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MRCP Part 1 > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

Zollinger-Ellison syndrome

A

Gastrinomas mainly formed in duodenem

Features:
multiple gastroduodenal ulcers
diarrhoea
malabsorption

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2
Q

Hyperthyroidism in pregnancy mx

A

1st trimester Propylthiouracil
2nd trimester onwards carbimazole

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3
Q

Hypothyroidism in pregnancy mix

A

increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy

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4
Q

The most appropriate treatment for this patient with excessive facial hair due to polycystic ovarian syndrome is

A
  1. combined oral contraceptive
  2. co-cyprindiol (anti-androgen)
  3. topical eflornithine.
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5
Q

blood glucose targets in gestational diabetes

A

The target for fasting blood glucose in gestational diabetes is <5.3 mmol/L.

The target for blood glucose two hours after an oral glucose tolerance test is <6.4 mmol/L.

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6
Q

Diabetes meliitus diagnosis:

A

fasting > 7.0, random > 11.1 - if asymptomatic need two readings

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7
Q

biochemical abnormality in Cushing’s Syndrome

A

hypokalaemic metabolic alkalosis (excess cortisol has mineralocorticoid action)

hyperglycaemia

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8
Q

Management of pre-existing diabetes in pregnancy

A

weight loss for women with BMI of > 27 kg/m^2

stop oral hypoglycaemic agents, apart from metformin, and commence insulin

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8
Q

diagnosing cushings syndrome vs disease

A

disease (pituitary tumour)
- (ACTH) production from the pituitaries can be inhibited by high doses of dexamethasone

syndrome (adrenal gland) however autonomous cortisol production from the adrenals will not be affected.

distinguishing Cushing’s syndrome due to other causes (e.g. adrenal adenomas) vs ectopic ACTH (eg. lung ca) – measure ACTH levels

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9
Q

First line treatment in diabetic neuropathy

A

amitriptyline, duloxetine, gabapentin or pregabalin

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10
Q

link between plasma glucose and HBA1c

A

average plasma glucose = (2 * HbA1c) - 4.5

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11
Q

SIADH - drug causes

A

carbamazepine, sulfonylureas, SSRIs, tricyclics

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12
Q

mx thyrotoxic storm

A

Thyrotoxic storm is treated with beta blockers, propylthiouracil and hydrocortisone

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13
Q

medical management of prolactinoma?

A

cabergoline (dopamine agonist)

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14
Q

medical management to control the growth of advanced neuroendocrine tumours for instances where surgery is not possible

A

Octreotide is a synthetic form of the natural hormone somatostatin

*side effect - biliary stasis and frequent gall stones

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15
Q

fasting glucose vs impaired glucose cut offs

A

a fasting glucose (hepatic insulin resistance) greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)

impaired glucose tolerance (IGT) (muscle insulin resistance) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

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16
Q

Turner’s syndrome - most common cardiac defect ?

A

bicuspid aortic valve

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17
Q

where does mRNA splicing occur?

A

nucleus

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18
Q

features of DiGeorge Syndrome

A

CATCH22:
C - Cardiac abnormalities
A - Abnormal facies
T - Thymic aplasia –> T Cell disorder
C - Cleft palate
H - Hypocalcaemia/ hypoparathyroidism
22 - Caused by chromosome 22 deletion

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19
Q

Obesity hormones

A

Leptin Lowers appetite
Ghrelin Gains appetite

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20
Q

disorders associated with marfanoid appearances and their distinguishing features

A

multiple endorine neoplasia 2b (AD)
- phaechromocytoma
- neuromas

marfans (AD)
- UPWARD lens dislocation

Homocystinuria (AR)
- DOWNWARD lens dislocation
- intellectual disability
caused by a deficiency of cystathionine beta synthase. This results in severe elevations in plasma and urine homocysteine concentrations.
mx. Treatment is vitamin B6 (pyridoxine) supplements.

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21
Q

what is subclinical hypothyroidism?

A

high TSH
normal T3/4

usually asymptomatic

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22
Q

management of t2DM, on triple therapy

A

switch one drug for a GLP-1 mimetic (eg. exenatide)

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23
Q

which diabetic drug can cause weight gain

A

sulfonylureas eg. gliclazide

they stimulate insulin release resulting in increased glucose uptake

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24
Q

thyroid hormone changes in pregnancy that are normal

A

Raised total T3 and T4 but normal fT3 and fT4 suggest high concentrations of thyroid binding globulin, which can be seen during pregnancy due to increased oestrogen

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25
Q

Klinnefelter vs kallman

A

Klinefelter XXY: testosterone low, syndrome the LH and FSH levels are raised

Kallman: X linked recessive. neurons don’t migrate in hypothalmus. anosmia.
The LH and FSH levels are inappropriately low-normal given the low testosterone concentration,

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26
Q

Metabolic ketoacidosis with normal or low glucose

A

alcoholic ketoacidosis

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27
Q

X ray findings primary hyperparathyroidism

A

pepperpot skull
osteitis fibrosa cystica

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28
Q

how to distinguish gout and pseudogout from x ray

A

Chondrocalcinosis = pseudogout

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29
Q

osteopetrosis vs paget’s disease of the bone

A

paget’s disease - abnormal bone formation, raised ALP, older

osteopetrosis - AD inheritance, younger patients, thick bone forms within bone making it more brittle, normal calcium, phosphate, ALP and PTH levels –> bone pain and neuropathies

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30
Q

management of Thyrotoxicosis with tender goitre and recent viral infection

A

= subacute (De Quervain’s) thyroiditis

conservative mx
naproxen

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31
Q

what drugs can cause false negatives results in investigations for primary hyperaldosteronism?

A

RAAS inhibitors

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32
Q

Thyrotoxic storm treatment and explanation

A

beta blockers, propylthiouracil and hydrocortisone

Hydrocortisone acts to prevent the peripheral conversion of T4 to T3 and is particularly effective in Graves’ disease. Propranolol blocks the effects of thyroid hormones and reduces the heart rate. Propylthiouracil stops the release and production of thyroid hormones and reduces the peripheral conversion of T4 to T3.

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33
Q

which dibaetic drugs cause weight gain?

A

sulfonylureas
thiazolidinediones (glitazones)

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34
Q

where do sulphonylureas bind to exert their effects?

A

bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells.

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35
Q

how do thiazolidinediones (glitazones) exert their effects?

A

Activation of peroxisome proliferator-activated receptor-gamma (PPAR gamma) –> increased insulin sensitivity

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36
Q

where does metformin bind?

A

activating the AMP-activated protein kinase (AMPK), helping cells to respond more effectively to insulin and take in glucose from the blood.

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37
Q

PHaeochromocytoma mx

A
  • give PHenoxybenzamine (alpha blocker) before beta-blockers (propranolol)
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38
Q

Rick factor for malt lymphoma

A

Hashinotis thyroditis

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39
Q

Which type two diabetes drug increases risk of developing dka?

A

SGLT - 2 inhibitors ie. Flozins

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40
Q

what can cause the development / worsening of thyroid eye disease in Grave’s disease

A

Radioiodine treatment

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41
Q

Impaired fasting glycaemia (IFG) cut offs

A

is defined as a fasting plasma glucose level between 6.1 mmol/l and 6.9 mmol/l,

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42
Q

blood glucose cut offs to diagnose T2DM

A

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 patient needs the above results on 2 separate occasions

43
Q

mx. intrahepatic cholestasis of pregnancy

A

features: itchy, raised bili,

mx:
ursodeoxycholic acid is used for symptomatic relief
weekly liver function tests
women are typically induced at 37 weeks

44
Q

features + mx. Acute fatty liver of pregnancy

A

occurs in 3rd trimester/ post partum

features: severe abdominal pain, jaundice
nausea & vomiting
headache
hypoglycaemia
severe disease may result in pre-eclampsia

HELLP
Haemolysis, Elevated Liver enzymes, Low Platelets

mx. supportive

45
Q

Marfan’s syndrome is caused by a mutation in ?

A

in a protein called fibrillin-1

46
Q

when to use hypertonic saline

A

Patients with acute, severe (<120 mmol/L) or symptomatic hyponatraemia require close monitoring, preferably in an HDU or above setting.

BOLUS Hypertonic saline (typically 3% NaCl) is used to correct the sodium level more quickly than would be done in patients with chronic hyponatraemia.

47
Q

how can carcinoid syndrome affect BP?

A

hypotension

48
Q

ramadan and T2DM management

A

metformin dose should be split one-third before sunrise and two-thirds after sunset (Iftar)

recommends switching once-daily sulfonylureas to after sunset. For patients taking twice-daily preparations such as gliclazide it is recommended that a larger proportion of the dose is taken after after sunset

no adjustment is needed for patients taking pioglitazone

49
Q

sarcoidosis management

A

majority = conservative

major organ failure = immunosuppressants
splenic/hepatic/renal/cardiac involvement, lupus pernio, hypercalcemia, eye/CNS involvement or deteriorating pulmonary function tests or deteriorating chest x-ray changes.

50
Q

Subclinical hyperthyroidism is defined as:

A

normal serum free thyroxine and triiodothyronine levels
with a thyroid stimulating hormone (TSH) below normal range (usually < 0.1 mu/l)

51
Q

first-line test for acromegaly

A

Serum IGF-1 levels

The OGTT test is recommended to confirm the diagnosis if IGF-1 levels are raised.

52
Q

best test to diagnose Addison’s disease

A

The short synacthen test

53
Q

Lithium Toxicity may be precipitated by:

A

dehydration
renal failure
drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

54
Q

drugs that may exacerbate myasthenia:

A

beta-blockers
lithium
phenytoin
antibiotics: gentamicin, macrolides, quinolones, tetracyclines

penicillamine
quinidine, procainamide

55
Q

monitoring after starting ACEi

A

acceptable changes are an increase in serum creatinine, up to 30% from baseline and an increase in potassium up to 5.5 mmol/l.

otherwise stop

56
Q

distinguishing Primary hyperaldosteronism, bilateral renal artery stenosis and Bartter syndrome

A

Primary hyperaldosteronism, bilateral renal artery stenosis and Bartter syndrome are associated with hypokalaemia due raised serum aldosterone.

Aldosterone is elevated in bilateral renal artery stenosis and Bartter syndrome due to reduced renal perfusion. Aldosterone is high in primary hyperaldosteronism due to (most commonly) an aldosterone producing adenoma.

However, serum renin is usually low in primary hyperaldosteronism due to the resulting hypertension causing excessive renal perfusion, which results in decreased renin production (negative feedback mechanism). High renin levels are seen in renal artery stenosis and Bartter syndrome as a mechanism to improve renal perfusion.

57
Q

the single most useful test in determining the cause of hypocalcaemia

A

Parathyroid hormone

58
Q

diagnostic for obstructive sleep apnoea

A

Polysomnography

59
Q

increased serum and urine levels of hydroxyproline

A

Paget’s disease - (collagen marker)

60
Q

Anorexia biochemical features

A

G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

61
Q

Insulinoma is diagnosed with

A

supervised prolonged fasting

62
Q

Maturity-Onset Diabetes of the Young (MODY) is a form of monogenic diabetes, inheritance pattern?

A

autosomal dominant

treatment with low-dose sulfonylureas

63
Q

ccording to NICE guidelines which type of insulin should be tried initially?

A

NPH insulin
[also known as isophane insulin] (injected once or twice daily according to need) should be offered.

64
Q

Nephrogenic diabetes insipidus may be caused by which genetic mutations?

A

the more common form affects the vasopression 2 (ADH) receptor
the less common form results from a mutation in the gene that encodes the aquaporin 2 channel

65
Q

dermatomyositosis antibodies

A

ANA positive

66
Q

SLE antibodies

A

SLE is the underlying disease, for which the most sensitive test is an antinuclear antibody (ANA) with 100% sensitivity. However, there are other tests for SLE with better specificity. The most specific tests are anti-double-stranded DNA (dsDNA) antibody and an anti-Smith (Sm) antibody with 99% specificity.

67
Q

mechanism of digoxin toxicity in hypoklaemia

A

Digoxin normally binds to the ATPase pump on the same site as potassium. Hypokalaemia results in digoxin more easily binding to the ATPase pump and increased inhibitory effects,

68
Q

diagnostic for phaecromocytoma

A

24 hr urinary collection of metanephrines (sensitivity 97%*)

this has replaced a 24 hr urinary collection of catecholamines (sensitivity 86%)

69
Q

what hyperthyroid feature is very specific for Graves

A

pretibial myxoedema

70
Q

Stages of sleep

A

N1 (jerks) → N2 → N3 (sleep working, nightmares) → REM (dreaming, loss of muscle tone, erections)

Theta → Sleep spindles/K-complexes → Delta → Beta

The Sleep Doctor’s Brain

71
Q

most common cause of primary hyperaldosteronism

A

1) Bilateral idiopathic adrenal hyperplasia
2) adrenal adenoma (Conn’s)

72
Q

is Azathioprine considered safe to use in pregnancy?

A

yes

73
Q

atorvastatin 20 mg should be offered if type 1 diabetics who are:

A

older than 40 years, or
have had diabetes for more than 10 years or
have established nephropathy or
have other CVD risk factors

74
Q

collagen disorders by type

A

Type 1: of osteogenesis imperfecta
- fractures following minor trauma
- blue sclera
- deafness secondary to otosclerosis
- dental imperfections

Type 2 collagen is the main component of cartilage. Chondrodysplasias

Type 3 collagen is the main component of reticular fibres. Ehlers-Danlos syndrome.

Type 4 collagen forms the basal lamina.
Alport’s syndrome and Goodpasture’s syndrome.

Type 5 collagen is found in cell surfaces, hair and placentas. Disorders include the classical variant of Ehlers-Danlos syndrome.

75
Q

Grave’s eye disease complications

A

Exposure keratopathy
this is the most common complication of thyroid eye disease
- exposed and irritated eye. Pain, dryness, corneal ulceration

Optic neuropathy - inflamed eye muscles compress optic nerve, reducing visual acuity and visual field defects

Strabismus and diplopia - inflamed eye muscles

76
Q

most common Grave’s eye disease complications

A

Exposure keratopathy

77
Q

Mycophenolate mofetil (MMF) mechanism of action

A

reduces lymphocyte production through inhibition of iosine-5’-monophosphate dehydrogenase.

78
Q

rickets X ray findings and blood work

A

raised ALP, low Ca, low vit D

Swollen metaphyseal region on X-ray.

Calcium is required for the mineralisation and formation of mature bone tissue. If this cannot occur, a build up of this non-mineralised osteoid bone results in rickets disease.

aka. osteomalacia in adults
rickets in children

79
Q

Sarcoidosis CXR

A

1 = BHL
2 = BHL + infiltrates
3 = infiltrates
4 = fibrosis

80
Q

Ocular manifestations of rheumatoid arthritis

A

keratoconjunctivitis sicca (most common, dry eyes )
episcleritis (erythema)
scleritis (erythema and pain)
corneal ulceration
keratitis (moderate to intense pain and usually involves impaired eyesight, photophobia, redness of the eye with a gritty sensation)

81
Q

which disease-modifying anti-rheumatic drug which is safe in both pregnancy and breastfeeding

A

Sulfasalazine

82
Q

Causes of raised prolactin - the p’s

A

pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

83
Q

stopping anti depressants

A

Antidepressants should be continued for at least 6 months after remission of symptoms to decrease risk of relapse

84
Q

arthralgia, myositis and Raynaud’s

what is the disease? what is the diagnosis?

A

Anti-ribonuclear protein (anti-RNP) = mixed connective tissue disease

85
Q

HLA associated with coeliac disease.

A

HLA-DQ2

86
Q

first hormone secreted in response to hypoglycaemia

A

Glucagon

87
Q

Homocystinuria
- what is the inheritance pattern?
- what enzyme is deficient?
- what is the treatment?

A

Homocystinuria is a rare autosomal recessive disease caused by a deficiency of cystathionine beta synthase.

Treatment is vitamin B6 (pyridoxine) supplements.

88
Q

best sign of active SLE

A

complement levels (C3, C4)

89
Q

Looser’s zones x-ray are most characteristically associated with which condition?

A

osteomalacia

also known as pseudofractures or Milkman’s fractures

occur due to insufficient mineralisation of osteoid produced by osteoblasts.

due to low vit D resulting in low ca absorption from intestine

90
Q

polyarteritis nodosum diagnosis

A

clinical diagnosis: unexplained fever, arthralgia, subcutaneous nodules, skin ulcers, pain in the abdomen or extremities, new foot drop or wrist drop, or rapidly developing hypertension.

The diagnosis when other causes are excluded.

pANCA and hep B serology MAY be positive

91
Q

bone pain
bone/muscle tenderness
fractures: especially femoral neck
proximal myopathy: may lead to a waddling gait

A

Osteomalacia

92
Q

the first-line investigation in suspected primary hyperaldosteronism

A

A plasma aldosterone/renin ratio

93
Q

Indications for corticosteroid treatment for sarcoidosis are:

A

parenchymal lung disease (not just hilar lymphadenopathy), uveitis, hypercalcaemia and neurological or cardiac involvement

94
Q

In toxic multinodular goitre, nuclear scintigraphy reveals ?

graves?

A

patchy uptake = toxic multinodular goitre

diffuse increased uptake = graves

95
Q

most common non-iatrogenic cause of Cushing’s syndrome?

A

Pituitary tumour. This condition, also known as Cushing’s disease,

96
Q

how can carcinoid syndrome affect the heart?

A

right side of the heart.

The valvular effects are tricuspid insufficiency and pulmonary stenosis (TIPS)

97
Q

Peptic ulceration, galactorrhoea, hypercalcaemia -

A

multiple endocrine neoplasia type I

98
Q

which patients should be on metformin?

A

diabetics BMI >25

99
Q

On examination a hard, fixed, painless goitre is noted. It is usually seen in middle-aged women.

A

Riedel’s thyroiditis is a rare cause of hypothyroidism characterised by dense fibrous tissue replacing the normal thyroid parenchyma.

It is associated with retroperitoneal fibrosis.

100
Q

Diabetic ketoacidosis: the IV insulin infusion dose

A

should be started at 0.1 unit/kg/hour

101
Q

Poor compliance with thyroxine blood test results

A

high TSH
normal T4 (starts taking meds before blood test)

102
Q

recent steroids, thyroxine blood test result

A

low TSH
normal T4

103
Q

subclinical hypothyroidism result

A

high TSH
normal T4

104
Q

euthyroid sick syndrome, which is commonly seen in critically ill patients.

A

In this condition, there is a decrease in serum triiodothyronine (T3) and thyroxine (T4) levels, with a normal or slightly decreased thyroid-stimulating hormone (TSH).

105
Q

link between CKD and vit D

A

advanced chronic kidney disease there is impaired 1-alpha hydroxylation of 25-hydroxycholecalciferol by the kidney to 1,25-dihydroxycholecalciferol.

1,25-dihydroxycholecalciferol is the active form of vitamin D. In health, 1,25-dihydroxycholecalciferol promotes calcium and phosphate absorption from the gut and kidney,

MRCP Part 1 (21 decks)

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