Endocrine

Question 1

Which DM meds contraindicated in HF

Answer 1

Pioglitazone

Question 2

Factors that decrease HbA1c

Answer 2

sickle cell, GP6D Def, hereditary spherocytosis, haemodialysis

Question 3

Factors that increase HbA1c

Answer 3

vit B12/folic acid def, IDA, splenectomy

Question 4

sulfonylureas mechanism

Answer 4

gliclzide, glipizide, tolbutamide. bind to ATP-dependent potassium channel of pancreatic beta cells

Question 5

Target HbA1c life style

Answer 5

48mmol/L 6.5%

Question 6

Target HbA1c life style + metformin

Answer 6

48mmol/L 6.5%

Question 7

target HbA1c DM control second agent OR receiving meds which may cause HYPOglycaemia

Answer 7

53mmol/L 7%

Question 8

Dx DM2

Answer 8

Sx fasting glucose >=7mmol/L
Random glucose >=11mol/L or after 75g OGTT
HbA1c >= 48mmol/L (6.5%)

Question 9

When to add 2nd drug T2DM

Answer 9

HbA1c rises to 58mmol/L (7.5%)

Question 10

Aldosterone electrolyte

Answer 10

low potassium, high sodium, increase blood volume, high BP

Question 11

Dx DKA

Answer 11

glucose >11mmol/l OR known DM; pH < 7.3 or bicarb <15mmol/l, ketones >3mmol/l OR urine dip stick ++ ketone

Question 12

electrolyte in Conn’s

Answer 12

hyperaldosteronism
hypernatraemia
Hypokalaemia
metabolic alkalosis (proton loss)

Question 13

when to add DPP-4 inhibitor

Answer 13

only if pt does NOT tolerate triple tx

causes WEIGHT LOSS

Question 14

Subclinical hypothyroidism definition

Answer 14

TSH high, normal T3+T4
ASX

Question 15

Mx subclinical hypothyroidism

Answer 15

TSH >10mU/L + T3/4 normal: offer levothyroxine if elevated 2 separate occasion taken 3months apart

TSH 5.5-10 + normal T3/4:
<65yrs offer 6month trial of levothyroxine
if >80yrs-> watch + wait

Question 16

Pituitary cause of hypothyroidism: lab result

Answer 16

low TSH + T3+ T4

(LOW EVERYTHING)

Question 17

Aim of levothyroxine

Answer 17

normalisation of TSH level

Question 18

What to do with iron + levothyroxine

Answer 18

levothyroxine absorption decreases with iron-> give at least 2 hours apart

Question 19

What is Hashimoto’s thyroiditis
What does it cause HYPER/ HYPOthyroidism?

Answer 19

Autoimmune thyroiditis

transient thyrotoxicosis in acute phase BUT later results in HYPOTHYRODISM

Question 20

Ab in Hashimoto’s thyroiditis

Answer 20

anti TPO, anti- thyroglobulin

Question 21

What is subacute thyroiditis
What does it cause HYPER/ HYPOthyroidism?

Answer 21

Typically occurs follwoing viral infection

De Quervain’s thyroiditis

Phase 1: hyperthyroidism, painful goitre, high ESR
2. Euthyroid
3. Hypothyroidism
4. Thyroid structure and function- normal

Question 22

Phases of subacute thyroiditis

Answer 22

1. 3-6 weeks: hyperthyroidism, PAINFUL GOITRE, raised ESR
2. 1-3 wks: euthyroid
3. wks- months: hypothyroidism
4. back to normal

Question 23

Which disease causes painful goitre

Answer 23

subacute thyroiditis/ De Quervain’s thyroiditis

Question 24

Mx subacute thyroiditis

Answer 24

self limiting
analgesia: NSAIDS, aspirin

severe: steroid

Question 25

Most common cause of thyrotoxicosis

Answer 25

Grave's disease

Question 26

Ab found in Grave's disease

Answer 26

TSH receptor stimulating Ab Anti- TPO Ab

Question 27

Mx Grave's disease

Answer 27

1. initial sx mx: propranolol 2. antithyroid meds: carbimazole 40mg 3, Radioidodine- relapse follow ATD OR resistant to ATD - CI: agre, <16yrs, thyroid eye disease-> may worsen

Question 28

Mx Thyroid storm

Answer 28

1st line: BB- iv propranolol (CI: COPD, ASthma), calcium channel bl can be used ATD: Methimazole/ Propylthiouracil PTU Lugol's iodine dexamethasone Plasma exchange

Question 29

Primary hyperaldosteronism aka, sx esp electrolyte

Answer 29

Conns disease Hyperkalaemia, hyponatraemia, hypertension metabolic alkalosis

Question 30

Addison disease , sx, mx

Answer 30

Primary adrenal insufficiency Low sodium, high potassium, low BP, metabolic acidosis, low BM Give hydrocortisone, fludrocortisone. Sick day rule, double dose of hydrocortisone

Question 31

Affects of adrenal and what disease is insufficiency

Answer 31

Increases sodium, decreases potassium, increases BP, increases BM. Causes Addisons disease

Question 32

Normal levels of cortisol 9am

Answer 32

If cortisol >500nmol/l unlikely abonormal If btw 100-500 will need short sync than test If <100 then def. Abnormal

Question 33

Ix for addisons disease

Answer 33

Primary aldrenal insuffficiency Check 9am cortisol >00nmol/l normal Btw 100-500nmol/l then need short sync than test If <100nmol/l then def. Abonormal Short synectan test take cortisol 30min before giving sync then and 30min after Is cortisol level is still low then do of primary adrenal insufficiency as synacthen is copy of ACTH

Question 34

Ix for conns disease

Answer 34

1st line:aldosterone:renin ratio If primary- high aldosterone:low renin If secondary high aldosterone &renin

Question 35

Mx of conns disease\ hyperaldosteronism

Answer 35

Adrenal adenoma- lap adrenalectomy If bilateral adrenal, hyperplasia- needs aldosterone ATG- spironolactone

Question 36

Diabetic neuropathy mx

Answer 36

1st line: amitriptyline, duloxetinem gabapentin, pregabalin 2nd line: tramadol rescue Try others first before changing

Question 37

AutoAb found in DM1

Answer 37

Anti-glutamic acid decarboxylase, islet cell AB, insulin autoantibody , insulinoma ass 2 AutoAb. C -peptide low

Question 38

Dx of impaired fasting glycemic

Answer 38

Fasting >6.1 but <7mmol/l After 2hours <7.8mmol/l

Question 39

Impaired glucose tolerance dx

Answer 39

Fasting <7 mmol/l 2hour >7.8 mol/l but <11mmol/l

Question 40

Visual disturbances in prolactinoma

Answer 40

Bitemporal hemianopia or upper quadrant quadrantopia

Question 41

Mx prolactinoma

Answer 41

>1cm macroadenoma- likely need surgery Or medical mx Dopamine AG- cabergoline or bromocriptine inhibit release of prolactin from pituitary gland

Question 42

Pheochromocytoma mx & dx

Answer 42

Alpha blocker- phenoxybenzamine 1st then beta blocker Dx: 4 hr urine metanephrines 1st line or 24 hour collection of catechilamine

Question 43

Which drug can cause gynaecomastia

Answer 43

Spironolactone, anabolic steroid,

Question 44

Regulation of prolactin Mx of hyperprolactin level

Answer 44

Dopamine inhibit release of prolactin TRH therefore hypothyroidism stimulates prolactin release Mx: dopamine AG: cabergoline, bromocriptin Treat hypothyroidism

Question 45

Indication of anti thyroid drug in pregnancy

Answer 45

PTU can use in 1st trimester Methimazole can use in 2nd trimester Radioiodine contraindicated

Question 46

Antibodies of Graves’ disease

Answer 46

Graves’ disease - hyperthyroidism AutoAb against thyroid stimulating receptor in follicular cell TSH-R Ab, anti-thyroid peroxidase Ab

Question 47

What needs to be taken into consideration when taking thyroxine?

Answer 47

Iron decreases absorption of thyroxine therefore taken 2 hours apart

Question 48

Causes of pri, sec, tertiary hyperparathyroidism

Answer 48

Primary: solitary adenoma of parathyroid gland Sec: CKD, vit D deficiency-> chronically low calcium level stimulates parathyroid hormone Tertiary: due to long term secondary parathyroidism, proliferation of parathyroid gland cells therefore produce excessive path even if level normalised

Question 49

Mx hypercalcaemia

Answer 49

1st line: ivi/ loop diuretics Increase GI excretion- glucocorticoids Prevent bone resorption- bisphosphonat4, calcitonin

Question 50

Causes of Conn’s disease

Answer 50

Hyperaldosteronism Primary- adrenal adenoma, hyperplasia Secondary: outside adrenal Renin dependent- low Bp eg HF, cirrhosis, renal artery stenosis

Question 51

Causes of hyperaldosteronism

Answer 51

Primary: adrenal axis- idiopathic hyperaldosteronism, conns syndrome- bilateral idiopathic adrenal hyperplasia Secondary: outside adrenal low BP, cirrhosis, renal arthritis stenosis