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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
Intralesional steroid site in trigger finger?
Palpate nodule along MCP area
25
Dupuytren contracture commonly involves which finger
4th finger
26
Rx for Dupuytren contracture
Radiation Needle aponeurotomy Collagenase injection Hand Sx
27
Carpal compression test
Durkan test
28
Adhesive capsulitis
Reversible contracture of joint capsule
29
Stages of frozen shoulder
S1: freezing or painful stage(6wks to 9 months) S2: frozen or adhesive stage(4-9 months) S3: thawing stage(5-26 months)
30
Frozen shoulder is aggravated by
Rest
31
Rx of frozen shoulder
NSAIDS analgesics Intra articular steroids
32
CRPS,synonyms
Complex regional pain syndrome | Shoulder hand syndrome
33
X ray finding in CRPS
Transient Patchy osteoporosis
34
CNS involvement in CRPS
Limbic system | Depression and suicide are common
35
CRPS
U/L abnormal sensitivity to temperature,touch,vasomotor instability
36
Course of CRPS
Edema-pain-atrophy
37
Rx of CRPS
SSRI anti epileptics Stellate ganglion block
38
X ray appearance in diabetic foot
Sucked candy appearance due to forefoot osteolysis
39
DD for diabetic muscle infarction
Pyomyositis Nodules Sarcoidosis Abscess
40
DISH commonly affects which spine
Thoracic spine
41
DISH is associated with calcification of __________ ligament
Anterior spinal ligament
42
Diff btw DISH and AS
Flowing wax appearance on rt side only(aorta prevents calcification on lt side) Disk space is not altered No sacroilitis
43
Dermatogical manifestations in DM1 and 2
DM1- autoimmune conditions | DM2- infections
44
Which infection is common in diabetics
Fungal(candidiasis)
45
__________ infection is common in DM with PVD
Toe nail onychomycosis
46
Most common skin manifestation of diabetes
Diabetic dermopathy | Shin spots
47
Shin spots is a marker of
Diabetic microangiopathy
48
Presentation of diabetic shin spots
Hyperpigmented macules over shin
49
Types of granuloma annulare
Generalised | Perforating
50
Necrobiosis lipoidica diabeticorum
Yellowish brown plaques over pretibial shin | Rare but specific manifestation
51
Diabetic thick skin
Diabetic cheiroarthropathy
52
Diabetic bullae
Painless non pruritic bullae over lower limb | Non scarring
53
Pathogenesis of acanthosis nigricans
Hyperinsulinemia---> increased IGF ----> Keratinocyte proliferation
54
Peau de orange appearance in diabetics
Scleredema diabeticorum
55
Skin manifestation in diabetics on hemodialysis
Perforating dermatosis
56
Eruptive Xanthoma is common in which type of diabetes
DM1
57
Xanthelasma is common in which type of diabetes
DM2
58
Insulin lipodystrophy
Atrophy | Hypertrophy
59
Course of bullosis diabeticorum
Resolve in 2-3 weeks without scarring
60
Bullosis diabeticorum is common in
Diabetic men with peripheral neuropathy
61
Polyglandular autoimmune syndrome 1
Vitiligo | Gonadal failure
62
APS2
``` Adrenal failure Autoimmune thyroid disease DM1 Pernicious Anemia Alopecia areata ```
63
Which is more common? | APS1 or 2
APS 2
64
Diabetic yellow nail,common site
Distal end of hallux nail
65
Other name for pebbled knuckles
Huntley papules
66
Scleredema diabeticorum,common site
Back and posterior neck
67
Diff btw Scleredema of bushke and Scleredema diabeticorum
Scleredema of bushke Self limiting Occurs after respiratory tract infection Dermal thickening affecting face,hands,arms Common in women
68
Skin tags are also known as
Acrochordons
69
Skin tags are markers of
IGT | CAD risk
70
Drugs causing acanthosis nigricans
Nicotinic acid | Corticosteroids
71
Most effective treatment for acanthosis nigricans
Life style modification
72
Calciphylaxis,common sites
Breast Thigh Abdomen
73
Calciphylaxis
Medial calcification of small vessels Medial calcification of large vessels- monkeberg sclerosis
74
Causes of monckeberg sclerosis
Renal failure Diabetes Vit D intoxication
75
Common sites of eruptive xanthomas
Extensor aspects | Buttocks
76
Rx of erythrasma
Erythromycin
77
Rx for malignant otitis externa
Quinolones
78
Allergic reactions to insulin
Immediate local reactions Generalised reactions Delayed hypersensitivity reactions(itchy nodules) Biphasic reaction(Arthus type)
79
Onset of insulin atrophy
6-24 months
80
Lipohypertrophy presents as
Lipoma
81
Cause of lipoatrophy due to insulin injection
Lipolytic components of insulin preparation Inflammatory process Cryotrauma
82
Most common dermatological adverse effects of SUR
Maculopapular rash
83
Pseudo acanthosis nigricans is associated with
Obesity
84
Mucous membrane acanthosis nigricans is common in
Type 5
85
Acquired perforating dermatosis
Purpuric umbilicated papules with central hyperkeratotic crust
86
Causes of Calciphylaxis
Hyperparathyroidism DM ESRD
87
Challenging agents in Calciphylaxis
``` Glucocorticoids Calcium heparinate Tobramycin im Iron dextran complex Immunosuppressive agents Vitamin D Albumin infusions ```
88
Is Calciphylaxis painful?
Extremely painful
89
Common sites of Calciphylaxis
``` Posterior and lateral calf Abdomen Buttocks Fingers Glans ```
90
Common sites of granuloma annulare
Dorsa of hands,feet,ankle,elbow

Endocrinology (5 decks)

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