Endocrinology

Question 1

What is addison’s disease?

Answer 1

Adrenal insufficiency resulting in steroid deficiency

Question 2

Two parts of the adrenal gland - what do they produce?

Answer 2

Medulla - adrenaline & noradrenaline (Sympathetic innervation)

Cortex - Glucocorticoid, mineralocorticoid, androgens (“salt, sugar, sex - deeper is sweeter”)

Question 3

Main type of glucocorticoid and mineralocorticoid, what do they do?

Answer 3

Gluco. - CORTISOL results in increased glucose

Mineralo. - ALDOSTERONE results in Na and H20 retention therefore maintaining a reduced BP

(categories not exclusive, cortitsol has mineralo. functions too for example)

Question 4

Symptoms of Addisons?

Answer 4

Tired - reduced cortisol results in decreased glucose

Decreased BP and increased HR - decreased aldosterone

Freckles and Hyperpigmentation - POMC increases. Melanocytes stimulated

Question 5

Biochemical findings

Answer 5

Decreased Na+ and Increased K+

Low glucose

Question 6

Correct investigations?

Answer 6

Random cortisol (remember diurnal activity…)
Short Synacthen test
Plasma renin and aldosterone
Adrenal antibodies

Question 7

Management?

Answer 7

Give fluids then IV hydrocortisone (cortisol) and flucocortisone (aldosterone)

Regular Obs, renal function, daily bloods/BM/ect.

Home with oral hydrocortisone

Question 8

Patient hypotensive and tachycardic - what is this?

Answer 8

Shock : end-organ hypo perfusion can manifest as confusion and decreased renal output

Question 9

Blood pressure formula?

Answer 9

BP = CO x TPR

Therefore, shock can occur when one of these/both decrease beyond compensateble levels

Question 10

Caused of decreased CO?

Answer 10

PUMP FAILURE - HF, MI, valvular disease

OBSTRUCTIVE - Tamponade, PE, AS, pneumothorax

Hypovolaemia - AAA, trauma, pancreatitis, N&V, fistula

AND ENDOCRINE - ADDISON’S DISEASE!

Question 11

Causes of decrease TPR?

Answer 11

("DISTRIBUTIVE")
Sepsis
Drugs
Anaphylaxis
Neurogenic - spinal lesion

Question 12

What is LADA?

Answer 12

Latent autoimmune diabetes of adulthood

i.e. late onset of T1DM. Up to 15% of T2DM may actually have LADA.

Question 13

Grades of hypertensive retinopathy?

Answer 13

Grade 1 - silver wiring or arteries and tortuoscity

Grade 2 - AND AV nipping

Grade 3 - AND flame shaped haemorrhages and cotton wool spots

Grade 4 - AND papiloedema

Question 14

What are the two stages of diabetic retinopathy?

Answer 14

Non-proliferative:
Microaneurysms 
Dot and blot hemorrhages
Cotton wool spots 
Hard exudates 
VISION USUALLY NORMAL

Proliferative:
Macular oedema
New vascular growth
Retinal Haemorrhage
Vitreous Haemorrhage (sudden visual loss)
VISION CAN GO FROM NORMAL TO SIGHT-THREATENING

Question 15

What is Cushing’s syndrome?

Answer 15

Syndrome caused by an increased amount of steroid in the body (can be iatrogenic or pathological)

Question 16

What are the characteristic symptoms patients have?

Answer 16

C - cataracts/central weight gain
U - Ulcers
S - striae/skin changes (bruising)
H - HTN, hirsutism, hyperglycaemia
I - infections
N - avascular necrosis of femoral head
G - glycosuria
O - osteoperosis
I - immunosupresion
D - diabetes

Question 17

Treatment of overt hyperthyroidism?

Answer 17

Carbimazole and levothyroxine (plus beta blocker propanolol)

Question 18

First line investigation in cuching’s syndrome?

Answer 18

Synacthin test (i.e. tetracosactide and check cortisol before and after)

Question 19

What is the first line oral medication in type II diabetes?

Answer 19

Metformin

Question 20

Discrete lumps on an enlarged goitre - diagnosis?

Answer 20

Multinodular goiter

Question 21

Which nerve controls lateral gaze? What is it’s course through the cranium?

Answer 21

Abducens CN VI.

Courses through cavernous sinus and beneath pituitary fossa. A tumour in the sella region can cause lat gaze problems via pressing on cavernous sinus

Question 22

In a diabetic patient, if you saw new vessel formation what does that tell you about their control?

Answer 22

Worsening diabetic control

Question 23

What is the minimum amount of evidence you need to diagnose diabetes?

Answer 23

Any symptoms + random glucose of >11.1mmol/L

Question 24

What are some characteristics of diabetic neuropathy?

Answer 24

Increased liklihood in elderly
progressive pain, tingling, and tightness in both feet
Glove and stocking pattern
Reduces ankle reflexes
Charcot's joints

Question 25

Which drugs reduce dopamine levels and what are the side effects?

Answer 25

Prochlorperazine
Metoclopramide
Haloperidol
Domperidone?

SEs: hyperprolactinaemia and galactorrhoea
Breast discharge and decreased periods

Question 26

What is the pharmacological treatment of hyperthyroidism?

Answer 26

Carbimazole and levothyroxine (to prevent iatrogenic hypoT)

Question 27

What is the first line investigation in suspected Cushing’s syndrome?

Answer 27

Synacthin Test (tetracosactide - checking cortisol before and after)