Endocrine

Question 1

Addisonian crisis presentation

Answer 1

Hyponatraemia, Hypokalaemia
Low BP
V. low cortisol

Question 2

Gluco vs mineralo -corticosteroids

Answer 2

Gluco - Cortisol
Mineralo - Aldosterone

Question 3

Adrenal insufficiency presentation

Answer 3

Thin
Tired
Thirsty
Tanned (hyperpigmentation)
Tearful

Question 4

Diagnosis/Ix of addisons

Answer 4

AM Cortisol <100 adrenal insuff, >400 unlikely
Synacthen test (Check response to synthetic ACTH, inc in cortisol normal. Abnormal response likely addisons)

Question 5

Mx addisonian crisis

Answer 5

100mg hydrocortisone IV or IM
Fluids, normal NaCl

Question 6

Chronic addisons mx

Answer 6

Oral hydrocortisone TDS (higher dose in AM)
+/- fludrocortisone

Question 7

Sick day rules

Answer 7

Double steroid when ill/trauma/surgery/stress
Never stop

Question 8

Cushings disease v syndrome

Answer 8

Syndrome = too much cortisol
Disease = pituitary adenoma => more acth

Question 9

Ix Cushings

Answer 9

24hr urinary cortisol (3 collections, dx if 2 or more have 3x normal level)
Low dose Dex suppression test (1mg given 11pm, 8am measure. Normal = cortisol reduced, cushings = no suppression)
Midnight cortisol

Question 10

Most common cause of cushings

Answer 10

Exogenous steroids

Question 11

Mx cushings disease

Answer 11

Surgical remove tumour
Radiotherapy
Stop steroid

Question 12

Define hypoglycaemia

Answer 12

<4mmol/ml

Question 13

Whipple’s triad

Answer 13

Symptoms of hypo
Hypoglycaemia on CBG
Resolution on admin of glucose

Question 14

If patient hypoglycaemic + on insulin…?

Answer 14

Do not omit dose
Half dose

Question 15

DKA mx re insulin

Answer 15

> 60kg = 6units/hr
<60kg = 0.1units/kg/hr

Question 16

DKA mx re potassium

Answer 16

Dont give replacement before insulin
Start when levels normal/low
infusion 20mm

Question 17

DKA VBG frequency

Answer 17

every hour