Endocrinology

Question 1

Iodine deficeincy

Answer 1

Most common cause of hypothyroidism globally and suspect in cases where iodine is not added to diet.

Question 2

Pheochromocytoma

Answer 2

Triad of sweating, headaches and palpitations. investigate with urinary metanephrines

Question 3

Nephrogenic DI

Answer 3

Urine osmolality low after fluid deprivation and desmopressin

Question 4

Prolactinomas

Answer 4

First line treatment with dopamine agonists (cabergoline, bromocriptine)

Question 5

Prednisolone

Answer 5

Steroids increase the risk of osteonecrosis

Question 6

Primary hyperaldosteronism

Answer 6

Symptoms include hypertension, headaches, muscle weakness and nocturia. Investigated with aldosterone/renin ratio

Question 7

Klinefelter’s syndrome

Answer 7

Causes high LH and low testosterone

Question 8

Wilm’s tumour and neuroblastoma

Answer 8

Refer any child with a palpable abdominal mass or unexplained enlarged organ very urgently to specialist

Question 9

Primary hyperparathyroidism

Answer 9

Parathyroid adenoma may have normal PTH level

Question 10

SGT2 inhibitors

Answer 10

Increased risk of urinary tract infection

Question 11

Sulfonylureas

Answer 11

Often cause weight gain

Question 12

Angiotensin II receptor blocker

Answer 12

Used first line in all black T2DM patients with hypertension

Question 13

Diabetes blood pressure

Answer 13

Aim for 135/85 home readings

Question 14

Metoclopramide

Answer 14

Can cause galactorrhoea

Question 15

Adrenal venous sampling

Answer 15

After inconclusive CT AVS can be used to determine between unilateral adenoma and bilateral hyperplasia in primary hyperaldosteronism

Question 16

Bilateral idiopathic adrenal hyperplasia

Answer 16

Most common cause of primary hyperaldosteronism

Question 17

Pregabalin

Answer 17

Used in neuropathic pain with a history of benign prostatic hyperplasia

Question 18

Adrenal insufficiency

Answer 18

Can occur on surgery after long term steroid use and needs IV hydrocortisone 100mg

Question 19

Diabetic ketoacidosis

Answer 19

Hyperglycaemia and ketones, man aged with immediate IV fluids then insulin infusion and potassium

Question 20

Glucocorticoids

Answer 20

Can induce neutrophilia

Question 21

Smoking

Answer 21

Risk factor for Grave’s disease

Question 22

Cushing’s syndrome

Answer 22

Hypokalaemia and metabolic acidosis seen

Question 23

Addison’s disease

Answer 23

Can cause hypoglycaemia

Question 24

Addison’s disease management

Answer 24

Prescribed hydrocortisone and fludrocortisone

Question 25

MODY

Answer 25

Autosomal dominant inheritance pattern

Question 26

Pretibial myzoedema

Answer 26

Specific feature of Grave's disease

Question 27

Spironolactone

Answer 27

Can cause gynaecomastia

Question 28

Goserelin

Answer 28

A GnRH agonist used in the management of prostate cancer | -can cause gynaecomastia

Question 29

DKA

Answer 29

Stop short acting insulin but continue fixed rate long acting insulin

Question 30

Addison's crisis

Answer 30

- hyponatraemia - hyperkalaemia - hypoglycaemia

Question 31

Thyrotoxic storm

Answer 31

Consider in patients with Grave disease and infection | -give corticosteroids, PTU and propranolol

Question 32

Cushing's disease

Answer 32

Low dose dexamethasone does not cause suppression but high dose does

Question 33

Addison's disease

Answer 33

- tiredness | - hyperpigmentation

Question 34

Levothyroxine

Answer 34

Needs to be increased in pregnancy by about 50% from 4-6 weeks

Question 35

Metoclopramide

Answer 35

Can cause galactorrhoea

Question 36

Diabetes type 2

Answer 36

Requires two abnormal HbA1c readings if asymptomatic

Question 37

Acromegaly

Answer 37

Trans-sphenoidal surgery

Question 38

Anaplastic thyroid carcinoma

Answer 38

- late presenting and aggressive - pressure symptoms including dysphagia - hoarseness

Question 39

Grave's disease

Answer 39

Propranolol should be given to help control symptoms

Question 40

Insulinoma

Answer 40

Whipple's triad of hypoglycaemia with fasting or exercise, reversal of symptoms with glucose and low BMs

Question 41

DKA insulin

Answer 41

Give fixed rate intravenous insulin infusion at 0.1units/kg/hour

Question 42

HbA1c

Answer 42

Target 48 mmol/mol for type two diabetes

Question 43

Latent autoimmune diabetes of adulthood

Answer 43

Slow autoimmune destruction of the islets

Question 44

Levothyroxine

Answer 44

Iron and calcium carbonate tablets can reduce absorption of levothyroxine

Question 45

Bromocriptine

Answer 45

Treatment for galactorrhoea

Question 46

Myxoedema comas

Answer 46

- confusion - hypothermia - hyponatraemia - hypercarbia

Question 47

Empagliflozin

Answer 47

SGLT-2 inhibitor

Question 48

Primary hyperaldosteronism

Answer 48

The most common cause is bilateral idiopathic adrenal hyperplasia - high bp - muscle weakness - low K - high aldosterone to renin ratio

Question 49

Sick euthyroid syndrome

Answer 49

- occurs post infection | - TSH low and free T4 low

Question 50

Subacute thyroiditis

Answer 50

- low TSH - very high free T4 - tender goitre - raised ESR - globally reduced iodine uptake