Endocrine

Question 1

Causes of hyperandrogenism
1+2+3+3

Answer 1

Ovarian
- benign or malignant ovarian tumours
Adrenal disease
- CAH
- Benign or malignant adreanl tumourse
Pituitary disease
- Cushings Syndrome
- Acromegaly
- prolactinoma
Other
- Obesity
- Metabolic syndrome
- Medications

Question 2

Skin flushing + diarrhoea + valvular heart disease

Answer 2

Carcinoid syndrome
- hormone secretion from carcinoid cells/tumour
- other features: wheezing, hypotension, telengectasia
- Dx 24hr urine 5-hydroxyindoleacetic acid

Question 3

Individual goals for T2DM (6)

Answer 3

Essentially SNAWAP (but BSL at end)
1. Diet - as per Australian dietary guidelines
2. BMI - 5-10% weight loss for overweight/obese
3. Physical activity - 150mins/wk
4. Smoking - CEASE
5. Alcohol - <2 STD per day
6. BSL - for insulin, pregnancy, or anyone who is at risk

Question 4

DDx for primary amenorrhoea (no menses by 16) (6)

Answer 4

1. Constitutional delay (FHx of delayed puberty)
2. Hypothalamic dysfunction (excessive exercise, caloric restriction)
3. PCOS (S+Sx hyperandrogenism: hirsutism, acne, abnormal hair growth)
4. Prolactinoma (Galactorrhoea, headaches, visual changes)
5. Hypothyroid (cold intolerance, weight gain)
6. Imperforate Hymen (cyclical abdo or pelvic pain)

Question 5

Contra-indication for DPP4 inhibitors (gliptins)

Answer 5

Pancreatitis, or PMHx of pancreatitis

Question 6

Non-modifiable (2) + Lifestyle (7) risk factors for OP

Answer 6

Non Modifiable
- Age >70
- Parent with hip fracture
Lifestyle
- Falls/poor balance
- Low physical activity/immobility
- Low body weight
- Low muscle mass
- Protein/calcium malnutrition
- Vit D insufficiency
- Smoking/Alcohol >2STD/day

Question 7

Non pharma management of OP (3+3)

Answer 7

1. Calcium >1300mg/day
2. Vit D - correcct <50 if treating OP
3. Adequate protein in diet
4. Mod-vig strengthening exercise 2+ days/week
5. Weight bearing exercise most days
6. Balance training, should be challenging

Question 8

KFP: Screening Ix for pt with T1DM (7)

Answer 8

1. HbA1c
2. UEC
3. UrACR
4. TSH (screen for autoimmune)
5. Coeliac serology (autoimmune)
6. Fasting lipids (every yrs at min)
7. LFT (MAFLD increased in T1DM)

Question 9

KFP: Advice for diabetic with non commercial license re driving (other than needing annual review)? (3)

Answer 9

1. Advise not to drive if BSL <5
2. Advise check BSL for every 2hours during a journey
3. Advise if any symptoms occur, safely pull over, turn the car off and remove the keys from ignition

Question 10

Complication to be aware of with SGLT2-i (gliflozins)

Answer 10

DKA (often normoglycaemic)
- consider in acute illness, dehydration, lo carb diet or fastin

Question 11

Pt with tiredness, high sodium, low potassium, HTN

Answer 11

Hyperaldosteronism / Conn Syndrome

Question 12

Features of Addisons Disease
- 3 symptoms, 3 exam findings, 3 investigationss

Answer 12

Sx: Fatigue, weight loss, abdo pain
Ex: Hypotension, skin hyperpigmentation, Loss of axillary/pubic hair
Ix: HypoNa+, HyperK+, hypoglycaemia

Question 13

Test for suspected Cushings

Answer 13

Overnight 1mg Dexamethasone supression test

Question 14

Criteria for GDM diagnosis? (3)

Answer 14

1. Fasting BSL >5.5
2. 2hr BSL >8.0
3. If meets DM diagnostic criteria = DMiP rather than GDM

Question 15

Excluding insulin - 5 classes of diabetic drugs + eg

Answer 15

1. Biguanide (Metformin)
2. Sulfonylurea (Glicazide, glimepreride)
3. DPPT-inhibitors = Gliptins
4. SGLT2-inhibitors = Flozins
5. GLP1 RA - semagluide, dulaglutide, liraglutide

Question 16

Metformin dosing in CKD (3)

Answer 16

Max 2g if eGFR >60
Max 1g if eGFR 30-60
Dont use if eGFR <30

Question 17

DDx for short stature in children (5)

Answer 17

1. Constitutional Delay
2. Familial Short stature
3. Hypothyroidism
4. GH deficiency
5. Malabsorptive if relevant (Coeliac)

Question 18

DDx for androgen deficiency in male (3+3)

Answer 18

Primary - Kleinfelters, testicular torsion, previous chemo
Secondary - Pituitary tumour, haemachromatosis, exogenous test

Question 19

Feet exam for peripheral neuropathy (4: 1/3 + 3)

Answer 19

1. Sensation
   Small fibre - pinprick sensation
   Large fibre
   - vibration using 128Hz fork
   - 10g monofilament pressure sensation at distal plantar great toe + MT joints
   - ankle reflexes
2. Pulses
3. Foot deformity
4. Active lesion/ulcer

Question 20

Pt with OP risk factors but no fracture. Has a DEXA scan. What are your cut-offs for treatment? (1,2)

Answer 20

1. T <-2.5
2. T score -1.5 to -2.5
   -> Check FRAX result
   If risk of MOF# >20% or Hip# >3%

Question 21

DDx for precocious puberty (3)

Answer 21

1. Idiopathic central precocious puberty
2. Adrenal tumour OR CAH
3. Ovarian tumour OR functional ovarian cyst