Endocrinology

Question 1

nephrogenic diabetes
water deprivation and desmopressin?

Answer 1

Water deprivation test: nephrogenic DI
urine osmolality after fluid deprivation: low
urine osmolality after desmopressin: low

Question 2

Cranial DI
water deprivation
desmopressin

Answer 2

Low urine osmolality after fluid deprivation,

High after desmopressin ( can concentrate urine again )

Question 3

T2DM not controlled with metformin?
which Hba1c target do we need to consider adding another drug ?

Answer 3

T2DM on metformin, if HbA1c has risen to 58 mmol/mol then one of the following should be offered depending on the individual clinical scenario:
DPP-4 inhibitor- sitagliptin
pioglitazone
sulfonylurea
SGLT-2 inhibitor if CVD and QRISK >10%

Question 4

DKA treatment and definition

Answer 4

Key points
glucose > 11 mmol/l or known diabetes mellitus
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick

Treatment :
Fluids
insulin
K+ ( bc insulin shifts k+ into cells)
If not resolved in 24hrs then endocrinology review

Question 5

Thyroid storm treatment

Answer 5

IV propranolol, propylthiouracil and hydrocortisone

Question 6

BP target for diabetics

Answer 6

age <80 = less than 140/90
age >80 = more than 150/90

Question 7

Gitazones Moa and side effects

Answer 7

Glitazones are agonists of PPAR-gamma receptors, reducing peripheral insulin resistance
+ weight gain
+ liver impairment
+fluid retention
+bladder cancer

Question 8

Thyrotoxicosis with tender goitre

Answer 8

subacute (De Quervain’s) thyroiditis

Question 9

Addisons disease signs and definition

Answer 9

Hyponatraemia,
hyperkalaemia
weight loss
Hypoglycaemia
Tanned appearance

Addisons disease is the Autoimmune destruction of the adrenal glands is the commonest cause of primary hypoadrenalism in the UK, accounting for 80% of cases. This is termed Addison’s disease and results in reduced cortisol and aldosterone being produced.

Question 10

Phaeocytochroma

Answer 10

PHaeochromocytoma - give PHenoxybenzamine before beta-blockers

tests :
24 hr urinary collection of metanephrines

Question 11

Investigations for addisons disease

Answer 11

Synacthen ACTH stimulation test

Question 12

Gastroparesis in diabetes management and symptoms

Answer 12

symptoms include erratic blood glucose control, bloating and vomiting

management options include metoclopramide, domperidone or erythromycin (prokinetic agents)

Question 13

T1DM

Answer 13

HBA1c target of 48
Insulin
Metformin can be added if BMI> 25

Question 14

Diagnostic criteria for DM

Answer 14

If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)

If asymptomatic then they should have the above criteria on 2 separate occasions

In T1DM - C peptide is low

Question 15

Cushings disease causes

Answer 15

ACTH dependent causes
Cushing’s disease (80%): pituitary tumour secreting ACTH producing adrenal hyperplasia
ectopic ACTH production (5-10%): e.g. small cell lung cancer is the most common causes

ACTH independent causes
iatrogenic: steroids
adrenal adenoma (5-10%)

Question 16

Thyroid nodules imaging ?

Answer 16

Ultrasonography

Question 17

When should metformin be avoided

Answer 17

When eGFR is below 30

Question 18

Cushings disease investigations

Answer 18

Overnight low dose dexamethasone suppression test

24hr urinary free cortisol

High dose dexamethasone suppression test

Question 19

Hypercalcaemia treatment

Answer 19

IV 0.9% saline

Question 20

Hypoglycaemia with impaired GCS

Answer 20

Give IV glucose if there is access 100ml of 20% glucose stat