blackboard endocrine questions Flashcards
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?
Provision of protective footwear
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?
An abnormality of the basement membrane of the glomerulus
Which one of the following statements is correct about the examination of the thyroid gland?
it moves on swallowing
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?
E.coli
A 67 year old man with type 2 diabetes is found to have unexpected persistent hyperglycaemia. What is most likely responsible?
sepsis
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?
Glomerulonephritis
You see a patient with Conn’s syndrome (hyperaldosteronism). What is likely to have occured in the blood on further investigation?
A fall in plasma potassium concentration
Which if the following statements is true of rapid acting insulin therapy?
If administered intravenously has a half life of approximately 4 minutes
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?
Active resorption of sodium from the ascending limb
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?
Acute post-infective glomerulonephritis
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?
Glomerulus
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?
Mobilises liver glycogen
The use of metformin in type 2 diabetes mellitus…?
Is thought to enhance the action of insulin in promoting tissue glucose uptake
hormones secreted by adrenal glands:
Zona glomerulus : Aldosterone
Zona fasciculata - cortisol
Zona reticularis: Androgens
what conditions can secondary diabetes occur?
So: Haemachromatosis chronic pancreatitis cushings syndrome long term corticosteroid use
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?
Benign hyperplasia of the prostate gland
sensitivity vs specificity
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.
The principle action of the hypoglycaemic sulphonylureas (e.g. gliclazide) is:
Stimulation of insulin release
Which physiological change will lead to an increase in glomerular filtration rate?
Decrease in afferent arteriole pressure
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?
Decreased cortisol; decreased aldosterone
Low blood glucose levels
low sodium
high potassium
Raised TSH
DKA diagnosis?
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.
Difference between familial hypocalciuric hypercalcaemia and primary hyperparathyroidism ?
So:
Primary hyperparathyroidism: 24 hour urinary caclium excretion would be elevated
FHH: 24 hour urinary excretion levels are low!
Managament for thyroid storm?
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.
metabolic syndrome :
‘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.