Endocrine

Question 1

Causes of raised ALP

Answer 1

Osteomalacia 
Bone mets 
Pregnancy 
Hyperparathyroidism 
Bone fracture 
Liver: cholestasis, hepatitis, fatty liver, neoplasia
Renal failure

Question 2

Causes of pseudohyponatremia

Answer 2

Taking blood from a drip arm

Hyperlipidaemia (increase in serum volume)

Question 3

ECG features of hypokalaemia

Answer 3

Prolonged QT interval
Prolonged PR interval
U waves

Question 4

ECG features of hyperkalaemia

Answer 4

Tall tented T waves
Widening of QRS complex
Small P waves

Question 5

Causes of hyperkaleamia

Answer 5

Addisons 
AKI 
Metabolic acidosis
Rhabdomyolysis 
Massive blood transfusion
Drugs: potassium sparing diuretics, ACEi, ARBs, spironolactone, ciclosporin, heparin

Question 6

Management of hypercalcaemia

Answer 6

IV fluids - huge amounts. 3-4L/day

IV bisphosphonates - take 2-3 days to work with max effects at 7 days. Give after rehydration

Question 7

Trousseau’s sign

Answer 7

carpopedal spasm caused by

inflating the blood-pressure cuff to a level above the systolic blood pressure in patients with hypocalcaemia

Question 8

SIADH drug causes

Answer 8

Carbamazepine, sulfonylureas, SSRIs, tricyclics, ecstasy

Question 9

Metformin

Answer 9

Increases insulin sensitivity
Weight neutral
GI side effects + lactic acidosis
CI if eGFR <30

Question 10

Skin signs of diabetes

Answer 10

Acanthosis nigricans
Skin tags
Central obesity
Hirsutism

Question 11

Which 2 DM drugs CI together?

Answer 11

DDP4 inhibitors + GLP-1 R agonists

Question 12

Dose of metformin

Answer 12

500mg BD increasing to 1000mg BD

Question 13

Hba1c aim if on dual therapy for DM

Answer 13

53

Question 14

First intensification of DM treatment

Answer 14

Metformin PLUS

• SU
• Pioglitazone
• SGLT-2
• DPP-4i

Question 15

Which DM drug is injectable?

Answer 15

GLP-1 R agonist

• Dulaglutide
• Exenatide

Question 16

Which DM drug is in an incretin?

Answer 16

GLP1-R agonist

• Stimulates insulin release
• Suppresses glucagon
• Inhibits gastric emptying
• Promotes saiety

Question 17

Who to give GLP1-R agonist to?

Answer 17

Given in combination with metformin + SU to

• BMI >35 where WL would benefit obesity related comorbidities or psychological
• BMI <35 where insulin would lead to occupational restrictions or WL would benefit them

Question 18

DPP-4i

Answer 18

Gliptins

• Alogliptin
• Linagliptin
• Sitagliptin

SEs = gord + abdo pain

Question 19

TZDs

Answer 19

Pioglitazone

SEs = hypos, #, increased risk of infection, increased LFTs (check every 8wks for 1yr), weight gain, fluid retention, ankle oedema

CI = stop if ALT >3 fold, HF, bladder Ca, v haematuria

Question 20

SU

Answer 20

Gliclazide

SEs = weight gain, abdo pain, hypos

Question 21

SGLT2 inhibitors

Answer 21

Canagliflozin

SEs = UTI, balanoposthitis, thirst, dyslipidaemia

Question 22

GLP1-R agonist

Answer 22

Dulaglutide
Exenatide

SEs = reduced appetite, GI problems, asthenia
CI = GFR <30, ketoacidosis