Endo

Question 1

delayed puberty

Answer 1

Follicle-stimulating hormone - ontrol the menstrual cycle and stimulates the growth of eggs in the ovaries. FSH levels in women change throughout the menstrual cycle, with the highest levels happening just before an egg is released by the ovary. This is known as ovulation. In men, FSH helps control the production of sperm

luteinising hormone levels- secreted by the anterior pituitary gland that stimulates ovulation in females and the synthesis of androgen in males.

Question 2

Nephrotic syndrome

Answer 2

nephrotic syndrome and other congestion type conditions sych as liver cirrhosis, congestive cardiac failure and renal artery stenosis can all cause secondary hyperaldosteronism through the mechanism of increased circulating renin levels. Rarely this could be secondary to a renin ssecreting tumour.

Question 3

screening medullary thyroid cancer recurrence

Answer 3

Medullary thyroid cancers are a cancer of the parafollicular cells and so secrete calcitonin. Medullary cancer is monitored with serum calcitonin every 3 months for 2 years, followed by every 6 months for 3 years. If levels are undetectable they can then be followed annually

Question 4

exophthalmos

Answer 4

bulging or protruding eyeball or eyeballs

sign of graves

Anti-TSH receptor antibodies are present in 90% of patients. They bind to and stimulate the TSH receptor, stimulating thyroid hormone synthesis and thyroid growth.

hyperthyroid

Question 5

Primary hypothyroidism bloods

Answer 5

high TSH, low T3 and 4

Question 6

Secondary hypothyroidism

Answer 6

all low

Question 7

Primary hyperthyroidism

Answer 7

low TSH, high T3 and 4

Question 8

Secondary hyperthyroidism

Answer 8

all high

Question 9

Sub-clinical hyperthyroidism

Answer 9

low TSH and normal t3 and 4

Question 10

middle eastern and hypothyroid problems caused by

Answer 10

iodine deficiency

Question 11

chronic kidney disease

Answer 11

combination of vitamin D deficiency (caused by the inability of the kidney to convert 25-hydroxyvitamin D to the active metabolite 1,25(OH)2D) and the inability of the kidneys to excrete phosphate (leading to raised phosphate)

Question 12

toxic adenoma or toxic multinodular goitre/radioisotope scan shows increased uptake in one area of the thyroid gland, with suppressed uptake in the rest of the gland.

Answer 12

radioiodine therpay

Question 13

SGLT-2 inhibitor.

Answer 13

-flozin

Question 14

acromegaly

Answer 14

rare condition where the body produces too much growth hormone, causing body tissues and bones to grow more quickly. Over time, this leads to abnormally large hands and feet

Question 15

Adrenal Insufficiency symptoms/addisons

Answer 15

Hypotension
Fatigue and weakness
GI symptoms
Syncope
Pigmentation (due to an increase in ACTH pre-cursors)

not enough cortisol

Question 16

De Quervain’s thyroiditis

Answer 16

thyroiditis caused by granulomatous inflammation and destruction of thyroid cells

after infection

hyperthyroidism

hypothyroid phase.

It also presents with a painful neck due to the inflammation. Its presentation is similar to Grave’s disease and a radioisotope scan can differentiate the two. It is self-resolving.

reduced uptake of the radioisotope.

Question 17

steroid induced hyperglycaemia treatment

Answer 17

gliclazide

Question 18

Thyroid Lymphoma

Answer 18

thyroid Lymphoma is seen particularly in female elderly patients. It is often a non- Hodgkin’s B cell lymphoma in the vast majority of cases. Commonly it presents as a rapidly expanding mass in the neck which can cause mass effect leading to symptoms of hoarseness, difficulty swallowing and difficulty breathing. In addition Hashimoto’s Thyroiditis is considered a risk factor. The prognosis of Thyroid Lymphoma is poor due to its often late presentation

Question 19

Follicular Carcinoma

Answer 19

Follicular cells are responsible for the production and secretion of thyroid hormones. Like Papillary cancer it presents in young-middle age females and has a greater propensity to metastasise to the lung and bone than papillary thyroid cancer

Question 20

Papillary Thyroid Cancer

Answer 20

This is common in young females and offers the best prognosis > 90% survival. Patients usually present with slow growing mass in the neck and is often present in patients with previous head and neck irradiation. Investigation by ultrasound and fine needle aspiration cytology is warranted. Metastasis is commonly by the lymphatic route. Serum Thyroglobulin can be used as a tumour marker

Question 21

T2 HbA1c aim

Answer 21

48 mmol/mol (6.5%)

Question 22

Diabetic ketosis

Answer 22

Hyperglycaemia and raised ketones in the absence of acidosis is known as diabetic ketosis. Although the patient does not have a previous history of diabetes, a random blood glucose of >11.1 mmol/L is suggestive of a new diagnosis. The treatment for this would be guided by trust policy and specialist advice, but would involve subcutaneous insulin, fluids (IV or oral depending on clinical picture) and careful ongoing monitoring of blood glucose and ketones

Question 23

Management of Hyperthyroidism - Medical

Answer 23

Carbimazole
Propylthiouracil

Carbimazole – contraindicated in pregnancy
Propylthiouracil – Treatment of choice in first trimester pregnancy/thyroid storm

Question 24

Thyroid Storm Management and symptoms

Answer 24

IV propranolol
IV digoxin
Propylthiouracil through NG tube followed by Lugol’s iodine 6 hours later
Prednisolone/hydrocortisone

rapid heartbeat.
a high temperature.
diarrhoea and being sick.
yellowing of the skin and eyes (jaundice)
severe agitation and confusion.
loss of consciousness.

Question 25

Hashimoto’s thyroiditis antibodies

Answer 25

Anti-TPO

Question 26

acromegaly first line tests

Answer 26

The level of serum IGF-1 is correlated with level of growth hormone. A high serum IGF-1 level means a high growth hormone level. The levels of serum IFG-1 do not fluctuate much and is therefore a fairly stable indicator

If IGF-1 is raised or equivocal, growth hormone is measured following intake of oral glucose (Oral Glucose Tolerance Test) to see if growth hormone is inappropriately suppressed and to confirm the diagnosis of acromegaly.
If acromegaly has been diagnosed, an MRI should be performed to assess the size and extent of the tumour. If MRI is contraindicated, CT scan is second line. If the tumour is found to be close to the optic chiasm, visual fields should be regularly tested.

Question 27

Impaired fasting glucose

Answer 27

fasting glucose 6.1-7mmol/L
2h glucose >7.8mmol/L but <11.1mmol/L

pre diabetes