Endocrinology

Question 1

What are two hand/nail signs of hyperthyroidsim?

Answer 1

Acropachy and onycholysis

Question 2

When is insulin taken and glucose checked?

Answer 2

Before meals

Question 3

What is the blood glucose target for someone taking insulin upon waking/ pre breakfast?

Answer 3

5-7 mmol/L

Question 4

What is the blood glucose target for someone taking insulin 90 minutes after a meal?

Answer 4

5-9 mmol/L

Question 5

What is the blood glucose target for someone taking insulin pre lunch/ dinner?

Answer 5

4-7 mmol/L

Question 6

How would you change the dose of insulin if a patient had a lower/ higher blood glucose before a meal?

Answer 6

Hypoglycaemia has a bigger threat than hyperglycaemia so reduce the insulin dose

Question 7

A housebound patient has a tender rib cage on patient. What does this suggest?

Answer 7

Osteomalacia

Question 8

What is an example of peripheral neuropathy vs autonomic neuropathy in diabetics?

Answer 8

Peripheral neuropathy: glove and stocking
Autonomic neuropathy: gastroparesis

Question 9

In a DKA patient with a potassium <5.5 what is the first line treatment?

Answer 9

IV 0.9% saline and KCl

Question 10

What are four ECG changes in hyperkalaemia?

Answer 10

1. tall, tented T waves
   2 wide QRS complexes
2. no p waves
   4 sinusodial waves

Question 11

What is the first investigation for a patient with symptoms of hypercalcaemia?

Answer 11

Fasting serum calcium

Question 12

A patient with palpitations and hypertension with a history of total thyroidectomy. What investigation is indicated?

Answer 12

24 hour urinary metanephrines (vanillylmendelic acid)
for phaeocytochroma (MEN2A)

Question 13

What breathing is seen in DKA patients?

Answer 13

Kussmaul breathing
deep and laboured to blow off the CO2

Question 14

How does hypothyroidism lead to hyperprolactinaemia?

Answer 14

By stimulating increased TRH which increases prolactin production

Question 15

What syndrome describes cushingoid features, patchy skin, bone abdormalities and hypophosphataemia?

Answer 15

Mccume-Albright syndrome

Question 16

What is measured first in hypo or hyperthyroidism?

Answer 16

TSH levels

Question 17

Describe Nelson syndrome

Answer 17

Adrenelectomy causes an increase in ACTH levels leading to headache, bitemporal haemanopia, and increased pigmentation of skin

Question 18

What is the visual field defect in pituitary apoplexy?

Answer 18

Bitemporal superior quandrantopia

Question 19

A patient is oedematous, shaking and has rust coloured sputum. What are they experiencing?

Answer 19

Myxoedema coma

Question 20

What is secondary adrenal failure caused by and what are the ACTH levels like?

Answer 20

Steroid abuse leading to low ACTH Addisons disease

Question 21

What can be given to slow the rate of sodium correction?

Answer 21

5% dextrose

Question 22

What does an increased T4 but an even higher TSH indicate in someone taking levothyroxine?

Answer 22

Non-compliance to medication

Question 23

How does panhypopituitarism affect prolactin levels?

Answer 23

Increased as non functioning pituitary adenoma can have a negative effect on dopaminergic neryones

Question 24

What is the first line treatment for pituitary apoplexy?

Answer 24

IM bolus 100ml hydrocortisone

Question 25

What medication can be given to treat primary parahyperparathyroidism after IV fluids are given?

Answer 25

Cinacalcet
decreases PTH secretion from parathyroid gland

Question 26

What scan can look at parathyroid function?

Answer 26

Sestamibi nuclear scan

Question 27

How much fluids should be given over 6 hours in HHS?

Answer 27

3L NaCl over 6 hours

1 litre for:
1hr, 2hr, 2hr, 4hr, 4hr

Question 28

What causes hypovolaemic hyponatraemia with a high urinary sodium?

Answer 28

Furosemide use

Question 30

How does Riedel’s thyroiditis affect thyroxine leveles?

Answer 30

Fibrosis of the thyroid gland leads to hypothyroidism

Question 31

How does Hashimoto’s affect prolactin levels

Answer 31

Increases TRH which can increase prolactin levels

Question 32

When investigating polyuria and polydipsia what must be ruled out before doing a water deprivation test?

Answer 32

Hypercalcaemia

Question 33

If the patient is alert enough to swallow what mode of glucose should the patient receive?

Answer 33

Glucose tablets not gel

Question 34

How is serum osmolality measured?

Answer 34

2*Na + urea + glucose

Question 35

What medication is approved to treat diabetes in CKD patients?

Answer 35

Sitagliptins

Question 36

What is the triad for IgA vascultis / Henoch Schonlein purpura?

Answer 36

Rash
Abdo pain
Arthralgia

Question 37

In nephrotic syndrome what medication should be started to reduce swelling?

Answer 37

Furosemide