overview of anatomy of major endocrine glands

Question 1

A 33-year-old man presents complaining of visual disturbance. Examination reveals a bitemporal hemianopia with predominately the upper quadrants being affected. What is the most likely lesion?
Craniopharyngioma
Brainstem lesion
Pituitary macroadenoma
Frontal lobe lesion
Right occipital lesion

Answer 1

disturbance to optic chasm - pituitary lies above this and so tumour could compress this

Question 2

what attaches the hypothalamus to the pituitary gland

Answer 2

infundibulum

Question 3

where is the antioer pituitary derived from

Answer 3

rathkes pouch
ectoderm

superior hypophyseal artery- internal carotid and hypophyseal portal system

Question 4

rathkes cysts causing what

Answer 4

chronic headaches

Question 5

67-year-old female goes to the GP for routine blood tests. The abnormality below is noted in the thyroid function test (TFT).
TSH is 7.8 normal is 0.5-5.5
Free T4 14 normal is 9-18

What condition does she have?

Hyperthyroidism
Secondary hypothyroidism
Subclinical hypothyroidism
Hashimoto’s thyroiditis
Graves’ disease

Answer 5

subclinical hypothyroidism

Tsh is higher than usual but T4 normal meaning patient has not gone to full blown hypo yet

Question 6

thyroid what germ layer

Answer 6

thyroglossal bud from the endoderm

Question 7

A 33-year-old woman presents with weight loss and excessive sweating. Her partner reports that she is ‘on edge’ all the time and during the consultation you notice a fine tremor. Her pulse rate is 96/min. A large, non-tender goitre is noted. Examination of her eyes is unremarkable with no evidence of exophthalmos. Her blood results are below. What is the most likely diagnosis?

TSH is less than 0.05 when normal is 0.5-5.5
T4 free is 26 normal is 9-18
anti-tsh is positive

Toxic multinodular goitre
De Quervain’s thyroiditis
Hashimoto’s thyroiditis
Graves’ disease
Iodine deficiency

Answer 7

graves

Can immediately rule out Hashimoto’s, De Quervain’s and Iodine deficiency as they all cause hypothyroidism

wight loss
heat intolerance 
sweating 
oligomenohrha 
smooth painless goitre 
anxiety 

Pretibial myxoedema is erythematous pitting oedema usually found around the tibia above the malleoli

Question 8

treatment of graves

Answer 8

propanolol then carbimazole

Question 9

hasimoto treatment and symptoms

Answer 9

weight gain 
cold intolerance 
dry skin 
non pitting oedema 
hair loss
cosntipation 
menorrhagia 
brief thryotix period 

levothyroxine

Question 10

de quervains thyroiditis

symtpoms

treated with nsaids

Answer 10

mixed

painful goitre
raised ESR
iodine uptake is global reduced on scintigraphy

Question 11

iodine deficiency cause hypothyroidism

symtpoms

Answer 11

same as hashimoto

dietary iodine replacement

Question 12

60-year-old woman has presented to her GP with fatigue and constipation. She has a history of hypertension and depression and normally takes amlodipine, venlafaxine and over-the-counter vitamin D supplements. She has a 30-pack-year smoking history. Blood test results show the following:
calcium high 
phosphate low 
sodium and potassium normal 
urea and creatinine normal 
PTH normal 
VIt D normal 

What is causing her hypercalcaemia?
Drug-induced
Lung cancer
Primary hyperparathyroidism
Secondary hyperparathyroidism
Tertiary hyperparathyroidism

Answer 12

primary hyperparathyroidism

PTH normal but calcium up and phosphate low

secondary is excess PTH due to low calcium

not tertiary as due to high PTH and enlarged glands and kidney derangement show in urea and elctrylotyes

Question 13

embryology of parathryoid glands

Answer 13

Embryology:
Superior glands derived from 4th pharyngeal arch
Inferior glands derived from 3rd pharyngeal arch

Question 14

embryology of the pancreas

Answer 14

ventral and dorsal pancreatic buds of the foregut

Question 15

arterial supply of pancreas

Answer 15

splenic artery to body and to head is sup and inf pancreaticodudoednal arteries

venis is hepatic portal vein to body and splenic vein

All Autonomic
Parasympathetic: CN X
Induce secretion from acinar cells and Islets of Langerhans
Sympathetic: Splanchnic nerves
Limit exocrine secretion

Question 16

A 47-year-old-female presents to her normal diabetic outpatient appointment as part of her regular check up. She is a type two diabetic with a body mass index of 24kg/m². She is currently on full dose metformin monotherapy. Her HbA1c is 59mmol/mol. She reports that she is compliant with her medications. After discussion the patient feels there is not much more she can do with lifestyle modification or diet and is willing to add extra therapeutics to her management as needed. Which of the following would be the most appropriate management options?
Sitagliptin
Gliclazide
Pioglitazone
Continue metformin only
Insulin

Answer 16

Gliclazide is the preferred option when there is no concern about weight gain
If there was concern, sitagliptin (DPP-4 inhibitor) would be used as it does not cause weight gain
Insulin is not used until very far down the treatment pathway

Question 17

56 year-old gentleman has a known pituitary adenoma causing excessive secretion of ACTH. Which part of his adrenal gland will be excessively stimulated?
Zona glomerulosa
Zona fasciculata
Zona reticularis
Adrenal medulla

Answer 17

cortisol release from the bona fasciculatata

Question 18

the adrenal cortex comes from the mesoderm but where does the medulla come from

Answer 18

neural crest from the ectoderm

Question 19

three layers GFR

Answer 19

Salt, sugar, sex – the deeper you go the sweeter it gets
Mineralocorticoids – aldosterone, production stimulated by angiotensin 2 as part of the RAAS
Glucocorticoids – cortisol
Androgens – dehydroepiandrosterone (DHEA) which is the precursor to testosterone (reticularis does synthesise a nominal amount of the others as well)

Question 20

HPA axis

Answer 20

CRH - ACTH - glucocorticoids and catecholamines

Question 21

You review a 52-year-old man who is being investigated for weight gain (particularly around his face), impotence and hypertension. On examination you record a blood pressure of 180/110 mmHg and notice purple striae around his abdomen. He also has some difficulty getting up from a chair and you observe generalised decreased muscle strength. What is the most likely diagnosis?
Cushing’s syndrome
Addison’s disease
Conn’s syndrome
Type 2 diabetes
Depression

Answer 21

Cushing syndrome

striae of skin - moon face, obesity , weight Gain
easy brusing and diabetes

Question 22

Addison’s is autoimmune normal

Answer 22

vitiligo , anorexia and weakness and hyper pigmentation in palms as excessive acth produces

bloods show low sodium and low glucose but high potassium

hydrocortisone and fludrocortisone to replace he aldosterone

criisis is when hypovolaemic , hyponatraemic and hyperkalaemic

Question 23

what nerve lies infront of the parotid gland

Answer 23

facial nerve

Question 24

A 75-year-old man presented with a 2-month history of dysphagia and regurgitation of undigested food. He also complains of halitosis and a chronic cough. Examination shows a small neck swelling which gurgles on palpation. Barium studies show a diverticulum or pouch forming at the junction of the pharynx and the oesophagus.

Based on the likely diagnosis, this diverticulum ( hidden canal or tube) commonly occurs between which of the following muscles?

Answer 24

Thyropharyngeus and cricopharyngeus muscles

Question 25

what artery supplies the prostate gland

Answer 25

he arterial supply to the prostate gland is from the inferior vesical artery, it is a branch of the prostatovesical artery. The prostatovesical artery usually arises from the internal pudendal and inferior gluteal arterial branches of the internal iliac artery.