TBL ans

Question 1

if given prednisolone and fludrocortisone for addisons what advice should you be given regarding the meds

Answer 1

to double dose of pred if she becomes unwell eg fever

Question 2

if a pt presents with aches and pains, normal renal func, high ca, low phos, slightly low vit d, high PTH what is the diagnosis

Answer 2

primary hyperparathyroidism
when have high ca and pth - primary/tertiary
when normal renal func (ie no CKD) it cannot be tertiary so is primary
not secondary because wouldn’t have high ca- at max it would be low normal if parathyroid glands had compensated
not hypercalacaemia of malignancy - ca would be released from cancer which would cause low pth by -ve feedback
tertiary - renal failure means you cant hydroxylase vit d so produce a lot of pth to increase ca, then glands become autonomous if you don’t treat renal problem because they are so busy

Question 3

pt with weight loss, tremor, palpitations, apyrexial, sweaty and tachycardic, smooth diffuse goitre and bilateral exophthalmos - blood tests confirm she is hyperthyroid - what are the next steps of management

Answer 3

a non-selective b blocker and thionamide (carbimazole, and propylthiouracil)
give B blocker to control symptoms while waiting for the clinical effect of the thionamides

Question 4

man with t2dm - has HbA1c on the limit of high, non smoker, high bp, currently only on metformin, urine sample contains microalbuminuria - what should he be offered next

Answer 4

an ace inhibitor and on-going review of his bp

Question 5

what benefit is progesterone only contraceptives

Answer 5

less thromboembolic risks compared to combined oestrogen/progesterone oral contraceptive

Question 6

how does ghrelin stimulate appetite

Answer 6

activation of the arcuate neuropeptide Y (NPY)/Agrp neurons

Question 7

how does cabergoline reduce the serum prolactin

Answer 7

activation of lactotroph dopamine receptors

Question 8

what limits the use of HbA1c

Answer 8

iron def anaemia

Question 9

pt with history of weight gain and difficulty climbing stairs, plethoric face, centripedal obesity, abdo striae, high BMI, hypokalaemia, high BP - what investigation is needed to confirm the diagnosis

Answer 9

low dose dexamethasone suppression test

Question 10

what is a normal response to water deprivation

Answer 10

increased water absorption from renal collecting ducts

Question 11

drug used to slow down hr in hyperthyroidism

Answer 11

propranolol

Question 12

in hyperthyroidism what happens to your hands if you stretch your arms out and look carefully

Answer 12

tremor

Question 13

rapid mental changes that occur in hyperthyroidism

Answer 13

mood swings

Question 14

treatment for primary hypothyroidism

Answer 14

levothyroxine

Question 15

hormones that increase in preg

Answer 15

lh fsh

Question 16

why would very high prolactin be hyperprolactinoma

Answer 16

hyperprolactinoma secretes prolactin
non-func pit adenoma can block the pit stalk and stop dopamine entering - meaning loss of inhibition of prolactin production - this would cause a small increase in prolactin but nothing like the levels of a prolactinoma

Question 17

things that mean you cant have combined oral contraceptive pill and why

Answer 17

over 35
high bmi - put at risk of clot 
smoking
hypertension 
FH of clotting - means have hereditary thrombophilia 

these are contraindications for oestrogen which is thromboembolotic
could have combined med as a patch - just not orally because of the 1st pass metabolism