passmed

Question 1

kleinfeleter low testoesteorne in men undiagnosed

Answer 1

osteoporosis if present late

Question 2

agdha score

Answer 2

The score of the QoL-AGHDA is used to determine the extent to which growth hormone deficiency has affected the patient’s quality of life, and what treatment can then be administered. A high score on the QoL-AGHDA indicates that the patient suffers from many symptoms and therefore has a lower quality of life.

Question 3

moa of orlistat

Answer 3

The primary mode of action of orlistat is to inhibit pancreatic lipases, which in turn will decrease the absorption of lipids from the intestine

Question 4

A 45-year-old woman presents to her GP with 2 weeks history of feeling constantly weak. She has noticed that she now struggles with climbing stairs and combing her hair.

Her past medical history includes poorly controlled type-2 diabetes and a recent admission for severe pneumonia, in which she was started on a reducing course of steroids.

Observations are normal. Examination reveals bilateral reduced power of the shoulders, biceps and hip flexors/extensors. Tone, sensation, reflexes and cranial nerves are normal, with no fatiguability of speech.

What is the most likely cause of her weakness?

Answer 4

proximal myopathy
patient is complaining of a proximal muscle weakness that matches a proximal myopathy. The prolonged course of steroids could be causing this.

Question 5

what causes proximal myopathy

Answer 5

prolonged course of steriods

Question 6

Raised total T3 and T4 but normal fT3 and fT4 suggest

Answer 6

high concentrations of thyroid binding globulin, which can be seen during pregnancy

Question 7

when is thyroid globulin high

Answer 7

in pregnancy

Question 8

two most common causes of high Ca therefore what would be the best test

Answer 8

malignancy and hyperparathyroidism

so PTH

Question 9

addisonian characteristics

Answer 9

An Addisonian crisis is characterised by hyperkalaemic metabolic acidosis. Symptoms include abdominal pain, confusion, nausea, and vomiting. In this case, it is likely that the patient had suffered from undiagnosed Addison’s disease, as supported by the history of fatigue, dizziness, and weight loss - most likely due to immune-regulatory changes following pregnancy

Question 10

Peptic ulceration, galactorrhoea, hypercalcaemia

Answer 10

MEN 1

Multiple endocrine neoplasia type 1 is a genetic disorder that affects the endocrine system through development of neoplastic lesions in the pituitary gland, parathyroid gland and pancreas.

The milky white discharge is suggestive of hyperprolactinaemia which can occur to due a prolactinoma.

The excessive thirst and urination could be explained by hypercalcaemia which can occur due to primary hyperparathyroidism.

The chronic and unresponsive peptic ulceration is suggestive of Zollinger-Ellison syndrome. Zollinger-Ellison syndrome is a rare condition caused by a gastrin-secreting tumour found either in the islet cells of the pancreas or in the duodenal wall. The high levels of gastrin leads to stimulation of hydrochloric acid production in the gastric antrum resulting in predominantly duodenal ulceration.

Question 11

what diuretics worsen hypercalcaemia

Answer 11

indapamide and thiazides

Question 12

hypercalcaemia, normocytic anaemia and renal failure suppressed PTH

Answer 12

multiple myeloma

Question 13

treatment of choice for toxic mutlinodular goitre

Answer 13

radioactive iodine

Question 14

suspected type 1 diabetes on fasting glucose what next

Answer 14

Arrange C-peptide and diabetic autoantibodies

Question 15

Thyroid acropachy

Answer 15

feature of Graves disease where there is clubbing of the fingernails.

Question 16

what tests are best way to distinguish between T1DM and T2DM

Answer 16

C-peptide levels and diabetes-specific autoantibodies are useful to distinguish between type 1 and type 2 diabetes

A low level of C-peptide indicates the body is not producing enough insulin and may suggest type 1 diabetes. A high level of C-peptide indicates that the body is producing more than the required levels of insulin and may suggest type 2 diabetes.

Question 17

what is c peptide a measure of

Answer 17

Measuring C-peptide is an accurate way to find out how much insulin your body is making

Question 18

is addisons disease a cause of hypoglycaemia

Answer 18

yes

Question 19

what is the key parameter to monitor in peope with HHS

Answer 19

serum osmolality
This patient has a hyperosmolar hyperglycaemic state (HHS). The diagnostic criteria for HHS include hypovolaemia, hyperglycaemia (blood sugar > 30mmol/L) and a serum osmolality > 320mosmol/kg. This patient’s estimated serum osmolality is (2x148) + 32 + 8 = 336mosmol/kg, with a blood sugar of 31mmol/L and therefore meeting the criteria. Clinical features are commonly secondary to hypovolaemia and include fatigue, lethargy, altered consciousness, hypotension and tachycardia. HHS has a high risk of morbidity and mortality secondary to complications associated with a raised serum osmolality (e.g. thrombosis) or from rapid correction of serum osmolality (cerebral oedema). Therefore, it is vitally important that during a patient’s treatment of HHS, that serum osmolality is monitored.

Question 20

dx od diabtes over what value and does it depend whether they are symptomatic or asymptomatic

Answer 20

Diabetes meliitus diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic need two readings

Question 21

every person with insulin should have what kind of kit for emergencies

Answer 21

glucagon kit

Question 22

adrenal insufficeny requires IV hydrocortisone - it is common in HIV patients with what potential potentiator

Answer 22

CMV

Question 23

addisons disease - what do you do when ill with hydrocortisone and fludrocortisone

Answer 23

Addison’s patient with intercurrent illness → double the glucocorticoids, keep fludrocortisone dose the same

ludrocortisone, on the other hand, is a mineralocorticoid that regulates electrolyte balance and blood pressure; it does not need to be adjusted during acute illness.

Question 24

do wCC count go up in DKA

Answer 24

yes

infection or any physiological stress could precipitate dka
Anything not enough glucose left

Question 25

Salt-2 inhibitor cause secretion of what

therfore in what type of diabetes can we not use them

Answer 25

sodium ketones and glucose in urine

Risk for DKA in type 1 so cannot use in 1
Water follows sodium so diuretic effect

Question 26

dianostic criteria for DKA

Answer 26

ph below 7.3
bicarb below 15
keotnes over 3
sugars over 14

Question 27

how to we measure capillary ketones

Answer 27

Capillary ketones much better than urinary ketones

Question 28

Klinefelter’s syndrome causes what gonadotrophin results

Answer 28

high LH and low testosterone

Question 29

Radioiodine treatment may lead to the development / worsening of thyroid eye disease in up to 15% of patients with

Answer 29

graves

Question 30

Subclinical hypothyroidism with TSH level of level is 5.5 - 10mU/L: offer patients < 65 years a 6-month trial

Answer 30

of thyroxine if TSH remains at that level on 2 separate occasions 3 months apart and they have hypothyroidism symptoms

Question 31

addisons disease people should be giving a injecting resus kit contianign what

Answer 31

hydrocortisone

Question 32

subclinical hypothyroidism what shoudl you test for and why

Answer 32

Check thyroid peroxidase antibodies in patients who have subclinical hypothyroidism as this can indicate patients who are more likely to progress to overt hypothyroidism

Question 33

Diplopia and eye pain in the context of hyperthyroidism are suggestive of thyroid eye disease. specific to what condition

Answer 33

graves

Question 34

adverse affect of radioiondine thrapy

Answer 34

hypothyroidism

Question 35

Thyrotoxicosis with tender goitre

Answer 35

subacute (De Quervain’s) thyroiditis

Question 36

TD2M: if a triple combination of drugs has failed to reduce HbA1c then switching one of the drugs for a

Answer 36

GLP-1 mimetic is recommended, particularly if the BMI > 35 - zone

Question 37

Sick euthyroid is common in unwell, elderly patients and often needs no treatment

Question 38

Water deprivation test: primary polydipsia
urine osmolality after fluid deprivation: high
urine osmolality after desmopressin: high

Answer 38

In cranial diabetes insipidus, the body is incapable of producing any antidiuretic hormone. As a result, the urine would not concentrate and the urine osmolality would not increase in response to water deprivation. Following injection of desmopressin, however, the kidneys would then suddenly be able to concentrate the urine, and we would see a sudden rise in the urine osmolality.

Nephrogenic diabetes insipidus is incorrect. In nephrogenic diabetes insipidus, the kidneys cannot respond to the antidiuretic hormone and therefore cannot concentrate the urine; the urine will be diluted. Urine osmolality will be low and will remain low after water deprivation and after desmopressin injection.

Question 39

Corticosteroids can induce what white blood cells to go up

Answer 39

neutrophilia

Question 40

Thyrotoxicosis with tender goitre = subacute (De Quervain’s) thyroiditis
Important for meLess important how do we manage

Answer 40

ibuprofen

Question 41

if takign both levothyroxine and calcium tablets when do you take

Answer 41

levy 4 hours before calcium as cna reduce absorption