Formative Quiz

Question 1

insulin receptor type?

Answer 1

tyrosine kinase

Question 2

growth hormone receptor?

Answer 2

cytokine

Question 3

calcium receptor type?

Answer 3

GPCR

Question 4

how does insulin affect hepatic glycogen synthesis?

Answer 4

increases it
anabolic hormone (not catabolic)
increases DNA synthesis

Question 5

what is the cavernous sinus?

Answer 5

part of the brains dural venous sinus

either side of the sella turcica (where pituitary sits)

Question 6

what cranial nerves are found around the cavernous sinus and intermediate vicinity?

Answer 6

3, 4, 5(1), 5(2), 6

Question 7

which structure is at risk of damage in total thyroidectomy?

Answer 7

recurrent laryngeal nerve

Question 8

which diabetics need to check blood glucose every time they drive?

Answer 8

everyone on insulin

Question 9

what is the target of action for the drug dapagliflozin?

Answer 9

sodium glucose cotransporter-2 (SGLT2)

Question 10

what is the most appropriate first line action for an ulcer in a type 2 diabetic with fever, nausea and sweats?

Answer 10

IV antibiotics

don’t need to swab first - commence best guess antibiotics

Question 11

graves disease vs toxic multi-nodular goitre vs thyroiditis on thyroid uptake scan?

Answer 11

graves disease = even uptake - whole gland would be dark
nodular = patchy uptake - patches of dark
thyroiditis = whole gland would be grey or white as no uptake

Question 12

side effects of carbimazole?

Answer 12

granulocytosis

• can present as severe sore throat and fever
• should stop carbimazole and do urgent FBC

Question 13

solitary thyroid nodule with normal thyroid function, no inflammatory infiltrate or visible nodule?

Answer 13

papillary thyroid cancer

Question 14

first line treatment for prolactinoma?

Answer 14

cabergoline (dopamine agonist)
- can give for 3-5 years (usually normalises within a few months, shrinks tumour within 3-5 years)
surgery = last resort

Question 15

what visual field is affected by an enlarged pituitary?

Answer 15

bi-temporal hemianopia

Question 16

first line for addisons disease?

Answer 16

..

Question 17

how is an adrenal tumour managed (causing sweating, panic attacks with hypertension and raised urinary catecholamines)?

Answer 17

alpha then beta blockers

beta blocker first can cause hypotensive crisis due to unopposed alpha action?

Question 18

what initial test is done for primary hyperaldosteronism(conns syndrome)?

Answer 18

paired renin and aldosterone measurement

saline suppression test can be used before surgery

Question 19

hypercalcaemia associated with a raised parathyroid hormone level and high urinary calcium, thyroid uptake scan showed a dark right inferior parathyroid gland?

Answer 19

right inferior parathyroid adenoma

Question 20

best initial test for Cushing’s?

Answer 20

low dose dexamethasone suppression test

Question 21

best initial test for acromegaly?

Answer 21

glucose tolerance test

- should suppress growth hormone if normal

Question 22

most appropriate initial action in Addisonian crisis?

Answer 22

urgent IV normal saline and hydrocortisone

Question 23

goal for all diabetics is HbA1c <53, true or false?

Answer 23

false

Question 24

all diabetics needs to check blood glucose at least once per day?

Answer 24

no

only if on insulin, SURs or relevant job

Question 25

is metformin always first line in type 2?

Answer 25

no - majority but not all

Question 26

hypoglycaemia management?

Answer 26

20% dextrose

Question 27

presentation of non-functional pituitary tumour?

Answer 27

headache
no hormonal effects
bloods can show some low hormone levels and some higher hormone levels

Question 28

treatment of non-functional pituitary adenoma if anterior pituitary dysfunction (abnormal synacthen, high prolactin, low testosterone, low LH, low T3/T4 with normal TSH)

Answer 28

hydrocortisone

always steroids first (straight into thyroxine can cause crisis)

Question 29

raised calcium in child
father has primary hyperparathyroidism, recurrent peptic ulcer and raised prolactin
what is the genetic condition?

Answer 29

MEN1

3 Ps - parathyroid, pancreas, pituitary