Endo

Question 1

Electrolyte abnormalities in addisonian crisis

Answer 1

HypoNa, Hyper K

Late feature: hypoglycaemia

Question 2

What are the typical LDL, HLD and TG findings in patients with diabetes?

Answer 2

TG elevated

HDL and LDL are low or normal

Question 3

Aromatase converts testosterone to estradial T/F

Answer 3

T

Question 4

In a pt with T1DM doing sick day dosing should the lantus be increased or decreased?

Answer 4

Increased - she will have increased insulin requirements in the setting of her acute illness

Question 5

During puberty breast enlargement occurs in about 10% of males T/F

Answer 5

F - occurs in 40-60% of males, it is due to metabolism of testosterone, usually resolves in 2-3 years and does not need treatment

Question 6

Dawn phenomenon is due to noctural hypoglycaemia and subsequent rebound hyperglycaemia in the early morning T/F

Answer 6

F - this is the description of smogyi effect, features of noctural hypoglycaemia (nightmares, tremors and rarely sz, early am headaches)

Dawn phen - early am hyperglycaemia from growth hormone secretion, peaks around 0400 - 0500. Can tx with increased insulin dosing

Question 7

In pts with DM growth spurt leads to hypo or hyperglycaemia?

Answer 7

Hyperglycaemia and increased insulin requirements

Question 8

Precocious puberty in males often has a pathological cause T/F

Answer 8

T - 80%

Question 9

What is the most common enzyme deficiency causing congenital adrenal hyperplasia?

Answer 9

Deficiency in 21-hydroxylase

Question 10

Enzyme 21 hydroxylase converts what to what?

Answer 10

17OH progesterone to 11 deoxycortisol

Hence in deficiency will get a build up of 17OHP and a low 11 deoxycortisol. However levels of 17OHP are elevated in normal infants in the first 1-2 days of life, especially so if they are premature or ill.

Question 11

Most reliable way to diagnosis 21 hydroxylase def?

Answer 11

Measure 17OHP at baseline and then 30, 60 min after admin of ACTH

Question 12

What is the second most common enzyme def leading to congenital adrenal hyperplasia?
Clinical features?

Answer 12

11 beta hydroxylase def (converts 11deoxycortisol to cortisol)

Features:
Signs of androgen excess
HTN
Do not have adrenal crisis

Question 13

Target HbA1c for type 1 DM children and young adults

Answer 13

48mmol/mol or less

Note: these are new stricter NICE guidelines

Question 14

First sign of puberty in girls?

Answer 14

Breast development

Question 15

First sign of puberty in boys?

Answer 15

Increase in testicular volume

Question 16

Time from onset of puberty to menarche is usually?

Answer 16

4 yrs or less

Question 17

In treatment of DM how often is insulatard dosed?

Answer 17

Twice daily

Question 18

Patient on TID steroids is prescribed carbamazepine what adjustment needs to be made to the steroids?

Answer 18

Increase each dose of steroids

Question 19

When is the peak incidence of type 1 DM?

Answer 19

When children start school 5-7 yrs and at puberty 10 -14 yrs

Note: there is an increased incidence after Coxsackie virus, mumps and rubella epidemics suggesting that initial viral infection triggers an autoimmune response against the islet cells. There is a seasonal variation with peaks in the autumn and winter months

Question 20

T1DM is associated with an increased risk in siblings T/F

Answer 20

T - 1-7% risk

Question 21

How often should HbA1c be checked in pts with T2DM?

Answer 21

every 3 months (remember life cycle of RBC is 3 months)

Question 22

What are the two most common causes of acquired hypothyroidism?

Answer 22

Hashimotos thyroiditis

Post total body irradiation (part of the prep for bone marrow transplant)

Question 23

Causes of elevated creatinine in DKA?

Answer 23

Dehydration

Falsely elevated Cr as the ketones interact with the Jaffe method

Question 24

What physical exam finding in a male helps to differentiate central from peripheral causes of precocious puberty?

Answer 24

Peripheral: secondary sexual characteristics in a boy with pre-pubertal testes
Central: secondary sexual characteristics + bilaterally enlarging testes

Question 25

Growth hormone deficiency has what effect on bone age?

Answer 25

Causes a delay in bone age Hypothyroidism also causes a delay

Question 26

What lab abnormality can been seen on sulphonylurea overdose?

Answer 26

Increased C peptide -- stimulation of beta cells to produce both c peptide and insulin Note in exogenous insulin OD there will be decreased C peptide

Question 27

What is the risk of T1 DM in a patient who's identical twin has type 1 DM?

Answer 27

30-50% Note: glutamic acid decarboxylase, islet cell or islet tyrosine phosphatase 2 (IA-2) antibodies will increase the risk

Question 28

What % of patients with T1 DM also have celiac disease?

Answer 28

Around 10%

Question 29

Growth hormone is indicated in the treatment of idiopathic short stature T/F

Answer 29

F - it is not licensed for idiopathic short stature or normal short children It is also not listed for achondroplasia Note: it is licensed for Turner syndrome, chronic renal insufficiency or Prader Willi

Question 30

Compared to untreated children by how much does growth hormone increase final height?

Answer 30

3-4 cm

Question 31

Parathyroid hormone is secreted in response to what?

Answer 31

Low levels of iCal in the blood

Question 32

What is the role of parathyroid hormone?

Answer 32

To increase renal Ca absorption and mobilise Ca and phosphate from the bone

Question 33

MEN1 is associated with mucosal neuromas T/F

Answer 33

F MEN 2b is associated with mucosal neuromas MEN 1 is associated with pit adenoma, parathyroid tumors and pancreatic tumors

Question 34

Somatostatin has what effect on growth hormone?

Answer 34

Inhibits release of growth hormone

Question 35

Factors that increase secretion of growth hormone?

Answer 35

Hypoglycaemia Mod to high intensity exercise Stress due to emotional disturbances, illness or fever Dopamine agonists such as bromocriptine

Question 36

Cortisol is a counter regulatory hormone of?

Answer 36

Insulin --> it has the opposite effects of insulin. Hence cortisol increases gluconeogenesis, hepatic glycogenolysis and ketongensis

Question 37

One of the main mechanisms of action of insulin is to induce translocation of the preformed GLUT 4 transporter to the cell surface. T/F

Answer 37

T - then insulin binds to the transporter which generates a signal within the cell to stimulate glucose conversion to glucose-6-phosphate and terminates metabolism or storage of the glucose molecule

Question 38

How to sulphonylureas increase insulin release?

Answer 38

Stimulation of cell surface ATP-sensitive K+ channels This then causes hyper polarisation and Ca influx that leads to insulin release

Question 39

Is the urinary concentration of Na in a pt with SIADH low or high?

Answer 39

It is high, they will pass a small volume of concentrated urine.

Question 40

Insulin is the mainstay of treatment of neonatal diabetes T/F

Answer 40

F - about 50% of pts can be managed with glibenclamide and do not need insulin Note: neonatal DM is likely due to a monogentic mutation and genetic investigations are needed

Question 41

What is Laron syndrome?

Answer 41

Autosomal recessive disorder caused by insensitivity to growth hormone

Question 42

What is the most appropriate long term treatment for a patient with GLUT 1 deficiency?

Answer 42

Ketogenic diet Note: thioctic acid can be used as an adjunct but it is not the primary treatment

Question 43

How often should a patient with type 1 diabetes be seen in endocrine clinic?

Answer 43

Every 3 months

Question 44

What is the goal of calcitonin in the body?

Answer 44

To decrease Ca (eg opposite effect of PTH)

Question 45

A child presents with diabetes, what age should you consider other types of diabetes besides type 1 or 2?

Answer 45

If they are less than 1 yr old at presentation Note: should also consider in those who rarely/never develop ketones with hyperglycaemia

Question 46

A patient with new onset T1 DM is likely to have what antibodies at presentation?

Answer 46

Islet cells Note: would be rare to have insulin antibodies at presentation, can have them later once they have started on exogenous insulin

Question 47

What are the three layers of the adrenal cortex and what do they produce?

Answer 47

3 zona - glomerulosa --> mineralocorticoids fasciculata --> glucocorticoids reticularis --> androgens

Question 48

What is the K value in SIADH?

Answer 48

K is normal Also normal acid base balance

Question 49

Patient with serum hypoNa and hypo osm and concentrated urine. What pathology should be suspected?

Answer 49

SIADH -> retaining water, if patient's water intake is higher than their urine output they will become hypoNa -> initial management is restriction of fluids to 2/3 maintenance

Question 50

How often should an insulin pump site be changed?

Answer 50

Every 2-3 days

Question 51

When/how is prolactin secreted?

Answer 51

Sleep related secretion Note: growth hormone is also sleep related

Question 52

C peptide levels can help to differentiate type 1 DM from other types T/F

Answer 52

T - they are more useful the longer time between the initial presentation and the test

Question 53

How often is Insulatard dosed?

Answer 53

This form of insulin is dosed BID, useful in school aged children as they do not have to have insulin admin during school day. Usually given in am and afternoon

Question 54

From what age should children with diabetes (1 and 2) be monitored for retinopathy and albuminuria?

Answer 54

From 12 years old

Question 55

From what age should those with T1 diabetes be monitored for thyroid disease?

Answer 55

At diagnosis and then annually

Question 56

In terms of an isolated findings which is more concerning premature pubarche or thelarche?

Answer 56

Premature pubarche (development of pubic or axillary hair without other features of precocious puberty) - likely due to androgen excess Note: premature thelarche is usually benign and self limiting

Question 57

In the thyroid what do the parafollicular cell secrete?

Answer 57

Calcitonin - they are also known as C cells

Question 58

Thyroid hormone is synthesised at the cellular level and stored as thyroglobulin T/F

Answer 58

T

Question 59

Testosterone, FSH and LH levels on Klinefelter syndrome

Answer 59

Reduced testosterone leading to increased FSH and LH due to negative feed back

Question 60

Infants with 21 hydroxyls deficiency present with a salt losing crisis and ambiguous genitalia T/F

Answer 60

F - females will present this way; males will have normal genitalia