Endo

Question 1

what is the name given to a syndrome which has abnormal findings on thyroid function tests yet there is no-thyroidal illness:

Answer 1

euthyroid sick syndrome

• deficiency of thyroid hormones
• catabolic states
• —-> body breaks down proteins

Question 2

MEN 1 syndrome is characterised by presence of two of which three tumour types:

Answer 2

Pituitary adenoma

pancreatic islet cell tumours

parathyroid

Question 3

MEN 2 syndrome characterised by:

Answer 3

Thryoid
- medullary thyroid carcinoma

Phaeochromocytoma

Parathyroid

Question 4

Describe how chronic renal failure may affect levels of calcium and phosphate in the body?

Answer 4

Chronic renal failure
- 1a-hydroxylation of 25-hydroxycholecalciferol to form calcitrol IMPAIRED

• REDUCES Ca2+
• REDUCED phosphate excretion due to renal impairement
• Low plasma Ca2+ causes PTH to INCREASE
• Secondary hyperparathyroidism

Question 5

In chronic renal failure, as the disease progresses how might it lead to tertiary hyperparathyroidism:

Answer 5

• glands act autonomously
• due to hyperplastic or adenomatous change
• INCREASED PTH secretion
• so elevated Ca2+§

Question 6

what are the levels of PTH and Calcium in primary hyperparathyroidim:

Answer 6

PTH high

• high calcium
• low phosphate

Question 7

Features of hypocalcaemia:

TAP CT

Answer 7

TAP CT

T-tetany

A-abdominal cramps

P-perioral parasthesiae

C-chovsteks sign

T- trousseaus (carpal spasm after occlusion)

Question 8

this is decreased production of PTH due to suppression by hypercalcaemia:

Answer 8

secondary hypoparathyroidism

Question 9

pseudohypoparathyroidism occurs as a result of:

Answer 9

target cell failure to respond to PTH appropriately

PTH elevated

Ca2+ low

Phosphate HIGH

Question 10

37 M

pc: 2 episodes pancreatitis , calcium was raised at the time

now patient has reduced urinary calcium.

patient likely has:

Answer 10

hypocalciuric hypercalcaemia

Question 11

54 M

pc: confused, digital clubbing and RHS pleural effusion.

patient has significant hyponatraemia and is euvolaemic.

urine osmolality raised.

likely diagnosis:

Answer 11

HYPONATRAEMIA
- confusion

Urine osmolality - RAISED

• -> continued ADH secretion
• —> SIADH

associated with small cell lung cancer

Question 12

which is given to patients before removal of an adrenal phaeochromocytoma:

Answer 12

alpha-adrenergic receptor blockers

- phenoxybenzamine or doxazosin

Question 13

The following signs are associated with:

1. exopthalmos
2. diffuse goitre
3. pre-tibial myoedema

Answer 13

GRAVES DISEASE

• autoimmune
• TSH receptor antibodies
• hyperthyroidism

Question 14

this describes presence of viral infection with

• fever
• neck pain
• tenderness
• dysphagia
• hyperthyroidism features

Answer 14

De-Quervains thyroiditis

tx
- NSAIDS + BB

Question 15

35 y/o F

pc: lethargy, decreased appetite, weight gain

bloods:
- Low T3, T4
- Low TSH even after TRH injection

Answer 15

secondary hypothyroidism
- failure in pituitary gland to produce enough TSH

e. g.
- tumours
- infection
- Sheehan syndrome
- radiation

Question 16

patient has the following blood results:

ELEVATED PTH
Low Calcium
ELEVATED phosphate

indicative of:

Answer 16

PTH is high: we would except calcium to be high and low phosphate.

BUT

we’ve got high PTH and low calcium and high phosphate.

indicating their is failure of target cell response
–> PSUEDOHYPOPARATHYROIDISM

Question 17

patient:

lethargy, weight loss, fainting episodes.

postural drop in BP.

low sodium:

patients condition:

Answer 17

Addison’s disease

• decreased cortisol
• decreased aldosterone

primary adrenal failure

autoimmune destruction of adrenal cortex, reduction in cortisol and aldosterone levels.

deficiency of cortisol + aldosterone

• hypotension
• hyponatraemia
• hyperkalaemia
• skin and mucosal hyperpigmentation

Question 18

somatostatin action:

Answer 18

inhibits the release of GH

Question 19

what three things are increased after a glucagon stimulationtest:

Answer 19

• C-peptide
• cortisol
• growth hormone

glucagon stimulates both insulin and C-peptide.

Question 20

C-peptide is cleaved of what during insulin production:

Answer 20

C-peptide cleaved from proinsulin

during insulin production.

Question 21

which signalling pathway does growth hormone use?

Answer 21

tyrosine kinase receptor that uses the

JAK/STAT pathway

other tyrosine kinase receptor hormone :

• platelet derived growth factor
• fibroblast growth factor
• insulin like growth factor 1

Question 22

22M

• > 7 fasting glucose
• brother diabetic
• FH hepatocellular carcinoma

likely diagnosis:

Answer 22

MODY

MODY-3

• most common
• mutation HNF-1A gene
• strong FH diabetes
• • hepatocellular carcinoma

Question 23

why does goitre arise in Hashimoto’s thyroiditis:

Answer 23

• lymphocytic and plasma cell infiltration

Question 24

patient with a thyroid storm should be treated with:

Answer 24

propylthiouracil

iodine

propranolol

hydrocortisone

Question 25

how do propylthiouracil and iodine work?

Answer 25

block the synthesis of new thyroid hormone

prevent further deterioration of the condition.

in addition hydrocortisone works through inhibiting the less potent form of thyroid hormone T4 to more potent R3

Question 26

72 F

acute agitation, fever, nausea and vomiting

disorientated, pyrexic, tachycardic, irregular pulse.

congestive cardiac failure.

pmh: Graves disease

likely diagnosis?

Answer 26

thyroid storm

• high temperature
• tachycardia
• agitation

pmh: graves disease

Question 27

patient presents with addisonian crisis, why is her past medical history of having a joint disorder important?

Answer 27

patient may have RA
- controlled with oral prednisolone

• may suppress natural cortisol production over long periods

Question 28

this is a syndrome caused by adrenal haemorrhage causing addison’s disease, as a result of severe bacterial infection :

Answer 28

waterhouse-friderichsen syndrome