Passmed

Question 1

Grave’s disease may be worse during what period of pregnancy?

Answer 1

Graves’ disease may present first or become worse during the post-natal period.

Question 2

Blistering rash (necrolytic migratory erythema) + new-onset diabetes + diarrhoea is a sign of what hormone secreting tumour?

Answer 2

Blistering rash (necrolytic migratory erythema) + new-onset diabetes + diarrhea → glucagonama.

Question 3

Medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus arise in what inheritted condition?

Answer 3

Medullary thyroid cancer, phaeochromocytoma, marfanoid body habitus - multiple endocrine neoplasia type IIb.

Question 4

What is the triad of primary hyperaldosteronism?

Answer 4

Primary hyperaldosteronism can present with hypertension, hypernatraemia, and hypokalemia.

Question 5

What hormones are deficient in Addison’s?

Answer 5

Addison’s disease - no aldosterone or cortisol is produced.

Question 6

What leads to diabetic ketoacidosis in diabetes?

Answer 6

DKA is caused by uncontrolled lipolysis (not proteolysis) which results in an excess of free fatty acids that are ultimately converted to ketone bodies.

Question 7

What is used to treat acromegaly?

Answer 7

Acromegaly is caused by excessive growth hormone. Somatostatin directly inhibits the release of growth hormone, and hence somatostatin analogues are used to treat acromegaly.

Question 8

What is a marker of insulin production?

Answer 8

C-peptide is secreted in proportion to insulin and is a marker of endogenous insulin production.

Question 9

What are the two incretins types and where are they produced?

Answer 9

There are 2 main groups of incretins; gastric inhibitory peptide (GIP) which is glucose dependent and released from the duodenum, and glucagon-like peptide (GLP-1) produced from the distal ileum.

Question 10

Through what mechanism does orlistat promote weight loss?

Answer 10

Orlistat works by inhibiting gastric and pancreatic lipase to reduce the digestion of fat.

Question 11

Through what mechanism do Sulfonyureas help manage type 2 diabetes?

Answer 11

Sulfonyureas increase stimulation of insulin secretion by pancreatic B-cells and decrease hepatic clearance of insulin.

Question 12

ADH promotes water reabsorption how?

Answer 12

Antidiuretic hormone promotes water reabsorption by the insertion of aquaporin-2 channels.

Question 13

What does SGLT2 do?

Answer 13

SGLT2 is the major transport protein and promotes reabsorption from the glomerular filtration glucose back into circulation and is responsible for approximately 90% of the kidney’s glucose reabsorption.

Question 14

Gliflozins treat diabetes how?

Answer 14

Gliflozins - SGLT2 inhibitors

Question 15

What is the mechanism of metformin?

Answer 15

Metformin works by increasing insulin sensitivty and decreasing hepatic gluconeogenesis. It has no direct effect on insulin secretion from pancreatic beta cells, therefore, it cannot cause significant hypoglycaemia.

Question 16

What does metoclopramide do?

Answer 16

Pro-kinetic which speeds up gastrointestinal motility by blocking the action of dopamine.

Question 17

Through what mechanism do Sulfonylureas work?

Answer 17

Stimulate insulin release.

Sulphonylureas work via mimicking the role of ATP on potassium-ATP channels from the outside. They act to block these channels causing membrane depolarisation and thus opening of voltage-gated calcium channels. This process results in the stimulation of insulin release.

Question 18

Octreotide is what?

Answer 18

A somatostatin analogue - inhibits GH in cases of acromegaly.

Question 19

Kleinfelter’s chromosomal abnormality:

Answer 19

Klinefelter’s - 47, XXY

Question 20

coarse facial appearance, larger tongue and excessive sweating and oily skin is symptomatic of what?

Answer 20

Acromegaly leads to an excess of growth hormone resulting in a coarse facial appearance, larger tongue and excessive sweating and oily skin.

Question 21

Drivers of growth and age in:

Babies

Childhood

Puberty

Answer 21

In infancy nutrition and insulin are the major drivers of growth.

In childhood growth is driven by growth hormone and thyroxine.

Puberty growth is driven by growth hormone and sex steroid, high amount of growth hormone is important in growth spurts.

Question 22

Chvostek’s sign is seen in hypocalcaemia due to increased irritability of the peripheral nerves.

Answer 22

Chvostek’s sign is seen in hypocalcaemia due to increased irritability of the peripheral nerves.

Question 23

Features of Conns syndrome

Answer 23

hypertension

hypokalaemia

e.g. muscle weakness

this is a classical feature in exams but studies suggest this is seen in only 10-40% of patients

alkalosis

Question 24

How do hyper and hypothyroidism affect menstruation.

Answer 24

Hyperthyroidism is associated with oligomennorhoea, or amennorhoea, whereas hypothyroidism is associated with menorrhagia

Question 25

The PTH level in primary hyperparathyroidism may be normal.

Answer 25

The PTH level in primary hyperparathyroidism may be normal.

Question 26

Most common electrolyte abnormality associated with cancer?

Answer 26

Hypercalcaemia is the most common metabolic complication in patients with cancer.

Stones (renal), Bones (pain), Groans (abdo pain), Thrones (inc urine frequency), Psychiatric overtones (axiety, altered mental status).

Question 27

Management of bilateral adrenal hyperplasia?

Answer 27

Primary hyperaldosteronism: manage with spironolactone

Question 28

What are the elctrolyte feautres of addisonian crisis?

Answer 28

Features of an addisonian crisis:

• Hyponatraemia
• Hyperkalaemia
• Hypoglycaemia

Question 29

What is the first line investigation in primary hyperaldosteronism?

Answer 29

A plasma aldosterone/renin ratio is the first-line investigation in suspected primary hyperaldosteronism.

Question 30

Management of hypertension in pheochromocytoma:

Answer 30

Both alpha and beta blockade is required when controlling hypertension in pheochromocytoma to avoid hypertensive crises

Question 31

A 66-year-old woman is admitted to the emergency department with acute confusion. She is alone and unable to articulate any of her past medical history. On examination, she is overweight, there is non-pitting oedema affecting the eyes and legs, and she has dry skin and coarse hair. Her observations are a heart rate of 50 beats/min, blood pressure of 90/60mmHg, respiratory rate of 10 breaths/min, temperature of 30°C, and oxygen saturation of 90% on air.

What is the most likely diagnosis?

Answer 31

Myxoedema coma typically presents with confusion and hypothermia.

Question 32

First line treatment for prolactinoma

Answer 32

Dopamine agonists (e.g. cabergoline, bromocriptine) are first-line treatment for prolactinomas, even if there are significant neurological complications

Question 33

Inheritance of MODY diabetes:

Answer 33

MODY is inherited in an autosomal dominant fashion so a family history is often present

Question 34

A venous blood gas likely shows what in a patient with Cushing’s?

Answer 34

Cushing’s syndrome - hypokalaemic metabolic alkalosis. The metabolic alkalosis is due to excess aldosterone which increases acid and potassium excretion in the kidney.

Question 35

How is a high dose dexamethasome test used to localise pathology in Cushing’s?

Answer 35

High dose testing is used to localise the problem. If both ACTH and cortisol are suppressed by high dose dexamethasone, this points to a pituitary cause. If only ACTH is suppressed by high dose dexamethasone, an adrenal cause is likely. If neither are suppressed, ectopic ACTH secretion is likely the cause.

Question 36

Chronic and unresponsive peptic ulceration = what?

Answer 36

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 37

When is adrenal venous sampling used?

Answer 37

Adrenal venous sampling (AVS) can be used to distinguish between unilateral adenoma and bilateral hyperplasia in primary hyperaldosteronism

Question 38

HBA1c target in type 2 diabetics?

Answer 38

The standard HbA1c target in type 2 diabetes mellitus is 48 mmol/mol

Question 39

Myxodemic coma is treated with what?

Answer 39

Myxoedemic coma is treated with thyroxine and hydrocortisone.

Question 40

Older woman with labial lump and inguinal lymphadenopathy → ?

Answer 40

Older woman with labial lump and inguinal lymphadenopathy → vulval carcinoma

Question 41

Patient is presenting symptomatically with a triad of sweating, headaches, and palpitations. What’s the cause and what’s the investigation?

Answer 41

Phaeochromocytoma - urinary metanephrines

Question 42

GLP1 analogs like exenatide are indicated when?

Answer 42

GLP1 analogs are indicated in patients with poor control despite triple therapy AND having a BMI >35

Question 43

Side effects of SGLT-2’s

Answer 43

GLT-2 inhibitors have the beneficial side effect of weight loss in patient with T2DM.

UTI

Question 44

Example cases of CAH:

Answer 44

A 7-day-old newborn boy is brought into hospital with vomiting and poor feeding. The infant is dehydrated and tachycardic. Electrolytes reveal hyponatraemia and hyperkalaemia. The patient demonstrates signs of shock. On genital exam, a phallic structure is noted with hyperpigmentation of the scrotum, but no testes are palpated.

A 16-year-old, previously healthy female presents with acne, hirsutism, and irregular menses. Her pubertal history reveals breast development at 9 years of age and pubic hair development at 7 years of age, and she reported 1 episode of vaginal spotting at approximately 11.5 years of age. A family history indicates some female relatives with symptoms of infertility, irregular menses, polycystic ovary syndrome, or alopecia. She is significantly shorter than her target height.

Under-virilisation of newborn males can be seen in 3-beta-hydroxysteroid dehydrogenase deficiency and 17-alpha-hydroxylase deficiency.