Endocrinology

Question 1

Thyroid storm Mx

Answer 1

1. IV propranolol (or atenolol, metoprolol)
2. Paracetamol (fever)
3. Methimazole or propylthiouracil
4. Lugol’s iodine
5. IV dexamthasone - stops T4 -> T3

Question 2

Milk-Alkali syndrome

Answer 2

Hypercalcaemia, renal failure, metabolic alkalosis
Large amounts of calcium/alkalines

Question 3

Chvostek sign

Answer 3

Facial twitching when flicked seen in hypocalcaemia

Question 4

Trousseau’s sign

Answer 4

Carpopedal spasm after compression of upper arm via inflation of BP cuff

Question 5

MEN 1 mutation + diagnosis

Answer 5

MEN 1 tumour suppressor gene

Either 2+ of the associated tumours,
or 1 tumour + first degree relative w MEN1,
or on genetic testing

Question 6

MEN 2 mutation and 3 conditions

Answer 6

RET proto-oncogene

MEN2A, MEN2B, Familial medullary thyroid cancer

Question 7

MEN 1 endocrine tumours

Answer 7

Parathyroid adenoma
Pituitary adenoma
Gastrinomas + enteropanreatic tumours
CNS tumours inc meningioma
Adrenal cortical tumour
Thyroid tumours (similar frequency to rest of population)

Question 8

MEN 1 non-endocrine tumours + other features

Answer 8

Cutaneous tumours
Lipoma
Facial angiofibromas
Primary hyperparathyroidism

Question 9

MEN 2A (Simple’s syndrome)

Associated conditions

Answer 9

Multigland parathyroid adenomas with hyperPTH

a/w
Hirschprung’s disease
Cutaneous lichen amyloidosis

Question 10

MEN2 (A+B) tumours

Answer 10

Medullary thyroid cancer
Phaeochromocytoma
Parathyroid adenoma

Question 11

MEN 2B

Answer 11

Marfanoid
Mucosal intestinal ganglioneuromatosis

Question 12

Waterhouse - Frideriechson syndrome

Answer 12

Adrenal failure due to massive haemorrhage into one or (usually) both adrenal glands
A/w N. meningitides infection

Question 13

Secondary hyperparathyroidism causes, biochemistry and features

Answer 13

Renal failure, low dietary vitamin D

Ca low
PTH high
PO4 high
ALP high

Short 4th metacarpals, short stature, rounded face, ossification of soft tissues

Question 14

Tertiary hyperparathyroidism biochem

Answer 14

PTH very high
Ca high
PO4 low
ALP high

Question 15

Primary hyperparathyroidism biochemistry

Answer 15

PTH inappropriately high
Ca high
ALP normal
PO4 low

Question 16

Riedel’s thyroiditis

Answer 16

Dense fibrosis extending beyond the thyroid capsule
Stony hard thyroid
Usually euthyroid, 1/3 hypothyroid

Question 17

HbA1c DM cut-off

Answer 17

48mmol/mol (6.5%)

Question 18

Falsely high HbA1c a/w

Answer 18

Iron deficiency anaemia, B12 deficiency, alcoholism

Question 19

Falsely low HbA1c a/w

Answer 19

HIV, Sickle cell anaemia and other haemaglobinopathies (hereditary spherocytosis and G6PD deficiency)

Question 20

B2 deficiency

Answer 20

Angular stomatitis, scrotal dermatitis, photophobia

Question 21

Toxic nodular goitre

Answer 21

Second most common cause of hyperthyroidism
High T4, undetectable TSH
May develop from nontoxic goitre
Grossly enlarged neck swelling

Question 22

Acromegaly test

Answer 22

IGF-1 levels (less variable than HGH levels)

Question 23

Pseudohypoparathyroidism
- cause
- features

Answer 23

PTH resistance
AD inherited inability to respond to PTH

Low Ca, High PO4, High PTH

Question 24

Secondary hyperparathyroidism
- causes

Answer 24

Vitamin D deficiency
Renal failure