Endocrine

Question 1

Carb ratio (g/unit)

Answer 1

Grams of carbohydrate covered by 1 unit of insulin

Question 2

Estimate Total daily Insulin requirement (unit/kg/day)

Answer 2

0.5 to 1

Question 3

Insulin sensitivity factor

Answer 3

120/TDD

Question 4

Teenagers more insulin resistant in the morning

Answer 4

Than night

Question 5

Carb ratio

Answer 5

400/TDD

Question 6

Slice of bread

Answer 6

15g

Question 7

Glp agonists

Answer 7

Lower hba1c by 1.3%
Incretin mimicker
- increase insulin secretion
- suppress glucagon

Question 8

Hba1c target

Answer 8

<7%

Question 9

Target time in range

Answer 9

<70%

Question 10

Target bgl

Answer 10

3.9-10

Question 11

Metformin

Answer 11

Biguanide

Increase insulin sensitivity

Question 12

Psychosocial issues (long case)

Answer 12

Sleep
Mood disorder
eating disorder
Diabetes burnout

Question 13

Minimise cardiovascular risk factors (long case)

Answer 13

Dont smoke

Exercise

Question 14

Sick day (except gastroenteritis)

Answer 14

Insulin resistance

Increase lantus dose by 10-15%
temporary basal on pump

Question 15

Precocious puberty in girls

Answer 15

before 8 yo

Question 16

Precocious puberty in boys

Answer 16

before 9yo

Question 17

Delayed puberty in girls

Answer 17

after 15yo

Question 18

Delayed puberty in boys

Answer 18

after 14yo

Question 19

Investigation of central precocious pubery

Answer 19

MRI brain in all boys + girls <6yo

Bone age

Question 20

What does advance bone age suggest

Answer 20

central or peripheral precocity

rather than benign

Question 21

What does high LH suggest

Answer 21

Central precocious puberty

Question 22

What does high DHEAS suggest

Answer 22

Adrenal production of sex hormones

such as non-classical CAH and virilizing adrenal tumors

Question 23

Adrenarche

Answer 23

activation of adrenal androgen production causing pubarche, in conjunction with a mild elevation (DHEAS)

Question 24

Pubarche

Answer 24

Pubic/axillary hair

Question 25

Gonadarche

Answer 25

Activation of gonads by the pituitary hormones FSH and LH

Question 26

Menarche

Answer 26

Onset of menses

Question 27

Thelarche

Answer 27

Onset of breast development

Question 28

Normal progression of -arche's

Answer 28

Girls : adrenarche → gonadarche → thelarche → (growth spurt → pubarche) → menarche Boys: adrenarche → gonadarche→ (pubarche → growth spurt ) → androgenic hair growth

Question 29

Causes of central procicity

Answer 29

Idiopathic | CNS tumour e.g. hypothalamic hamartoma, pit adenoma

Question 30

Causes of peripheral precocity

Answer 30

Adrenal tumour secreting sex hormone Ovarian/testicular tumour which may secrete hCG or sex hormone) Autonomous gonadal activation (McCune Albright) Familial male-limited PP (mutation of LH receptor gene) CAH Primary hypothyroidism Exposure to exogenous sex steroids

Question 31

Treatment of central precocious puberty

Answer 31

GnRH agonist DEPOT | Target LH <2

Question 32

Treatment of peripheral precocity

Answer 32

Blocking production of / response to the excess sex steroids

Question 33

Hypogonadotrophic hypogonadism + anosmia

Answer 33

Kallman

Question 34

What causes low serum TOTAL T4 but normal free T4 and TSH

Answer 34

TBG deficiency

Question 35

Indication for GnRH stimulation test

Answer 35

Differentiate CPP from benign pubertal variant

Question 36

Is GH, IGF1 and insulin anabolic or catabolic

Answer 36

Anabolic (build up) thus GH abused by body builders and diabetes (insulin deficiency) causes breakdown

Question 37

Post resection of craniopharyngioma

Answer 37

Hypothalamic dysfunction including obesity | Panhypopit

Question 38

Sensorineural deafness + hypothyroidism

Answer 38

Pendred syndrome

Question 39

Prolactin indicative of

Answer 39

hypothalamic damage

Question 40

GH stimulation test

Answer 40

Use glucagon --> insulin --> GH | Positive if GH >7.5

Question 41

Endogenous hydrocort production

Answer 41

5-6mg/m2

Question 42

Dosage regimes of hydrocort for Hypopit vs CAH

Answer 42

Hypopit - use 6-8 mg/mg2 | CAH - need to overcome a block and reduce production of sex steroids - higher dose

Question 43

Treatment of delayed puberty in boys

Answer 43

cyclical hCG (similar LH) and FSH

Question 44

Treatment of delayed puberty in girls

Answer 44

oestrogen

Question 45

When to treat precocious puberty

Answer 45

>3 year bone age advancement | <6yo

Question 46

What does having serum thyroglobulin indicate, when no uptake seen on radionucleotide scan

Answer 46

Hypoplastic thyroid, as opposed to NO thyroid