Endocrinology

Question 1

DKA resolution defined as

Answer 1

pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L

Question 2

Tx once DKA resolved

Answer 2

Switch the patient to subcutaneous insulin so long as patient is eating and drinking normally

Question 3

Insulin stress test:
insulinoma vs inappropriate exogenous insulin injection

Answer 3

Insulinoma- C-peptide levels do not fall
Inappropriate exogenous insulin injection: C-peptide levels fall

Question 4

Medullary thyroid cancer gene association

Answer 4

RET oncogene

Question 5

Endocrine parameters reduced in stress response:

Answer 5

Insulin
Testosterone
Oestrogen

Question 6

DKA insulin dose

Answer 6

fixed rate IV insulin infusion at 0.1 unit/kg/hour

Question 7

High dose dexamethasone suppression test- Cushings disease

Answer 7

suppressed cortisol and ACTH

Question 8

falsely high HbA1c

Answer 8

due to increased lifespan of RBC:

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

Question 9

falsely low HbA1c

Answer 9

due to decreased lifespan of RBC:

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

Question 10

most common complication of thyroid eye disease

Answer 10

exposure keratopathy
(red and painful eye)

Question 11

How to distinguish between primary adrenal failure and secondary adrenal insufficiency?

Answer 11

skin pigmentation

Question 12

atypical features of T1DM that require further investigation (c-peptide levels, autoantibodies)

Answer 12

age 50 years or above
BMI of 25 kg/m² or above
slow evolution of hyperglycaemia or long prodrome

Question 13

insulin vs gliclazide overdose

Answer 13

insulin: raised insulin levels, c-peptide normal

gliclazide: raised insulin and c-peptide levels

Question 14

Insulinoma Whipple’s triad of symptoms

Answer 14

1) hypoglycaemia with fasting or exercise
2) reversal of symptoms with glucose,
3) recorded low BMs at the time of symptoms

Question 15

Gradual withdrawal of steroids if:

Answer 15

received more than 40mg prednisolone daily for more than one week
received more than 3 weeks of treatment
recently received repeated courses

Question 16

Cx of fluid resuscitation in DKA

Answer 16

cerebral oedema:

headache, irritability, visual disturbance, focal neurology etc.

Question 17

Non-functioning pituitary adenomas

Answer 17

hypopituitarism and mass effect symptoms, (postural headache and visual loss)

Question 18

serum osmolality

Answer 18

2Na + urea + glucose

Question 19

phaeo Ix

Answer 19

urinary metanephrines

Question 20

Thyroid nodules Ix

Answer 20

Ultrasonography

Question 21

tender goitre

Answer 21

De Quervain’s thyroiditis

Question 22

Sx specific to Graves

Answer 22

Eye signs (exophthalmos, ophthalmoplegia)
pre-tibial myxoedema
thyroid acropachy

Question 23

Drugs causing galactorrhea

Answer 23

metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids

Question 24

De Quervains thyroiditis Tx

Answer 24

NSAIDs- self-limiting

Question 25

causes of raised Prolactin

Answer 25

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

Question 26

Patients with type I diabetes and a BMI > 25

Answer 26

Metformin in addition to insulin

Question 27

first line insulin regimen in children with T1DM

Answer 27

multiple daily injection basal-bolus insulin regimen

Question 28

Gastroparesis Tx

Answer 28

metoclopramide presents as upper gastrointestinal symptoms and erratic glucose control due to gastric emptying dysfunction

Question 29

Most important blood test to measure response to levothyroxine

Answer 29

TSH

Question 30

MODY Tx

Answer 30

sulphonylureas - gliclazide

Question 31

hypercalcaemia secondary to malignancy

Answer 31

PTH is low, although PTHrP may be raised

Question 32

high dose dexamethasone test: adrenal adenoma

Answer 32

cortisol not suppressed ACTH suppressed

Question 33

secondary hypothyroidism Ix

Answer 33

MRI pituitary

Question 34

Acromegaly Ix

Answer 34

First line= IGF-1 gold standard= OGTT

Question 35

HHS risk

Answer 35

central pontine myelinolysis

Question 36

subclinical hypothyroidism in elderly

Answer 36

watch and wait if age>80 if <65--> trial of levothyroxine, and recheck TFT in 6 months

Question 37

drug induced gynaecomastia

Answer 37

spironolactone (most common drug cause) cimetidine digoxin cannabis finasteride GnRH agonists e.g. goserelin, buserelin oestrogens, anabolic steroids

Question 38

In type 1 diabetics, blood glucose targets:

Answer 38

5-7 mmol/l on waking and 4-7 mmol/l before meals at other times of the day

Question 39

high dose dexamethasone test adrenal adenoma

Answer 39

cortisol not suppressed ACTH suppressed tumour produces excess cortisol

Question 40

kallmann vs klinefelters

Answer 40

kallman= hypogonadotrophic hypogonadism klinefelters= hypergonadotrophic hypogonadism

Question 41

Sick euthyroid syndrome =

Answer 41

low T3/T4 and normal TSH with acute illness

Question 42

hyperthyroidism in pregnancy

Answer 42

in the first trimester --> propylthiouracil

Question 43

C-peptide levels in T1 vs T2 DM

Answer 43

low in T1 high in T2

Question 44

MALT lymphoma associations

Answer 44

hashimotos H.pylori

Question 45

gliclazide drug class

Answer 45

sulphonylurea

Question 46

subclinical hypothyroidism Investigation

Answer 46

Check thyroid peroxidase antibodies --> can indicate patients who are more likely to progress to overt hypothyroidism

Question 47

pre-diabetes and BMI>35

Answer 47

liraglutide

Question 48

Cushing's syndrome ABG

Answer 48

hypokalaemic metabolic alkalosis

Question 49

Erratic blood glucose control, bloating and vomiting

Answer 49

gastroparesis

Question 50

klienfelters

Answer 50

47XXY high LH FSH low testosterone gynaecomastia tall small firm testes infertile

Question 51

-gliptins mechanism of action

Answer 51

DPP-4 inhibitors reduce peripheral breakdown of incretins such as GLP-1

Question 52

metformin contraindicated if

Answer 52

eGFR of less than 30 ml/min.

Question 53

Thyrotoxic storm is treated with

Answer 53

beta blockers, propylthiouracil and hydrocortisone

Question 54

diabetes medication contraindicated in HF

Answer 54

pioglitazone