Endocrinology

Question 1

What condition causes a phaeochromocytoma + hyperparathyroidism (high Ca2+ and low Mg2+)?

Answer 1

MEN2a - Sipple Syndrome

Question 2

What is the most common cause of Cushings syndrome?

Answer 2

Iatrogenic, related to corticosteroid use usually

Question 3

How should HHS be manged?

Answer 3

With cautious rehydration with IV fluids

Question 4

Do all cases of multinodular goitre result in biochemical changes?

Answer 4

No

Question 5

What is first-line management for pheochromocytoma?

Answer 5

Alpha-blockers –> surgery

Question 6

What is another name for DeQuervain’s thyroiditis?

Answer 6

Viral thyroiditis –> thyroid becomes swollen, erythematous and tender to touch. There is an initial phase of hyperthyroidism, followed by hypothyroidism as it recovers, before returning to euthyroid state. Thyroxine is not usually given during the hypothyroid state due to quick return to euthyroid state

Question 7

What is the most specific marker for Graves disease?

Answer 7

Anti-TSH receptor stimulating antibodies

Question 8

How is DeQuervain’s thyroiditis diagnosed?

Answer 8

TFTs + radioactive iodine test

Question 9

Which test might be useful for distinguishing between T1Dm and T2DM?

Answer 9

C-peptide (low = T1DM, high = T2DM)

Question 10

What is the target HbA1c in T2DM?

Answer 10

48

Question 11

What are the causes of hyperprolactinaemia?

Answer 11

The p’s:

1. Pregnancy
2. Prolactinoma
3. Physiological
4. PCOS
5. Primary hypothyroidism
6. Phenothiazines/metocloPramide/domPeridone

Question 12

Which condition can cause hyperpigmentation, especially to the palmar creases?

Answer 12

Addison’s disease

Question 13

What do you do with the meds for Addison’s disease in periods of illness/

Answer 13

Double the hydrocortisone, keep the fludrocortisone the same

Question 14

What are the causes of lower than expected HbA1c?

Answer 14

Sickle cell anaemia
G6PD
Hereditary spherocytosis

Question 15

What are the causes of higher than expected HbA1c?

Answer 15

Vitamin B12/folic acid deficiency
Iron deficiency anaemia
Splenectomy

Question 16

Which is the drug that most commonly causes gynaecomastia?

Answer 16

Spironolactone

Question 17

At what HbA1c should you add another drug in the control of T2DM?

Answer 17

When HbA1c >58

Question 18

How do you diagnose Addison’s disease?

Answer 18

Short synacthen test

Question 19

How is Conn’s syndrome (primary hyperaldosteronism) treated?

Answer 19

Spironolactone (adrenalectomy if the underlying cause is unilateral adrenal adenoma)

Question 20

How do you calculate serum osmolality?

Answer 20

2NA + urea + glucose

Question 21

What rate of insulin should be used in HHS?

Answer 21

0.05units/kg/hr

Question 22

What is primary hyperparathyroidism?

Answer 22

High PTH (usually due to secreting adenoma) - causing hight calcium and low phosphate

Question 23

What is secondary hyperparathyroidism?

Answer 23

High PTH (usually due to renal disease, in response to…) low calcium (due to the renal disease (and high phosphate

Question 24

What is tertiary hyperparathyroidism?

Answer 24

Occurs following a long period of secondary hypoparathyroidism –> high PTH, and calcium eventually becomes high

Question 25

Which electrolyte disturbance is associated with Conn's syndrome?

Answer 25

Hypokalaemia

Question 26

What is the difference in pigmentation pattern in Addison's vs. hemochromatosis?

Answer 26

Pigmentation associated with hemochromatosis rarely affects the mucosa

Question 27

How does MEN1 present?

Answer 27

Hyperparathyroidism (from adenoma) Pituitary tumour Bronchial carcinoma Enteropancreatic tumours

Question 28

How does MEN2 present?

Answer 28

Hyperparathyroidism (from adenoma) Thyroid C-cell tumours Pheochromocytoma

Question 29

What is the most reliable measure of thyroid function?

Answer 29

TSH level

Question 30

How is anion gap calculated?

Answer 30

(Na2+ + K+) - (HCO3- + Cl-)

Question 31

What is Chvostek sign?

Answer 31

A tetany - abnormal reaction to the stimulation of the facial nerve - seen in response to hypocalcaemia

Question 32

How may medullary thyroid cancer present?

Answer 32

Diarrhoea and facial flushing (due to elevated calcitonin)

Question 33

How do you distinguish between Cushing's disease and Cushing's syndrome?

Answer 33

Cushing's disease - suppression in high-dose dexamethasone suppression test Cushing's syndrome - no suppression in high-dose dexamethasone suppression test

Question 34

What DM medication may cause excessive flatulance?

Answer 34

Acarbose (by delayed absorption of sucrose and starch)

Question 35

Which medication used in HTN can cause an increase in blood DMs?

Answer 35

Bendroflumethiazide

Question 36

Which medication can cause upset tummy, poor sleep and cold fingers and toes?

Answer 36

Propanalol

Question 37

In what proportion of Graves patients does Graves ophthalmology occur?

Answer 37

1/3rd

Question 38

How is Graves ophthalmology (pain in eye, photophobia, diplopia) treated?

Answer 38

Corticosteroids | Orbital decompression only if it has proves refractory to treatment

Question 39

What are the side effects of sulphonylureas?

Answer 39

Hypoglycaemia and weight gain --> if these are a problem, and BMI >35, may be worth trying pioglitazone

Question 40

What is the prolactin threshold difference between micro and macroadenoma?

Answer 40

``` Microadenoma = prolactin up to 2000 Macroadenoma = prolactin >2000 ```