Endocrine

Question 1

role of PTH

Answer 1

made by chief cells
causes high calcium
activates vitamin D
release is dependent on Mg

Question 2

turners syndrome hormones

Answer 2

hypergonadotropic hypogonadism
abnormal ovaries
high FSH and LH, low oestrogen
give exogenous oestrogen

Question 3

BM for hypoglycaemia

Answer 3

<2.6

Question 4

3 features of McCune Albright

Answer 4

1) fibrous bone dysplasia
2) cafe au lait spots
3) precocious puberty

Question 5

Turner’s syndrome + virilisation=

Answer 5

Y chromosome material = gonadoblastoma risk

Question 6

CAH inheritance and pathophysiology

Answer 6

autosomal recessive

overproduction of androgens
underproduction of mineralocorticoids and gluclocorticoids

Question 7

DI urine and blood results

Answer 7

dilute urine
hypernatraemic hypovolaemia

Question 8

C peptide production

Answer 8

low in T1DM
high in T2DM

Question 9

first signs of puberty

Answer 9

breast buds in F
testicular enlargement >4mm in M

Question 10

bone age in thyroid disease

Answer 10

delayed in hypothyroid
advanced in Hashimotos (Ab like FSH)
advanced in hyperthyroid

Question 11

DKA initial bolus

Answer 11

10ml/kg for all children (no K+)

<15 mins if shocked
<30 mins if not shocked

Question 12

DKA further fluids

Answer 12

deficit (% x kg x 10) + maintenance/ 48

include K+
subtract bolus unless shocked

Question 13

when to start and stop IV insulin

Answer 13

start after 1-2 hours of fluids

stop when E+D and ketones <1 and 30 mins of SC insulin completed

Question 14

when to add glucose to fluids in DKA

Answer 14

BM <14

Question 15

FSH and LH in AIS

Answer 15

FSH normal
LH high

Question 16

AIS karyotype

Answer 16

46XY

Question 17

how can CAH be treated in utero

Answer 17

give dex to oppose androgens effect on genitals

Question 18

fast growth in CAH

Answer 18

inadequate treatment (high androgens drive growth)

Question 19

Kallman’s hormones

Answer 19

low GnRH causes low LH and FSH

Question 20

pathophysiology of discordant puberty

Answer 20

GnRH independent
peripherally driven
overactive androgens

Question 21

presentation of discordant puberty

Answer 21

breast or penile enlargement
small testes
no pubic hair

Question 22

adrenal medulla hormones

Answer 22

noradrenaline
adrenaline
dopamine

Question 23

thyroid in Turner’s

Answer 23

low (Hashimoto’s)

Question 24

Diagnosis of delayed puberty

Answer 24

No testicular enlargement by 14
No breast buds by 13
No periods by 15

Question 25

tests for growth hormone deficiency

Answer 25

insulin tolerance test glucagon stimulation test

Question 26

adrenal crisis U+Es

Answer 26

high potassium low sodium high renin

Question 27

neck swelling that moves on tongue protrusion

Answer 27

thyroglossal cyst USS to r/o ectopic thyroid tissue

Question 28

DKA pH and bicarb limits

Answer 28

Mild: pH 7.2-7.29, bicarb 10-15 Moderate: pH 7.19-7.2, bicarb 5-10 Severe: pH <7.19, bicarb <5

Question 29

assumed dehydration levels in DKA

Answer 29

mild and moderate 5% severe 10%

Question 30

which hypo cut off to use

Answer 30

2.6 normally 4 in diabetics

Question 31

contents of annual review for T1DM

Answer 31

TFTs and HbA1c bp and urinary A:Cr and retinopathy for 12yo+

Question 32

Ix for rickets

Answer 32

bloods and XR long bone

Question 33

rickets in vegans

Answer 33

offer lichen based colecalciferol or vit D2 (ergocalciferol) instead

Question 34

type 1 vs type 2 vitamin d dependent rickets

Answer 34

type 1 has low 1,25 type 2 has high 1,25 both have low calcium and secondary hyperparathyroidism