Endocrine pathology

Question 1

Anterior pituitary embryology

Answer 1

Ectoderm

Question 2

Supra-optic tumour

Answer 2

Posterior pituitary
ADH
Water on the brain

Question 3

Prolactinoma

Answer 3

Excess prolactin
Headache
Bitemporal hemianopia
Male - erectile dysfunction and reduced libido
Female - amenorrhoea and galactorrhoea

Question 4

Management of prolactinoma

Answer 4

Bromocriptine
Transphenoidal surgery

Question 5

Acromegaly symptoms

Answer 5

Increased GH
Increased hand size
HOCM

Question 6

Management of acromegaly

Answer 6

Somatostatin
Surgery

Question 7

SIADH

Answer 7

Posterior pituitary
HTN
Low sodium

Question 8

Central diabetes insipidus physiology

Answer 8

Deprive patient of water
ADH does not increase, urine osmolality does not increase
If you give ADH —> increased urine osmolality

Question 9

Nephrogenic diabetes insipidus physiology

Answer 9

Deprive patient of water
ADH does not increase, urine osmolality does not increase
If you give ADH —> urine osmolality does not change

Question 10

Central diabetes insipidus causes

Answer 10

V1 receptor mutation
Reduced or absent ADH

Question 11

Nephrogenic diabetes insipidus causes

Answer 11

V2 receptor mutation
Normal ADH
Aquaporin in collecting ducts

Question 12

Enzyme in liver cause vitamin D hydroxylation

Answer 12

25-hydroxylase

Question 13

Enzyme in kidney cause vitamin D hydroxylation

Answer 13

1 alpha hydroxylase

Question 14

Which part of kidney does vit D get hydroxylated?

Answer 14

PCT

Question 15

Scan used to locate parathyroid tumour

Answer 15

Sestamibi

Question 16

Which thyroid drugs can be used in pregnancy?

Answer 16

Propythiouracul - pro pregnancy - ok in 1st trimester

Question 17

SE of carbimazole

Answer 17

Pancytopaenia

Question 18

T cell lymphoma

Answer 18

Small bowel
T - tiny - small bowel

Question 19

B cell lymphoma

Answer 19

Testicle
B - big bollocks

Question 20

Hashimotos thyroiditis

Answer 20

Hyper then hypo
Hurtle cells
Risk of non-hodgkins lymphoma
TPO antibodies

Question 21

Subacute thyroiditis

Answer 21

Painful

Question 22

Diagnosis of thyroid cancer

Answer 22

Radioactive iodine uptake scan
USS
FNA

Question 23

Papillary thyroid cancer

Answer 23

Most common
Psammoma
Orphan Annie nuclei

Question 24

Follicular thyroid cancer

Answer 24

Spread to blood
Invades capsule
Hemi thyroidectomy

Question 25

Medullary thyroid cancer

Answer 25

Neuroendocrine tumour of parafollicular "C" cells Congo red - amyloid Men 2A and 2B = RET mutation

Question 26

Why is medullary thyroid cancer not picked up on bone scan?

Answer 26

Parafollicular C cells do not take up iodine

Question 27

Anaplastic thyroid cancer

Answer 27

Elderly Hard mass Poor prognosis

Question 28

Tracheomalacia

Answer 28

Large thyroid removed --> breathing difficulties

Question 29

Pre op management of Addisons

Answer 29

100my hydrocortisone on induction then QDS

Question 30

Which part of adrenal gland does phaechromocytoma effect?

Answer 30

Adrenal medulla - chromatin cells RET gene mutation

Question 31

10s of pheochromocytoma

Answer 31

10% bilateral 10% malignant 10% extra adrenal 10% calcify 10% children

Question 32

Scan to detect phaechromocytoma

Answer 32

MIBG scan Potassium iodide given pre to saturate thyroid

Question 33

Peri op management of phaeochromocytoma

Answer 33

Alpha blocker before beta blocker to reduce risk of stroke

Question 34

MEN inheritance

Answer 34

Autosomal dominant

Question 35

MEN 1

Answer 35

Parathyroid tumours Pituitary tumours Pancreatic tumours Menin gene

Question 36

MEN 2a

Answer 36

Medullary thyroid Parathyroid tumours Pheochromocytoma RET gene

Question 37

MEN 2b

Answer 37

Marfan Mucosal neuroma Medullary thyroid Phaeochromocytoma RET GENE

Question 38

Gastrinoma association

Answer 38

MEN gene