Endocrine and Metabolic Medicine

Question 1

Which hypoglycaemic agents are indicated in patients at risk of/with established CVD or CCF?

Answer 1

SGT2 inhibitor (e.g. dapagliflozin)

Question 2

Which hypoglycaemic agents are indicated in patients with low risk of CVD or CCF?

Answer 2

DPP-4 inhibitors (e.g. sitagliptin, saxagliptin, linagliptin, and alogliptin)
TZDs (Pioglitazone)
Sulphonylureas (e.g. Gliclazide, glipizide)

Question 3

Which side effects are associated with sulfonylureas (e.g. gliclazide)?

Answer 3

Hypoglycaemia
Weight gain
GI upset
Hypersensitivity

Question 4

Which side effects are associated with incretin analogues (e.g. exanatide)?

Answer 4

Weight loss
Reduced hepatic fat accumulation
Hypoglycaemia
Nausea

Question 5

Which side effects are associated with pioglitazone?

Answer 5

Weight gain
Fluid retention

Question 6

What are the contraindications of pioglitazone?

Answer 6

CCF
Bladder cancer
Liver impairmentW

Question 7

Which hypoglycaemic drug should be given if Q Risk score > 10%?

Answer 7

SGLT2 inhibitors

Question 8

Which disorder is phaeochromocytoma associated with?

Answer 8

MEN II

Question 9

Which investigation is used to diagnose pheochromocytoma?

Answer 9

24 hour urinary metanephrines

Question 10

Which metabolic abnormality is seen in Cushing’s syndrome?

Answer 10

Hypokalaemia metabolic alkalosis

Question 11

Which TFT pattern is seen in thyrotoxicosis (e.g. Grave’s disease)?

Answer 11

Low TSH
High free T4

Question 12

Which biochemical pattern is seen in primary hyperparathyroidism?

Answer 12

High calcium
Low phosphate
High/normal PTH

Question 13

Which biochemical pattern is seen in secondary hyperparathyroidism?

Answer 13

Chronic disease (e.g. CKD)

Low calcium
High phosphate
Compensatory increased PTH

Question 14

Which biochemical pattern is seen in tertiary hyperparathyroidism?

Answer 14

Parathyroid hyperplasia

High calcium
High PTH

Question 15

How is primary hyperparathyroidism treated?

Answer 15

Total parathyroidectomy

Question 16

Which investigations are diagnostic in T1DM?

Answer 16

Low C peptide
Anti - GAD (80%)
Islet cell antibodies (70-80%)
Insulin autoantibodies (IAA)

Question 17

What are the caused of primary hyperaldosteronism?

Answer 17

Bilateral idiopathic hyperplasia (60-70% of cases)
Adrenal adenoma
Unilateral hyperplasia
Familial hyperaldosteronism
Adrenal carcinoma

Question 18

How is bilateral adrenal hyperplasia treated?

Answer 18

Spironolactone

Question 19

Which fasting glucose level is diagnostic of T2DM?

Answer 19

> = 7.0 mmol/l

Question 20

Which random glucose level is diagnostic of T2DM?

Answer 20

> = 11.1 mmol/l

Question 21

What is a normal fasting glucose?

Answer 21

<=6.0 mmol/l

Question 22

Which HbA1c level is diagnostic of T2DM?

Answer 22

> = 48 mol/mol

Question 23

Define impaired fasting glucose

Answer 23

> =6.1 mmol/l but < 7.0 mmol/l

Question 24

Define impaired glucose tolerance

Answer 24

Plasma glucose <7.0 mmol/l

AND

OGTT at 2 hours >= 7.8 mmol/l but < 11.1 mmol/l

Question 25

How is suspected Addison’s disease diagnosed?

Answer 25

Short Synacthen test

Question 26

Which metabolic abnormalities are seen in Addison’s disease?

Answer 26

Raised K+
Low Na+
Low glucose
Metabolic acidosis

Question 27

How is myxoedema coma managed?

Answer 27

IV thyroid replacement
IV fluids
IV steroids
Electrolyte imbalance correction

Question 28

What can cause hypothyroidism?

Answer 28

Hashimoto’s thyroiditis
Riedels
Iodine deficiency
Lithium
Subacute thyroidits

Question 29

How is thyroid replacement therapy monitored?

Answer 29

TSH - aim for 0.5 -2.5 mU/l

Question 30

How is plasma osmolality calculated?

Answer 30

2Na+ + Urea + Glucose

Question 31

Which is the commonest thyroid cancer?

Answer 31

Papillary carcinoma

Question 32

How is acromegaly investigated?

Answer 32

IGF-1

Question 33

What is the commonest cause of hypercalcaemia?

Answer 33

Primary hyperparathyroidism

Question 34

Which drug is used to treat galactorrhea?

Answer 34

Bromocriptine (dopamine agonist)

Question 35

Which conditions can cause lower-than-expected levels of HbA1c?

Answer 35

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

(Due to reduced RBC lifespan)