Endocrinology

Question 1

Why do patients with cushings present with weakness?

Answer 1

Hypokalaemia

Question 2

2 first line tests for cushings

Answer 2

• Dex suppression test, check 8am cortisol

- 24 hour urinary cortisol

Question 3

Most common cause of hypothyroidism?

Answer 3

Hashimotos thyroidistis

Question 4

Which conditions are associated with hashimotos thyroiditis?

Answer 4

IDDM, addisons & pernicious anaemia.

Question 5

What condition is associated with yellow/blue blindness?

Answer 5

Pernicious anaemia

Question 6

What can severe hypothyroidism cause (in blood)?

Answer 6

Macrocytic anaemia

Question 7

Which type of anaemia may you see a yellow tinge to the skin?

Answer 7

Pernicious anaemia

Question 8

Neuro involvement in pernicious anaemia

Answer 8

Subacute combined degeneration of the spinal cord has an insidious onset with peripheral neuropathy.

Question 9

Classic triad of neuro symptoms associated with subacute combined degeneration of the spinal cord?

Answer 9

The classic triad of signs associated with subacute combined degeneration of the spinal cord is extensor plantar reflexes, brisk knee jerks, and absent ankle jerks.

Question 10

Inv for pernicious anaemia?

Answer 10

If the haemoglobin level is low and the mean cell volume (MCV) is high, check serum vitamin B12 and serum folate concentrations. Red cell folate can also be used to screen for folate deficiency.
If the haemoglobin level is low and the MCV is normal or low, check ferritin, vitamin B12, and folate levels.
Conditions such as iron deficiency anaemia or thalassaemia trait can mask the development or presence of macrocytosis. For more information, see the CKS topic on Anaemia - iron deficiency.
Generally, the diagnosis should rely on the clinical situation and the vitamin B12 and folate levels. A blood film may be useful in certain cases if there is diagnostic uncertainty.

Question 11

Megaloblastic anaemia on blood film

Answer 11

Oval macrocytes and hypersegmented nuclei in neutrophils

Question 12

How is diabetes insipidus characterised?

Answer 12

A high plasma osmolality and a low urine osmolality

Question 13

How do you confirm diagnosis of diabetes insipidus?

Answer 13

Water deprivation test.

Normally urine osmolality will increase when deprived of water.

Question 14

What causes diabetes insipidus?

Answer 14

Diabetes insipidus (DI) is characterized by impaired water resorption by the kidney as a result of lack of ADH secretion by the posterior pituitary (cranial DI) or reduced sensitivity of the kidneys to the action of ADH (nephrogenic DI).

Question 15

FYI

Answer 15

A urine osmolality of >700 mOsm/kg excludes diabetes insipidus.

Question 16

Differentiating between cranial DI and nephrogenic DI?

Answer 16

So nephrogenic DI will not respond to vasopressin (exogneous ADH) but cranial DI will. Also

Question 17

Cause of metabolic alkalosis?

Answer 17

Prolonged vomiting, hypokalaemia, cushings, conns

Question 18

Causes of respiratory acidosis?

Answer 18

COPD, benzo, opiate overdose

Question 19

Causes of respiratory alkalosis?

Answer 19

pulmonary embolism
salicylate poisoning
CNS disorders: stroke, subarachnoid haemorrhage, encephalitis
altitude
pregnancy
hyperventilation

Question 20

Hypothyroid symptoms plus lack of goitre?

Answer 20

Think primary myxodema

Question 21

Complications of thyroid surgery?

Answer 21

Bleeding, voice change and hypercalcaemia.