Random stuff Flashcards
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
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
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
