Endocrine

Question 1

Name the features that suggest severe DKA

Answer 1

• Blood ketones > 6mmol/l
• Bicarbonate < 5mmol/l
• Blood pH <7.1
• Hypokalaemia
• GCS <12
• Sats <92%
• Systolic BP <90mmHg
• Tachycardia or bradycardia

Question 2

Describe the management of DKA

Answer 2

Hour 1: 1L 0.9% saline and Actrapid
Hour 2: 1L 0.9% saline and continue actrapid while BG>14
Hour 3: 500ml 0.9% saline +/- KCl
Hours 4-discharge: reduce rate of saline and restart s/c regime when eating and drinking

Question 3

Name the potential complications of DKA

Answer 3

• Hyper and hypokalaemia
• Hypoglycaemia
• Rebound ketosis
• Arrhythmias
• Acute brain injury
• Cerebral oedema
• Aspiration pneumonia
• Arterial and venous thromboembolism
• ARDS

Question 4

How does diabetic retinopathy present?

Answer 4

• Non-proliferative: retinal capillary dysfunction, platelet dysfunction and blood viscosity abnormality
• Proliferative: retinal ischaemia, new blood vessel formation, vitreous haemorrhage and retinal tears/detachment

Question 5

How does hyperosmolar hyperglycaemic state present?

Answer 5

• Usually T2DM
• Osmolality >320mOsm/kg
• Hyperglycaemia > 30mmol/l

Question 6

What causes HHS?

Answer 6

• Inadequate insulin/non-compliance
• Acute illness
• Endocrine
• Drugs: B-blockers, anti-psychotics, steroids and immunosuppressants

Question 7

How is HHS managed?

Answer 7

• IV fluids
• IV insulin
• IV potassium
• Gradual treatment
• Treat underlying causes

Question 8

Name the options for managing hypoglycaemia

Answer 8

• 15-20g quick acting carbohydrates
• 1.5-2 tubes of glucogel
• 1mg Glucagon IM
• IV glucose: 75ml 20% or 150ml 10% glucose

Question 9

How can type 2 diabetes be managed?

Answer 9

• 1st line: metformin or sulfonylurea
• 2nd line: Thiazolidinedione, DPP-IV inhibitor or SGLT-2 inhibitor
• 3rd line: any of the 2nd line agents + GLP-1 agonist or insulin

Question 10

Give two examples of sulfonylureas

Answer 10

• Glimepiride

- Gliclazide

Question 11

Give an example of a thiazolidinedione

Answer 11

Pioglitazone

Question 12

Give an example of a DPP-IV inhibitor

Answer 12

Sitagliptan

Question 13

Give an example of a SGLT-2 inhibitor

Answer 13

Empagliflozin

Question 14

Give an example of a GLP-1 agonist

Answer 14

Lixisenatide

Question 15

Name some of the side effects of metformin

Answer 15

• Lactic acidosis
• Nephrotoxic
• GI side effects

Question 16

Name some of the side effects of sulphonylureas

Answer 16

• Hypoglycaemia
• Weight gain
• Blood disorders

Question 17

Name some of the side effects of thiazolidinediones

Answer 17

• Fluid retention
• Weight gain
• Fractures in females

Question 18

Name some of the side effects of DPP-IV inhibitors

Answer 18

• Headaches
• Changes in bowel movements
• Gallstones
• Pancreatitis

Question 19

Name some of the side effects of GLP-1 agonists

Answer 19

• Acute pancreatitis
• Nausea and vomiting
• Renal impairment
• Atrioventricular block

Question 20

Name some of the side effects of SGLT-2 inhibitors

Answer 20

• UTIs
• URTI
• Increased urination
• Dyslipidaemia
• Genital yeast infections

Question 21

At which HbA1c level should you consider adding another diabetes drug?

Answer 21

58mmol

Question 22

Describe the TFT results for primary hypothyroidism

Answer 22

• Raised TSH
• Low T4
• Compensated: raised TSH and normal T4

Question 23

Describe the TFT results for secondary hypothyroidism

Answer 23

• Low TSH

- Low T4

Question 24

How would a solitary thyroid nodule be investigated?

Answer 24

• TFTs
• USS
• FNA

Question 25

Name the types of thyroid cancer

Answer 25

- Papillary (commonest) - Follicular - Anaplastic - Lymphoma - Medullary (MEN 2)

Question 26

How does subacute thyroiditis present?

Answer 26

- Young patients - Viral trigger - Painful goitre +/- fever/myalgia and raised ESR

Question 27

How can subacute thyroiditis be managed?

Answer 27

Short term steroids and NSAIDs

Question 28

How can hypercortisolism be investigated?

Answer 28

- Overnight dex test - 24 hour urine free cortisol - ACTH cortisol - MRI/CT

Question 29

How can hyperaldosteronism be investigated?

Answer 29

- Plasma aldosterone renin ratio - 24 hour urine aldosterone - CT scan of adrenal glands - Adrenal vein sampling - Potassium (hypokalaemia)

Question 30

How does a phaeochromocytoma present?

Answer 30

- Hypertension - Headache - Sweating and palpitations - Tremor - Pallor - Anxiety/fear

Question 31

What are the different types of hyperparathyroidism?

Answer 31

- Primary: parathyroid gland produces excess PTH - Secondary: low calcium because of kidney, liver or bowel disease - Tertiary: autonomous secretion of PTH because of CKD

Question 32

How can acromegaly be investigated?

Answer 32

- Blood glucose - IGF-1 - OGTT - MRI Pituitary - Visual field tests

Question 33

How can acromegaly be managed?

Answer 33

- Trans-phenoidal surgery - Radiotherapy - Octreotide and lanreotide

Question 34

How can Cushing's syndrome be investigated?

Answer 34

- FBC and U&Es - 24 hour urinary free cortisol - Low dose dexamethasone suppression test - Midnight cortisol levels - Plasma ACTH test

Question 35

How can Cushing's syndrome be managed?

Answer 35

- Tumour removal - Metyrapone and ketoconazole - Pituitary radiotherapy

Question 36

How can diabetes insipidus be managed?

Answer 36

- Cranial: desmopressin | - Nephrogenic: well hydration, correct metabolic abnormalities and desmopressin (+ NSAIDs and thiazide diuretics)