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MRCP > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

28F on Lithium
weight gain, oligomenorrhoea, primary infertility

High TSH
Low T4
High Prolactin

Dx?
Mx?

A

Primary hypothyroidism due to Lithium

Mx

  1. Thyroxine
  2. Don’t stop lithium (psych relapse)

NB. high prolactin as hypothyroid -> high TRH -> high prolactin

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2
Q

Advantage insulin analogue e.g. aspart

A

Rapid onset action

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3
Q

45F weight gain and sweating for 1 yr

Dx?

A

Insulinoma

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4
Q

Best intervention for reducing micro/ macro- vascular events in T2DM?

A

anti-HTN medication

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5
Q

1st and 2nd line Rx for Cushing’s Disease

A

surgery (remove ACTH tumour)

2nd line = Ketoconazole

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6
Q

Retrosternal goitre and stridor

Ix for airway obstruction?

A

Flow volume loop (detects tracheal obstruction)

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7
Q

Amyloid polypeptide on pancreas histology

Dx?

A

T2DM

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8
Q

Best intervention for reducing diabetic retinopathy progression

A

anti - hypertensives

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9
Q

Soft exudates

in pre-proliferative or proliferative retinopathy?

A

pre-proliferative retinopathy

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10
Q

48M post colectomy

L1 fracture and wt loss w normal diet

Low Ca
Low Phos

Cause for fracture?

A

Vit D deficiency

get low Ca, and increased PTH -> low Phos

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11
Q

51M HTN obesity T2DM
pituitary-dependent Cushing’s.

preoperative BP is elevated at 175/100 mmHg, BMI is 32 and fasting glucose is 11.2

Rx to improve his metabolic parameters prior to surgery?

A

Metyrapone
inhibits 11-beta hydroxylase inhibits cortisol production
rapid onset of action
without associated weight gain of e.g. insulin

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12
Q

Criteria for metabolic syndrome

A

Central obesity
(≥94 cm for men, ≥80 cm for women) plus any two of:

Hypertriglyceridaemia >1.7 mmol/L
Low HDL concentration <1.03 mmol/L male, <1.29 mmol/L female
BP ≥ 130/85 mmHg, or on treatment for hypertension
Fasting glucose ≥5.6 mmol/L, or known to have type 2 diabetes.

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13
Q 
45F 
chronic diarrhoea.
opening her bowels 8x/day  watery motions
Low K 
abdo US - pancreatic mass

Dx?

Rx?

A

VIPoma

Somatostatin analogues

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14
Q

weight loss
hypokalaemia
chronic diarrhoea
metabolic acidosis

Dx

A

VIPoma

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15
Q

Bromocriptine

MOA

Indication

A

is a dopamine agonist which can be used in the treatment of prolactinoma

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16
Q

Cholestyramine

MOA

Indication

A

is a bile acid sequestrant that can be used in the management of diarrhoea related to small bowel malabsorption or pancreatitis.

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17
Q

Urge incontinence

1st line

2nd line

A

1) bladder training

2) oxybutinin

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18
Q

52M

HGV driver

morbidly obese

On Metformin 1g BD
HbA1c 73

Rx?

A

Exanatide

(as morbidly obese (or risk hypos) give exanatide)

Otherwise give metformin or sulphonylurea

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19
Q

HRT risks

A

HRT increases CVD and stroke

frequently produces a rise in triglyceride concentrations.

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20
Q

Most likely complication anaplastic thyroid cancer

A

upper airway obstruction

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21
Q

When to monitor bgl in diabetes

A

On insulin, sulphonylureas or glinides (repaglinide or netaglinide)

fasting and pre-prandial glucose levels

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22
Q

Thyroidectomy commonest complication

A

transient hypoparathyroidism

low Ca

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23
Q

TB drug interrupts thyroxine absorption

A

Rifampicin

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24
Q

Drugs for PCOS

hirsutism
conception

A

hirsutism - COCP

conception - metformin

25
Q

Artery close to recurrent laryngeal nerve

A

inferior thyroid artery

26
Q

Rx to reduce risk renal failure in diabetic nephropathy (proteinuria)

A

ACEi e.g. lisinopril

27
Q

Headache
Vomiting
Visual disturbance
Hormonal dysfunction

A

Pituitary apoplexy

(acute haemorrhage/infarct to pituitary)

  • initially worried about no ACTH -> Addisonian crisis -> give hydrocortisone
  • then can get low TSH and low LH/FSH
28
Q

Low BP
Low Na
High K
Low glucose

A

Addisonian crisis

29
Q

Galactorrhoea and amenorrhoea for 1 year

Visual fields normal

Prolactin 10500

Dx?

Rx?

A

Dx = macroprolactinoma

Rx = DA carbergoline or bromocriptine
lowers prolactin and normalises oestrogen

30
Q

Changes to TFTs during pregnancy

A

High total T4 (as higher thyroid binding globulin)

Low TSH

31
Q

Low Ca
High Phos
High PTH

Short stature
Short 4th/5th metatarsals
Intellectual impairment

A

Pseudohypoparathyroidism

PTH resistance

32
Q

Low Ca
High Phos
Low PTH

A

Hypoparathyroidism

33
Q

Thigh pain
Progresses to proximal muscle wasting
loss knee reflexes

Dx?

Ix?

A

Diabetic amyotrophy
(as vasa nervorum occlusion for lumabr plexus +- femoral nerve

Ix = (test for DM), so OGTT or BGL

34
Q

Flu-like illness
hyperthyroid -> hypothyroid
then recovert
Gland diffusely tender

Dx?
Rx?

A

Dx = de Quervains thyroiditis

Rx = NSAIDs (no need to give thyroid meds)

35
Q

32F amenorrhoea 4m

FSH low
LH low
raised prolactin 800

A

MRI mpituitary

Hypogonadotrophic hypogonadism

in the presence of raised prolactin is likely secondary to microprolactinoma

36
Q

23F
T1DM
Weight loss, no other Sx
microcytic anaemia

Ix?

A

anti - TTG Ab

?coeliac in bg of T1DM as well
can have Fe and B12 deficiency and have few Sx with coeliac

37
Q

Leptin function

A

satiety

made by adipocytes
acts on hypothalamus

38
Q

31F
T1DM

Pain R shoulder
Reduced passive and active movements R side

A

Adhesive capsulitis

associated w diabetes

39
Q

diffuse tender goitre

hyperthyroidism

very low uptake on radioactive iodine uptake scan

A

de Quervain’s thyroiditis

get hyperthyroidism due to rapid release preformed thyroid hormones

40
Q

de Quervain’s thyroiditis

Rx?

A

symptomatic control

BB for tremor/anxiety

Pred or NSAIDs for thyroiditis

41
Q

Lipaemia retinalis

associated with

A

hypertriglyceridaemia

42
Q

Xanthelasma and corneal arcus

associated with

A

hypercholesterolaemia

43
Q

Dx for gestational diabetes

A

75 g oral glucose tolerance test

at 16-18 weeks

rpt at 28wks if normal

44
Q

Rx gestational diabetes

A

diet and exercise

if fails after 1-2 weeks give meds
(METFORMIN, GLEBENCLAMIDE, INSULIN)

if evidence fetal macrosomia start meds immediately

45
Q

Cause osteoporosis in young men

A

Hypogonadism

do testosterone level first (before prolactin)

46
Q

Drug causing nephrogenic DI

A

Lithium

47
Q

K and Na

in primary hyperaldosteronism

other Ix?

A

K low
Na high

K CAN BE NORMAL IN 12% PATIENTS

do aldosterone: renin ration (stop BB before doing this)

48
Q

amenorrhoea

raised LH:FSH ratio

insulin resistance

hyperandrogenism -raised androstenedione + slightly raised testosterone

A

PCOS

49
Q

important predictor of potential ulceration in diabetic foot

A

callus formation

50
Q

Prolactin levels

<1000

1000 - 3000

> 3000

A

<1000 = drug induced high prolactin/ hypothyroid

1000-3000 = microprolactinoma

> 3000 = macroprolactinoma

51
Q

h ypoaldoseteronism
-> reduction in PCT ammonium excretion

mild (normal anion gap) metabolic acidosis

A

type 4 RTA

52
Q

exanatide MOA

A

GLP 1 analogue

suppresses appetite
inhibits glucose production in the liver
slows gastric emptying
stimulates insulin release

53
Q

Alpha subunit G protein mutation

A

pseudohypoparathyroidism
(pth resistance)

hypothyroidism

54
Q

neuroendocrine tumour

xs SEROTONIN

flushing, diarrhea and wheezing

A

carcinoid SYNDROME

  • commonly in SI, appendix tumours
  • but NOT commonly w/ carcinoid tumours

Lung carcinoid TUMOUR a/w Cushings (as produces ectopic ACTH)

55
Q

Carinoid tumour Rx

A

Octreotide
somatostatin analogue

(also used in acromegaly)

56
Q

exanatide rare SE

A

pancreatitis

57
Q

Rare renal disorder (AR)
defect in Loop of Henle

Low K
high renin + aldosterone
Normal BP

A

Barrters syndrome

58
Q

Hasimotos’s thyroiditis increased risk of which cancer

A

thyroid lymphoma

59
Q

amenorrhea
hypergonadotropinism - high fsh
low oestrogen

A

primary ovarian failure

MRCP (12 decks)

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