STJ ENDO + REPRO

Select the false statement

• 1. Thyroid hormone is mainly stored in the colloid and not follicular cells 

• 1. Oxyphil cells are degenerated parafollicular cells 

• 1. The neurohypophysis does not produce any hormones 

• 1. Adrenal medulla contains chromaffin cells 

• 1. The thyroid is located deep to the platysma muscle 

When the pituitary stalk is cut (eliminating hypothalamic control of pituitary function), secretion of all of the following hormones will decrease EXCEPT

• Growth hormone

• Prolactin

• Follicular stimulating hormone (FSH)

• Oxytocin

• Thyroid stimulating hormone (TSH)

Which of the following statements about aldosterone is FALSE?

• Aldosterone increases potassium secretion at the distal tubule

• 1. In a disease state, a high plasma aldosterone concentration will always be accompanied by decreased renin activity due to negative feedback

• 1. Excessive aldosterone secretion rarely causes oedema

• Aldosterone exerts its physiological effect by binding to intracellular receptors which regulate gene transcription

• Adrenocorticotropic hormone (ACTH) may increase aldosterone secretion

A middle-aged man has lung cancer. His plasma sodium concentration is 125mmol/L (normal range: 135-145), his plasma osmolality is 265 mOsm/kg (normal range: 280-295), his urine osmolality is 650 mOsm/kg (normal range: 650-1200). What is the most likely problem?

• Aldosterone production was increased due to metastasis of the cancer to the adrenal glands

• There was polydipsia due to spread of the cancer to the thirst center of the hypothalamus

• There was an excess secretion of Na+

• There was excess ADH production

• There is excessive sodium loss in the urine because of kidney damage

Low blood glucose concentration will lead to all of the following EXCEPT:

• loss of consciousness

• increased heart rate

• decreased ACTH

• decreased insulin

• increased growth hormone

 50 year old lady presents to clinic looking like this. Select the best statement.

• 1. She is in a hyperthyroid state, etiology unknown.

• 1. She is in a thyroid storm, treat urgently. 

• 1. She has Graves’ disease.

• She has Hashimoto’s disease

52 year old lady with small diffuse painless goitre as an incidental finding. She has a BPM of 56, increase in BMI, anti TSH receptor and anti thyroid peroxidase. What is the most accurate statement?

• 1. There will be low TSH and low T4

• 1. It is simple follicular hyperplasia caused by low iodide

• 1. Clusters of Follicular cells and colloid scalloping can be seen

• It is Graves disease with the production of anti thyroid autoantibodies

• She has an increased chance of lymphoma if there is continued enlargement of the goitre

A 28-year-old woman with Graves’ disease has been taking propylthiouracil (PTU) for the past 2 weeks. She presents to her GP with a sudden onset of fever, sore throat, and malaise. On examination, she is febrile at 38.5 °C with mild pharyngeal erythema.

Which is the most appropriate next step in management?

• 1. Advice the patient to continue with meds as per usual and take paracetamol for fever

• 1. Increase the PTU dosage as symptoms suggest poorly controlled hyperthyroidism

• 1. Continue PTU, stay at home and avoid contact for the next few days as this is probably a viral infection

• Stop PTU immediately and do an urgent FBC

• Switch PTU to Carbimazole immediately

Which statement on iodine is false?

• 1. High concentrations of iodine are contraindicated in pregnant women as they can cause foetal goitre

• 1. Patients who take iodine long term may experience increased salivation and headache

• 1. A/Es experienced by patients can disappear spontaneously within a few days of stopping iodine treatment

• 1. Allergic-like reactions including angioedema are the most common A/E

• 1. Patients can take iodine with juice or milk to reduce GI irritation

Patient with known Graves’ comes in with fever, agitation, tachycardia and altered mental status. Diagnosed with thyroid storm. What medications should be given to her? (>1 correct answer)

• Propranolol

• Propylthiouracil

• Lugol's iodine

• Antipyretics

• Hydrocortisone