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Question 1

How to differentiate between Cushing syndrome, disease and ectopic ACTH secretion from high dose dex test

Answer 1

Question 2

Primary hypoadrenalism - what metabolic abnormalities do you have (Na/K/ABG/Cortisol/Aldosterone)

Answer 2

Addisons Disease:
Autoimmune destruction adrenal glands
ACTH stimulation test - short synacthen test. If not available then 9am cortisol (<100 abn, 100-500 do acth Sim test)
Hydrocortisone (x2 in illness) and fludrocortisone
In crisis = Hydrocortisone

↓ cortisol + ↓ Aldosterone
↓ Na+ ↑K+ hypoglycemia, metabolic acidosis, hyperpigmentation

Question 3

Most common cause conns (primary hyperaldosteronism) and how is Na/K+ affected

Answer 3

Cause - most commonly bilateral idiopathic adrenal hyperplasia which needs aldosterone antagonist (spironolactone)
(used to be adrenal adenoma-surgery)
HTN, ↓ K+ (muscle weakness), Metabolic alkalosis, ↓ Na+
Most common case of secondary HTN

Question 4

Dx conns

Answer 4

Plasma aldosterone/renin ratio
CT abdomen and adrenal vein sampling

Question 5

Dx T2DM

Answer 5

FG>7, RG/2hrs after OGTT>11.1 If asymptomatic do 2 tests

Impaired FG = 6.1-6.9
Impaired glucose tolerance 7.8-11 + FG<7

Question 6

Target for T2DM in HbA1c and medications

Answer 6

Target 53

Not CVD RFs + no HF = (1) Metformin. If HbA1c>58 then (2) Add DDP-4/Pioglitazone/Sulfonylurea (3) dual therapy - triple therapy - GLP at specialist

If CVD/High risk/established or HF or if at any point CVD risk then (1) Metformin (establish + titrate up) + SGLT2 inhibitor

Question 7

DM sick day rules - if gastroenteritis how do you change insulin

Answer 7

When unwell - if a patient is on insulin, they must not stop it due to the risk of DKA. They should continue their normal insulin regime but ensure that they are checking their blood sugars frequently
Try have sugary drinks, etc

Question 8

Pre diabetes

Answer 8

42-47

Question 9

sick euthyroid bloods

Answer 9

↓/N TSH, ↓ T4/T3 - recent illness

Question 10

mx thyrotoxic storm

Answer 10

Hydrocortisone, BB, PTU

Question 11

Mx myxoedema coma

Answer 11

Thyroxine and hydrocortisone

Question 12

Uptake scan - graves vs TMN

Answer 12

Graves = diffuse uptake
TMN - patchy

Question 13

↑ PTH, ↑ Ca, ↓ PO4 = what type of hyperparathyroidism and symptoms

Answer 13

Primary HPTH
bones, stones, abdo groans, psychic moans = total parathyroidectomy

Question 14

↑ PTH, ↓/N Ca, ↑PO4, Vit D low = what type of hyperparathyroidism

Answer 14

Secondary

Question 15

How the water deprivation test differs for primary psychiatric polydipsia, Cranial DI and Nephrogenic DI

Answer 15

Question 16

SIADH - what is this

Answer 16

↓ Na secondary to dilution effects of excessive water retention
Causes = Malignancy (SCLC), neuro (stroke/SAH), infection, meds…
Mx = Fluid restriction, correction slow or central pontine myelinolysis.

Question 17

Sulphonylureas S/E

Answer 17

Sulfonylureas - S/E hypos + weight gain

Question 18

Gliptins (DDP4 inhibitors) - MOA

Answer 18

increase levels incretin by decreasing their peripheral breakdown. Do not cause weight gain

Question 19

What meds cause gynaecomastia

Answer 19

spironolactone, digoxin, cannabis, finasteride, GNRH agonists (goserehlin), oestrogen.

Question 20

First line ix in acromegaly

Answer 20

Serum IGF-1 levels first line . If these are raised then OGTT test to confirm.