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Questions and Answers
What is NOT a key symptom of patients with new-onset diabetes mellitus might present with.
What may be the initial presentation of a patient with type 1 diabetes mellitus? Select the single best answer from the list below.
Which of the following features indicates that a patient’s thyrotoxicosis is caused by Graves’ disease?
Which of the following is the most useful initial investigation for a patient presenting with a palpable thyroid nodule who has normal thyroid function tests?
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Which drug is commonly used to treat hyperprolactinaemia?
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In which condition is the thyroid-stimulating hormone (TSH) concentration high? Select the single best answer from the list below.
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Which of the following endocrine tests might be used to confirm a suspected diagnosis of diabetes insipidus?
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Tumours compressing the pituitary stalk are associated with which hormone abnormality?
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Which endocrine cause of hypertension is associated with hyperaldosteronism and a suppressed renin?
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What condition may present with fatigue and increased skin pigmentation?
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What is NOT a microvascular complications of diabetes and the screening methods used to detect each one at an early stage.
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A patient with type 1 diabetes develops a chest infection. Eating less than usual, they omit their insulin treatment. What acute complications of diabetes are they at risk of developing?
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A 55-year-old woman is losing weight. Her thyroid function tests show:
What is NOT a possible cause of her thyrotoxicosis
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A 55-year-old woman is losing weight. Her thyroid function tests show:
A diagnosis of thyrotoxicosis is made.
What is NOT a further investigation that could assist you in confirming the diagnosis (the cause of her hyperthyroidism)?
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A 55-year-old woman is losing weight. Her thyroid function tests show:
A diagnosis of thyrotoxicosis is made.
She is quite happy about the weight loss. What is NOT a long-term risk to her health if she is not treated?
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A 35-year-old Caucasian woman is admitted to hospital for further tests after presenting to their GP with excessive weight gain over the previous months, muscle fatigue and a high blood pressure of 152/91 mmHg (normal range is between 90/60 and 120/80 mmHg). A suspected diagnosis of Cushing syndrome is made.
Which hormone would you expect to see elevated in the patients blood to confirm this diagnosis?
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A patient with type 1 diabetes develops a chest infection. Eating less than usual, they omit their insulin treatment.
Which blood test would give the most information about their average glycaemic control?
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Vitamin D is one of the regulators of calcium metabolism.
What is NOT a way we acquire Vitamin D
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A 28-year-old woman had a subtotal thyroidectomy operation for Graves’ disease. Two days after her operation she presents to her GP complaining of a tingling sensation in her fingers and around her lips, with muscle cramps.
Her ECG is abnormal (long Q-T interval). What immediate treatment does she need, and by what route?
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Vitamin D is one of the regulators of calcium metabolism.
What is NOT an organ where Vitamin D acts to regulate calcium concentrations
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A 28-year-old woman had a subtotal thyroidectomy operation for Graves’ disease. Two days after her operation she presents to her GP complaining of a tingling sensation in her fingers and around her lips, with muscle cramps.
Which organ in her neck may have been damaged?
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A 35-year-old Caucasian woman is admitted to hospital for further tests after presenting to their GP with excessive weight gain over the previous months, muscle fatigue and a high blood pressure of 152/91 mmHg (normal range is between 90/60 and 120/80 mmHg). A suspected diagnosis of Cushing syndrome is made.
Another member of the MDT wants to perform an MRI. To inform the radiologist where to look, altered levels of which other hormone may indicate whether the patients Cushing syndrome is arising from dysfunction at the adrenal gland or at the pituitary?
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A 35-year-old Caucasian woman is admitted to hospital for further tests after presenting to their GP with excessive weight gain over the previous months, muscle fatigue and a high blood pressure of 152/91 mmHg (normal range is between 90/60 and 120/80 mmHg). A suspected diagnosis of Cushing syndrome is made.
Following confirmation that an adrenalectomy is needed, it is important to discuss treatment regime following surgery. What is NOT a steroid hormone that she will need as life-long replacement therapy?
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A 35-year-old Caucasian woman is admitted to hospital for further tests after presenting to their GP with excessive weight gain over the previous months, muscle fatigue and a high blood pressure of 152/91 mmHg (normal range is between 90/60 and 120/80 mmHg). A suspected diagnosis of Cushing syndrome is made.
When explaining the life-long replacement therapy that will be needed following adrenalectomy, it is important to explain the importance of strict adherence to the drugs. What life threatening medical emergency can occur when abruptly stopping glucocorticoid treatment?
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In a patient with central obesity, WHAT is NOT an investigation you would you have to perform to see whether they also had the metabolic syndrome?
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What is NOT a disease that patients with metabolic syndrome are at increased risk of developing.
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Name one drug with a license for the treatment of obesity, and state its mechanism of action.
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Patients with morbid obesity may be considered for bariatric surgery. Assuming the operation and recovery period are uncomplicated, What is NOT a long-term complications of bariatric surgery.
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What is the imaging modality used regularly in clinical practice that enables dynamic real time imaging of internal structures?
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What is NOT a drawback associated with computed tomography (CT) scanning?
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What is the modality (type) and the orientation (plane) of the image below?
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Name the anatomical structures labelled X and Y on the image below:
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Study Notes
Diabetes Mellitus
- New-onset diabetes mellitus patients may present with polyuria, polydipsia, weight loss, and fatigue.
- Type 1 diabetes mellitus initial presentation may include diabetic ketoacidosis.
- Key symptoms of diabetes mellitus do not include hypertension.
Thyroid Disorders
- A diagnosis of Graves' disease can be confirmed by the presence of exophthalmos or dermopathy.
- Fine-needle aspiration cytology (FNAC) is the most useful initial investigation for a patient presenting with a palpable thyroid nodule who has normal thyroid function tests.
- Bromocriptine is commonly used to treat hyperprolactinaemia.
- High TSH concentration is associated with primary hypothyroidism.
Endocrine Tests
- The water deprivation test is used to confirm a suspected diagnosis of diabetes insipidus.
- Tumours compressing the pituitary stalk are associated with hypopituitarism.
Hypertension
- Hyperaldosteronism and a suppressed renin are associated with Conn's syndrome.
- Adrenalectomy may be needed for patients with Cushing syndrome.
- Following adrenalectomy, patients will need life-long replacement therapy with glucocorticoids and mineralocorticoids, but not androgens.
Complications of Diabetes
- Omitting insulin treatment during a chest infection increases the risk of developing diabetic ketoacidosis or hyperosmolar hyperglycemic state.
- Haemoglobin A1c (HbA1c) test provides information about average glycaemic control.
Vitamin D
- Vitamin D can be acquired through dietary sources, sunlight exposure, and supplements.
- Vitamin D acts to regulate calcium concentrations in the gut, bones, and kidneys, but not in the lungs.
Surgical Complications
- Subtotal thyroidectomy operation for Graves' disease can lead to hypocalcaemia, which may present with a tingling sensation in the fingers and around her lips, with muscle cramps.
- Calcium gluconate is needed to treat hypocalcaemia, and it should be administered intravenously.
- The parathyroid gland may be damaged during subtotal thyroidectomy.
Cushing Syndrome
- Elevated cortisol levels in the blood confirm the diagnosis of Cushing syndrome.
- ACTH levels can indicate whether the patient's Cushing syndrome is arising from dysfunction at the adrenal gland or at the pituitary.
- Adrenal insufficiency can occur when abruptly stopping glucocorticoid treatment.
Metabolic Syndrome
- Patients with metabolic syndrome are at increased risk of developing cardiovascular disease and type 2 diabetes mellitus.
- Orlistat is a licensed drug for the treatment of obesity, and its mechanism of action is by inhibiting pancreatic lipase.
Imaging Modalities
- Ultrasound is the imaging modality used regularly in clinical practice that enables dynamic real-time imaging of internal structures.
- Computed tomography (CT) scanning is associated with exposure to ionizing radiation.
- The image below is a sagittal section of a magnetic resonance imaging (MRI) scan.
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Description
Test your knowledge on the key symptoms of patients with new-onset diabetes mellitus and identify what is NOT commonly presented. Evaluate your understanding of this medical condition.
