endocrine clinical skills

Question 1

how does hypocalcaemia cause intestinal cramping?

Answer 1

increased gut motility due to increased excitability –> intestinal cramping

Question 2

ipsilateral contraction of facial muscles when facial nerve is tapped
what sign is this?

Answer 2

Chvostek’s sign

Question 3

carpopedal spasm when a sphygomanometer is inflated above systolic pressure after 3 min
what sign is this?

Answer 3

trosseau’s sign

Question 4

what drugs can cause hypothyroidism?

Answer 4

lithium, amiodarone (anti-arrhythmmic drug)

Question 5

ketotic breath, hyperventilation, kussmaul breathing
what is this indicative of?

Answer 5

DKA

Question 6

what is acanthosis nigricans a sign of?

Answer 6

insuline resistance (in T2DM)

Question 7

what signs are usually seen in T1DM patient presenting with acute DKA?

Answer 7

1. ketotic breath
2. decreased tissue turgor due to dehydration
3. delayed capillary refill
4. kussmaul breathing

Question 8

what are the diagnostic criteria for diabetes?
fasting glucose of >___ mmol/L
oral glucose tolerance test >___ mmol/L
HbA1c >___%

Answer 8

FBG: >7.0 mmol/L
oral glucose tolerance test: >11.1 mmol/L
HbA1c >6.5%

Question 9

which of the following examination findings would least likely to be found in a patient with Hashimoto’s thyroiditis?
a. periorbital oedema
b. positive tinel’s sign
c. xanthelesma
d. signs of CHF on auscultation

Answer 9

d. signs of CHF on auscultation (more likely find pericardial and pleural effusion)

tinel’s sign –> carpal tunnel syndrome
xanthelesma (decreased BMR –> liver does not process and uptake cholesterol well)

Question 10

60M T2DM patient
- pulses on feet not palpable
which of the following symptoms he reported is indicative of severe peripheral vascular disease predisposing him to increased risk of diabetic foot ulcers?
a. burning pain in feet at night
b. dry feet with cracked skin
c. intermittent claudication
d. tingling sensation on both feet

Answer 10

c. intermittent claudication
(pain, cramping, or discomfort in the muscles of the legs, typically the calf muscles, during physical activity)

Question 11

what is necrobiosis?

Answer 11

symmetrical plaques on shins with yellow appearance and waxy feel

Question 12

which of the positive urinalysis findings would be most suggestive of bladder cancer?
a. elevated specific gravity and bilirubin
b. isolated haematuria
c. leukocytes, nitrites, haematuria
d. nitrites and glucose

Answer 12

isolated haematuria

Question 13

what is an audible bruit over the thyroid gland indicative of?

Answer 13

Grave’s disease

Question 14

hearing impairment, bradycardia, positive phalen’s sign, delayed tendon reflexes, xanthelesma
what endocrine disorder?

Answer 14

hypothyrodism

Question 15

what does positive GAD (glutamic acid decarboxylase) antibodies in blood test indicate?

Answer 15

type 1 diabetes

Question 16

Edward, a 32 year old man, presents with polydipsia and polyuria and is found to have elevated blood glucose levels. Which of the following would be suggestive of Type 1 Diabetes Mellitus (rather than Type 2) as the cause of his symptoms?

a. family Hx of coeliac disease
b. fishy smelling breath
c. brown pigmentation on neck and axilla
d. visible buffalo hump
e. cataracts

Answer 16

a. family Hx of coeliac disease (T1DM has strong links to autoimmune diseases such as thyroid disease and coeliac disease)