teach

Question 1

weight agin woman, straie, puff facial high BP and blood sugar
low dose dexamethasone overnigth test shos raised cortisol
high dose voernigth both cortisol adn ACTh levels suppressed what is the cause

Answer 1

piutitary adenoma

Question 2

cushing disease is caused by what

Answer 2

has to be caused by ACTh secreting pituiary adenoma

so all disease can be syndrome but not other way

Question 3

diagnosing cushings sydnrome

Answer 3

first line low dose dexamethasone - person already got raised level of steriod so not good at repsonidng to negaitve feedback - even though given steriod body wont respond so get hgh cortisol
low cortisol would be normal

high dose dexamethasone (8mg) test, CT chest and abdo , MRI head

cushings disease is where you have pituitaury adenoma secreting ACTH which we knwo prodcues cortisol.
more adrenal activity in this condtion making my cortisol

with high dose dexa - pituitary adenoma will respond so decreasing activity decrease ACTH so les cortisol so both of them low

adrenals cushings - adrenal glands are producing loads of cortisol indepedent of ACTh and piutiatry - maybe tumour. less ACTH and high cortisol

high cortisol and high acth - ACTh secreting ectopic tumour - after dexamethasone - no negative feedback loop

Question 4

mx of cushings

Answer 4

metyrapone, ketoconazole, mifepristoen, pasireotide

adenoma - trans sphenoial surgery
tumours - adrenal surgical resection
surgicla resect AACTh secreting tumour

Question 5

28 yr old lady who is 24w preg offered OGTT because mother has T2DM. fasting at 6.2 and 2hour 8.4. BMI 29 no PMH what management do you do

Answer 5

trial of diet and exercise

she has gestational diabetes

Question 6

management of gestation db in preg on db in opreg

Answer 6

gestational
if 7 a booking or over 6 with macrosomnia or polyhydraminios
then insulin
alternative is gibenclamide

if less than 7 trial of diet and exercise for 1-2 weeks
fail to meet give metformin then if not insulin

pre existing diaebtes - stop orla antihypertensives - start insulin , add folic acid from preconecption to 12 weeks
75mg of asprin from 12 week birth - risk of pre-eclmapsia
detialed preg scan - 4 chamber of heart - increase rx TGA

Question 7

what is a risk factor for TGA

Answer 7

pre existing diabetes
not gestational

Question 8

tumour of chromaffin cells

Answer 8

phaechromocytoma

Question 9

adernaline adn sympathetic sx with phaechromocytoma

Answer 9

hypertension
palpitations
anxiety
tremour
weigth loss
abdo pain
fatigue
sweating
pyrexia
headaches
flushing
dyspnoea

Question 10

dx pheochromocytoma

Answer 10

low suspicion - urinary metanephrines
high risk - plasma metanephrines
either postive then CT/MRI abdo /pelvis

biochemical first then scan

Question 11

Tx for phao

Answer 11

surgery and then beta blocker and

Question 12

test for soemone with large jaw, teeth have gradullay formed large gaps, hands and feet grown - acromegaly

diagnosis for them 3 lines

Answer 12

serum insulin like growth factor levels

if these rasied then what

OGTT

then growth hromones - insulin shoudl suppress GH

MRI pituitary

Question 13

mx acromegaly

Answer 13

trasnsphenoidal surgery

if not

somatostatin or pegvisomant or cabergoline or radiotherapy

echo and colonoscopy every 5 years

Question 14

what repeat exmaination due you need to do every 5 years

Answer 14

echo and colonoscopy every 5 years =- risk of bowel cancer

replace all hromones taken out

Question 15

poorly ocmtroll ed type2 , very cofnused, nausea, vomit, lethargi and weak, weak thredy peripheral pulse, dry mucou smemrvanes, high blood suggar - hyperosmolar hyperlglycaemic state - high sugar

Answer 15

1.0 1l saline need to be given

Question 16

HHS - T2DM - triggered my infection, low GFR and meds causing fluid loss, imapired glucose tolerance

sezirures , confusion, dehydrated
severe hyper over 30 , low BP, hyperosmolaility
no acidosis or ketosis

DK - T1DM - infectiojn dehydration, ,isssed dose , fasting
acetone breasth, polydip and uria, kussmal breathing
glucose over 11
acidosis and ketone

what is HHS management if shocked

Answer 16

500ml 0.9 saline bolus - still shcoke deliver another 500ml and then to below

if not shocked 1l 0.9% saline over 60mins with or without potassium

now

0.05unit/kg/hr insulin infusion and continue any long acting insulin as normal

then VTE prophylaxis giving LMWH

potassium repalcement
if over 5.5 no potassium
3.5-5.5 40mmol
under 3.5 senior review as additonal potsassium

Question 17

DI is when the boy either does not produce enough ADH or does no respond to it hwen excreted

urine very dilute and low sodium

Question 18

malrotation in child treatment

Answer 18

ladds manourve