Endocrinology Questions Flashcards
A 14-year-old girl sees you in the outpatients department with a variety of troubling symptoms. She has suffered with bullying at school due to facial hair and large stature. She also reports menarche was at 10 years old. You organise some investigations which show;
Normal Testosterone
High Plasma 17-hydroxyprogesterone
Dexamthasone Suppression test is normal
What is the most likely diagnosis?
- Turner’s syndrome
- Addison’s Disease
- Congenital adrenal hyperplasia
- Cushing’s syndrome
Congenital Adrenal Hyperplasia
Congenital adrenal hyperplasia has the following biochemical abnormalities;
Increased plasma 17-hydroxyprogesterone levels
Increased plasma 21-deoxycortisol levels
Increased urinary adrenocorticosteroid metabolites
It is inherited via an autosomal recessive pattern.
The condition is due to a deficiency of the 21-hydroxylase enzyme (responsible for biosynthesis of aldosterone + cortisol)
A diabetic man is diagnosed as having painful diabetic neuropathy in his feet. He has no other medical history of note. What is the most suitable first-line treatment to relieve his pain?
Duloxetine Sodium Valproate Carbamezepine Referral to pain management clinic Tramadol
Duloxetine
NICE updated it’s guidance on the management of neuropathic pain in 2013. Diabetic neuropathy is now managed in the same way as other forms of neuropathic pain:
first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug treatment does not work try one of the other 3 drugs
tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
A 55-year-old man presents to his GP with intermittent nausea, constipation and increased thirst. Bloods show the following:
Calcium 3.05 mmol/L
Albumin 39 g/L
What are the two most likely differential diagnoses in this patient?
Primary hyperparathyroidism OR malignancy
Primary hyperparathyroidism OR sarcoidosis
Malignancy or Osteoporosis
Oesteoporosis or Sarcoidosis
Primary hyperparathyroidism OR malignancy
Malignancy and primary hyperparathyroidism account for 90% of hypercalcaemia cases
A 60-year-old man who is known to have lung cancer comes for review. For the past three weeks he has lost his appetite, has been feeling sick and generally feels tired. On examination he appears to be mildly dehydrated. You order some blood tests:
Calcium 3.12 mmol/l Albumin 40 g/l Glucose (random) 6.7 mmol/l Urea 10.2 mmol/l Creatinine 115 µmol/l
Which one of his existing medications is most likely to be contributing to his presentation?
Amlodipine
Simvastatin
Bendroflumethiazide
Aspirin
Bendroflumethiazide
Thiazides cause hypercalcaemia
A 42-year-old man presents to his GP feeling generally unwell. For the past three months he has been experiencing daily frontal headaches which have not been helped by regular paracetamol. He has also noticed some unusual symptoms such as his wedding ring no longer fitting, his shoe size apparently increasing and a small amount of milky discharge from both nipples. On examination his blood pressure is 168/96 mmHg. What is the most likely diagnosis?
DI
Cushing’s syndrome
Acromegaly
Acromegaly
Which one of the following unwanted effects is most likely to occur in patients taking gliclazide?
Peripheral neuropathy
Cholestasis
SIADH
Weight gain
Weight gain
A 76-year-old woman suffers a fall at home and sustains a facial injury. She is brought to the emergency department where she receives a head CT due to a suspected fracture. The CT confirms the presence of a zygomatic arch fracture, however, the report also contains the following observation:
‘multiple well-defined lucencies in the calvaria consistent with a pepper pot skull appearance’
Before the injury, the patient mentions that she had been suffering from tiredness, abdominal pain and excessive urination.
Which of the following explains this patient’s CT findings?
CML
Bony metastasis
Hypothyroidism
Primary hyperparathyroidism
Primary Hyperparathyroidism
Pepperpot skull is a characteristic X-ray finding of hyperparathyroidism
A 49-year-old woman is admitted to hospital with abdominal pain. She has some routine bloods taken by the emergency department and the HbA1c result is shown below:
HbA1c 31 mmol/mol (27-48 mmol/mol)
Which of the following medical conditions would mean this result would under-estimate her blood sugar levels?
Iron deficiency anaemia
HSS
Previous splenectomy
Folic acid deficiency
HSS
HbA1c UNDERestimates glucose levels in hereditary spherocytosis
A 51-year-old female presented to her GP with a nodule on the thyroid region of her neck. She has a past medical history of Cushing’s disease and small mucosal neuromas. She was referred to the ENT surgeons who performed a biopsy and unfortunately diagnosed her with having thyroid cancer. On her blood tests, she was noted to have a raised calcitonin level. From the information provided above, what type of thyroid cancer is this lady most likely suffering from?
Papillary Follicular Medullary Anaplastic Lymphoma
Medullary
3) Medullary - 5%, sporadic or part of MEN2 syndrome. It originates from the parafollicular cells which produce calcitonin - can be used as a tumour marker.
A 29-year-old man attends the fertility clinic with his wife after unsuccessfully attempting to conceive for the past 18 months. Prior to organising fertility testing, the consultant performs a physical examination of both patients. On examination, the man has small testicles and pronounced gynaecomastia. He also has truncal obesity, is 188cm tall (UK average = 175cm) and has sparse axillary and pubic hair. The examination is otherwise normal as is the patient’s medical history.
Which of the following syndromes is the most likely explanation for this patient’s physical characteristics and inability to conceive?
Kallmann’s syndrome
Klinefelter’s syndrome
Turner’s syndrome
Marfan’s syndrome
Klinefelter’s syndrome is a chromosomal disorder that affects males and is caused by the presence of an additional X chromosome (i.e. a 47, XXY karyotype). Its characteristic features are small testes, infertility, gynaecomastia, above average height and a lack of secondary sexual characteristics
An obese 55-year-old man presents with a three day history of drowsiness and increasingly severe polydipsia. He feels weak and reports a marked increase in frequency of urination. He is recovering from a recent diarrhoeal illness and has only a past medical history of hypercholesterolaemia and bilateral knee osteoarthritis. He is currently taking simvastatin and paracetamol. Examination is normal. His blood glucose is found to be 42mmol/L. Serum osmolarity is found to be 400 mmol/L (278-305 mmol/L).
Urinalysis shows:
Appearance Normal Blood Negative Leukocytes Negative Nitrites Negative Ketones Negative
A recent arterial blood gas (ABG) shows:
pH 7.39
pO2 11.6 kPa
pCO2 5.4 kPa
Bicarbonate 26 mmol/l
What is the most likely diagnosis?
DKA UTI Hyperglycaemic Hyperosmolar State PE T1DM
Clues to the correct diagnosis of hyperglycaemic hyperosmolar state are hyperglycemia with increased serum osmolarity and no ketosis.
A 47-year-old woman is admitted to the emergency department with a left upper lobe pneumonia. She has a routine set of bloods taken for a review of systems which show the following:
Cortisol 431 nmol/l (68-357 nmol/l)
Thyroid stimulating hormone (TSH) 2.1 mu/l (0.5-5.5 mu/l)
Free thyroxine (T4) 4 pmol/l (9-18 pmol/l)
Free triiodothyronine (T3) 1.9 pmol/l (3.5-7.8 pmol/l)
What is the most likely cause of her deranged thyroid function?
Sick euthyroid Syndrome
De Quervain’s thyroiditis
Hashimoto’s thyroiditis
Addison’s disease
Sick euthyroid syndrome = low T3/T4 and normal TSH with acute illness
In the context of an acute illness, a normal TSH and low T3 and T4 levels are diagnostic of sick euthyroid syndrome. The TSH would be raised if the cause was De Quervain’s or Hashimoto’s thyroiditis
A 62-year-old woman attends her GP complaining of weight gain, lethargy and hair loss. She denies any intercurrent illness. Thyroid function tests are performed and the results are as follows:
Thyroid stimulating hormone (TSH) 0.3 mu/l (low)
Free T4 8 pmol/l (low)
Which investigation is most likely to be diagnostic?
Thyroid US
Anti TPO
MRI Pituitary gland
MRI Pituitary gland
patient has secondary hypothyroidism (rare)
Secondary hypothyroidism is very rare and results in a low TSH and low T4. In these cases, pituitary insufficiency is most likely and therefore an MRI of the gland should be performed.
A 60-year-old woman who is known to have metastatic breast cancer presents following a grand mal seizure at home. For the past few weeks she has been having progressively worsening headaches. Given the likely diagnosis, what is the most appropriate first-line management whilst she is awaiting brain imaging?
Prednisolone Paracetomal Diazepam Flid restriction Dexamethasone
This woman is likely to have cerebral metatases. The first-line treatment is high-dose dexamethasone which may reduce cerebral oedema.
Question 24 of 148
A 25-year-old man presents to the emergency department after being found in a confused and drowsy state by a friend. He appears to be in pain and has his hands over is abdomen. His friend informs you he has vomited twice on the way to the hospital. An arterial blood gas shows:
pH 7.29 7.35-7.45 HCO3- 17mmol/L 22-26mmol/L pCO2 3kPa 4.5-6kPa p02 12kPa 10-14kPa Anion gap 20mEq/L 10-14mEq/L
Which investigation would most quickly provide an indication to the diagnosis?
Paracetamol Levels Blood cultures LFTs AXR blood glucose monitoring
blood glucose monitoring
this man has presented with drowsiness and abdominal pain. All of the above options are valid investigations for a patient with these symptoms, however the ABG shows a metabolic acidosis with partial respiratory compensation and an increased anion gap. This is highly suggestive of DKA and this should therefore be investigated first.
