Download IMPERIAL COLLEGE SCHOOL OF MEDICINE

SESSION 1
Hypothalamo-hypophysial axis: disorders 1
HYPOPITUITARY DISORDERS
TRUE/FALSE QUESTIONS
1.
Hypopituitary disorders are invariably associated with single hormone deficiencies. F
2.
Hypopituitary disorders occasionally arise as a consequence of hypothalamic disease. T
3.
Cranial injury is one cause of hypopituitarism. T
4.
Patients with GH deficiency show an impaired GH response to insulin. T
5.
The most important hormone to replace in subjects with pituitary insufficiency is thyroxine F
6.
GH is normally given by mouth F
7.
Growth hormone therapy frequently causes obesity in adults. F
8.
The lack of circulating growth hormone in children results in short stature. T
9.
Replacement therapy with recombinant GHRH is the treatment of choice in childrenlacking
growth hormone. F
10.
Anti-inflammatory treatment with glucocorticoids is associated with an increase in the
circulating corticotrophin concentration. F
11.
The clinical symptoms associated with the absence of circulating thyrotrophin are usually
treated with thyroxine replacement. T
12.
Destruction of the neurohypophysial system is associated chronically with increased water
retention (antidiuresis). F
13.
Diabetes insipidus can be associated with raised circulating levels of vasopressin. T
14.
Cranial diabetes insipidus is usually treated with a vasopressin V1 receptor agonist. F
15.
Desmopressin is the drug of choice in the treatment of cranial diabetes insipidus. T
16.
Thiazide diuretics (e.g. bendroflumethiazide) cause hypokalaemia. T
17.
Terlipressin is a potent pressor agent. T
18.
Desmopressin is effective by mouth. T
SESSION 2
Hypothalamo-Pituitary axis: disorders 2
HYPERPITUITARY DISORDERS
TRUE/FALSE QUESTIONS
1. Hypersecretory activity of the adenohypophysis usually involves more than one anterior
pituitary hormone. F
2. Excessive secretion of an anterior pituitary hormone is often associated with a pituitary tumour
(adenoma) T
3. Pituitary tumours can be associated with visual field defects T
4. Hyperprolactinaemia is commonly associated with sexual precocity F
5. One treatment of hyperprolactinaemia is the administration of a dopamine agonist T
6. A chronic excess of circulating growth hormone can be associated with cardiomegaly T
7. Untreated diabetes mellitus can result in secondary acromegaly F
8. Somatostatin analogues can be used for the treatment of acromegaly
T
9. The ectopic production of vasopressin can result in the syndrome of inappropriate antidiuretic
hormone (SIADH) T
10. SIADH is commonly associated with hypernatraemia
F
11. Oral glucose causes a very marked suppression of the plasma GH concentration in acromegalic
subjects. F
12. Long acting somatostatin analogues (e.g. octreotide) reduce GH release in acromegalic
subjects. T
13. The adverse effects of bromocriptine include Parkinson-like movement disorders. F
14. Bromocriptine reduces prolactin secretion in subjects with hyperprolactinaemia. T
15. Oxytocin is the drug of choice for early (1st trimester) therapeutic abortion. F
16. Ergometrine causes a marked increase in uterine tone and is therefore useful in the control of
post-partum haemorrhage. T
17. Prostaglandins facilitate cervical ripening. T
18. When used to induce labour, oxytocin is normally given by mouth. F
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SESSION 5
Gonadal disorders 1
TRUE/FALSE QUESTIONS
1) The ovarian steroids synthesised by thecal cells are mainly oestrogens F
2) In the menstrual cycle an LH surge initiates ovulation
T
3) Polycystic Ovary Syndrome (PCOS) often involves peripheral insulin resistance
4) Anorexia is commonly associated with PCOS
T
F
5) The presence of polycystic ovaries can be confirmed with ultrasound imaging T
6) Circulating androgens in PCOS are usually derived from the ovary
F
7) Only 1 in 10 cases of infertility is associated with a male cause F
8) Androgens taken to increase muscle mass can cause gonadal hypertrophy
9) Sertoli cells envelop and support developing spermatids
T
T
10) Prolactin can suppress the release of FSH and LH from the pituitary
T
3
SESSION 6
Gonadal disorders 2
TRUE/FALSE QUESTIONS
1. During pregnancy the main circulating oestrogen in the mother is oestradiol. F (oestriol)
2. Placental oestriol is synthesised from fetal 16-hydroxy DHEAS.
T
3. Progesterone is synthesized by the maternal ovaries during the third trimester of pregnancy.F
4. Plasma progesterone levels fall steadily throughout pregnancy F
5. The LH concentration in the maternal circulation is raised during pregnancy. F (inhibited by
high oestrogen/progesterone negative feedback)
6. Human Chorionic Gonadotrophin (hCG) acts mostly on FSH receptors.
7. hCG levels increase throughout pregnancy.
F (LH receptors)
F (peak around12 weeks then fall)
8. Detection of hCG in the urine is the basis of a pregnancy test. T (or at least a fragment of it)
9.
Oxytocin stimulates uterine muscle (myometrial) contraction at term. T
10. The fetal pituitary production of corticotrophin may be the principal initiating factor of labour.
T
11. The milk ejection reflex involves the action of prolactin on myoepithelial cells in the breast. F
12. The menopause can be confirmed by detecting raised levels of LH in the circulation. T
13. Ovarian follicles continue to develop after the menopause.
F
14. Osteoporosis is associated with the menopause. T
15. The menopause is associated with increased protection against cardiovascular disease. F
16. All oral contraceptives contain oestrogens but not progestogens
F
17. Menopausal symptoms can be treated with oral contraceptives.
F (doses differ)
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SESSION 7
Thyroid disorders
TRUE/FALSE QUESTIONS
1. The thyroid is situated in the neck
T
2. Thyroxine is synthesised from the amino acid tyrosine T
3. Thyroxine is an iodinated molecule
T
4. T3 has a longer half life than T4
F
5. The immune system can cause hypothyroidism.
T
6. The immune system can cause hyperthyroidism.
T
7. Patients with severe hypothyroidism usually have a low plasma TSH level
8. Tc99m scanning shows decreased overall uptake in Graves’ disease
F
F
9. Tc99m scanning shows decreased overall uptake in Plummer’s disease F
10. Tc99m scanning shows decreased overall uptake in viral (De Quervain’s) thyroiditis T
11. Alpha-adrenoceptor blocking drugs are useful in patients with hyperthyroidism.
F
12. Beta-adrenoceptor blocking drugs are useful in patients with hyperthyroidism. T
13. Alpha-adrenoceptor blocking drugs are useful in patients with hypothyroidism.
F
14. Beta-adrenoceptor blocking drugs are useful in patients with hypothyroidism. F
15. Hyperthyroidism is associated with weight gain. F
16. Hyperthyroidism is associated with an increased appetite.
T
17. Lid lag is a feature of hyperthyroidism. T
18. Surgery for hyperthyroidism or thyroid cancer can cause hyponatraemia
F
19. Surgery for hyperthyroidism or thyroid cancer can cause hypocalcaemia
T
20. Surgery for hyperthyroidism or thyroid cancer can cause hypokalaemia
F
21. An increase in basic metabolic rate is a consequence of excessive
dosing with thyroxine sodium.
T
22. Thyroid hormones (T3 and T4) are used to treat Graves' disease
F
23. T4 has a short plasma half-life of 2-3 minutes. F
24. T4 is the major circulating thyroid hormone.
T
5
25. T4 has a greater binding affinity for the thyroid hormone receptor than T3.
26. Thyroxine increases cardiac output and heart rate.
F
T
27. Carbimazole is a drug which enhances secretion of thyroid hormones. F
28. The clinical effects of the thiourylene drugs take weeks to develop.
T (the point is that
these drugs inhibit iodothyronine synthesis and therefore they don’t act immediately but take 12 weeks to reduce plasma thyroxine levels. For this reason beta blockers should be given
initially).
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SESSION 8
Adrenal disorders 1
True/False questions
1. Addison’s disease causes hypertension F
2. Cushing’s disease causes hypertension
T
3. Addison’s disease causes hyperkalaemia
T
4. Cushing’s disease causes hyperkalaemia
F
5. Addison’s disease causes hyperpigmentation
T (because of high ACTH)
6. Cushing’s disease causes hyperpigmentation
T
specifically to a pituitary tumour making ACTH)
(because
Cushing’s
Disease
refers
7. Congenital adrenal hyperplasia is caused by a deficiency in adrenal enzymes T
8. The commonest variety of congenital adrenal hyperplasia is 21 hydroxylase deficiency
9. 21-hydroxylase deficiency causes hirsutism and virilisation
10. 21-hydroxylase deficiency causes hyperkalaemia
T
T
T
11. The hypotension caused by complete pituitary failure and resultant cortisol deficiency is more
severe than the hypotension caused by autoimmune Addison’s disease. F
(Pituitary failure does not cause aldosterone deficiency)
Pharmacology & Therapeutics self-assessment: Try the following yes/no questions.
1.
Hydrocortisone is given intramuscularly for maintenance therapy in Addison's disease.F
2.
Hydrocortisone does not bind to mineralocorticoid receptors.F
3.
Suppressing ACTH secretion is an important therapeutic objective in the control of congenital
adrenal hyperplasia.
T
4.
Fludrocortisone is routinely given preoperatively to protect Addisonian patients undergoing
surgery. F
5.
Dexamethasone is a potent, long acting glucocorticoid with negligible mineralocorticoid
activity.T
6.
Low doses of dexamethasone normally suppress ACTH and cortisol secretion in subjects with
ectopic ACTH secreting tumours.F
7.
Acute adrenal insufficiency is treated with hydrocortisone, given by i.v. infusion or i.m. injection.
T
8.
Aldosterone receptor blockade with spironolactone causes severe K+ loss in patients with Conn's
syndrome. F
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SESSION 9
Adrenal disorders 1
TRUE/FALSE QUESTIONS
1. Some of the following drugs are enzyme inhibitors: Write down the name of the enzyme
inhibited. (If they are not enzyme inhibitors, note below what class of drug they are).
Spironolactone F. This is an aldosterone receptor antagonist
Hydrocortisone F. This is a glucocorticoid receptor agonist
Metyrapone
T. 11- hydroxylase inhibitor (on the pathway to cortisol synthesis).
Ketoconazole
T. Inhibits several P450 enzymes on the same pathway.
Fludrocortisone F. Mineralocorticoid
Propranolol
F. Beta adrenoreceptor antagonist
Phenoxybenzamine F. Alpha adrenoreceptor antagonist : non-competitive
Phentolamine
F. Alpha adrenoreceptor antagonist : competitive
Carbimazole
T. inhibits organification of thyroxine
Bromocriptine
F. Dopamine receptor agonist
Cabergoline
F. Dopamine receptor agonist (longer half life)
Metaclopramide F. Dopamine receptor antagonist.
2. The discovery of a phaeochromocytoma is a medical emergency
T
3. Phaeochromocytomas can cause ventricular fibrillation
T
4. Patients with phaeochromocytomas will have high urinary cortisol levels.
F
5. Surgery to remove a phaeochromocytoma must be performed immediately after the diagnosis is
confirmed F (it is essential to prepare the patient medically by alpha and beta blockade first)
6. Beta blockade is the first therapeutic step in a patient with a phaeochromocytoma F
7. Alpha blockade is the first therapeutic step in a patient with a phaeochromocytoma T
8. Spironolactone is the first therapeutic step in a patient with a phaeochromocytoma. F
9. The discovery of a Conn’s adenoma is a medical emergency
F
10. Patients with Conn’s adenomas will have high urinary cortisol levels. F
11. Patients with Conn’s adenomas will have high urinary catecholamine levels
F
12. Surgery to remove a Conn’s adenoma must be performed immediately once the diagnosis is
confirmed
F
13. Beta blockade is the first therapeutic step in a patient with a Conn’s adenoma F
14. Alpha blockade is the first therapeutic step in a patient with a Conn’s adenoma F
15. Dexamethasone is useful in the investigation and treatment of patients with Cushing’s
syndrome
F
(Useful in diagnosis but not in treatment)
16. Glucose tolerance testing is useful in establishing the diagnosis of Cushing’s syndrome.F
17. Patients with Conn’s syndrome will have a high plasma renin activity F
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SESSION 10
Endocrine bone disease
TRUE/FALSE QUESTIONS
1. Osteoblasts resorb bone.
F
2. Vitamin D3 is hydroxylated in the 1 position in the liver
F
3. Osteoporosis is associated with an increased risk of bone fractures T
4. Osteoporosis is due to a loss of bone mass
T
5. Hormone replacement therapy with oestrogen during the menopause is
beneficial in preventing osteoporosis
6.
The plasma calcium concentration is raised in osteoporosis
T
F
7. Female athletes are at risk for osteoporosis T
8. Osteoporosis is a consequence of primary hyperparathyroidism
F
9. In secondary hyperparathyroidism the plasma calcium concentration is raised
F
10. The serum alkaline phosphatase concentration is normal in Paget’s disease F
11. Paget’s disease can be treated with calcium supplementation of the diet
F
12. The elderly population is more prone to osteomalacia than younger people T
13. Oral bisphosphonates are the treatment of choice for osteomalacia F
14. Treatment of osteomalacia is with vitamin D
T
15. Intravenous calcium chloride may be given to treat hypocalcaemic tetany T
16. Vitamin D reduces intestinal absorption of Ca++
F
17. Ergocalciferol is a pro-drug which is metabolised to a more active compound in the body T
18. Bisphosphonates should be taken after meals with a drink of milk F
19. Calcitonin is the drug of choice in to treat hypocalcaemic states F
20. Estrogens are effective in the prevention of postmenopausal osteoporosis T
21. Hormone replacement therapy with estrogen is free of unwanted side effects
F
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