Endo 2

Question 1

DM
c-peptide and specific antibodies

Answer 1

in type 1 low / no c peptide due to absolute insulin deficiency

Question 2

diagnosing t2DM

asymptomatic but abnormal HBA1c?

Answer 2

repeat then can be confirmed T2dm

Question 3

monitoring in t1dm?

Answer 3

before each meal and before bed

Question 4

in pts with t2dm when would you immediately add empagliflozin?

Answer 4

SGLT-2 should be introduced at any point they develop CVD

/ have high risk of CVD

Question 5

if there is active eye disease in hyperthyroid what tx should be avoided?

Answer 5

radioiodine therapy should be avoided as it can worsen eye disease

Question 6

contraindications for metformin?

Answer 6

lactic acidosis and eGFR <30
HF, renal impairment, acute MI, resp failure, severe infection

Question 7

first line tx for peripheral neuropathy?

Answer 7

amitriptyline
duloxetine
gabapentin
pregabalin

Question 8

when should you treat subclinical hypothyroidism?

Answer 8

> 10 TSH on 2 separate occasions

3 months apart

Question 9

when starting antidiabetic medication for someone with CVD RF

Answer 9

start metformin titrate dose

then add SGLT2 inhibitor

Question 10

lagophthalmos?

Answer 10

incomplete eyelid closure

Question 11

proptosis

Answer 11

bulging eyes

Question 12

most common cause of primary hyperaldosteronism

Answer 12

bilateral adrenal hyperplasia

Question 13

Cushing syndrome

biochemical abnormality

Answer 13

hypokalaemia
metabolic alkalosis
> increased renal mineralocorticoid action from excess cortisol

impaired glucose tolerance

Question 14

gliclazide is a?

Answer 14

sulfonyurea

Question 15

what is an example of SGLT-2 inhibitor?

Answer 15

dapagliflozin
empagliflozin

Question 16

features of primary hyperaldosteronism?

1st line ix?

Answer 16

HTN

hypokalaemia

plasma aldosterone/renin ratio
> high aldosterone and low renin

> High resolution CT abdo
adrenal vein sampling

Question 17

Where does a phaeo arise from?

Answer 17

adrenal medulla

releases metanephrine : adrenaline

Question 18

Investigating adrenal insufficiency?

Answer 18

9am cortisol

100-500

then short synacthen test
cortisol measured
ACTH adminstered
cortisol measured again

cortisol should rise

Question 19

short Synacthen test

Answer 19

plasma cortisol am measured

Synacthen 250ug IM

check cortisol again (normally should rise in response (>500)

Question 20

exogenous insulin overdose

Answer 20

serum insulin is high
c-peptide is low

Question 21

insulinoma findings?

Answer 21

high insulin
high c peptide

Question 22

neuroglycopenic symptoms occur at?

Answer 22

<2.8 mmol/l

Question 23

what is acropachy?

Answer 23

autoimmune reactions in nails > soft tissue swelling under the nail bed

symptomatic of GRaves

Question 24

nail pitting is associated with?

Answer 24

psoriasis

Question 25

addisonian crisis
Mx?

Answer 25

IV hydrocortisone 100mg

or IM

1 litre normal saline over 30-60 minutes

continue hydrocortisone 6 hourly

Question 26

causes of addisonian crisis?

Answer 26

sepsis
surgeryg

adrenal haemorrhage
steroid withdrawal

Question 27

pregnancy and addisons?

Answer 27

immune reg changes during pregnacy

Question 28

what is ketonaemia?

Answer 28

> 3mmol/l

ketonuria on urine dip

Question 29

Graves disease is managed?

Answer 29

secondary care - carbimazole

but in primary care
beta blocker can be started to manage adrenergic symptoms

if rly bad whilst awaiting referal can start carbimazole

Question 30

in DKA mx when giving fluid

how to replace?

systolic BP <90
>90

Answer 30

<90
500ml of0.9% nacl over 5 mins

> 90
1L 0.9% NaCl / hour

Question 31

unrecordable blood glucose means?

Answer 31

too high blood sigar

Question 32

diabetic neuropathy how to manage?

Answer 32

refer to diabetic foot centre

Question 33

complication of hypothyroidism?
mx?

Answer 33

myxoedema coma

thyroid hormone replacement and hydrocortisone given