Endocrine/ clinical chemistry

Question 1

Suggest which tests should be done to investigate the cause of hyponatraemia.

Answer 1

Bloods- FBC, UEs, LFTs, TFTs, Protein, lipids, glucose

Serum osmolality

Urine sodium and osmolality

Question 2

Which of these tests is used to determine whether the cause of Diabetes Insipidus is cranial or nephrigenic?

1. Serum osmolality
2. 8 hour water deprivation test
3. CT pituitary

Answer 2

8 hour water deprivation test

Question 3

Which of these drugs is used to manage cranial diabetes insipidus?

1. Desmopressin
2. Demecleocyclin
3. Tolvaptan

Answer 3

Desmopressin

Question 4

Which of these drugs is used to manage nephrogenic diabetes insipidus?

1. Desmopressin
2. Thiazide diuretics eg. Bendroflumethiazide
3. Tolvaptan

Answer 4

Thiazide diuretics eg. Bendroflumethiazide

Question 5

A patient who recently underwent an adrenalectomy to treat Cushing’s syndrome presents to GP with skin hyperpigmentation. Investigations reveal raised serum ACTH and an enlarging pituitary tumour. What condition are they most likely to have?

1. Nelson’s syndrome
2. Alport syndrome
3. Haemolytic uraemia syndrome

Answer 5

Nelson’s syndrome

Question 6

What triad of features is typical of Phaeochromocytoma?

Answer 6

1. Sweating
2. Episodic headaches
3. Tachycardia

Question 7

Which of these drugs should be given BEFORE adrenalectomy to remove a phaeochromocytoma?

1. Alpha blockers and Beta blockers
2. Beta blockers and Diuretics
3. Alpha blockers and Diuretics

Answer 7

1. Alpha blockers and Beta blockers

To prevent intraoperative morbidity and mortality from large alterations in blood pressure.

Question 8

Which condition is diagnosed using the 9am serum cortisol and short synacthen tests?

1. Cushing’s syndrome
2. Phaeochromocytoma
3. Diabetes insipidus
4. Addison’s disease

Answer 8

Addison’s disease

Question 9

Which condition is diagnosed by initially measuring serum aldosterone and renin measurements?

1. Cushing’s syndrome
2. Phaeochromocytoma
3. Primary aldosteronism (Conn’s)
4. Addison’s disease

Answer 9

Primary aldosteronism (Conn’s)

Question 10

Which condition is most likely to present with hypokalaemic hypertension?

1. Cushing’s syndrome
2. Phaeochromocytoma
3. Primary aldosteronism (Conn’s)
4. Addison’s disease

Answer 10

Primary aldosteronism (Conn’s)

Question 11

What is the most common endocrine condition in women of reproductive age?

Answer 11

Polycystic ovarian syndrome

Question 12

2/3 of the following criteria should be present to diagnose PCOS…

Answer 12

1. Clinical and/or biochemical features of hyperandrogenism
2. Oligo/anovulation
3. Polycystic ovaries on USS

Question 13

Name 3 or more features of PCOS.

Answer 13

1. Polycystic ovaries
2. Hyperandrogenism
3. Oligo or amenorrhoea
4. Obesity
5. Hirtuism
6. Subfertility
7. Acne

Question 14

Name 2 or more options for managing PCOS.

Answer 14

1. Weight loss
2. Metformin
3. Combined oral contraceptive pill- with withdrawal bleed at least every 3 months. Manages amenorrhoea
4. IVF
5. Clomifene citrate for stimulation of ovulation
6. Anti-androgen creams or systemic therapy (Spironalactone, Finasteride) for hirtuism

Question 15

Why is a withdrawal bleed recommended at least every 3 months in patients with PCOS?

1. Reduces hyperandrogenism
2. Reduces endometrial hyperplasia
3. Reduces prolactin levels

Answer 15

2. Reduces endometrial hyperplasia

Question 16

Diabetic retinopathy is most common in which type of diabetes?

Answer 16

Type 1 diabetes

Question 17

What is the target clinic BP in diabetics aged 80 or under?

1. 150/90
2. 140/90
3. 135/85

Answer 17

140/90

Same as non diabetics

Question 18

Which of these retinal features usually occurs first in non-proliferative diabetic retinopathy?

1. Neovascularisation
2. Micro aneurysms
3. Cotton wool spots
4. Macula oedema

Answer 18

Microaneurysms

Question 19

Name 1 or more non-retinal feature of diabetic eye disease.

Answer 19

1. Cataracts
2. Cranial nerve palsies (CN 3 and 6)
3. Neovascular glaucoma
4. Frequent lens changes
5. Argyll Robertson pupils

Question 20

Which drug used for managing diabetes has side effects including weight gain, hypoglycaemia and hyponatreamia?

1. Metformin
2. Sulfonylureas (Glicazide)
3. DPP4 inhibitors (Gliptins)
4. GLP1 mimetics

Answer 20

2. Sulfonylureas (Glicazide)

Question 21

Which drug used for managing diabetes has side effects including rashes and hypersensitivity, headaches and pancreatitis?

1. Metformin
2. Sulfonylureas (Glicazide)
3. DPP4 inhibitors (Gliptins)
4. GLP1 mimetics

Answer 21

3. DPP4 inhibitors (Gliptins)

Question 22

Which drug used for managing diabetes has side effects including weight gain, deranged lipids and LFTS, increased fracture risk and fluid retention?

1. Pioglitazone
2. Sulfonylureas (Glicazide)
3. DPP4 inhibitors (Gliptins)
4. GLP1 mimetics

Answer 22

1. Pioglitazone

Question 23

Which of these drugs used for managing diabetes is contraindicated in patients with high fracture risk, bladder cancer, haematuria or heart failure?

1. Pioglitazone
2. Sulfonylureas (Glicazide)
3. DPP4 inhibitors (Gliptins)
4. GLP1 mimetics

Answer 23

1. Pioglitazone

Question 24

Which of these drugs is used to manage treatment refractory diabetes in patients with a high BMI, who have already tried 3 other diabetic drugs?

1. Pioglitazone
2. Sulfonylureas (Glicazide)
3. DPP4 inhibitors (Gliptins)
4. GLP1 mimetics

Answer 24

4. GLP1 mimetics

Question 25

Which treatment should be given first in patients with acute severe hyponatraemia? 1. Tolvaptan 2. IV Dextrose 10% 3. Hypertonic saline (1.8%) bolus

Answer 25

3. Hypertonic saline (1.8%) bolus

Question 26

Central pontine myelinolysis can occur due to over-correction of severe ...... 1. Hypocalcaemia 2. Hyponatraemia 3. Hypernatramia 4. Hypokalaemia

Answer 26

2. Hyponatraemia

Question 27

Name 2 or more causes of hyponatramia where patients are dehydrated and have high urine sodium levels?

Answer 27

1. Addison's 2. Diuretics- loop and thiazide 3. Renal failure

Question 28

Name 2 or more causes of hyponatramia where patients are NOT dehydrated and appear oedematous?

Answer 28

1. Heart failure 2. Liver failure 3. Renal failure 4. Nephrotic syndrome

Question 29

Gestational diabetes is diagnosed if fasting blood glucose levels are: 1. >5.6 2. >7 3. >11

Answer 29

1. >5.6

Question 30

What are the 2 most common causes of hypercalcaemia? 1. Primary hyperparathyroidism & malignancy 2. Primary hyperparathyroidism & sarcoidosis 3. Primary hyperparathyroidism & thyrotoxicosis

Answer 30

1. Primary hyperparathyroidism & malignancy