Endocrinology Flashcards
1
Q
What is hyperuricaemia associated with?
A
Hyperlipidaemia, hypertension, metabolic syndrome
2
Q
What are the enzyme abnormalities in Gitelman’s syndrome?
A
hypokalaemia, hypocalciuria, hypomagnesaemia
3
Q
What are the diagnostic thresholds for gestational diabetes?
A
FG >= 5.6, 2-hr glucose >= 7.8
4
Q
What threshold for FG should insulin be started in gestational diabetes?
A
FG >= 7.0
5
Q
What causes predominantly hypercholesterolaemia rather than hypertriglyceridaemia?
A
nephrotic syndrome, cholestasis, hypothyroidism
6
Q
What causes predominantly hypertriglyceridaemia rather than hypercholesterolaemia?
A
diabetes, obesity, alcohol, chronic renal failure, drugs, liver disease
7
Q
What is the MOA of meglitinides?
A
bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells
8
Q
What are the three symptoms of Pendred’s syndrome?
A
bilateral sensorineural deafness, mild hypothyroidism and goitre
9
Q
What is the MOA of evolocumab?
A
prevents PCSK9-mediated LDL receptor degradation
10
Q
What is the MOA of fibrates?
A
Increase lipoprotein lipase activity via PPAR-alpha agonism
11
Q
What is the MOA of ezetimibe?
A
reduces intestinal absorption of cholesterol
12
Q
What is cholesterol a precursor to?
A
steroids, bile acids, vitamin D
also used to maintain cell membranes
13
Q
What defect leads to familal hypercholesterolaemia?
A
Mutations in the LDL receptor gene (these are used for LDL clearance and breakdown to free cholesterol in the liver)
14
Q
Which medication can increase fertility in PCOS?
A
Clomifene
15
Q
Which medication is used to treat hyperthyroidism in the first trimester?
A
Propylthiouracil
16
Q
Which medication is used to treat hyperthyroidism in the second and third trimester?
A
Carbimazole
17
Q
What helps to determine the risk of fetal hypothyroidism when a mother is being treated for thyrotoxicosis in pregnancy?
A
thyrotrophin receptor stimulating antibodies at 30-36 weeks gestation
18
Q
What is the treatment of myxoedemic coma?
A
Hydrocortisone and levothyroxine
19
Q
Which type of MODY is most common and what gene is responsible?
A
MODY3 - HNF-1 alpha gene
20
Q
Which gene is responsible for MODY2
A
glucokinase gene
21
Q
Which gene is responsible for MODY5
A
HNF-1 beta gene
22
Q
What is the diagnostic test for gastroparesis in DM
A
Isotrope gastric motility scintigraphy scan
23
Q
What causes asymmetrical quadriceps wasting in DM
A
Diabetic amyotrophy (motor neuropathy)
24
Q
What is the MOA of carbimazole
A
Blocks thyroid peroxidase from coupling and iodinating tyrosine residues on thyroglobulin - reducing thyroid hormone production
25
What antiglycaemic agent is linked with severe pancreatitis
exenatide
26
Which drugs cause SIADH
carbamazepine, sulphonylureas, SSRIs, TCAs
27
What condition describes lack of blood flow to the pituitary after blood loss during childbirth
Sheehan's syndrome
28
what is seen in sick euthyroid syndrome
Low TSH, low thyroxine, low T3
29
what is the action of metformin in PCOS
increases peripheral insulin sensitivity
30
Which antibodies can be used to test for LADA
GAD
31
What is the first line investigation of Conn’s syndrome
Plasma aldosterone/renin ratio
32
What is the HbA1c target for a patient with T2DM on metformin
48
33
What is the HbA1c target for a patient with T2DM on a drug that may cause hypoglycaemia
53
34
Which insulin should a patient with T2DM start with
NPH insulin (intermediate-acting)
35
What is the first line treatment for remnant hyperlipidaemia
Fibrates
36
Which anti-diabetic medication is associated with increased risk of foot amputations
Canagloflozin
37
What levels of FSH and LH are seen in Kallmann syndrome
Low/normal
38
What levels of FSH and LH are seen in Klinefelter syndrome
Raised FSH and LH
39
What is the inheritance of Kallmann’s syndrome
X-linked recessive
40
When should statins be started in T1DM
age over 40yrs, had diabetes >10 years, established nephropathy, or has other CVD risk factors
41
What is the management of subclinical hypothyroidism in an asymptomatic person with TSH < 10
Watch and wait
42
What is the management of subclinical hypothyroidism in an asymptomatic person aged less than 70 with TSH >10
start levothyroxine
43
Which steroids have the lowest mineralocorticoid activity
dexamethasone, betmethasone
44
what are the endocrine deficiencies seen in autoimmune polyendocrinopathy syndrome (APS) type 2
Addisons + T1DM or autoimmune thyroid disease
45
what are the endocrine deficiencies seen in autoimmune polyendocrinopathy syndrome (APS) type 1
2 of: Addisons, chronic mucocutaneous candidiasis, primary hypoparathyroidism
46
What is the treatment of liddle's syndrome
amiloride or triamterene
47
What is the central feature of MEN1
hyperparathyroidism
48
What is the difference between MEN2a and MEN2b
MEN2a has hyperparathyroidism, MEN2b has marfanoid body. (both have medullary thyroid cancer and phaeochromocytoma)
49
When should metformin be considered in T1DM
BMI > 25
50
What does nuclear scintigraphy show in toxic multinodular goitre
Patchy uptake
51
What causes excessive sweating in acromegaly
Sweat gland hypertrophy
52
What are the symptoms of MEN1
Peptic ulcer (from insulinomas/gastrinomas), hyperparathyroidism, pituitary disease
53
Which MEN gives a marfanoid body habitus
MEN 2b
54
Which MEN Types cause hyperparathyroidism
MEN1, MEN2a
55
What condition is associated with tendon and tuberous xanthoma
Familial hypercholesterolaemia
56
What is the treatment of familial hypercholesterolaemia
Max dose statins
57
Which condition is associated with palmar xanthoma
Remnant hyperlipidaemia
58
What is associated with eruptive xanthoma
Familial hypertriglyceridaemia, lipoprotein lipase deficiency
59
What features are diagnostic of metabolic syndrome
Central obesity + 2 of: raised triglycerides, low HDL, hypertension, raised fasting glucose
60
Where is leptin produced
Adipose
61
Where is ghrelin produced
Stomach/pancreas
62
Which condition is due to inhibition of lipoprotein lipase leading to raised triglycerides and recurrent abdominal pain
Chylomicronaemia syndrome
63
How is insulinoma diagnosed
72 hr fast - if symptoms develop check insulin and c-peptide
64
What is the MOA of fibrates
Activate PPAR alpha receptors - increases LPL activity
65
What percentage of insulinomas are malignant
10%
66
Which malignancy is necrolytic migratory erythema associated with
Glucagonoma
67
What is Wolfram’s syndrome
DIDMOAD - DI, DM, optic atrophy and deafness
68
What is the usual inheritance of nephrogenic DI
X-linked recessive
69
What is the treatment of nephrogenic DI
Indomethacin, thiazide, low sodium diet
70
What is the treatment of cranial DI
Fluids, vasopressin
71
What is the inheritance of Liddle’s syndrome
Autosomal dominant
72
Which inherited condition causes severe hypokalaemia due to defective Cl absorption at the Na-K-2Cl co-transporter in ascending loop of henle
Bartter’s syndrome
73
What is the treatment of Bartter’s syndrome
Spironolactone/Indomethacin
74
What is the inheritance of Bartter’s syndrome
Autosomal recessive
75
What electrolyte abnormalities are seen in Gitelman’s syndrome
Hypokalaemia, hypomagnesaemia and hypocalciuria
76
Where is the transport defect located in Gitelman’s syndrome
DCT (thiazide-sensitive Na-Cl transporter)
77
What is the main cause of hyperaldosteronism
Bilateral idiopathic adrenal hyperplasia
78
How do corticosteroids cause osteoporosis
Inhibit osteoblast activity and increase osteoblast apoptosis
79
What is the most accurate way to test for pituitary source of cushing’s
Inferior petrosal sinus sampling
80
Which antibodies are typically seen in Addison’s disease
Anti-2l hydroxylase antibodies
81
What are the causes of SIADH
Sulphonylureas, SSRIs, TCAs, antipsychotics, carbamazepine, thiazides, omeprazole, porphyrias
82
Where does phaeochromocytoma arise from
Chromaffin cells in medulla
83
Which conditions are associated with phaeochromocytoma
MEN2, neurofibromatosis, VHL
84
What causes increased IGF-1
Acromegaly, pregnancy
85
What complications are associated with acromegaly
Hypertension, diabetes, colorectal cancer, cardiomyopathy
86
What is the diagnostic test for GH deficiency
Insulin tolerance test - <10mg/L of GH released confirms diagnosis
87
What is the most important treatment in pituitary apoplexy
IV hydrocortisone
88
What test can be used to diagnose factitious hyperthyroidism
Low thyroglobulin
89
What are the most common antibodies in Grave’s disease
Anti-TSH receptor stimulating Abs (90%) (50% have TPO Abs)
90
What is toxic multinodular goitre
Thyroid gland contains multiple autonomously functioning thyroid nodules
91
What is the biggest risk factor for developing thyroid eye disease
Smoking
92
What pattern of thyroid disease does De Quervain’s have
Post viral: hyperthyroid -> hypothyroid -> euthyroid
93
Which HLA is associated with De Quervain’s thyroiditis
HLA B35
94
What is the treatment of De Quervain’s thyroiditis
Self limiting, no treatment required
95
What are the complications of subclinical hyperthyroidism
SVT, osteoporosis
96
Which antibodies are positive in Hashimoto’s thyroiditis
Anti-TPO, Anti-TG
97
Which drugs interfere with thyroxine absorption
Rifampicin, amiodarone, calcium, iron tablets, cholestyramine, sevelamer, PPIs
98
Which syndrome describes increased reverse T3, low T3 and T4 seen in ITU patients
Sick euthyroid syndrome
99
Which thyroid cancer is associated with FAP
Papillary
100
Which cancer associated with MEN2 secretes calcitonin
Medullary thyroid cancer
101
Which thyroid cancer is associated with local invasion and metastases
Anaplastic thyroid cancer
102
What does PTH do to calcium and phosphate
Increases plasma calcium, decreases plasma phosphate (by decreasing renal PO4 absorption)
103
What else causes hypercalcaemia other than PTH and malignancy
Thiazides, thyrotoxicosis, addisons
104
Which electrolyte abnormalities can cause nephrogenic diabetes insipidus
Hypercalcaemia, hypokalaemia
105
What is the pathophysiology of pseudohypoparathyroidism
Target cells insensitive to PTH
106
Which electrolyte disturbance results in hypocalcaemia
Hypomagnesaemia
107
Which inherited condition is characterised by impaired PO4 reabsorption in the renal tubules
Vitamin D resistant rickets
108
Which is more sensitive and specific for hypocalcaemia out of trosseau’s and chvostek’s sign
Trosseau’s sign ( carpal spasm with brachial artery occlusion)
109
Which neurotransmitter constantly inhibits prolactin
Dopamine
110
What are the causes of gynaecomastia
Testicular failure, liver cirrhosis, hyperthyroidism, spironolactone, cimetidine, omeprazole, goserelin
111
What is the treatment of hirsutism and acne in PCOS that doesn’t respond to COCP
Topical eflornithine
112
Which anti-hyperglycaemics can cause weight gain
Sulphonylureas, TZDs
113
What is the treatment of choice for toxic multinodular goitre
Radioiodine therapy
114
What are the causes of hyperprolactinaemia
Pregnancy, prolactinoma, physiological, PCOS, primary hypothyroidism, phenothiazines, metoclopramide, domperidone
115
What is the MOA of orlistat
Pancreatic lipase inhibitor
116
What BMI is orlistat indicated for
BMI >28 with RFs or >30
117
What is measured during dynamic pituitary function tests
GH, glucose, cortisol, TSH, LH, FSH
118
What is the starting plasma osmolality in a water deprivation test in a patient with psychogenic polydipsia
Low
119
What is the pattern of results seen in a water deprivation test in a patient with cranial diabetes insipidus
High starting plasma osmolality, low starting urine osmolality (<300), high urine osmolality after ADH (>600)
120
When should gestational diabetes be screened for in a women who has had GD in a previous pregnancy
As soon as possible after booking and at 24-28 weeks if first test is normal
121
What are the glucose targets for self-monitoring in pregnancy
Fasting 5.3; 1 hour after meals 7.8; 2 hours after meals 6.4
122
Which foods have a high glycaemic index
White rice, baked potato, white bread
123
How should metformin be adjusted for Ramadan
1/3 before sunrise, 2/3 after sunset
124
What are the adverse effects of pioglitazone
Weight gain, liver impairment, fluid retention (CI in HF, worse with insulin), bladder cancer, increased risk of fractures
125
What causes higher-than-expected levels of HbA1c
Vit B12/folate deficiency, IDA, splenectomy
126
What are the clinical features of pseudohypoparathyroidism
Low IQ, short stature, shortened 4th and 5th metacarpals, low calcium, high phosphate, high PTH
127
What indicates that a patient with T2DM might benefit from meglitinides
Erratic lifestyle - taken shortly before a meal
128
What are the contraindications to an insulin stress test for investigation of hypopituitarism
Epilepsy, IHD, adrenal insufficiency
129
What is the Simon Broome criteria
Used to diagnose familial hypercholesterolaemia: TC >7.5 and LDL >4.9, tendon xanthoma in pt or 1st/2nd degree relatives, FHx of MI <60 in 1st degree relative
130
What is the medical management of stress incontinence that doesn’t respond to pelvic floor exercises
Duloxetine
131
When is hypertonic saline indicated in hyponatraemia
Acute, severe, symptomatic hyponatraemia (<120)
132
Where are chylomicrons produced
GI tract - contain mostly triglycerides
133
Where are VLDLs produced
The liver - contain mainly triglycerides but some cholesterol
134
What is the main function of triglycerides
Energy source for tissues
135
What should a patient with hypothyroidism do with their thyroxine dose in pregnancy
Increase thyroxine dose by up to 50% as early as 4-6 weeks of pregnancy
136
What is the definitive diagnosis of remnant hyperlipidaemia (dysbetalipoproteinaemia)
Lipoprotein electrophoresis or genotyping of apo-protein E
137
What is the first test to do when excluding anyone with hyperprolactinaemia
Pregnancy test
138
What is Von Hippel Lindau syndrome
Phaeochromocytoma, renal cell carcinoma, retinal and cerebellar haemangioblastomas
139
What can lead to a false positive dexamethasone suppression test
Enzyme inducers (CYP450)
140
What is the best treatment of venous ulcers
Multi layer bandaging
141
What is the preferred anti-thyroid drug therapy in late pregnancy
Carbimazole
142
What is the initial follow up for patients with microprolactinomas
Yearly MRI
143
What is the treatment of Kallman’s syndrome
Pulsed GnRH
144
What disease is characterised by precocious puberty, cafe-au-lait skin pigmentation, polyostotic fibrous dysplasia and hyperthyroidism
McCune-Albright syndrome
145
What is the commonest cause of primary hyperthyroidism
Benign adenoma
146
What is the most common electrolyte abnormality in anorexia
Hypokalaemia
147
What is the treatment of ABPA
Oral corticosteroids + prolonged course of itraconazole
148
What is the treatment of DI after trans-sphenoidal surgery
IV desmopressin whilst matching fluid output with appropriate replacement (only a few will go on to need DDVAP long term)
149
What causes raised c peptide with low glucose
Sulfonylurea abuse (most common), insulinoma (very rare)
150
Which type of amiodarone-induced thyrotoxicosis has normal radioiodine uptake and normal IL-6
AIT type 1
151
What is the treatment of AIT type 1
Anti-thyroid drugs (e.g. carbimazole) and potassium perchlorate
152
Which AIT causes high IL-6
AIT type 2
153
What is the treatment of AIT type 2
Prednisolone 40mg/day
154
What is the treatment of amiodarone-induced hypothyroidism
Continue amiodarone and add levothyroxine
155
What is the treatment of grave’s ophthalmology with sight-threatening features
IV corticosteroids
156
What is the equation for plasma osmolarity
2(Na+K) + urea + glucose
157
What are the plasma osmolarity and glucose levels usually seen in HHS
Osmolarity >320
Glucose >30
158
What is the most useful marker of tumour recurrence of thyroid carcinomas after total thyroid ablation
Thyroglobulin
159
What can be used to diagnose medullary thyroid cancer
Pentagastrin stimulation test (measures calcitonin at 2 and 5 minutes - rise suggests cancer)
160
What joint condition is associated with T1DM due to HLA-DR4
Rheumatoid arthritis
161
What is present on 75% of MRI brain scans in Kallman’s syndrome
Absent olfactory bulbs (no sense of smell)
162
What is the management of insulin-related fluid retention
Furosemide
163
What is the initial treatment of a macroprolactinoma
Dopamine agonist - bromocriptine
164
Which condition can present with modest CK rise and muscle symptoms when untreated
Hypothyroidism
