endocrine Flashcards
1
Q
which T2DM drug can cause UTI?
A
SGLT-2 inhibitors
canagliflozin, dapagliflozin and empagliflozin.
inhibit Na - Glucose co-transporter 2 in the renal proximal convoluted tubule
increases urinary glucose excretion
can therefore increase UTI
2
Q
other sfx of SGLT-2 inhibitors? eg?
A
lose weight
canagliflozin, dapagliflozin and empagliflozin.
3
Q
DKA - initial tx - very first thing?
A
IV fluids
4
Q
what does raised TSH, normal T3,4 mean?
A
subclinical hypothyroidism
5
Q
does everyone need managing with subclinical hypothyroidism?
A
no - nice cks
if older than 80 or asymptomatic then repeat TFTs in 6/12
6
Q
tx hypothyroidism:
A
levothyroxine
7
Q
if hypothyroidism + pregnant - what to do about tx?
A
increase dose of levothyroxine to 150mg per day
if already on 150mcg then increase by 50%
8
Q
‘unrecordable’ blood sugar measurement with confusion and abdominal pain could be?
A
DKA
unrecordable means high not low
9
Q
mx of DKA: (5 things)
A
fluid replace with saline IV insulin 0.1u/kg/hr FIXED when glucose<15 -> 5% dextrose given correct hypokalaemia long acting insulin continue, short acting stop
10
Q
cx of DKA?
A
gastric stasis VTE arrhythmia due to hyperkalaemia/iatrogenic hypokalaemia cerebral oedema ARDS AKI
11
Q
Diabetes sick day rules
A
when unwell, If a patient is on insulin, they must not stop it due to the risk of diabetic ketoacidosis. They should continue their normal insulin regime but ensure that they are checking their blood sugars frequently
stop metformin. also drink 3L fluid a day
12
Q
Grave’s disease triad:
A
exopthalmos, opthalmoplegia
pretibial myxoedema
clubbing, swelling hands/feet, periosteal new bone formation
tx with propranolol
13
Q
specific Abs ix for Grave’s?
A
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)
14
Q
commonest type of hypothyroidism?
A
hashimoto’s thyroiditis
chronic autoimmune thyroiditis
15
Q
what is hashimoto’s thyroiditis commonly associated with?
A
other autoimmune conditions - eg T1DM, coeliac, vitiligo
also MALT lymphoma
16
Q
presentation and ix of hashimoto’s thyroiditis?
A
CP - hypothyroid sx
goitre, firm, non-tender
ix - anti-thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) Abs
17
Q
woman with br ca has worsening headaches and seizure - sx control while awaiting imaging?
A
Dexamethasone to prevent cerebral oedema
18
Q
what is characterised by extremely high serum PTH with moderately raised serum calcium?
A
tertiary hyperparathyroidism
19
Q
who is affected by tertiary hyperparathyroidism?
A
CKD patients
20
Q
what commonly causes primary hyperparathyroidism?
A
benign tumour of parathyroid gland - adenoma
21
Q
PTH (Elevated)
Ca2+ (Elevated) - mild
Phosphate (Low)
Urine calcium : creatinine clearance ratio > 0.01
A
primary hyperparathyroidism
22
Q
PTH (Elevated)
Ca2+ (Low or normal)
Phosphate (Elevated)
Vitamin D levels (Low)
A
secondary hyperparathyroidism
23
Q
Ca2+ (Normal or high) PTH (Elevated) Phosphate levels (Decreased or Normal) Vitamin D (Normal or decreased) Alkaline phosphatase (Elevated)
A
tertiary hyperparathyroidism
24
Q
what can mimic cushing’s disease?
A
chronic alcohol excess
25
how can differentiate between cushing's and pseudo-cushings?
serum cortisol and dex suppression test both normal in pseudo
26
hypoglycaemia with impaired GCS mx:
IV glucose with impaired GCS
27
definitive mx of primary hyperparathyroidism:
total parathyroidectomy
28
hyperparathyroidism X-Ray changes show:
osteopenia
29
Asymptomatic patients with an abnormal HbA1c or fasting glucose :
repeat test to confirm dx of diabetes
30
what tx will a child with Turner's syndrome receive ?
Growth Hormone tx
31
commonest cause of thyrotoxicosis in UK?
Grave's disease
| hyperthyroid
32
45-F -> GP BP 165/95 mmHg. Also reports that she has had some muscle weakness. Bloods show a high aldosterone : renin ratio. CT scan shows bilateral adrenocortical hyperplasia. tx?
What is the most appropriate management plan for this woman?
spironolactone
| she has primary hyperaldosteronism (Conn's)
33
in elderly lady, what can over correction with levothyroxine cause?
osteoporosis
-> increased bone turnover
AF
34
acropachy?
dermopathy associated with Graves' disease. It is characterized by soft-tissue swelling of the hands and clubbing of the fingers.
periosteal new bone formation
35
most thyroid nodules/cancerous nodules lead to what effect of thyroid?
hypothyroid
| lower risk if TSH is low (hyperthyroid)
36
commonest thyroid cancer?
papillary - best prognosis
| follicular
medullary
anaplastic
these are the others
37
what symptom is a red flag for thyroid ca?
hoarseness
38
3 conditions which make up MEN 2a?
medullary thyroid ca
phaeo
parathyroid hyperplasia
39
tender goitre, hyperthyroidism and raised ESR. The globally reduced uptake on technetium thyroid scan is also typical
dx?
subacute thyroiditis
40
which syndrome causes high LH and low T?
Kleinfelters syndrome
41
what is the karyotype of Kleinfelters?
XXY
42
in T1DM what HbA1c target should be used?
48 or 6.5%
43
what HbA1c needed to consider a second T2DM drug?
58
44
what cx can thiazides cause?
hypercalcaemia
45
HHS (hyperosmolar hyperglycaemic state) characterised by 3 things:
severe hyperglycaemia
dehydration and renal failure
mild/absent ketonuria
46
HHS dx:
1. Hypovolaemia
2. Marked Hyperglycaemia (>30 mmol/L) without significant ketonaemia or acidosis
3. Significantly raised serum osmolarity (> 320 mosmol/kg)
47
Long term steroid use can cause cushings syndrome, what would this look like on a VBG?
hypokalaemic metabolic alkalosis
due to excess aldosterone which increases acid and K excretion in kidney
48
addison's VBG findings:
hyperkalaemic metabolic acidosis
insufficiency of aldosterone which decreases acid secretion in the kidney and leads to the retention of potassium.
49
first line ix in primary hyperaldosteronism:
plasma aldosterone:renin ratio
| Conn's
50
A middle-aged male presents to the endocrinology clinic after needing to buy larger shoes and noticing that his hands are enlarging. An MRI brain shows a brain tumour accounting for his symptoms. He is sent for visual field testing.
What is the classical visual field deficit seen in these patients?
bitemporal hemianopia
51
gliclazide sfx:
hypos
| weight gain
52
presence of which sx differentiates primary and secondary adrenal failure?
skin hyperpigmentation - primary
53
68-year-old male presents with headache and double vision. On examination you note pigmentation of his skin and a right CN VI palsy. He has a past medical history of a bilateral adrenalectomy 1 year ago for Cushing's disease. An urgent MRI demonstrates a pituitary tumour that is invading the right cavernous sinus. dx?
Nelson's syndrome
54
what is nelsons syndrome?
rapid enlargement of a pituitary corticotroph adenoma (ACTH producing adenoma) that occurs after the removal of both adrenal glands (bilateral adrenalectomy) which is an operation used for Cushing's syndrome.
55
3 P's make up MEN type I?
Parathyroid (95%): hyperparathyroidism due to parathyroid hyperplasia
Pituitary (70%)
Pancreas (50%): e.g. insulinoma, gastrinoma (leading to recurrent peptic ulceration)
Also: adrenal and thyroid
56
insulinoma: whipple's triad:
sx hypoglycaemia
BM<2.5
reversibility of sx on administration of glucose
57
differentiating between insulinoma and abuse of insulin use?
C-peptide production does not fall on exogenous insulin injection in pts with insulinoma
would fall with insulin abuse
58
how is latent AI diabetes of adulthood (LADA) dx?
Glutamic Acid Decarboxylase (GAD) Autoantibodies
usually evidence of other AI diseases
(T1DM also anti-islet cell, ZnT8)
C-pep low/normal
59
what happens to periods with either thyroid disease?
hyper - oligo
| hypo - menorrhagia
60
HbA1c underestimates the glucose levels in which condition?
hereditary spherocytosis
| also sickle cell, g6pd
61
what is used as a monitoring tool for levothyroxine tx in hashimotos?
TSH
62
what is a potentially fatal complication of longstanding undertreated hypothyroidism. It may be precipitated by illness, stress, and certain drugs.?
myxoedema coma
Apart from confusion and hypothermia, patients may have non-pitting periorbital and leg oedema, reduced respiratory drive, pericardial effusions, long QT, anaemia, seizures, and other symptoms of hypothyroidism.
63
sglt2 sfx:
normoglycaemic ketoacidosis
UTI
risk of LL amputation - skin ulcers
64
standard hba1c target in type 2?
48
65
what opthalmological finding in graves disease means severe eye problem?
corneal involvement
66
The severity of Grave's eye disease can be graded using the mnemonic NOSPECS
No signs / symptoms
Only signs (e.g: upper lid retraction)
Signs & symptoms (including soft-tissue involvement)
Proptosis
Extra-ocular muscle involvement
Corneal involvement
Sight loss due to optic nerve involvement
67
how often should t1dm monitor their glucose?
4 - including before each meal and before bed
68
what 2 things cause 90% of hypercalcaemia cases?
primary hyperparathyroidism
malignancy
others: sarcoid, vit d intox, acromegaly, thyrotoxicosis
69
Hyponatraemia and hyperkalaemia in a patient with lethargy is highly suggestive of
addisons disease
70
best test to ix addisons?
short synacthen test
| give synthetic ACTH and in Addison's this doesn't cause the adrenals to make cortisol cos they're fucked
71
Impaired glucose tolerance (IGT) is defined as
fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
72
usual first line tx for burning pain in soles of t2dm feet?
amitriptyline
73
in pt with burning sensation in soles of feet of t2dm and BPH pt, what drug?
pregabalin
| amitriptyline will cause urinary retention
74
hypertension, hypernatraemia, and hypokalemia - indicates?
primary hyperaldosteronism
75
Trousseau's sign:
carpal spasm on inflation of BP cuff to pressure above systolic
hypocalcaemia
76
metabolic alkalosis with high bicarb that also shows hypokalaemia in context of HTN- which syndrome?
conns - hyperaldosteronism
77
which oral steroid has lowest mineralcorticoid activity?
dexamethasone
78
can addisons cause collapse? if so why
yes
| causes hypos
79
Pepperpot skull is a characteristic X-ray finding of??
hyperparathyroidism
80
Consider adding exenatide to metformin and a sulfonylurea if:
BMI >= 35 kg/m² and high weight
| BMI<35 and insulin can't be used
81
DKA fluids given, what is insulin dose??
0.1 unit/kg/hr
82
phaeochromocytoma: iX
24h collection metanephrines
83
phaeochromocytoma symptoms:
```
hypertension (around 90% of cases, may be sustained)
headaches
palpitations
sweating
anxiety
```
84
what DM drugs have been linked to necrotising fasciitis of the genitalia or perineum (Fournier's Gangrene)??
SGLT2is
85
A 34-year-old female presents with a thyroid nodule. She has a family history of thyroid disease and both her sisters have undergone total thyroidectomies. Her past medical history includes hypertension which has been difficult to manage.
medullary carcinoma
86
A 52-year-old woman presents with a neck swelling. Her GP reports that her TSH value is low at 0.01 mu/l. A scintigraphy demonstrates a hot nodule.
toxic adenoma
87
An 18-year-old female presents with 3 nodules in the right lobe of the thyroid. Clinically she is euthyroid and there is associated cervical lymphadenopathy. She has no family history of thyroid disease.
papillary carcinoma
likely to spread to nodes
88
inheritance of MODY (maturity onset DM of young)?
autosomal dominant
89
which diuretic can cause gynaecomastia?
spironolactone
| other causes - goserelin
90
commonest effect of radioiodine therapy?
causes hypothyroidism
91
Thyrotoxicosis with tender goitre =
subacute (De Quervain's) thyroiditis
| also reduced iodine uptake
92
addisons crisis: mx?
IV hydrocortisone only (not fludro...)
93
A 19-year-old lady is admitted to ITU with severe meningococcal sepsis. She is on maximal inotropic support and a CT scan of her chest and abdomen is performed. The adrenal glands show evidence of diffuse haemorrhage. dx???
Waterhouse- Friderichsen syndrome
pre-terminal event associated with sepsis and coagulopathy
94
34-year-old lady is admitted with recurrent episodes of non-specific abdominal pain. On each admission all blood investigations are normal, as are her observations. On this admission a CT scan was performed. This demonstrates a 1.5cm nodule in the right adrenal gland. This is associated with a lipid rich core. Urinary VMA is within normal limits. Other hormonal studies are normal
benign incidental adenoma
95
MOA orlistat?
pancreatic lipase inhibitor
| reduces digestion of fat
96
should delay insulin tx in adults in DKA?
no - some evidence that in children, waiting 1 hour helps prevent cerebral oedema, no evidence for this in adults
97
what would acromegaly show on an ECHO?
cardiomyopathy
| Left ventricular hypertrophy
98
what is the most appropriate investigation for patients with increased urinary cortisol and low plasma ACTH levels?
CT adrenals
99
newly dx T1Dm - first line insulin?
basal-bolus
| twice‑daily insulin detemir
100
what BM measurement is hypoglycaemia?
<3, some say <4 'four is the floor'
101
non-dm causes of hypoglycaemia (EXPLAIN):
```
Exogenous drugs such alcohol, aspirin poisoning, pentamidine, quinine sulfate, ACE-inhibitor
Pituitary insufficiency
Liver failure
Addison's disease
Islet cell tumours eg insulinoma
Non-pancreatic neoplasms
```
102
if unsure between t1 and t2 dm, what test can help differentiate?
c-peptide
| low in t1, n or high in 2
103
fasting glucose for PRE-dm?
6-7
104
There is decreased secretion of which hormones in response to major surgery:
insulin
testosterone
oestrogen
105
DKA abg result?
metabolic acidosis with partial respiratory compensation (low co2) and an increased anion gap
106
which thyroid ca gives high calcitonin result?
medullary
107
which thyroid ca causes 'orphan annie' eyes on on light microscopy?
papillary
108
which thyroid ca is thyroglobulin used as a tumour marker?
follicular
109
when don't you need a second test to dx DM?
when symptomatic
110
In toxic multinodular goitre, nuclear scintigraphy reveals??
patchy uptake
111
Hypothermia, hyporeflexia, bradycardia and seizures, - ??
myxoedemic coma
112
8 causes of secondary HTN:
```
phaeo
hyperparathyroidism
renal artery stenosis
renin secreting tumour (secondary hyperaldosteronism)
acromegaly
cushings
hyperaldosteronism
CKD
hyperthyroidism
obstructive sleep apnoea
polycystic kidney disease
```
113
what is conns syndrome?
primary hyperaldosteronism
renin will be low as suppressed by the high BP
caused by 1. bilateral idiopathic adrenal hyperplasia
2. adrenal adenoma
114
in tx of hyperaldosteronism what is first line?
surgery first depending on size of nodule
| dopamine agonists second line if tiny nodules
115
symptoms of cushings?
```
thin skin
bruising
buffalo hump
purple striae
DM - resistant
HTN - resistant
osteoporosis in males
menorrhagia
prox myopathy
moon face
```
116
Water deprivation test: primary polydipsia:
urine osmolality after fluid deprivation: high
| urine osmolality after desmopressin: high
117
what is primary polydipsia?
a psychogenic disorder characterised by excessive drinking despite being properly hydrated, hence the patient's symptoms of polyuria, nocturia and chronic dry mouth. The past medical history of depression is relevant as primary polydipsia is more common in patients with psychiatric disorders
118
Low urine osmolality after both fluid deprivation and desmopressin is typical of ?
nephrogenic DI
119
what is nephrogenic DI?
kidneys insensitive to ADH so unable to concentrate urine
| caused by CKD, nephrotoxics, metabolic disorders, lithium
120
Low urine osmolality after fluid deprivation, but high after desmopressin is typical of ?
cranial DI
121
what is cranial DI?
insufficient ADH release. This lack of ADH results in an inability to concentrate urine even if a patient is hypovolaemic, therefore producing a low urine osmolality even during water deprivation. when ADH given synthetically can concentrate urine tho
122
which drug can cause neutrophilia?
pred - glucocorticoids
123
what is known to cause drug-thrombocytopaenia?
furosemide
gold
penicillin
124
drug causing renal impairment with blood results often showing a raised eosinophils and may show raised neutrophils?
inuprofen, nsaids
125
Kallman's syndrome - sex hormones?
FSH, LH low,
testosterone low
no sense of smell late puberty
126
x-rays demonstrate generalised osteopenia, erosion of the terminal phalyngeal tufts (acro-osteolysis) and sub-periosteal resorption of bone particularly the radial aspects of the 2nd and 3rd middle phalanges. These changes are consistent with>
hyperparathyroidism
127
myxoedema coma tx?
IV thyroid tx
IVI
IV corticosteroids (HC)
128
obese T2DM maxed out on metformin - doesn't want 2nd line DM drug to cause weight gain. HbA1c 59. which drug next?
DPP-4 inhibitor - weight neutral
129
which DM drugs cause weight gain?
sulfonylureas
| pioglitazone
130
MODA DPP-4-inhibitors? (sitagliptin)
increase levels of incretins (GLP-1 and GIP) by decreasing their peripheral breakdown
131
thyrotoxicosis mx:
1st line: IV Propranolol
antithyroid therapy with propylthiouracil or carbimazole
then lugols solution 1-4h after
hydrocortisone if storm
132
difference between thyrotoxicosis and thyroid storm?
Thyroid storm represents the extreme manifestation of thyrotoxicosis as a true endocrine emergency
133
differentiating graves from other forms of hyperthyroid?
TSH receptor stimulating abs
134
which syndrome typically presents with proteinuria, hypoalbuminaemia, oedema, and hyperlipidaemia?
nephrotic syndrome
135
which syndrome typically presents with haematuria, hypertension, oliguria, and azotemia?
nephritic syndrome
136
what is azotemia?
high urea and high creatinine
| high levels of nitrogen in blood due to failed excretion by kidneys
137
HHS mx:
1. Normalise the osmolality (gradually)
2. Replace fluid and electrolyte losses
3. Normalise blood glucose (gradually)
138
72M on allopurinol and metformin. 6 months ago gave lifestyle advice re HTN. Now BP is 148>80. mx?
ACE-I
139
What is the best way that her risk of developing thyroid eye disease can be reduced?
stop smoking
140
62F comes in with low TSH and low T4 - what type of disease is this and what ix should you do?
secondary hypothyroidism
| MRI pituitary gland
141
U&Es in cushings?
hypokalaemia and hypernatraemia
142
patient has hyponatraemia
| A high urine osmolality and low serum osmolality is characteristic of:
SIADH
143
Erratic blood glucose control, bloating and vomiting think:
gastroparesis in T1DM
| due to neuropathy of the vagus nerve
144
cardiac cx of thyrotoxicosis?
high output cardiac failure
| AF
145
what should be used to assess for diabetic neuropathy in the feet?
10g monofilament
146
42F irritability and altered bowel habit. smooth enlargement of the thyroid gland. Low TSH, low T4, normal ESR. dx?
graves
| TSH receptor stimulating Abs stim the thyroid to make T4. however, negative feedback loop means TSH low.
147
gastroparesis mx:
metoclopramide, domperidone, erythromycin - prokinetic agents to help gastric emptying
148
PHaeochromocytoma - give (tx):
```
phenozybenzamine (a-blocker)
before BBs (propranolol or labetolol)
```
149
what is definitive mx of phaeochromocytoma and when?
surgery to remove tumour 10 days after starting alpha blockers
150
how to tell if poor compliance with levothyroxine?
high TSH normal T4
| if take thyroxine again before the blood test then t4 will normalise but tsh takes longer to
151
primary hypothyroidism: TFTs:
high TSH low T4
152
acral overgrowth, prognathism and macroglossia on a background of difficulty driving - which condition and which visual field defect?
acromegaly
| bitemporal hemianopia
153
acromegaly blood ix?
IGF-1 level
154
in addison's what would you expect a serum ACTH to shhow?
ACTH would be high - PGs are fine. They are trying hard to stimulate the adrenals to make cortisol but adrenals are the problem so they don't - no negative feedback so ACTH high
155
What is cushing's syndrome?
prolonged abnormal elevation of cortisol.
| in cushing disease this is due to Pituitary adenoma -> ACTH
156
which cancer has a paraneoplastic syndrome that causes cushing's syndrome?
SCLC
157
cushing's ix:
1. low dose dexamethasone suppression test (1mg)
(positive if cortisol not suppressed)
2. high dose dex suppression test (8mg)
(low cortisol = cushing's disease
norm/high cortisol, high ACTH = ectopic ACTH (SCLC)
norm/high cortisol, low ACTH = adrenal adenoma)
158
if ?cushing's disease - what ix to confirm -
MRI brain
159
if cushing's syndrome from ectopic ACTH - ix to cocnfirm?
chest CT for SCLC
160
if cushing's syndrome from adrenal source - ix to confirm?
CT abdo for adrenal adenoma
161
differentiating between primary and secondary hyperaldosteronism?
renin low primary
| renin high secondary
162
causes of secondary hyperaldosteronism:
Renal artery stenosis
Renal artery obstruction
Heart failure
renin secreting tumour rare
163
phaechromocytoma - what is it?
tumour of chromaffin cells in adrenals
| secretes unregulated and excessive amounts of adrenaline
164
60-M incidental finding of a mass within the pituitary sella. Subsequent pituitary MRI shows a 1.2cm pituitary lesion that does not compress on the optic nerve and chiasm.Denies having headache or visual field defects. There are no symptoms of acromegaly, Cushing's disease or hypopituitarism.
No stigmata of Cushing's disease and acromegaly. He is clinically euthyroid.
What should be done for this patient?
laboratory investigation must be done to determine if it is functional or non-functional - hypersecretion or hypopituitarism
165
boy with DKA in ED tx with IVI and insulin goes on to have a seizure. why?
cerebral oedema
166
what is a risk factor for grave's disease?
smoking
vit d deficiency
female
167
An 80-year-old woman has a hip fracture. Her calcium is normal. She has never been given a diagnosis of osteoporosis.
mx?
risedronate and calcium supplements
| no need for a dexa as post-menopausal woman
168
A 60-year-old man presents with recurrent renal stones. He is found to have a calcium of 2.72 (elevated) and a PTH of 12 (elevated).
mx?
parathyroidectomy
169
An 82-year-old woman from a nursing home is admitted to the orthopaedic ward with a hip fracture. She is acutely confused and agitated. Her Calcium is 2.95 (elevated).
mx?
IV fluids
| IV bisphosphonate needed if ca > 3
170
what overdose causes hyperinsulinemia and high C-peptide levels?
sulfonylurea - gliclazide
171
rare but recognised complication of corticosteroid therapy is -
psychosis
172
what should insulin-dependent DM's have for emergencies?
glucagon kit
173
what can cause a falsely high HbA1c?
splenectomy - increases lifespan of RBCs
also, IDA and b12/folate deficiency
174
A 43-year-old woman with Addison's disease presents to the Emergency Department with gastroenteritis. While admitting her to the medical ward, what should you do regarding her steroid replacement?
double hydrocortisone dose
| same fludrocortisone dose
175
first line tx for diabetic neuropathy causing pain. Nil PMH:
```
duloxetine
also amitryptiline, gabapentin, pregabalin
2. if one doesn't work try one of others
3. tramadol rescue tx
pain clinic referral if resistant
```
176
addisons dosing throughout day?
10mg am 5mg noon 5mg early evening for a 20mg dose hydrocortisone
mimics normal cortisol
177
why is pioglitazone CI in CCF patients?
can cause fluid retention and is therefore contraindicated in patients with heart failure.
178
31-year-old woman has been referred to endocrinology complaining of lethargy, weight loss and anorexia. On examination you note patches of depigmented skin on her upper limbs and increased pigmentation in her palmar creases dx?
addison's disease
179
Toxic multinodular goitre - tx of choice?
radioactive iodine
180
DKA resolution is defined as:
pH>7.3, ketones <0.3
181
PTH levels are raised or 'inappropriately' normal in?
primary hyperparathyroidism
myeloma would -> low PTH
182
```
74-F 6/12 hx worsening confusion, unintentional weight loss and low back pain. PMH hypothyroidism - levothyroxine. 2/12 ago, investigations under the surgeons due to normocytic anaemia, but no cause was found.
Calcium 3.05 mmol/L (2.1-2.6)
Phosphate 1.28 mmol/L (0.8-1.4)
Vitamin D 53 mmol/L (50-250)
PTH 0.8 pmol/L (1.6-6.9)
Na+ 143 mmol/L (135 - 145)
K+ 4.6 mmol/L (3.5 - 5.0)
Urea 11.5 mmol/L (2.0 - 7.0)
Creatinine 175 µmol/L (55 - 120)
dx?
```
multiple myeloma
hx of weight loss and bone pain
anaemia+hypercalcaemia+RF
183
First line treatment for most patients with a pituitary tumour causing acromegaly:
trans-sphenoidal surgery
2. somatostatin analogue - octreotide
3. GHRA
4. RT
184
serious sfx carbimazole?
agranulocytosis (FBC)
| seek medical attention if sx of infection
185
autoantibodies are useful to distinguish between type 1 and type 2 diabetes?
c-peptide - low in T1
DM specific:
anti-glutamic acid decarboxylase
(80% T1DM have this)
186
A 25-year-old gentleman is found to have a fracture of the distal scaphoid and a plaster of Paris cast is applied. Which medications will increase the risk of osteonecrosis?
pred - steroids
187
results establishes a diagnosis of impaired fasting glucose?
fasting glucose 6.1-6.9 on 2 occasions
188
A 55-year-old man is on the intensive care unit for many months after open aortic surgery. He is maintained on total parenteral nutrition. Clinically he is euthyroid, but his thyroid function tests reveal a low TSH and low T4. dx?
sick euthyroid syndrome
mx: gp recheck tfts 6/52
189
The patient has been diagnosed with maturity onset diabetes of the young (MODY) - type Hepatic Nuclear Factor 1 Alpha (HNF1A). HNF1A accounts for 70% of MODY cases. tx?
sulfonylureas - gliclazide
190
A 14-year-old girl sees you in the outpatients department with a variety of troubling symptoms. She has suffered with bullying at school due to facial hair and large stature. She also reports menarche was at 10 years old. You organise some investigations which show; plasma 17-hydroxyprogesterone - 2 mg/l (0.2-1 mg/l) dx?
congenital adrenal hyperplasia
| PCOS would cause amenorrhoea not early menarche
191
In 1ml of (most standard) insulin, how many units?
100
192
what can reduce the absorption of levothyroxine - ?
iron / calcium carbonate tablets
| give 4 hours apart
193
t1DM and driving:
can drive if have hypo awareness
| should inform the DVLA
194
pathology SIADH? (renals)
increased permeabiblity of collecting ducts to water -> ↑ water reasbsorption -> Dilutional hyponatraemia
195
DKA pathology?
excessive hyperglycaemia leads to increased lipolysis
196
3 OTHER causes of high BMs?
corticosteroids
Cushing's
phaeo
also haemachromatosis, amyloid, CF
197
high anion gap (MUDPILES):
```
methanol
uraemia
DKA
Paraldehyde
Iron/isoniazid
Lactic acidosis
Ethylene glycol
salicylates
```
198
normal anion gap (metabolic acidosis):
```
diarrhoea
CKD, renal tubular acidosis
adrenal insufficiency
hypoaldosteronism
spironolactone, trimethoprim
```
199
features of diabetes insipidus?
polydipsia, polyuria, no glycosuria
200
what is action of ADH?
aquaporins into DCT and leads to loss of sodium and water follows
201
Thyrotoxic storm is treated with?
BB, propylthiouracil and hydrocortisone
202
What is the single most useful test for determining the cause of her hypercalcaemia?
PTH - differentiates between HoM and Primary PTH
203
17-M -> GP not begun puberty. He reports that he has no growth of pubic, facial or underarm hair. He also reports that he has no sense of smell. Small testes and penis. His height is 6 foot 1 inch. dx?
kallman's
204
43M -GP tiredness, low mood and unintentional weight gain of 13kg past 4 months. Prior to feeling like this he recalls having a flu-like illness following which he had a two-week period of feeling very anxious, shaky and energetic. He wonders if this is connected. HR 68, bp 147/83 temp 37.1ºC. No goitre or any palpable lymphadenopathy. dx? TSH 6.1 (mildly raised). T4 6 (low)
subacute thyroiditis (de quervain's)
causes hyper- then hypothyroidism
205
mx hypercalcaemia:
rehydration 3-4L NS
| bisphosphonates
206
DM drug are associated with an increased risk of bladder cancer?
thiazolidinediones
207
In type 1 diabetics, blood glucose targets:
5-7 mmol/l on waking and
| 4-7 mmol/l before meals at other times of the day
208
glitazone MOA? (pioglitazone)
agonists of PPAR-gamma receptors, reducing peripheral insulin resistance
209
The most common endogenous cause of Cushing’s syndrome is a ?
PG adenoma - cushings disease
210
low T3/T4 and normal TSH with acute illness???
sick euthyroid disease
211
42M -GP feeling generally unwell. 3/12 daily frontal headaches - not helped by paracetamol. Wedding ring no longer fitting, his shoe size increasing and a small amount of milky discharge from both nipples. BP 168/96 mmHg. What is the most likely diagnosis?
acromegaly
212
30F recent dx Graves, incision and drainage of a pilonidal abscess 3h ago. Agitated, confused and is noted to be jaundiced and sweaty. t 39 oC, hr 152, bp 95/60. ECG shows an irregular ventricular rate with absent p waves. After resuscitation what is the most appropriate next step in management?
BB and thionamides
213
what should be used first-line for black TD2M patients who are diagnosed with hypertension?
ARB
214
32M recently emigrated from Nepal. He attends his GP practice with regards to symptoms of weight gain, tiredness and hoarseness of voice. Following blood tests, including a thyroid function test, it is found that he has hypothyroidism. What is the most likely cause of hypothyroidism in this patient?
iodine deficiency
215
A 52-year-old man presents to his GP as he is concerned about a discharge from his nipples. Which one of the following drugs is most likely to be responsible?
chlorpromazine
216
What is the most likely explanation for this patient’s impaired hypoglycaemia awareness?
neuropathy in the ANS
217
long term steroid -bone?
OP, avascular necrosis
