Passmedicine Flashcards
A 70-year-old patient is brought to the emergency department. She has a GCS of 11. Her relatives tell you that she has been drinking large amounts of water in order to remain well hydrated during the hot weather. You find that she has a sodium level of 108 mmol/l. Her most recent sodium was 131 mmol/l when last checked 3 weeks ago. What is the underlying pathology by which acute hyponatraemia is causing her reduced GCS?
Central pontine myelinolysis Concurrent hypoglycaemia Intracranial haemorrhage Cerebral oedema Cerebral vasospasm
Acute severe hyponatraemia can cause cerebral oedema
A 48-year-old man presents to his GP with a 3-year history of hypertension that has been difficult to bring under control. No medication has been successful in reducing his blood pressure significantly. Accompanying the high blood pressure are muscle weakness and nocturia.
On examination, his blood pressure is 164/82 mmHg. Blood tests demonstrate low potassium and high aldosterone-to-renin ratio.
Given the likely diagnosis, which of the following is the most likely cause of this patient’s presentation?
Adrenal adenoma Adrenocortical carcinoma Bilateral idiopathic adrenal hyperplasia Ectopic aldosterone-producing adenoma Unilateral adrenal hyperplasia
Bilateral idiopathic adrenal hyperplasia is the most common cause of primary hyperaldosteronism
A 35-year-old female is referred to the endocrine clinic due to weight loss and palpitations. The following results are obtained:
TSH < 0.05 mu/l
T4 178 mmol/l
Which one of the following features would most suggest a diagnosis of Grave’s disease?
Atrial fibrillation Lid lag Family history of radioiodine treatment Pretibial myxoedema Multinodular goitre
Pretibial myxoedema is not seen in other causes of thyrotoxicosis and points towards a diagnosis of Graves’
A 47-year-old male visits the GP for review and a routine blood check. He has a past medical history of angina, hypertension, asthma and hyperlipidaemia. You look to his medications which shows an extensive polypharmacy including fenofibrate. This drug lowers triglyceride levels and increases high-density lipoprotein (HDL) synthesis.
What is the mechanism of this drug?
A. Inhibition of hepatic diacylglycerol acyltransferase-2
B. HMG-CoA reductase inhibitor
C. Activation of PPAR receptor resulting in increase lipoprotein lipase (LPL) activity
D. Reduction in the reabsorption of bile acids
E. Increased production of apolipoprotein E by the liver
Fibrates work through activating PPAR alpha receptors resulting in an increase in LPL activity reducing triglyceride levels
C. Activation of PPAR receptor resulting in increase lipoprotein lipase (LPL) activity
An 80-year-old man is admitted with a 3 month history of gradual decline and dizziness on standing, followed by a 3 day history of inability to mobilise, general weakness and nausea. The medical consultant asks you to perform a short synacthen test which returns as normal. Which cause of adrenocortical insufficiency has not been excluded?
A. Infiltration of the adrenal gland by amyloidosis
B. Enlarging pituitary malignancy
C. Haemorrhage into the adrenal gland
D. Autoimmune adrenal failure
E. Infiltration of the adrenal gland by tuberculosis
Enlarging pituitary malignancy
A normal short synacthen test does not exclude adrenocortical insufficiency due to pituitary failure
The short Synacthen test is a method of excluding adrenal insufficiency. A baseline cortisol level is taken, IV synthetic ACTH is then administered and a second cortisol level is taken 30 minutes later. If the cortisol post ACTH rises to > 420 nmol/L at 30 minutes, the adrenal response to ACTH is adequate and Addison’s disease (adrenal failure) can be excluded.
However, this excludes only primary adrenal failure and does not exclude cortisol deficiency secondary to failure of the pituitary to produce ACTH. The correct answer is therefore pituitary failure due to damage by an enlarging malignancy. The other answers all cause damage to the adrenal gland.
A 33-year-old female is referred to endocrinology with thyrotoxicosis. Following a discussion of management options she elects to have radioiodine therapy. Which one of the following is the most likely adverse effect?
Hypothyroidism Thyroid malignancy Agranulocytosis Oesophagitis Precipitation of thyroid eye disease
It is well documented that radioiodine therapy can precipitate thyroid eye disease but a majority of patients will eventually require thyroxine replacement
Which of the following is least recognised as a potential complication of acromegaly?
Colorectal cancer Hypertension Cardiomyopathy Diabetes mellitus Pulmonary hypertension
Acromegaly is associated with systemic rather than pulmonary hypertension.
Secondary causes of pulmonary hypertension include COPD, congenital heart disease (Eisenmenger’s syndrome), recurrent pulmonary embolism, HIV and sarcoidosis.
26-year-old obese female is investigated for menstrual disturbance. A diagnosis of polycystic ovarian syndrome is made. Which of the following findings is most consistently seen in polycystic ovarian syndrome?
Obesity Hirsutism Ovarian cysts on ultrasound Raised LH:FSH ratio Clitoromegaly
Ovarian cysts on ultrasound
