ENDOCRINOLOGY

Question 1

Causes of thyroid cancer

Answer 1

ionising radiation exposure

genetic- papilary thyroid associated with RET and NTRK1

Question 2

types of thyroid cancer and the cells they arise from

Answer 2

follicular epithelial cells:
papilary (70-85%)
follicular

parafollicular ‘C’ cells:
medullary

undifferentiated:
anaplastic

Question 3

where do papilary thyroid cancers metastasise

Answer 3

via lymphatics to regional lymphnodes to lungs and bone

Question 4

histological features of papillary thyroid cancers

Answer 4

intranuclear cytoplasmic inclusions (orphan annie eyes)

calcified psammoma bodies

Question 5

how do follicular thyroid cancers metastasise

Answer 5

haematological spread

Question 6

epidemiology of follicular thyroid cancer

Answer 6

2nd most common (10-15)
peak age 40-60yrs

Question 7

management of papillary and follicular thyroid cancer

Answer 7

thyroidectomy (complications: damage to laryngeal nerve and hypoparathyroidism)
post op thyroxine
high risk pts, post of rodio-iodine ablation

Question 8

how does raadio iodine treat hyperthyroidism

Answer 8

the iodine is taken up by thyroid follicular cells and this causes cell death by emission of beta rays

Question 9

causes of:

hypernatraemia

Answer 9

D&V, burns
diabetes insipidus and unable to drink sufficiently
hyperadrenalism

Question 10

causes of:

hyponatraemia

Answer 10

hypovolaemic:
dehydration eg. D&V
low salt diet
addisons
sepsis

euvolaemic:
hypothyroidism
SIADH (eg. pneumonia, lung Ca)

hypervolaemic:
cardiac failure (increased hydrostatic pressure)
liver and kidney failure (reduced oncotic pressure)

Question 11

causes of:

hypercalcaemia

Answer 11

normal or high PTH
- hyperparathyroidism
- benign familial hypercalciuria

low PTH
- boney mets
- PTHrH releaseing lung Ca
- myeloma
- exogenous vitamin D excess

Question 12

polyuria differentials

Answer 12

• UTI
• prostate enlargement
• detrusor instability
• medications (loops, thiazides, SGLT2i)
• 3rd space mobilisation (NOCTURIA)
• polydipsia
• DI
• DM
• hypercalcaemia

Question 13

causes of cranial DI

Answer 13

V- Sheehans
I- meningitis, TB
T- head injury
A- hypopysitis, langerhans histocytosis, sarcoid
M-
I- transphenoidal surgery
N- craniopharyngioma
C- pit stalk insufficiency syndrome

Question 14

causes of nephrogenic DI

Answer 14

congenital
post AKI (acute)
drugs eg. lithium
hypercalcaemia
hypokalaemia

Question 15

carbohydrate counting and units

Answer 15

1 unit per 10g carbs
1 unit brings down by ~3mmol/L
inject insulin ~15mins before eating

Question 16

long and short term complications of hypoglycaemia

Answer 16

short:
loss of consciousness
- seizures
- arrhythmias
- sudden cardiac arrest

long:
- reduced cognition
- lack of awareness of symptoms and increased risk of hypo

Question 17

osteoporosis RFs

Answer 17

post menopausal
immobility
hypothalamic hypogonadism- AN
not able to weight bare
low testosterone
cushings

Question 18

causes of primary hyperaldosteronism

Answer 18

bilateral idiopathic adrenal hyperplasia: the cause of around 60-70% of cases

adrenal adenoma: 20-30% of cases

unilateral hyperplasia

familial hyperaldosteronism

adrenal carcinoma

Question 19

features of hyperaldosteronism

Answer 19

high aldosterone: renin ratio (high ald which is suppressing renin)

hypokalaemia - muscle weakness

metabolic alkalosis

Question 20

management of DKA in adults

Answer 20

Main principles of management:

fluid replacement
most patients with DKA are deplete around 5-8 litres
isotonic saline is used initially, even if the patient is severely acidotic

insulin
an intravenous infusion should be started at 0.1 unit/kg/hour
once blood glucose is < 14 mmol/l an infusion of 10% dextrose should be started at 125 mls/hr in addition to the 0.9% sodium chloride regime
correction of electrolyte disturbance
serum potassium is often high on admission despite total body potassium being low
this often falls quickly following treatment with insulin resulting in hypokalaemia
potassium may therefore need to be added to the replacement fluids
if the rate of potassium infusion is greater than 20 mmol/hour then cardiac monitoring may be required
long-acting insulin should be continued, short-acting insulin should be stopped

Question 21

mechanism of action of spironolactone

Answer 21

mineralocorticoid receptor antagonist

used in hyperaldosteronism

Question 22

drugs that cause neutrophilia

Answer 22

steroids
lithium

Question 23

Signs of thyroid eye disease

Answer 23

Failure of up and out movement due to tethering of the medial rectus by inflammation (+TSHrAb specific - cross reactivity)

Periorbital oedema

proptosis/ exopthalmous (sclera seen inferiorly)

conjunctival inject

symptoms:
gritty eyes
double vision
pain
loss of vision if inflammation compresses the optic nerve

Question 24

what can cause a falsly low HbA1c reading?

Answer 24

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

Question 25

what can cause a falsly high HbA1c reading

Answer 25

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

Question 26

management of steroid induced hyperglycaemia

Answer 26

if glucose >12mmol/L on more than one occasion in 24 hrs start a once daily sulfonyurea eg gliclazide

Question 27

treatment for diabetic neuropathy

Answer 27

amitriptyline, duloxetine, pregabalin or gabapentin as the first-line treatment for neuropathic pain

Question 28

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