CKD, HTN, Hyperlipidaemia, diabetes

Question 1

CKD:
- Management in primary care (5)
- Follow up
- Referral
- Safety net

Answer 1

-

Question 2

Hypertension:

• pathophysiology (3)
• complications (4)
• risk factors - modifiable vs non
• causes
• symptoms
• signs
• ix
• Management in primary care
• Follow up
• Safety net

Question 3

Hypercholesterolaemia:
- What is cholesterol
- Definition
- Complications
- Causes
- Symptoms
- Signs
- Investigations
- Management
- Follow up
- Safety net

Question 4

Diabetes drugs:
- Mech action
- SE

• Metformin
• Gliclazide
• Pioglitazone
• Sitagliptin
• Dapagliflozin
• Exenatide

Question 5

T1DM:
- Pathophysiology
- Symptoms
- Signs
- Ix
- Mx

Answer 5

T1DM:
- Pathophysiology: autoimmune destruction of pancreatic B cells in islets of langerhans therefore no insulin made so inc glucose in blood
- Symptoms: acute onset polyuria/dipsia (osmotic diuresis), fatigue, weight loss, blurry vision
- Signs: hyperkal
- Ix: autoab testing, serum c peptide low. Monitor via hba1c (>6.5%/48mmol), cbg (4.4-6.1mmol)
- mx: insulin OD long acting then short acting prn - change sites due to lipodystrophy
- mx in primary care:

1. same day referral
2. ensure access to diabetes team
3. provide insulin care when ill
4. screen for complications + other autoimmune diseases

Question 6

T2DM:
- Definition
- risk factors
- symptoms
- ix
- mx
- pre diabetes levels
- mx in primary care

Answer 6

• definition: repeated insulin and glucose causes inc resistance to insulin causing damage to B cells making them produce less insulin
• risk f: obesity, lack ex, high carb, black/asian, fx, age
• symptoms: gradual onset polyuria/dip, fatigue, weight loss, slow healing infections, acanthosis nigricans
• ix: hba1c >6.5%, random glucose >11.1, fasting glucose >7, ogtt >11.1
• mx: diet low glycemic, immunisations, metformin + titrate up, add another then add another and if not then just metformin + insulin
• pre diabetes levels: hba1c 42-47, fasting 6.1-6.9, ogtt 7.8-11 - lifestyle changes only
• mx in primary care:
  1. care plan
  2. group education programme
  3. lifestyle advice
  4. sick day rules
  5. advice on pre-pregnancy
  6. immunisations
  7. hba1c monitoring
  8. screening for complications

Question 7

Complications of diabetes
- microvascular (3)
- macrovascular (3)
- metabolic
- psychological

Answer 7

• Microvascular— retinopathy, nephropathy, and neuropathy.
• Macrovascular complications — such as myocardial infarction, stroke, and peripheral arterial disease.
• Metabolic — DKA and hypoglycaemia (blood glucose less than 3.5 mmol/L).
• Psychological — anxiety, depression, and eating disorders, behaviour issues
• Increased risk of developing other autoimmune conditions — including thyroid disease, coeliac disease, Addison’s disease, and pernicious anaemia.
  Reduced quality of life and life expectancy.