Capsule cases with Karim

Question 1

Which neuro condition does not affect lower limbs?

Answer 1

MS

endo 124 case

Question 2

What is produced by cancers, leading to hypercalcemia of malignancy?

Answer 2

PTHrp (related peptide)

Question 3

What is the phosphate level in hypercalcemia of malignancy vs primary hypercalcemia

Answer 3

Phosphate rises in hypercalcemia of malignancy, but not in primary hypercalcemia

Question 4

Why does dehydration worsen hypercalcemia?

Answer 4

Calcium is an osmotic diuretic, so you pee more and dehydrated

That means the kidneys don’t clear the PTHrp, so the calcium shoots up

Question 5

When do you give bisphosphonates in hypercalcemia?

Answer 5

If you don’t know cause of hypercalcemia, do not give bisphosphonates, give fluids and measure PTH

If you know they have cancer, give bisphosphonates to prevent boney mets, otherwise the bisphosphates with mask the phosphate levels?

Question 6

Secondary hypertension causes

Answer 6

Hypothyroidism
Aortic coarctation
Conns
Phaeo
Apparently lots, look back at DPD?

Question 7

When do you do plasma electrophoresis?

Answer 7

Myeloma

Question 8

Renin/aldosterone ratio is used for

Answer 8

Conns

Question 9

Cushings disease vs syndrome

Answer 9

Disease - pituitary

Question 10

What is a viscus?

Answer 10

Viscus - any hollow organ with gas in it

Question 11

What is Plummers?

Answer 11

Toxic multinodular goitre causing hyperthyroidism

Question 12

What is De Quervains thryoiditis?

Answer 12

Post viral, self resolving hyperthryoidism

Question 13

Can you give IV fluids in thyroid storm?

Answer 13

Yeah

Question 14

Why might you give hydrocortisone for someone with thyrotoxic crisis?

Answer 14

Hydrocortisone blocks T4 to T3 conversion

Question 15

What might you do to check for acromegaly?

Answer 15

Oral glucose tolerance test to check for paradoxical rise in glucose
MRI of pituitary

Question 16

What test do you do a

Answer 16

Low dose dexamethasone suppression test

Question 17

How do you identify acromegaly on the face?

Answer 17

Wide nose (cartilage growth)
Skin is thick

Question 18

Treatment for acromegaly

Answer 18

Cabergoline
Ocreotide

steroids if pituitary failure????

Question 19

What dose do you start with for hyperthryoidism

Answer 19

Start with high dose of PTU / carbimazole then taper down

Question 20

Which thyroid drug might cause neutropenia

Answer 20

Carbimazole

Question 21

If you get a rash from carbimazole, what do you do?

Answer 21

Switch to PTU

Question 22

If you get neutropenia from carbimazole, what do you do?

Answer 22

DO NOT switch to PTU, try surgery or radioiodine

Question 23

What is carcinoid tumour/ syndrome? Explain why it usually goes unnoticed / when it does get noticed

Answer 23

Neuroendocrine tumour in gut that releases serotonin

This is normally removed by the liver so people die without even knowing they have this tumour

If there are liver mets, it prevents the liver clearing it so it builds up and causes the problems

Question 24

Name a heart and lung complication from carcinoid tumours

Answer 24

Tricuspid valve damage by serotonin via IVC travel

Pulmonary fibrosis/stenosis

Question 25

What do you measure to diagnose carcinoid tumour?

Answer 25

5HIAA (serotonin)

Question 26

Symptoms of carcinoid tumour

Answer 26

Diarrhoea
Hot flushes worsened by alcohol
Chest pain
Wheeze

Question 27

Facts about carcinoid tumour - where do they arise from? What percentage metastasise? What syndrome can develop?

Answer 27

Derive from argentaffin cells
Arise in appendix and distal ileum - common sites
3% metastasise
Can release ACTH and cause Cushing’s syndrome
50% cardiac involvement?

Question 28

What do you call it when the carcinoid tumours develop arms and legs to surrounding areas?

Answer 28

Desmoplastic tumours (often in mesentery)

Question 29

Explain why you get pollagra from carcinoid tumours

Answer 29

Nicotinamide/niacin (vit B3) - precursor to 5HIAA

Carcinoid tumour therefore consumes B3, resulting in deficiency. This causes pollagra.

Question 30

Symptoms of pollagra

Answer 30

Dermatitis
Diarrhoea
Dementia