypertension
Hypokalaemia
Hypernatremia
Alkalosis
Hyperaldosteronism (conn's)
45
Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Hypercalcaemia
Raised urea
Addisons crisis
46
Low calcium
low PTH
normal/raised phosphate
hypocalcaemia due to hypoparathyroidism
47
Hypokalaemic metabolic alkalosis
Crushings
48
Low calcium
High PTH (due to resistance)
pseudohypoparathyroidism
49
Raised calcium
Undetectable PTH
Raised alkaline phosphatase (ALP)
malignancy-related hypercalcaemia
= ANY CANCER
50
What is hyperglycaemia?
high blood glucose (sugar) levels
= Normal fasting glucose:
3.9–5.6 mmol/L
Hyperglycaemia:
Usually defined as >7.0 mmol/L fasting
Or >11.1 mmol/L any time (random)
51
A 65-year-old man has a painful ulcer on the heel of his foot. The pain is
worse at night when his legs are elevated. He has type 2 diabetes mellitus and admits to not attending his appointments with his diabetes specialist nurse since his divorce six months ago. On examination, the ulcer has a ‘punched out’ appearance and has a white, shiny border. His legs are
hairless, but he does not shave. Left-sided ankle brachial pressure index is
0.4 (0.8-1.2)
Which is the most appropriate first line of management?
Revascularisation
= man has an arterial ulcer (most likely from the diabetes), which is apparent
from the pain on elevation (due to reduced blood flow), hair loss and punched out appearance of the ulcer. His ankle brachial pressure index is extremely low, and revascularisation is needed urgently to prevent necrosis.
Compression would be the correct answer if this were a venous ulcer, which it is not
52
A 40-year-old female presents with a slow-growing lump low in the anterior
neck, which moves when she swallows.
Which is the most likely diagnosis?
Thyroid cyst
53
A 76-year-old female patient is noted to have a raised corrected serum
calcium and a normal serum alkaline phosphatase and creatinine. She is on
amlodipine for hypertension. She is asymptomatic and has no history of
renal stones or any other problems. Nuclear medicine scan shows an
isolated enlarged right inferior parathyroid gland
Reference ranges:
Serum calcium 2.71 mmol/L (2.15-2.55)
Serum parathyroid hormone 12.3 pmol/L (1.6–8.5)
What is the most appropriate management?
Do nothing, but monitor the calcium concentrations = she's asymompatic
if she showed symptoms, you remove 1
54
The first line treatment for crushing disease is what?
Metyrapone
(a 11B hydroxylase blocker) to reduce the cortisol levels until it is in the normal range, and then she can go for surgery
55
Laryngeal cancer typically presents with what?
hoarse voice longer than 3 weeks,
difficulty swallowing & weight loss
56
Deficiency of which hormone can lead to raised plasma osmolality?
Vasopressin (ADH)
57
Growth Hormone is a peptide hormone that stimulates growth, cell reproduction, and cell regeneration in humans and other animals
What is the major metabolic change that stimulates the secretion of growth hormone?
A decrease in plasma glucose levels
58
An increase in plasma cortisol levels leads to what happens to the growth hormone?
negatively impacts it
59
'A thyroid isotope scan shows no uptake'
This excludes what?
Solitary toxic nodule
60
Which hormone is synthesised in cells of the paraventricular and supraoptic nuclei of the hypothalamus and is released from the neurohypophysis in response to an increase in the concentration of solutes in the blood?
Antidiuretic hormone
= When your blood becomes too concentrated, the brain makes ADH in special areas (paraventricular and supraoptic nuclei), and releases it from the posterior pituitary to help the kidneys keep water, diluting the blood back to normal
61
Adrenocorticotropic hormone (ACTH) role
Produced by: Anterior pituitary
Function: Stimulates the adrenal cortex to secrete cortisol (stress hormone)
62
Gonadotropin-releasing hormone (GnRH) role
Produced by: Hypothalamus
Function: Stimulates the anterior pituitary to release LH and FSH, which regulate reproduction
63
Prolactin role
Produced by: Anterior pituitary
Function: Promotes milk production in the mammary glands
64
Somatotropin (Growth hormone) role
Produced by: Anterior pituitary
Function: Stimulates growth, cell reproduction, and IGF-1 production in the liver
65
A 68-year-old female with known lung cancer complains of weight gain and thirst
Which hormone is secreted by some tumour cells to cause weight gain, striae, and glucose intolerance?
Adrenocorticotropic hormone
- ACTH
66
A patient with type 1 diabetes describes vomiting after large meals
Which underlying neurological process is most likely to have occurred?
Autonomic neuropathy
67
A 40-year-old lady presents to her GP worried about a swelling in her neck. She has lost 10 kilos, is not sleeping well, has loose bowels and is sweating. Neck palpation reveals a smooth, diffuse swelling that moves with swallowing
Which is the first critical investigation that her doctor should do?
Thyroid function tests
68
High insulin, High C-peptide = Endogenous insulin production → Insulinoma or sulfonylurea use/abuse = what investigation do you use?
CT abdomen with contrast
69
What tumour can cause hypopituitarism?
Non-functioning pituitary tumours - Pituitary adenoma
70
'increase levels of incretins' is what
LIPTIN you dumb forgettable bitch who's exam is in 4 days
71
What beta blocker is used for graves disease
Propranolol
72
A 45-year-old woman presents with hypoglycaemia and has high levels of insulin and C-peptide in her blood. What is the most likely cause?
Insulinoma or sulfonylurea use
73
A patient with Type 1 diabetes presents with confusion and hypoglycaemia. Blood tests show high insulin levels but low C-peptide. What is the most likely cause of the high insulin?
injected insulin
74
A 30-year-old man with a history of morbid obesity and polyuria presents with fatigue. His blood tests show low insulin and low C-peptide levels. What is the most likely diagnosis?
Type 1 diabetes or insulin deficiency
75
What would high C-peptide and low insulin show?
Type 2 diabetes
76
'Erratic blood glucose control, bloating and vomiting' This suggest what?
Gastroparesis
77
What is the most appropriate investigation for patients with increased urinary cortisol and low plasma ACTH levels?
CT adrenals
78
A 23-year-old man presents with episodes of severe headaches, sweating, and anxiety. He also reports occasional vague abdominal pain. Examination reveals tachycardia and a blood pressure of 180/110 mmHg.
What is the most likely diagnosis?
Phaeochromocytoma
79
The adrenal medulla produces catecholamines, which exert their action by binding to α- and β-adrenoreceptors
What effects of catecholamines are mediated by stimulation of α-adrenoreceptors?
Inhibition of insulin release
80
What best describes thyroid-stimulating hormone (TSH)?
made up of an alpha and beta subunit
81
A 30-year-old male came into the Emergency Department with severe headaches and palpitations. On examination, his blood pressure is 180/100 mmHg. He had raised urinary metanephrines and was diagnosed with phaeochromocytoma. Select the site this tumour is most likely to originate.
Adrenal medulla
= The adrenal medulla is the site of production of catecholamines
82
A 14-year-old boy visits his GP because he is concerned that he hasn't had any growth of secondary sexual hair.
What hormonal mechanism underpins this physiological change?
Activation of pulsatile GnRH secretion
82
A 28-year-old man presents with joint pain, headache and sweating. He also complains of decreased libido. On examination, there is coarsening of his facial features, widely spaced teeth and a very large tongue.
After taking his oral glucose tolerance test, a diagnosis of acromegaly is made. Select the medication that is most likely to suppress the secretion of GH from the pituitary
Octreotide
83
What hormone is produced in the anterior pituitary gland?
Growth hormone
84
Acromegaly is caused by GH excess after puberty and fusion of the epiphyseal plates has occurred.
Analogues of which endogenous hormone may be useful in treating this condition?
Somatostatin
85
What is the correct hormone classification for 'growth hormone?'
Protein hormone
86
Growth hormone is secreted by the somatotrophs of the anterior pituitary and is the dominant endocrine regulator of growth
What is its role?
Inhibits glycogen synthesis in muscle
87
A 14-year-old girl presents to your GP clinic with a past medical history of Cushing's syndrome. Her height is below the level expected on her growth chart
Why might a child with Cushing's syndrome have restricted growth?
Cortisol inhibits growth hormone release from anterior pituitary
88
Excess ACTH causes what?
Cushing's syndrome
88
Excess of prolactin causes what?
galactorrhoea
89
Excess of growth hormone causes what?
acromegaly
90
What is a common feature of hypothyroidism?
Bradycardia
91
What effect do high levels of thyroid hormone have on metabolism?
↑ gluconeogenesis
92
Can thyroid hormones cause infertility?
yes
93
Thyroid hormones interact with the sympathetic nervous system. Most notably, they can lead to an increased heart rate and cardiac output
What is an example of a mechanism by which they exert these effects?
Through increasing the number of β adrenoreceptors
94
In times of stress, a hormone called cortisol is released from the adrenal cortex
What correctly describes the effect that cortisol has on the following metabolic processes?
Increase in
1. Lipolysis
2. Gluconeogenesis
3. proteolysis
Decrease in
1. Insulin release
2. glycogen synthesis
95
Steroid hormones can be divided into mineralocorticoids, glucocorticoids and adrenal androgens, all of which can be produced from the common precursor...
Cholesterol
96
Where is adrenocorticotropic hormone (ACTH) secreted from?
The anterior pituitary gland
97
A 47-year-old woman presents with difficulty standing up from a seated position. Further questioning reveals weight gain and easy bruising.
Examination reveals a patient with centripetal obesity and stretch marks, along with clinical hypertension (160/100). Investigation reveals raised serum ACTH levels
What is the most likely underlying pathophysiology?
Crushings = Pituitary adenoma
98
Cortisol is converted into what biologically inactive metabolite?
Cortisol is converted to biologically inactive cortisone by 11-beta hydroxysteroid dehydrogenase
99
Zona reticularis produces adrenal androgens - dehydroepiandrosterone (DHEA) and androstenedione
What factor would lead to a decrease in the production and secretion of adrenal androgens?
High cortisol
100
Corticosteroids like prednisolone can cause what that leads to what happening?
insulin resistance, leading to an increased risk of developing type 2 diabetes mellitus
101
What hormone is produced in the hypothalamus?
Oxytocin
102
What Is the function of oxytocin?
Ejection of breast milk
Prolactin is responsible for production of breast milk
103
A 17-year-old female visits her GP because she has not started her periods yet. Her GP takes a history, examines her and requests several blood tests, including the levels of oestrogen, progesterone and testosterone
Why are these hormones all found bound to proteins in the circulation?
They are cholesterol based
104
A 24-year-old man presents with a 6-month history of a headache. Physical examination reveals bilateral hemianopia, and after an MRI scan, he is diagnosed with a pituitary tumour.
What is the most common finding in the blood tests of a patient with a pituitary tumour?
Raised prolactin levels
105
What is an indication for the use of vasopressin?
Pituitary diabetes insipidus
106
A 40-year-old woman presents with fatigue, weight loss, and cold intolerance. On examination, she has dry skin and a delayed relaxation phase of her deep tendon reflexes. Her thyroid function tests show low T4 and normal TSH.
An MRI of the pituitary shows a small pituitary gland. What is the most likely cause?
Sheehan’s syndrome
107
What causes the hyperpigmentation in Addisons?
ACTH
108
MEN-1 is associated with what?
1. parathyroid hyperplasias
2. adenomas
3. gastrinomas
4. insulinomas
5. prolactinomas
109
Which of the drug classes works, at least in part, by increasing glycosuria?
SGL2
110
What is the site of androgen production?
Leydig cells
111
Upon which tissue does glucagon act to produce its major effects on carbohydrate
metabolism?
Liver
112
What pathway is responsible for ketone development in states of insulin depletion?
Lipolysis
113
What drug increases insulin sensitivity
Metformin + Pioglitazone (reduces peripheral insulin resistance as they're agonists of PPAR-gamma receptors)
114
If someone had a paracetamol overdose, what features in the medical history would increase the risk that the patient would develop liver failure?
chronic alcohol, HIV, anorexia or P450 inducers
115
What are the causes of lower-than-expected levels of HbA1c (due to reduced red blood cell lifespan) ?
1. Sickle-cell anaemia
2. GP6D deficiency
3. Hereditary spherocytosis
4. Haemodialysis
116
What are the causes of higher-than-expected levels of HbA1c (due to increased red blood cell lifespan) ?
1. Vitamin B12/folic acid deficiency
2. Iron-deficiency anaemia
3. Splenectomy
117
When do you check your blood glucose before driving your car?
Check before driving and every 2 hours regardless of if she has eaten or not
118
Impaired hypoglycaemia awareness occurs due to what factor?
Neuropathy in the autonomic nervous system
= (eg) Heart rate, digestion, bladder control, sweating etc
When these nerves are damaged, you might get symptoms like dizziness on standing, digestive problems, or bladder issues
119
An 8-year-old boy with type 1 diabetes presents to the emergency department with vomiting. You take a brief history and establish that he has recently had a chest infection.
Upon investigation, you find ketones in the urine and his blood sugars are elevated, therefore highly suspecting diabetic ketoacidosis.
Which is the primary ketone body involved in diabetic ketoacidosis?
Acetoacetate
120
What does alcohol cause in the body?
Redistribution of pancreatic blood flow
121
Explain Fasting glucose
Normal: less than 5.6
Impaired fasting glucose (pre-diabetes): 5.6 to 6.9
Diabetes: 7.0 or above
122
Explain glucose tolerance
Normal: less than 7.8
Impaired glucose tolerance (pre-diabetes): 7.8 to 11.0
Diabetes: 11.1 or above
123
A 28-year-old female has been diagnosed with hyperthyroidism. She complains of heat intolerance and palpitations, the latter is proving to be very frightening to her. The GP starts her on Carbimazole and a second medication to manage the palpitations.
What receptors are being overstimulated by the enhanced catecholamine effects in this patient to cause her palpitations?
B1 receptors
124
You see a 24-year-old female in the endocrinology clinic. She has been diagnosed with Graves' disease. The diagnosis was based on the elevated levels of the thyroid hormones T3 and T4 and he symptoms of heat intolerance, weight loss and tremors. Where are the thyroid hormone receptors typically found?
Nucleus
125
A 36-year-old woman presents to your general practice presenting with unexplained weight gain and fatigue. She reports being very sensitive to cold weather. You decide to test her serum thyroid-stimulating hormone (TSH) and free thyroxine (T4) levels, as you suspect she may have hypothyroidism. TSH is released from the anterior pituitary.
Which one of the following hormones is not released from the anterior pituitary?
A. Anti-diuretic hormone
B. Adrenocorticotropic hormone
C. Growth hormone
D. Follicle-stimulating hormone
E. Prolactin
A - released by the posterior pituitary gland
126
The first sign of male puberty is what?
Testicular enlargement
127
A 23-year-old lady undergoes a total thyroidectomy as treatment for a papillary carcinoma of the thyroid. The pathologist examines histological sections of the thyroid gland and identifies a psammoma body.
What are these primarily composed of?
Clusters of calcification ??? yea idk either bro
128
What thyroid-associated protein is raised during pregnancy?
Thyroid binding globulin
129
A 24-year-old man presents to the review clinic after surgical removal of an endocrine organ. Before the decision for surgery, he had been complaining of excessive sweating, headache, palpitations and had high blood pressure (200/120mmHg).
Histological staining of the organ in question would reveal which cells?
Chromaffin cells
= This is describing
pheochromocytoma:
(1) Excessive sweating, headache, palpitations (classic “pheo” symptoms)
(2) Very high blood pressure (200/120 mmHg) often sudden and severe
130
A 34-year-old male presents to the GP with a new diagnosis of Conn's syndrome. As a result of this, they are producing too much aldosterone. What will this do to the sodium and potassium balance in the blood?
Increased sodium, decreased potassium
131
What is the main component of colloid in the thyroid gland?
Thyroglobulin
132
How is subclinical hypothyroidism managed in patients?
(1) TSH 5-10 with normal T4
(2) TSH above 10
(1) Under 65 ONLY
TSH is checked twice, 3 months apart. If TSH remains high with T3/4 normal and symptoms persist
= A 6-month trial of thyroxine is offered
(2) Any age
Treatment is started straight away
133
What is Acropachy?
Finger clubbing - think graves’ disease
134
What is the first-line imaging of choice when investigating thyroid nodules?
1. Ultrasound
2. Fine needle aspiration biopsy is done if suspicious or large nodules to check for cancer
135
'If TSH is normal or high'
What investigations do you do?
Do an ultrasound and consider needle aspiration based on ultrasound features
High - anti-TPO antibodies first
136
'If TSH low'
What investigations do you do?
Do a nuclear scan:
(1) Cold nodule → consider needle aspirate (higher cancer risk)
(2) Hot nodule → usually benign, treat hyperthyroidism instead.
137
Any change in vision with thyroid eye disease requires what?
urgent review by a specialist
138
' A woman had a sudden hypertensive emergency and had a cardiac arrest after her surgical removal of a phaeochromocytoma on her left adrenal gland'
What could have prevented this from happening?
Given her Phenoxybenzamine before a beta blocker
139
In secondary hypothyroidism what investigation is most likely to be diagnostic?
MRI pituitary gland
(Also, the same test for secondary hyperthyroidism too!)
140
What is exposure keratopathy?
eye damage caused when the eyelids don’t close fully, so the cornea gets dry and irritated
141
Thionamides examples
carbimazole and propylthiouracil (PTU
142
Subacute (De Quervain's) thyroiditis treatment
NSAIDS U DUMB BITCH
143
Do you ever check TSH in those people who have hypothyroidism?
If so, when?
Yes.
Check TSH 6-8 weeks after starting or changing levothyroxine dose to see if it's working
144
When is ESR increased in regards to thyroid disease stuff
De Quervain's thyroiditis (because it's inflammatory)
Is normal in the rest
145
What hormones are produced in the posterior pituitary?
1. ADH – Antidiuretic Hormone (aka vasopressin)
2. Oxytocin - squeeze the baby out, squeeze the milk out, feel the love between mum and baby
146
Somatostatin is released from what cells in the pancreas?
Delta cells
147
Which cell type releases insulin?
Beta
148
Which cell type releases glucagon?
Alpha
149
A 47-year-old lady is diagnosed as suffering from a phaeochromocytoma.
From what amino acid are catecholamines primarily derived from?
Tyrosine
150
A 73-year-old lady is diagnosed with hyperaldosteronism. From which part of the structure is aldosterone released?
= Zona glomerulosa of the adrenal cortex
(1) Conn’s syndrome is caused by too much aldosterone from the adrenal gland.
(2) Excess aldosterone causes the kidneys to keep more sodium and water, which raises blood volume and blood pressure.
(3) It also makes kidneys lose potassium, causing low potassium (hypokalaemia). So in Conn’s, the extra aldosterone causes high blood pressure and low potassium.
151
You are a medical student on the wards in the endocrinology department. On the ward round, you see a patient who is suffering from the syndrome of inappropriate antidiuretic hormone secretion. The consultant leading the ward round decides to test your knowledge and asks you about the normal release of anti-diuretic hormone (ADH) in the brain.
Which pathway leads to the release of the hormone causing this patient's condition?
ADH is released from the posterior pituitary gland via neural cells which extend from the hypothalamus
152
Graves disease - immunoglobulin
IgG - diabolical behaviour Caitlin!!
153
What is seen in females with Addison's disease due to reduced production of testosterone from the adrenal gland?
Thinning of pubic and axillary hair
154
A 27-year-old woman presents to the GP with significant fatigue and malaise. Additionally, she has observed dark patches on her neck and palms. Her past medical history includes well-controlled Hashimoto's thyroiditis, for which she is on levothyroxine. Blood tests have excluded common causes of fatigue such as anaemia.
What is the gold standard single test for the likely diagnosis?
Short Synacthen test - Addisons
155
Typically, a prolactinoma would cause a prolactin level to be what?
>100
156
ACTH suppression etc explain - Addison's
ACTH - DEPENDENT CAUSE
1. High ACTH before the test
2. High-dose dexamethasone usually suppresses ACTH and cortisol (because pituitary tumours still respond to feedback)
ACTH - INDEPENDENT CAUSE
1. Low ACTH before test (because adrenal cortisol suppresses pituitary)
2. High-dose dexamethasone does not affect ACTH or cortisol (cortisol is high from the adrenal; pituitary is therefore already suppressed)
ECOPTIC ACTH SECRETION
(a subtype of ACTH-dependent):
1. High ACTH before the test
2. High-dose dexamethasone does NOT suppress ACTH or cortisol
(Ectopic tumours don’t respond to feedback)
157
A 42-year-old woman presents to her GP with a tremor, weight loss, anxiety, palpitations and diarrhoea.
On examination, there is a smooth, non-tender goitre. There is evidence of lid retraction and proptosis. Visual acuity and eye movements are normal.
She has started on carbimazole and propranolol
What is the most appropriate treatment for the patient's eye disease?
Prednisolone
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A 45-year-old male comes to the GP for a general check-up. He is a heavy smoker of 60 pack years and does not drink alcohol. When questioned, he states he has had a cough that has not gone away for the last few months. On further questioning, he reports blood-stained sputum once or twice last week. As well as this, he has experienced weight gain of 10kg in the previous 3 months and chronic muscle fatigue. His wife makes fun of his 'chubby' face and purple stretch marks. He has no significant past medical history and is not on any regular medications.
On examination, he is alert and oriented, though tired, and struggles to get up from his chair. He has a persistent cough, but his chest is clear and his heart sounds normal. His pulse is 90/min, resp 18/min, blood pressure 189/102 mmHg and oxygen saturation 93% on room air.
What is the most likely diagnosis?
Small cell lung carcinoma secreting ACTH can cause Cushing's syndrome
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'Headaches, amenorrhoea, visual field defects'
This suggests what?
Prolactinoma
160
A 48-year-old man presents to the endocrine clinic. He has been feeling tired and lethargic for several weeks, with intolerance of cold weather and weight gain. More recently, he has developed a headache which is worse at night.
His blood tests show the following:
TSH. 0.2 mU/L (0.5-5.5)
Free T4 2.1 pmol/L) (9.0 - 18)
Prolactin 2 ng/mL (2 - 18)
FSH 0 IU/L (1-7)
LH 0 IU/L (1-8)
What is the most likely underlying diagnosis? Explain your reasoning
Pituitary adenoma
(1) The symptoms are all suggestive of hypothyroidism
(2) Results show secondary hypothyroidism
= it’s a problem with the pituitary (or hypothalamus) not stimulating the thyroid properly
(3) FSH = 0
LH = 0
These are also undetectable, meaning the pituitary isn’t releasing these hormones either, suggesting hypogonadotropic hypogonadism (again, a pituitary issue)
(4) Prolactin = 2 ng/mL (low-normal)
You might expect high prolactin in a pituitary tumour, especially prolactinomas, but very low levels can happen if the entire pituitary is being compressed, affecting all hormone secretion
(5) The headache is worse at night, suggesting a space-occupying lesion like a pituitary macroadenoma
This means it's likely a
= Non-functioning pituitary macroadenoma causing hypopituitarism
This means the tumour itself isn’t secreting hormones (so prolactin is not high), but it’s compressing the normal pituitary cells, so they stop producing TSH, LH, FSH, etc
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Hypercalcaemia relates to what
MEN 1
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A 33-year-old man complains of a tingling sensation in his hands for several months, occasionally waking him during sleep. The patient has noticed he has gained weight and no longer wears his wedding ring as it has become too tight.
You notice the patient is sweating while speaking to you and has quite a large jaw, furrowed tongue and large hands. His blood pressure reading is 142/91 mmHg.
The most appropriate investigation would be what?
Glucose tolerance test
= acromegaly
Growth hormone levels alone — not reliable because GH fluctuates during the day; a random GH level can be misleading
163
A 49-year-old man has recently been diagnosed with type 2 diabetes and is being carefully monitored. He has been advised to maintain a healthier diet and lifestyle.
He attends a follow-up clinic and claims to have been following the diet stringently since his last appointment three months ago. The most appropriate investigation would be what?
Glycated haemoglobin
164
Bilateral adrenalectomy in question means the answer will always be...
Nelson syndrome
165
A 58-year-old woman presents with an acutely painful neck. The patient has a fever, blood pressure which is 135/85 mmHg and a heart rate of 102 BPM
The patient explains that the pain started 2 weeks ago and has gradually become worse. She also notes palpitations, particularly and believes she has lost weight. The symptoms subside, and the patient presents again complaining of intolerance to cold temperatures.
The most likely diagnosis is what?
De Quervain’s thyroiditis
= The cold intolerance appears after the initial hyperthyroid phase
166
A 47-year-old woman presents to the clinic after being referred by her GP for consistently elevated blood pressure. Her last reading was 147/93.
The female does not report any symptoms, but recently lost her job and attributes the elevated
reading to stress.
Her blood tests are as follows:
(1) Sodium 146
(2) Potassium 3.4
(3) Glucose (random) 7.7
(4) Urea 4
The most appropriate investigation is:
A. CT scan
B. 24-hour ambulatory blood pressure
C. Abdominal ultrasound scan
D. Aldosterone–renin ratio
E. Glucose tolerance test
Explain
Have to confirm the hypertension first, so B
After that we can then do D
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A 29-year-old man presents with a 4-week history of polyuria and extreme thirst. The patient denies difficulty voiding, hesitancy or haematuria, although the urine is very dilute.
The patient does not believe he has lost any weight and maintains a
good diet. No findings are found on the urine dipstick.
The most appropriate
Investigation is:
A. Serum osmolality
B. Fasting plasma glucose
C. Urinary electrolytes
D. Magnetic resonance imaging (MRI) scan of the head
E. Water deprivation test
E
The reason it isn't B is
= Polyuria + very dilute urine + no glucose suspect diabetes insipidus. The urine dipstick would've picked up glucose
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In a question, what symptoms have to be present to think its pheochromocytoma?
1. High blood pressure
2. Sweating and palpitations
3. Weight is not a factor
ESSENTIAL
169
A pituitary adenoma may present with what?
Cranial nerve III palsy
170
A 32-year-old female is seen in the clinic with a painless lump in the anterior aspect of her neck. On examination, she had a 2cm firm lump left of the midline, which moves up on swallowing but not on tongue protrusion. Biopsy confirms the presence of malignant cells.
What is the most likely type of cancer present?
Papillary
171
Pure vitamin D deficiency would lead to what results?
low calcium AND phosphate
172
A 25-year-old female is seen on the surgical ward round. Three days ago, she underwent a thyroidectomy for Graves disease. For the past day, she has been feeling nauseous and complaining of numbness and a tingling sensation around her mouth.
What is the cause of her symptoms?
Hypocalemia
173
A 24-year-old woman presents to her GP surgery with recent symptoms of increased thirst and urination throughout the day. She also reports feeling more tired than normal. Otherwise, she is fit and well with no weight issues. The GP suspects that this may be diabetes and so orders a blood glucose check. Her blood glucose is 12 mmol/L, and urine dip has no ketones. Her mother was also diagnosed with diabetes around the same age. The GP thinks this may be a case of maturity-onset diabetes of the young.
What is the inheritance pattern for this condition?
MODY
= autosomal dominat
174
A 35-year-old man, diagnosed as having type 2 diabetes mellitus 10 years ago, has had poor control despite taking metformin. Several family members also have diabetes mellitus and a recent genotyping revealed a mutation in the HNF-1 alpha.
What is the most appropriate treatment?
Sulfonylureas
175
A 49-year-old man attends his GP practice for annual drug monitoring. He is keen to improve his health and has a background of hypertension and hypercholesterolaemia, for which he takes ramipril and atorvastatin. On examination, his blood pressure is 134/82mmHg, heart rate 68/min and BMI 36kg/m². His latest blood results show:
Creatinine 64 mmol/L (59-104)
HbA1c 45 mmol/mol (<42)
Total cholesterol 4.9 mmol/L (<5)
What additional medication would he benefit from?
He is not diabetic yet, therefore skip metformin and go straight to LUTIDE
176
Hypothyroidism is what type of disease?
Autoimmune
177
Orphan Annie eyes with psammoma bodies is a characteristic histology finding in
Papillary
