endocrine

Question 1

what is the role of ADH

Answer 1

acts on CD to reabsorb water from urine

Question 2

pathophys of diabetes insipidus

Answer 2

no ADH so kidneys cant concentrate urine as cant reabsorb water from the urine

causes polyuria and polydispsia because blood is so concentrated

Question 3

what is primary polydipsia

Answer 3

drinking XS water causing polyuria and polydipsia

Question 4

types of diabetes insipidus

Answer 4

nephrogenic
cranial

Question 5

causes of nephrogenic DI

Answer 5

lithium
AVPR2 gene on Xchr
intrinsic kidney disease
electrolytes -> hypoK, hyperCa

Question 6

causes of cranial DI

Answer 6

hypothalamus doesnt produce ADH for posterior pituitary to secrete

idiopathic
iatrogenic
tumour
meningits
TB

Question 7

symptoms of DI

Answer 7

polyuria
polydipsia
dehydration
postural hypotension
hyperNat

Question 8

IX and results of these in diabetes insip

Answer 8

UE-> hypernat
urine osmol = low
high serum osmol
water deprivation test

Question 9

explain water deprivation test

Answer 9

no fluids for 8 hours
measure urine osmol
then desmopressin given
8 hours later then
measure urine osmol again

Question 10

water dep test for cranial DI

Answer 10

after dep = low urine
after desmopressin = high urine osmol

as kidneys can still respond to ADH so can then dilute urine once desmopressin is given

Question 11

nephrogenic DI water dep test results

Answer 11

after 8 hours water dep = low
after desmo = low

Question 12

primary polydipsia water deprivation results

Answer 12

high after deprivation so dont need to give desmopressin as DI is already ruled out by this result

Question 13

BP target for diabetic pt

Answer 13

<140/90 clinic
<135/85 AMBP

Question 14

what is max dose of metformin

Answer 14

1g BD

Question 15

prolactinoma vs somatroph pituitary adenoma

Answer 15

both may cause compressive symptoms such as headache or visual changes.
prolactinoma
- fertility and period problems

pituitary adenoma
- acromegaly symptoms
such as enlarged nose/forehead or hyperhydrosis, deepening of voice

Question 16

appropriate dose of oral glucose if hypoG patient is able to eat/swallow

Answer 16

10-20g of glucose in the snack/gel

Question 17

causes of raised prolactin

Answer 17

Causes of raised prolactin - the p’s

pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metocloPramide, domPeridone

Question 18

first line insulin regimen in kids?

Answer 18

multiple daily injection basal-bolus insulin regimen

Question 19

diagnostic investogation results for DM

Answer 19

fasting > 7.0
random > 11.1

if asymptomatic need two readings

Question 20

tx of myxoedemic coma

Answer 20

thyroxine and hydrocortisone IV

Question 21

addisonian crisis vs myxoedemic coma

Answer 21

both will have low BP

myx will have significant weight gain (fluid overload) and dry skin

Question 22

1st line IX for phaechromocytoma

Answer 22

urinary metanepherines

has replaced catecholamines

Question 23

LH/FSH and testosterone in kallmans and klinefelters

Answer 23

kALLmans (ALL low)
- low LH/FSH, low testosterone

Klinefelters
- high LH/FSH with low testosterone

Question 24

ramadan changes to meformin regime?

Answer 24

normal dose:
one-third = before sunrise
two-thirds = after sunset

Question 25

monitoring blood test for carbimazole

Answer 25

FBC for agranulocytosis

Question 26

reasons for falsely low HBA1c readings

Answer 26

G6PD def sickle cell hereditary spherocytosis all reduce the lifespan of an RBC

Question 27

reasons for falsely high HBA1c readings

Answer 27

splenectomy lifecycle of RBC is increased so there is more time for glycolysation of RBC

Question 28

mx of phaeochromocytoma

Answer 28

surgery is definitive before need to stabilise with alpha then beta blocker eg phenoxybenzamine/phentolamine (non-selective) then propranolol ABC aplha beta cut this is done as blocking alpha stops vasoconstriction so if we blocked beta first there would unopposed v.con = hypertensive crisis = cardiac arrest

Question 29

what is the tx for high prolactin

Answer 29

cabergoline

Question 30

neuropathic conditions caused by diabetes

Answer 30

gastroparesis - tx with metoclopramide - will have erratic blood glucose levels peripheral neuropathy - tx with duloxetine, amitryptyline etc

Question 31

how to calculate serum osmolality

Answer 31

GUNN glucose + urea + NA +NA

Question 32

what is trousseaus sign

Answer 32

carpal spasm on inflation of BP cuff to pressure above systolic due to hypocalcaemia

Question 33

blood test results for pagets

Answer 33

high ALP calcium is normal

Question 34

ix for acromegaly

Answer 34

first do IGF1 -> if raised then do OGTT (high) and serial glucose measurements to confirm diagnosis

Question 35

advise to give when taking levothyroxine

Answer 35

take calcium or iron supplements 4 hours after/ before affects absorption

Question 36

TSH low and T4 low?

Answer 36

secondary hypothyroidism cause is central therefore need to do an MRI rather than anti-TPO usually pituiary insufficiency

Question 37

symptoms for kallmans syndrome

Answer 37

Tallman, Small-ballman, Can't smell at allman!!!

Question 38

when to treat subclinical hypothyroidism

Answer 38

if the TSH level is > 10 mU/L on 2 separate occasions 3 months apart

Question 39

symptoms for men 1

Answer 39

Peptic ulceration, galactorrhoea, hypercalcaemia

Question 40

Peptic ulceration, galactorrhoea, hypercalcaemia points to a diagnosis of?

Answer 40

MEN 1