Endocrinology

Question 1

Refeeding syndrome electrolyte disturbances

Answer 1

Hypophosphatemia
Hypomagnasemia
Hypokalemia
(Hyperglycaemia)
(Fluid retention)

Question 2

Growth hormone (GH) stimulation

Answer 2

Deep sleep
Exercise
Trauma / sepsis
Malnourishment / hypoglycaemia
High protein meal
Oestrogen
Dopamine

Question 3

Growth hormone (GH) inhibition

Answer 3

Hyperglycaemia
Leptin
Glucocorticoid excess

Question 4

Most common endocrinopathies post pituitary radiotherapy

Answer 4

Growth hormone - most common
Gonadotroph - 2nd most common
ACTH / TSH - least common

Question 5

Pregnancy - hormone levels

Answer 5

FSH - low
LH - low
Prolactin - high
Oestrogen - high
Testosterone - high

Question 6

Polycystic ovarian syndrome (PCOS) - hormone levels

Answer 6

Testosterone - high
Oestrogen - high or normal
FSH - low or normal
LH - high (in 50%) relatve to FSH

Question 7

Congenital adrenal hyperplasia (CAH) - hormone levels

Answer 7

17-hydroxyprogesterone - high, with exaggerated ACTH stimulation test increase
Renin - low
Aldosterone - low

Question 8

Hydatiform mole - hormone levels

Answer 8

B-hCG - high (higher than intrauterine/ectopic pregnancy)

Question 9

Prolactinoma - hormone levels

Answer 9

Prolactin - high

Question 10

Primary ovarian insufficiency (POI) - hormone levels

Answer 10

FSH - high

Oestradiol - low

Question 11

Mature onset diabetes of youth (MODY) 1

Answer 11

HNF-4 alpha defect

- (Chromosome 20q)

Question 12

Mature onset diabetes of youth (MODY) 2

Answer 12

Glucokinase defect

• 2nd most common - 15%
• Mild hyperglycaemia
• Can be taken off treatment due to minimal complications

Question 13

Mature onset diabetes of youth (MODY) 3

Answer 13

HNF-1 alpha defect

• Most common - 70%
• Very sensitive to sulfonylurea treatment
• Offspring diabetes risk 50%
• High HDL cholesterol

Question 14

Indications to treat diabetic foot ulcers

Answer 14

Shock
Bacteraemia
Marked necrosis / gangrene
Ulceration of deep tissue
Severe cellulitis
Osteomyelitis
Septic arthritis

Question 15

Indications to treat diabetic foot ulcers

Answer 15

Shock
Bacteraemia
Marked necrosis / gangrene
Ulceration of deep tissue
Severe cellulitis
Osteomyelitis
Septic arthritis

Question 16

Contraindications to bisphosphonate therapy for osteoporosis

Answer 16

Recent fracture (4-6 weeks)
Oesophageal disorders
Gastrointestinal intolerance
Chronic kidney disease - eGFR less than 30

Question 17

Hyperprolactinaemia - presentation

Answer 17

Hypogonadotrophic hypogonadism
Reduced libido
Impotence
Infertility
Gynaecomastia
Galactoorrhoea

Question 18

Hyponatraemia - BSL correction

Answer 18

+2 mmol/L serum Na for each 5.5 mmol/L BSL (over 10 mmol/L)

Question 19

Primary aldosteronism - hormone levels

Answer 19

Renin - low
Aldosterone - high
Aldosterone/renin ratio - more than 20

Question 20

Phaeochromocytoma - hormone levels

Answer 20

Metanephrine - high

Urinary catecholamines - high

Question 21

Secondary hyperaldosteronism - hormone levels

Answer 21

Renin - high
Aldosterone - high
Aldosterone/renin ratio - approx. 10

Question 22

Causes of secondary hyperaldosteronism

Answer 22

Renovascular hypertension
Diuretic use
Renin secreting tumour
Malignant hypertension
Coarctation of the aorta

Question 23

Glucocorticoid excess - hormone levels

eg. Cushing’s syndrome, exogenous mineralcorticoid, glucorticoid resistance

Answer 23

Renin - low

Aldosterone - low

Question 24

Biguanide - mechanism of action

Answer 24

eg. metformin
- Increase insulin action
- Decrease hepatic gluconeogenesis
- Increase peripheral glucose uptake
- Minor decrease in gut glucose absorption

Question 25

Biguanide - indications for T2DM

Answer 25

eg. metformin - 1st line initial therapy - Reduced weight - Reduced CVS events - in overweight patients - Reduced all-cause mortality

Question 26

Sulfonylurea - mechanism of action

Answer 26

eg. gliclazide - Stimulate relase of insulin from β-cells - Used in early T2DM, less effective in advanced / progressive T2DM

Question 27

Sulfonylurea - indications for T2DM

Answer 27

eg. gliclazide - 1st line - if metformin intolerant - 2nd line - in addition to metformin - Side effects - weight gain, hypoglycaemia

Question 28

Glucosidase inhibitor - mechanism of action

Answer 28

eg. acarbose - Inhibit saccharide breakdown at brush border of gut - Reduces post-prandial hyperglycaemia

Question 29

Glucosidase inhibitor - indications for T2DM

Answer 29

eg. acarbose - 3rd line - if post-prandial hyperglycaemia - Side effects - diarrhoea / flatulence, malabsorption

Question 30

Thiozolidinedione - mechanism of action

Answer 30

eg. pioglitazone - Binds and activates PPAR-gamma receptor - Decreased hepatic gluconeogenesis - Increased peripheral insulin sensitivity

Question 31

Thiozolidinedione - indications for T2DM

Answer 31

eg. pioglitazone - 3rd line - if no congestive heart failure - Side effects - weight gain, fluid retention / CCF, fractures, cardiovascular disease / MI (except pioglitazone)

Question 32

Incretin mimetic - mechanism of action

Answer 32

eg. exenatide - GLP-1 analogue, stimulates β cells, inhibits α cells - Increases insulin - Decreases glucagon - Slows stomach emptying

Question 33

Incretin mimetic - indications for T2DM

Answer 33

eg. exenatide - 3rd line - if BMI more than 30, desire to lose weight, can self-inject - Improves glycaemic control - Reduces weight - No difference in CVS outcomes

Question 34

Dipeptidyl peptidase-4 (DDP-4) inhibitor - mechanism of action

Answer 34

eg. sitagliptin - Inhibits DPP-4 inactivation of GLP-1 - Dependent on endogenous GLP-1 production

Question 35

Dipeptidyl peptidase-4 (DDP-4) inhibitor - indications for T2DM

Answer 35

eg. sitagliptin | - 3rd line - if weight gain concerning

Question 36

SGLT-2 inhibitor - mechanism of action

Answer 36

eg. dapagliflozin - Blocks sodium-glucose transport protein 2 - Reduces glucose reabsorption from urine in tubules - Increased efficacy as BSL increases

Question 37

SGLT-2 inhibitor - indications for T2DM

Answer 37

eg. dapagliflozin - 3rd line - when other drugs contraindicated - Reduces all-cause mortality, CVD events, CCF admissions, and weight - Contraindicated in renal impairment eGFR less than 45 - Side effects - genital infections / candidiasis (not UTIs), syncope / hypotension, euglycaemic DKA

Question 38

Most common secretory hormone in silent / non-functioning adenoma

Answer 38

Gonadotrophin (80-90%)

Question 39

Most common secretory hormone in functioning adenoma

Answer 39

Prolactin (50% all adenomas, typically microadenoma)

Question 40

Most common type of macroadenoma

Answer 40

Gonadotroph adenoma

Question 41

Most common factors associated with thyroid opthalmology

Answer 41

Genetic factors Smoking Female sex

Question 42

Causes of metabolic acidosis - with increased anion gap

Answer 42

``` Lactic acidosis Ketoacidosis (diabetes, alcohol, starvation) Drugs/toxins (salicylates, biguanides) Renal failure (urate) ```

Question 43

Causes of metabolic acidosis - with normal anion gap

Answer 43

``` Renal tubular acidosis Diarrhoea Drugs (acetazolamide) Ammonium chloride ingestion Addison's disease Pancreatic fistula ```

Question 44

Causes of metabolic alkalosis

Answer 44

Vomiting Burns Potassium depletion (eg. diuretics) Ingestion of base

Question 45

Primary hyperparathyroidism - hormone levels

Answer 45

PTH - inappropriately normal Ca - high PO4 - low Vitamin D (calcitriol) - high

Question 46

Secondary hyperparathyroidism - hormone levels

Answer 46

PTH - high Ca - low PO4 - high Vitamin D (calcitriol) - low (in vit D deficiency) or normal

Question 47

Pseudohyperparathyroidism - hormone levels

Answer 47

PTH - high Ca - low PO4 - high Vitamin D (calcitriol) - low