Management

Question 1

Grave’s Disease (5)

Answer 1

Initial (during referral):
1. Propranolol - Sxs control

1st Line:
2. Carbimazole 40mg then reduce - (specialist medicine)

or a block and replace regimine

3. Carbimazole + Thyroxine

2nd Line:
4. Radioiodine Treatment

Radical:
5. Surgical Ressection

Question 2

Phaeochromocytoma (2)

Answer 2

1. A-Blocker - Phenoxybenzamine
2. B-Blocker if not enough
3. Surgery

Question 3

Addisonian Crisis (5)

Answer 3

1. IV lr IM Hydrocortisone 100mgSTAT
2. 1 Litre NS over 30 - 60 minutes
3. Continue Hydro until stable every 6 hours
4. Oral Rehydration can start at 24hrs and reduce to maintenance over 4 days

Question 4

Primary Hyperparathyroidism (2)

Answer 4

1. Total parathyroidectomy
2. Cincacalcet (calcimimetic) if not suitable for surgery

Question 5

Subacute Hypothyroidiism (5)

Answer 5

1. Levothyroxine if TSH >10 on 2 readings 3 months appart
2. If TSH 5.5-10 but T4 normal + Symptoms then
3. <65s get a 6 month Levo trial
4. If asymptomatic, repeat TFTs in 6 months
5. If over 80 watch and wait

Question 6

Addison’s patient on steroids who gets acutely unwell (2)

Answer 6

1. DOUBLE the glucocorticoids (hydro)
2. DONT CHANGE the mineralocorticoids (fludro)

Question 7

List the 3 Indications for referral to Parathyroidectomy in Primary Hyperparathyroidism: (3)

Answer 7

1. Corrected Ca2+ above 2.85
2. Symptoms of hypercalaemia
3. End-organ disease (Renal stones, osteoporosis etc)

Question 8

List the 3 indications of needing to wean off steroids over weeks (3)

Answer 8

1. If dosed over 40mg of prednisolone for a week daily
2. If received over 3wks of treatment
3. If recently recevied repeated courses

Question 9

Conn’s Caused by Bilatreral Adrenal Hyperplasia: (1)

Answer 9

1. Spironolactone

Question 10

Conn’s caused by unilateral adrenal adenoma (1)

Answer 10

1. Surgical resseciton

Question 11

Diabetic Gastropareisis (3)

Answer 11

1. Metoclopramide
2. Domperidone

or

3. Erythromycin

(prokinetic agents)

Question 12

Hypothyroidism in Pregnancy (1)

Answer 12

1. Up Levo dose by 50% in weeks 4-6

Question 13

Thyroid Storm (3)

Answer 13

1. Corticosteroids
2. PTU (Propylthiouracil)
3. Propranolol

Question 14

NICE indications for using GLP-1s (eg liraglutide) (2)

Answer 14

1. BMI >35
2. Prediabetes HbA1c - 42-47

(They help cause weight loss)

Question 15

Myxoedema Coma (3)

Answer 15

1. Thyroxine
2. Hydrocortisone
3. +/- Wamring blankets

Question 16

Turner’s Syndrome (1)

Answer 16

1. Growth Hormone

Question 17

Rheumatoid Arthritis Flare-ups (1)

Answer 17

1. IM Methylprednisolonen (IM Steroids)