Endocrinology

Question 1

Insulin infusion rate in children in DKA?

Answer 1

0.05 - 0.1 units/ kg /hr

Question 2

Single best test to assess thyroid function

Answer 2

TSH

Question 3

HbA1c threshold to diagnose diabetes

Answer 3

48

Question 4

Desmopressin test, results in

Craniogenic DI

Nephrogenic DI

Answer 4

1. Responds, increase urine osmolality
2. opposite

Question 5

Glucose % and ml/hr once BGL <14 in DKA

Answer 5

10 % 125ml/hr

Question 6

Fluid resus in adults with DKA

Answer 6

500ml NaCl initially over 10-15 mins
+ another 500ml if BP <90

Then 1L NaCl over 90 mins

Question 7

Initial immediate treatment for a thyroid storm

Answer 7

beta blockers

Question 8

Osmolality formula

Answer 8

2Na + glucose + urea

Question 9

DKA CRITERIA

Answer 9

Glucose >11 or known diabetes
Ketones - >3 serum or 2+ on urine dip
Bicarb <15 and or pH <7.3

Question 10

Complications of HSS

Answer 10

Re-hydrating too quickly
Cerebral oedema
Pulmonary oedema

cental pontine myelionsis

Question 11

Congenital adrenal hypoplasia, deficiency in what?

Answer 11

deficiency of the enzyme 21-hydroxylase.

Question 12

Test for congenital adrenal hypoplasia

Answer 12

17-hydroxyprogesterone.

Question 13

HHS and advice regarding VTE

Answer 13

The risk of thromboembolism is very high in patients with HHS, and low molecular weight heparin should be routinely given. In patients such as this with a serum osmolality greater than 350 mmol/l full heparinisation should be considered.

Question 14

Diabetic amyotrophy

(Proximal diabetic neuropathy)

Answer 14

second most common type of diabetic neuropathy

initially presents with pain in the buttocks, hips or thighs and is frequently unilateral initially.

Weakness and wasting of the proximal muscles of the lower limbs follow, and it can result in the patient being unable to go from sitting to standing without assistance.

Reflexes can also be affected in the corresponding areas involved. Diabetic amyotrophy is reversible with good glycaemic control, physiotherapy and lifestyle measures.

Question 15

Nelson’s syndrome

Answer 15

Nelson’s syndrome is a rare condition that occurs many years after a bilateral adrenalectomy for Cushing’s syndrome. It is thought that it develops due to the loss of the negative feedback control that usually suppresses high cortisol levels. This, in turn, results in the re-establishment of CRH production by the hypothalamus, which subsequently stimulates the growth of an adrenocorticotrophic hormone (ACTH) producing pituitary adenoma.

Question 16

Biochemical features of Addison’s disease

Answer 16

The classical biochemical features of Addison’s disease are as follows:
Increased ACTH levels
Elevated serum renin level
Hyponatraemia
Hyperkalaemia
Hypercalcaemia
Hypoglycaemia
Metabolic acidosis

Question 17

Type A vs B lactic acidosis

Answer 17

Type-B lactic acidosis is defined as not having to do with tissue hypoxia or hypoperfusion.

Question 18

Cushing’s disease vs Cushing’s syndrome

Answer 18

Cushing’s disease should be distinguished from Cushing’s syndrome and refers to one specific cause of the syndrome, an adenoma of the pituitary gland that secretes large amounts of ACTH and in turn elevates cortisol levels.

Question 19

Metabolic acidosis
(with raised anion gap) causes:

(4)

Answer 19

Lactic acidosis (e.g. hypoxaemia, shock, sepsis, infarction)
Ketoacidosis (e.g. diabetes, starvation, alcohol excess)
Renal failure
Poisoning (e.g. late stages of aspirin overdose, methanol, ethylene glycol)

Question 20

Metabolic acidosis
(with normal anion gap) causes:

(4)

Answer 20

Renal tubular acidosis
Diarrhoea
Ammonium chloride ingestion
Adrenal insufficiency

Question 21

Metabolic alkalosis causes:

(4)

Answer 21

Vomiting
Potassium depletion (e.g. diuretic usage)
Cushing’s syndrome
Conn’s syndrome

Question 22

Respiratory acidosis causes:

(5)

Answer 22

COPD
Life-threatening asthma
Pulmonary oedema
Sedative drug overdose (e.g. opiates, benzodiazepines)
Neuromuscular disease
Obesity

Question 23

Respiratory alkalosis cause:

(6)

Answer 23

Hyperventilation (e.g. anxiety)
Pulmonary embolism
CNS disorders (e.g. CVA, SAH, encephalitis)
Altitude
Pregnancy
Early stages of aspirin overdose