endo pass med questions Flashcards
A 51-year-old gentleman presents to the general practice complaining of a one-week history of muscle cramps and constipation. He is otherwise well. You decide to measure his serum potassium and find that it is below normal limits. You now want to identify why this is the case.
Which of the following conditions is associated with hypokalaemia?
psssssst. he has cushing’s
Cushings
- excess cortisol
- high [cortisol] can exhibit mineralocorticoid activity by binding to Na+/K+ pumps
A 59-year-old man is a known type 2 diabetic. He presents to the GP for review and is started on a new medication, a glucagon-like peptide (GLP-1) analogue. Physiologically, from what part of the body is this hormone normally secreted?
There are 2 main groups of incretins;
gastric inhibitory peptide (GIP) which is glucose dependent and released from the duodenum,
and glucagon-like peptide (GLP-1) produced from the distal ileum.
A 38-year-old lady presents with a recent episode of renal colic. As part of her investigations the following results are obtained:
PTH 88pg/ml (increased)
Her serum urea and electrolytes are normal.
What is the most likely diagnosis?
Primary Hyperparathyroidism
The question mentions that serum urea and electrolytes are normal, which makes tertiary hyperparathyroidism unlikely.
A young girl presents with her mother due to ambiguous genitalia that is causing them concern. After taking a history and several investigations, her doctor diagnoses her with congenital adrenal hyperplasia and says that this is due to a deficiency of a particular enzyme. Which enzyme is this?
21- alpha hydroxylase
A 15-year-old patient presents to his GP due to difficulties in school. The patient’s mother reports that her son is being bullied at school for poor coordination and weakness, reading difficulties, and “breasts”. Additionally, she is concerned that her son has not gone through puberty yet. The patient himself does not offer any further history.
On examination, the patient appears to be sat comfortably. He is noted to be taller than average boys of his age, with a rounded body type and marked gynaecomastia. He does not appear to have any atypical features of the head or neck. An examination of the thorax and abdomen are unremarkable, although a testicular exam reveals microorchidism, with both testicles under 4 ml in volume. The patient is referred to a paediatrician, who subsequently refers the patient to the genetics team. As part of their assessment, the genetics team order a karyotype.
Given the likely diagnosis, what results would be expected from the karyotype?
This patient is presenting with clinical features consistent with Klinefelter syndrome: poor coordination, muscle weakness, reading difficulties, gynaecomastia, secondary sexual characteristic development delay, taller than average, rounded body, and microorchidism. Hence, the karyotype will likely demonstrate 47,XXY.
A young woman presents with polyuria, polydipsia and weight loss. She is subsequently diagnosed with type 1 diabetes mellitus. What is she at an increased risk of developing?
Type 1 diabetes = autoimmune disorder
thus associated with other autoimmune disorders such as
- –> addison’s
- –> Grave’s
- –> Coeliac’s
A 65-year-old female is seen in the respiratory clinic for the follow-up of chronic obstructive pulmonary disease (COPD). She has previously required multiple courses of prednisolone, however, has noticed excessive weight gain, reddening of her face and the practice nurse commented on her high blood pressure of 180/96 mmHg.
likely diagnosis ?
Which part of adrenals are glucocorticoids produced in?
Cushing’s syndrome as a result of exogenous steroid use.
Zona Fasciculata
A 57-year-old man with a known history of type-2 diabetes presents to clinic for a review. He currently takes metformin only for his diabetes and reports following the regime as instructed.
His HbA1c is 63 mmol/mol (target = 53mmol/mol) and the clinician and patient decide he should start a sulfonylurea in addition to his metformin.
Which of the following best describes the new treatment’s mechanism of action?
Increases stimulation of insulin secretion by pancreatic B-cells and decreases hepatic clearance of insulin.
An 11-year-old boy with no past medical history presents to the emergency department with diarrhoea and vomiting. He also complains of non-specific abdominal pain. A venous blood gas is performed and it shows the following:
pH : low
pCO2 : low
HCO3 : low
Diabetic Ketoacidosis
A 58-year-old woman presents to her family physician complaining of weight gain over the past two months. She reports that she has not made any changes to her diet and still go to her weekly aerobic classes. However, her friends have been commenting on her face appears rounder and she is worried that she has developed some purplish stretch marks on her abdomen. On examination, she is noted to have a heart rate of 89 beats per minute, a respiratory rate of 16 breaths per minute and blood pressure of 157/84 mmHg. She has a waist circumference of 41 inches and a body mass index of 28 kg/m2.
Which of the following correctly describes one of the effects of the main hormone implicated in this patient’s condition?
Up-regulation of alpha-1-adrenoreceptors on arterioles.
results in high blood pressure
as smooth muscle in the blood vessels are more sensitive to circulating norepinephrine and epinephrine.
72 y/o back pain and chronic renal failure.
Low calcium
High parathyroid hormone
normal phosphate
secondary hyperparathyroidism
- hyperplasia of parathyroid glands in response to chronic hypocalcaemia
A 28-year-old female has been diagnosed with hyperthyroidism. She complains of heat intolerance and palpitations, the latter is proving to be very frightening to her. The GP starts her on Carbimazole and a second medication to manage the palpitations. What receptors are being over stimulated by the enhanced catecholamine effects in this patient to cause her palpitations?
beta 1 receptors
thyroid hormones increase bodies sensitivity to catecholamines.
heart contains B1 receptors.
when activated by catecholamines increase heart rate.
28 y/o female, increase in size, face more flushed, rounded, steady increase in weight, BP increased, bruises on her arm.
most appropriate investigation is
Cushing’s symptoms
Urinary free cortisol measurement to see if there is a pathological excess of cortisol.
49 y/o male, difficulty sleeping, increasingly tired, general weakness which he attributes to his poor sleep. patient has coarse facial features. Most likely diagnosis is:
acromegaly.
glucose intolerance test diagnostic for suspected acromegaly.
42 y/o female with visual disturbances. double vision intermittent initally but now more frequent.
breathless very easily, experiences palpitations/
on examination: raised painless lesions on the front of her shins, finger clubbing
diagnosis?
Grave’s disease
- IgG antibodies binding to TSH receptor
