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MRCP > MRCP Endocrinology > Flashcards

MRCP Endocrinology Flashcards

1
Q

FIRST LINE investigation for acromegaly

A

IGF-1 (raised)

OGTT & GH levels are GOLD STANDARD for diagnosis.

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2
Q

Pathophysiology in acromegaly

A

GH released by pituitary tumour
IGF-1 released from hepatocytes in response to elevated GH
Stimulates bone & soft tissue growth

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3
Q

First line treatment for acromegaly

A

Trans-sphenoidal resection of pituitary tumour
Medical if unsuccessful/unsuitable:
- dopamine agonist eg bromocriptine, cabergoline
- somatostatin analogue eg octreotide

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4
Q

TFTs in subclinical hypothyroidism

A

Raised TSH, normal T3 & T4 (usually asymptomatic)

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5
Q

Drugs causing hypothyroidism

A

Lithium

Amiodarone

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6
Q

Antibody in Hashimoto’s

A

Anti-TPO

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7
Q

Low TSH & low T3/T4

A

Hypopituitarism

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8
Q

High/inappropriately normal TSH & high T3/T4

A

Pituitary tumour (secreting TSH)

TSH should be low if T4 raised, if secreted from elsewhere it may be inappropriately normal/high despite raised T4

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9
Q

Aim with levothyroxine treatment

A

Normalise TSH (not suppress)

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10
Q

Treat Addisonian crisis

A

IV hydrocortisone & 0.9% NaCl

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11
Q

Investigation adrenal insufficiency

A

Short synacthen test

Insufficiency - failure of cortisol to rise >550 at 60min

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12
Q

Best first test to identify cause of hypercalcaemia?

A

PTH

PTH normally suppressed by hypercalcaemia

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13
Q

Explain the meaning of low urine osmolality

A

Low urine osmolality eg <300 = Low amount of particles relative to amount of liquid
ie dilute

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14
Q

Pathophysiology of cranial diabetes insipidus

A

Failure to secrete ADH from posterior pituitary

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15
Q

Pathophysiology of nephrogenic diabetes insipidus

A

Failure of kidneys to respond to ADH

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16
Q

Investigation of diabetes insipidus

A

Water deprivation test

- Failure to respond to dehydration, ie continue to produce dilute urine (low osmolality)

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17
Q

Differentiating cranial/nephrogenic diabetes insipidus

A

After water deprivation test, give desmopressin:

  • Urine concentrated, ie increased osmolality (>600): Cranial
  • Urine remains dilute, ie low osmolality: Nephrogenic (failure to respond to synthetic ADH)
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18
Q

Treatment of hyperthyroidism in pregnancy

A

1&2nd T: Propylthiouracil

3rd T: Carbimazole

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19
Q

TSH receptor antibodies

A

Grave’s disease

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20
Q

Post-partum haemorrhage + hypothyroidism

A

Sheehan’s syndrome

- fail to lactate & remain amenorrhoeic after delivery

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21
Q

Hypercalcaemia symptoms

A

Renal stones, abdominal groans, painful bones, psychiatric moans
Also polyuria, polydipsia, thirst

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22
Q

Main SE carbimazole

A

Agranulocytosis

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23
Q

Main SE radioionide therapy (for thyrotoxicosis)

A

Hypothyroidism

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24
Q

Hypothyroid, goitre, anti-TPO

A

Hashimoto’s

assoc with thyroid lymphoma

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25
Q

Kartagener’s syndrome

A

Immotile cilia (dextrocardia)

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26
Q

Hyperthyroid phase then hypothyroid phase, goitre

A

De Quervain’s

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27
Q

Acromegaly increases chance of which cancer?

A

Colorectal

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28
Q

SNHL, mild hypothyroidism, goitre

A

Pendred syndrome (aut dom)

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29
Q

Conn’s biochemistry

A

Hypokalaemia, hypernatraemia, HTN

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30
Q

Subclinical hyperthyroidism

A

Low TSH, normal T3 & T4

Left untreated = AF & osteoporosis

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31
Q

Treat thyroid storm

A

Fever: paracetamol
Tachycardia: IV propranolol
Thyroid: methimazole/propylthiouracilm, IV dexamethasone

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32
Q

Hypopigmented skin spots, atrial myxoma, endocrine tumours = ?

A 
Carney complex
(autosomal dominant, chromosome 17)
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33
Q

Diagnosis of gestational diabetes;
Fasting glucose above.. or
2h GTT glucose above..

A

Fasting glucose above 5.6

2h GTT above 7.8

34
Q

What stimulates PTH release?

A

HyPOcalcaemia
HypERphosphataemia
LOW vitamin D

35
Q

Name the syndrome: profuse watery diarrhoea, dehydration, hypokalaemia, metabolic acidosis

A

Verner-Morrison syndrome. Caused by VIPoma.

Test: Plasma VIP level

36
Q

Hormone profile in premature ovarian failure

A

High FSH & LH

Low oestradiol

37
Q

Young patient, taking antacids/has dyspepsia, hypercalcaemia, alkalotic

A

Milk-alkali syndrome

Ingestion of large amounts of calcium and alkaline substances

38
Q

Mild hypercalcaemia, low urinary calcium. Asymptomatic

A

Familial hypocalciuric hypercalcaemia

  • aut dominant
  • mutation CaSR gene means body doesnt detect hypercalcaemia, therefore PTH high or normal
  • no treatment required, benign lifelong condition
39
Q

Impaired fasting glucose, normochromic normocytic anaemia, weight loss, angular stomatitis, groin/buttock/leg rash (necrolytic migratory erythema)

A

Glucagonoma

  • tumour of pancreatic alpha cells –> overproduction of glucagon
  • > 70% are malignant. Indolent presentation so often metastasise prior to diagnosis
40
Q

Thyrotoxicosis, solitary lesion. Scan: ‘Hot’ nodule one lobe, suppression of activity elsewhere.

A

Thyroid adenoma

41
Q

Most frequently occurring functional pituitary tumour

A

Prolactinoma

42
Q

Impaired glucose tolerance values

A

2h post OGTT, 7.8 - 11.1

43
Q

How long does it take HbA1c to equilibrate?

A

3 months

44
Q

Preceding symptoms of pituitary adenoma & sudden onset headache, normal BP.

A

Pituitary apoplexy - haemorrhage or infarct of adenoma

45
Q

Hormone responsible for epiphyseal fusion & cessation of growth (in males and females)

A

Oestrogen

46
Q

Initial management of amiodarone induced thyrotoxicosis

A

Anti-thyroid drugs & glucocorticoids

47
Q

Hypokalaemia, metabolic alkalosis, low/normal BP

A

Bartter syndrome

- rare inherited disorder affecting thick limb of loop of Henle

48
Q

Hypokalaemia, metabolic alkalosis, hypertension

A

Liddle syndrome

49
Q

Predominantly which type of bone is affected in osteoporosis

A

Trabecular (sponge-like bone at the end of long bones)

50
Q

Recent flu-like illness, hyperthyroid Sx, tender goitre

A

De Quervain’s thyroiditis (subacute)

51
Q

Hormone profile in pregnancy

A

FSH & LH suppressed
Oestradiol raised
Prolactin mildly raised

52
Q

Secondary amenorrhoea, female excessive training/weight loss - diagnosis & hormone profile

A

Hypothalamic hypogonadism

  • Reduced secretion GnRH from hypothalamus resulting in reduced stimulation of LH & FSH in anterior pituitary
  • ie low LH & FSH
53
Q

Raised HDL, preserved insulin sensitivity, glycosuria

A

Maturity-onset diabetes of the young (MODY) (think T2DM)

  • 10-30yrs, normal BMI
  • FAMILY HISTORY
  • ketosis not a feature
  • Managed with SUs
54
Q

GLP-1 contraindicated if history of what?

A

Gastroparesis

- delay gastric emptying

55
Q

Diagnosing insulinoma

A

Measurement of fasting blood glucose and serum insulin & c-peptide during an attack
Dx: low glucose, high insulin, high c-peptide (byproduct created when insulin is produced)

56
Q

Pathophysiology of insulinoma

A
  • Insulin levels fail to fall during periods of fasting

- Increased risk of symptomatic hypoglycaemia

57
Q

Excess production of what is seen in familial hypertriglyceridaemia

A

Very low-density lipoprotein (VLDL)

- Autosomal dominant disorder

58
Q

Slow-growing, fibrous thyroid

A

Riedel’s thyroiditis

  • Fibrous tissue replaces thyroid tissue
  • Generally hyPOthyroidism, but depends on extent to which normal thyroid tissue has been replaced
  • Local extension & pressure symptoms
59
Q

Definitive treatment of thyroid adenoma

A

Radioactive iodine therapy

if contraindicated eg pregnancy, young child - surgical excision

60
Q

Hard, rapidly enlarging thyroid mass, local compression, regional lymphadenopathy = ?

A

Anaplastic thyroid cancer

Very poor prognosis

61
Q

Treatment of thyroid lymphoma

A

Chemotherapy & external beam radiotherapy

62
Q

Tall female, inguinal hernias in childhood, normal genitals, no pubic hair

A

Androgen insensitivity syndrome

63
Q

Anti-hypertensive of choice in phaeochromocytoma prior to surgery

A

Phenoxybenzamine

- alpha blocker. More potent than doxazosin

64
Q

Pharmacological management of drug induced nephrogenic diabetes inspipdus

A

Thiazide diuretic

65
Q

What is pseudo-Cushing’s syndrome?

A

Occurs in response to prolonged heavy alcohol use and obesity.
Elevation in cortisol but not to the extent of Cushing’s syndrome

66
Q

Pharmacological management of gastroparesis

A

Domperidone

metoclopramide no longer used due to SE profile

67
Q

Commonest genetic mutation causing MODY

A

HNF-1 alpha

68
Q

Very high LDL, tendon/skin xanthomas, early ACS

A

Heterozygous familial hypercholesterolaemia

- aut dom

69
Q

Signs/symptoms of adrenal failure following life threatening illness (commonly meningococcal disease)

A

Waterhouse Friderichsen syndrome

- bilateral adrenal haemorrhage

70
Q

Management of De Quervain’s thyroiditis

A

Propranolol (anxiety), NSAIDs

- self-limiting

71
Q

Thyrotoxicosis & REDUCED uptake on isotope scan

A

Subacute/De Quervain’s thyroiditis

- other causes of thyrotoxicosis have increased uptake

72
Q

Short stature, short 4th&5th metacarpals, seizures, bilateral basal ganglia calcification

A

Pseudohypoparathyroidism

- hypocalcaemia causing seizure

73
Q

ABG findings in Grave’s disease

A
  • Low PaCO2
  • Raised PaO2
  • pH normal or raised
74
Q

PCOS hormone profile

A
  • Raised LH (abnormal GnRH release preferential towards LH)
  • Normal FSH
  • Normal oestrogen
  • Raised testosterone
  • Low SHBG (sex hormone binding globulin)
75
Q

Epilepsy, port wine stain, phaeochromocytoma

A

Sturge-Weber syndrome

76
Q

Effect of hypothyroidism on cholesterol

A

Raised LDL cholesterol. HDL & triglycerides can also be raised.
- treat underlying thyroid disease and it will resolve

77
Q

Fasting glucose above what level in pregnancy do you go straight to insulin as first line treatment? (ie bypass metformin)

A

Fasting glucose >7

78
Q

Treatment to improve Graves ophthalmopathy

A

IV steroids

79
Q

Gold standard treatment for PCOS

A

Weight loss

80
Q

Hormone deficiency in congenital adrenal hyperplasia?

A

21-hydroxylase

81
Q

Gold-standard for confirmation of charcot joint?

A

Indium-labelled white cell scan

can differentiate between infective causes and Charcot

MRCP (14 decks)

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