Endocrine

Question 1

Test for phaechromocytoma

Answer 1

24 hour urinary collection for metanephrines

Question 2

Management of phaeochromocytoma

Answer 2

Surgery - Stabilisation required first:
1. Alpha blocker (phenoxybenzamine) and then
2. Beta blocker

Question 3

Mechanism of action of GLP 1 mimetics (eg exenatide)

Answer 3

Increase insulin secretion and inhibit glucagon secretion

Question 4

Mechanism of action of DPP 4 inhibitors eg vildagliptin

Answer 4

Increase levels f incretins (GLP 1 and GIP) by decreasing their peripheral breakdown

Question 5

ECG abnormality associated with hypercalcaemia

Answer 5

Shortened QT interval

Question 6

ECG abnormalities associated with hypokalaemia

Answer 6

U waves
Small or absent T waves
Prolonged PR interval
ST depression
Long QT

Question 7

Antibodies seen in hashimotos thyroiditis

Answer 7

Anti TPO
Ati Tg antibodies

Question 8

What can cause HBA1c to be lower than expected

Answer 8

Sickle cell anemia
G6PD deficiency
Heriditary spherocytosis
Haemodylasis

Due to reduced red blood cell lifespan

Question 9

What can cause higher than expected levels of HbA1c?

Answer 9

Vitamin B12/Folate deficiency
Iron deficiency anaemia
Splenectomy

Due to increased red blood cell lifespan

Question 10

Definition of impaired fasting glucose

Answer 10

Fasting glucose greater than or equal to 6.1 but less than 7

Question 11

Definition of impaired glucose tolerance

Answer 11

Fasting glucose less than 7 and OGTT 2 hour value greater than or equal to 7.8 but less than 11.1

Question 12

Treatment for acromegaly

Answer 12

Trans sphenoidal surgery
If inoperable then:
1. Somatostatin analogue eg octreotide
2. Pegvisomant (GH receptor antagonist)
3.Dopamine agonist eg bromocriptine only effective in a minority.

Question 13

Treatment for a prolocatinoma?

Answer 13

Dopamine agonist eg cabergoline or bromocriptine
Surgery if this fails

Question 14

How often should HBA1c be checked?

Answer 14

Every 3 - 6 months until stable and then 6 monthly.

Question 15

What is the 10% rule in phaechromocytoma?

Answer 15

10% are bilateral
10% are malignant
10% are extra adrenal

Question 16

Adverse affects of pioglitazone

Answer 16

Weight gain
Liver impairment
Fluid retention
Increased risk of fractures
Increased risk of bladder cancer

Question 17

What is the starting rate of IV insulin for DKA

Answer 17

0.1 units/kg/hour

Question 18

What are the causes of primary hyperaldosteronism?

Answer 18

1. Bilateral idiopathic adrenal hyperplasia (60 - 70% of cases)
2. Adrenal adenoma (20 - 30% of cases)
3. Unilateral hyperplasia
4. Familial hyperaldosteronism
5. Adrenal carcinoma

Question 19

Who should be screened for primary hyperaldosteronism?

Answer 19

1. Hypertension with hypokalaemia
2. Treatment resistant hypertension

Question 20

What is the first line investigation for primary hyperaldosteronism?

Answer 20

Aldosterone/renin ratio

Question 21

What will the renin aldosterone ratio show is patients with primary hyperaldosteronism?

Answer 21

High aldosterone and low renin

Question 22

What is the management for bilateral adrenocorticol hyperplasia?

Answer 22

Aldosterone antagonist (spironolactone)

Question 23

Treatment for toxic multinodular goitre

Answer 23

Radioiodine therapy

Question 24

Nuclear scintigraphy results in toxic multinodular goitre

Answer 24

Patchy uptake

Question 25

Nuclear scintigraphy results in graves disease

Answer 25

Diffuse enlargment of both thyroid lobes

Question 26

Blood gas result in cushings syndrome

Answer 26

Hypokalaemic metabolic alkalosis

Question 27

First line test to confirm cushings syndrome

Answer 27

Overnight (low dose) dexamethasone suppression test - Most sensitive test. Patients with cushings - no supression of morning cortisol

Question 28

What tests allows you to localise the pathology resulting in cushings syndrome

Answer 28

1. 9am and midnight ACTH + cortisol levels. If ACTH supressed then a non ACTH dependant cause is likely (eg adrenal adenoma) 2. High dose dexamethasone supression test

Question 29

Antibodies in graves disease

Answer 29

Anti TPO TSH receptor stimulating antibodies

Question 30

What medication interacts with levothyroxine

Answer 30

Iron

Question 31

What is the optimal management of thyrotoxicosis in patients who are pregnant or planning a pregnancy?

Answer 31

Thyroidectomy then thyroxine replacment

Question 32

Blood gas results in an addisonian crisis

Answer 32

Metabolic acidosis with low sodium and raised pottasium

Question 33

Triad of MEN 2A

Answer 33

Medullary thyroid cancer Primary hyperparathyroidism Phaeochromocytoma

Question 34

Triad of MEN1

Answer 34

Hyperparathyroidism Pituitary adenoma (usually prolactinoma) Pancreatic islet cell tumour

Question 35

Diagnosis of adrenal failure

Answer 35

short synacthen test. In adrenal failure plasma cortisol will not rise to above 550

Question 36

What is the mechanism of action of sulfonlyureas

Answer 36

Stimulated insulin secretion for the beta cells of the islets of langerhans

Question 37

What is the mechanism of action for DPP4 inhibitors such as sitagliptin

Answer 37

Inhibit DPP4 which destroys incretics. Allsos increase in incretins which stimulate the release of insulin and inhibit the release of glucagon.

Question 38

What are the results of FSH, LH and testosterone in kallmans syndrome

Answer 38

Low LH, FSH and low Testosterone

Question 39

Management of a thyroid strom

Answer 39

IV Propanolol Anti thyroid durgs et Methimazole or propylthiouracil Lugols iodine Dexamthasone

Question 40

Treatment for myxodema coma

Answer 40

IV thyroid replacement IV fluids IV corticosteroids