endocrinology

Question 1

Cushing syndrome: investigation (3)

Answer 1

one of the following

• Overnight 1mg Dexamethasone suppression test
• 24 hrs urine cortisol collection (x2 reading)
• Late night salivary cortisol level (x2 reading)

Question 2

Conn’s disease: investigation (1)

Answer 2

Aldosterone / renin ratio

Question 3

Addison disease- investigation (3)

Answer 3

Short Synacthen test (ACTH stimulation test)
plasma renin - elevated
morning ACTH level - elevated

Question 4

Addison disease - key aspect of self-care (4)

Answer 4

• Increase glucocorticoid dose when in stress, surgery, trauma
• Aware of C/F of adrenal crises (N/V/D)
• Carry injectable glucocorticoid
• Wear an alert bracelet or necklace

Question 5

Addison disease- Physical examination (4)

Answer 5

1. hypotension-orthostatic
2. loss of pubic and axillary hair
3. hyperpigmentation
4. dehydration

Question 6

Addison crises- immediate management (5)

Answer 6

1. x2 large IV cannula
2. IV normal saline 500mg bolus
3. hydrocortisone 100mg then 50mg IV q6h
4. treat hyperkalaemia
5. seek immediate advice from a tertiary hospital

Question 7

Cushing disease- when to suspect? (9)

Answer 7

1. uncontrolled hypertension
2. moon face
3. proximal myopathy
4. central obesity
5. hirsutism
6. osteoporosis in young adults
7. easy bruising
8. menstrual abnormality
9. hyperglycaemia

Question 8

diabetes Insipedus- causes

Answer 8

A. Central
     1. head trauma
     2. pituitary adenoma
     3. infection
B. nephrogenic
     1. Li+
     2. Ca++
     3. alcohol
     4. sickel cell aneamia
      5. Sjogren disease

Question 9

diabetes Insipidus- investigation (3)

Answer 9

1. decrease urine osmolarity
2. increase S. Na+
3. increase serum osmolarity

Question 10

diabetes Insipidus- treatment (2)

Answer 10

1. Central - desmopressin 10mcg intranasal spray daily

2. nephrogenic- HCT (Hydrochlorothiazide)

Question 11

SIADH-causes (2)

Answer 11

1. CNS: tumor, trauma, infection

2. Lung: small cell cancer, lung abscess

Question 12

SIADH- investigation (3)

Answer 12

1. increase urine osmolarity
2. decrease S. Na+
3. decrease Serum osmolarity

Question 13

SIADH- treatment (3)

Answer 13

1. water deprivation < 1L/day
2. replace Na+ slowly
3. demeclocycline or Li+

Question 14

Pheochromocytoma- C/F (5)

Answer 14

1. headache
2. hypertension
3. sweating
4. palpitation
5. tremor

Question 15

Pheochromocytoma- Ix (1)

Answer 15

24 hours urine collection for catecholamines

Question 16

Pheochromocytoma- Rx (2)

Answer 16

1. alpha-blocker: phenoxybenzamine

2. surgery

Question 17

DKA- management (5)

Answer 17

1. x2 large IV cannula
2. normal saline
3. Insulin infusion
4. correct K+ level
5. monitor glucose level hourly

Question 18

DKA- definition criteria (D,K,A)

Answer 18

1. Glucose > 15 mmol/L
2. Ketones in urine +ve
3. PH < 7.35, HCO3 < 18
   2.

Question 19

carcinoid-C/F

Answer 19

1. facial flush
2. diarrhoea
3. hypotension
4. wheeze

Question 20

carcinoid-Ix

Answer 20

24 hours urine 5-hydroxyindoleacetic acid