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4th Year General Medicine > Classic Presentations - Endocrine > Flashcards

Classic Presentations - Endocrine Flashcards

1
Q

A diabetic patient complains of thirst, tiredness, blurred vision, weight loss, polyuria, nocturia and memory problems

A

Hyperglycaemia

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2
Q

A diabetic patient become pale and sweaty, with tremor and nausea

A

Hypoglycaemia

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3
Q

A type 1 diabetic patient begins vomiting, has abdominal pain and is confused

A

DKA

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4
Q

A type 2 diabetic patient presents with thirst, nausea, dry skin and disorientation. They have extremely high blood glucose and elevated serum osmolality (ie significant dehydration). They only have mild ketones/acidosis

A

Hyperglycaemic Hyperosmolar Syndrome

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5
Q

A patient who has recently been in a car crash that resulted in a skull fracture develops polyuria and polydipsia. They have very dilute urine (decreased urine osmolality) and increased serum osmolality

A

Cranial diabetes insipidus

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6
Q

A bipolar patient on lithium develops polyuria and polydipsia. They have very dilute urine (decreased urine osmolality) and increased serum osmolality

A

Nephrogenic diabetes insipidus

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7
Q

An obese patient’s test results indicate insulin resistance, raised plasma triglycerides, microalbuminuria (marker of kidney disease) and raised arterial BP

A

Metabolic syndrome

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8
Q

A patient is experiencing palpatations, tachycardia, intolerance to heat/excessive sweating, tremor, sleep disturbance and agitation. On examination you notice exophthalmos/proptosis of both eyes and a goitre

Tests show a high T4 and slightly elevated T3. TSH is suppressed. Anti-thyroid antibody tests are positive for TSH receptor antibody (TRAb).

A

Graves disease

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9
Q

A patient is experiencing palpatations, tachycardia, intolerance to heat/excessive sweating, tremor, sleep disturbance and agitation. On examination you find a goitre.

Tests show raised T4 and T3. TSH is low and the patient is antibody negative

A

Nodular thyroid disease/Toxic Multinodular Goitre (TMG)

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10
Q

A patient presents with osteoperosis, AF and a goitre. Their TSH is low but their T3&4 levels are normal

A

Subclinical hyperthyroidism

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11
Q

A hyperthyroid patient who has recently been unwell/undergone surgery developes hyperthermia, tachycardia, diarrhoea & vomiting and agitation. On examination they have exaggerated reflexes

A

Thyroid storm

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12
Q

A patient who has recently had a viral infection presents with fever, malaise and local tenderness around the thyroid gland. They also experience symptoms of hyperthyroidism for a few days. Examination shows slight thyroid enlargement and blood tests show raised T3&4 and suppressed TSH.

After a few days, the patient develops symptoms of hypothyroidism for a few weeks. Eventually they return to a euthyroid state

A

De Quervain’s Thyroiditis

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13
Q

A patient with a poor diet develops lethargy, weight gain, a puffy face, cold intolerance, poor memory and loss of appetite. On examination they have a goitre. Tests show increased TSH and decreased T4

A

Hypothyroidism caused by iodine deficiency

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14
Q

A patient with a poor diet develops lethargy, weight gain, a puffy face, cold intolerance, poor memory and loss of appetite. On examination they have a goitre and palpable lymph nodes.

Tests show T4 and T3 are suppressed while TSH is raised. Anti-thyroid antibody test shows presence of antibodies against thyroid peroxidase (TPO)

A

Hashimoto’s thyroiditis

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15
Q

A patient presents with classic hypothyroid symptoms and has high TSH but normal thyroid hormone levels

A

Subclinical hypothyroidism

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16
Q

A patient presents with classic hypothyroid symptoms but no goitre. Thyroid autoantibodies are present

A

Atrophic thyroiditis

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17
Q

An elderly woman presents with confusion, hypothermia and drowsiness. Tests show she has type 2 respiratory failure (hypoxia, hypercapnia & respiratory acidosis)

On ECG she has bradycardia, low voltage complexes, varying degrees of heart block, T wave inversion and prolongation of the QT interval.

A

Myxoedema coma

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18
Q

A 70 year old woman with a PMH of autoimmune hypothyroidism experiences a rapid onset of mass in her thyroid

A

Thyroid lymphoma

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19
Q

A 40 year old woman presents with palpable nodules in her neck with no other symptoms. On examination, she is found to also have lymphadenopathy

A

Papillary thyroid cancer

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20
Q

A 40 year old woman presents with palpable nodules in her neck and no other symptoms. There is no lymphadenopathy

A

Follicular thyroid cancer

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21
Q

The blood results of a patient with a severe infection in hospital show suppressed TSH

A

Sick euthyroid syndrome/Non-thyroidal illness

22
Q

A pregnant woman’s blood results show an increase in T4 and low TSH

A

Variant of normal thyroid in pregnancy

Increased demand on thyroid = raised T4. hCG acts like TSH = low TSH

23
Q

A baby presents with delayed jaundice, poor feeding but normal weight gain, hypotonia, constipation, umbilical hernia and skin and hair changes

A

Congenital thyroid disease

24
Q

A patient under 40 has hypertension and hypokalaemia. A CT scan shows a mass on one of the adrenals

A

Conn’s syndrome - primary aldosteronism caused by an adrenal adenoma

25
Q

A patient with small cell lung carcinoma/Cushing’s disease etc has secondary hypertension

A

Acquired adrenal hyperplasia - primary aldosteronism caused by endogenous or ectopic ACTH production

26
Q

A baby has adrenal insufficiency at 2-3 weeks old and poor weight gain. A female baby with this condition has genital ambiguity and a male has precocious puberty. What is the condition?

A

Congenital adrenal hyperplasia

27
Q

A 30 year old woman presents with excessive bruising, proximal myopathy of upper and lower limbs, polydipsia and polyuria, back and bone pain, insomnia and lethergy.

On examination she has a moon face, central obesity, a buffalo hump in the supraclavicular fossa and male patterned baldness.

A high dose dexamethasone test shows ACTH levels <300 (suppressed by 50%)

A

Cushing’s disease - adenoma in the pituitary gland

28
Q

A patient presents with Cushing’s symptoms. A high dose dexamethasone test shows ACTH levels <1 (suppressed by 0%)

A

ACTH independent Cushing’s - caused by adrenal adenoma/adrenal carcinoma/nodular hyperplasia/high dose steroid use

29
Q

A patient presents with Cushing’s symptoms. A high dose dexamethasone test shows ACTH levels >300 (suppressed by 0%)

A

Cushing’s caused by ectopic cancer (lung, thymus or pancreas)

30
Q

A patient presents with fatigue, weight loss, vomiting, diarrhoea and abdominal pain. On examination you find they are hypotensive and very tanned.

A synacthen test shows a basal cortisol level of <100 after 30 minutes

A

Addison’s disease (Primary adrenal insufficiency)

31
Q

A young patient has hypertension, excessive sweating and headaches. Urinary catecholamines and metabolites are raised

A

Pheochromocytoma

32
Q

A patient who has just been taken off long term high dose steroids presents with weight loss, tiredness, vomiting, diarrhoea, abdominal pain and hypotension

A

Secondary adrenal insufficiency

33
Q

A patient is found to have a pituitary adenoma, parathyroid hyperplasia (hyperparathyroidism) and pancreatic tumours

A

MEN1

34
Q

A patient is found to have medullary thyroid cancer, parathyroid tumors, and pheochromocytoma

A

MEN2

35
Q

A patient with multiple hemangioblastomas is found to have a pheochromocytoma

A

Von Hippel-Lindau (VHL)

36
Q

A patient with axillary freckling, café-au-lait patches and neurofibromas is found to have a pheochromocytoma

A

Neurofibromatosis type 1 (NF1)

37
Q

A patient presents with excessive sweating, acne, joint pain and proximal muscle weakness, tireness, snoring and tingling sensations. They have been diagnosed with hypertension and diabetes. On examination you notice they have coarse facial features and large hands.

Tests show that IGF-1 is raised and an oral glucose tolerance test shows no suppression of growth hormone secretion

A

Acromegaly (mostly due to pituitary adenoma)

38
Q

A patient presents with headaches and bitemporal hemianopia

A

Pituitary tumour - a micro or macroadenoma

39
Q

A woman presents with galactorrhoea, infertility, amenorrhoea and lack of libido

A

Hyperprolactinaemia

40
Q

A man presents with impotence, lack of libido, headache and bitemporal hemianopia

A

Prolactinoma

41
Q

A patient presents with tiredness, confusion, sore bones, constipation, myopathy and thirst, with a PMH of kidney stones, osteoperosis and depression.

Serum calcium and serum PTH are raised but serum phosphate is normal. Urine calcium is high

A

Primary hyperparathyroidism - caused by a parathyroid adenoma

42
Q

A patient with chronic kidney failure presents with bone and joint pain.

Serum calcium is low but PTH is raised

A

Secondary hyperparathyroidism

43
Q

On routine tests, an asymptomatic patient is found to have raised blood calcium. Further tests show low urine calcium

A

Familial hypocalciuric hypocalcaemia

44
Q

A patient presents with tiredness, confusion, sore bones, constipation, myopathy and thirst, with a PMH of kidney stones, osteoperosis and depression.

Serum calcium and serum phosphate are raised. Urine calcium is high

A

Hypercalcaemia due to high bone turnover (eg mets, bedridden, Pagets etc)

45
Q

A patient complains of cramping muscles, pins and needles in the extremities and around the lips, muscle weakness, fatigue and breathing difficulty.

On examination you find Chvostek’s sign (twitching of facial muscle when gentle tapping is applied to the facial nerve) and Trousseau’s sign (inflation of the blood pressure cuff over systolic pressure for a period of time will result in tetany of the muscles in hand and wrist)

A

Hypocalcaemia

46
Q

A patient presents with symptoms of hypercalcaemia. Tests show hypocalcaemia and hyperphosphatemia in the blood serum and decreased PTH. Parathyroid antibodies are present

A

Idiopathic hypoparathyroidism

47
Q

A patient presents with symptoms of hypercalcaemia. Tests show hypocalcaemia and hyperphosphatemia in the blood serum and decreased PTH. Parathyroid antibodies are absent

A

Hypoparathyroidism caused by Di George syndrome / malignancies / autoimmune disease / hypomagnesaemia

48
Q

A patient has bone abnormalities, obesity, subcut calcification, learning disability and brachdactyly (blunting of the 4th metacarpal) Blood tests show raised PTH, low Ca2+, raised PO4 3-

A

Pseudohypoparathyroidism

49
Q

A patient with pathological fractures who is very pale has decreased calcium and phosphate and increased PTH

A

Vitamin D deficiency

50
Q

A patient with pathological fractures has a DEXA scan that shows BMD ≥ 2.5

A

Osteoperosis

51
Q

A sick patient presents confused and hyperventilating. Blood results show reduced bicarbonate, raised phosphate and a raised anion gap, with no ketonaemia

A

Lactic acidosis type A

52
Q

A type 2 diabetic presents confused and hyperventilating. Blood results show reduced bicarbonate, raised phosphate and a raised anion gap, with no ketonaemia

A

Lactic acidosis type B

4th Year General Medicine (6 decks)

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