Endocrine Flashcards
30 year old girl is getting attacks of dizziness, headache, sweating, palpitations, cool clammy hands, blurred vision. BP is 220/110, pulse 120. Bloods show hyponatremia and hyperglycaemia (10). Has had previous episodes but this is much worse. Diagnosis?
a) Solitary brain lesion
b) Phaeochromocytoma
c) Hypoaldosterone
d) Cushing’s syndrome
Phaeochromocytoma
Guy has MVA, has a concussion. Through the night is peeing like crazy and thirsty. Dx?
a) Nephrogenic diabetes insipidus
b) Diabetes mellitus
c) Cranial diabetes insipidus
d) SIADH
Cranial diabetes insipidus
High urine Na+, normal serum K+, low serum Na+. Dx?
a) Nephrogenic diabetes insipidus
b) Diabetes mellitus
c) Cranial diabetes insipidus
d) SIADH
Lots of water in serum.. but not enough water in the urine. –> SIADH
Woman with previous gestational diabetes. Postnatal testing shows normal fasting glucose levels. Has presented with several similar episodes of hypoglycaemia. Blood tests show high insulin levels, low C peptide. What is the likely cause of hypoglycaemia?
a) Insulin administration (exogenous)
b) Metformin use (exogenous)
c) Insulinoma
d) Sulphonylurea use
Insulin administration (exogenous)
22 year old female athlete getting fatigue. New dark skin pigmentation “like big freckles” on arms. hyponatraemia, hyperkalaemia (6.5), high creatinine + urea, hypercalciuria. What test best confirms your diagnosis?
a) ACTH stimulation test (synacthen)
b) Dexamethasone test
c) Random serum cortisol
d) 24h urine cortisol
e) Thyroid function tests
f) Adrenal antibodies
g) CT adrenals
h) CT abdomen
i) ACTH levels
j) Urinalysis
ACTH stimulation test
Addison’s disease = autoimmune process –> primary adrenal hypofunction
- Low aldosterone–> low Na+, high K+
- Low cortisol –> hypoglycaemia, hypotension
- High ACTH –> stimulate melanocytes –> hyperpigmentation
Women with weight loss, sweating, palpitations. Low TSH and homogenous/diffuse uptake on thyroid. What treatment do you give along with metoprolol/propanolol?
a) Total thyroidectomy
b) Carbimazole
c) Prednisone
d) Radioactive iodine
e) Lugol’s iodine
Carbimazole
Lady with hypertension, oedema, high renin AND high aldosterone, high Na, low K. Cause?
a) Primary hyperaldosteronism
b) Secondary hyperaldosteronism
Secondary
Primary would have low renin
Aldosterone –> Na retention, K secretion
Young guy with low K, and high BP 198/118. Asymptomatic. Normal sodium. What is the test that will most likely give you the diagnosis?
a) Renin and aldosterone
b) Urea and creatinine
c) UPCR
Super high blood pressure and low potassium….
Prob renin + aldosterone
32 year old male sales manager/athlete with resistant hypertension, otherwise healthy. No FHx of hypertension. O/E normal apart from high BP. Urinalysis negative. FBC normal. Renal function tests: hypokalaemia with normal creatinine. Diagnosis?
a) Hyperaldosteronism
b) Hypoaldosteronism
c) Cushing’s
d) Coarctation of the aorta
e) Anabolic steroid use
f) Addison’s disease
g) Acromegaly
h) Erythropoietin supplements
i) Essential hypertension
j) Glomerulonephritis
k) Pheochromocytoma
Hyperaldosteronism
Retired police cop lady. Tired, high calcium, normal PO4, everything else normal. What do you next test?
a) Vitamin D
b) Parathyroid hormone levels
c) Retest calcium
d) ALP
e) Bone scan
Parathyroid hormone levels
35 year old lady, periods stopped 3 months ago. She has also noticed extra fine hair growth on her face. On exam she has thin arms and legs, but a large abdomen. She also has a moon face and striae on her abdomen. Negative pregnancy test. What investigation would best support your clinical diagnosis?
a) 24 hour urinary cortisol
b) High dose dexamethasone suppression test
c) Serum ACTH
d) Random serum cortisol
e) Bitemporal petrosal sampling
24 hour urinary cortisol
IT WOULD BE LOW!!! DOSE DEX SUPPRESSION TEST
Painless 2cm thyroid nodule on R side plus cough, fever. What do you do to investigate the nodule?
a) Check thyroid antibodies
b) CXR
c) Thyroid USS
d) Excision Biopsy
USS –> fna biopsy is suspicious
Most common cause of primary hyperparathyroidism?
a) Single adenoma in parathyroid gland
b) Multiple adenomas
c) Generalised hyperplasia of gland
d) Ectopic
Single adenoma in parathyroid gland
Most common cause of DKA?
a) Type 1 diabetic missing insulin
b) First time presentation of type 1 diabetes
c) First time presentation of type 2 diabetes
d) Infected foot in insulin-dependent diabetic
e) Steroid use
First time presentation of type 1 diabetes
Elevated TSH. T3 low and T4 low-normal. Dx?
a) Primary hypothyroidism
b) Secondary hypothyroidism
Primary hypothyroidism
