mock questions

Question 1

what are the 3 key aspects to conn’s disease?

Answer 1

hypertension associated with hypokalaemia, hypertension despite being on 3 or more antihypertensives, hypertension before 40 years of age

Question 2

Judy, a 34 year-old female, presents to the GP with symptoms of hypertension despite
being on a current regimen of antihypertensive medications. The junior doctor orders
appropriate blood tests and the results come back which suggest a diagnosis of Conn’s
syndrome. She is scheduled to have an operation for an adrenalectomy. What medication
is prescribed prior to her operation to stabilise her BP and K+ levels?

Answer 2

spironolactone

Question 3

Jeremy presents to your GP for review of his recent blood test results. They show raised
Renin and raised Aldosterone levels. What is the most likely diagnosis?

Answer 3

secondary hyperaldosteronism

Question 4

what does cushing’s syndrome often present with?

Answer 4

abdominal striae, moon face, buffalo hump

and weight loss in extremities.

Question 5

how does addison’s disease often present?

Answer 5

hyperpigmentation, central

weight loss as well as hypotension.

Question 6

through with feedback system does cortisol levels increase in the body?

Answer 6

Hypothalamo-pituitary-adrenal axis

Question 7

Luke presents with symptoms of polyuria, polydipsia and dehydration. You suspect the
diagnosis to be Diabetes Insipidus. What test would you perform to differentiate whether
the cause is cranial or nephrogenic?

Answer 7

water deprivation test with desmopressin

Question 8

James’s HbA1c levels are tested in order to determine whether he has Diabetes Mellitus or
not. Which of the following values will prove diagnostic?

Answer 8

48mmol/mol

Question 9

what are the causes of hypercalcaemia?

Answer 9

CHIMPANZEES- Calcium supplements,
Hydrochlorothiazide, Iatrogenic/Immobilisation, Multiple myeloma/Medication (lithium), Parathyroid
hyperplasia, Alcohol, Neoplasm, Zollinger ellison syndrome, Excessive Vit D, Excess Vit A, Sarcoidosis

Question 10

how does hyperkalcaemia present on an ECG?

Answer 10

tall tented T-waves

Question 11

Due to his excessive alcohol intake, Martin developed pancreatitis. Recently he started to
feel thirsty and complained of having to wake up during the night to go the toilet. What is
the most likely cause of his symptoms?

Answer 11

pancreatogenic diabetes

Question 12

Molly has come into GP complaining of diarrhoea, heart palpations and feeling quite
flushed. She has also noticed a change in mood but thinks this is due to her being recently
fired from her job. What is the most likely explanation for her symptoms?

Answer 12

caricnoid syndrome

Question 13

what does hyperparathyroidism look like on an ECG?

Answer 13

short QT, j waves, flattened T waves (hypercalcaemia)

Question 14

describe the relationship between TSH ad thyroxine?

Answer 14

negative feedback, high thyroxine leads to reduced TSH production which lowers the thyroxine levels,

Question 15

how do pituitary tumours produce symptoms?

Answer 15

Direct pressure on local structures e.g. optic chiasm leading to bitemporal hemianopia
Direct pressure damage to normal pituitary leading to hypopituitarism
Effects due to secretion of pituitary hormones from a functioning tumour

Question 16

what does the pituitary produce in relation to cortisol?

Answer 16

ACTH

Question 17

What are the commonest biochemical abnormalities found on blood investigations in Addisons disease and why?

Answer 17

low sodium and raised potassium due to reduced Aldosterone secretion
normal anion gap metabolic Acidosis due to the link between sodium and H+ ion management in the kidney. Increased sodium loss leads to increased H+ retention in the serum. This is also due to reduced aldosterone secretion
Decreased Glucose due to reduced cortisol
Raised Calcium due to volume depletion and increased release into the extracellular space

Question 18

What is the commonest cause of addisonian crisis and what is the most important initial treatment for it?

Answer 18

The commonest cause is abrupt cessation of long term steroid treatment either by choice or due to concurrent illness preventing the use of oral steroids.
The most important initial treatment is Hydrocortisone. Patients should have their own supply of parenteral hydrocortisone to use in the event of being unable to take oral steroids.

Question 19

define hypoparathyroidism

Answer 19

Due to gland failure – causes reduced calcium with normal/raised phosphate and normal alkaline phosphatase

Question 20

define secondary hypoparathyroidism

Answer 20

Due to an external cause - commonest cause is surgical damage leading to the same biochemical abnormalities as above

Question 21

define pseudohypoparathyroidsm

Answer 21

Peripheral resistance to parathyroid hormone – causes reduced calcium, raised phosphate, normal or raised alkaline phosphatase

Question 22

what are the common feautures of hypercalcaemia?

Answer 22

Weakness
Tiredness
Dehydration
Renal Stones
Fractures due to osteopenia/osteoporosis
Abdominal pain (constipation/pancreatitis)
Depression/confusion

Question 23

how does metformin work?

Answer 23

It acts by decreasing hepatic glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity by increasing peripheral glucose uptake and utilisation.

Question 24

what are the signs of cushings?

Answer 24

buffalo hump, hypertension, moon face, truncal obesity, ance, mood change, thinning of skin

Question 25

what does cushing’s disease do to menstrual cycles?

Answer 25

amenorrhoea

Question 26

what do SGL2 inhibitors do?

Answer 26

block reabsorption of glucose in the kidneys.

Question 27

what do sulfonureas do?

Answer 27

lower blood glucose by stimulating insulin secretion.

Question 28

how do you differentiate DI from DM and how do you then differentiate cranial CI from nephrogenic DI?

Answer 28

water deprivation test, then IM desmopressin test (urine concentrated in cranial, diluted in nephrogenic

Question 29

how is de quevain’s thyroiditis treated?

Answer 29

aspirin and ibuprofen

Question 30

what would indicate testicular cancer?

Answer 30

heavy feeling in scrotum, unilateral, firm, painless lump

Question 31

what is the first line and gold standard investigations for acromegaly?

Answer 31

I-GF levels = first line

oral glucose tolerence test = gold standard