blackboard endocrine questions

Question 1

Mrs KL is a 45 year old type diabetic who presents with a punched out painless ulcer under her right great toe. She is found to have ‘glove and stocking anaesthesia’ from below the knee on both legs. What is the appropriate initial therapy?

Answer 1

Provision of protective footwear

Question 2

Mrs RJ is a 45-year old woman. She is normally fit and well. She presents with oedema of the face and ankles and on urine dipstick testing is found to have 4+ of protein but no glucose or blood. What is the likely pathological basis for this presentation?

Answer 2

An abnormality of the basement membrane of the glomerulus

Question 3

Which one of the following statements is correct about the examination of the thyroid gland?

Answer 3

it moves on swallowing

Question 4

A 78 year old woman presents who has had a bladder catheter inserted for incontinence. After two weeks she develops a fever and bilateral loin pain. Which organism is likely to be cultured from the urine?

Answer 4

E.coli

Question 5

A 67 year old man with type 2 diabetes is found to have unexpected persistent hyperglycaemia. What is most likely responsible?

Answer 5

sepsis

Question 6

A 50 year old man has recently noticed ankle swelling. Urine testing reveal non-visible haematuria and 4+ proteinuria. What is likely to be causing the haematuria?

Answer 6

Glomerulonephritis

Question 7

You see a patient with Conn’s syndrome (hyperaldosteronism). What is likely to have occured in the blood on further investigation?

Answer 7

A fall in plasma potassium concentration

Question 8

Which if the following statements is true of rapid acting insulin therapy?

Answer 8

If administered intravenously has a half life of approximately 4 minutes

Question 9

The mechanisms in the loop of Henle produce highly concentrated conditions in the pelvis of the kidney. Which one of the following is important in this process?

Answer 9

Active resorption of sodium from the ascending limb

Question 10

A 15 year old boy presents with swelling of the face and legs, cloudy urine and ASO titre elevated. Which one of the following is the likely diagnosis?

Answer 10

Acute post-infective glomerulonephritis

Question 11

A 7 year old girl develops haematuria and hypertension two weeks after a streptococcal sore throat. What structure is likely to contain the associated pathological changes?

Answer 11

Glomerulus

Question 12

A 20 year old type 1 diabetic develops confusion and drowsiness suggestive of hypoglycaemia. It is decided to administer glucagon. Which of the following is correct?

Answer 12

Mobilises liver glycogen

Question 13

The use of metformin in type 2 diabetes mellitus…?

Answer 13

Is thought to enhance the action of insulin in promoting tissue glucose uptake

Question 14

hormones secreted by adrenal glands:

Answer 14

Zona glomerulus : Aldosterone
Zona fasciculata - cortisol
Zona reticularis: Androgens

Question 15

what conditions can secondary diabetes occur?

Answer 15

So:
Haemachromatosis
chronic pancreatitis 
cushings syndrome 
long term corticosteroid use

Question 16

A 76 year old male presents with severe kidney failure. Examination confirms a suprapubic mass consistent with an enlarged bladder. What pathology is most likely to result in this presentation?

Answer 16

Benign hyperplasia of the prostate gland

Question 17

sensitivity vs specificity

Answer 17

Sensitivity: the ability of a test to correctly identify patients with a disease.

Specificity: the ability of a test to correctly identify people without the disease.

Question 18

The principle action of the hypoglycaemic sulphonylureas (e.g. gliclazide) is:

Answer 18

Stimulation of insulin release

Question 19

Which physiological change will lead to an increase in glomerular filtration rate?

Answer 19

Decrease in afferent arteriole pressure

Question 20

A patient presents with lethargy, weight loss and fainting episodes. In the Emergency Department, a postural drop in blood pressure is noted of >20 mmHg systolic from the supine to the standing position. Blood glucose is 2.9 mmol/l and Na+ is 122 mmol/l.

Which of the following is the patient’s condition due to?

Answer 20

Decreased cortisol; decreased aldosterone

Low blood glucose levels
low sodium
high potassium
Raised TSH

Question 21

DKA diagnosis?

Answer 21

Diagnosing diabetic ketoacidosis (DKA) involves:

hyperglycaemia (glucose >11),
ketosis (>3mmol/l)
acidemia (pH <7.3, bicarbonate < 15).

This patient has diabetic ketoacidosis (low pH, ketonaemia and hyperglycaemia).

DKA, though preventable, remains a frequent and life-threatening complication of type 1 diabetes.

Question 22

Difference between familial hypocalciuric hypercalcaemia and primary hyperparathyroidism ?

Answer 22

So:
Primary hyperparathyroidism: 24 hour urinary caclium excretion would be elevated

FHH: 24 hour urinary excretion levels are low!

Question 23

Managament for thyroid storm?

Answer 23

Propylthiouracil, iodine, propranolol, hydrocortisone

Both propylthiouracil and iodine work by blocking the synthesis of new thyroid hormone and prevent further deterioration of the condition.

Hydrocortisone will help by inhibiting the less potent form of thyroid hormone T4 from being converted to the more potent version T3.

Propranolol, which is a beta-blocker, will tone down the severe adrenergic response and help decrease the heart rate and blood pressure.

Question 24

metabolic syndrome :

Answer 24

‘Metabolic syndrome’ is defined by the International Diabetes Federation (IDF) as three or more of: increased waist circumference, body mass index (BMI) >30 kg/m2, raised triglycerides, reduced HDL cholesterol, hypertension and raised fasting glucose.

Question 25

Primary hyperaldosteronism is thought to be the most common form of secondary hypertension.

Answer 25

Primary hyperaldosteronism is commonly due to a solitary adrenal adenoma (Conn syndrome) or bilateral adrenal hyperplasia. There are rare familial forms of hyperaldosteronism, and adrenal carcinoma is also a rare cause.