endocrine

Question 1

what are TZDs (pioglitazone) associated with?

Answer 1

an increased risk of bladder cancer

Question 2

what is required to diagnose type 2 diabetes?

Answer 2

a fasting glucose >7.0 or a random glucose >11.1
if asymptomatic then 2 readings needed

Question 3

what are results of a dexomethasone suppression test with an adrenal adenoma?

Answer 3

cortisol= not suppressed
ACTH= suppressed

Question 4

what are results of a dexomethasone suppression test with a pituitary adenoma?

Answer 4

cortisol= suppressed
ACTH= suppressed

Question 5

what are results of a dexomethasone suppression test with ectopic ACTH secretion?

Answer 5

cortisol= not suppressed
ACTH= not suppressed

Question 6

what is diabetes insipidus characterised by?

Answer 6

a high plasma osmolarity and a low urine osmolarity

Question 7

what drug can be used to treat galactorrhoea?

Answer 7

bromocriptine

Question 8

why is turners syndrome associated with an ejection systolic murmur?

Answer 8

due to its bicuspid aortic valve

Question 9

what is the biochemistry in kallmanns syndrome?

Answer 9

low testosterone
low/normal LH and FSH

Question 10

what is MEN2 associated with?

Answer 10

medullary thyroid cancer

Question 11

how is a prolactinoma treated?

Answer 11

dopamine agonist (eg cabergoline)- first line
transphenoidal surgery- second line

Question 12

how is acromegaly treated?

Answer 12

transphenoidal surgery- first line
somatostatin analogue (eg octreotide)- second line

Question 13

what can give falsely low HbA1c readings?

Answer 13

sickle cell anaemia

Question 14

what is the mechanism of action of carbimazole?

Answer 14

inhibits thyroid peroxidase enzymes

Question 15

what renal condition can give falsely low HbA1c readings?

Answer 15

haemodialysis

Question 16

what is adjusted in a dexa scan?

Answer 16

Z score is adjusted for age, gender and ethnicity

Question 17

what triggers ovulation?

Answer 17

LH surge

Question 18

what is the best way to measure if ovulation has occured?

Answer 18

see if progesterone peaks at day 21 (roughly)

Question 19

what hormone is released during the follicular phase?

Answer 19

LH and FSH

Question 20

when does ovulation take place?

Answer 20

14 days

Question 21

what happens after the LH surge?

Answer 21

oocyte released

Question 22

where is FSH secreted from?

Answer 22

anterior pituitary

Question 23

what does FSH do in females?

Answer 23

thickens endometrium
stimulates follicular development

Question 24

what does FSH do in males?

Answer 24

stimulates sertoli cells
spermatogenesis

Question 25

where is LH secreted from?

Answer 25

anterior pituitary

Question 26

what does LH do in females?

Answer 26

peak stimulates ovulation

Question 27

what does LH do in males?

Answer 27

stimulated leydig cells testosterone secretion spermatogenesis

Question 28

what are the endocrine features of PCOS?

Answer 28

high free androgens high LH impaired glucose tolerance

Question 29

what is needed for a PCOS diagnosis?

Answer 29

chronic anovulation polycystic ovaries hyperandrogenism (2/3 needed for diagnosis)

Question 30

what is the target HbA1c for diabetics on meds which may induce hypoglycaemia (eg. sulphonylureas)?

Answer 30

53

Question 31

when can metformin and insulin be used in combination?

Answer 31

Patients with type I diabetes and a BMI > 25

Question 32

how is insulin managed in acute DKA?

Answer 32

insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin

Question 33

what is the mechanism of sulphonylureas?

Answer 33

Sulfonyureas increase stimulation of insulin secretion by pancreatic B-cells and decrease hepatic clearance of insulin

Question 34

what is the mechanism of metformin?

Answer 34

reduced hepatic glucose production (gluconeogenesis) and increases gut glucose utilisation and metabolism

Question 35

what is the mechanism of TZD (pioglitazone)?

Answer 35

reduces insulin resistance by interaction with PPAR-y nuclear receptor

Question 36

what is the mechanism of GLP-1 agonists?

Answer 36

enhance the incretin effect by activating the GLP-1 receptors

Question 37

what is the mechanism of DPP-4i?

Answer 37

they inhibit DPP-4 which usually inactivates GLP-1. this increases insulin secretion and reduces glucagon secretion

Question 38

what is the mechanism of SGLT-2i?

Answer 38

inhibit SGLT2 in the kidneys

Question 39

what are the classic features of MEN 1?

Answer 39

pancreatic tumour pituitary tumour primary hypoparathyroidism

Question 40

what are the classic features of MEN 2a?

Answer 40

primary hypoparathyroidism pheochromocytoma medullary thyroid cancer

Question 41

what are the classic features of MEN2b?

Answer 41

pheochromocytoma medullary thyroid cancer

Question 42

in a suspected T1 diagnosis, what are the features that would prompt further tests?

Answer 42

being over 50yo a BMI>25

Question 43

what are the features of sub acute thyroiditis?

Answer 43

tender goitre can cause hyper followed by hypothyroidism

Question 44

what are the blood results for secondary hyperparathyroidism?

Answer 44

low Ca high phosphate, ALP and PTH

Question 45

what does a low TSH and a hot solitary nodule indicate?

Answer 45

toxic adenoma

Question 46

what is chovsteks sign?

Answer 46

twitching of facial muscles upon tapping over the facial nerve

Question 47

what is trousseaus sign?

Answer 47

involuntary contraction of the muscles in the hand and wrist after compression of upper arm with a BP cuff