Endocrine

Question 1

What is the relevance of oestrogen therapy when assessing thyroid fxn?

Answer 1

Oestrogen causes raised thyroxine binding globulin in the serum –> total serum thyroxine may be misleading
In that situation measure serum free thyroxine

Question 2

Unifying diagnosis for a pt presenting with DM, deranged LFTs and hypogonadotropic hypogonadism? Initial screening test?

Answer 2

Haemochromotosis

Genetic analysis for C282Y and H63D mutations (will pick up 90% of cases in Europeans) or Serum ferritin

Question 3

10% of patients with PCOS will also have increased prolactin. What is mechanism of this?

Answer 3

Unknown

Note: does not suppress oestradiol and LH/FSH like a prolactinoma. PCOS increased LH and normal/low FSH

Question 4

FSH/LH findings in PCOS

Answer 4

PCOS increased LH and normal/low FSH

Question 5

Treatment of familial hypocalciuric hypercalcaemia

Answer 5

None needed

Question 6

In managing DM what is the pre breakfast glucose goal?

Answer 6

4-7

Note: if need to increase insulin generally it is increased in 10% increments

Question 7

In a patient with congenital adrenal hyperplasia who requires stress dosing of there steroids the glucocorticoid is increased but the mineralocorticoid is not T/F

Answer 7

T

Question 8

Stoping amiodarone is the management for amiodarone induced thyrotoxicosis T/F

Answer 8

F - stop amiodarone (if possible) and treat with steroids

Question 9

What type of vision loss with craniopharygioma

Answer 9

inferior bitemporal hemianopia

Note: pit tumor typically causes superior bitemporal hemianopia

Question 10

If free T4 and T3 are high, but TSH is normal or high, what is the next step in investigation

Answer 10

Pituitary MRI

Note: to look for a pituitary mass (TSH-secreting adenoma)

Question 11

What is Nelson’s syndrome

Answer 11

Enlargement of an ACTH-producing tumour in the pituitary gland, following surgical removal of both adrenal glands in a patient with Cushing’s disease.

Question 12

What testosterone and FSH/LH pattern would be expected in a male with primary vs secondary hypogonadism

Answer 12

In both decreased testosterone and sperm count

Primary: problem with testes –> increased FSH/LH as they try to stimulate the testes

Secondary: problem with either hypothalamus or pituitary gland –> decreased or inappropriately normal FSH/LH

Question 13

In a pregnant pt with hyperthryoidism what is the treatment

Answer 13

1st trimester: PTU

2nd trimester: carbimazole

Question 14

DeQuervain’s thyroiditis typical presentation

Answer 14

Tender goitre, weight loss and general malaise.

A markedly raised ESR (>50 and usually 100) is typical.

Initially hyperthryoid and then become hypothyroid

Question 15

What is the relevance of sick euthyroidism being associated with hypoadrenalism

Answer 15

Hypoadrenalism which is either primary or secondary, the addition of thyroxine can precipitate acute hypoadrenalism

Question 16

Insulin antibodies are found almost exclusively in which patient cohort?

Answer 16

Young children with type 1 diabetes.

Question 17

What TFT pattern would be expected in over replacement with thyroxine?

Answer 17

Increased T3/T4

Suppressed TSH

Question 18

3 criteria needed to define the resolution of DKA

Answer 18

pH >7.3
ketones <0.3 mmol/L
patient is able to eat and drink

Question 19

When is K replacement needed in DKA mgmt

Answer 19

K up to 5.5mmol/L

Note: 3.5 - 5.5 give 40mmol in IVF L; < 3.5 seek specilaist advice for how much to give

Question 20

Which investigation most likely to differentiate between Amiodarone induced thyrotoxicosis (AIT) type 1 and type 2?

Answer 20

Colour flow Doppler

NB: appears to be superior to IL-6

Question 21

Which diabetes drugs increase levels of PTH, drive an increase in bone turnover, and are associated with increased risk of bone fracture.

Answer 21

SGLT-2 inhibitors

such as canagliflozin

Question 22

Most authorities recommended that metformin should be stopped in patients with a creatinine above ___

Answer 22

150

Note: This is not universal policy and many patients continue on metformin with creatinines much higher than 150 without any ill effect.

Question 23

Which MEN is associated with mutation in RET

Answer 23

MEN2

Note: MEN1 and 2 are both autosomal dominant

Question 24

Which MEN is associated with MENIN?

Answer 24

MEN1

Question 25

Which MEN2 has a worse prognosis?

Answer 25

MEN2B - this is because the medullary thyroid Ca is usually more aggressive.

Note: death in mid twenties can commonly occur in its who present with clinical signs of medullary thyroid Ca

Question 26

What is the most common type of thyroid Ca?

Answer 26

Papillary ( 80-85)

Note: then follicular (5-10%); rare medullary and anaplastic

Question 27

What is the typical presentation of thyroid Ca?

Answer 27

Single nodule and otherwise asymptomatic
Presents in 30s or 70s usually

Note: TFTs are normal

Question 28

Which type of thyroid Ca has worse prognosis?

Answer 28

Anaplastic

Question 29

Which type of thyroid Ca is more common in areas with low iodine?

Answer 29

Follicular

Question 30

Which type of thyroid Ca is more common in areas with high rates of thyroiditis?

Answer 30

Thyroid lymphoma

Question 31

T2 DM is association what that islet pathology

Answer 31

Islet amyloid deposition

Question 32

Most common antibodies in Hashimotos

Answer 32

Anti TPO

Note: aka anti microsomal antibodies

Question 33

Typically when reducing insulin go in increments of ___%

Answer 33

20%

Question 34

In a patient with T2DM and Hba1c significantly below 75 mmol/mol what is the insulin of choice to start?

Answer 34

Humane isophane insulin (also referred to as a Neutral Protamine Hagedorn [NPH] insulin) is the first-line recommended insulin to use in a type 2 diabetic. These are intermediate acting insulins usually used once daily at night or twice a day.

Note:
A long-acting insulin analogue might be useful in someone who struggles to inject a twice a day NPH insulin to reduce the frequency of injections to once a day (e.g. someone who requires assistance to inject from a carer or district nurse).
A biphasic ‘mixed’ preparation is recommended if an individual’s diabetic control is especially poor (HbA1c > 75 mmol/mol).

Question 35

Tx of papillary thyroid carcinoma

Answer 35

Thyroidectomy AND radioiodine-131 therapy

Question 36

Colonoscopy recommendations for pts with acromegaly?

Answer 36

Start at 40 yrs due to high risk colon Ca

If elevated IGF1 or adenomas found: repeat in 3 yrs

If not: repeat in 5 years

Question 37

In the setting of diabetes and stable renal function what test is considered the most appropriate test to detect and quantify proteinuria.

Answer 37

Albumin:creatinine ratio

Question 38

The presence of breast development in the absence of secondary sexual hair, with a history of hernias as a child is suggestive of a diagnosis of ____

Answer 38

Androgen insensitivity syndrome

Question 39

Drugs that interfere with thyroxine absorption?

Answer 39

Binding agents ( cholestyramine and sevelamer)
iron sulphate
proton pump inhibitors

Question 40

Relevance of undetectable thyroglobulin on TFTs

Answer 40

Clinches the diagnosis of factitious hyperthyroidism.
Note: thyroglobulin is the precursor of thyroid hormones, therefore if undetectable, indicates an external source of thyroid hormone has been administered.

Question 41

Goal BS in insulin dependent DM

Answer 41

Pre meal: 4-7
Pre bed: 6-8

Question 42

1st line tx of thyroid eye disease?

Answer 42

Steroids

Question 43

Compare Turners to Kallmans?

Answer 43

Both have decreased oestrogen but
Turners is a hypergonadatrophic hypogonadism (increased FSH/LH)

Kallmans hypogonadatrophic hypogonadism (normal/decreased FSH/LH). It is also assoc with central defects (eg cleft lip), colour blindness, and deafness.

Question 44

Pseudohypoparathyroidism is associated with ____

Answer 44

Short stature and shortening of the fifth metacarpal

Question 45

_____ is the best investigation for confirming subacute thyroiditis

Answer 45

Radioactive iodine uptake scan

Note: aka De Quervains. It is due to increased release of stored thyroid hormone rather than increased production therefore no role for PTU/carbimazole. Can treat symptoms with propranolol

Question 46

Metformin is known to cause what nutritional deficiency?

Answer 46

B12

Question 47

Tx of myxoedema coma?

Answer 47

IV T3 and hydrocortisone

Note: can treat clinically even before lab results