Endocrine

Question 1

Fall in which hormone precedes menstruation?

Answer 1

Progesterone
= corpus luteum degrades, reduced production of progesterone > shedding of endometrium

Question 2

Panretinal photocoagulation
- Target
- Complication

Answer 2

= focuses on peripheral retina
- Decrease in night vision: rods found mainly in periphery and responsible for night vision
- Decrease in peripheral vision

Question 3

Pseudohypoparathyroidism
- What is it?
- Inheritance
- Blood results profile

Answer 3

Type I and II
- Lack of response to PTH due to mutation in receptor
- Autosomal dominant
- Raised PTH but LOW calcium

Question 4

What endocrine abnormality is associated with pulmonary TB?

Answer 4

Hyponatraemia due to SIADH

Question 5

What kind of receptor does insulin act on?

Answer 5

Tyrosine kinase

Question 6

Firm non tender goitre with nil thyroid symptoms
- diagnosis
- association

Answer 6

Riedel’s thyroiditis = fibrous invasion of thryoid
Associated with retroperitoneal fibrosis

Question 7

How does vitamin D raise serum calcium

Answer 7

Via increased gut absorption of calcium

Question 8

First line management of primary hyperparathyroidism

Answer 8

Surgery

Question 9

Klinefelter’s Syndrome
- Hormone results

Answer 9

Testosterone LOW
LH and FSH LOW or inappropriately normal
- they should be raised to try and boost the testosterone levels

Question 10

Treatment of phaeochromocytoma

Answer 10

Non-selective alpha blocker
e.g. phenoxybenzamine

Question 11

Phaeochromocytoma + medullary thyroid cancer
- Syndrome
- Genetic fault

Answer 11

MEN II
A. parathyroid adenomas
B. marfanoid habitus
RET oncogene

Question 12

Drug class sitagliptin
- Mechanism

Answer 12

DPP-4 inhibitor
= increases GLP-1 levels by decreasing their breakdown

Question 13

Mechanism of action of bisphosphonates

Answer 13

Inhibition of osteoclasts

Question 14

Glucocorticoid VS mineralocorticoid effects

Answer 14

Glucocorticoid = anti-inflammatory
Mineralocorticoid = fluid retention (via secretion of aldosterone)

Question 15

Which steroid has the least mineralocorticoid effects?

Answer 15

Dexamethasone - why so useful in brain tumours and desired anti-swelling effect

Question 16

What cancer is associated with hashimoto’s thyroiditis?

Answer 16

MALT lymphoma

Question 17

What is octreotide?
Mechanism of action
Produced from where?

Answer 17

Somatostatin analogue
Inhibits serotonin
D cells

Question 18

How does carbimazole work?

Answer 18

Blocks thyroid peroxidase from binding to residues on thyroglobulin

Question 19

Kallman Syndrome =

Answer 19

hypogonadotrophic hypogonandism

Question 20

11 beta hydroxylase deficiency =

Answer 20

Congenital adrenal hyperplasia

Question 21

Subacute thyroiditis =

Answer 21

De Quervain’s thyroiditis

Question 22

Results in high dose dexamethasone suppression test
- +VE
- -VE

Answer 22

+VE = supressed cortisol, likely pituitary cause
-VE = cortisol not supressed, likely adrenal/ectopic cause

Question 23

Causes of raised gastrin (4)

Answer 23

Gastrinoma
Zollinger-Ellison syndrome
Vagotomy
PPI

Question 24

TSH
- controlled by
- actions (2)

Answer 24

Under control of TRH
Actions
1. Growth of thyroid gland
2. Synthesis + release of T3/T4

Question 25

LH - controlled by - cell - actions (2)

Answer 25

GnRH Leydig cells 1. Male - increased testosterone production 2. Female - development of corpus luteum

Question 26

FSH - controlled by - cell - action

Answer 26

GnRH Sertoli cell Action = increase in seminiferous tubules

Question 27

Prolactin - controlled by - increased (4)

Answer 27

Inhibited by dopamine Increased = exercise, pregnancy, hypothyroidism, renal failure

Question 28

Growth Hormone - controlled by

Answer 28

Inhibited by somatostatin

Question 29

What is the most common cause of Conn's syndrome

Answer 29

Bilateral adrenal hyperplasia

Question 30

Effect of hypocalcaemia on NMJ

Answer 30

Increased neuronal excitability - can result in tetany

Question 31

What does axillary freckling feature in?

Answer 31

Neurofibromatosis NOT a feature of tuberous sclerosis

Question 32

Types of amiodarone-induced thyrotoxicosis - management of each type

Answer 32

Type 1 = excess hormone synthesis, see goitre Give carbimazole Type 2 = destructive thyroiditis Give steroids

Question 33

Type 1 amiodarone thyrotoxicosis management

Answer 33

Give carbimazole

Question 34

Type 2 amiodarone thyrotoxicosis management

Answer 34

Give steroids

Question 35

Treatment of Paget's Disease

Answer 35

Bisphosphonate

Question 36

Mechanism of action of Bisphosphonate

Answer 36

Inhibits bone resorption by INTERFERING with osteoclasts

Question 37

Gold standard diagnosis for insulinoma

Answer 37

Supervised prolonged fasting

Question 38

Malignancy associated with acromegaly - why?

Answer 38

Colorectal cancer Increased secretion of growth hormone

Question 39

Investigation of Zollinger Ellison Syndrome

Answer 39

Secretin stimulation test = paradoxical rise in gastrin secretion Gastrin is usually inhibited by secretin

Question 40

What can cause a worsening of thyroid eye disease?

Answer 40

Radioiodine

Question 41

Most common cause of congenital adrenal hyperplasia

Answer 41

21 hydroxylase deficiency

Question 42

Options for management of Grave's Disease (2)

Answer 42

Down titration of carbimazole Block and replace - carbimazole, start levothyroxine when euthyroid Down titration has a better side effect profile

Question 43

Mechanism of metabolic alkalosis in cirrhosis

Answer 43

Reduced steroid hormone production Depleted intravascular volume = increased secretion of aldosterone = metabolic alkalosis

Question 44

How do the metaglitinides work?

Answer 44

Same mechanism as sulphonylureas