Endocrinology

Question 1

Patient is on metformin for type 2 diabetes. His HbA1c is 60mmol/mol. What action should be taken regarding his sugar control?

Answer 1

Second drug should be added if HbA1c is >58mmol/mol

Question 2

What is the single most useful test for determining the cause of hypercalcemia?

Answer 2

Parathyroid hormone

Question 3

Acute management of DKA?

Answer 3

Fixed rate insulin whilst continuing regular injected long-actin insulin but stopping short-acting insulin

Question 4

What is Kussmaul’s breathing?

Answer 4

Laboured deep breathing occurs whereby excess carbon dioxide is exhaled as a compensatory mechanism for an increased blood pH

Question 5

What will bloods show in DKA?

Answer 5

Hyponatraemia
Hypokalaemia
Low bicarbonate (indicating acidosis)

Question 6

Side effects of metformin?

Answer 6

• Lactic acidosis
• Nausea
• Diarrhoea
• Abdominal pain

Stop if tissue hypoxia

Question 7

Side effect of sulfonylureas (e.g. gliclazide)?

Answer 7

• Hypoglycaemia

- Weight gain

Question 8

Side effects of thiazolidinediones (e.g. pioglitazone)?

Answer 8

• Fluid retention
• Fractures
• Hypercalcemia (thiazides)
• Increased risk of bladder cancer
• Not to be used in heart failure

Question 9

Side effects of DPP4 (e.g. sitagliptin) inhibitors and GLP1 agonists?

Answer 9

Pancreatitis

Question 10

Signs of Addisonian crises?

Answer 10

Severe hypovolaemia and hyponatraemia

Addisonian crisis = acute exacerbation of chronic insufficiency

Question 11

What is maturity-onset diabetes of the young (MODY)?

Answer 11

Development of type 2 diabetes in patients <25 years old

Typically inherited as autosomal dominant

Question 12

Complication of fluid resuscitation in DKA? (especially in young patients)

Answer 12

Cerebral oedema

Question 13

How do SGLT-2 inhibitors work?

Answer 13

Increase urinary excretion of glucose

Question 14

Side effects of SGLT-2 inhibitors (e.g. dapaglifozin)?

Answer 14

• Increased urine output
• Weight loss (beneficial for patients with a high BMI)
• UTI

Linked to necrotising fasciitis of genitalia or perineum

Question 15

What medication can cause hyperglycaemia in diabetes patients?

Answer 15

Corticosteroids

Can worsen diabetic control due to their anti-insulin effects

Question 16

Treatment for hypoglycaemia with impaired GCS?

Answer 16

IV glucose if there is access

Question 17

Treatment for hypothyroidism?

Answer 17

Levothyroxine

Taken 30 minutes before food as absorption can be affected by food, caffeine or other medications

Question 18

Treatment of hypothyroidism in pregnancy?

Answer 18

Increase thyroid replacement dose by up to 50% as early as 6-8 weeks of pregnancy

Question 19

Side effects of GnRH agonists (e.g. goserelin)

Answer 19

Gynaecomastia

Question 20

What is the standard HbA1c target in type 2 diabetes?

Answer 20

48 mmol/mol

Question 21

How to treat asymptomatic patients with abnormal HbA1c or fasting glucose?

Answer 21

Must be confirmed with a second reading before diagnosis is made

Question 22

What medications would increase insulin sensitivity?

Answer 22

Pioglitazone

Glitozones reduce peripheral insulin resistance

Question 23

At what rate should insulin be infused when managing DKA?

Answer 23

0.1 units per kg per hour

Question 24

First line insulin regimen to be offered adults with type 1 diabetes?

Answer 24

Basal bolus insulin regimen with twice-daily insulin detemir (long actin insulin)

Question 25

Minimum HbA1c diagnostic of diabetes?

Answer 25

48 mmol/mol

Question 26

Cause of arrhythmia in DKA patient?

Answer 26

Hypokalaemia

Question 27

Definitive management of primary hyperparathyroidism?

Answer 27

Total parathyroidectomy

Question 28

Which medical condition can result in under-estimation of HbA1c?

Answer 28

Hereditary spherecytosis

Question 29

Clinical signs of Grave's disease?

Answer 29

Clubbing with hyperthyroidism

Question 30

Management of blood pressure in a patient with phaechromocytoma??

Answer 30

Beta blockers

Question 31

DVLA advice for diabetic patients?

Answer 31

Diabetic patients on insulin may drive if they have hypoglycaemic awareness and have not had any severe hypoglycaemic event in the past 12 months

Question 32

Most appropriate screening test for diabetic neuropathy of the feet?

Answer 32

Test sensation using 10g monofilament

Question 33

What is a thyrotoxic storm and myxoedema coma?

Answer 33

Thyrotoxic storm = complication of hyperthyroidism - Hyperthermia - Tachycardia - Vomiting - Agitation Myxoedema coma = complication of hypothyroidism - Confusion - Hypothermia - Oedema

Question 34

Which drug can reduce the effectiveness of levothyroxine?

Answer 34

Iron/calcium tablets Should be given 4 hours apart

Question 35

What is the diabetic sick day rule?

Answer 35

If a patient is on insulin, they must not stop due to the risk of DKA Should continue the normal insulin regime but ensure they are checking their blood sugars regularly

Question 36

Most important test to test for responsiveness to levothyroxine?

Answer 36

TSH levels

Question 37

Most likely cause of hypothyroidism in patients from Africa or Asia?

Answer 37

Iodine deficiency

Question 38

How often is it recommended that a patient with type 1 diabetes monitors their blood glucose?

Answer 38

At least 4 times a day, including before each meal and before bed

Question 39

What is the target blood sugar level before meals in patients with type 1 diabetes?

Answer 39

4-7 mmol/l

Question 40

How do you differentiate Hyperglycaemic Hyperosmolar State (HHS) from DKA?

Answer 40

HHS does not cause hyperketonaemia and metabolic acidosis