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Question 1
Correct
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A 55-year-old male visits his GP for an insurance medical. The GP observes that the patient has rough facial features, an enlarged tongue, and greasy skin. The patient is also experiencing profuse sweating. Which hormone excess is likely to be accountable for these symptoms?
Your Answer: Growth hormone
Explanation:Acromegaly is a condition that results from an excess of growth hormone, which can cause a person to have a coarse facial appearance, a larger tongue, and excessive sweating and oily skin. This condition is often caused by a pituitary adenoma.
If a person has an excess of insulin, they may experience hypoglycemia and confusion. This can occur in cases of factitious illness, over-administration of insulin in diabetics, and insulinomas (neuroendocrine pancreatic tumors).
An excess of glucagon can cause hyperglycemia. Glucagon is secreted by alpha cells in the pancreas and is often elevated in cases of glucagonomas (neuroendocrine pancreatic tumors).
An excess of thyroid-stimulating hormone can be seen in cases of primary hypothyroidism and secondary hyperthyroidism.
Acromegaly is a condition characterized by excess growth hormone, which is usually caused by a pituitary adenoma in over 95% of cases. However, in some cases, it can be caused by ectopic GHRH or GH production by tumors, such as those found in the pancreas. The condition is associated with a number of physical features, including a coarse facial appearance, spade-like hands, and an increase in shoe size. Other features include a large tongue, prognathism, interdental spaces, excessive sweating, and oily skin, which are caused by sweat gland hypertrophy. In some cases, patients may also experience hypopituitarism, headaches, bitemporal hemianopia, and raised prolactin levels, which can lead to galactorrhea. Approximately 6% of patients with acromegaly also have MEN-1.
Complications associated with acromegaly include hypertension, diabetes (which affects over 10% of patients), cardiomyopathy, and colorectal cancer. It is important to diagnose and treat acromegaly early to prevent these complications from developing.
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This question is part of the following fields:
- Endocrine System
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Question 2
Correct
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A 35-year-old woman comes in with symptoms of renal colic. Upon conducting tests, the following results are obtained:
Corrected Calcium 3.84 mmol/l
PTH 88 pg/ml (increased)
Her serum urea and electrolytes are within normal range.
What is the probable diagnosis?Your Answer: Primary hyperparathyroidism
Explanation:The most probable diagnosis in this scenario is primary hyperparathyroidism, as serum urea and electrolytes are normal, making tertiary hyperparathyroidism less likely.
Primary Hyperparathyroidism: Causes, Symptoms, and Treatment
Primary hyperparathyroidism is a condition that is commonly seen in elderly females and is characterized by an unquenchable thirst and an inappropriately normal or raised parathyroid hormone level. It is usually caused by a solitary adenoma, hyperplasia, multiple adenoma, or carcinoma. While around 80% of patients are asymptomatic, the symptomatic features of primary hyperparathyroidism may include polydipsia, polyuria, depression, anorexia, nausea, constipation, peptic ulceration, pancreatitis, bone pain/fracture, renal stones, and hypertension.
Primary hyperparathyroidism is associated with hypertension and multiple endocrine neoplasia, such as MEN I and II. To diagnose this condition, doctors may perform a technetium-MIBI subtraction scan or look for a characteristic X-ray finding of hyperparathyroidism called the pepperpot skull.
The definitive management for primary hyperparathyroidism is total parathyroidectomy. However, conservative management may be offered if the calcium level is less than 0.25 mmol/L above the upper limit of normal, the patient is over 50 years old, and there is no evidence of end-organ damage. Patients who are not suitable for surgery may be treated with cinacalcet, a calcimimetic that mimics the action of calcium on tissues by allosteric activation of the calcium-sensing receptor.
In summary, primary hyperparathyroidism is a condition that can cause various symptoms and is commonly seen in elderly females. It can be diagnosed through various tests and managed through surgery or medication.
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This question is part of the following fields:
- Endocrine System
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Question 3
Incorrect
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A 56-year-old man visits the breast clinic with a solitary lump in the upper-right quadrant of his right breast. He has a history of non-alcoholic liver disease, hypertension, and gout, and is currently taking Bisoprolol, Naproxen, and Allopurinol. The lump is smooth and firm. Based on his medical history and current medications, what is the probable cause of his breast lump?
Your Answer: Allopurinol
Correct Answer: Liver disease
Explanation:Understanding Gynaecomastia: Causes and Drug Triggers
Gynaecomastia is a condition characterized by the abnormal growth of breast tissue in males, often caused by an increased ratio of oestrogen to androgen. It is important to distinguish the causes of gynaecomastia from those of galactorrhoea, which is caused by the actions of prolactin on breast tissue.
Physiological changes during puberty can lead to gynaecomastia, but it can also be caused by syndromes with androgen deficiency such as Kallmann and Klinefelter’s, testicular failure due to mumps, liver disease, testicular cancer, and hyperthyroidism. Additionally, haemodialysis and ectopic tumour secretion can also trigger gynaecomastia.
Drug-induced gynaecomastia is also a common cause, with spironolactone being the most frequent trigger. Other drugs that can cause gynaecomastia include cimetidine, digoxin, cannabis, finasteride, GnRH agonists like goserelin and buserelin, oestrogens, and anabolic steroids. However, it is important to note that very rare drug causes of gynaecomastia include tricyclics, isoniazid, calcium channel blockers, heroin, busulfan, and methyldopa.
In summary, understanding the causes and drug triggers of gynaecomastia is crucial in diagnosing and treating this condition.
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This question is part of the following fields:
- Endocrine System
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Question 4
Correct
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As a medical student in community care, while shadowing a health visitor, I observed her measuring the height and weight of children to monitor their growth. What factors drive growth during the developmental stage of 4 to 10 years old?
Your Answer: Growth and thyroid hormones
Explanation:Understanding Growth and Factors Affecting It
Growth is a significant difference between children and adults, and it occurs in three stages: infancy, childhood, and puberty. Several factors affect fetal growth, including environmental, placental, hormonal, and genetic factors. Maternal nutrition and uterine capacity are the most crucial environmental factors that affect fetal growth.
In infancy, nutrition and insulin are the primary drivers of growth. High fetal insulin levels result from poorly controlled diabetes in the mother, leading to hypoglycemia and macrosomia in the baby. Growth hormone is not a significant factor in infancy, as babies have low amounts of receptors. Hypopituitarism and thyroid have no effect on growth in infancy.
In childhood, growth is driven by growth hormone and thyroxine, while in puberty, growth is driven by growth hormone and sex steroids. Genetic factors are the most important determinant of final adult height.
It is essential to monitor growth in children regularly. Infants aged 0-1 years should have at least five weight recordings, while children aged 1-2 years should have at least three weight recordings. Children older than two years should have annual weight recordings. Children below the 2nd centile for height should be reviewed by their GP, while those below the 0.4th centile for height should be reviewed by a paediatrician.
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This question is part of the following fields:
- Endocrine System
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Question 5
Incorrect
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A 44-year-old man has been diagnosed with type II diabetes mellitus but cannot tolerate metformin therapy. What is the mechanism of action of alogliptin, which has been prescribed as an alternative?
Your Answer: Reduces insulin resistance
Correct Answer: Reduce the peripheral breakdown of incretins
Explanation:Gliptins (DPP-4 inhibitors) work by inhibiting the enzyme DPP-4, which reduces the breakdown of incretin hormones such as GLP-1. This leads to a glucose-dependent increase in insulin secretion and a reduction in glucagon secretion, ultimately regulating glucose homeostasis. However, gliptins do not increase the production of GLP-1, directly stimulate the release of insulin from pancreatic beta cells, inhibit the SGLT2 receptor, or reduce insulin resistance.
Diabetes mellitus is a condition that has seen the development of several drugs in recent years. One hormone that has been the focus of much research is glucagon-like peptide-1 (GLP-1), which is released by the small intestine in response to an oral glucose load. In type 2 diabetes mellitus (T2DM), insulin resistance and insufficient B-cell compensation occur, and the incretin effect, which is largely mediated by GLP-1, is decreased. GLP-1 mimetics, such as exenatide and liraglutide, increase insulin secretion and inhibit glucagon secretion, resulting in weight loss, unlike other medications. They are sometimes used in combination with insulin in T2DM to minimize weight gain. Dipeptidyl peptidase-4 (DPP-4) inhibitors, such as vildagliptin and sitagliptin, increase levels of incretins by decreasing their peripheral breakdown, are taken orally, and do not cause weight gain. Nausea and vomiting are the major adverse effects of GLP-1 mimetics, and the Medicines and Healthcare products Regulatory Agency has issued specific warnings on the use of exenatide, reporting that it has been linked to severe pancreatitis in some patients. NICE guidelines suggest that a DPP-4 inhibitor might be preferable to a thiazolidinedione if further weight gain would cause significant problems, a thiazolidinedione is contraindicated, or the person has had a poor response to a thiazolidinedione.
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This question is part of the following fields:
- Endocrine System
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Question 6
Incorrect
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A 55-year-old male visits his doctor complaining of a milky discharge from his nipples. He has a history of schizophrenia and has been taking olanzapine for a while now. No recent changes have been made to his medication.
Which compound with elevated levels is most likely causing this symptom?Your Answer: Dopamine, released from the substantia nigra
Correct Answer: Prolactin, released from the anterior pituitary
Explanation:The patient is experiencing galactorrhea, which is commonly associated with hyperprolactinemia. Prolactin stimulates milk production in the mammary glands, and the patient’s hyperprolactinemia is likely due to his use of olanzapine, which acts as a dopamine antagonist. Dopamine normally inhibits prolactin secretion. The other answer choices are incorrect as they do not accurately explain the mechanism behind the patient’s presentation.
Understanding Prolactin and Its Functions
Prolactin is a hormone that is produced by the anterior pituitary gland. Its primary function is to stimulate breast development and milk production in females. During pregnancy, prolactin levels increase to support the growth and development of the mammary glands. It also plays a role in reducing the pulsatility of gonadotropin-releasing hormone (GnRH) at the hypothalamic level, which can block the action of luteinizing hormone (LH) on the ovaries or testes.
The secretion of prolactin is regulated by dopamine, which constantly inhibits its release. However, certain factors can increase or decrease prolactin secretion. For example, prolactin levels increase during pregnancy, in response to estrogen, and during breastfeeding. Additionally, stress, sleep, and certain drugs like metoclopramide and antipsychotics can also increase prolactin secretion. On the other hand, dopamine and dopaminergic agonists can decrease prolactin secretion.
Overall, understanding the functions and regulation of prolactin is important for reproductive health and lactation.
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This question is part of the following fields:
- Endocrine System
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Question 7
Correct
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The following results were obtained on a 57-year-old male who complains of fatigue:
Free T4 9.8 pmol/L (9.0-25.0)
TSH 50.02 mU/L (0.27-4.20)
What physical signs would you anticipate during the examination?Your Answer: Slow relaxation of tendon jerks
Explanation:Symptoms and Signs of Hypothyroidism
Hypothyroidism is a condition that is characterized by an underactive thyroid gland, which leads to a decrease in the production of thyroid hormones. This condition is associated with several symptoms and signs, including a relative bradycardia, slow relaxation of tendon jerks, pale complexion, thinning of the hair, and weight gain. In severe cases of hypothyroidism, hypothermia may also be present.
A relative bradycardia refers to a slower than normal heart rate, which is a common symptom of hypothyroidism. Additionally, slow relaxation of tendon jerks is another sign of this condition. This refers to a delay in the relaxation of muscles after a reflex is elicited. Other physical signs of hypothyroidism include a pale complexion and thinning of the hair, which can be attributed to a decrease in metabolic activity.
Weight gain is also a common symptom of hypothyroidism, as the decrease in thyroid hormone production can lead to a slower metabolism and decreased energy expenditure. In severe cases of hypothyroidism, hypothermia may also be present, which refers to a body temperature that is lower than normal.
It is important to note that while a thyroid bruit is typical of Graves’ thyrotoxicosis, it is not a common sign of hypothyroidism. Overall, the symptoms and signs of hypothyroidism can vary in severity and may require medical intervention to manage.
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This question is part of the following fields:
- Endocrine System
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Question 8
Correct
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A young man comes to the clinic with symptoms suggestive of mania. After further inquiry and assessment, he is found to have tachycardia, sweaty palms, and a recent bout of diarrhea. What is the probable diagnosis?
Your Answer: Grave's disease
Explanation:The correct diagnosis for this patient is Grave’s disease, which is characterized by hyperthyroidism. While mania may be a symptom, it is important to note that tachycardia, sweaty hands, and exophthalmos are specific to Grave’s disease.
Bipolar disorder may also present with manic episodes, but it does not typically include the other symptoms associated with hyperthyroidism.
Hashimoto’s thyroiditis is another autoimmune thyroid disorder, but it causes hypothyroidism instead of hyperthyroidism. Symptoms of hypothyroidism may include bradycardia and dry skin.
Graves’ Disease: Common Features and Unique Signs
Graves’ disease is the most frequent cause of thyrotoxicosis, which is commonly observed in women aged 30-50 years. The condition presents typical features of thyrotoxicosis, such as weight loss, palpitations, and heat intolerance. However, Graves’ disease also displays specific signs that are not present in other causes of thyrotoxicosis. These include eye signs, such as exophthalmos and ophthalmoplegia, as well as pretibial myxoedema and thyroid acropachy. The latter is a triad of digital clubbing, soft tissue swelling of the hands and feet, and periosteal new bone formation.
Graves’ disease is characterized by the presence of autoantibodies, including TSH receptor stimulating antibodies in 90% of patients and anti-thyroid peroxidase antibodies in 75% of patients. Thyroid scintigraphy reveals a diffuse, homogenous, and increased uptake of radioactive iodine. These features help distinguish Graves’ disease from other causes of thyrotoxicosis and aid in its diagnosis.
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This question is part of the following fields:
- Endocrine System
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Question 9
Incorrect
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A 26-year-old male patient comes to the follow-up clinic after undergoing surgery to remove an endocrine gland. He had been experiencing symptoms such as profuse sweating, headaches, palpitations, and high blood pressure (200/120mmHg) prior to the decision for surgery. What type of cells would be revealed through histological staining of the removed organ?
Your Answer: Thyrotrope cells
Correct Answer: Chromaffin cells
Explanation:The man’s initial symptoms are consistent with a diagnosis of phaeochromocytoma, a type of neuroendocrine tumor that affects the chromaffin cells in the adrenal medulla. This condition leads to an overproduction of adrenaline and noradrenaline, resulting in an excessive sympathetic response.
Calcitonin is secreted by the parafollicular C cells in the thyroid gland.
The anterior pituitary gland contains gonadotropes, lactotropes, and thyrotropes, which secrete gonadotropins (FSH, LH), prolactin, and TSH, respectively.
Phaeochromocytoma: A Rare Tumor that Secretes Catecholamines
Phaeochromocytoma is a type of tumor that secretes catecholamines and is considered rare. It is familial in about 10% of cases and may be associated with certain syndromes such as MEN type II, neurofibromatosis, and von Hippel-Lindau syndrome. This tumor can be bilateral in 10% of cases and malignant in 10%. It can also occur outside of the adrenal gland, with the most common site being the organ of Zuckerkandl, which is adjacent to the bifurcation of the aorta.
The symptoms of phaeochromocytoma are typically episodic and include hypertension (which is present in around 90% of cases and may be sustained), headaches, palpitations, sweating, and anxiety. To diagnose this condition, a 24-hour urinary collection of metanephrines is preferred over a 24-hour urinary collection of catecholamines due to its higher sensitivity (97%).
Surgery is the definitive management for phaeochromocytoma. However, before surgery, the patient must first be stabilized with medical management, which includes an alpha-blocker (such as phenoxybenzamine) given before a beta-blocker (such as propranolol).
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This question is part of the following fields:
- Endocrine System
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Question 10
Incorrect
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A 22-year-old male presents to the emergency department with a two-hour history of nausea, confusion, and drowsiness. The patient has a medical history of type 1 diabetes mellitus.
Upon conducting an A-E examination, the only significant finding is a plasma glucose level of 3.4 mmol/L. The patient is capable of swallowing.
What is the most suitable course of action for managing this patient?Your Answer:
Correct Answer: Two tubes of oral glucose gel
Explanation:The recommended first-line treatment for a conscious patient with hypoglycaemia is a fast-acting carbohydrate taken orally, such as glucose liquids, tablets, or gels. In this case, the appropriate course of action would be to administer two tubes of glucose gel. Glucagon via intramuscular injection is not necessary unless the patient is experiencing severe hypoglycaemia or is unable to swallow. Insulin via intramuscular injection is not appropriate for treating hypoglycaemia, and intravenous glucose is only used in cases of severe hypoglycaemia.
Understanding Hypoglycaemia: Causes, Features, and Management
Hypoglycaemia is a condition characterized by low blood sugar levels, which can lead to a range of symptoms and complications. There are several possible causes of hypoglycaemia, including insulinoma, liver failure, Addison’s disease, and alcohol consumption. The physiological response to hypoglycaemia involves hormonal and sympathoadrenal responses, which can result in autonomic and neuroglycopenic symptoms. While blood glucose levels and symptom severity are not always correlated, common symptoms of hypoglycaemia include sweating, shaking, hunger, anxiety, nausea, weakness, vision changes, confusion, and dizziness. In severe cases, hypoglycaemia can lead to convulsions or coma.
Managing hypoglycaemia depends on the severity of the symptoms and the setting in which it occurs. In the community, individuals with diabetes who inject insulin may be advised to consume oral glucose or a quick-acting carbohydrate such as GlucoGel or Dextrogel. A ‘HypoKit’ containing glucagon may also be prescribed for home use. In a hospital setting, treatment may involve administering a quick-acting carbohydrate or subcutaneous/intramuscular injection of glucagon for unconscious or unable to swallow patients. Alternatively, intravenous glucose solution may be given through a large vein.
Overall, understanding the causes, features, and management of hypoglycaemia is crucial for individuals with diabetes or other conditions that increase the risk of low blood sugar levels. Prompt and appropriate treatment can help prevent complications and improve outcomes.
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This question is part of the following fields:
- Endocrine System
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Question 11
Incorrect
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A 23-year-old male patient visits his GP complaining of breast tissue enlargement that has been progressively worsening for the past 3 months. He also reports the presence of a new lump on his left testicle. Upon thorough examination and taking a detailed medical history, the GP suspects that the patient may be suffering from testicular cancer.
What is the probable diagnosis?Your Answer:
Correct Answer: HCG secreting seminoma
Explanation:Gynaecomastia can be caused by testicular conditions such as seminoma that secrete hCG.
Understanding Gynaecomastia: Causes and Drug Triggers
Gynaecomastia is a condition characterized by the abnormal growth of breast tissue in males, often caused by an increased ratio of oestrogen to androgen. It is important to distinguish the causes of gynaecomastia from those of galactorrhoea, which is caused by the actions of prolactin on breast tissue.
Physiological changes during puberty can lead to gynaecomastia, but it can also be caused by syndromes with androgen deficiency such as Kallmann and Klinefelter’s, testicular failure due to mumps, liver disease, testicular cancer, and hyperthyroidism. Additionally, haemodialysis and ectopic tumour secretion can also trigger gynaecomastia.
Drug-induced gynaecomastia is also a common cause, with spironolactone being the most frequent trigger. Other drugs that can cause gynaecomastia include cimetidine, digoxin, cannabis, finasteride, GnRH agonists like goserelin and buserelin, oestrogens, and anabolic steroids. However, it is important to note that very rare drug causes of gynaecomastia include tricyclics, isoniazid, calcium channel blockers, heroin, busulfan, and methyldopa.
In summary, understanding the causes and drug triggers of gynaecomastia is crucial in diagnosing and treating this condition.
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This question is part of the following fields:
- Endocrine System
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Question 12
Incorrect
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Release of somatostatin from the pancreas will lead to what outcome?
Your Answer:
Correct Answer: Decrease in pancreatic exocrine secretions
Explanation:Octreotide is utilized to treat high output pancreatic fistulae by reducing exocrine pancreatic secretions, although parenteral feeding is the most effective treatment. It is also used to treat variceal bleeding and acromegaly.
Octreotide inhibits the release of growth hormone and insulin from the pancreas. Additionally, somatostatin, which is released by the hypothalamus, triggers a negative feedback response on growth hormone.
Somatostatin: The Inhibitor Hormone
Somatostatin, also known as growth hormone inhibiting hormone (GHIH), is a hormone produced by delta cells found in the pancreas, pylorus, and duodenum. Its main function is to inhibit the secretion of growth hormone, insulin, and glucagon. It also decreases acid and pepsin secretion, as well as pancreatic enzyme secretion. Additionally, somatostatin inhibits the trophic effects of gastrin and stimulates gastric mucous production.
Somatostatin analogs are commonly used in the management of acromegaly, a condition characterized by excessive growth hormone secretion. These analogs work by inhibiting growth hormone secretion, thereby reducing the symptoms associated with acromegaly.
The secretion of somatostatin is regulated by various factors. Its secretion increases in response to fat, bile salts, and glucose in the intestinal lumen, as well as glucagon. On the other hand, insulin decreases the secretion of somatostatin.
In summary, somatostatin plays a crucial role in regulating the secretion of various hormones and enzymes in the body. Its inhibitory effects on growth hormone, insulin, and glucagon make it an important hormone in the management of certain medical conditions.
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This question is part of the following fields:
- Endocrine System
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Question 13
Incorrect
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A 56-year-old patient visits his primary care physician for a follow-up on his diabetes treatment. He is currently taking metformin and expresses concern about adding more medications that may lead to hypoglycemia. The patient has a medical history of bladder cancer, which was treated through surgery. On examination, the only notable finding is an elevated body mass index of 32 kg/m².
Based on recent blood test results, with an HbA1c level of 61 mmol/L (<48), the GP wants to prescribe a medication that does not cause weight gain or hypoglycemia. What is the probable mechanism of action of this drug?Your Answer:
Correct Answer: Reduction of the peripheral breakdown of incretins such as glucagon-like peptide (GLP-1)
Explanation:Diabetes mellitus is a condition that has seen the development of several drugs in recent years. One hormone that has been the focus of much research is glucagon-like peptide-1 (GLP-1), which is released by the small intestine in response to an oral glucose load. In type 2 diabetes mellitus (T2DM), insulin resistance and insufficient B-cell compensation occur, and the incretin effect, which is largely mediated by GLP-1, is decreased. GLP-1 mimetics, such as exenatide and liraglutide, increase insulin secretion and inhibit glucagon secretion, resulting in weight loss, unlike other medications. They are sometimes used in combination with insulin in T2DM to minimize weight gain. Dipeptidyl peptidase-4 (DPP-4) inhibitors, such as vildagliptin and sitagliptin, increase levels of incretins by decreasing their peripheral breakdown, are taken orally, and do not cause weight gain. Nausea and vomiting are the major adverse effects of GLP-1 mimetics, and the Medicines and Healthcare products Regulatory Agency has issued specific warnings on the use of exenatide, reporting that it has been linked to severe pancreatitis in some patients. NICE guidelines suggest that a DPP-4 inhibitor might be preferable to a thiazolidinedione if further weight gain would cause significant problems, a thiazolidinedione is contraindicated, or the person has had a poor response to a thiazolidinedione.
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This question is part of the following fields:
- Endocrine System
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Question 14
Incorrect
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A 63-year-old male presents with a sudden onset of double vision that has been ongoing for eight hours. He has a medical history of hypertension, which is managed with amlodipine and atenolol, and type 2 diabetes that is controlled through diet. Upon examination, the patient displays watering of the right eye, a slight droop of the eyelid, and displacement of the eye to the right. The left eye appears to have a full range of movements, and the pupil size is the same as on the left. What is the probable cause of his symptoms?
Your Answer:
Correct Answer: Diabetes
Explanation:Causes of Painless Partial Third Nerve Palsy
A painless partial third nerve palsy with pupil sparing is most likely caused by diabetes mononeuropathy. This condition is thought to be due to a microangiopathy that leads to the occlusion of the vasa nervorum. On the other hand, an aneurysm of the posterior communicating artery is associated with a painful third nerve palsy, and pupillary dilatation is typical. Cerebral infarction, on the other hand, does not usually cause pain. Hypertension, which is a common condition, would normally cause signs of CVA or TIA. Lastly, cerebral vasculitis can cause symptoms of CVA/TIA, but they usually cause more global neurological symptoms.
In summary, a painless partial third nerve palsy with pupil sparing is most likely caused by diabetes mononeuropathy. Other conditions such as aneurysm of the posterior communicating artery, cerebral infarction, hypertension, and cerebral vasculitis can also cause similar symptoms, but they have different characteristics and causes. It is important to identify the underlying cause of the condition to provide appropriate treatment and management.
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This question is part of the following fields:
- Endocrine System
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Question 15
Incorrect
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A 25-year-old woman has a total thyroidectomy to treat papillary carcinoma of the thyroid. During examination of histological sections of the thyroid gland, the pathologist discovers the presence of psammoma bodies. What is the primary composition of these bodies?
Your Answer:
Correct Answer: Clusters of calcification
Explanation:Clusters of microcalcification, known as psammoma bodies, are frequently observed in papillary carcinomas.
Thyroid cancer rarely causes hyperthyroidism or hypothyroidism as it does not usually secrete thyroid hormones. The most common type of thyroid cancer is papillary carcinoma, which is often found in young females and has an excellent prognosis. Follicular carcinoma is less common, while medullary carcinoma is a cancer of the parafollicular cells that secrete calcitonin and is associated with multiple endocrine neoplasia type 2. Anaplastic carcinoma is rare and not responsive to treatment, causing pressure symptoms. Lymphoma is also rare and associated with Hashimoto’s thyroiditis.
Management of papillary and follicular cancer involves a total thyroidectomy followed by radioiodine to kill residual cells. Yearly thyroglobulin levels are monitored to detect early recurrent disease. Papillary carcinoma usually contains a mixture of papillary and colloidal filled follicles, while follicular adenoma presents as a solitary thyroid nodule and malignancy can only be excluded on formal histological assessment. Follicular carcinoma may appear macroscopically encapsulated, but microscopically capsular invasion is seen. Medullary carcinoma is associated with raised serum calcitonin levels and familial genetic disease in up to 20% of cases. Anaplastic carcinoma is most common in elderly females and is treated by resection where possible, with palliation achieved through isthmusectomy and radiotherapy. Chemotherapy is ineffective.
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This question is part of the following fields:
- Endocrine System
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Question 16
Incorrect
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A 56-year-old woman visits her primary care physician with concerns about recent weight gain. She reports maintaining her usual diet and exercise routine, but has noticed her face appearing rounder and the development of purplish stretch marks on her abdomen. During the exam, her heart rate is 89 beats per minute, respiratory rate is 16 breaths per minute, and blood pressure is 157/84 mmHg. Her waist circumference measures 41 inches and her body mass index is 28 kg/m2. What is one effect of the primary hormone involved in this patient's condition?
Your Answer:
Correct Answer: Upregulation of alpha-1-adrenoceptors on arterioles
Explanation:The patient is exhibiting symptoms consistent with a state of elevated cortisol levels, known as Cushing syndrome. These symptoms include recent weight gain, a round face (moon face), abdominal striae, high blood pressure, and truncal obesity. Cushing syndrome can have various causes, including the use of glucocorticoids or an ectopic ACTH secretion.
Elevated cortisol levels can lead to an increase in blood glucose levels, putting individuals at risk for hyperglycemia and diabetes. Cortisol can also suppress the immune system, inhibiting the production of prostaglandins, leukotrienes, and interleukin-2, and decreasing the adhesion of white blood cells. Additionally, cortisol can up-regulate alpha-1-adrenoceptors on arterioles, resulting in high blood pressure. High cortisol levels can also decrease osteoblast activity, leading to weakened bones, and reduce fibroblast activity and collagen synthesis, resulting in delayed wound healing. The abdominal striae seen in patients with high cortisol levels are typically due to decreased collagen synthesis.
Causes of Cushing’s Syndrome
Cushing’s syndrome is a condition that can be caused by both endogenous and exogenous factors. However, it is important to note that exogenous causes, such as the use of glucocorticoid therapy, are more common than endogenous ones. The condition can be classified into two categories: ACTH dependent and ACTH independent causes.
ACTH dependent causes of Cushing’s syndrome include Cushing’s disease, which is caused by a pituitary tumor secreting ACTH and producing adrenal hyperplasia. Ectopic ACTH production, which is caused by small cell lung cancer, is another ACTH dependent cause. On the other hand, ACTH independent causes include iatrogenic factors such as steroid use, adrenal adenoma, adrenal carcinoma, Carney complex, and micronodular adrenal dysplasia.
In some cases, a condition called Pseudo-Cushing’s can mimic Cushing’s syndrome. This is often caused by alcohol excess or severe depression and can cause false positive results in dexamethasone suppression tests or 24-hour urinary free cortisol tests. To differentiate between Cushing’s syndrome and Pseudo-Cushing’s, an insulin stress test may be used.
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This question is part of the following fields:
- Endocrine System
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Question 17
Incorrect
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A father is concerned about his 14-month-old child who has been having up to 10 wet nappies a day. He recalls that his cousin had a kidney condition and wonders if it could be affecting his child. After being referred to a paediatrician, the doctor mentions the possibility of Bartter's syndrome.
What is the root cause of Bartter's syndrome?Your Answer:
Correct Answer: Mutated NKCC2 channel in the ascending loop of Henle
Explanation:The cause of Bartter’s syndrome is a faulty NKCC2 channel located in the ascending loop of Henle.
Polydipsia, polyuria, and dehydration are common symptoms of Bartter’s syndrome, which is an inherited disorder resulting from mutated NKCC2 channels.
Gitelman syndrome is a related condition caused by a mutated NCl symporter.
Nephrogenic and central diabetes insipidus are characterized by mutated ADH receptors and a lack of ADH production, respectively.
Bartter’s syndrome is a genetic disorder that causes severe hypokalaemia due to a defect in the absorption of chloride at the Na+ K+ 2Cl- cotransporter in the ascending loop of Henle. This disorder is usually inherited in an autosomal recessive manner. Unlike other endocrine causes of hypokalaemia, such as Conn’s, Cushing’s, and Liddle’s syndrome, Bartter’s syndrome is associated with normotension. Loop diuretics work by inhibiting NKCC2, which is similar to the effects of Bartter’s syndrome. The symptoms of Bartter’s syndrome usually appear in childhood and include failure to thrive, polyuria, polydipsia, hypokalaemia, normotension, and weakness.
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This question is part of the following fields:
- Endocrine System
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Question 18
Incorrect
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A 58-year-old woman arrives at the emergency department complaining of persistent nausea and vomiting for the past 4 days. Despite taking cyclizine and metoclopramide, she has not experienced any relief. The patient is currently under palliative care for lung cancer with cerebral metastases.
Upon consultation with the palliative care team, it is decided to administer a steroid with potent glucocorticoid activity and minimal mineralocorticoid activity.
What medication is the patient expected to receive?Your Answer:
Correct Answer: Dexamethasone
Explanation:Dexamethasone is the most suitable example of a steroid that has very high glucocorticoid activity and minimal mineralocorticoid activity among the given options.
Corticosteroids are commonly prescribed medications that can be taken orally or intravenously, or applied topically. They mimic the effects of natural steroids in the body and can be used to replace or supplement them. However, the use of corticosteroids is limited by their numerous side effects, which are more common with prolonged and systemic use. These side effects can affect various systems in the body, including the endocrine, musculoskeletal, gastrointestinal, ophthalmic, and psychiatric systems. Some of the most common side effects include impaired glucose regulation, weight gain, osteoporosis, and increased susceptibility to infections. Patients on long-term corticosteroids should have their doses adjusted during intercurrent illness, and the medication should not be abruptly withdrawn to avoid an Addisonian crisis. Gradual withdrawal is recommended for patients who have received high doses or prolonged treatment.
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This question is part of the following fields:
- Endocrine System
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Question 19
Incorrect
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Sam, a 75-year-old man, presents to the GP with a complaint of breast growth that has developed rapidly over the past 3 months. Sam insists that he has no trouble with sexual function. He has recently been diagnosed with a heart problem and is taking multiple medications for it, although he cannot recall their names. Other than that, he claims to be in good health. Upon examination, all of Sam's vital signs are within normal limits. After measuring his height and weight, his body mass index is calculated to be 24 kg/m². Each breast is approximately 10 cm in diameter, with large nipples and tenderness but no pain. Moderate cardiomegaly and a 3rd heart sound are noted during chest assessment. No abnormalities are found during an abdominal examination. Pitting edema is present up to his mid calf. Based on the history and examination, what is the most probable cause of Sam's gynaecomastia?
Your Answer:
Correct Answer: Digoxin
Explanation:Digoxin is the correct answer as it can lead to drug-induced gynaecomastia. Sam is likely taking digoxin due to his heart failure, and this medication has a side effect of causing breast tissue growth in men. This is thought to occur because digoxin has a similar structure to oestrogen and can directly stimulate oestrogen receptors.
While cirrhosis can also cause gynaecomastia, it is unlikely in this case as there are no signs or symptoms of liver disease. Cirrhosis typically causes gynaecomastia due to the liver’s reduced ability to clear oestrogens from the bloodstream.
Obesity is not the correct answer as Sam is not obese, with a BMI of 24 kg/m². However, obesity is a common cause of gynaecomastia as excess fat can be distributed to the breasts and result in increased aromatisation of androgens to oestrogens.
An oestrogen-secreting tumour is not the correct answer as there is no evidence in Sam’s history or examination to suggest he has one, although these tumours can cause gynaecomastia in men.
Understanding Gynaecomastia: Causes and Drug Triggers
Gynaecomastia is a condition characterized by the abnormal growth of breast tissue in males, often caused by an increased ratio of oestrogen to androgen. It is important to distinguish the causes of gynaecomastia from those of galactorrhoea, which is caused by the actions of prolactin on breast tissue.
Physiological changes during puberty can lead to gynaecomastia, but it can also be caused by syndromes with androgen deficiency such as Kallmann and Klinefelter’s, testicular failure due to mumps, liver disease, testicular cancer, and hyperthyroidism. Additionally, haemodialysis and ectopic tumour secretion can also trigger gynaecomastia.
Drug-induced gynaecomastia is also a common cause, with spironolactone being the most frequent trigger. Other drugs that can cause gynaecomastia include cimetidine, digoxin, cannabis, finasteride, GnRH agonists like goserelin and buserelin, oestrogens, and anabolic steroids. However, it is important to note that very rare drug causes of gynaecomastia include tricyclics, isoniazid, calcium channel blockers, heroin, busulfan, and methyldopa.
In summary, understanding the causes and drug triggers of gynaecomastia is crucial in diagnosing and treating this condition.
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This question is part of the following fields:
- Endocrine System
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Question 20
Incorrect
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A 60-year-old male presents with increasing fatigue.
Three months ago, he was diagnosed with bronchial carcinoma and has undergone chemotherapy. Upon admission, his electrolyte levels were measured as follows:
- Sodium: 118 mmol/L (137-144)
- Potassium: 3.5 mmol/L (3.5-4.9)
- Urea: 3.2 mmol/L (2.5-7.5)
- Creatinine: 65 µmol/L (60-110)
What would be the most appropriate initial investigation for this patient?Your Answer:
Correct Answer: Urine osmolality and sodium concentration
Explanation:Hyponatraemia in Bronchial Carcinoma Patients
Hyponatraemia is a common condition in patients with bronchial carcinoma. It is characterized by a marked decrease in sodium levels, which appears to be dilutional based on other test results that fall within the lower end of the normal range. The most likely cause of this condition is the syndrome of inappropriate ADH secretion (SIADH), which occurs when the tumour produces ADH in an ectopic manner. However, the diagnosis of SIADH is one of exclusion, and other possibilities such as hypoadrenalism due to metastatic disease to the adrenals should also be considered.
To determine the cause of hyponatraemia, initial tests such as urine sodium and osmolality are recommended. These tests can help rule out other possible causes and confirm the diagnosis of SIADH. Treatment for this condition typically involves fluid restriction. It is important to note that measuring ADH concentrations is not a reliable diagnostic tool as it is not widely available and does not provide any useful information.
In summary, hyponatraemia is a common condition in bronchial carcinoma patients, and SIADH is the most likely cause. Initial tests such as urine sodium and osmolality can help confirm the diagnosis, and treatment involves fluid restriction.
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This question is part of the following fields:
- Endocrine System
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Question 21
Incorrect
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A 38-year-old woman presents with symptoms of irritability and changes in bowel habits. During examination, a smooth enlargement of the thyroid gland is noted. Thyroid function tests are ordered and the results are as follows:
TSH 0.1 mug/l
Free T4 35 pmol/l
What is the most likely underlying diagnosis?Your Answer:
Correct Answer: Graves disease
Explanation:When TSH receptor antibodies are present, they stimulate the thyroid to produce T4. This results in a decrease in TSH levels due to negative feedback on the pituitary. However, in cases where hyperthyroidism is caused by pregnancy, the TSH levels are usually elevated.
Understanding Thyroid Disease and its Management
Thyroid disease can present with various manifestations, which can be classified based on the presence or absence of clinical signs of thyroid dysfunction and the presence of a mass. To assess thyroid disease, a thorough history and examination, including ultrasound, are necessary. If a nodule is identified, it should be sampled through an image-guided fine needle aspiration. Radionucleotide scanning is not very useful.
Thyroid tumors can be papillary, follicular, anaplastic, medullary, or lymphoma. Multinodular goitre is a common reason for presentation, and if the patient is asymptomatic and euthyroid, they can be reassured. However, if they have compressive symptoms, surgery is required, and total thyroidectomy is the best option. Patients with endocrine dysfunction are initially managed by physicians, and surgery may be offered alongside radioiodine for those with Graves disease that fails with medical management or in patients who prefer not to be irradiated. Patients with hypothyroidism do not generally get offered a thyroidectomy.
Complications following surgery include anatomical damage to the recurrent laryngeal nerve, bleeding, and damage to the parathyroid glands resulting in hypocalcaemia. For further information, the Association of Clinical Biochemistry guidelines for thyroid function tests and the British Association of Endocrine Surgeons website can be consulted.
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This question is part of the following fields:
- Endocrine System
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Question 22
Incorrect
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Sarah is a 19-year-old female with type 1 diabetes. After dinner, she goes out for the night and drinks 15 units of alcohol. She has taken her insulin according to her carbohydrate counting. However, in the early morning, her friend finds it difficult to wake her up and she is hospitalized due to hypoglycemia. How did her alcohol consumption play a role in this?
Your Answer:
Correct Answer: Alcohol inhibits glycogenolysis
Explanation:Alcoholic drinks contain carbohydrates that can cause an increase in blood glucose levels. However, the consumption of alcohol can also inhibit glycogenolysis, leading to a delayed hypoglycemia, particularly during the night. This can result in neuroglycopenia, which may impair one’s level of consciousness.
Understanding Diabetes Mellitus: A Basic Overview
Diabetes mellitus is a chronic condition characterized by abnormally raised levels of blood glucose. It is one of the most common conditions encountered in clinical practice and represents a significant burden on the health systems of the developed world. The management of diabetes mellitus is crucial as untreated type 1 diabetes would usually result in death. Poorly treated type 1 diabetes mellitus can still result in significant morbidity and mortality. The main focus of diabetes management now is reducing the incidence of macrovascular and microvascular complications.
There are different types of diabetes mellitus, including type 1 diabetes mellitus, type 2 diabetes mellitus, prediabetes, gestational diabetes, maturity onset diabetes of the young, latent autoimmune diabetes of adults, and other types. The presentation of diabetes mellitus depends on the type, with type 1 diabetes mellitus often presenting with weight loss, polydipsia, polyuria, and diabetic ketoacidosis. On the other hand, type 2 diabetes mellitus is often picked up incidentally on routine blood tests and presents with polydipsia and polyuria.
There are four main ways to check blood glucose, including a finger-prick bedside glucose monitor, a one-off blood glucose, a HbA1c, and a glucose tolerance test. The diagnostic criteria are determined by WHO, with a fasting glucose greater than or equal to 7.0 mmol/l and random glucose greater than or equal to 11.1 mmol/l being diagnostic of diabetes mellitus. Management of diabetes mellitus involves drug therapy to normalize blood glucose levels, monitoring for and treating any complications related to diabetes, and modifying any other risk factors for other conditions such as cardiovascular disease. The first-line drug for the vast majority of patients with type 2 diabetes mellitus is metformin, with second-line drugs including sulfonylureas, gliptins, and pioglitazone. Insulin is used if oral medication is not controlling the blood glucose to a sufficient degree.
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This question is part of the following fields:
- Endocrine System
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Question 23
Incorrect
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A young male with a history of diabetes mellitus type 1 is admitted to the emergency department. He was previously found to be confused by his roommates in his room. As well as this, he complains of nausea and abdominal pain.
An ECG is performed and shows tall tented T waves.
A simple blood test reveals marked hyperglycemia. A urinalysis shows the presence of ketones ++.
His bloods show the following:
Hb 136 g/L Male: (135-180)
Platelets 210 * 109/L (150 - 400)
WBC 9.5 * 109/L (4.0 - 11.0)
Na+ 137 mmol/L (135 - 145)
K+ 7.1 mmol/L (3.5 - 5.0)
Bicarbonate 31 mmol/L (22 - 29)
Urea 8.0 mmol/L (2.0 - 7.0)
Creatinine 155 µmol/L (55 - 120)
He is given insulin, calcium gluconate and IV saline.
What is the main mechanism as to why the patient's potassium level will decrease?Your Answer:
Correct Answer: Insulin increases sodium potassium pump
Explanation:Insulin stimulates the Na+/K+ ATPase pump, leading to a decrease in serum potassium levels. This is primarily achieved through increased activity of the sodium-potassium pump, which is triggered by phosphorylation of the transmembrane subunits in response to insulin. While calcium gluconate is used to protect the heart during hyperkalaemia-induced arrhythmias, it does not affect potassium levels. Although IV fluids can improve renal function and potassium clearance, they are not the primary method for reducing potassium levels. Calcium-activated potassium channels are present throughout the body and are activated by an increase in intracellular calcium levels during action potentials.
Insulin is a hormone produced by the pancreas that plays a crucial role in regulating the metabolism of carbohydrates and fats in the body. It works by causing cells in the liver, muscles, and fat tissue to absorb glucose from the bloodstream, which is then stored as glycogen in the liver and muscles or as triglycerides in fat cells. The human insulin protein is made up of 51 amino acids and is a dimer of an A-chain and a B-chain linked together by disulfide bonds. Pro-insulin is first formed in the rough endoplasmic reticulum of pancreatic beta cells and then cleaved to form insulin and C-peptide. Insulin is stored in secretory granules and released in response to high levels of glucose in the blood. In addition to its role in glucose metabolism, insulin also inhibits lipolysis, reduces muscle protein loss, and increases cellular uptake of potassium through stimulation of the Na+/K+ ATPase pump.
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This question is part of the following fields:
- Endocrine System
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Question 24
Incorrect
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You have been requested to evaluate a patient in your general practice, who has come in after discovering a new lump in her neck. The patient is in her mid-40s, has no significant medical history, and does not take any regular medications.
Upon examination, you observe a small mass in the front of the neck that moves upwards when the patient swallows. There is no associated lymphadenopathy. You refer the patient for an ultrasound and biopsy, which reveals the presence of 'Orphan Annie eyes with psammoma bodies.'
Based on this finding, what is the most probable diagnosis?Your Answer:
Correct Answer: Papillary thyroid cancer
Explanation:The patient has a painless lump in the thyroid gland that moves on swallowing, indicating thyroid pathology. The biopsy result of Orphan Annie eyes with psammoma bodies is a characteristic finding in papillary thyroid cancer, which is a slow-growing malignancy with less likelihood of lymphadenopathy. Graves’ disease is an incorrect diagnosis as it would not present with this appearance on biopsy and would likely exhibit signs of thyrotoxicosis. A multinodular goitre also does not have this appearance and may cause a thyrotoxic state. Anaplastic carcinoma is a more aggressive thyroid malignancy that readily invades nearby tissues and has a different histological appearance with spindle cells and giant cells.
Thyroid cancer rarely causes hyperthyroidism or hypothyroidism as it does not usually secrete thyroid hormones. The most common type of thyroid cancer is papillary carcinoma, which is often found in young females and has an excellent prognosis. Follicular carcinoma is less common, while medullary carcinoma is a cancer of the parafollicular cells that secrete calcitonin and is associated with multiple endocrine neoplasia type 2. Anaplastic carcinoma is rare and not responsive to treatment, causing pressure symptoms. Lymphoma is also rare and associated with Hashimoto’s thyroiditis.
Management of papillary and follicular cancer involves a total thyroidectomy followed by radioiodine to kill residual cells. Yearly thyroglobulin levels are monitored to detect early recurrent disease. Papillary carcinoma usually contains a mixture of papillary and colloidal filled follicles, while follicular adenoma presents as a solitary thyroid nodule and malignancy can only be excluded on formal histological assessment. Follicular carcinoma may appear macroscopically encapsulated, but microscopically capsular invasion is seen. Medullary carcinoma is associated with raised serum calcitonin levels and familial genetic disease in up to 20% of cases. Anaplastic carcinoma is most common in elderly females and is treated by resection where possible, with palliation achieved through isthmusectomy and radiotherapy. Chemotherapy is ineffective.
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This question is part of the following fields:
- Endocrine System
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Question 25
Incorrect
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A 38-year-old woman presents to the Emergency Department with a 2-day history of left flank pain. She has been recently diagnosed with osteoporosis after a low-energy, femoral neck fracture.
Her blood results show the following:
Na+ 140 mmol/L (135 - 145)
K+ 3.6 mmol/L (3.5 - 5.0)
Calcium 2.9 mmol/L (2.1-2.6)
Phosphate 0.6 mmol/L (0.8-1.4)
Her urine dip is positive for erythrocytes making a diagnosis of renal calculi likely.
What is the pathophysiological reason for the low serum phosphate level, given the likely underlying pathology?Your Answer:
Correct Answer: Decreased renal phosphate reabsorption
Explanation:The decrease in renal phosphate reabsorption is caused by PTH.
The symptoms presented are indicative of a kidney stone, which can be a sign of hyperparathyroidism. Primary hyperparathyroidism, caused by a functioning parathyroid adenoma, can result in low phosphate and high calcium levels. PTH reduces renal phosphate reabsorption, leading to increased phosphate loss in urine. Pituitary adenomas are associated with osteoporosis due to excessive PTH causing bone resorption.
PTH activates vitamin D, which increases phosphate absorption in the gastrointestinal tract. However, the renal loss of phosphate is greater than the increase in absorption, resulting in a net loss of phosphate when PTH levels are high.
PTH also increases renal vitamin D activation, leading to increased intestinal absorption of calcium and phosphate, as well as increased osteoclast activity. This results in elevated levels of serum calcium and phosphate.
Hypothyroidism does not significantly affect phosphate regulation, so it would not cause low serum phosphate levels.
Increased osteoclast activity caused by PTH leads to bone resorption and the release of calcium and phosphate into the blood. However, the renal loss of phosphate is greater than the increase in serum phosphate due to osteoclast activity, resulting in an overall decrease in serum phosphate levels.
Understanding Parathyroid Hormone and Its Effects
Parathyroid hormone is a hormone produced by the chief cells of the parathyroid glands. Its main function is to increase the concentration of calcium in the blood by stimulating the PTH receptors in the kidney and bone. This hormone has a short half-life of only 4 minutes.
The effects of parathyroid hormone are mainly seen in the bone, kidney, and intestine. In the bone, PTH binds to osteoblasts, which then signal to osteoclasts to resorb bone and release calcium. In the kidney, PTH promotes the active reabsorption of calcium and magnesium from the distal convoluted tubule, while decreasing the reabsorption of phosphate. In the intestine, PTH indirectly increases calcium absorption by increasing the activation of vitamin D, which in turn increases calcium absorption.
Overall, understanding the role of parathyroid hormone is important in maintaining proper calcium levels in the body. Any imbalances in PTH secretion can lead to various disorders such as hyperparathyroidism or hypoparathyroidism.
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This question is part of the following fields:
- Endocrine System
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Question 26
Incorrect
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A 65-year-old male with a diagnosis of lung cancer presents with fatigue and lightheadedness. Upon examination, the following results are obtained:
Plasma sodium concentration 115 mmol/L (137-144)
Potassium 3.5 mmol/L (3.5-4.9)
Urea 3.2 mmol/L (2.5-7.5)
Creatinine 67 µmol/L (60-110)
What is the probable reason for his symptoms based on these findings?Your Answer:
Correct Answer: Syndrome of inappropriate ADH secretion
Explanation:Syndrome of Inappropriate ADH Secretion
Syndrome of inappropriate ADH secretion (SIADH) is a condition characterized by low levels of sodium in the blood. This is caused by the overproduction of antidiuretic hormone (ADH) by the posterior pituitary gland. Tumors such as bronchial carcinoma can cause the ectopic elaboration of ADH, leading to dilutional hyponatremia. The diagnosis of SIADH is one of exclusion, but it can be supported by a high urine sodium concentration with high urine osmolality.
Hypoadrenalism is less likely to cause hyponatremia, as it is usually associated with hyperkalemia and mild hyperuricemia. On the other hand, diabetes insipidus is a condition where the kidneys are unable to reabsorb water, leading to excessive thirst and urination.
It is important to diagnose and treat SIADH promptly to prevent complications such as seizures, coma, and even death. Treatment options include fluid restriction, medications to block the effects of ADH, and addressing the underlying cause of the condition.
In conclusion, SIADH is a condition that can cause low levels of sodium in the blood due to the overproduction of ADH. It is important to differentiate it from other conditions that can cause hyponatremia and to treat it promptly to prevent complications.
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This question is part of the following fields:
- Endocrine System
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Question 27
Incorrect
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A 67-year-old man has visited the doctor with concerns about his blood glucose levels. He has type 1 diabetes and also suffers from chronic obstructive pulmonary disease (COPD). Following a recent bout of pneumonia, he has been experiencing difficulty in managing his blood sugars. You suspect that one of his newly prescribed medications may be contributing to this issue. Which medication could be causing acute problems with diabetic control?
Your Answer:
Correct Answer: Prednisolone
Explanation:The use of corticosteroids, such as prednisolone, can have a negative impact on diabetic control due to their anti-insulin effects. This can cause an increase in glucagon levels, leading to elevated blood sugar levels. While this effect is usually temporary and should resolve on its own, higher doses of insulin may be necessary during treatment. Prednisolone is often prescribed to manage exacerbations of COPD.
Amoxicillin, a penicillin antibiotic, can be prescribed alongside prednisolone to treat infective asthma exacerbations. Its bactericidal effects are unlikely to affect diabetes control.
Carbocisteine is a mucolytic medication commonly used for long-term management of COPD and bronchiectasis. It helps to thin sputum in the lungs, making it easier to cough up and preventing colonization. It is not known to worsen diabetes control.
Doxycycline, a tetracycline antibiotic, is commonly used to treat COPD exacerbations. However, it does not typically affect blood sugar control and is unlikely to be a contributing factor in this case.
Corticosteroids are commonly prescribed medications that can be taken orally or intravenously, or applied topically. They mimic the effects of natural steroids in the body and can be used to replace or supplement them. However, the use of corticosteroids is limited by their numerous side effects, which are more common with prolonged and systemic use. These side effects can affect various systems in the body, including the endocrine, musculoskeletal, gastrointestinal, ophthalmic, and psychiatric systems. Some of the most common side effects include impaired glucose regulation, weight gain, osteoporosis, and increased susceptibility to infections. Patients on long-term corticosteroids should have their doses adjusted during intercurrent illness, and the medication should not be abruptly withdrawn to avoid an Addisonian crisis. Gradual withdrawal is recommended for patients who have received high doses or prolonged treatment.
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This question is part of the following fields:
- Endocrine System
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Question 28
Incorrect
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A 29-year-old female has been diagnosed with hyperthyroidism. She is experiencing heat intolerance and is very frightened by her palpitations. The GP prescribes Carbimazole and a second medication to manage the palpitations. Which receptors are being overstimulated by the increased catecholamine effects in this patient, leading to her palpitations?
Your Answer:
Correct Answer: β1 receptors
Explanation:The sensitivity of the body to catecholamines is heightened by thyroid hormones. When catecholamines activate the β1 receptors in the heart, it leads to an elevation in heart rate.
Thyroid disorders are commonly encountered in clinical practice, with hypothyroidism and thyrotoxicosis being the most prevalent. Women are ten times more likely to develop these conditions than men. The thyroid gland is a bi-lobed structure located in the anterior neck and is part of a hypothalamus-pituitary-end organ system that regulates the production of thyroxine and triiodothyronine hormones. These hormones help regulate energy sources, protein synthesis, and the body’s sensitivity to other hormones. Hypothyroidism can be primary or secondary, while thyrotoxicosis is mostly primary. Autoimmunity is the leading cause of thyroid problems in the developed world.
Thyroid disorders can present in various ways, with symptoms often being the opposite depending on whether the thyroid gland is under or overactive. For example, hypothyroidism may result in weight gain, while thyrotoxicosis leads to weight loss. Thyroid function tests are the primary investigation for diagnosing thyroid disorders. These tests primarily look at serum TSH and T4 levels, with T3 being measured in specific cases. TSH levels are more sensitive than T4 levels for monitoring patients with existing thyroid problems.
Treatment for thyroid disorders depends on the cause. Patients with hypothyroidism are given levothyroxine to replace the underlying deficiency. Patients with thyrotoxicosis may be treated with propranolol to control symptoms such as tremors, carbimazole to reduce thyroid hormone production, or radioiodine treatment.
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This question is part of the following fields:
- Endocrine System
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Question 29
Incorrect
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As a medical student observing a metabolic medicine clinic, a 40-year-old woman comes in seeking answers about her obesity. With a BMI of 46 kg/m² and a family history of obesity, she is referred for further investigation. After genetic sequencing, it is discovered that she has a mutation in a hormone-regulating gene that is secreted by adipose tissue.
Which hormone is likely impacted by this genetic mutation?Your Answer:
Correct Answer: Leptin
Explanation:Leptin is produced by adipose tissue and is responsible for regulating feelings of fullness and satiety. Mutations in the leptin gene can lead to severe obesity in infants due to increased appetite and reduced feelings of satiety. Ghrelin, on the other hand, is a hormone released by the stomach that stimulates hunger. Melatonin, produced by the pineal gland, regulates the sleep-wake cycle and circadian rhythms but is not known to play a significant role in obesity. Obestatin, released by stomach epithelial cells, has a controversial role in obesity.
The Physiology of Obesity: Leptin and Ghrelin
Leptin is a hormone produced by adipose tissue that plays a crucial role in regulating body weight. It acts on the hypothalamus, specifically on the satiety centers, to decrease appetite and induce feelings of fullness. In cases of obesity, where there is an excess of adipose tissue, leptin levels are high. Leptin also stimulates the release of melanocyte-stimulating hormone (MSH) and corticotrophin-releasing hormone (CRH), which further contribute to the regulation of appetite. On the other hand, low levels of leptin stimulate the release of neuropeptide Y (NPY), which increases appetite.
Ghrelin, on the other hand, is a hormone that stimulates hunger. It is mainly produced by the P/D1 cells lining the fundus of the stomach and epsilon cells of the pancreas. Ghrelin levels increase before meals, signaling the body to prepare for food intake, and decrease after meals, indicating that the body has received enough nutrients.
In summary, the balance between leptin and ghrelin plays a crucial role in regulating appetite and body weight. In cases of obesity, there is an imbalance in this system, with high levels of leptin and potentially disrupted ghrelin signaling, leading to increased appetite and weight gain.
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This question is part of the following fields:
- Endocrine System
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Question 30
Incorrect
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A 3 day old infant is found to have difficulty urinating and upon closer examination, is diagnosed with hypospadias. What is the most frequently associated abnormality with this condition?
Your Answer:
Correct Answer: Cryptorchidism
Explanation:Understanding Hypospadias: A Congenital Abnormality of the Penis
Hypospadias is a congenital abnormality of the penis that affects approximately 3 out of 1,000 male infants. It is usually identified during the newborn baby check, but if missed, parents may notice an abnormal urine stream. This condition is characterized by a ventral urethral meatus, a hooded prepuce, and chordee in more severe forms. In some cases, the urethral meatus may open more proximally in the more severe variants, but 75% of the openings are distally located.
There appears to be a significant genetic element to hypospadias, with further male children having a risk of around 5-15%. While it most commonly occurs as an isolated disorder, associated conditions include cryptorchidism (present in 10%) and inguinal hernia.
Once hypospadias has been identified, infants should be referred to specialist services. Corrective surgery is typically performed when the child is around 12 months of age. It is essential that the child is not circumcised prior to the surgery as the foreskin may be used in the corrective procedure. In boys with very distal disease, no treatment may be needed.
Overall, understanding hypospadias is important for parents and healthcare providers to ensure proper management and treatment for affected infants.
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This question is part of the following fields:
- Endocrine System
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