Which one of the following is the most common cause of hypothyroidism in the UK?
Correct Answer D: In European countries primary atrophic hypothyroidism is the most cause causes of hypothyroidism, whereas in North America Hashimoto's thyroiditis appears to account for the majority of cases. The reason for this discrepancy is unclear.
Hypothyroidism: causes:
Hypothyroidism affects around 1-2% of women in the UK and is around 5-10 times more common in females than males.
A- Primary hypothyroidism:
Primary atrophic hypothyroidism:
Hashimoto's thyroiditis:
After thyroidectomy or radioiodine treatment Drug therapy (e.g. lithium, amiodarone or anti-thyroid drugs such as carbimazole) Dietary iodine deficiency.
B- Secondary hypothyroidism (rare) From pituitary failure
C- Other associated conditions:
Each one of the following is a cause of cranial diabetes insipidus, EXCEPT:
Correct Answer B: Lithium causes a nephrogenic diabetes insipidus.
Diabetes insipidus: Diabetes insipidus (DI) is a condition characterized by either a deficiency of antidiuretic hormone, ADH, (cranial DI) or an insensitivity to antidiuretic hormone (nephrogenic DI).
Causes of cranial DI:
Causes of nephrogenic DI:
Features:
Investigation:
What is the most common cause of primary hyperaldosteronism?
Correct Answer E: Bilateral idiopathic adrenal hyperplasia is the most common cause of primary hyperaldosteronis.
Primary hyperaldosteronism: Primary hyperaldosteronism was previously thought to be most commonly caused by an adrenal adenoma, termed Conn's syndrome. However, recent studies have shown that bilateral idiopathic adrenal hyperplasia is the cause in up to 70% of cases. Differentiating between the two is important as this determines treatment. Adrenal carcinoma is an extremely rare cause of primary hyperaldosteronism.
Investigations:
Management:
A 45-year woman who you have treated for obesity comes for review. Despite ongoing lifestyle interventions and trials of orlistat and sibutramine she has failed to lose a significant amount of weight. She is currently taking ramipril for hypertension but a recent fasting glucose was normal.
For this patient, what is the cut-off body mass index (BMI) that would trigger a referral for consideration of bariatric surgery?
Correct Answer A:
Obesity - NICE bariatric referral cut-offs:
Obesity: bariatric surgery: The use of bariatric surgery in the management of obesity has developed significantly over the past decade. It is now recognized that for many obese patients who fail to lose weight with lifestyle and drug interventions the risks and expense of long-term obesity outweigh those of surgery.
NICE guidelines on bariatric surgery for adults
Consider surgery for people with severe obesity if:
Consider surgery as a first-line option for adults with a BMI of more than 50 kg/m2 in whom surgical intervention is considered appropriate; consider orlistat before surgery if the waiting time is long.
Types of bariatric surgery:
Which operation?
Which one of the following features is least commonly seen in Gitelman's syndrome?
Correct Answer B: Gitelman's syndrome: normotension with hypokalaemia.
Gitelman's syndrome:
Gitelman's syndrome is due to a defect in the thiazide-sensitive Na+ Cl- transporter in the distal convoluted tubule.
Click to expand