Diabetes & Endocrinology

Question 1

What is Grave’s Disease?

Answer 1

An autoimmune cause of hyperthyroidism, caused by antibodies binding to TSH receptors.

Question 2

How would you distinguish a thyroglossal duct cyst and a dermoid cyst?

Answer 2

Both are found in the midline of the neck, a thyroglossal duct cyst would move up on tongue protrusion and swallowing, a dermoid cyst would not.

Question 3

What are the 3 main causes of hyperthyroidism?

Answer 3

Autoimmune Grave’s disease
Toxic multinodular goitre
Thyroiditis

Question 4

What is a Charcot joint/Charcot arthropathy?

Answer 4

Condition that can occur in the feet of people with diabetes who have neuropathy, an injury can happen that causes the bones in the foot to either break or dislocate but the patient doesn’t notice, swelling can cause deformity and possible fusion of the bones in the feet very rapidly, can also increase the risk of foot ulcers

Question 5

What is osteomyelitis?

Answer 5

Infection of the bone, usually cause by infection of an open fracture or spread through the blood, commonly a complication of a diabetic foot ulcer

Question 6

What is gestational diabetes?

Answer 6

A temporary state of insulin resistance that occurs during pregnancy, once the pregnancy is over it resolves, but the patient is at an increased risk of T2DM.

Question 7

Of T1DM and T2DM patients, which are more likely to present with DKA?

Answer 7

T1DM (DKA is rare in T2DM)

Question 8

Which antibodies can you test for to prove a patient has autoimmune T1DM?

Answer 8

Anti-islet cell antibodies
Anti-insulin antibodies
Anti-GAD antibodies

Question 9

What is diabetic ketoacidosis?

Answer 9

State where diabetic patients have insufficient insulin to get glucose to their cells, so the body starts producing energy by using ketones, this is less efficient and can produce an acidosis.

Question 10

What test can be used to determine endogenous insulin production from the pancreas?

Answer 10

C-peptide levels, as it’s produced in equimolar amounts to pro-insulin

Question 11

Name some causes/risk factors for T2DM.

Answer 11

Obesity
PCOS (weight gain and effect of other hormones)
Increased age
Pregnancy (insulin-resistant state)
Genes
Cushing's Syndrome

Question 12

What is the treatment for diabetic ketoacidosis?

Answer 12

Immediate insulin and fluid resuscitaton

Question 13

What is a hyperosmolar hyperglycaemia state?

Answer 13

An acute state in T2 diabetics where they have very high blood glucose and are very dehydrated (DKA equivalent of T1DM)

Question 14

What is the treatment for a hyperosmolar hyperglycaemic state?

Answer 14

Fluid resuscitation (don’t need to give insulin as T2DM are still producing some insulin).

Question 15

What is the Freestyle Libre system?

Answer 15

A subcutaneous glucose monitor that sticks on the back of the arm and lasts for 2 weeks, it continuously monitors your glucose levels and you can link it to an app on your phone.

Question 16

What is the MOA of GLP-1 agonists and name an example?

Answer 16

Stimulates insulin release from pancreatic islet cells,slows gastric emptying and reduces food intake (can help diabetic patients o lose weight) e.g. Liraglutide, Exenatide

Question 17

What is the MOA of SGLT2 inhibitors and name an example.

Answer 17

Inhibits SGLT2 (sodium glucose co-transporter 2) in the PCT, preventing of glucose and increasing its excretion in the urine, as glucose is excreted its plasma levels fall e.g. Dapagliflozin

Question 18

What is HbA1c?

Answer 18

A marker of how good glucose control has been over the last few months. The worse the glucose control/higher the readings, the higher HbA1c is.

Question 19

What would you find in the urine of a patient who has diabetic ketoacidosis?

Answer 19

Positive for ketones.

Question 20

What is primary aldosteronism?

Answer 20

When the adrenal glands make too much aldosterone, leading to hypertension and hypokalaemia, suspect if patient has a low serum potassium and high/normal sodium.

Question 21

How is Cushing’s Syndrome diagnosed?

Answer 21

24 hour urine cortisol excretion (will be elevated)

Low-dose dexamethasone suppression test

Question 22

What is the treatment for hyperthyroidism?

Answer 22

Thionamides such as carbimazole, which reduced the synthesis of T3 and T4, beta blockers can also be used to control symptoms until thyroid function returns to normal.

Question 23

What is the treatment for hypothyroidism?

Answer 23

Thyroxine replacement

Question 24

Which acid-base abnormality is associated with vomiting?

Answer 24

Metabolic alkalosis

Question 25

Which acid-base abnormality is associated with Bulimia nervosa?

Answer 25

Metabolic alkalosis (as the patient is vomiting), can also lead to enamel erosion to do vomiting.

Question 26

Name some fundoscopy findings for diabetic retinopathy.

Answer 26

Abnormal new vessel proliferation
Microaneurysms
Cotton wool spots
Hard exudates

Question 27

What visual field defect is typically associated with a pituitary adenoma?

Answer 27

Bitemporal hemianopia - due to compression of the optic chiasm.

Question 28

Which neurotransmitter inhibits prolactin secretion?

Answer 28

Dopamine

Question 29

What is maturity onset diabetes of the young (MODY)?

Answer 29

A hereditary form of diabetes mellitus that is autosomal dominant and affects the gene responsible for insulin production. If a child inherits the mutation they will generally develop type 2 DM before the age of 25 regardless of weight, lifestyle or ethnic group.

Question 30

Name 2 conditions that can present with ambiguous genitalia at birth.

Answer 30

Androgen insensitivity syndrome

Congenital adrenal hyperplasia

Question 31

What is Conns syndrome/a Conns adenoma?

Answer 31

Rare condition where adrenal glands make too much aldosterone - leads to primary hyperaldosteronism. Can result in secondary hypertension.

Question 32

What is sick euthyroid syndrome?

Answer 32

Seen in chronically ill patients or those with starvation. Thyroid function tests (t4 and TSH) are often low but the patient is euthyroid.

Question 33

What is the main difference between type 1 and type 2 diabetes?

Answer 33

1- autoimmune destruction of pancreatic beta cells (absolute deficiency)
2- increased insulin resistance and decreased insulin production, heavily associated with metabolic syndrome (relative deficiency)

Question 34

What is a rare but serious side effect of carbimazole?

Answer 34

Agranulocytosis - a severe leukopaenia most commomly of neutrophils (neutropenia) - patients should be advised to seek urgent medical attention if the develop any symptoms of infection e.g. sore throat or fever.

Question 35

What is one of the most common electrolyte imbalances in patients with metastatic cancer? How would it cause patients to present?

Answer 35

Hypercalcaemia

Stones, bones and groans - renal stones, bone pain, abdominal pain, N+V, confusion.

Question 36

What is De Quervain’s/subacute thyroiditis?

Answer 36

Condition that typically presents with hyperthyroidism, is thought to occur following viral infection. There is globally reduced uptake of iodine on a scan.

Question 37

Name some drugs that are known for causing gynaecomastia.

Answer 37

Spironolactone
Finasteride
LHRH analogues e.g. goserelin (used for prostate cancer)
Oestrogen
Anabolic steroids
N.B. Gynaecomastia (due to an increased oestrogen:androgen) is not the same as galactorrhoea (which is due to the action of prolactin on breast tissue)

Question 38

What is post-prandial hypoglycaemia?

Answer 38

Commonly seen in post-gastric bypass patients, have fainting and sweating after a meal due to food of high osmotic potential being dumped in the duodenum, which causes rapid fluid shifts and hypovolaemia, also causes hypoglycaemia.

Question 39

Why can you get hypoglycaemia in addisonian crisis?

Answer 39

Corticosteroid deficiency leads to an extreme sensitivity to insulin.

Question 40

Name some clinical signs in a patient with Addisonian crisis.

Answer 40

Hypotension
Tachycardia
Oliguria
Confused

Question 41

If a patient with T2DM is taking metformin, at what level of HbA1c should another agent be added?

Answer 41

58

Question 42

What values of HbA1c signify normal, pre diabetic and diabetic?

Answer 42

Normal is <41
Pre diabetic 42-47
Diabetic >48