9

Question 1

Whipples triad of hypoglycaemia

Answer 1

1) Symptoms
2) Plasma glucose conc <4 diabetics w insulin/<2.8 (normal)
3) Improves with glucose

Question 2

Treatments for DKA and HHS

Answer 2

DKA:

1) Correct insulin deficiency = IV Insulin
2) Clear ketones and restore fluid balance = crystalloid fluids 0.9NaCl/ Hartmann’s - causes potassium and glucose to fall
3) Restore potassium and glucose (otherwise hypoglycemia/kalemia)

HSS:
1) Fluids - 0.9NaCl
2) Insulin
Other - LMWH (DVT risk)and foot protection

Question 3

In what order do diabetic complications occur

Answer 3

1st 5 years - retinopathy
around 10 years - cardio and renal (CVD/nephropathy)
around 15-20 years - neurovascular

Question 4

Hormones responsible for inception effect

Answer 4

Gut hormones:

GLP1, GIP1

Question 5

Genes and autoantibodies affected in T1DM

Answer 5

Genes: HLA D3/4

AAbs: GAD (glutamic acid decarboxylase) and IA2 (Insulinoma associated antibody 2)

Question 6

What class of T2DM drugs can be used in renal impairment and the elderly?

Answer 6

GLP1 agonists

Question 7

What classes of T2DM drugs cause weight loss/ gain?

Answer 7

Loss: metformin, GLP1 agonists, SGLT2 inhibitors
Gain: Sulphonureas, insulin, TZD pioglitazone

Question 8

What layers of the adrenal gland produce which steroids

Answer 8

Glomerulosa = mineralocorticoids
Fasciculata = cortisol
Reticularis = androgens

Question 9

Main enzyme defect in congenital adrenal hyperplasia and effects

Answer 9

CYP21 = 21 alpha dehydroxylase

Prevents full conversion to aldosterone/ cortisol so DHEA builds up

Question 10

Genes associated with familial hyperparathyroidism

Answer 10

MEN1/2

Question 11

Antibodies in hypothyroidism

Answer 11

Thyroid paroxysmal abs

Question 12

Gene mutation in medullary thyroid tumour

Answer 12

RET protooncogene