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MRCP - Part 1 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

Primary ammenorhea

A

Failure to establish menstruation by the time of expected menarche

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2
Q

Secondary ammenorrhoea

A

Cessation of menstruation in women with previous menses

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3
Q

Definition of oligomenoorhoea

A

Menses occuring less frequently than < 35 days

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4
Q

Causes of primary amenorrhoea in those with normal secondary sexual characteristics

A

Constituional delay
Pregnnacy
GU malformations
- imperforate hymen
- transverse septum
- absent vagina or uterus
Endocrine
- hypothyroidism
- hyperthyroidism
- hyperprolactinaemia
- cushings
- PCOS
Androgen insensitivity syndrome

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5
Q

Causes of primary ammenorhoea in those with no secondary sexual characteristics

A

POI
- chromoosomal irregularities (e.g. turners and gonadal agensis)
- chemotherapy
- pelvic irridation
- autoimmune disease
hypothalamic dysfunction
- stress / execive exercise / weight loss
- chronic systemic illness (uncontrolled DM, severe renal and cardiac disorders, coeliac, cancer, infection)
- hypothalamic or pituitary tumours
- cranial irridation
- head injury
- kallmans syndrome

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6
Q

Causes of ambigious genitalia

A

5-alpha-reductase deficiency
androgen secreting tumours
congenital adrenal hyperplasia

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7
Q

WHat is sheehans syndrome

A

Pituitary infarction after major obstetric haemorrhage

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8
Q

Pathology of T2DM

A

Peripheral insulin resistance (exists in overweight individuals)
Inadequate insulin secretion by pancreatic B cells
Decreased glucose transport into cells, causing hyperglycaemia

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9
Q

If you suspect LADA (latent autoimmune diabetes in adults) what do you measure

A

Islet cell antibodies

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10
Q

Impaired fasting glucose

A

> 5.6 but < 7

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11
Q

Impaired glucose tolerance

A

2hr post OGTT value of 7.8 - 11.1

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12
Q

HbA1c diagnostic of T2DM

A

> 48

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13
Q

HbA1c of pre diabetes

A

> 42

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14
Q

Examples of autonomic neuropathy

A

Postural hypotension
gastroporesis
Gustatory sweating

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15
Q

What is assosiated with more severe symptoms of exopthalmos

A

Smoking

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16
Q

Risk factors for thyroid eye disease

A

Genetics
Female
Smoking
Radioiodine therapy
Advanced age
Stress
Poorly controlled hypothyrodisim

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17
Q

What is secondary hyperthyroidism usually secondary to

A

A TSH secreting tumoura

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18
Q

What is subclinical hyperthyroidism

A

T3 AND T4 normal
TSH is supressed

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19
Q

Most common cause of thyrotoxicosis

A

Graves disease

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20
Q

Management thyrotoxicosis

A

Drugs
- carbimazole
- prophythiouracil
- CCBs
- BBs
Radioiodine therapy
Partial or total thyroidectomy

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21
Q

What is the most common cause of thyrotoxicosis in people over 60

A

toxic multinodular goitre

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22
Q

WHat can cause subclinical thyrotoxicosis

A

Thyroxine excess
Steriod therapy
Non thyroidal illness
Dopamine infusion

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23
Q

Autoantibodies in thyrotoxicosis

A

TSH receptor Abs
Antithyroglobulin abs
Antimicrosomal abs (75% graves disease)

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24
Q

What is proximal neuropathy in DM?

A

Patients develop severe burning/aching and lancinating pain in the hip and thigh
Followed by weakness and wasting of the thigh muscles, which often occur asymmetrically

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25
Q

Antibodies of hashimotos

A

Antithyroid microsomal
Antithyroglobulin antibodies

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26
Q

Treatment of graves in early vs late pregnancy

A

early - propothiouracil
late - carbimazole

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27
Q

What is urinary 5HIAA used to indicate

A

Neuroendocrine (carcinoid) tumours

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28
Q

Metabolic acidosis

A

Low Ph
Low HCO3

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29
Q

Metabolic alkalosis

A

High Ph
High HCO3

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30
Q

Respiratory acidosis

A

Low pH
higher PCO2

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31
Q

Respiratory alkalosis

A

High pH
Low PCO2

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32
Q

What is the anion gap

A

Sodium - (Chloride + Bicarb)

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33
Q

Normal anion gap

A

8-12

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34
Q

What does an anion gap of >20 indicate

A

an anion gap acidosis

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35
Q

What does an anion gap of 12 - 20 indicate

A

MAYBE an anion gap acidosis

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36
Q

Causes of non anion gap metabolic acidosis

A

Acute or chronic kidney disease
Renal tubular acidosis
GI loss

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37
Q

Causes of anion gap metabolic acidosis

A

Methanol intoxication
Uraemia
DKA
Paraldehyde
Isoniazid or iron overdose
Lactate
Ethylene glycol intoxication
salicylate overdose

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38
Q

Causes of chloride responsive metabolic alkalosis (i.e. will correct with NaCl)

A

Severe HF
Vomiting / NG suction
Loop and thiazide diuretics

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39
Q

Causes of chloride unresponsive metabolic alkalosis

A

primary hyperaldosteronism
Barter syndrome
Cushings syndrome
Depletion of magnesium

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40
Q

Causes of respiratory acidosis

A

Hypoventilation (accumulation of PCO2) due to problems with ventilation

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41
Q

Caues of respiatory alkalosis

A

Hyperventilation

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42
Q

What is pre proliferative diabetic retinopathy defined by

A

Cotton wool spots
Venous changes
Intra retinal vascular abnormalitie

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43
Q

WHat does background retinopathy comprise of

A

Haemorrhages
Hard exudates
Micro haemorrhages

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44
Q

What is proliferative diabetic retinopathy defined by

A

Retinal neovascularisation at the disc or elsewhere

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45
Q

What are the earliest lesions detected in diabetic retinopathy

A

Microaneurysms

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46
Q

Treatment of diabetic foot ulcer

A

Non removeable casting
To offload pressure

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47
Q

Diagnostic features of HHS

A

Glucose > 30
Serum osmolality >320
Profound dehydration
ph >7
Bicarb > 15
Small or absent ketonuria
Some alteration in consciousness

May also cause
Neurological signs
Hyperviscosity/increased risk of clots

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48
Q

When is PTH secreted

A

In response to low calcium

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49
Q

What is secondary hyperparathyroidism usually caused by

A

CKD
Low vit D

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50
Q

What is tertiary hyperparathyroidism usually caused by

A

Longstanding CKD

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51
Q

Features of hypercalcaemia

A

Weakness
Mood instability
Dehydrated
Abdominal pain

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52
Q

Cause of raised prolactin levels

A

Prolactin secreting pituitary tumour
Hypothyroidism
Acromegaly

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53
Q

Presentation of raised prolactin

A

Galactorrhoea
Ammenorhoea

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54
Q

What is the most common cause of hypercalcaemia in patients with non metastatic solid tumours and in some patients with NHL?

A

Secretion of parathyroid hormone related protein
Also called humeral hypercalcaemia of malignancy

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55
Q

Mutation of MEN1

A

mutation in MENIN gene

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56
Q

MEN1 predisposes patients to what

A

Pancreatic neuroendocrine tumours
Primary hyperparathyroidism (due to 4 gland hyperplasia)
Pituitary adenomas
Benign skin tumours - angiofibromas
High urinary calcium excretion

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57
Q

What do 80% of patients with MEN1 present with?

A

Hypercalcaemia due to hyperparathyroidism

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58
Q

Inheritance of familial hypocalcuiric hypercalcaemia and pathology

A

AD
Defect in the calcium sensing receptor

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59
Q

Features of familial hypocalcuric hypercalcaemia on investigation

A

Slightly elevated calcium and PTH levels
Urinary calcium excretion low

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60
Q

Mutation of MEN2a

A

RET gene

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61
Q

What does patients with MEN2a present with

A

Primary hyperparathyroidism (due to pituaitary adenoma)
Medullary thyroid cancer
Phaechromocytoma

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62
Q

What is pseudohyperparathyroidism and blood findings

A

Rare condition
caused by resistance to PT hormone
Results in low phosphate and calcium levels
High PTH

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63
Q

Treatment of prolactinoma

A

Dopamine agonists (usually cabergoline)

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64
Q

Diagnosis of cushings

A

1mg overnight dexamethasone suppression test
two midnight salivary cortisol levels
two 24 hr urinary free cortisol levels

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65
Q

Treatment of mild symptomatic subacute thyroiditis

A

Propranolol
NSAIDs

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66
Q

Presentation of subacute (De Quervians) thyroiditis

A

Mod-severe pain in thyroid often radiating to ears, jaw and throat
Several weeks Hx
Malaise
Low grade fever

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67
Q

What comes before subacute / de quervians thyroiditis

A

A viral illness

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68
Q

What is cranial Diabetes insipidus common after

A

Head injury

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69
Q

Presentation of cranial diabetes insipidus

A

Polyuria
Polydipsia
Hypernatraemia
NORMAL glucose

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70
Q

Two classes of diabetes inspidius

A

Cranial
Nephrogenic

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71
Q

Common causes of nephrogenic DI

A

Electrolyte derangements (hypercalcaemia, hypokalaemia)
Lithium

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72
Q

Diagnosis of diabetes inspidius

A

Water deprivation test

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73
Q

Treatment of cranial DI

A

Treating underlying cause
Ensuring adequate hydration
Sometimes high doses of DDAVP

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74
Q

Treatment of nephrogenic DI

A

Treating underlying cause
BFM may be trialled

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75
Q

Initial water deprivation test results in cranial DI

A

High plasma osmolality
Low urine osmolality

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76
Q

Urine osmolality post DDAVP in cranial DI

A

High > 600

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77
Q

Initital water deprivation test results in nephrogenic DI

A

High plasma osmolality
Low urine osmolality

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78
Q

Urine osmolallity post DDAVP in nephrogenic DI

A

Low urine osmolality

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79
Q

What is MEN1 assosiated with?

A

THE PS
Parathyroid tumours
Pitutary tumours
Pancreas tumours
Angiofibromas

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80
Q

What is MEN2a assosiated with

A

Parathyroid tumour
Phaechromocytoma
Medually thyroid cancer

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81
Q

WHat is Men 2b assosiated with

A

Phaechromocytoma
Medullary thyroid cancer
Marfanoid appearance
Mucosal neuromas

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82
Q

What is important in MEN2

A

Prophylactic Thyroidectomy

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83
Q

Genetics of MEN1

A

Defect in tumour suppressor gene
Menin gene
Chromosome 11
AD
10% of cases are sporadic

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84
Q

Genetics of MEN2

A

Mutations are rearranged during transfection (ret) proto-oncogene
AD
Defect in tumour supressir gene
Chromosome 10

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85
Q

What can both MEN syndromes be assosiated with

A

hypercalcaemia

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86
Q

Investigation for phaechromocytoma

A

24 hr urine catecholamines
Vanillymandelic acid
MIGB scan
MRI

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87
Q

What do medually thyroid cancers cause

A

Elevated calcitonin

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88
Q

Genetics of MODY

A

HNF1 alpha mutation

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89
Q

What cells does MODY affect

A

Beta cells of the pancreas

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90
Q

Delta cells of the pancreas prodcue what

A

somatostatin

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91
Q

Features of Batters syndrome

A

Increased urinary calcium excretion
Hypokalaemia
Metabolic alkalosis
Raised RAAS levels

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92
Q

What does secondary hyperparathyroidism occur from

A

CKD

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93
Q

Investigation for cushings

A

Overnight low dose dexamethsone suppression test

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94
Q

Presentation of porphyria cutanea tarda (PCT)

A

Hyperpigmentation and scarring
Blisterign and crusted lesions on back of hands and other areas that are prone to sun exposure
Hypertrichosis
Dark or reddish urine
Scarring alopecia
Oesotrens can precipitate development

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95
Q

Investigation findings of PCT

A

Substantial increase in porphyrins in plasma or urine
Assay of red bloods cells for UROD activity

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96
Q

Where is metformin metabolised

A

Liver

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97
Q

What drug can worsen thyroid eye disease

A

RAI

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98
Q

Treatment of amoidarone induced thyrotoxicosis

A

Proprothiouracil
+/- steriods if mixed picture

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99
Q

Diagnosis with hypercalcaemia and low urinary calcium excretion

A

Familial hypocalcuric hypercalcaemia (FHH)

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100
Q

Treatment of FHH

A

None

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101
Q

What does failing to concentrate urine post water deprivation test indicate

A

Diabetes insipidus

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102
Q

Diagnosis of insulinoma

A

Low glucose
High insulin
High C peptide

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103
Q

In weight restricted adults, what hormone is often high and why

A

Cortisol
Permanent state of physical stress on the body related to starvation or catabolic state

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104
Q

Pathology of hypercalcaemia in patients with carcinomas which are non metastatic

A

Secretion of parathyroid hormone related peptide by the tumour

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105
Q

Features of anaplastic thyroid carcinoma

A

Hard
Rapidly evolving
Regional lymphadenopathy
Stridor due to tracheal compression

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106
Q

What is the medical term for someone with a low BMI who has ammenorrhoea

A

Functional hypothalamic ammenorhoea (FHA)

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107
Q

Management of symptoms of hyperadrogenism in PCOS

A

co-cyprindiol

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108
Q

Features of androgen insensitvity syndrome

A

External female genitalia
Testes remain undescended
They do not menstruate at all

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109
Q

LH:FSH ratio in PCOS

A

Elevated

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110
Q

Features of turners syndrome

A

Short stature
Primary ammenorhoea
Delayed secondary sexual characteristics
Dyspraxia
Poor spatial awareness
Mild intellectual impariement
AS
Bicuspid aortic valve
Coarctation of the aorta
Increased risk of hypothryoidism

111
Q

FSH and LH in primary ovarian failure

A

Elevated

112
Q

FSH and LH in secondary ovarian failure

A

Normal or low

113
Q

Treatment of macroprolactinoma

A

Dopamine agonist

114
Q

Features of primary hyperaldosteronism

A

Hypokalaemia
Hypernatraemia
Metabolic alkalosis
Resistant HTN despite 3 agents

115
Q

What is primary hyperaldosteronism secondary to a aldosterone secreting adenoma called

A

Conns syndrome

116
Q

Investigation for primary hyperaldosteronism

A

aldosterone to renin ratio (HIGH)

117
Q

Features of Liddles syndrome

A

Profound HTN
Hypokalaemia
Alkalosis
Suppressed RAAS

118
Q

Genetics of turners syndrome

A

45X

119
Q

How does glucagon cause rapid reversal of hypoglycaemia

A

Acitvates adenylate cyclase

120
Q

Investigations of conns syndrome

A

Hypokalaemia
Suppressed renin
Elevated aldosterone to renin ratio
Saline suppression test
Adrenal venous sampling to localise the disease

121
Q

Why is linagliptin beneficial

A

Not renally excreted
No increased risk for weight gain or hypoglycaemiaT

122
Q

Thyroid cancer assosiated with hashiomotors

A

Thyroid lymphoma

123
Q

Gases of DKA

A

Metabolic acidosis
Raised anion gap

124
Q

Gases of addisons disease

A

Metabolic acidosiso
Normal anion gap

125
Q

WHat is adrenal insufficiency

A

Inability of the adrenal glands to produce mineralcorticoids e.g. aldosterone

126
Q

What is primary hypoadrenalism called

A

Addisons

127
Q

Causes of secondary hypoadrenalism

A

Exogenous steriod use (most common cause)
ACTH deficiency, most commonly caused by a pituitary lesion
Withdrawl of longstanding steriod therapy

128
Q

Presentation of CAH

A

Salt wasting
Ambigious genitalia

129
Q

Non classical CAH presentation

A

Presents later in life
Hyperadronagism
Elevated testosterone and 17-OH progesterone

130
Q

Which hormone is under continuous inhibition

A

Prolactin
By dopamine

131
Q

Characteristic skin rash of a glucagonoma

A

Necrolytic Migratory Erythema

132
Q

What is a glucangonoma

A

pancreatic alpha cell tumour that secretes glucagon

133
Q

Investigation for a glucangonoma

A

Plasma glucagon levels

134
Q

WHat test would confirm adrenal failure

A

Short synacthen test

135
Q

WHat hormone causes increased skin pigmennation when it is in excess

A

ACTH

136
Q

Most common functioning pituitary tumour

A

Prolactinoma

137
Q

What molecule lingers and continues to cause a mild acidosis after DKA

A

Beta hyroxybuutryate

138
Q

Treatment of gastroporesis in DM

A

Domperidone

139
Q

How does glucagon resolve bradycardia

A

Promotes the formation of cyclic AMP

140
Q

Treatment of ?DM in a pregnant patient who has no complications and fasting glucose < 7

A

1-2 weeks of lifestyle advice
If continues despite above, for metformin

141
Q

Metabolic gas of cushings

A

Hypocholeraemic metabolic alkalosis

142
Q

Increased incidence of which cancer is assosiated with acromegaly

A

CRC

143
Q

What would make you concerned of a presentation of acromegaly

A

Normal weight
Skin tag formation
Excessive acne
Carpal tunnel syndrome

144
Q

Investigation for acromegaly

A

ILGF1

145
Q

What odd blood test can be coupled in addisons diseaseE

A

Elevated TSH

146
Q

Diagnosis of graves disease

A

High TSH receptor antibody titres

147
Q

Treatment of hyponatraemia in patients with SiADH

A

Fluid restriction

148
Q

What part of the bone is impaired in osteoporosis

A

Trabecular bone

149
Q

What is reidels thyroiditis

A

Rare chronic inflammatory disease of the thyroid gland characterised by dense fibroiss that replaces the normal thyroid parenchyma

150
Q

Investigation for hyperadrenalism

A

Saline suppression test

151
Q

How does tamoxifen work

A

Oestrogen receptor antagonist and partial agonist

152
Q

Confirmatory test if you suspect hyperglycaemia secondary to acromegaly

A

GTT and GH levels
(high glucose and high GH)

153
Q

Treatment of acromegaly

A

Cabergoline (dopamine agonist)
Octerotide (somatostain analogue)
Lanreotide (somatostatin anaglogue)

154
Q

What is of significance of a rise in LH

A

Indicates ovulation will occur about 24 hrs after the LH peak

155
Q

What is MODY characterised by

A

Raised HDL cholesterol levels
Preserved insulin sensitivity
Low renal threshold for glucose (glycosuria)

156
Q

Is there any antibodies in MODY

A

No

157
Q

What is the direct precursor to oestrogen

A

Testosterone

158
Q

What is the prescence of maternal autoantibodies assosiated with

A

Miscarriage and pre term delivery

159
Q

Which HLA subtype is most assosiated with type 1 diabetes and autoimmune thyroid disease

A

DR3

160
Q

What renal condition can occur alongisde multiple autoimmune conditions and causes hypokalaemia?

A

Renal tubular acidosis type I

161
Q

Treatment of solitary thryoid nodule causing thyrotoxicosis

A

RAI

162
Q

Treatment of phaechromocytoma

A

urgent alpha blockade (phenoxybenzamine)
then B blockcade if required
Unilateral adrenectomy

163
Q

OGGTT and GH

A

Should suppress GH to an undetectable level

164
Q

WHat causes hirsituism in non classicical CAH

A

DHEA

165
Q

Presentation of congential homocystinuria

A

Skeletal (marfan like features, scoliosis, OP)
ocular (lens dislocation or myopia)
neurological/psychiatric difficulties
Predisposition to thrombosis
Later development
- thrombosis, CV or cerebrovascular disease

166
Q

Two categories of homocystinuria

A

Pyridoxine B6 resposnive or unresponsive

167
Q

Pathology of type I homocystinuria

A

Problem with enzyme cysathione beta synthase (CBS)
AR inheritance

168
Q

Blood tests of PCOS

A

Low sex hormone binding globulin (SHBG)
Raised free androgen index

169
Q

Treatment of hyperlipidaemia in hypothyroidism

A

Will resolve with thyroxine therapy

170
Q

How do bisphosphonates work

A

Inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis (cell death) and thereby slowing bone loss

171
Q

What hormone is chiefly responsible for epiphyseal fusion and cessation of growth

A

Oestrogen

172
Q

Examples of drugs causing hyperprolactinaemia

A

Haloperidol
Dopamine receptor agonists
Antidepressants
Verapamil
Metyhldopa
Opiates
H2 antagonists

173
Q

WHat hormone is assosiated with endometrial shedding

A

Progesterone

174
Q

Example of treatment for severe OP

A

Denosumab

175
Q

How is melatonin naturally synthesised

A

Increased serotonin N-acetyltransferase

176
Q

Most common S/Es of HRT

A

Breast tenderness
Bloating
Nausea
Leg cramps
Headache

177
Q

Hyperlipoproteinaemia type IB has mutations for the gene coding for which protein

A

Apolipoprotein CII (APO CII)

178
Q

When does barter syndrome present

A

< 5 yrs old

179
Q

Prednisolone dose vs hydrocortisone dose

A

Pred dose - 25% of hydrocortisone dose

180
Q

Mechanism of action of levonogestrel in emergency contraception

A

Delays ovulation

181
Q

What is a serious potential S/E of anti thyroid drugs

A

Agranulocytosis

182
Q

Ideal insulin regime for a new T1DM

A

Basal bolus regime

183
Q

What is a pituitary apoplexy

A

Haemorrhage or infarction of the pituitary gland
Usually occurs in a pre-exisiting adenoma

184
Q

Presentation of pituitary apoplexy

A

CN palsies
Headache
Collapse
Hypotension

185
Q

Investigations of pituitary apoplexy

A

Pituitary hormone screen
MRI

186
Q

Treatment of pituitary apoplexy

A

IV steriods

187
Q

Primary cause of DKA

A

Lipolysis

188
Q

Over 90% of people who have hypothyroidism have what

A

Dyslipidaemia

189
Q

Assosiations of myoxedema coma (profound hypothyroidism)

A

Reduced T4
High TSH
Hypothermic
Unconscious
Heart failure

190
Q

Antibodies assosiated with adrenal insufficiency

A

21-hyroxylase antibodies
Not always positive when measured

191
Q

Blood tests of PCOS

A

High LH (ratio of LH to FSH high)
Normal FSH
Normal oestrogen
High testosterone
Low SHBG

192
Q

Genetics of klenfielters syndrome

A

XXY genotype
(extra X chromosome)

193
Q

Presentation of klenfielters syndrome

A

Usually diagnosed in late pubertal or adult life because of delayed sexual development or infertility
Tall stature
Gynaecomastia
Small testicular volumes
Infertility

194
Q

Investigation for klenfelters syndrome

A

Chromosomal analysis

195
Q

What is the common presentation of pagets disease

A

High ALP levels
Mixed lytic and sclerotic lesions
In a man who is otherwise systemically well

196
Q

Treatment of pagets disease

A

Bisphosphonates

197
Q

What is kallman syndrome assosiated with

A

A decreased sense of smell

198
Q

Genetics of kallman syndrome

A

Familial
X linked

199
Q

Features of kallman syndrome

A

Isolated GnRH deficiency
Hypogonadism (testosterone < 6)
Small and soft testes
Sparse axillary and pubic hair

200
Q

Example of sulphonyura

A

Gliclazide

201
Q

Example of GLP1 inhibitor

A

Semgaglutide
Liraglutide

202
Q

WHat diabetic drug should be stopped in patients who have an unstable circulation post MI?

A

Metformin

203
Q

Investigation for ACTH and GH deficiency in patients with suspected hypopituitism

A

Insulin stress test

204
Q

WHat causes hypokalaemic periodic paralysis

A

muscle voltage gated calcium channel mutation

205
Q

WHat can long term treatment with lithium cause

A

Frank hypothyroidism

206
Q

Who are GLP1 inhibitors contraindicated in?

A

People with gastroporesis

207
Q

Treatment of thyroid lymphoma

A

NOT treated by surgical excision
Chemotherapy and external beam radiotherapy

208
Q

WHat part of the nephron is affected in CDI

A

Cortical and medullary collecting tubules

209
Q

Investigation of conns syndrome

A

Aldosterone to renin ratio
(elevated aldosterone, suppressed renin)

210
Q

WHat kind of drug is dapagliflozin

A

an SGLT2 inhibitor

211
Q

How does dapagliflozin work

A

Increases renal glucose excretion

212
Q

Time for rpt HbA1c

A

3 months

213
Q

Cushings disease vs cushings syndrome

A

Disease - excess ACTH from anterior pituitary
Syndrome - excess cortisol from any source

214
Q

S/Es pitoglitazone

A

HF due to water retention

215
Q

How does metaclopramide cause hyperprolactinaemia

A

Binds to D2 receptors on pituitary lactotropes

216
Q

How does sarcoidosis cause hypercalcaemia

A

Increased hydroxylation of vitamin D

217
Q

Mechanism of action of silagliptin

A

DDPIV inhibitor

218
Q

WHat mutation is seen in MODY

A

HNF 1 aplha mutation

219
Q

Best imaging modality to assess for retrosterna extension of a thyroid goitre

A

CT chest

220
Q

What happens to the urine osmolality post vasopressin administration in CDI

A

Rises > 50%

221
Q

What kind of DI does lihtium cause

A

nephrogenic

222
Q

What happens to the urine osmolality post vasopressing administration in NDI

A

The urine will fail to concentrate fully
Rise < 45%

223
Q

What happens in men2b as opposed to men 2a

A

marfanoid appearance

224
Q

Treatment of MODY

A

GLICLAZIDE

225
Q

Which thyroid cancer has a very low risk of recurrence

A

Papillary

226
Q

WHat is gietleman syndroem

A

Hypokalaemic metabolic alkalosis
Normal BP
Low calcium excretion

227
Q

Inheritance of polyglandular syndrome 1

A

AR

228
Q

Presentation of polyglandular syndrome 1

A

Hypoparathyroidism (90%)
Mucocutaneous candidasis
Adrenal insufficiency (60%)
Primary gonadal failure
Primary hypothyroidism
Hypopituitism/diabetes inspidus (rarely)
Malabsorption
Pernicious anaemia
Chronic active hepatitis

229
Q

Inheritance of polyglandular syndrome 2

A

AR or AD or polygenic

230
Q

Presentation of polyglandular syndrome 2

A

Adrenal insufficency (all patients)
Hypothyrodisim
T1DM
Gonadal failure
Diabetes insipidus (rare)
Vitiligo
Myasthenia gravis
alopecia
ITP
Pernicious anaemia

231
Q

Treatment of secondary hyperparathyroidism

A

1-aplha calcidol

232
Q

How is the diagnosis of carney complex made

A

Two features out of the following (or one in a first degree relative)
- spotty skin pigmentation
- myxoma
- endocrine tumours
- PMS

233
Q

Genetics of carney complex

A

AD
Inactivating mutation of protein kinase A on chromosome 17

234
Q

Which hormone drives the development of secondary sexual characteristics

A

Dihyrostestosterone

235
Q

What test is the best for investigation of thyroid size

A

USS

236
Q

When does psuedo cushings syndrome occur

A

Response to heavy alcohol consumption and obesity
Assosiated with elevated in cortisol but not to the extent that is seen in cushings syndrome itselt

237
Q

What would suggest milk alkali syndrome

A

Young age
Dyspepsia
Raised bicarbonate

238
Q

What is gordons syndrome also known as

A

Pseudohypoaldosteronism (mimics hypoaldosteronism)

239
Q

Pathology of gordons syndrome

A

Failure of response to aldosterone
Aldosterone elevated due to lack of feedback inhibition

240
Q

Presentation of gordons syndrome

A

short stature
intellectual impariement
dental abnormalities
Muscle weakness
Severe HTN by 3rd decade of life
Low fractional excretion of NA
Normal renal function
Hypercholeraemic metabolic acidosis
Low renin
High aldosterone
Hyperkalaemia

241
Q

What are the features of von Hippel-Lindau disease

A

CNS and retinal hemangioblastomas
Renal cysts and carcinomas (occuring later)
Phaeochromocytoma
Pancreatic tumours (50% non functioning)

242
Q

What does thyroid eye disease predispose your eyes to and why

A

Optic nerve compression
swelling of extraorbital muscles and orbital fat compresses the nerve

243
Q

Treatment to induce ovulation in ladies with PCOS

A

Clomiphene

244
Q

Mechanism of action of ondansetron

A

5-HT3 antagonist

245
Q

What nerve is most suspceptible to damage during thyroid surgery and why

A

Right recurrent laryngeal nerve
Close to the bifructation of the right inferior thyroid artery

246
Q

Mechanism of action of carbimazole

A

Thyroid perioxidase inhibitor

247
Q

What DEXA scan finding confirms osteoporosis

A

T score of - 2.5 SD or below

248
Q

Treatment of osteoporosis

A

Aledronate (significant GI S/Es)
Vitamin D
Calcium

249
Q

Secondary prevention of osteoporosis

A

Oral bisphosphonate
Second line; alfacalcidol or calcitriol

250
Q

Biochemical findings of pagets disease

A

Normal calcium
Normal phosphate
Raised ALP

251
Q

RBCs in multiple myeloma

A

Rouleux formation

252
Q

Levels of what are indicative of poor prognosis in multiple myeloma

A

Raised B2-microglobulin
Low levels of albumin

253
Q

S/E sildenafil

A

Blood discolouration of eyes

254
Q

Action of dapagliflozin

A

SGLT2 inhibitor

255
Q

Mechanism of action of gliclazide

A

Increases glucose independent insulin release

256
Q

What type of drug is gliclzide

A

Sulphonyurea

257
Q

Treatment of raynauds

A
  1. Nifedipine
  2. Sildenafil
258
Q

Guidelines for hydrocortisone and pred dosing in adrenal insufficiency

A

15-25mg/day in two divided doses of hydrocortisone
pred is 4x more potent than hydrocortisone

259
Q

How to assess prognosis post operatively after removal of a phaechromocytoma

A

24 urinary catecholamines 2 weeks post removal

260
Q

What type of receptor is the insulin receptor

A

Tyrosine kinase receptor

261
Q

How does insulin primarily work

A

Inhibition of gluconeogenesis

262
Q

What causes osteomalacia

A

Vitamin D deficiency

263
Q

Alongside single joint disease, what can pagets disease present with

A

Hearing loss

264
Q

What maternal pituitary hormone is recognised to fall in pregnancy

A

GH

265
Q

MOST COMMON TYPE OF MODY

A

MODY-3

266
Q

Mode of action of bisphosphonates

A

Impairment of osteoclast bone adherence

267
Q

Which antibodies are the likely cause of neonatal hyperthyroidism

A

Thyrotropin receptor Abs

268
Q

Drugs that reduce thyroxine absorption

A

Omeprazole
PO iron
Antacids
Bile acid resins

269
Q

How does calcitonin work

A

Inhibitis osteoclast activity

270
Q

Which malignancy is most at risk of in patients with hashimotos

A

NHL

271
Q

What is the initital driver for the development of T2DM

A

Ectopic fat deposition

272
Q

What vitamin deficiency is seen commonly in patients following gastric bypass surgery

A

zinc

273
Q

WHat causes increased urination during drinking alcohol

A

Decreased aquaporin 2 channels

274
Q

How does metofrmin primarily reduce blood glucose

A

Reduces hepatic glucose output

MRCP - Part 1 (20 decks)

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