Endocrinology Module 2

All of the following drugs are known to cause hyperthyroidism except?

All of the following drugs are known to cause low serum TBG except?

What is the most specific test for Graves disease?

A patient presents with fever,malaise, neck pain and painful dysphagia. Blood test shows low TSH and High T4.

What is the most likely diagnosis?

Which of the following does NOT cross the placenta from mother to foetus?

Which of the following lipid-lowering drugs works primarily by the upregulation of low density lipoprotein (LDL) receptor activity?

Hypoglycaemia unawareness is predominantly due to failure of secretion of which one of the following hormones?

A 28-year old woman presents five weeks post-partum with new-onset headaches, fatigue and sudden cessation of lactation. Her blood pressure is 85/60.

The first step that you would take is:

An asymptomatic patient presents for investigation of hypercalcaemia.

His mother has a similar diagnosis three years ago. She had a parathyroidectomy that was unsuccessful in treating her raised calcium level.

• Serum Calcium is 2.8 (2.1 – 2.6 mmol/L)
• Phosphate is 0.8 (0.75- 1.45 mmol/L)
• PTH is normal.

What is the most appropriate investigation?

A 38 year old woman presents with a two year history of weight gain, hypertension and easy bruising. Clinical examination reveals thin skin, facial hirsutism and proximal muscle weakness. Cushing’s syndrome is suspected. The results of a 1 mg dexamethasone suppression test demonstrated a plasma cortisol of 296 nmol/L at 0800 hours the following morning (normal < 100 nmol/L). 24 hour urinary free cortisol is 1523 nmol/24 h (normal < 350 nmol/24h).

The most appropriate investigation to perform NEXT is:

A 27-year old woman with type 1 diabetes presents for review and reports frequent unexplained hypoglycaemic episodes in the past three weeks.

The MOST important test to request is:

A 72-year old woman presents with back pain and is found to have a vertebral fracture at T7. Bone mineral densitometry shows that she has osteoporosis. You write out a prescription for a bisphosphonate and counsel her about the potential side-effects of this medication.

Which ONE of the following is NOT a recognised potential side effect of a bisphosphonate?

A 31-year old woman with a body mass index of 42 kg/m2 is attending for ante-natal care.

Because of her obesity, the pregnancy has an increased risk of all of the following, EXCEPT:

A 65-year old man presents with a ten year history of hypertension. His current medications are metoprolol, irbesartan, ramipril and hydrochlorothiazide. On examination, his BP is 160/90 and his heart rate is 60 bpm. His BMI is 34 kg/m2.

Investigations showed:

• Serum Na+ 145 mmol/L
• Serum K+ 3.0 mmol/L
• Plasma aldosterone 499 pmol/L (55 – 250)
• Plasma renin activity < 0.16 ng/L/hr
• Elevated plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio.
• Measurement of urinary aldosterone on a high salt diet confirmed the presence of primary hyperaldosteronism.
• A CT abdomen shows a left adrenal mass.

The NEXT best step in the management of this patient is:

A 61-year old man with type 2 diabetes attends your clinic for an annual review. He had just been discharged from hospital a week ago following a NSTEMI. He takes metformin 500 mg bd for glycaemic control, irbesartan for HT and mini-dose aspirin. He has recently had fundal screening and there is no evidence of retinopathy.

His investigations show:

• HbA1c 6.5% Ur alb/cr ratio 4.6
• Total cholesterol 4.2 mmol/L
• Triglycerides 2.3 mmol/L
• A carotid doppler shows bilateral stenoses of 15 – 30% (asymptomatic)

With respect to his lipid profile, what is your next step?

A 41 year old university professor complained of discomfort on swallowing and tenderness in the right anterior neck about a month ago. This has worsened over the past 2 weeks and he now has shooting pain to the angle of the jaw on the left and into the left ear. On examination: Heart rate 92; Has a stare but no signs of ophthalmopathy. Has fine tremor of outstretched fingers. Thyroid is asymmetrically enlarged, firm, nodular and tender. Reflexes are brisk.

• Free T4 is 42.5 pmol/L
• TSH is <1.0 mU/L.
• Full blood count and electrolytes are normal.

Which one of the following tests would most specifically confirm your clinical diagnosis?

A 21-year old Anglo-Celtic woman presents with new-onset diabetes mellitus. She has a sibling and one parent who also have diabetes. Her BMI is normal and she has no evidence of acanthosis nigricans.

Her pancreatic antigens are negative. Her C-peptide was 0.95 nmol/L at a time when her BG was 8.5 mmol/L. She is subsequently diagnosed as having monogenic diabetes due to a mutation of the gene that encodes for the transcription factor HNF1A.

Which ONE of the following is NOT true?

A 64-year old woman with a history of thyroidectomy for Graves disease has been taking thyroxine 150 μg per day for many years. She recently sustained head injuries in a motor vehicle accident. She now has seizures for which she takes phenytoin.

Her recent tests showed:

• T4 8.0 pmol/L (9 – 26)
• T3 3.9 pmol/L (3.5 – 6.5)
• TSH 1.5 mU/L (0.5 – 4.0)

The NEXT best step is:

A 76-year old woman being treated for bacterial meningitis has a tonicclonic seizure. She has been treated with intravenous vancomycin and is on a glucose/saline drip. She has no relevant past medical history. After investigation of the seizure, she is found to have hyponatraemia.

Her lab results are as follows:

• Na+ 114 mmol/L
• glucose 38 mmol/L
• creatinine 130 μmol/L
• TSH 7.0 mU/L
• cortisol 800 nmol/L
• plasma osmolality 262 mOsmol/kg (280 – 296)
• urinary osmolality 380 mOsmol/kg
• urinary Na+ 45 mEq/L

Which ONE of the following best explains her hyponatraemia?

A 16-year old girl is referred with a problem of primary amenorrhoea. She has short stature and Hashimoto’s thyroiditis for which she takes thyroxine.

On examination, her height is 1.48 m and her weight is 48 kg. She has small volume breast tissue. Pubic hair is present. There is no palpable goitre.

Investigation results are as follows:

• Karyotype 45XO/46XX
• TSH 2.0 mU/L
• IGF-1 normal
• Prolactin 300 mIU/L (50 – 500)
• FSH 35 IU/L
• Bone age 15 years

A diagnosis is made. The NEXT step is:

A 42-year old woman returned from a holiday in Greece in September. She is perplexed that her tan has not yet faded. She has also noticed discolouration of her gums.She is on thryoxine for autoimmune thyroiditis and is fatigued despite being optimally replaced.

You suspect that she has Addisons’s disease.

The BEST test to perform to confirm the diagnosis is:

A 65-year old man with CLL has recently been diagnosed with type 2 diabetes. Random BG levels range from 12 to 16 mmol/L. He is currently being treated with fludarabine for the leukaemia. On examination, he has a BMI of 25 kg/m2. He has no diabetic complications. He has a 2/6 ejection systolic murmur and mild peripheral oedema.

Laboratory results show:

• HBA1c 5.6 %
• Glucose 13.3 mmol/L
• Hb 80 g/L
• Haematocrit 24%
• WBC 105,000 mm3
• Creatinine 80 μmol/L

Which of the following is the single BEST answer?

A 51-year old man presents to your clinic because he noticed that his hands have increased in size. He has had his wedding ring cut off because it was too tight.

He also reports increasing tiredness and sensory changes in both hands typical of carpal tunnel syndrome.

Which of the following test would be most helpful?

Only 50% of of blood calcium is free Calcium.The rest is bound either to plasma proteins such as albumin,citrate,lactate and phosphate.

What is the major determinant for calcium binding in the blood?

Calcium sensing receptor(CaSR) responds to changes in serum calcium and amino acid levels.It is expressed in all of the following cells except?

In response to hypercalcemia, what is the effect from the activation of calcium sensing receptors on the proximal tubule?

Which of the following feature is not consistent with the diagnosis of autosomal dominant hypocalcemia?

What is the mechanism of action of cinacalcet?

Which of the following is the strongest indication for surgery in a patient with asymptomatic primary hyperparathyroidism?

A patient presents with mucosal neuromas.

What should this patient be investigated for?