Endocrine Flashcards
A 20 year old female presents with a 6 week history of a painless, slowly growing
lump in her neck. On examination a lump is noted in the submental triangle of the
neck and moves up with tongue protrusion.
01. What is the most likely diagnosis?
1. Dermoid cyst
2. Lipoma
3. Thyroglossal cyst
4. Thyroid nodule
5. Reactive lymphadenopathy
Thyroglossal cyst
a. submadibular
b. submantle
c. carioted
These make up the anterior triangle.
d. posterior triangle
A 48 year old female presents with a 4 week history of a painless lump in her neck.
She has no other symptoms. On examination the lump was present in the lower
part of the anterior triangle of the neck in the midline and moves on swallowing.
Her TFT is normal.
02. What is the most appropriate next test in this patient?
1. Serum thyroglobulin
2. Ultrasound
3. 99m TC scan
4. CT chest
5. Serum calcitonin
Ultrasound
papillary carcinoma of the thyroid therefore
B - obstructive and toxic systems plus it s nodular
A 43 year old female presents to the GP with a 8 week history of a racing heart. No
PMH of note. On the combined oral contraceptive pill
Smokes 15 cigs/day; 2-3u alcohol 3X/week; 3 cups coffee/day
F/H- Sister has regular B12 injections
Table Talk:
Write down 3 differentials.
hyperthyroidism
anxiety
pregnancy
drugs
A 43 year old female presents to the GP with a 8 week history of a racing heart. No
PMH of note. On the combined oral contraceptive pill
Smokes 15 cigs/day; 2-3u alcohol 3X/week; 3 cups coffee/day
F/H- Sister has regular B12 injections
06. What further feature on history would be most consistent with a thyroid cause
for her palpitations?
A. Weight gain
B. Dry skin
C. Heat intolerance
D. Paresthesia
E. Headache
Heat intolerance
m
On examination she appears anxious and thin. Her HR is 105 and irregular. Her BP is
145/70. Her CVS and Resp exams are normal. She has a palpable painless diffuse goitre.
A 43 year old female presents to the GP with a 8 week history of a racing heart. No
PMH of note. On the combined oral contraceptive pill
Smokes 15 cigs/day; 2-3u alcohol 3X/week; 3 cups coffee/day
F/H- Sister has regular B12 injections
What is the most likely diagnosis?
1. Grave’s disease
2. Toxic multinodular goitre
3. Thyroid adenoma
4. Subacute thyroiditis
5. Secondary hyperthyroidism
Graves disease
A 43 year old female presents to the GP with a 8 week history of a racing heart. No
PMH of note. On the combined oral contraceptive pill
Smokes 15 cigs/day; 2-3u alcohol 3X/week; 3 cups coffee/day
F/H- Sister has regular B12 injections
What sign on ocular examination is most specific for Grave’s rather
than hyperthyroidism due to other causes?
1. Periorbital oedema
2. Lid retraction
3. Exophthalmos
4. Lid lag
5. Dilated pupils
Exophthalmos
A 43 year old female presents to the GP with a 8 week history of a racing heart. No
PMH of note. On the combined oral contraceptive pill
Smokes 15 cigs/day; 2-3u alcohol 3X/week; 3 cups coffee/day
F/H- Sister has regular B12 injections
The appearance of her eyes on examination is shown.
09. What is the most likely pathogenesis of the exophthalmos?
1. Granulomatous inflammation
2. Fibroblast proliferation
3. Sympathetic overactivity
4. Neutrophilic inflammatory infiltrate
A 43 year old female presents to the GP with a 8 week history of a racing heart. No
PMH of note. On the combined oral contraceptive pill
Smokes 15 cigs/day; 2-3u alcohol 3X/week; 3 cups coffee/day
F/H- Sister has regular B12 injections
Positive TRad
A 43 year old female presents to the GP with a 8 week history of a racing heart. No
PMH of note. On the combined oral contraceptive pill
Smokes 15 cigs/day; 2-3u alcohol 3X/week; 3 cups coffee/day
F/H- Sister has regular B12 injections
What features are likely to be seen on histology if a biopsy was performed on this patient?
1. Follicular atrophy and inflammation
2. Plenty of lymphocytes & lymphoid follicles
3. Follicle hyperplasia & vacuolation of colloid
4. Lymphocytic inflammation & hyperplasia
5. Papillary structures with colloid vacuolation
Follicle hyperplasia & vacuolation of colloid
A 43 year old female presents to the GP with a 8 week history of a racing heart. No
PMH of note. On the combined oral contraceptive pill
Smokes 15 cigs/day; 2-3u alcohol 3X/week; 3 cups coffee/day
F/H- Sister has regular B12 injections
What is the most appropriate initial treatment or definitive
treatment of her thyrotoxicosis?
1. Thyroidectomy
2. Radioiodine
3. B blocker
4. Carbimazole
A 42 year old woman presents with a 3 month history of slight weight gain, irregular periods and fatigue despite getting adequate sleep. The fatigue is getting her down.
No PMH/Surgical history. On no medications,
Married, three children, works full time. Never smoked. Does not consume alcohol.
Family history: Mother (70) - Type 2 DM, Father (72) - Hypertension; both are well. All siblings well.
List 3 most likely differentials in this patient.
Menopause
diabetes
anemia
cancer
depression
hypothyroidism
OSA
A 42 year old woman presents with a 3 month history of slight weight gain, irregular
periods and fatigue despite getting adequate sleep. The fatigue is getting her down.
No PMH/Surgical history
On no medications
Married, three children, works full time. Never smoked. Does not consume alcohol.
Family history: Mother (70) - Type 2 DM, Father (72) - Hypertension; both are well.
All siblings well.
13. What tool should be used to screen for depression in this patient?
1. K10
2. MMSE
3. Geriatric depression scale
4. Modified IMRIE score
5. HEADS screen
K10
A 42 year old woman presents with a 3 month history of fatigue.
She has had irregular periods for 6/12 and associated weight gain.
She is not depressed when screened.
On examination: Vitals normal, small goitre noted, CVS, Resp, GI, Neuro NAD
14. Which of the following clinical sign is most commonly seen in hypothyroidism?
1. Alopecia
2. Hypercarotenemia
3. Dry skin
4. Delayed relaxation of reflexes
5. Loss of lateral eyebrows
Dry skin
A 42 year old woman presents with a 3 month history of fatigue.
She has had irregular periods for 6/12 and associated weight gain.
She is not depressed when screened.
On examination: Vitals normal, small goitre noted, CVS, Resp, GI, Neuro NAD
Increased LDL -
A 42 year old woman presents with a 3 month history of fatigue.
She has had irregular periods for 6/12 and associated weight gain.
She is not depressed when screened.
On examination: Vitals normal, small goitre noted, CVS, Resp, GI, Neuro NAD
Which of the following is an example of primordial prevention in
hypothyroidism?
1. Fortification of foods
2. Newborn screening
3. Early treatment with thyroxine
4. Interval monitoring of TFTs
Fortification of foods
A 58 year old male presents with a 1 week history of headache, and blurred vision.
He is a non smoker and does not drink alcohol.
PMH- no known medical problems
FH: Mum had a stroke, dad had hypertension
On examination: Vitals BP 100/60, PR 80 bpm, regular, BMI 24, Temp 37.
Visual field defect was noted (shown below). No other focal neurological deficits.
Other systems examination was normal.
18. Where is the lesion?
- Occipital cortex
- Optic radiation
- Optic chiasm
- Optic nerve
- Retina
Optic chiasm
A 58 year old male presents with a 1 week history of headache, and blurred vision.
He is a non smoker and does not drink alcohol.
PMH- no known medical problems
FH: Mum had a stroke, dad had hypertension
On examination: Vitals BP 100/60, PR 80 bpm, regular, BMI 24, Temp 37.
Visual field defect was noted (shown below). No other focal neurological deficits.
Other systems examination was normal.
What imaging investigation would be most appropriate?
1. CT head
2. MRI head
3. Lateral skull Xray
MRI head
His imaging is shown below. His biochemical tests are normal.
He undergoes neurosurgical intervention.
He attends for a review 2 weeks post surgery. He complains of polyuria and
increased thirst.
20. What is most likely abnormality to be noted on his biochemical/urine test?
1. Hyponatraemia
2. Increased plasma osmolality
3. Increased urine osmolality
4. Glycosuria 3+
5. Urinary sodium 35 mmol/L
Diabetes insipidus
therefore increased plasma osmolarity
- What feature will make nephrogenic diabetes insipidus more likely
than a central cause? - High normal ADH level
- Hypernatraemia
- Decreased plasma osmolality
- Low urine osmolality
- Hyperglycaemia
What is the most likely underlying cause for her symptoms?
1. Parathyroid adenoma
2. Sarcoidosis
3. Lymphoma
4. Paget’s disease
5. Metastatic breast cancer
presenting with suspected renal stone
(IF HAVE PTH LEVEL)
Parathyroid adenoma
What feature would make primary hyperparathyroidism more likely
than secondary hyperparathyroidism?
1. Increased calcium
2. Elevated PTH
3. Increased phosphate
4. Reduced Vitamin D
Bryce is diagnosed with hypertension
Bryce is 35 years old. He was recently discharged from the local hospital’s mental health unit. He was diagnosed with
schizophrenia and commenced on clozapine.
He reports some intermittent heart palpitations and constipation. Bryce lives with his partner Sam. Sam has been complaining more about his snoring and how sweaty Bryce gets at night time.
Bryce works as a stockbroker and uses cocaine on the weekends. He goes to the gym 5 days a week. He drinks OTC protein shakes and sometimes injects steroids to help his training. He has lost 5kgs in the last 2 months.
Bryce has a family history of Inflammatory Bowel Disease.
Table talk
Based on the history provided, what potential causes are there for Bryce’s Hypertension?
Secondary
OSA
Cocaine
Steroids
Protein shakes
Hyperthyroidism
Pheochromocytoma
Medications?
Primary
Renal artery stenosis
primary hyperaldosteronism
Bryce is 35 years old. He was recently discharged from the local
hospital’s mental health unit. He was diagnosed with
schizophrenia and commenced on clozapine.
He reports some intermittent heart palpitations and constipation.
Bryce lives with his partner Sam. Sam has been complaining more
about his snoring and how sweaty Bryce gets at night time.
Bryce works as a stockbroker and uses cocaine on the weekends.
He goes to the gym 5 days a week. He drinks OTC protein shakes
and sometimes injects steroids to help his training. He has lost
5kgs in the last 2 months.
Bryce has a family history of Inflammatory Bowel Disease.
On examination Bryce’s BP is moderately elevated. You also examine his fundi.
01. Which of the following retinal changes would be suggestive of chronic, poorly controlled hypertension?
1. Microaneurysms
2. Neovascularisation
3. Arteriovenous nipping
4. Vitreous haemorrhage
5. Roth’s spots
Arteriovenous nipping - having arteriosclerotic changes
If sudden, would have haemorrhgnes,
Diabetes would have micoaneurisms
After taking a thorough history and examination from Bryce, and excluding other causes, you suspect he may have primary hyperaldosteronism
Bryce is 35 years old. He was recently discharged from the local hospital’s mental health unit. He was diagnosed with
schizophrenia and commenced on clozapine.
He reports some intermittent heart palpitations and constipation. Bryce lives with his partner Sam. Sam has been complaining more about his snoring and how sweaty Bryce gets at night time. Bryce works as a stockbroker and uses cocaine on the weekends. He goes to the gym 5 days a week. He drinks OTC protein shakes
and sometimes injects steroids to help his training. He has lost 5kgs in the last 2 months.
Bryce has a family history of Inflammatory Bowel Disease.
- The most common cause of primary hyperaldosteronism is increased
aldosterone from:
A. Adrenal Adenoma
B. Idiopathic bilateral hyperplasia
C. Glomerulosa cells responsive to ACTH
D. Adrenal carcinoma
Idiopathic bilateral hyperplasia
Primary hyperaldosteronism occurs at
which site?
A - mineral corticoids Zona glomerulosa (aldosterone)
Which of the following specimens of the adrenal gland would be seen in patients on long term corticosteroids?
A - atrophy
B- normal
c- hyperplasia
A 59 year old male presents to the GP with a 24 hour history of dyspnoea and palpitations.
He has a 1 week history of facial swelling and worsening fatigue for the past 6 weeks.
He also has weight loss+, ↑ appetite.
No cough/fever
PMH: nil; meds: nil
On Examination:
Plethoric
Large face + neck
Pulse 100 bpm reg N volume
BP 178/105 mm Hg
Proximal myopathy
Varicosities trunk
Striae
What biochemical abnormality is most likely in this patient?
1. Hypokalaemia
2. Hypoglycaemia
3. Hyponatremia
4. Hypocalcaemia
5. Metabolic acidosis
- Hypokalaemia
- Hypoglycaemia - should be hyper
- Hyponatremia - should be hyper
- Hypocalcaemia - should be hyper
- Metabolic acidosis - should be alkalosis
A 45 year old male (shown below) presents with a 1 month history of worsening
headaches and increased sweating.
PMH/PSH- nil. No H/o of hypercalcaemia or nephrolithiasis.
F/H- H/o of hyperparathyroidism
17. What initial investigation would be most useful in this patient ?
1. IGF-1 level
2. CT brain
3. Blood glucose
4. Prolactin level
5. Calcium level
Most common cause of acromegaly is pituitary adenoma
IGF-1 level
Visual field test - bitemporal hemifeild
Would do MRI
