Endocrinology

Question 1

Why should insulin not be given in Hyperosmolar hyperglycaemic state?

Answer 1

Because it may lead to central pontine myelinolysis. Fluid replacement is sufficient.

Question 2

What type of medication is always fourth line for type 2 diabetes?

Answer 2

If triple therapy is not effective, switch one of the drugs for GLP-1 agonists e.g. exenatide

Question 3

When should sulphonylureas be avoided?

Answer 3

In severe renal impairment

Question 4

Results of high dose dexamethasone suppression test in investigating causes of Cushings?

Answer 4

1. Cushing’s syndrome due to other causes (e.g. adrenal adenomas): Cortisol not suppressed, ACTH suppressed
2. Cushing’s disease (i.e. pituitary adenoma → ACTH secretion): Cortisol suppressed, ACTH suppressed
3. Ectopic ACTH syndrome: Cortisol not suppressed, ACTH not suppressed

Question 5

What type of thyroid cancer has excellent prognosis?

Answer 5

Papillary carcinoma

Question 6

What is metoclopramide?
How can it affect the breasts?

Answer 6

2 receptor antagonist- mainly used in the management of nausea.
May result in galactorrhoea due to hyperprolactinaemia.

Question 7

What does bromocriptine do?

Answer 7

dopmine receptor agonist- so used to treat prolactinoma/galactorrhoea

Question 8

Give examples of long acting, moderate and short acting insulin types?

Answer 8

Long acting- detemir, glargine
Moderate- isophane
short acting- aspart

Question 9

What is the first line insulin regime in newly diaagnosed adults with type 1 diabetes?

Answer 9

A basal bolus using twice-daily insulin detemir (long acting)

i.e. insulin detemir twice daily and insulin aspart with meals

Question 10

If pt presents with subclinical hypothyroidism, what would you check for and why?

Answer 10

Check thyroid peroxidase antibodies bc this can indiciate pts who are more likely to progress to overt hypothyroidism

Importance: 99