Oxford Clinical Medicine

Question 1

What is the diagnosis?

• Hair loss
• pretibial myxoedema
• onycholysis
• exophthalmos

Answer 1

Thyrotoxicosis

Question 2

What is the diagnosis?

• Central obesity and wasted limbs
• Moon face
• Buffalo hump
• supraclavicular fat pads
• striae

Answer 2

Cushing’s syndrome

Question 3

What is the diagnosis?

- Hyperpigmentation of face, neck, buccal mucosa and palmar creases

Answer 3

Addison’s disease

Question 4

What is the diagnosis?

• pale or yellow tinged thinned skin, resulting in fine wrinkling around the eyes and mouth, making the patient look older
• decreased strength
• central obesity
• osteoporosis
• decreased glucose

Answer 4

Hypopituitarism

Question 5

What is the diagnosis?

• Hair loss
• eyebrow loss
• cold, pale skin
• characteristic face

Answer 5

Hypothyroidism

Question 6

What is the diagnosis?

• Hirsutism
• temporal balding
• acne

Answer 6

Hyperandrogenism

Question 7

What is the diagnosis?

• Short statue
• short neck
• Short 4th and 5th metacarpals

Answer 7

Pseudohypoparathyroidism

Question 8

What is the diagnosis?

• acral (distal) + soft tissue overgrowth
• big jaws (macrognathia), hands and feet
• the skin is thick, facial features are coarse

Answer 8

Acromegaly

Question 9

Besides being an endocrine condition, what other body system is Diabetes also highly associated with?

Answer 9

cardiovascular system

Question 10

What is the target blood glucose levels before meals and 2 hours after meals?

Answer 10

Before meals, blood glucose level target is 3.5 to 5.5 mmol/L.
2 hours after meals, targeted blood glucose level is <8mmol/L

Question 11

What is the target of HbA1c?

Answer 11

<48mmol/mol (<6.5%)

or <53mmol/mol (<7.0%)

Question 12

Give an example of a long-acting insulin and a short acting insulin

Answer 12

Long-acting insulin: Insulin glargine or insulin detemir

Ultra-fast acting insulin: Humalog, or Novorapid

Question 13

What is the action of Metformin?

Answer 13

Metformin increases the sensitivity of insulinand helps with weight

Question 14

What is the action of Sulfonylurea?

Give an example of a drug in the Sulfonylurea group.

Answer 14

Sulfonylurea increases insulin secretion.

Gliclazide

Question 15

What is Hypoglycaemia?

Answer 15

Hypoglycaemia is when blood glucose level is <3mmol/L

Question 16

What are the 2 types of hypoglycaemia?

Answer 16

Fasting hypoglycaemia and Post-prandial hypoglycaemia

Question 17

What is the chief cause of fasting hypoglycaemia?

Answer 17

Insulin or sulfonylurea treatment in a known diabetic.
In non-diabetic patients, it is EXPLAIN:
1. EXogenous drugs: insulin, oral hypoglycaemics, body builders may misuse insulin to help stamina
2. Pituitary insufficiency
3. Liver failure, plus some rare inherited enzyme defect
4. Addison’s disease
5. Islet cell tumours (insulinoma) and immune hypoglycaemia (eg anti-insulin receptor antibodies in Hodgkin’s disease)
6. Non-pancreatic neoplasms, eg fibrosarcomas and haemangiopericytomas

Question 18

What is suggested if the insulin level is high but there is an absence of C-peptide?

Answer 18

Patient has injected insulin.

C-peptide is produced only with endogenous insulin.

Question 19

When does post-prandial hypoglucaemia occur?

Answer 19

May occur after bariatric/gastric surgery

Question 20

What is the treatment for post-prandial hypoglycaemia?

For patients who can swallow and those who cannot swallow

Answer 20

Patients who can swallow: give oral sugar and a long-acting starch
Patients who cannot swallow: 25-50ml of 50% IV glucose. (via large vein with 0.9% saline flush to prevent phlebitis), or glucagon 1MG IM if no IV access

Question 21

How long is the action of 1MG IM glucagon? Elaborate.

Answer 21

Short duration of effect. Hence, need to repeat after 20mins and follow with oral carbohydrates.

Question 22

What is Whipple’s triad?

Answer 22

Whipple’s triad is a collection of 3 criteria that suggest a patient’s symptoms results from hypoglycaemia that may indicate insulinoma.

Question 23

Describe the Suppressive test for Insulinoma

Answer 23

Give IV insulin and measure C-Peptide. Normally exogenous insulin will suppress C-Peptide production, but this does not occur in insulinoma.

Question 24

What are the clinical signs of hypoparathyroidism?

Answer 24

Clinical signs are those of hypocalcaemia: [SPASMODIC]
S - Spasms - Trousseau’s sign due to carpopedal spasms
P - Perioral paraesthesia
A - Anxiety and irritability
S - Seizures
M - Muscle tone increases in smooth muscles: causing dysphagia, wheeze
O - Orientation impaired and confusion
D - Dermatitis
I - Impetigo herpetiformis
C - Chvostek’s sign (corner of the mouth twitches when the facial nerve is tapped over the parotid), cardiomyopathy (long QT interval), Cataract

Question 25

Why does hypomagnesaemia lead to hypocalcaemia?

Answer 25

Magnesium is required for Parathyroid hormone release. Low Magnesium leads to Secondary Hypoparathyroidism.

Question 26

What triggers the release of PTH and what it does?

Answer 26

Parathyroid hormone is released in response to low ion calcium levels. It cause an overall increase in ion calcium levels and a decrease in phosphate levels.