Endocrinology

Question 1

A 58 year old woman presents with an acutely painful neck, the patient has a fever, blood pressure is 135/85, and heart rate is 102 bpm. The patient explains the pain started 2 weeks ago and has gradually become worse. She also experiences palpitations and believes she has lost weight. She presents one week later complaining of intolerance to cold temperatures. What would you see if you performed a radioisotope scan on her?

A) Single area of increased uptake 
B) Multiple areas of increased uptake 
C) Diffuse increased uptake 
D) No uptake 
E) She does not need a radioisotope scan

Answer 1

D) No uptake
- De Quervain's thyroiditis 
- hyper then hypothyroid
- painful goitre + fever
Gives no uptake on radioisotope scan

Question 2

A 15 year old girl complains of headaches which started 6 weeks ago. The headaches initially occurred 1-2 times a week but now occur up to five times a week, they are not associated with any neurological problems, visual disturbances, nausea or vomiting. The girls also reports a white discharge from both of her nipples. She has not started menstruating. The most appropriate investigation is:

A) Lateral skull X ray 
B) CT scan
C) MRI scan
D) Thyroid function tests
E) Serum prolactin measurement

Answer 2

E) Serum prolactin measurement

• galactorrhoea + headaches = suspected prolactinoma
• hyperprolactinaemia investigated –> serum prolactin, TFTs, pituitary/cranial MRI (or after prolactin if prolactinoma suspected)

Question 3

A 50 year old Asian man is referred to diabetes clinic after presenting with polyuria and polydipsia. He has a BMI of 30, a blood pressure measurement of 137/88 and a fasting plasma glucose of 7.7mmol/L. The most appropriate first-line treatment is:

A) Dietary advice and exercise 
B) Sulphonylurea 
C) Exenatide 
D) Thiazolidinediones 
E) Metformin

Answer 3

A) Dietary advice and exercise

• obese, fasting >7 = T2DM
• T2DM Mx = dietary advice, metformin, +/- sulphonylurea, +/- insulin

Question 4

A 49 year-old man presents with a history of difficulty sleeping. He reports feeling increasingly tired and general weakness which he attributes to his poor sleep pattern. Additionally, the patient has noticed he has gained weight and sweats more easily. On examination, the patient has coarse facial features. What is the most likely diagnosis?

A) Hyperthyroidism 
B) Cushing’s disease
C) Acromegaly 
D) Hypothyroidism
E) Diabetes

Answer 4

C) Acromegaly

- Sleep apnoea + weight gain + increased sweating + COARSE FACIAL FEATURES = acromegaly

Question 5

A 35 year old female presents with 4 month history of amenorrhoea. On examination, she is noted to have loss of peripheral vision. What is the most likely underlying problem?

A) Second cranial nerve palsy
B) Stroke 
C) Hyperparathyroidism 
D) Prolactinoma 
E) Pregnancy

Answer 5

D) Prolactinoma

• amenorrhoea + visual deficit
• other either produce visual deficit without amenorrhoea or amenorrhoea without visual deficit

Question 6

A 16 year old boy presents to the GP with polyuria and polydipsia. He is diagnosed with diabetes insipidus. This condition is characterized by overproduction of which of the following?

A) Antibodies against insulin-producing beta cells of the pancreas 
B) Anti-diuretic hormone  
C) Brain natriuretic peptide
D) Oxytocin 
E) Aldosterone

Answer 6

B) Anti-diuretic hormone

• DI = ADH hypersecretion/insensitivity
• Beta-cell auto-antibodies = DM
• BNP (>100) = HF

Question 7

A 49 year old woman presents with 4kg weight loss over 2 months. She complains of feeling hot all the time and her partner mentions that she’s been more irritable recently. On examination she has a smooth goitre, and you also notice proptosis and a rash on her shins. What is the most likely diagnosis?

A) De Quervain’s thyroiditis 
B) Toxic multinodular goitre 
C) Grave’s disease
D) Menopause 
E) Medullary thyroid cancer

Answer 7

C) Graves’ disease

- hyperthyroidism symptoms, smooth goitre, pretibial myxoedema, exophthalmos