Endocrinology

Question 1

De quervains thyroiditis

Answer 1

Post viral 
Painful goitre
Raised esr 
Self-limiting 
If severe - steroids

Question 2

Graves’ disease - which antibody to check

Answer 2

TSH receptor (TRAb)

Question 3

Addisons causes

Answer 3

Autoimmune 
TB
Adrenal mets
Renal haemorrhage 
Congenital

Question 4

Electrolytes abnormalities in addisons

Answer 4

Low sodium
High potassium
Low glucose

Question 5

Test for addisons

Answer 5

Short synacthen test

Cortisol levels before and after (1/2 hour)
Give 250micrograms tetracosatide IM

If second cortisol >550 this excludes addisons

Question 6

Cushing disease

Answer 6

Bilateral adrenal hyperplasia from an ACTH-s creating pituiTary adenoma

Question 7

Diagnosing diabetes

Answer 7

1. Symptoms of hyperglycaemia, and raised venous glucose detected once ( fasting >7 or random >11.1)

OR

2. Raised venous on 2 separate occasions or OGTT >11.1

Question 8

Impaired fasting glucose

Answer 8

6.1-7.0

Offer oral glucose tolerance test

Question 9

Impaired glucose tolerance test

Answer 9

Fasting 7.8 but less than 11.1

Question 10

Hba1c target

Answer 10

6.5% (48 mmol/mol)

Question 11

Management of type II diabetes

Answer 11

Lifestyle interventions
1. Metformin
2. If hba1c is still >7% 16 weeks later - use a sulfonylurea
(If risk of hypo consider a thiazilinonedione or a PPD-4 inhibitor)
3. 6 months hba1c still >7.4 give insulin

Question 12

Mechanism of action of metformin

Answer 12

Decreases gluconeogenesis

Increases peripheral utilisation of glucose