Endocrine

Question 1

Lower HbA1c

Answer 1

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis

Question 2

Higher HbA1c

Answer 2

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

Question 3

Addison’s patient with intercurrent illness - steroid management

Answer 3

double glucocorticoid (hydrocort), keep mineralcorticoid (fludrocort) the same

Question 4

Sulphynurea (gliclazide)
MOA
SE

Answer 4

bind to ATP-dependent K channel
hypoglycaemia, weight gain

Question 5

Carbimazole SE

Answer 5

agranulocytosis (sore throat, fever)

Question 6

T2DM initial therapy: if metformin is contraindicated + patient has a risk of CVD, established CVD or chronic heart failure

Answer 6

SGLT-2 monotherapy (dapagliflozin)

Question 7

prolactinoma Mx

Answer 7

1st - dopamine agonist (bromocriptine)
2nd - transphenoid surgery

Question 8

Addisons Ix

Answer 8

short synachten test

Question 9

spirinolactone SE

Answer 9

gynaecomastia

Question 10

hypoglycaemia Mx

Answer 10

1st - oral glucose
2nd - sc/IM glucagon (if unconsious)
3rd - IV 20% glucose

Question 11

radioiodine se

Answer 11

hypothyroidism, thyroid eye disease

Question 12

myxoedema coma Features

Answer 12

hypothermia, confusion

Question 13

primary hyperaldosteronism (adrenal tumour) Mx

Answer 13

bilateral hyperplasia- spirinolactone
unilateral adenoma - adrenal surgery

Question 14

Thiazide electrolyte abnormality

Answer 14

HYPOkal, nat, mag
HYERcal

Question 15

ACTH and cortisol interpretation

Answer 15

ACTH low CORTISOL supressed = Adrenal adenoma (cushing syndrome)

ACTH high CORTISOL supressed = Ectopic ACTH

ACTH high CORTISOL not supressed = pituitary adenoma (Cushings disease)

Question 16

Addisons disease (adrenal insufficiency) Ix

Answer 16

Short synbacthen test

Question 17

Milk-alkali syndrome Fx

Answer 17

hyerpCAL
renal failure
metabolic alkalosis
can be caused by antacid + VitD/ Cal supplements