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MRCP 1 > Endo > Flashcards

Endo Flashcards

1
Q

Electrolyte abnormalities in addisonian crisis

A

HypoNa, Hyper K

Late feature: hypoglycaemia

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2
Q

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

A

TG elevated

HDL and LDL are low or normal

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3
Q

Aromatase converts testosterone to estradial T/F

A

T

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4
Q

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

A

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

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5
Q

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

A

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

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6
Q

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

A

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

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7
Q

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

A

Hyperglycaemia and increased insulin requirements

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8
Q

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

A

T - 80%

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9
Q

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

A

Deficiency in 21-hydroxylase

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10
Q

Enzyme 21 hydroxylase converts what to what?

A

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.

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11
Q

Most reliable way to diagnosis 21 hydroxylase def?

A

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

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12
Q

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

A

11 beta hydroxylase def (converts 11deoxycortisol to cortisol)

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

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13
Q

Target HbA1c for type 1 DM children and young adults

A

48mmol/mol or less

Note: these are new stricter NICE guidelines

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14
Q

First sign of puberty in girls?

A

Breast development

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15
Q

First sign of puberty in boys?

A

Increase in testicular volume

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16
Q

Time from onset of puberty to menarche is usually?

A

4 yrs or less

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17
Q

In treatment of DM how often is insulatard dosed?

A

Twice daily

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18
Q

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

A

Increase each dose of steroids

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19
Q

When is the peak incidence of type 1 DM?

A

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

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20
Q

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

A

T - 1-7% risk

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21
Q

How often should HbA1c be checked in pts with T2DM?

A

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

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22
Q

What are the two most common causes of acquired hypothyroidism?

A

Hashimotos thyroiditis

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

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23
Q

Causes of elevated creatinine in DKA?

A

Dehydration

Falsely elevated Cr as the ketones interact with the Jaffe method

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24
Q

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

A

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

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25
Q

Growth hormone deficiency has what effect on bone age?

A

Causes a delay in bone age

Hypothyroidism also causes a delay

26
Q

What lab abnormality can been seen on sulphonylurea overdose?

A

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

27
Q

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

A

30-50%

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

28
Q

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

A

Around 10%

29
Q

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

A

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

30
Q

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

A

3-4 cm

31
Q

Parathyroid hormone is secreted in response to what?

A

Low levels of iCal in the blood

32
Q

What is the role of parathyroid hormone?

A

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

33
Q

MEN1 is associated with mucosal neuromas T/F

A

F MEN 2b is associated with mucosal neuromas

MEN 1 is associated with pit adenoma, parathyroid tumors and pancreatic tumors

34
Q

Somatostatin has what effect on growth hormone?

A

Inhibits release of growth hormone

35
Q

Factors that increase secretion of growth hormone?

A

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

36
Q

Cortisol is a counter regulatory hormone of?

A

Insulin –> it has the opposite effects of insulin.

Hence cortisol increases gluconeogenesis, hepatic glycogenolysis and ketongensis

37
Q

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

A

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

38
Q

How to sulphonylureas increase insulin release?

A

Stimulation of cell surface ATP-sensitive K+ channels

This then causes hyper polarisation and Ca influx that leads to insulin release

39
Q

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

A

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

40
Q

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

A

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

41
Q

What is Laron syndrome?

A

Autosomal recessive disorder caused by insensitivity to growth hormone

42
Q

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

A

Ketogenic diet

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

43
Q

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

A

Every 3 months

44
Q

What is the goal of calcitonin in the body?

A

To decrease Ca (eg opposite effect of PTH)

45
Q

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

A

If they are less than 1 yr old at presentation

Note: should also consider in those who rarely/never develop ketones with hyperglycaemia

46
Q

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

A

Islet cells

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

47
Q

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

A

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

48
Q

What is the K value in SIADH?

A

K is normal

Also normal acid base balance

49
Q

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

A

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

50
Q

How often should an insulin pump site be changed?

A

Every 2-3 days

51
Q

When/how is prolactin secreted?

A

Sleep related secretion

Note: growth hormone is also sleep related

52
Q

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

A

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

53
Q

How often is Insulatard dosed?

A

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

54
Q

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

A

From 12 years old

55
Q

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

A

At diagnosis and then annually

56
Q

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

A

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

57
Q

In the thyroid what do the parafollicular cell secrete?

A

Calcitonin - they are also known as C cells

58
Q

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

A

T

59
Q

Testosterone, FSH and LH levels on Klinefelter syndrome

A

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

60
Q

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

A

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

MRCP 1 (21 decks)

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