mock questions Flashcards
what are the 3 key aspects to conn’s disease?
hypertension associated with hypokalaemia, hypertension despite being on 3 or more antihypertensives, hypertension before 40 years of age
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?
spironolactone
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?
secondary hyperaldosteronism
what does cushing’s syndrome often present with?
abdominal striae, moon face, buffalo hump
and weight loss in extremities.
how does addison’s disease often present?
hyperpigmentation, central
weight loss as well as hypotension.
through with feedback system does cortisol levels increase in the body?
Hypothalamo-pituitary-adrenal axis
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?
water deprivation test with desmopressin
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?
48mmol/mol
what are the causes of hypercalcaemia?
CHIMPANZEES- Calcium supplements,
Hydrochlorothiazide, Iatrogenic/Immobilisation, Multiple myeloma/Medication (lithium), Parathyroid
hyperplasia, Alcohol, Neoplasm, Zollinger ellison syndrome, Excessive Vit D, Excess Vit A, Sarcoidosis
how does hyperkalcaemia present on an ECG?
tall tented T-waves
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?
pancreatogenic diabetes
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?
caricnoid syndrome
what does hyperparathyroidism look like on an ECG?
short QT, j waves, flattened T waves (hypercalcaemia)
describe the relationship between TSH ad thyroxine?
negative feedback, high thyroxine leads to reduced TSH production which lowers the thyroxine levels,
how do pituitary tumours produce symptoms?
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
what does the pituitary produce in relation to cortisol?
ACTH
What are the commonest biochemical abnormalities found on blood investigations in Addisons disease and why?
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
What is the commonest cause of addisonian crisis and what is the most important initial treatment for it?
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.
define hypoparathyroidism
Due to gland failure – causes reduced calcium with normal/raised phosphate and normal alkaline phosphatase
define secondary hypoparathyroidism
Due to an external cause - commonest cause is surgical damage leading to the same biochemical abnormalities as above
define pseudohypoparathyroidsm
Peripheral resistance to parathyroid hormone – causes reduced calcium, raised phosphate, normal or raised alkaline phosphatase
what are the common feautures of hypercalcaemia?
Weakness Tiredness Dehydration Renal Stones Fractures due to osteopenia/osteoporosis Abdominal pain (constipation/pancreatitis) Depression/confusion
how does metformin work?
It acts by decreasing hepatic glucose production, decreasing intestinal absorption of glucose, and improving insulin sensitivity by increasing peripheral glucose uptake and utilisation.
what are the signs of cushings?
buffalo hump, hypertension, moon face, truncal obesity, ance, mood change, thinning of skin
what does cushing’s disease do to menstrual cycles?
amenorrhoea
what do SGL2 inhibitors do?
block reabsorption of glucose in the kidneys.
what do sulfonureas do?
lower blood glucose by stimulating insulin secretion.
how do you differentiate DI from DM and how do you then differentiate cranial CI from nephrogenic DI?
water deprivation test, then IM desmopressin test (urine concentrated in cranial, diluted in nephrogenic
how is de quevain’s thyroiditis treated?
aspirin and ibuprofen
what would indicate testicular cancer?
heavy feeling in scrotum, unilateral, firm, painless lump
what is the first line and gold standard investigations for acromegaly?
I-GF levels = first line
oral glucose tolerence test = gold standard
