Endocrinology

Question 1

29 year old woman
History of hypothyroidism
Weakness, particularly of her arms
Double vision towards the end of the day ( normal examination at the opticians )

Answer 1

Myasthenia gravis

Question 2

State the dosing of hydrocortisone and fludrocortisone in an Addison’s patient with intercurrent illness

Answer 2

Double the glucocorticoids, keep fludrocortisone dose the same.

Question 3

Patient with high BP and hypokalemia. Most appropriate investigation to request?

Answer 3

Renin-aldosterone ratio ( suspected primary hyperaldosteronism/ Conn’s syndrome )

• If medication needed, then use doxazosin before doing screening test.

Question 4

State the management for a patient < 70 years old, with subclinical hypothyroidism ( TSH < 10 ) with hypothyroid symptoms.

Answer 4

3 month trial of LT4, then assess response to treatment.

Question 5

State the management for a patient <70 years old with TSH >10.

Answer 5

Treat with L-Thyroxine.

Question 6

State the management of a patient <70 years old, whose TSH < 10 and has no hypothyroid symptoms.

Answer 6

Observe and repeat TFT in 6 months.

Question 7

Name the sign and when it occurs.

Involuntary contraction of the muscles of the hand/wrist that occurs after inflation of BP cuff.
( flexion of the wrist, thumb, and metacarpophalangeal joints and extension of fingers )

Answer 7

Trousseau’s sign and it is a classic sign of hypocalcemia.