Endocrinology

Question 1

Graves specifc features

Answer 1

Unique to Graves -
1)Ex“opathalmo”s+“ Opthalmo”plegia [ NOT lid lag]
2) Pretibial myxedema
3) Thyroid acropachy (clubbing)

Question 2

Liddle’s syndrome

Answer 2

hypokalaemia + hypertension

Liddle’s syndrome is an autosomal dominant disorder that mimics hyperaldosteronism, resulting in hypokalaemia associated with hypertension.

Liddle Cushing Conn’d 11 people with a hyperlink (Hypertension)

Shopping at Lidl is stressful but bartering with a gentleman is not
(Liddles= HTN, Bartters and Gitelmans = no HTN)

Question 3

Metoclopramid causes what SE related to breast tissue

Answer 3

GALATORREHEA (not gynaaecomastia) due to dopaamine aanatagonism.
It is known to cause galactorrhoea - secretion of milk from the nipples - but not gynaecomastia. Dopamine normally inhibits prolactin, which is responsible for milk secretion, and so antagonising dopamine results in increased prolactin levels.

Question 4

first-line pharmacological treatment in patients with MODY type 1

Answer 4

the underlying genetic defect results in reduced endogenous insulin secretion

Sulpholyureas

Question 5

Causes of pseudohyponatraemia

Answer 5

hyperlipidaemia (increase in serum volume) or a taking blood from a drip arm

Question 6

RET oncogene throid CA

Answer 6

Medullary

Question 7

Tender goitre =

Answer 7

Subacute dequervians thyroiditis

There is an initial period of hyperthyroid, due to the release of thyroid hormone from damaged cells. Following the hyperthyroid state, a period of hypothyroid then ensues, eventually resolving back to a euthyroid state.

Question 8

Systemic glucocorticoids can cause drug-induced acne

Answer 8

This is characterised as monomorphic papular rash without comedones or cysts. This does not respond to acne treatment but improves on drug discontinuation

Question 9

Osteoporosis Normal Normal Normal
Pagets Normal Normal High
Myeloma High Nor/ High Normal
Bone Mets High Nor/ High High
Osteomalacia Low Low High
Hypoparathyroid Low High Normal
Renal Failure Low High Normal

Question 10

pioglitazone SE

Answer 10

Pioglitazone may cause fluid retention

weight gain
liver impairment: monitor LFTs
fluid retention - therefore contraindicated in heart failure. The risk of fluid retention is increased if the patient also takes insulin
recent studies have indicated an increased risk of fractures
bladder cancer: recent studies have shown an increased risk of bladder cancer in patients taking pioglitazone (hazard ratio 2.64)

Question 11

most aggressive thyroiid ca

Answer 11

anaplastic

Question 12

most common thyroid ca

Answer 12

Papillary 70% Often young females - excellent prognosis

Question 13

MODY inheritance pattern

Answer 13

autosomal dominantt

Question 14

thyroid lymphoma associated with

Answer 14

Lymphoma Rare Associated with Hashimoto’s thyroiditis

Question 15

insulin stress test (IST) is primarily used to assess

Answer 15

hypopituitaryism

insulin stress test (IST) is primarily used to assess the integrity of the hypothalamic-pituitary-adrenal axis, and it is considered the gold standard for diagnosing hypopituitarism. In this test, insulin-induced hypoglycaemia should stimulate the pituitary gland to secrete adrenocorticotropic hormone (ACTH), which in turn stimulates the adrenal glands to produce cortisol. If there’s a deficiency in ACTH due to hypopituitarism, cortisol response will be inadequate.

Question 16

Sulfonylureas have been associated with an increased risk of developing

Answer 16

heart failure

Question 17

pendred syndrome

Answer 17

Pendred is an autosomal recessive genetic disorder that is characterised by bilateral sensorineural deafness, with mild hypothyroidism and a goitre.

Question 18

Familial hypercholesterolaemia inheritance

Answer 18

autosoma dominant q

Question 19

impaired fasting glycaemia (IFG) is defined as

Answer 19

fasting plasma glucose level between 6.1 mmol/l and 6.9 mmol/l,

Question 20

normal fasting plasma glucose levels are typically between

Answer 20

3.9 and 6.0 mmol/l

Question 21

symptomatic hypokalaemia and maintains normotension, which are characteristic features

Answer 21

xBartter’s syndrome. This disorder stems from a dysfunction in the NKCC2 channel located in the ascending loop of Henle. Typically presenting during childhood, Bartter’s syndrome is defined by normal blood pressure levels, setting it apart from other conditions commonly associated with hypertension.

Question 22

Impaired glucose tolerance

Answer 22

Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Question 23

Acromegaly: investigations

Answer 23

Serum IGF-1 levels have now overtaken the oral glucose tolerance test (OGTT) with serial GH measurements as the first-line test. The OGTT test is recommended to confirm the diagnosis if IGF-1 levels are raised.

Question 24

The first-line treatment in remnant hyperlipidaemia (dysbetalipoproteinaemia) is

Answer 24

fibrats

Question 25

MODY gene

Answer 25

HNF-1 alpha

Question 26

oral steroid has the least amount of mineralocorticoid activity

Answer 26

dex

MRCPI Jan/21 - Question about use of a steroid agent in heart failure patient - answer : dexamethasone

Question 27

Gestational diabetes targets for Dx and Mx

Answer 27

Dx:
(5,6,7,8)
Fasting > 5.6
2-hour >7.8

Targets:
Fasting - 5.3
1h - 7.8
2h - 6.4

Question 28

Normal anion gap

Answer 28

4-12 mmol/L

Question 29

Drugs causing Gynaecomastia

Answer 29

D- Digoxin
I- Isoniazid
S- Spironolactone
C- Cimetidine
O- Oestrogen

Question 30

Hypokalaemia with Hypertension caauses

Answer 30

'’Little Cushing Conned 11 Russian by High Tension’’

Liddle’s, Cushing’s , Conn’s , 11-beta Hydroxylase deficiency and RAS

Question 31

Seious SEs of GLP1 mimetics

Answer 31

Severe pancreatitis & renal impairement

Question 32

Serum osmo for HHS

Answer 32

> 320

o precise diagnostic criteria but the following are typically seen
hypovolaemia
marked hyperglycaemia (>30 mmol/L)
significantly raised serum osmolarity (> 320 mosmol/kg)
can be calculated by: 2 * Na+ + glucose + urea
no significant hyperketonaemia (<3 mmol/L)
no significant acidosis (bicarbonate > 15 mmol/l or pH > 7.3 - acidosis can occur due to lactic acidosis or renal impairment)

Question 33

Pheocystochroma associated with whaat syndomes?

Answer 33

Phaeochromocytoma is associated with 1,2,3
NF-1, MEN 2, VHL (chromosome 3)

Question 34

Main androgen in females

Answer 34

Dehydroepiandrosterone is the most abundant circulating adrenal steroid. Adrenal glands are the main source of dehydroepiandrosterone in females - loss of functioning adrenal tissue as in Addison’s disease may result in symptoms secondary to androgen deficiency, such as loss of libido. Research is ongoing as to whether routine replacement of DHEA is beneficial

Question 35

Diabetes meliitus diagnosis

Answer 35

fasting > 7.0, random > 11.1 - if asymptomatic need two readings

You can buy lots of unhealthy snacks at a 7/11, which might give you diabetes.

7 = cutoff for fasting flucose
11 = cutoff for random or after glucose load

Question 36

Impaired glucose tolerance (IGT) is defined as

Answer 36

fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

Question 37

impaired fasting glucose (IFG)

Answer 37

a fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)

Question 38

Thyrotoxic storm is treated with

Answer 38

beta blockers, propylthiouracil and hydrocortisone