ENDOCRINE

Question 1

Which insulin do you give once a day

Answer 1

basal (long acting) e.g. Lantus

Question 2

DIFFERENT names for insulins

Answer 2

rapid acting analogue (humalog, novorapid)

short-acting (humulin S, actrapid)

intermediate acting (insulatard, humulin I)

long acting (lantus, levemir)

rapid acting analogue-intermediate mix (humalog mix25, novomix30)

short acting-intermediate mix (humulin M3)

Question 3

Glucocorticoid receptor

Answer 3

binds corticosteroids

Question 4

Thyroxine biochemistry

Answer 4

T3 is more active than T4 and they work on nuclear receptor THR

Question 5

Which diabetic drug is weight neutral

Answer 5

DPP4 Inhibitors e.g. sitagliptin

Question 6

Weight loss diabetic drug

Answer 6

GLP1 agonist e.g. exenatide

Question 7

Which causes glycosuria

Answer 7

– SGLT2 inhibitor e.g. dapagliflozin

Question 8

Hyperparathyroidism causes what conditions?

Answer 8

– bone disease, renal stones, GI complications, depression, lethargy, seizures, weakness, fatigue, calcification of aortic and mitral valves

Question 9

Hypoparathyroidism causes what

Answer 9

– rare, neuromuscular irritability, Chovstek’s sign, Trousseau’s sign, emotional lability, anxiety, confusion, psychosis, basal ganglia calcification, cataract formation, prolonged QT, dental abnormalities

Question 10

Strawberry milkshake coloured blood ?

Answer 10

hyperlipidaemia

Question 11

What hormone do you test for in pregnancy –

Answer 11

HCG

Question 12

Which hormone peaks before ovulation

Answer 12

– LH ~ 12 hours before

Question 13

What hormone do you test for fertility –

Answer 13

progesterone

Question 14

Pagets what is it

Answer 14

(normal Ca and phosphate, high alk phos) increased osteoclastic reabsorption followed by increased osteoblastic activity

Question 15

pagets aetiology

Answer 15

Old age, male, FH. 
Bone pain (pelvis, lumbar spine, femur).

Question 16

pages treatment and complications

Answer 16

Tx: Bisphosphonate (risedronate). Complications - deafness, cardiac failure, fractures, skull thickening

Question 17

Osteomalacia – (rickets in children) - what is it?

Answer 17

vit D deficiency. Low Ca & phosphate & high alk phos. abnormal softening of bone due to deficient mineralization of osteoid (immature) bone

Question 18

causes/symptoms/treatment of osteomalacia

Answer 18

Causes are vit D def (malabsorption, poor diet or lack of sunlight).

Bone pain, tenderness, fractures - esp femoral neck, proximal myopathy - waddling gait.

Tx: Vit D therapy with Ca & phosphate supplements.

Question 19

cause of bone mets

Answer 19

Bone mets – high Ca. Osteoclast proliferation. Bone pain

Question 20

what is indicative of normal biochem and bone pain

Answer 20

osteoporosis

Question 21

graves symptoms/signs

Answer 21

gradual onset
mild/moderate thyroid enlargement
diffuse enlargement on palpation
hyperdynamic tachycardia
heat intolerance
thrill or bruit over thyroid
tremor present
dysthyroid eye disease
restless
anxious
insomnia
warm
sweating
pretibial myxoedema

increased BMR
weight loss (or gain due to appetite), raised T4 and free T3, suppressed TSH

Question 22

hashimotos

Answer 22

slow onset
can be huge or impalpable enlargement
firm and well-defined lymph nodes
bradycardia
cold intolerance
tremor absent
hoarseness
dysphagia
pressure effect
sleep apnoea
fatigue
depression
pseudo-dementia
memory dysfunction
decreased sweating
hair loss
neuropathies
weight loss
low T4 and free T3, raised TSH

Question 23

de quervians

Answer 23

acute, painful, moderate swelling, smooth, diffuse and tender bilateral swelling, initially transiently hyperdynamic, tremor in early stages, painful dysphagia, initially warm with sweating, flu-like symptoms, raised T4 and free T3, supressed TSH

Question 24

multi nodular goitre

Answer 24

slow onset (years), mild/moderate swelling with palpable nodules, normal CVS, no tremor, obstructive neck symptoms, normal mental health and skin, normal bloods
Idiopathic thyroid swelling – gradual onset, moderate smooth swelling, no CVS symptoms, no tremor, mild pressure effects, normal mental health, no skin changes or other symptoms of note, increased BMR, weight loss (or gain due to increased appetite), normal bloods

Question 25

Hypocalcaemia

Answer 25

see primary hypoparathyroidism

Question 26

commonest, lymphatic spread,
can spread haematogenously to lungs, bone, liver and brain,

assoc. with Hashimoto’s thyroiditis

good prognosis,
investigated with US guided FNA or biopsy,
surgery is treatment of choice

Answer 26

Papillary thyroid cancer

Question 27

derived from C-cells, relatively rare, secretes calcitonin, aggressive, diarrhoea, Cushings

Answer 27

Medullary thyroid carcinoma

Question 28

haematogenous spread, good prognosis, FNA or biopsy, surgical treatment

Answer 28

Follicular carcinoma

Question 29

important for the breast feeding ‘let down’ reflex, and for induction of labour contractions and is therefore elevated during labour and breastfeeding

Answer 29

oxytocin

Question 30

generates ketone bodies which can be measured in urine plasma clinically in diabetic ketoacidosis/insulin deficiency

Answer 30

lipolysis

Question 31

Significantly reduced ABPI readings in a patient with IHD, COPD and/or hypertension with a painful ulcer is likely to have _____ ulcer

Answer 31

arterial

Question 32

Lipodermatosclerosis, essentially normal ABPI and ulcers on the malleoli are consistent with ______ ulceration

Answer 32

venous