Endocrinology (Week 9)

Question 1

What fasting glucose level is indicative of diabetes?

Answer 1

> /=7 mmol/L

Question 2

What random plasma glucose level is indicative of diabetes?

Answer 2

> /= 11mmol/L

Question 3

What is the significance of testing C-peptide in diabetes diagnosis?

Answer 3

Secreted in equimolar concentration to insulin (shows level secreted in blood/urine)

Question 4

What is the significance of HbA1c in diabetes diagnosis?

Answer 4

Shows blood sugar levels over the last 6-8 weeks

Question 5

Name three causes of pancreatic diabetes

Answer 5

1. Pancreatectomy
2. Pancreatitis
3. Cystic Fibrosis

Question 6

Why do patients with pancreatic diabetes have a greater risk of hypoglycaemia than T1DM?

Answer 6

Due to loss of alpha cells and hence glucagon

Question 7

What does LADA stand for?

Answer 7

Latent autoimmune diabetes of the adult

Question 8

What is the average HbA1c target for diabetics?

Answer 8

HbA1c <53mmol/L

Question 9

What is the mechanism of action of Metformin?

Answer 9

Reduced hepatic glucose production and increased muscle uptake and peripheral sensitivity

Question 10

What is the mechanism of action of Sulfonylureas?

Answer 10

Close K+ channels in beta cells to release insulin

Question 11

What is the mechanism of action of DDP-4 inhibitors?

Answer 11

Enhance effect of endogenous incretin to increase insulin release and decrease glucagon secretion

Question 12

What is the mechanism of action of Flozins?

Answer 12

Inhibit SGLT-2 transported in PCT to decrease renal glucose absorption

Question 13

What is the mechanism of action of Glitazones?

Answer 13

Increase fat, muscle and liver sensitivity to endo and exo insulin

Question 14

What is the major side effect of Metformin?

Answer 14

Diarrhoea

Question 15

During pituitary pathology, which cells are lost first and which cells tend to preserved until late disease?

Answer 15

1st to be lost: somatotrophs (hence growth hormone)

Last to be lost: Thyrotrophs

Question 16

Bruit and thyroid eye disease are indicative of which condition?

Answer 16

Grave’s disease

Question 17

Name 2 treatments for hyperthyroidism

Answer 17

1. Beta blockers for symptom relief e.g. sweating

2. Carbimazole to block thyroid hormone production

Question 18

Name a drug which actively causes hyper- and hypothyroidism

Answer 18

Amiodarone

Question 19

In thyroid eye disease, what is lid lag?

Answer 19

If the sclera is seen above the iris

Question 20

What is exophthalmos?

Answer 20

If the sclera is seen below the iris, indicates changes in pupil

Question 21

What does proptosis indicate?

Answer 21

Changes behind the pupil

Question 22

Which layer of the adrenal cortex produces aldosterone?

Answer 22

Zona glomerulosa

Question 23

Which layer of the adrenal cortex produces cortisol?

Answer 23

Zona fasciculata

Question 24

Which layer of the adrenal cortex produces androgens?

Answer 24

Zona reticularis

Question 25

What cells produce catecholamines and where are they found?

Answer 25

Chromograffin cells in the adrenal medulla

Question 26

Name three tests used to diagnose Cushing's syndrome

Answer 26

1. 24hr free urinary cortisol 2. Urine cortisol:creatinine ratio 3. Dexamethasone suppression test

Question 27

What is Addison's disease?

Answer 27

Primary adrenal insufficiency

Question 28

What test is commonly used in Addison's disease diagnosis?

Answer 28

Short synacthen test

Question 29

What is congenital adrenal hyperplasia?

Answer 29

AR disorder with deficiency of 21 alpha-hydroxylase so cortisol cannot be produced

Question 30

How is late onset CAH diagnosed?

Answer 30

Short synacthen test with 17-OH progesterone (cortisol precursor)

Question 31

What is the best screening tool in primary aldosteronism?

Answer 31

Aldosterone-renin-ratio

Question 32

What is a paraganglioma?

Answer 32

Catecholamine producing tumour outside the adrenal glands in neural crest cells anywhere in the sympathetic chain

Question 33

Name the three components of Whipple's triad

Answer 33

1. Hypoglycaemia symptoms 2. Low plasma glucose 3. Symptoms resolve after plasma glucose raised

Question 34

In multiple endocrine neoplasia type 1, what three areas are predisposed to tumours?

Answer 34

Pancreas Pituitary (anterior) Parathyroids

Question 35

Name 4 symptoms of carcinoid syndrome

Answer 35

1. Flushing 2. Diarrhoea 3. Asthma 4. Right heart valvular lesions

Question 36

What is hirsutism?

Answer 36

Male pattern hair growth due to increased androgens and increased skin sensitivity to them

Question 37

Name the three chemicals implicated in PCOS

Answer 37

1. Gonadotrophins 2. Androgens 3. Insulin

Question 38

In hypogonadotrophic hypogonadism, where is the problem?

Answer 38

Hypothalamus or anterior pituitary

Question 39

In primary gonadal failure, where is the problem?

Answer 39

Testes

Question 40

Give three signs of hypogonadism in children

Answer 40

Slow growth Small testes Lack of 2nd sexual characteristics

Question 41

Give three signs of hypogonadism in adults

Answer 41

Low libido Depression ED

Question 42

On an orchidometer, what testes volume indicates late puberty?

Answer 42

12-15ml

Question 43

What syndrome is described as isolated gonadotrophin deficiency when GnRH cells don't migrate to the hypothalamus?

Answer 43

Kallmann's syndrome

Question 44

In Kallmann's syndrome, which sense is often absent?

Answer 44

Smell

Question 45

What sex chromosome karyotype is seen in Klinefelter's syndrome?

Answer 45

XXY

Question 46

How does androgen binding protein assist in sperm development?

Answer 46

It 'locks' testosterone in the testes to encourage sperm maturation

Question 47

What is bimanual synkinesia?

Answer 47

R and L hands execute same movements despite only one being intentionally moved