Endocrine

Question 1

What insulin do you give once a day and an example of it

Answer 1

Basal (long acting) e.g. lantus

Question 2

Names of rapid acting analogue

Answer 2

Humalog and novorapid

Question 3

Names of short acting analogue

Answer 3

Humulin S and actrapid

Question 4

Names of intermediate acting

Answer 4

Insulatard and humulin 1

Question 5

Names of long acting

Answer 5

Lantus and levemir

Question 6

What receptors does insulin act on and give a brief description

Answer 6

GPCR: Ligand binding and is the main sensors of internal environment. Bind neurotransmitters, chemokines, sympathetic and parasympathetic transmissions, somatostatin, GH, vasopressin etc.

RTK: Binds insulin and VEGF

Cytokine receptor: Binds cytokines

Steroid hormone receptor: Binds oestrogen, progesterone, cortisol and testosterone

Glucocorticoid receptor: Generally same as steroid receptor

Question 7

Explain a bit about thyroxine biochemistry

Answer 7

T3 is more active than T4 ans they work on THF

Question 8

Which diabetic drug is weight neutral

Answer 8

DPP4 e.g. sitagliptin and metformin

Question 9

Which diabetic drug is weight loss

Answer 9

GLP1 agonist e.g. exenatide

Question 10

Which diabetic drug can cause glycosuria

Answer 10

SGLT2 inhibitor e.g. dapagliflozin

Question 11

What does strawberry milkshake coloured blood show

Answer 11

Hyperlipidaemia

Question 12

What hormone peaks 12 hours before ovulation

Answer 12

LH

Question 13

What is pagets disease

Answer 13

Increased abnormal osteoclastic reabsorption followed by increased osteoblastic activity. Abnormal bone structure with reduced strength and increased fracture risk. Typically in old men with bone pain. Results show a normal Ca and phosphate but high ALK PHOS.

Question 14

Treatment of pagets disease

Answer 14

Bisphosphonate

Question 15

What is osteomalacia

Answer 15

Rickets caused by a vitamin D deficiency. Includes a low calcium and phosphate and high alk phos. Symptoms and signs include bone pain, tenderness, fractures (neck of femur) and a waddling gait.

Question 16

What is the treatment for osteomalacia

Answer 16

Vitamin D therapy with calcium and phosphate supplements

Question 17

What is used to assess risk of osteoporosis

Answer 17

DEXA scan

Question 18

What would a normal biochemistry and bone pain suggest

Answer 18

Osteoporosis

Question 19

Symptoms of graves disease

Answer 19

Gradual onset, thyroid enlargement, tachycardia, heat intolerance, thrill or bruit over thyroid, tremor, eye disease, restless, anxious, insomnia, pretibial myxoedema, increased BMR and weight loss.

Question 20

What thyroid results would show graves

Answer 20

Raised T4 and T3 with suppressed TSH

Question 21

Symptoms of hashimotos thyroiditis

Answer 21

slow onset, can be huge or impalpable enlargement, firm and well-defined lymph nodes, bradycardia, cold intolerance, tremor absent, hoarseness, dysphagia, pressure effect, sleep apnoea, fatigue, depression, pseudo-dementia, memory dysfunction, decreased sweating, hair loss, neuropathies, weight loss,

Question 22

Thyroid results of hashimotos thyroiditis

Answer 22

Low T3 and T4 with increased TSH

Question 23

Symptoms of de quervains thyroiditis

Answer 23

acute, painful, moderate swelling, smooth, diffuse and tender bilateral swelling, initially transiently hyperdynamic, tremor in early stages, painful dysphagia, initially warm with sweating, flu-like symptoms

Question 24

Thyroid results of de quervains thyroiditis

Answer 24

Raised T3 and T4 with suppressed TSH

Question 25

Symptoms of a multinodular goitre

Answer 25

``` slow onset (years), mild/moderate swelling with palpable nodules, normal CVS, no tremor, obstructive neck symptoms, normal mental health and skin, normal bloods Idiopathic thyroid swelling – gradual onset, moderate smooth swelling, no CVS symptoms, no tremor, mild pressure effects, normal mental health, no skin changes or other symptoms of note, increased BMR, weight loss (or gain due to increased appetite), normal bloods ```

Question 26

Give examples of thyroid cancers

Answer 26

Papillary thyroid cancer, follicular carcinoma and medullary thyroid carcinoma

Question 27

What is a papillary thyroid cancer

Answer 27

Papillary thyroid cancer – commonest, lymphatic spread, can spread haematogenously to lungs, bone, liver and brain, assoc. with Hashimoto's thyroiditis, good prognosis

Question 28

How to investigate a papillary thyroid cancer and what is the preferred treatment

Answer 28

US guided FNA or biopsy with surgical treatment

Question 29

What is a follicular carcinoma of the thyroid

Answer 29

haematogenous spread, good prognosis, FNA or biopsy, surgical treatment

Question 30

What is a medillary thyroid carcinoma

Answer 30

derived from C-cells, relatively rare, secretes calcitonin, aggressive, diarrhoea, Cushings

Question 31

What is thyroid remnant ablation

Answer 31

Iodine-131 is administered and removes residual tissue to prevent re-occurence

Question 32

Describe MEN 1

Answer 32

Otherwise known as wermer's syndrome is includes hyperparathyroidism, prolactinoma and a pancreatic tumour

Question 33

Describe MEN 2a

Answer 33

Otherwise known as Sipple syndrome it includes a parathyroid hyperplasia with medullary thyroid carcinoma and a phaeochromocytoma

Question 34

Describe MEN 2b

Answer 34

Marfanoid body, mucosal neuroma, medullary thyroid carcinoma and phaeochromocytoma

Question 35

What is the treatment of endometrial polyps

Answer 35

Myomectomy

Question 36

What does lipolysis produce

Answer 36

Ketone bodies