Endocrine

Question 1

Impaired glucose tolerance (IGT) is defined as … ( fasting plasma glucose and oral glucose tolerance test (OGTT) )

Answer 1

fasting plasma glucose less than 7.0 mmol/l
and
OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Question 2

An OGTT result below 11.1 mmol/l but above 7.8 mmol/l indicates

Answer 2

that the person doesn’t have diabetes but does have IGT.’

Question 3

According to WHO guidance, an HbA1c of greater than or equal to …% (… mmol/mol) is diagnostic of diabetes mellitus

Answer 3

6.5%, (though less than this doesn’t exclude diabetes)

48 mmol/mol

Question 4

7 situations where you can’t use HbA1c for diagnosis:

Answer 4

haemoglobinopathies
haemolytic anaemia
untreated iron deficiency anaemia
suspected gestational diabetes
children
HIV
chronic kidney disease

Question 5

Features of subacute (de Quervain’s) thyroiditis:

Answer 5

raised T4, low TSH, accompanied by tender goitre and raised ESR. A globally reduced uptake on technetium thyroid scan is typical

Question 6

Management of subacute thyroiditis?

Answer 6

Usually self limiting; steroids if severe. Pain may respond to aspirin or other NSAIDs.

Question 7

Which receptor ro thaizaolidinediones (eg pioglitazone) act on?
What side effects does it have?

Answer 7

PPAR-gamma
peripheral oedema/fluid retention (so contraindicated in heart failure)
Liver failure (monitor LFTs)
weight gain
Increased risk of bladder cancer

Question 8

Management of Addison’s

Answer 8

hydrocortisone (glucocorticoid) + fludrocortisone (mineralocorticoid)

Question 9

Management of intercurrent illness with Addison’s?

Answer 9

(in simple terms) the glucocorticoid dose should be doubled

Question 10

Inheritance of MODY (maturity onset diabetes of the young)?

Genes involved?

Answer 10

Strong family history, autosomal dominant condition.
Doesn’t present with ketoacidosis.
Glucokinase or HNF-1 alpha genes

Question 11

Most common cause of thyrotoxicosis in the UK?

Answer 11

Graves’ disease (50-60% of cases)

Question 12

What happens in the late phase of Hashimoto’s thyroiditis?

Answer 12

Hypothyroidism can develop

Question 13

What’s the best investigation to confirm the suspected diagnosis of Addison’s?

Answer 13

Short ACTH/synacthen test

Question 14

4 associated electrolyte abnormalities found in Addison’s?

Answer 14

• hyperkalaemia
• hyponatraemia
• hypoglycaemia
• metabolic acidosis

Question 15

Renal colic, increased PTH (or can be normal) and increased calcium (with normal serum urea and electrolytes) is suggestive of…

Which is associated with?

Answer 15

primary hyperparathyroidism (most commonly due to a solitary adenoma)

Associations:
hypertension
multiple endocrine neoplasia: MEN I and II

Question 16

Features of primary hyperparathyroidism:

Answer 16

‘bones, stones, abdominal groans and psychic moans’
polydipsia, polyuria
peptic ulceration/constipation/pancreatitis
bone pain/fracture
renal stones
depression
hypertension

Question 17

Features seen in Graves’ but not in other causes of thyrotoxicosis:

Answer 17

eye signs (30% of patients): exophthalmos, ophthalmoplegia
pretibial myxoedema
thyroid acropachy (pseudoclubbing, with periosteal  bone changes)

Question 18

Autoantibodies in Graves?

Answer 18

anti-TSH receptor stimulating antibodies (90%)

anti-thyroid peroxidase antibodies (50%)

Question 19

When should patients over the age of 40 years with type 2 diabetes mellitus be started on a statin?

Answer 19

If they have any other risk factors for cardiovascular disease, such as smoking, hypertension or a ‘high-risk’ lipid profile.

A high-risk lipid profile may be defined as:
total cholesterol > 4.0 mmol/L, or
low-density lipoprotein cholesterol > 2.0 mmol/L, or
triglycerides > 4.5 mmol/L

Question 20

What is the diagnostic test for acromegaly? (may present with large jaw/forehead, hands, cardiomegaly, possibly bitemporal hemianopia)

Answer 20

Oral glucose tolerance with growth hormone measurements (no GH suppression = positive result)

Question 21

NICE guidance on the management of diabetic neuropathic pain? (1st and 2nd line drugs)

Answer 21

First-line: oral duloxetine. (amitriptyline if duloxetine is contraindicated).
Second-line treatment: if on duloxetine, switch to amitriptyline or pregabalin, or combine with pregabalin.
If first-line treatment was with amitriptyline, switch to or combine with pregabalin.

Question 22

other options to manage neuropathic pain

Answer 22

Pain management clinic, tramadol (not other strong opioids), topical lidocaine for localised pain.

Question 23

Gastroparesis in DM - symptoms?

Answer 23

symptoms include erratic blood glucose control, bloating and vomiting

Question 24

Gastroparesis in DM - management options?

Answer 24

These include metoclopramide, domperidone or erythromycin (prokinetic agents)

Question 25

Type 2 diabetes blood pressure target (with and without evidence of end-organ damage)?

Answer 25

no organ damage: < 140 / 80

end-organ damage: < 130 / 80