MRCP 1 - ENDOCRINOLOGY COMPREHENSIVE EXAM
QUESTIONS WITH DETAILED VERIFIED AND 100%
ACCURATE ANSWERS BRAND NEW EXAM ALREADY
GRADED A+ PASS
titrate up metformin and encourage lifestyle changes to aim for a HbA1c
of 48 mmol/mol (6.5%), but should only add a second drug if the HbA1c
rises to 58 mmol/mol (7.5%) Ans✓✓✓titrate up metformin and
encourage lifestyle changes to aim for a HbA1c of 48 mmol/mol (6.5%),
but should only add a second drug if the HbA1c rises to 58 mmol/mol
(7.5%)
HbA1c should be checked every 3-6 months until stable, then 6 monthly
Ans✓✓✓
Metformin is still first-line and should be offered if the HbA1c rises to
48 mmol/mol (6.5%)* on lifestyle interventions.
the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should
be added from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%)
then triple therapy with one of the following combinations should be
offered:
→ metformin + gliptin + sulfonylurea
,→ metformin + pioglitazone + sulfonylurea
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered Ans✓✓✓Metformin is still
first-line and should be offered if the HbA1c rises to 48 mmol/mol
(6.5%)* on lifestyle interventions.
the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should
be added from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%)
then triple therapy with one of the following combinations should be
offered:
→ metformin + gliptin + sulfonylurea
→ metformin + pioglitazone + sulfonylurea
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered
Criteria for glucagon-like peptide1 (GLP1) mimetic (e.g. exenatide)
,if triple therapy is not effective, not tolerated or contraindicated then
NICE advise that we consider combination therapy with metformin, a
sulfonylurea and a glucagonlike peptide1 (GLP1) mimetic if:
→ BMI >= 35 kg/m² and specific psychological or other medical
problems associated with obesity or
→ BMI < 35 kg/m² and for whom insulin therapy would have
significant occupational implications or Ans✓✓✓
Addisonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia,
dehydration, decreased BP
Causes
sepsis or surgery causing an acute exacerbation of chronic insufficiency
(Addison's, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant
meningococcemia)
steroid withdrawal
The short synacthen test is the best test to diagnose Addison's disease
Bloods : hyponatraemia , hyperkalaemia ,hypoglycaemia
Management of Addisonian crisis (medical emergency):
, IV fluids +
corticosteroids (e.g iv dexamethasone) Ans✓✓✓Addisonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia,
dehydration, decreased BP
Causes
sepsis or surgery causing an acute exacerbation of chronic insufficiency
(Addison's, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant
meningococcemia)
steroid withdrawal
The short synacthen test is the best test to diagnose Addison's disease
Bloods : hyponatraemia , hyperkalaemia ,hypoglycaemia
Management of Addisonian crisis (medical emergency):
IV fluids +
corticosteroids (e.g iv dexamethasone)
Primary hyperparathyroidism
In exams, primary hyperparathyroidism is stereotypically seen in elderly
females with an unquenchable thirst and an inappropriately normal or
QUESTIONS WITH DETAILED VERIFIED AND 100%
ACCURATE ANSWERS BRAND NEW EXAM ALREADY
GRADED A+ PASS
titrate up metformin and encourage lifestyle changes to aim for a HbA1c
of 48 mmol/mol (6.5%), but should only add a second drug if the HbA1c
rises to 58 mmol/mol (7.5%) Ans✓✓✓titrate up metformin and
encourage lifestyle changes to aim for a HbA1c of 48 mmol/mol (6.5%),
but should only add a second drug if the HbA1c rises to 58 mmol/mol
(7.5%)
HbA1c should be checked every 3-6 months until stable, then 6 monthly
Ans✓✓✓
Metformin is still first-line and should be offered if the HbA1c rises to
48 mmol/mol (6.5%)* on lifestyle interventions.
the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should
be added from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%)
then triple therapy with one of the following combinations should be
offered:
→ metformin + gliptin + sulfonylurea
,→ metformin + pioglitazone + sulfonylurea
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered Ans✓✓✓Metformin is still
first-line and should be offered if the HbA1c rises to 48 mmol/mol
(6.5%)* on lifestyle interventions.
the HbA1c has risen to 58 mmol/mol (7.5%) then a second drug should
be added from the following list:
→ sulfonylurea
→ gliptin
→ pioglitazone
→ SGLT-2 inhibitor
if despite this the HbA1c rises to, or remains above 58 mmol/mol (7.5%)
then triple therapy with one of the following combinations should be
offered:
→ metformin + gliptin + sulfonylurea
→ metformin + pioglitazone + sulfonylurea
→ metformin + sulfonylurea + SGLT-2 inhibitor
→ metformin + pioglitazone + SGLT-2 inhibitor
→ OR insulin therapy should be considered
Criteria for glucagon-like peptide1 (GLP1) mimetic (e.g. exenatide)
,if triple therapy is not effective, not tolerated or contraindicated then
NICE advise that we consider combination therapy with metformin, a
sulfonylurea and a glucagonlike peptide1 (GLP1) mimetic if:
→ BMI >= 35 kg/m² and specific psychological or other medical
problems associated with obesity or
→ BMI < 35 kg/m² and for whom insulin therapy would have
significant occupational implications or Ans✓✓✓
Addisonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia,
dehydration, decreased BP
Causes
sepsis or surgery causing an acute exacerbation of chronic insufficiency
(Addison's, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant
meningococcemia)
steroid withdrawal
The short synacthen test is the best test to diagnose Addison's disease
Bloods : hyponatraemia , hyperkalaemia ,hypoglycaemia
Management of Addisonian crisis (medical emergency):
, IV fluids +
corticosteroids (e.g iv dexamethasone) Ans✓✓✓Addisonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia,
dehydration, decreased BP
Causes
sepsis or surgery causing an acute exacerbation of chronic insufficiency
(Addison's, Hypopituitarism)
adrenal haemorrhage eg Waterhouse-Friderichsen syndrome (fulminant
meningococcemia)
steroid withdrawal
The short synacthen test is the best test to diagnose Addison's disease
Bloods : hyponatraemia , hyperkalaemia ,hypoglycaemia
Management of Addisonian crisis (medical emergency):
IV fluids +
corticosteroids (e.g iv dexamethasone)
Primary hyperparathyroidism
In exams, primary hyperparathyroidism is stereotypically seen in elderly
females with an unquenchable thirst and an inappropriately normal or
