ENDOCRINE 5

Question 1

thyroid adenoma usually what and can be what

Answer 1

folliclular

thyroxicosis

Question 2

papillary carcinoma

Answer 2

solitary nodule

multifocal, cystic, calcified

Question 3

follicular carcinoma

Answer 3

painless, non function, haem spread to bone lungs liver

Question 4

medullary carcinoma

Answer 4

derived form c cells - secretes calcitonin

MEN2

Question 5

anapaestic carcinoma

Answer 5

undifferentiated
aggressive
history of thyroid cancer elderly px

Question 6

ix in thyroid cancer
low risk treatment
high risk treatment

Answer 6

TFTs, USS and FNA, TNM staging
low risk <55 and <4cm: lobectomy, TSH suppression
high risk : total thyroidectomy, radioiondine

Question 7

markers for thyroid cancer

Answer 7

thyroglobulin for undifferentiated

calcitonin for medullary

Question 8

osteoporosis is a what and what is being treated 
bone loss caused by what 
common fractures 
RF
primary 
secondary

Answer 8

asymp condition. treat risk of fractures

bone loss: sex hormone deficit, genetics, diet, immobility, steroids

NOF, vertebral, distal radium, hymenal neck

RS: age, gener, ethnicity, menopause, BMD, alcohol, weight, smoking, exercise, steroids

age related
thyroid, cushings, coeliac, crohns, anorexia

Question 9

calculate risk for osteoporosis
dexa
other ix

Answer 9

Q fracture risk
-1 to -2.4 osteopenia
under -2.5 osteoporosis
U&Es, FBC, calcium, bone biochemistry, LFTs, coeliac screen, testosterone, TFTs

Question 10

treatment lifestyle

when should bisphosphates be given

Answer 10

dietary, calcium and vit d supplements

osteopenia and on steroids or hsioty of low energy fracture

Question 11

bisphosphonates oral
IM
SC

how long treatment given
cal and vit d sup and bisphohnates reduce fracture risk by what

Answer 11

once weekly on empty stomach. upper GI SE
Benusomab 6 months
Teriparatide once daily 2 year course

5-10 y period then 1/2 year break and DEXA
50%

Question 12

Pagets in who 
cause 
symp/signs
complications 
ix
treatment

Answer 12

<49 makes. FH
idiopathic
long bones -pelvic, lumbar spins. skull. bone pain and deformity. deafness
osteosarcoma, high output cardiac failure. skull thickening.
incidental finding. lone risk in alk phos. normal LFTs
analgesia. bisphosphonates if still in pain

Question 13

osteogenesis imperfecta is what 
genetics 
assoc with what 
severe form 
mild form 
other symp
treatment

Answer 13

brittle bone dx. ADom. 
blue sclera 
severe present in childhood w fracture
mild might not present till adult life
fracture following minor trauma, deafness secondary to osteoclerosis, dental imperfections 

fracture fixation, surgery for deformities, bisphosphonates

Question 14

hypothalamic pit failure 10% of what 
cause
symp
ix
treatment

Answer 14

ovulatory disease
stress, excessive exercise, anorexia/low BMI, brain/pit tumours, head trauma, drugs, kallmans
amenorrhoea
decrease FSH/LH, oestrogen defic, normal PRL
stabilise weight, pulsatile GnRH or gonadotrophin daily injection - USS monitering

Question 15

hypothalamic pit dysfunction aka which what
FHS/LH, PRL, prog test
symp
whats seen in 50-80%

Answer 15

PCOS 80% of anovulatory disease

normla FSH/LH or maybe LH>FSH, PRL may be raised, normal oestrogen level

mostly oligo, amen

insulin resistance

Question 16

diagnosis of PCOS

Answer 16

1. oligo/amen
2. polycystic ovaries 12>= 2-9mm follicles increased ovarian reserve >10ml
3. clinical/biocehm features of hyperandrogegism - acne, hirsutism

Question 17

treatment of PCOS pre treatment 
if need onctraception
hirsutism and acne
1. 
2. 
3.

Answer 17

weight loss, alcohol, smoking, FA, rubble, normal semen analysis

COCP

COCP, topical eflonithine

climifine citrate + metaform if high BMI
gonadotrophin therapy - daily injections
laparoscopic ovarian diathermy

Question 18

risks of ovarian induction

Answer 18

hyperstimulation
MP
ovarian cancer
ovarian destruction with diatheramy

Question 19

ovarian failure is what 
cause 
symp
ix
treatment

Answer 19

menopause <40
idiopathic, genetic turners, cancer, AI, radio/chemo
amen
increased FSH/LH, decreased oestrogen 
HRT, egg/embryo donation

Question 20

turners syndrome genetics

symtpoms

Answer 20

only 1 x chromosome
short. webs neck. shield chest wide spaced nipples. short. failure to progress through puberty o primary/seoncdayr amen and infertility

Question 21

hirsutism causes

Answer 21

PCOS commonest
familial, idiopathic, CAH
adrenal or ovarian tumour - short history , signs of virilisation, high testosterone >5mcgmol/L

Question 22

treatment of hirsutism PCOS

late onset CAH

Answer 22

PCOS - OCP, anti androgens, cosmoses

late onset CAH - low dose glucocorticoid to suppress ACTH