Passmed - Endo

Question 1

Thyrotoxicosis with tender goitre =

Answer 1

subacute (De Quervain’s) thyroiditis

Question 2

De Quervain’s thyroiditis 4 phases

Answer 2

phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
phase 2 (1-3 weeks): euthyroid
phase 3 (weeks - months): hypothyroidism
phase 4: thyroid structure and function goes back to norma

Question 3

De Quervain’s thyroiditis investigations?

Answer 3

thyroid scintigraphy: globally reduced uptake of iodine-131

Question 4

first-line investigation in suspected primary hyperaldosteronism

Answer 4

plasma aldosterone/renin ratio

Question 5

Primary hyperaldosteronism causes?

Answer 5

bilateral idiopathic adrenal hyperplasia: the cause of around 60-70% of cases
adrenal adenoma: 20-30% of cases
unilateral hyperplasia
familial hyperaldosteronism
adrenal carcinoma

Question 6

Primary hyperaldosteronism features?

Answer 6

hypertension
Hypokalaemia e.g. muscle weakness
metabolic alkalosis

Question 7

Primary hyperaldosteronism treatment?

Answer 7

adrenal adenoma: surgery (laparoscopic adrenalectomy)
bilateral adrenocortical hyperplasia: aldosterone antagonist e.g. spironolactone

Question 8

GnRH agonists (e.g. goserelin) used in the management of prostate cancer may result in

Answer 8

gynaecomastia

Question 9

Drug causes of gynaecomastia

Answer 9

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

Question 10

Causes of gynaecomastia

Answer 10

physiological: normal in puberty
syndromes with androgen deficiency: Kallman’s, Klinefelter’s
testicular failure: e.g. mumps
liver disease
testicular cancer e.g. seminoma secreting hCG
ectopic tumour secretion
hyperthyroidism
haemodialysis

Question 11

Side-effects of thyroxine therapy

Answer 11

hyperthyroidism: due to over treatment
reduced bone mineral density
worsening of angina
atrial fibrillation

Question 12

What should be used first-line for black TD2M patients who are diagnosed with hypertension

Answer 12

angiotensin II receptor blocker

Question 13

In type 1 diabetics, a general HbA1c target of

Answer 13

48 mmol/mol (6.5%)

Question 14

SGLT-2 inhibitors (gliclazide)

Answer 14

should also be given in addition to metformin if any of the following apply:
-the patient has a high risk of developing cardiovascular disease (CVD, e.g. QRISK ≥ 10%)
-the patient has established CVD
-the patient has chronic heart failure

metformin should be established and titrated up before introducing the SGLT-2 inhibitor

SGLT-2 inhibitors should also be started at any point if a patient develops CVD (e.g. is diagnosed with ischaemic heart disease), a QRISK ≥ 10% or chronic heart failure

Question 15

T2DM second-line management?

Answer 15

metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor (if NICE criteria met)

Question 16

T2DM third-line treatment?

Answer 16

metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
metformin + (pioglitazone or sulfonylurea or DPP-4 inhibitor) + SGLT-2 if certain NICE criteria are met
insulin-based treatment

Question 17

If triple therapy is not effective or tolerated for T2DM?

Answer 17

consider switching one of the drugs for a GLP-1 mimetic

Question 18

SGLT-2 inhibitor examples?

Answer 18

canagliflozin, dapagliflozin, and empagliflozin

Question 19

DPP-4 inhibitor examples?

Answer 19

sitagliptin, saxagliptin, linagliptin, and alogliptin

Question 20

Pioglotazone?

Answer 20

Increases insulin sensitivity

Question 21

Sulphonylurea examples?

Answer 21

Gliclazide

Question 22

GLP-1 agonist examples

Answer 22

dulaglutide, exenatide, liraglutide, lixisenatide, and semaglutide

Question 23

Liraglutide should be considered as an adjunct for weight loss in

Answer 23

obese class II patients (BMI >35) who are prediabetic

Question 24

Sick euthyroid syndrome

Answer 24

= low T3/T4 and normal TSH with acute illness

Question 25

Acute management of DKA?

Answer 25

insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin

Question 26

The Hba1c target for patients on a drug which may cause hypoglycaemia (eg sulfonylurea) is

Answer 26

53 mmol/mol

Question 27

characteristic electrolyte disturbances seen in patients with refeeding syndrome

Answer 27

Hypophosphataemia, hypokalaemia and hypomagnesaemia

Question 28

Hypercalcaemia causes?

Answer 28

thiazides Addison's disease thyrotoxicosis primary hyperparathyroidism squamous cell lung cancer vitamin D intoxication dehydration bone metastases sarcoidosis acromegaly myeloma milk-alkali syndrome

Question 29

Hypokalaemia causes

Answer 29

thiazides diarrhoea vomiting primary hyperaldosteronism Cushing's syndrome magnesium deficiency renal tubular acidosis (types 1 and 2) acetazolamide

Question 30

Addison’s signs? Electrolyte

Answer 30

hypotension, hyperpigmentation, lethargy hyperkalaemia, hyponatraemia, hypoglycaemia hypercalcaemka

Question 31

Hyperkalaemia causes?

Answer 31

ACE inhibitors acute renal failure angiotensin 2 receptor blockers Addison's disease spironolactone metabolic acidosis rhabdomyolysis massive blood transfusion renal tubular acidosis (type 4) ciclosporin

Question 32

newly diagnosed adults with type 1 diabetes, the first-line insulin regime should be a

Answer 32

basal-bolus using twice-daily insulin detemir

Question 33

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

Answer 33

autosomal dominant

Question 34

De Quervain's thyroiditis:

Answer 34

initial hyperthyroidism, painful goitre and globally reduced uptake of iodine-131

Question 35

x is the key parameter to monitor in patients with hyperosmolar hyperglycaemic state

Answer 35

Serum osmolality

Question 36

Primary hyperaldosteronism (Conn's syndrome) symptoms

Answer 36

-Hypertension -Hypokalaemia (e.g. muscle weakness) -Metabolic alkalosis

Question 37

Primary hyperaldosteronism causes

Answer 37

bilateral idiopathic adrenal hyperplasia (60-70% of cases) adrenal adenoma (20-30% of cases) unilateral hyperplasia familial hyperaldosteronism adrenal carcinoma

Question 38

Primary hyperaldosteronism first line investigation?

Answer 38

a plasma aldosterone/renin ratio should show high aldosterone levels alongside low renin levels (negative feedback due to sodium retention from aldosterone)

Question 39

In toxic multinodular goitre, nuclear scintigraphy reveals

Answer 39

patchy uptake

Question 40

hypokalaemic metabolic alkalosis

Answer 40

Cushing's syndrome

Question 41

Whipple's triad of symptoms of

Answer 41

1) hypoglycaemia with fasting or exercise, 2) reversal of symptoms with glucose, and 3) recorded low BMs at the time of symptoms is hallmark for an insulinoma

Question 42

Causes of raised prolactin - the p's

Answer 42

pregnancy prolactinoma physiological polycystic ovarian syndrome primary hypothyroidism phenothiazines, metoclopramide, domperidone

Question 43

T2DM initial therapy: if metformin is contraindicated + patient has a risk of CVD, established CVD or chronic heart failure →

Answer 43

SGLT-2 monotherapy (dapagliflozin)

Question 44

Hypertension in diabetics - x are first-line regardless of age

Answer 44

ACE inhibitors/A2RBs

Question 45

x test is the best test to diagnosis Cushing's syndrome

Answer 45

The low-dose (overnight) dexamethasone suppression

Question 46

PHaeochromocytoma - give x before beta-blockers

Answer 46

PHenoxybenzamine

Question 47

x is associated with atrial fibrillation, osteoporosis and possibly dementia

Answer 47

Subclinical hyperthyroidism

Question 48

Myxoedemic coma is treated with x

Answer 48

thyroxine and hydrocortisone

Question 49

Hypercalcaemia sx

Answer 49

Stones (renal) Bones (bone pain) Groans (abdominal pain, nausea and vomiting) Thrones (polyuria) Psychiatric overtones (confusion and cognitive dysfunction, depression, anxiety, insomnia, coma)

Question 50

HHS or DKA? - x has no acidosis/significant ketosis, the history is longer and the glucose is often significantly raised eg >30mmol/L

Answer 50

HHS

Question 51

Low serum calcium, low serum phosphate, raised ALP and raised PTH -

Answer 51

osteomalacia

Question 52

Medullary thyroid cancer, hypercalcaemia, phaeochromocytoma -

Answer 52

multiple endocrine neoplasia type IIa