Endocrinology

Question 1

Ketone interpretation

Answer 1

<0.6 = normal
0.6–1.5 = repeat in 2 hrs
1.6–2.9 = high. contact GP or own diabetes team
≥3.0 very high. hospital admission

Question 2

Hypercalcaemia Fx

Answer 2

Bone stones groan moans

Bone pain, myopathy
Kidney stones
depression
nausea, vomiting, GI upset
dehydration

Question 3

Hypercalcaemia (normal PTH) DDx

Answer 3

Myeloma - Anaemia, renal impairment

Bone mets - CT CAP if prev Ca

Sarcoidosis - CXR

Paget’s - Raised ALP

Addison’s - Low Na, High K

Vit D Toxicity - high Vit D

Thyrotoxicosis - high T4

Question 4

High PTH DDx

Answer 4

Iatrogenic - normal Ca

Secondary high PTH - vit D def (low/ norm Ca)

Tertiary high PTH - in CKD

Question 5

primary hyperparathyroidism Mx

Answer 5

refer if symptomatic

Bisphosphonates

Annual bloods - Ca, GFR

DEXA

USS KUB if ?stones

Question 6

Cushing’s Ix

Answer 6

Dexamethasone suppression test
24 hour urinary cortisol

Question 7

Hyperthyroidism

Question 8

Diabetes in pregnancy counselling

Answer 8

Optician review and urine ACR
Folic acid until 12/40
Target fasting BM 5-7
Target HBA1C < 6.5%

Continue metformin and/ or insulin - stop all other oral hypoglycaemics for insulin