Endocrine

Question 1

Which insulin is given once a day?

Answer 1

basal (long acting) eg LANTUS

Question 2

Which diabetic drug is weight neutral?

Answer 2

DPP4 inhibitors eg sitagliptin

Question 3

What does strawberry milkshake coloured blood indicate?

Answer 3

hyperlipidaemia

Question 4

What biochemistry is seen in Paget’s?

Answer 4

normal Ca and phosphate

high ALP

Question 5

What biochemistry is seen in osteomalacia?

Answer 5

a low calcium, low serum phosphate and high serum alkaline phosphatase.

Question 6

How do you treat pagets?

Answer 6

biphosphonates eg risedronate

Question 7

How do you treat osteomalacia?

Answer 7

vitamin D therapy with calcium and phosphate

Question 8

What is seen in bone mets?

Answer 8

high ca, osteoclast proliferation, bone pain

Question 9

What hormone do you test for fertility?

Answer 9

progesterone

Question 10

What biochemistry is seen in primary hyperparathyroidism ?

Answer 10

inc Ca, dec phosphate, inc ALP, inc PTH

Question 11

What biochemistry is seen in secondary hyperparathyroidism?

Answer 11

dec ca, inc phosphate, inc ALP, inc PTH

Question 12

Tuning fork for diabetic foot

Answer 12

124 Hz

Question 13

treat endometrial polyps

Answer 13

myomectomy

Question 14

Diagnosing a DKA

Answer 14

ketonaemia (>3mmol/l) or 2++ on urinalysis
blood glucose >11
bicarbonate <15
venous pH<7.3

Question 15

When is kussmauls breathing?

Answer 15

compensating for metabolic acidosis

Question 16

Managing DKA

Answer 16

0.9% saline
50 units human soluble insulin (Actrapid or humulin)
potassium replacement
10% glucose 125ml

Question 17

What is hyperosmolar hyperglycaemic syndrome?

Answer 17

a complication of T2DM seen in older people

• very high glucose without ketoacidosis
• very dehydrated
• osmolality >320

Question 18

Treat HHS

Answer 18

0.9% saline given slowly
potassium
insulin?

Question 19

Manage hypoglycaemia

Answer 19

conscious –> 10-20g glucose

unconscious –> 10% 150mls glucose or 200-300mls of 10% dextrose

Question 20

Patient on metformin, with renal failure, is hyperventilating, confused and in stupor/coma
with reduced bicarbonate and raised phosphate

Answer 20

LACTIC ACIDOSIS

- stop metformin, give fluids and antibiotics

Question 21

When is metformin contraindicated?

Answer 21

GFR<30

Question 22

Hyperthyroid + painful neck swelling

Answer 22

thyroiditis

Question 23

Which hormone is raised acutely during breastfeeding and induction of labour?

Answer 23

oxytocin

Question 24

Which type of neuropathy would cause a patient with T1DM to vomit after large meals?

Answer 24

Autonomic nerve dysfunction

gastroparesis

Question 25

Which hormone can cause poor brain development if deficient in utero?

Answer 25

thyroxine

Question 26

Which type of diabetic neuropathy would cause pain in the foot?

Answer 26

peripheral

Question 27

Which type of diabetic neuropathy would cause charcot foot?

Answer 27

peripheral

Question 28

Which type of diabetic neuropathy would cause bowel changes?

Answer 28

autonomic

Question 29

Which type of diabetic neuropathy causes reduced hypoglycaemic awareness?

Answer 29

autonomic

Question 30

Which type of diabetic neuropathy would cause leg weakness?

Answer 30

proximal

Question 31

Which type of diabetic neuropathy would cause foot drop?

Answer 31

focal

Question 32

Which type of diabetic neuropathy would cause weight loss?

Answer 32

proximal

Question 33

Which type of diabetic neuropathy would cause increased sweating?

Answer 33

autonomic

Question 34

features of an addisonian crisis

Answer 34

Hyponatraemia Hyperkalaemia Hypoglycaemia

Question 35

rate of insulin in DKA

Answer 35

0.1 unit/kg/hour

Question 36

What effect does diabetes insipidus have on plasma and urine osmolality?

Answer 36

high plasma osmolality | low urine osmolality

Question 37

Which patient is more likely to develop diabetes a) impaired fasting glucose b) impaired glucose tolerance

Answer 37

B

Question 38

Which type of cancer is there increased risk of with MODY?

Answer 38

hepatocellular carcinoma

Question 39

Diabetic with bloating after meals + erratic blood sugar a) what is it? b) how is it managed?

Answer 39

a) gastroparesis | b) metoclopramide