Endocrinology

Question 1

Endocrine - Definition

Answer 1

Glands pour secretions directly into blood stream without ducts

Question 2

Exocrine - Definition

Answer 2

glands pour secretions through a duct to site of action

Question 3

Acromegaly - Definition

Answer 3

Increased GH in adults

Question 4

Primary adrenal insufficiency

Answer 4

1. Addison’s disease
2. Trauma
3. Surgical removal
4. ACTH resistance due to drugs
5. Invasion from tumour

Question 5

Secondary adrenal insufficiency - Aetiology

Answer 5

1. Iatrogenic (LT steroids)
2. Hypothalamic-pit disease –> less ACTH
3. Neoplasm
4. Radiotherapy
5. Surgery

Question 6

Cushing’s syndrome and D - definition

Answer 6

S = chronic excessive and inappropriate elevated circulating cortisol
D = excess glucocorticoids from inappropriate ACTH from pit tumour

Question 7

Cushing’s syndrome - Diagnostic

Answer 7

1. Random plasma cortisol (high)
2. Overnight dexamethasone suppression test (no suppression)
3. Urine free cortisol over 24hrs
4. 48hr dexamethasone suppression test
5. Plasma ACTH (adrenal or pit)

Question 8

Insulin secretion

Answer 8

1. Hyperglycaemia = increased uptake into cells
2. Increased ATP
3. K channel closes
4. Depolarisation
5. Ca open –> into cell
6. Exocytosis of insulin containing vesicles
7. Secreted by B cells in Islets of Langerhans

Question 9

Diabetes M 1+2 - Diagnosis

Answer 9

1. Random plasma glucose >11.1mmol/L
2. Fasting plasma glucose >7mmol/L
3. HbA1c
   = amount of glycated Hb
   <6.5% (48mmol/mol)
4. Oral glucose tolerance tests
   - Fasting >7mmol/L
   - 2hrs after glucose >11.1 mmol/L

Question 10

Diabetes M 1+2 - Microvascular Complications

Answer 10

1. Retinopathy
2. Nephropathy
3. Neuropathy

Question 11

DM1+2 - Macrovascular complications

Answer 11

1. Stroke
2. Renovascular disease
3. Limb ischaemia
4. CVD

Question 12

Hyperthyroidism - clinical presentation

Answer 12

1. Weight loss
2. Heat intolerance
3. Diarrhoea
4. Hyperkinesis - M spasm
5. Goitre
6. Palmar erythema
7. Graves –> eye

Question 13

Hyperthyroidism - Thyroid function tests

Answer 13

1. Serum TSH low
   - High if 2ndary
2. T3+T4 raised

Question 14

Hyperthyroidism - Antibodies

Answer 14

1. Thyroid peroxidase
2. Thyroglobulin
3. Graves - TSH receptor stimulating antibodies (TSHR-Ab)

Question 15

Hyperthyroidism - Treatment

Answer 15

1. B blocker - Propranolol
2. Propylthiouracil (PTU)
   - Carbimazole - stop T4 to T3
3. Radioactive Iodine (131)
4. Thyroidectomy

Question 16

Hashimoto’s thyroiditis

Answer 16

Autoimmune hypothyroidism

Question 17

Hypothyroidism - signs

Answer 17

BRADYCARDIA
B - Bradycardia
R - Reflexes relax slowly
A - Ataxia
D - Dry, thin hair/skin
Y- Yawn/drowsy/coma
C - Cold hands
A - Ascites
R - Round puffy face
D - Defeated demeanor
I - Immoblie +/- Ileus (temp arrest of intestinal peristalsis)
C - Congestive HF

Question 18

Hypothyroidism - Treatment

Answer 18

1. Oral levothyroxine (T4)

Question 19

Posterior pituitary - Hormones

Answer 19

1. Vasopressin/ADH

2. Oxytoxin (breast feeding/contraction)

Question 20

Diabetes insipidus - Clinical presentation

Answer 20

1. Polyuria (15L in 24hrs)
2. Compensatory polydipsia
3. No glycosuria
4. Hypernatraemia (water loss in excess of Na –> more conc)
5. Dehydration

Question 21

Carcinoid tumour - Definition

Answer 21

Originate from enterochromaffin cells and are capable of producing serotonin

Question 22

Phaeochromocytoma - Definition

Answer 22

Raised plasma catecholamines

- Produced in chromaffin cells in adrenal medulla

Question 23

Pituitary tumour - Presentation

Answer 23

1. Bitemporal hemianopia (P on optic chiasm)
2. Hypo/hyperpituitarism
3. Hydrocephalus
4. CSF leak

Question 24

Hypothyroidism - Causes

Answer 24

1. Autoimmune
2. Hashimoto’s thyroiditis
3. Post-partum thyroiditis
4. Iatrogenic
5. Drug induced
6. Iodine deficiency

Question 25

Cushing's D - Symptoms

Answer 25

1. Central obesity - stretch marks 2. Moon face 3. Mood change 4. Easy bruising 5. Acne

Question 26

Addison's disease - Symptoms

Answer 26

1. Skin pigmentation 2. Vitiligo (white patches + loss of body hair) 3. Postural hypothenison 4. Mood change 5. Weight loss

Question 27

Hypocalcaemia - Presentation

Answer 27

1. Trousseau's sign (carpopedal spasm - inflate BP cuff above S P) 2. Chvostek's sign (tap over facial N in parotid gland --> twitch ipsilat facial M) 3. Convulsions 4. Paraethesia 5. Increased excitability of M + N

Question 28

Secondary hyperparathyroidism - Levels

Answer 28

1. High PTH 2. Low Ca 3. High phosphate 4. High alkaline phosphatase

Question 29

Diabetes Insipidus - Diagnosis

Answer 29

1. Polyuria (>3L/day) 2. Glucose - exclude DM 3. Water deprivation test - IM desmopressin - Urine concentrated in cranial but not nephrogenic 4. MRI hypothalamus

Question 30

Fatiuge

Answer 30

1. Diabetes 2. Cancer 3. Hypothyroid 4. Depression 5. Infection