Endocrinology Module 6

A 40 year old man develops sudden onset of severe frontal headache, diplopia associated with nausea and vomiting.

Examination reveals CN III palsy and bitemporal hemianopia.

MRI shows pituitary apoplexy.

What is the most appropriate next step?

A 37 year old patient with schizophrenia on olanzapine complaint of muscle ache. His prolactin levels has been recorded as 870 and 980 (normal 60-600) on two separate occasions. He is on no other medication.

Examination reveals mild gynaecomastia, no galactorrhea or virilisation. Testicular size is normal.  There are no signs of hypothyroidism.

What is the next step in management?

The following sign is most specific for Cushing’s syndrome:

Which feature is most specific for Cushing’s disease?

A 30 year old woman treated with cabergoline 0.5mg weekly for amenorrhea secondary to a 4mm prolactinoma.

She consults you two weeks after recording a positive pregnancy test.

The most appropriate management is to:

Which condition causes a predominant increase in LDL-cholesterol?

Which medication should be avoided when managing a thyroid storm?

Carbimazole inhibits which pathway?

A 20 year old male patient with Type 1 diabetes on insulin pump presents with mild DKA with pH of 7.2 and a BSL of 23.

What is the most appropriate initial intervention?

The presence of multifocal subperiosteal bone resorption, is most specific for which condition?

An 85-year-old man from rest home with a background of type 2 diabetes presents to the emergency department with decreased level of consciousness. It seems that for the last 3 days, he has had watery diarrhea with six to ten bowel movements per day.

After looking at his medication list from the rest home, it appeared that this man had not taken his insulin for the past 3 days.

On examination, he is afebrile and clinically dehydrated.

• serum blood glucose level is 25
• serum sodium 150
• serum potassium 5.1
• serum Cr 280
• serum Urea 42
• plasma osmolality 375

You decide to administer IV Insulin for this man.

Which set of electrolytes are most likely to change after intravenous insulin is administered?

Which medication is not helpful in preventing post-menopausal osteoporosis?

The most potent biphosphonate is?

What is the BMI threshold for recommending metabolic surgery in caucasian patients with Type 2 diabetes regardless of their glycemic control?

Romosozumab is a novel monoclonal antibody used in preventing fracture in women with osteoporosis.

It works by binding against which protein?

Clinical inertia is likely the largest barrier to effective diabetes management in NZ and worldwide. The following interventions are all recommended to improve clinic inertia except?

A 42 year old Maori male presents to his GP for a routine check up. He is a current smoker and has a history of hypertension, hyperlipidemia and a BMI of 30. His HbA1c taken last week was 45 mmol/mol. He is currently asymptomatic. 

What is the best course of action for this man right now?

In patients with Type 2 diabetes and a BMI over 30 kg/m2, what is the recommended target total body weight loss to help achieve remission?

When managing patients with Type 2 diabetes, a more aggressive target of HbA1c of <48mmol/mol may be appropriate for the following patient group except?

The combination of dual SGLT2i/GLP1RA therapy in Type 2 Diabetes is likely to cause the following effect except?

Oral metformin is considered to be relatively safe for patients with chronic kidney disease. However, at what point should metformin be stopped?

Which of the following diabetic medication causes weight loss without inducing hypoglycemia?

A 47 year old Tongan male was recently diagnosed with Type 2 diabetes with a HbA1c of 50. He was advised on lifestyle changes and was commenced on oral metformin. However, three months later, his HbA1c has risen to 60 mmol/mol. His renal function is normal and he is of normal weight. There is no history of heart failure.

His GP is now considering adding a second agent. Which of the following medication would be the most appropriate for this man?