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Endocrinology > 24.7.2013(diabetology CME) > Flashcards

24.7.2013(diabetology CME) Flashcards

0
Q

C peptide assay in CKD

A

Not accurate

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1
Q

Metabolism of exogenous and endogenous insulin

A

Liver extracts 40-50% of endogenous insulin

Exogenous insulin is primarily eliminated by kidney

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2
Q

Course of diabetes in CKD

A

Initially- insulin resistance

Later- insulin requirement decreases due to poor clearance

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3
Q

Why HbA1c estimation is not accurate in CKD?

A

Reduced life span of RBC
increased erythropoiesis and Reticulocytosis in CKD Rx with erythropoietin
Metabolic acidosis

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4
Q

Goal HbA1C in diabetics

A

Does not differ in CKD

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5
Q

Safe SUR in CKD

A

Glipizide

Safe even if crcl is less than 30ml/min

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6
Q

Meglitinide that can be used in CKD

A

Repaglinide

Nateglinide metabolite accumulates in renal failure

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7
Q

Metformin and CKD

A

Metformin is contraindicated in renal failure due to risk of lactic acidosis(FDA)
Can be used if eGFR more than 30ml/min/1.73m2(NICE)

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8
Q

Thiazelidenidiones and CKD

A

Adverse effects are increased
Fractures
CCF

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9
Q

Insulin dosing in CKD

A

Greater than 50ml/min - no dose adjustment
10-50ml/min- 75% of required dose
Less than 10ml/min- 50% of required dose

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10
Q

Rx of DM2 in CKD

A

Initial oral agent : Glipizide 2.5-10mg
Or
Repaglinide
In pts on hemodialysis,start with insulin

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11
Q

DPP4 inhibitor that can be used in renal failure

A

Linagliptin

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12
Q

Effect of diabetes on CAD in females

A

Completely cancels hormonal protection in females

Incidence of CVS diseases more in diabetic females than diabetic males

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13
Q

Occurrence of CAD in diabetics

A

Occurs a decade earlier

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14
Q

HOMA-IR

A

Serum insulin*serum glucose/22.5

1 unit increase in IR increases the risk of CAD by 5%

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15
Q

Anti atherogenic substance that is low in diabetics

A

Adiponectin

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16
Q

CAD risk factors in DM1 and DM2

A

DM1- hyperglycaemia

DM2-insulin resistance

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17
Q

CAD in DM1

A

Risk starts only from diagnosis

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18
Q

Coronary occlusion in DM

A

Multisegment

Non DM- discrete

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19
Q

GLP1 analogues and heart

A

Improve LV function

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20
Q

Rheumatological manifestations are common in which type of diabetes?

A

DM1

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21
Q

Rheumatologic condition specific to diabetes ?

A

Diabetic muscle infarction

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22
Q

Stiff hand syndrome

A 
Diabetic cheiroarthropathy
LJM syndrome(limited joint movement)
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23
Q

Signs in LJM syndrome

A

Prayer sign

Pebble hand

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24
Q

Intralesional steroid site in trigger finger?

A

Palpate nodule along MCP area

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25
Q

Dupuytren contracture commonly involves which finger

A

4th finger

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26
Q

Rx for Dupuytren contracture

A

Radiation
Needle aponeurotomy
Collagenase injection
Hand Sx

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27
Q

Carpal compression test

A

Durkan test

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28
Q

Adhesive capsulitis

A

Reversible contracture of joint capsule

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29
Q

Stages of frozen shoulder

A

S1: freezing or painful stage(6wks to 9 months)
S2: frozen or adhesive stage(4-9 months)
S3: thawing stage(5-26 months)

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30
Q

Frozen shoulder is aggravated by

A

Rest

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31
Q

Rx of frozen shoulder

A

NSAIDS
analgesics
Intra articular steroids

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32
Q

CRPS,synonyms

A

Complex regional pain syndrome

Shoulder hand syndrome

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33
Q

X ray finding in CRPS

A

Transient Patchy osteoporosis

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34
Q

CNS involvement in CRPS

A

Limbic system

Depression and suicide are common

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35
Q

CRPS

A

U/L abnormal sensitivity to temperature,touch,vasomotor instability

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36
Q

Course of CRPS

A

Edema-pain-atrophy

37
Q

Rx of CRPS

A

SSRI
anti epileptics
Stellate ganglion block

38
Q

X ray appearance in diabetic foot

A

Sucked candy appearance due to forefoot osteolysis

39
Q

DD for diabetic muscle infarction

A

Pyomyositis
Nodules
Sarcoidosis
Abscess

40
Q

DISH commonly affects which spine

A

Thoracic spine

41
Q

DISH is associated with calcification of __________ ligament

A

Anterior spinal ligament

42
Q

Diff btw DISH and AS

A

Flowing wax appearance on rt side only(aorta prevents calcification on lt side)
Disk space is not altered
No sacroilitis

43
Q

Dermatogical manifestations in DM1 and 2

A

DM1- autoimmune conditions

DM2- infections

44
Q

Which infection is common in diabetics

A

Fungal(candidiasis)

45
Q

__________ infection is common in DM with PVD

A

Toe nail onychomycosis

46
Q

Most common skin manifestation of diabetes

A

Diabetic dermopathy

Shin spots

47
Q

Shin spots is a marker of

A

Diabetic microangiopathy

48
Q

Presentation of diabetic shin spots

A

Hyperpigmented macules over shin

49
Q

Types of granuloma annulare

A

Generalised

Perforating

50
Q

Necrobiosis lipoidica diabeticorum

A

Yellowish brown plaques over pretibial shin

Rare but specific manifestation

51
Q

Diabetic thick skin

A

Diabetic cheiroarthropathy

52
Q

Diabetic bullae

A

Painless non pruritic bullae over lower limb

Non scarring

53
Q

Pathogenesis of acanthosis nigricans

A

Hyperinsulinemia—> increased IGF —-> Keratinocyte proliferation

54
Q

Peau de orange appearance in diabetics

A

Scleredema diabeticorum

55
Q

Skin manifestation in diabetics on hemodialysis

A

Perforating dermatosis

56
Q

Eruptive Xanthoma is common in which type of diabetes

A

DM1

57
Q

Xanthelasma is common in which type of diabetes

A

DM2

58
Q

Insulin lipodystrophy

A

Atrophy

Hypertrophy

59
Q

Course of bullosis diabeticorum

A

Resolve in 2-3 weeks without scarring

60
Q

Bullosis diabeticorum is common in

A

Diabetic men with peripheral neuropathy

61
Q

Polyglandular autoimmune syndrome 1

A

Vitiligo

Gonadal failure

62
Q

APS2

A 
Adrenal failure 
Autoimmune thyroid disease
DM1
Pernicious Anemia 
Alopecia areata
63
Q

Which is more common?

APS1 or 2

A

APS 2

64
Q

Diabetic yellow nail,common site

A

Distal end of hallux nail

65
Q

Other name for pebbled knuckles

A

Huntley papules

66
Q

Scleredema diabeticorum,common site

A

Back and posterior neck

67
Q

Diff btw Scleredema of bushke and Scleredema diabeticorum

A

Scleredema of bushke
Self limiting
Occurs after respiratory tract infection
Dermal thickening affecting face,hands,arms
Common in women

68
Q

Skin tags are also known as

A

Acrochordons

69
Q

Skin tags are markers of

A

IGT

CAD risk

70
Q

Drugs causing acanthosis nigricans

A

Nicotinic acid

Corticosteroids

71
Q

Most effective treatment for acanthosis nigricans

A

Life style modification

72
Q

Calciphylaxis,common sites

A

Breast
Thigh
Abdomen

73
Q

Calciphylaxis

A

Medial calcification of small vessels

Medial calcification of large vessels- monkeberg sclerosis

74
Q

Causes of monckeberg sclerosis

A

Renal failure
Diabetes
Vit D intoxication

75
Q

Common sites of eruptive xanthomas

A

Extensor aspects

Buttocks

76
Q

Rx of erythrasma

A

Erythromycin

77
Q

Rx for malignant otitis externa

A

Quinolones

78
Q

Allergic reactions to insulin

A

Immediate local reactions
Generalised reactions
Delayed hypersensitivity reactions(itchy nodules)
Biphasic reaction(Arthus type)

79
Q

Onset of insulin atrophy

A

6-24 months

80
Q

Lipohypertrophy presents as

A

Lipoma

81
Q

Cause of lipoatrophy due to insulin injection

A

Lipolytic components of insulin preparation
Inflammatory process
Cryotrauma

82
Q

Most common dermatological adverse effects of SUR

A

Maculopapular rash

83
Q

Pseudo acanthosis nigricans is associated with

A

Obesity

84
Q

Mucous membrane acanthosis nigricans is common in

A

Type 5

85
Q

Acquired perforating dermatosis

A

Purpuric umbilicated papules with central hyperkeratotic crust

86
Q

Causes of Calciphylaxis

A

Hyperparathyroidism
DM
ESRD

87
Q

Challenging agents in Calciphylaxis

A 
Glucocorticoids
Calcium heparinate
Tobramycin im
Iron dextran complex
Immunosuppressive agents 
Vitamin D
Albumin infusions
88
Q

Is Calciphylaxis painful?

A

Extremely painful

89
Q

Common sites of Calciphylaxis

A 
Posterior and lateral calf
Abdomen
Buttocks
Fingers
Glans
90
Q

Common sites of granuloma annulare

A

Dorsa of hands,feet,ankle,elbow

Endocrinology (5 decks)

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