Endocrinology TBL Flashcards
- A 35 year old Caucasian man complains of polydipsia and polyuria over eight weeks. His body mass index is 28 kg/m2. His blood tests show: normal renal function, random blood glucose 16.0 mmol/L, HbA1c 69 mmol/mol (reference range for HbA1c 20-41 mmol/mol). Blood ketones are elevated. What would be the next step in his management?
A A biguanide eg metformin
B Insulin
C Lifestyle modification
D A GLP-1 analogue eg exenatide
B Insulin
- A 48 year old woman gives a six month history of weight gain and difficulty climbing stairs. On examination she had a plethoric face, centripetal obesity and abdominal striae. BMI was 32 kg/m2 and blood pressure was 160/90mmHg. She couldn’t rise to standing from a squatting position. What investigation would help you confirm the diagnosis?
A DEXA scan
B 9AM cortisol
C Low dose dexamethasone suppression test
D 25 hydroxycholecalciferol
C Low dose dexamethasone suppression test
- A 19 year old woman is diagnosed with Addison’s disease. She is started on prednisolone and fludrocortisone. What advice should she be given regarding her medication?
A She must avoid pregnancy whilst taking fludrocortisone
B Before an operation, she must double her fludrocortisone dose
C If she becomes unwell eg fever, she must double her prednisolone dose
D She must double her prednisolone dose if she feels dizzy on standing
C If she becomes unwell eg fever, she must double her prednisolone dose
- A 55 year old woman presents with nausea and constipation. Routine biochemistry shows: normal renal function, calcium 2.90 (reference range 2.15-2.60 mmol/L), phosphate 0.90 (reference range 0.80-1.40 mmol/L), 25 hydroxyvitamin D 60 (reference range 70-150 mmol/L), PTH 24 (reference range 1.1-6.8 mmol/L). What is the diagnosis?
A Primary hyperparathyroidism
B Secondary hyperparathyroidism
C Tertiary hyperparathyroidism
D Hypercalcaemia of malignancy
A Primary hyperparathyroidism
- A 25 year old women presents with secondary amenorrhoea. Her body mass index (BMI) is 18 kg/m2. She has normal secondary sexual characteristics. There is no evidence of acne or hirsutism. Blood results show oestradiol <70 (0-300 pmol/L), LH <2 (2-10 IU/L), FSH <1.5 (1.5 – 10IU/L), prolactin 400 (100-500 mU/L). What is the most likely cause of her secondary amenorrhoea?
A Low body mass index
B Pituitary adenoma
C Polycystic ovarian syndrome
D Turner’s syndrome
A Low body mass index
- A 65 year old man presents with aches and pains. He was diagnosed with coeliac disease two years ago. Routine biochemistry shows: normal renal function, calcium 2.10 (reference range 2.15-2.60 mmol/L), phosphate 0.80 (reference range 0.80-1.40 mmol/L), 25 hydroxyvitamin D 50 (reference range 70-150 mmol/L), PTH 24 (reference range 1.1-6.8 mmol/L). What is the diagnosis?
A Primary hyperparathyroidism
B Secondary hyperparathyroidism
C Tertiary hyperparathyroidism
D Hypercalcaemia of malignancy
B Secondary hyperparathyroidism
- A 55 year old man complains of sweatiness, headaches and an increase in his wedding ring size. A diagnosis of acromegaly is suspected. Which test would confirm this diagnosis?
A Suppressed IGF-1
B Elevated prolactin
C Insulin tolerance test to stimulate growth hormone release
D Oral glucose tolerance test showing paradoxical rise in growth hormone
D Oral glucose tolerance test showing paradoxical rise in growth hormone
- A 53 year old man with type 2 diabetes mellitus diagnosed 10 years ago attends clinic for his diabetes review. His BMI is 26 kg/m2. He is a non smoker. His recent retinal screening is normal, with no evidence of retinopathy. He is told that he has evidence of microalbuminuria on a urine sample. This urine sample is repeated and shows evidence of microalbuminuria a second time. His blood pressure is 120/80 mmHg and his renal function is normal. What is the next step in his management?
A Organise a 24h urine collection for protein
B Start an ACE inhibitor in view of his microalbuminuria
C Start any antihypertensive and reduce his blood pressure
D Counsel him that he will probably develop chronic kidney failure within 10 years
B Start an ACE inhibitor in view of his microalbuminuria
- A 30 year old man has a routine blood pressure check as part of a routine medical at work. His blood pressure on repeated measurements is found to be 200/100 mmHg. His pulse is 120 beats/minute. On further questioning he describes symptoms of feeling anxious and panicked. Sometimes he feels his heart beating really fast. He had put many of these symptoms down to stress at work. His weight has remained stable. His BMI is 23 kg/m2.
His thyroid function results are:
fT4 15.1 (9-23 pmol/L)
TSH 1.0 (0.3-4.2 mU/L)
What is the most likely diagnosis?
A Conn’s syndrome
B Essential hypertension
C Hyperthyroidism
D Phaeochromocytoma
D Phaeochromocytoma
- A 30 year old woman presents with a six month history of hypertension. On examination, she has no features of Cushing’s syndrome. Blood tests confirm that she has hypokalaemia. What investigation would confirm a diagnosis of Conn’s syndrome?
A Elevated serum aldosterone and suppressed plasma renin
B Failure to suppress serum cortisol following dexamethasone
C MRI scan of the adrenals
D Urine catecholamines
A Elevated serum aldosterone and suppressed plasma renin
A 59 year old woman presents to her GP with increasing tiredness, constipation and low mood over the last six months. Thyroid function tests are: fT4 6 (9 -23 pmol/L), TSH 30 (0.3 – 4.2 mU/L). What treatment would you start?
Correct answer: Thyroxine, levothyroxine, T4
A 30 year old woman has been trying to conceive unsuccessfully for 1 year. She has noticed that her periods have become irregular and recently, she has had occasional galactorrhoea. A pregnancy test is negative. Blood tests confirm a serum prolactin of 4250 (100-500 mU/L). What investigation would you perform next?
MRI pituitary or any imaging of the pituitary or head is ACCEPTABLE but just “SCAN” or “MRI” without saying of the pituitary is UNACCEPTABLE.
A 30 year old woman has been trying to conceive unsuccessfully for 1 year. She has noticed that her periods have become irregular and recently, she has had occasional galactorrhoea. A pregnancy test is negative. Blood tests confirm a serum prolactin of 4250 (100-500 mU/L). What treatment would you recommend?
Cabergoline, bromocriptine, dopamine agonist, dopamine 2 receptor agonist are the best answers. D2 receptor agonist also is fine. Surgery to the remove the prolactinoma would only be undertaken rarely if the patient could not have dopamine agonists, so it is a less good answer, but we are accepting it on this occasion.
A 25 year old man had had type 1 diabetes mellitus for 15 years. At this routine review, he is keen to know whether he has any endogenous insulin production (ie is he making any of his own insulin). What could you measure to check this?
C peptide is made at the same time as any insulin. This is NOT the same as CRP, which is a totally different inflammatory marker.
What result would you expect for the measurement in the last question?
The c-peptide result should be low or undetectable because if you are not making insulin, you are not making c-peptide.
