Endocrine and metabolic disorders

Question 1

Hashimoto’s thyroiditis: 3 top clinical signs/findings

Answer 1

Hashimoto’s thyroiditis = hypothyroidism + goitre + anti-TPO

Question 2

The main ECG abnormality seen with hypercalcaemia is

Answer 2

The main ECG abnormality seen with hypercalcaemia is shortening of the QT interval

Question 3

If the blood pressure is >= 180/120 mmHg:
admit for specialist assessment if:

Answer 3

• signs of retinal haemorrhage or papilloedema (accelerated hypertension) or
• life-threatening symptoms such as new-onset confusion, chest pain, signs of heart failure, or acute kidney injury

Question 4

Pretibial myxoedema is an uncommon but specific feature in

Answer 4

Pretibial myxoedema is an uncommon but specific feature in Grave’s disease that is not seen in hyperthyroidism secondary to other causes

Question 5

subclinical hypothyrodism definition and management

Answer 5

• subclinical hypothyroidism (very mildly raised TSH but normal T3 and T4)
• watch and wait

Question 6

when do you give IV glucose in hypos?

Answer 6

hospital setting: reduced GCS and already has IV access
100ml of IV glucose 20% STAT

Question 7

clinical picture of hypothyroidism with what appears to be a brief period of hyperthyroidism prior to this. diagnosis ?

Answer 7

most common cause of this is De Quervain’s thyroiditis

Question 8

biochemical abnormality in cushing’s

Answer 8

hypokalaemic metabolic alkalosis

Question 9

Primary hyperaldosteronism: manage with

Answer 9

Primary hyperaldosteronism: manage with spironolactone

Question 10

The Hba1c target for patients on a drug which may cause hypoglycaemia

Answer 10

The Hba1c target for patients on a drug which may cause hypoglycaemia (eg sulfonylurea) is 53 mmol/mol

Question 11

T1DM sick days rules

Answer 11

• if a patient is on insulin, they must not stop it due to the risk of diabetic ketoacidosis
  check blood glucose more frequently, for example, every 1-2 hours including through the night
• consider checking blood or urine ketone levels regularly
  maintain normal meal pattern if possible
• if appetite is reduced meals could be replaced with carbohydrate-containing drinks (such as milk, milkshakes, fruit juices, and sugary drinks)
• aim to drink at least 3 L of fluid (5 pints) a day to prevent dehydration

Question 12

T2DM sick day rules

Answer 12

advise the patient to temporarily stop some oral hypoglycaemics during an acute illness

medication may be restarted once the person is feeling better and eating and drinking for 24-48 hours
* metformin: stop treatment if there is a risk of dehydration, to reduce the risk of lactic acidosis.
* sulfonylureas: may increase the risk of hypoglycaemia
* SGLT-2 inhibitors: check for ketones and stop treatment if acutely unwell and/or at risk of dehydration, due to the risk of euglycaemic DKA
* GLP-1 receptor agonists: stop treatment if there is a risk of dehydration, to reduce the risk of AKI

if on insulin therapy, do not stop treatment
monitor blood glucose more frequently as necessary

Question 13

In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of…

Answer 13

In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%
(4.2 value usually)

Question 14

A 72-year-old female known to have osteoporosis is started on alendronate. Which one of the following side-effects is it most important to warn her about?

Answer 14

Heartburn
Bisphosphonates can cause a variety of oesophageal problems