Endocrinology

Question 1

T1DM multiple daily injection basal-bolus

Answer 1

Injections of short/rapid acting insulin before meals with 1+ separate daily injections of intermediate or long acting

Question 2

Continuous sub cut insulin infusion (pump)

Answer 2

regular or continuous amounts of rapid/short acting

Question 3

1, 2, or 3 insulin injections/day

Answer 3

short or rapid mixed w/intermediate

Question 4

Dietary Mx of T1DM

Answer 4

offer level 3 carbohydrate counting education

Question 5

Blood glucose and HBA1c targets/monitoring in T1DM

Answer 5

Routinely 5+ capillary glucose per day (4-7mmol)
after meal: 5-9mmol
if driving: >5
HbA1c target: <48mmol
Offer ketone testing strips and a meter if ill/hyperglycaemic
?continuous monitoring

Question 6

Indications for continuous glucose monitoring

Answer 6

Frequent severe hypos
Impairment of awareness of hypoglycaemia with adverse consequences
Inability to recognise or communicate hypo

Question 7

Cx of T1DM

Answer 7

retinopathy/nephropathy monitor annually from 12y

DKA

Question 8

Congenital hypothyroidism

Answer 8

thyroxine within 2-3wks

lifelong Rx

Question 9

Hyperthyroidism

Answer 9

carbimazole or propylthiouracil
- !neutropenia seek attention if sore throat/fever for FBC
Beta-blockers for Sx
Medical treatment for 2yrs
other options: radioiodine, surgery

Question 10

Hypocalcaemia

Answer 10

Acute: Ca gluconate
Chronic: PO Ca, high dose vit D analogues
Monitor urine excretion bc hypercalc. -> nephrocalcinosis

Question 11

Hypercalcaemia

Answer 11

rehydrate
diuretics
bisphosphonates

Question 12

Congenital adrenal hyperplasia

Answer 12

Affected females ?sugery
Definitive surgical correction delayed until puberty
Long term:
lifelong hydrocortisone, fludrocortisone if salt loss
monitor growth, skeleton, plasma androgens, 17ahydroxyprogesterone
Additional hormones if ill/surgery

Question 13

Addisons Dx

Answer 13

Crisis: IV saline, hydrocort, glucose
Long term: Mineralo/glucocorticoid replacement, increase glucocort in illness
wear medicalert bracelet and carry steroid card

Question 14

Cushings syndrome

Answer 14

adrenal tumour w/adrenalectomy

pituitary tumour w transsphenoidal resection or radiotherapy

Question 15

Precocious puberty Ix

Answer 15

Bone age assessment
Hormones: FSH, LH, oestrogen and testosterone
Pelvic USS
LHRH stimulation tes
?MRI brain, 17-OH progesterone

Question 16

Gonadotrophin dependent precocious puberty

Answer 16

90% in females idiopathic
manage brain ass. neoplasms (opic nerve glioma)
GnRH agonist (leuprolide) can supress
GH therapy (GnRH stunts growth)
Cyproterone used by specialists (antiandrogen)

Question 17

Gonadotrophin independent precocious puberty

Answer 17

Mccune Albright or testotoxicosis: ketoconazole or cyproterone, GnRH agonist, aromatase inhib
CAH: adjust hydrocort., GnRH agonist
Tumour: refer to specialist

Question 18

Delayed puberty definition, cause, investigations

Answer 18

Def: lack of signs in 13 for girls, 14 for boys
Causes:
Functional: constitutional delay, chronic dx, excessive exercise
Hypogonadotrophic hypogonadism (Kallmans)
Hypergonadotrophic hypogonadism (gonadal insufficiency)
Ix:
bone age (wrist X-ray)
Basal FHS + LH
LHRH stimulation test
MRI brain

Question 19

Mx of delayed puberty

Answer 19

Boys: most NOT need mx, 2L oxandrolone or testosterone (3-6months)
Girls: most NOT need mx, 2L short coures oestrogen 3-6m
Organic/permanent causes can be Mx w/test./oestrogen

Question 20

Androgen insensitivity syndrome

Answer 20

Ix: buccal smear or chromosomal analysis to reveal 46 XY
counselling raise as female
bilat. orchidectomy (risk of ca.)
oestrogen therapy

Question 21

Short stature

Answer 21

Cause: short parents, GH def., genetic, achondroplasia, cushing
Ix: mid parental height, random GH, insulin to;. test, CT/MRI brain, bone age
Mx: sc GH, surgery

Question 22

Childhood obesity

Answer 22

severely: 99th centile
obese: >95th
overweight 85-94