Metabolic and Endocrine

Question 1

Symmetrical dermatitis on sun-exposed skin
Diarrhoea and depression
Recently started on anti-TB treatment

What nutritional deficiency does he have?

Answer 1

Vitamin B6 deficiency

Question 2

Coeliac disease results in malabsorption of the fat-soluble vitamins, which are…

Answer 2

Vitamins A, D, E, K

Question 3

Patient on TPN (total parenteral nutrition) presents with red crusted lesions around the nostrils and corner of the mouth

What nutritional deficiency do they have?

Answer 3

Zinc deficiency

Question 4

Type 1 diabetes
Hyperlipidaemia
Mild hyponatraemia

What is the most likely cause for the sodium balance disorder?

Answer 4

Pseudohyponatraemia

Low plasma sodium concentration caused by hyperlipidaemia/hyperproteinaemia

Question 5

Back pain
Weight loss
Elevated ESR
Marked excretion of immunoglobulin chains in the urine

Answer 5

Myeloma

Question 6

Hypercalcaemia in a patient after renal transplant

Secondary or tertiary hyperparathyroidism?

Answer 6

Tertiary hyperparathyroidism

Question 7

Physiological hypertrophy of the parathyroid glands in response to hypocalcaemia.
Plasma calcium is usually low or normal
Causes include Vitamin D deficiency and chronic renal failure

Answer 7

Secondary hyperparathyroidism

Question 8

Autonomic parathyroid hyperplasia

Plasma calcium and phosphate are raised

Answer 8

Tertiary hyperparathyroidism

Question 9

45-year-old woman with diabetes presents with shiny areas on her skin with a yellowish colour and overlying telangiectasia

Answer 9

Necrobiosis lipoidica

Question 10

85-year-old man with type 2 diabetes
Painful wasting of the quadriceps muscle of the right leg with absent knee reflex
Area is very tender

Answer 10

Amyotrophy

Question 11

Treatment of diabetes

Type 2 diabetes patient presents with HONK
Blood glucose 40mmol/L

Answer 11

0.9% saline, insulin, heparin

Question 12

Treatment of diabetes

First-line treatment for 19-year-old with diabetes and metabolic ketoacidosis

Answer 12

0.9% saline, IV heparin, prophylactic heparin

Question 13

Treatment of diabetes

Type 1 diabetes patient brought to A&E
Unconscious with blood glucose level of 1.0mmol/L

Answer 13

IV 50% dextrose

Question 14

Vitamin deficiency

Prolonged bleeding

Answer 14

Vitamin K

Question 15

Vitamin deficiency

Malnourished, bleeding gums

Answer 15

Vitamin C

Question 16

Vitamin deficiency

Night-blindness

Answer 16

Vitamin A

Question 17

Vitamin deficiency

Bowed legs (rickets)

Answer 17

Vitamin D

Question 18

Vitamin deficiency

Nystagmus, ophthalmoplegia, ataxia

Answer 18

Vitamin B1 (thiamine)

Question 19

Vitamin deficiency

Diarrhoea, dementia, dermatitis

Answer 19

Nicotinic acid

Question 20

Vitamin deficiency

Sore red tongue, peripheral neuropathy

Answer 20

Vitamin B12

Question 21

Cardiac arrhythmias

ECG: tall T waves

Answer 21

Hyperkalaemia

Question 22

Muscle weakness, tetany

ECG: small T waves, prominent U wave

Answer 22

Hypokalaemia

Question 23

Carpopedal spasm, perioral anaesthesia

Positive Trousseau’s, Chvostek’s sign

Answer 23

Hypocalcaemia

Question 24

Abdominal pain, constipation, vomiting
Depression
Increased incidence of renal stones
ECG: reduced Q-T interval

Answer 24

Hypercalcaemia

Question 25

Endocrine symptoms

Change in facial appearance, visual problems

Answer 25

Acromegaly

Question 26

Endocrine symptoms

Weight gain, hirsutism, menstrual problems, depression

Answer 26

Cushing’s syndrome

Question 27

Endocrine examination signs

Buccal/palmar crease hyperpigmentation, postural hypotension

Answer 27

Addison’s disease

Question 28

Endocrine examination signs

‘Moon-shaped’ face, centripetal obesity, proximal myopathy, purple striae, hypertension, diabetes mellitus

Answer 28

Cushing’s disease

Question 29

Endocrine examination signs

Macroglossia, spade-like hands and feet

Answer 29

Acromegaly

Question 30

Endocrine examination signs

Bradycardia, dry thin hair, goitre, loss of outer third of eyebrow, slowly relaxing reflexes

Answer 30

Hypothyroidism