endocrine and diabetes formative Flashcards
- A patient with hypothyroidism would demonstrate which of the following symptoms:
A. Exophthalmos B. Increased heart rate C. Heat intolerance D. Increased protein catabolism E. Lethargy
lethargy
All other symptoms are symptoms of hyperthyroidism.
Osteoporosis is a consequence of hyperthyroidism (TSH<0.02)
- Goitre is a common symptom of thyroid dysfunction and can be present in both hypo- and hyper-thyroidism. However, it would not be present in which of the following thyroid pathologies?
A. Primary hypothyroidism B. Secondary hypothyroidism C. Primary hyperthyroidism D. Secondary hyperthyroidism E. Graves’ disease
secondary hypothyroidism.
Goitre comes about due to overstimulation of the thyroid gland, causes hypertrophy of the follicular cells in both hypo- and hyper-thyroidism. Primary hypothyroidism increases TSH release by removing negative feedback on the anterior pituitary (lack of T3/T4 production e.g. iodine deficiency); hyperthyroidism is associated with excessive activity of the thyroid gland (either due to antibodies mimicking TSH (primary) or over activity of the anterior pituitary (secondary)) so goitre is a typical feature. Only secondary hypothyroidism (decreased activity in the anterior pituitary) would be associated with a decrease in TSH release and therefore decreased stimulation of the thyroid leading to depleted plasma T3/T4 levels.
- A decrease in circulating cortisol levels would result in which of the following physiological responses:
A. Enhanced gluconeogenesis in the liver.
B. Hypotension
C. Decreased ACTH secretion from the anterior pituitary
D. Elevated fatty acid levels in the plasma
E. Suppression the immune system
hypotension.
All the other options are responses to cortisol secretion. Hypotension occurs due to a loss of the permissive effects of cortisol on norepinephrine binding to α1 receptors. Life threatening hypotension is associated with Addison’s Disease where there is “adrenal crisis” and a loss of both glucocorticoid and mineralocorticoid release, although in this situation the hypotensive crisis mainly results from the loss of the effect of aldosterone on Na+ retention at the kidney but is augmented by loss of cortisol.
- A person with primary hypercortisolism would demonstrate:
A. Depressed ACTH B. Elevated CRH C. Hypotension D. Hypoglycaemia E. Increased bone resorption
depressed ACTH (due to enhanced negative feedback form cortisol).
- Elevated CRH unlikely due to negative feedback from cortisol
- Hypertension occurs due to permissive effect of cortisol on α1 adrenoceptor
- Hyperglycaemia is an effect of cortisol secretion due to gluconeogenic action on liver
- Cortisol stimulates bone resorption so osteoporosis is more likely.
- Chronic glucocorticoid therapy is associated with which of the following:
A. Enhanced cortisol release from the adrenal glands
B. Enhanced ACTH release from the anterior pituitary
C. Enhanced CRH release from the hypothalamus
D. Adrenal insufficiency
E. Adrenal hypertrophy
Adrenal insufficiency.
Chronic glucocorticoid treatment leads to adrenal insufficiency because the adrenal glands effectively are no longer required to produce cortisol. The exogenous glucocorticoids supress ACTH release through the negative feedback pathway and subsequently cortisol release from the adrenal glands fall. Overtime the adrenal glands atrophy and adrenal insufficiency results. Hence the reason why glucocorticoid therapy should be withdrawn gradually to avoid hypocortisolism.
- Which of the following will elevate free calcium levels in plasma?
A. Alkalosis B. Activation of osteoblasts C. Increased phosphate excretion at the kidney D. Calcitonin E. All of the above
increased phosphate excretion at the kidney.
Phosphate and calcium are intricately linked, especially in the deposition of bone matrix. By increasing phosphate excretion, an action of PTH, the calcium is prevented from complexing with phosphate and this prevents calcium being laid down in bone, elevating free levels in the plasma.
- Regarding Growth Hormone which of the following is correct:
A. It is also known as Somatostatin
B. It is also known as Somatomedian
C. It is a steroid hormone
D. Levels in adults are at their highest during REM sleep
E. It is relatively insignificant in terms of foetal and neonatal growth
it is relatively insignificant in terms of foetal and neonatal growth.
Somatostatin and Somatomedian are alternative names for Growth Hormone Inhibiting Hormone and IGF-1 respectively. GH is a peptide hormone whose levels are greatest during delta sleep, and lowest during REM sleep. GH levels are very low in utero but increase rapidly in the months following birth.
- The adrenal zona glomerulosa secretes which hormone:
A. Testosterone B. Progesterone C. Aldosterone D. Cortisol E. Epinephrine/adrenaline
aldosterone
Testosterone and progesterone secreted by zona reticularis
Cortisol secreted by zona fasiculata
Epinephrine/adrenaline secreted by adrenal medulla
- Which of the following responses would you expect following insulin release:
A. Hepatic gluconeogenesis B. Increased ketone formation C. Increased uptake of glucose by the brain D. Adipose lipolysis E. Stimulation of Na+/K+ ATPase
Stimulation of Na+/K+ ATPase
Insulin stimulates the Na+/K+ ATPase and in doing so helps to control extracellular [K+].
A, B and D are actions of glucagon.
The brain is an obligatory glucose utilizer, so does not require insulin for glucose uptake.
- Which of the following is not a Glucose Counter Regulatory Hormone:
A. Thyroid hormone B. Epinephrine (adrenaline) C. Glucagon D. Cortisol E. Growth hormone
thyroid hormone
While TH stimulates gluconeogenesis, the increase in blood glucose stimulates the release of insulin so total blood glucose concentration remains in balance.
- A 26 year old man is diagnosed with Type 1 diabetes. He works offshore on a ‘2 week on 3 week off’ rota. He drives a car. He has just got married and his wife is expecting their first child. What information should he receive shortly after diagnosis?
A. He should be told he cannot drive.
B He may be able to work offshore depending on his employer and where he is going.
C He is likely to pass on his diabetes to his child.
D He should be advised to stop drinking any alcohol.
E He should be told he is unlikely to ever have any hypos (hypoglycaemic episodes) if he monitors his blood glucose regularly.
He may be able to work offshore depending on his employer and where he is going.
- An 80 year old lady who is keen to stay healthy and well comes to see you in clinic. She has been having daily episodes of sweating and palpitations and been feeling hungry. She has had type 2 diabetes for 30 years and is on Metformin 1g bd and Glipizide 5mg bd. Her renal function has deteriorated but her GFR is 50 with a creatinine of 88. Her HbA1c is 51mmol/mol.
During one of the episodes she checked her blood glucose and found that it was 3.0mmol/l.
What action should be taken initially with regard to her management?
A. Stop metformin B. Stop glipizide C. Check blood glucose more regularly D. Repeat HbA1c E. Request a Holter monitor
stop glipizide
Glipizide should be stopped as she is having daily hypos and sulphonylureas can cause hypoglycaemia. This is the biggest risk to her safety and her blood glucose levels appear to be reasonably well controlled and the aim of treating her diabetes is to keep her well and safe.
13. A 53 year old man diagnosed with T2 Diabetes Mellitus 6 months ago. He has lost 1 stone in weight his BMI is 28 and HbA1c is 75 mmol/mol (9%). What is the next appropriate medication in his management? A. Insulin B. Thiazolidinedione (e.g. pioglitazone) C. Sulphonylurea (e.g. glimepiride) D. Biguanide (e.g. metformin) E. DPP IV inhibitor (e.g. Sitagliptin)
Biguanide (e.g. metformin)
Bearing in mind patient needs to have a normal renal function and can upset bowel so small amount and titrate.
14. Which symptom below is NOT typical of hypoglycaemia? A. Headache B. Itch C. Poor concentration D. Sweating E. Irritability
itch.
Itch is not a symptom for hypos. All the others are.
15. A 32 year old patient with T1 Diabetes Mellitus is reviewed at the diabetes clinic. His blood sugar is 3.2 mmol/l and he tells you he is feeling well. What is the best course of action next? A. Administer IM glucagon B. Send him home for lunch C. Give 200ml fresh orange juice D. Give digestive biscuit E. Administer his lunchtime insulin
Give 200ml fresh orange juice
Glucagon – the patient is not unconscious and able to converse so can take oral treatment. Need to treat this NOW. No time to leave clinic and certainly shouldn’t be driving. Digestive biscuit while better than nothing needs to be digested to glucose to be absorbed and has fat in it. Certainly, don’t give insulin to hypo patient. Treat hypo but watch you should never omit insulin either.
