Chempath 21: Diabetes CPC Flashcards

1
Q

A Fasting plasma glucose of >……. defines diabetes

A

> 7mmol/L

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2
Q

A 2 hour plasma glucose in a GTT > …….. defines diabetes

A

> 11.1mmol/L

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3
Q

A HbA1c > ……. defines diabetes

A

> 48mmol/mol (6.5%)

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4
Q

Why is respiratory compensation for metabolic alkalosis limited ?

A

If you want to increase CO2 by restricted breathing it will be limited because you require a sufficient amount of ventilation to maintain oxygen levels

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5
Q

DKA is a metabolic acidosis with a ……….. anion gap

A

High

Anion gap = Na + k - Cl - HCO3

Normal is about 12 (8-16)

If >12 suggests other anions such as ketones

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6
Q

How does the dialysis regime differ in treatment of ATN and diabetic glomerular kidney disease ?

A

In ATN 3 weeks of dialysis should allow recovery of renal function

In diabetic glomerular kidney disease the patient will require lifelong dialysis of transplant.

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7
Q

Which of the following diseases is most likely to be associated with AA amyloidosis ?

A) Alzheimer’s disease 
B) Diabetes Mellitus 
C) Plasmacytoma
D) Rheumatoid Arthritis 
E) Thyroid carcinoma
A

D) Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory condition which contribute to serum amyloid associated (AA) protein production.

Alzheimer’s causes localised amyloid deposition know as amyloid angiopathy

Diabetes mellitus type 2 causes localised Islet cell amyloid deposition

Plasmacytoma (multiple myeloma) causes Light chain (AL) amyloid production

Medullary thyroid carcinomas cause local amyloid production in their stroma

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8
Q

Phaeochromocytoma shows increased levels of ……… in the urine. Whereas a congenital Neuroblastoma of the adrenal gland would more likely show …….. in the Urine

A

They both show catecholamines in the Urine but:

Phaeochromocytoma shows more : VMA
Neuroblastoma shows more: HMA

HMA is a more mature metabolite of epinephrine (adrenaline) than VMA is and has a better prognosis.

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9
Q

What are 3 causes of metabolic alkalosis

A

H+ loss (eg vomiting)
Hypokalaemia
Ingestion of bicarbonate

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10
Q

List causes of hypokalaemic alkalosis

A
Intestinal loss 
- diarrhoea
- vomiting
- fistula
Renal loss
- mineralocorticoid excess
- diuretics
- renal tubular disease
Redistribution
- Insulin (drives potassium into cells)
- Alkalosis 
- Beta agonists
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11
Q

What is the link between hypokalaemia and alkalosis

A

low K+
shifts H+ ions into cells
causing extracellular alkalosis

Hypokalaemia causes alkalosis
And alkalosis causes hypokalemia

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12
Q

Why can ectopic ACTH cause hypokalaemia

A

Causes such high levels of cortisol that they start binding aldosterone receptors

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