Question Bank

Primary hyperparathyroidism is characterized by elevated calcium and inappropriately elevated (or high-normal) PTH, often due to a solitary adenoma. Secondary hyperparathyroidism features high PTH but low/normal calcium (usually renal failure). Malignancy typically causes suppressed PTH due to PTHrP production.

According to UK national DKA guidelines, resolution is defined by pH >7.3, bicarbonate >18 mmol/L, and ketones <0.6 mmol/L. Glucose often normalizes before the metabolic acidosis resolves; therefore, glucose monitoring alone is insufficient for stopping the insulin infusion.

The Short Synacthen test (ACTH stimulation test) is the gold standard for diagnosing primary adrenal insufficiency (Addison's). A failure of cortisol to rise above 425-500 nmol/L (depending on the assay) 30 minutes after synthetic ACTH administration is diagnostic.

Agranulocytosis is a rare but life-threatening side effect of thionamides like Carbimazole. Patients must be warned to have an urgent Full Blood Count if they develop signs of infection, such as a sore throat or fever.

In phaeochromocytoma, alpha-blockade must be achieved before starting beta-blockers. Failure to do so can lead to unopposed alpha-adrenergic stimulation, causing a hypertensive crisis.

A suppressed ACTH in the presence of hypercortisolism indicates ACTH-independent Cushing's Syndrome, most commonly caused by an autonomous adrenal adenoma or exogenous steroids. If exogenous use is ruled out, an adrenal source is most likely.

In elderly patients or those with underlying ischaemic heart disease, Levothyroxine should be started at 12.5–25 micrograms to avoid precipitating a myocardial infarction or angina through sudden increases in metabolic demand.

In cranial DI, the kidneys can concentrate urine when exogenous ADH (Desmopressin) is provided. In nephrogenic DI, the kidneys fail to respond to Desmopressin, and in primary polydipsia, the urine should concentrate during the deprivation phase.

Primary hyperaldosteronism (Conn's Syndrome) presents with hypertension, hypokalaemia, and a high ARR. The first-line imaging to differentiate between an adrenal adenoma and bilateral adrenal hyperplasia is a CT Adrenal scan.

For a patient with hypoglycaemia who is conscious but cannot safely swallow (no safe swallow or uncooperative), IM Glucagon is the treatment of choice in the community. Oral options are unsafe due to aspiration risk, and IV access is rarely available outside a hospital setting.