Endocrinology Flashcards
Which of these causes hypercalcaemia?
a) Hypoparathyroidism
b) Addison’s disease
c) Exercise
d) ACE-i
e) Frusemide
B. “Pam P. Schmidt” Mnemonic
P – Parathyroid hormone
A – Addison’s disease
M – Milk-alkali syndrome
P – Paget’s disease
S – Sarcoidosis
C – Cancer (most common cause)
H – Hyperthyroidism
M – Multiple myeloma
I – Immobilization
D – Hypervitaminosis D
T – Thiazide diuretics
Which of these is a clinical sign of hypercalcaemia?
a) Hyporeflexia
b) Hyperreflexia
c) Pericarditis
d) Mania
e) Oliguria
“Stones, bones, groans, thrones, and psychiatric overtones”
Stones – nephrolithiasis, ectopic calcification
Bones – bone pain
Groans – lethargy, fatigue, weakness, headache Thrones – polyuria, polydipsia, oliguria (later)
Moans – ileus, abdominal pain, nausea and vomiting, pancreatitis
Psychiatric overtones – confusion, depression, AMS Watch for bradycardia and hypotension (volume depletion)
Bonus Pearl: hypercalcemia and hypermagnesemia cause HYPOreflexia, while hypocalcemia and hypomagnesemia produce HYPERrelexia!
Which of the following can precipitate DKA?
a) Exercise
b) Sulphonylurea OD
c) Calorie counting
d) Hospital admission
e) Ischaemia
E.
The 5 I’s
Infection
Ischaemia
Infarction
Intoxication
Insulin missed
What is the definitiion of imparied glucose tolerance or impaired fasting glucose? (mmol/L)
a) Impaired fasting glucose of 7.1 - 7.9
b) Imparied fasting glucose of 8.1 - 8.9
c) Impaired glucose test of 6.1 - 6.9
d) Impaired glucose test of 11.1 - 11.9
e) HbA1c 6.0 - 6.4%
E.
Impaired fasting glucose is 6.1 - 6.9 mmol/L
Impaired glucose tolerance is 7.8 - 11.0 mmol/L
HbA1c = 6.0 - 6.4%
Levels higher than stated are diagnostic criteria for diabetes.
What are the diagnostic criteria for diabetes?
a) Fasting plasma glucose >/= 8.0 mmol/L
b) 2 hours 75g oral glucose tolerance test >/= 11.1 mmol/L
c) Random plasma glucose >/= 10.0 mmol/L
d) HbA1c >6.5% in a child
e) HbA1c >6.5% in an adolescent
B.
Fasting glucose >/= 7.0 mmol/L (no intake for 8 hours)
2h 75g OGTT >/= 11.1 mmol/L
Random plasma glucose >/= 11.1 mmol/L
HbAic >6.5% (not for the diangosis of type 1, children, adolecscents or pregnant women)
Patients with hyperglycaemic symptoms (polyuria, polydipsia, polyphagia, weight loss and blurry vision)
Which of the following can cause diabetes?
a) CMV
b) Down’s syndrome
c) Klinefelter’s syndrome
d) Turner’s syndrome
e) HIV
A.
Type 1 DM is caused by immune mediated beta cell destruction usually leading to absolute insulin deficiency.
Type 2 DM ranges from predominantly insulin resistance with relative insulin deficiciency to a predominantly insulin secretory defect with insulin resistance secondary to beta cell dysfunction.
Other specific causes of DM:
Genetic defect of beta cell function (Maturity onset diabetes of the young)
Pancreatitis, pancreatectomy, neoplasia, cystic fibrosis, haemochromatosis (bronze diabetes)
Endocrinopathies: Acromegly, Cushing’s syndrome, glucagonoma, phaeochromocystoma, hyperthyroidis,.
Drug induced: Glucocorticosteroids, thyroid hormone, beta-adrenergic agonists, thiazides, phenytoin, clozapine.
Infections: Congenital rubella, CMV, coxsackie.
Down’s, Klinefelter’s and Turner’s syndrome are only associated with DM and not the cause.
Which of the following is a risk factor for type 1 diabetes?
a) Schizophrenia
b) First degree relative with DM
c) Hyperuricaemia
d) Myasthenia gravis
e) Black race
D.
Personal or family history of autoimmune disease increases risk. Grave’s, myasthenia gravis, autoimmune thyroid disease, coeliac disease and pernicious anaemia.
Type 2 risk factors include:
Age > 40, abdominal obesity, fatty liver, first-degree relative with DM, hyperuricaemia, race/ethnicity (Black or aboriginal, hispanic, Asian-American, Pacific Islander). History of insulin intolerance, HTN, dyslipidaemia, medications (2nd generation antipsychotics), PCOS and Hx of genestational DM or macrosomic baby.
Which of the following is correct when dosing insulin for diabetes?
a) In type 2 diabetes if insulin is required a nighttime basal dose fo 20 is a good starting dose.
b) In type 2 diabetes the fasting morning glucose should be <7.0 mmol/L. If not titrate up by 2 units until the target is achieved.
c) For type 1 DM the estimated total insulin requirement is 0.5 - 1.0 U/kg.
d) For type 1 DM the total insulin requirement is split to 40% basal at bedtime and 20% for breakfast, lunch and dinner.
e) For type 1 DM is premixed insulin is being used 1/3rd is given before breakfast and 2/3rds before dinner.
D.
T2DM: Start with 10 units of basal insulin at bedtime and titrate up by 1 unit until fasting glucose is <7.0 mmol/L.
T1DM: Estimated requirements is 0.5 - 0.7 U/kg. 40% is given as basal insulin at bedtime and 20% is given as bolus insulin before breakfast, lunch and dinner. If using a premixed insulin give 2/3 dose before breakfast and 1/3 dose before dinner.
Which of the following statements are true:
a) Exogenous insulin use causes increased c-peptide
b) Neuroglycopenic symptoms occur before adrenergic symptoms in hypoglycaemia
c) C-peptide is released into the circulation when proinsulin is cleaved to insulin.
d) Hypoglycaemic unawareness is prominant in type 2 diabetes.
e) Hypoglycaemic unawareness can be caused from an increased glucagon/epinephrine response.
C.
C-peptide is released into the circulation when proinsulin is cleaved to insulin.
Exogenous insulin causes decreased or normal c-peptide levels.
In hypoglycaemia adrenergic symptoms (palpitations, sweating, anxiety, tremor and tachycardia) occur before neuroglycopenic symptoms (dizziness, headache, clouding of vision, confusion, seizures and coma).
Hypoglycaemia unawarness is worse in type 1 diabetics and is caused by repeated low glucose and HbA1c levels, autonomic neuropathy and decreased glucagon/epinephrine response.
Which of the following statements are correct:
a) Pancreatic islet tumours can secrete ectopic GHRH
b) Growth Hormone excess in adults results in gigantism
c) In acromegaly there is decreased insulin-like growth factor-1
d) A glucose test of 75g will cause raised GH levels in healthy individuals.
e) Surgery is the only treatment option for a tumour in the sella turcica.
A.
Growth hormone excess in children causes gigantism but acromegaly in adults (i.e. once the epiphyseal plates have closed).
In GH excess there will be elevated serum insulin-like growth factor and a glucose suppression test will show normal or elevated levels of growth hormone. Normally glucose suppresses GH.
There are many treatment options including surgery, octreotide (somatostatin analogue), dopamine agonist (bromocriptine/cabergoline), GH receptor antagonist (pegvisomant), radiation.
Which of the following is correct?
a) A prolactinoma is a rare pituitary adenoma
b) Hyperprolactnaemia is common in pregnancy
c) Dopamine stimulates prolactin release
d) Prolactin-secreting tumours are fast growing
e) Prolactin is metabolised by the liver and excreted by the kidneys
B.
Hyperprolactinaemia is common in pregnancy and breastfeeding. It is the commonest pituitary adenomas and dopamine inhibits prolactin release. The tumours are usually slow growing. Prolactin is metabolised in both the liver and the kidneys.
Which of the following statement is true regarding diabetes insipidus (DI)?
a) Central DI can be caused by lithium
b) Nephrogenic DI can be caused by hyperkalaemia
c) A test dose of DDAVP will concentrate the urine in central DI
d) Fluid deprivation will not help with psychogenic polydipsia
e) Hyponatraemia is the classic laboratory finding
C.
Central DI is due to insufficent ADH from either pituitary surgery, tumours, idiopathi/autoimmune, stalk lesions, hydrocephalus, histocytosis X, trauma, familiar central DI.
Nephrogenic DI is due to an ineefective response from the kidneys to ADH caused by; drugs (lithium), hypercalacaemia, hypokalaemia, chronic renal disease and hereditary nephrogenic DI.
Osmotic diuresis and psychogenic polydipsia must be ruled out. A fliud deprevation test will rule out psychogenic DI as urine output will reduce and urine osmolality will increase (the oppposite occurs in true DI).
Hypernatraemia can develop with inadequate water consumption or secondary to impaired thirst mechnism while passages of large dilute urine are occuring.
DDAVP = desmopressin which is the synthetic version of vasopressin. A DDAVP test will concentrate the urine in a central cause (central = concentrated urine). However, in nephrogenic there is no effect.
Treatment is DDAVP for central DI
Nephrogenic requires solute restriction, NSAIDs and thiazide diuretics. DDAVP can be used is there is partial response.
Which is of the following is true of the SIADH definition?
a) Hypo-osmolar hyopnatraemia must be present
b) Urine sodium >40mmol/L
c) Thyroid function can be abnormal but pituitary and adrenal function must be normal.
d) The patient can be hypotensive.
e) Hyponatraemia corrects with 3% saline
A.
Hypo-osmolar hyponatremia
Urine osmolality greater than plasma osmolality
Urine sodium excretion greater than 20mmol/L
Normal renal, hepatic, cardiac, pituitary, adrenal and thyroid function
Absence of hypotension, hypovolemia, oedema and ADH-influencing drugs
Hyponatremia corrects with water restriction
Which of the following SIADH treatment is cheap and effective?
a) Tolvaptan
b) Urea
c) Conivaptan
d) Demeclocycline
e) Frusemide
B.
Tolvaptan and Conivaptan are very effective with minimal side effects but are very expensive. Urea is as effective and cheap (just tastes bad). Demeclocycline (antibiotic with anti-ADH properties) is now an old form of treatment and response is variable. Frusemide and 3% saline while cheap do often overshoot or cause electrolyte imbalances that are hard to monitor consistently. Fludrocortisone can also be used.
In which order do the pituitary hormones disappear when compressed by a tumour?
a) PRL, TSH, GH, LH, FSH, ACTH
b) TSH, ACTH, GH, LH, FSH, PRL
c) FSH, LH, TSH, ACTH, GH, PRL
d) GH, LH, FSH, TSH, ACTH, PRL
e) GH, LH, FSH, PRL, TSH, ACTH
D.
Go, Look For The Adenoma Please
GH, LH, FSH, TSH, ACTH, PRL + posterior pituitary hotmones (ADH and oxytocin)
