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ENDOCRINOLOGY > [diabetes] > Flashcards

[diabetes] Flashcards

1
Q

[diabetes][Dx]: What is HBa1c

A

Glycated haemoglobin

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2
Q

[diabetes][Dx]: HbA1c is a marker of average glucose levels over what prior time period

A

8 weeks (RBC t1/2)

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3
Q

[diabetes][Dx]: What symptoms are signs of DM according to WHO criteria for Dx. (6)

A 
Polyuria
Polydipsia
Visual blurring 
Genital thrush
lethargy
Unexplained wt loss
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4
Q

[diabetes][Dx]: Symptoms of DM + raised venous glucose once of …. (fasting)

A

> = 7mmol/L

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5
Q

[diabetes][Dx]: Symptoms of DM + raised venous glucose once of …. (random)

A

> =11.1 mmol/L

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6
Q

[diabetes][Dx]: Raised venous glucose on 2 occasions of … (fasting)

A

> = 7 mmol/L

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7
Q

[diabetes][Dx]: Raised venous glucose on 2 occasions of … (random)

A

> = 11.1 mmol/L

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8
Q

[diabetes][Dx]: On 2 occasions a raised OGTT after 2hrs of …. is Dx

A

> = 11.1 mmol/L

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9
Q

[diabetes][Dx]: an HbA1c of … mmol/L is Dx of DM

A

> =48 mmol/L

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10
Q

[diabetes][Dx]: an HbA1c of …. % is Dx of DM

A

6.5%

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11
Q

[diabetes][Dx]: An HbA1c of lower than the cut off for DM does exclude DM: T/F

A

F

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12
Q

[diabetes][Dx]: HbA1c measurements are avoided in (3)

A

Children
Pregnancy
DM 1

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13
Q

[diabetes][Dx]: pathophysiology behind DM1

A

Autoimmune destruction Beta cells

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14
Q

[diabetes][Dx]: What does LADA stand for

A

Latent autoimmune diabetes of adults

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15
Q

[diabetes][Dx]: What is LADA?

A

Late onset DM 1

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16
Q

[diabetes][Dx]: Cause of DM2 (2)

A

decreased insulin secretion

increased insulin resistance

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17
Q

[diabetes][Dx]: Impaired fasting or glucose tolerance in a marker for progression in to which DM ?

A

2

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18
Q

[diabetes][Dx]: When would lifestyle intervention be most crucially indicated?

A

DM 2

during impaired fasting glucose/tolerance

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19
Q

[diabetes][Dx]: What does MODY stand for

A

Maturity onset DM of the young

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20
Q

[diabetes][Dx]: MODY genetic inheritance pattern?

A

Autosomal Dominant

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21
Q

[diabetes][Dx]: Explain MODY

A

Autosomal dominant DM2 affecting the young with a family Hx

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22
Q

[diabetes][Dx]: Genetic concordance in DM1?

A

30% - strong environmental factors

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23
Q

[diabetes][Dx]: Genetic concordance in DM2?

A

80% - F Hx!

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24
Q

[diabetes][Dx]: what are the criteria to have impaired glucose tolerance?

A

a fasting glucose of < 7 mmol/L

OGTT of 7.8 mmol/L

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25
Q

[diabetes][Dx]: what are the criteria to have a raised fasting glucose?

A

6.1 mmol/L

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26
Q

[diabetes][Dx]: what Ix is indicated if pt has impaired fasting glucose

A

OGTT

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27
Q

[diabetes][Dx]: pancreatic destruction can cause DM. Name 2 diseases apart from surgery?

A

haemochromatosis

Cystic fibrosis

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28
Q

[diabetes][Dx]: Name 4 categories of drugs known to cause DM

A

Steroids
Anti HIV
Thiazides
New anti-psychotics

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29
Q

[diabetes][Dx]: 5 endocrinological diseases that can cause DM ?

A 
Phaechromocytoma
Hyperthyroidism
Pregnancy
Acromegaly
Cushings
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30
Q

[diabetes][pregnancy]: what % of pregnant women develop new-onset gestational DM

A

3.5%

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31
Q

[diabetes][pregnancy]: what advice can you offer the pt

A

control weight

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32
Q

[diabetes][pregnancy]: what supplement can you offer?

A

folic acid 5mg/day

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33
Q

[diabetes][pregnancy]: when should the pt take supplements until

A

12 weeks into the pregnancy

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34
Q

[diabetes][pregnancy]: All oral hypoglycaemics should be stopped apart from

A

metformin

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35
Q

[diabetes][pregnancy]: 6 weeks post partum?

A

Fasting glucose

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36
Q

[diabetes][pregnancy]: what % of GDM pts go on to develop DM

A

50% (regardless of post partum glucose)

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37
Q

[diabetes][pregnancy]: metformin can be used in conjunction (or alone) with what Tx for GDM

A

insulin

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38
Q
A

HLA D3 D4

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39
Q
A

DM 1

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40
Q
A

T

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41
Q

[diabetes][syndromeX]: what is metabolic syndrome aka

A

syndrome X

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42
Q

[diabetes][syndromeX]: defined as BMI …. or ^ waist circumference

A

> 30 (central obesity)

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43
Q

[diabetes][syndromeX]: cut off for BP in Dx?

A

> 130/85

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44
Q

[diabetes][syndromeX]: Cut off for TAGs in Dx?

A

=>1.7 mmol/L

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45
Q

[diabetes][syndromeX]: cut off for HDL in men?

A

1.03 mmol/L

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46
Q

[diabetes][syndromeX]: cut off for HDL in Females?

A

1.29 mmol/L

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47
Q

[diabetes][syndromeX]: cut off for fasting glucose?

A

> =5.6 mmol/L

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48
Q

[diabetes][syndromeX]: Presence of .. is Dx if increased BMI?

A

DM

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49
Q

[diabetes][syndromeX]: what 5 criteria do you need 2 of with an increased BMI to be Dx

A 
BP
TAGs
HDL
Fasting glucose
DM
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50
Q

[diabetes][syndromeX]: which cancer are you at risk from

A

pancreas (+other)

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51
Q

[diabetes][syndromeX]: decreased fertility affects which gender

A

M and F

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52
Q

[diabetes][syndromeX]: you are at increased risk of vascular event t/F?

A

T

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53
Q

[diabetes][syndromeX]: What very broad neurological disorder are you at risk of

A

neurodegeneration

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54
Q

[diabetes][syndromeX]: Lifestyle advice Tx? (2)

A

Exercise

Mediterranean diet

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55
Q

[diabetes][syndromeX]: Drug Tx same as DM?

A

Yes - metformin

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56
Q

[diabetes][syndromeX]: microalbuminuria risk in increased? T/F

A

T

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57
Q

[diabetes][syndromeX]: How might the bile duct be at risk?

A

Gallstone risk increased

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58
Q
A

asians

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59
Q
A

SSRIs

anti TB drugs

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60
Q

[diabetes][Tx]: what lifestyle advice should be given (3)

A

exercise
diet
smoking

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61
Q

[diabetes][Tx]: How would yo lower triglycerides

A

Statin

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62
Q

[diabetes][Tx]: 1st line tx for triglycerides

A

Simvastatin 40mg nocte

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63
Q

[diabetes][Tx]: how does simvastatin work

A

Inhibits HMG-CoA reductase

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64
Q

[diabetes][Tx]: What is HMG-CoA redutase

A

rate limiting step in endogenous production of cholesterol

65
Q

[diabetes][Tx]: When is Simvastatin not used in lowering triglycerides

A

if triglycerides are >4.5 mmol/L

66
Q

[diabetes][Tx]: what is used if there is a triglyceride level of cut off for simvastatin?

A

Bezalip 200mg/8hr

67
Q

[diabetes][Tx]: what is the target BP for DM management

A

<140/80 mmHg

68
Q

[diabetes][Tx]: what advice should be given about driving

A

do not drive if hypoglycaemic spells

69
Q

[diabetes][Tx]: DM1: mainstay of Tx?

A

Insulin

70
Q

[diabetes][Tx]: DM1: what is the danger with binge drinking

A

delayed hypoglycaemia

71
Q

[diabetes][Tx]: DM1: name 2 ultra fast acting insulins

A

Humalog

Novarapid

72
Q

[diabetes][Tx]: DM1: what is the usual dose of insulin in 1 injection regardless of speed of action?

A

100u/mL

73
Q

[diabetes][Tx]: DM1: when is ultra fast acting used

A

before or after a meal

74
Q

[diabetes][Tx]: DM1: medium acting insulin?

A

Isophane insuling

75
Q

[diabetes][Tx]: DM1: What is Novomix?

A

30% ultrafast

70% long acting

76
Q

[diabetes][Tx]: DM1: what are the 2 long acting insulins

A

Insulin glargine

Insulin Detemir

77
Q

[diabetes][Tx]: DM1: when is insulin glargine used

A

night time

78
Q

[diabetes][Tx]: DM1: why is insulin glargine used before bed

A

prevent nocturnal hypoglycaemia

79
Q

[diabetes][Tx]: DM1: there are 3 main regimens. name them

A

BD biphasic
QDS regimens
Once before bed

80
Q

[diabetes][Tx]: DM1: describe BD biphasic

A

2x daily Novamix

81
Q

[diabetes][Tx]: DM1: describe QDS

A

long acting before bed

ultra rapid before meal

82
Q

[diabetes][Tx]: DM1: Describe once before bed

A

Long acting before bed

83
Q

[diabetes][Tx]: DM1: if switching from metformin in type 2 DM to injections of insuling. Which regimens is most appropriate.

A

once before bed

84
Q

[diabetes][Tx]: DM1: what advice about autonomy in insulin regimens should you give

A

Promote autonomy i.e react to meals/exercise/illness

85
Q

[diabetes][Tx]: DM1: what effect does illness have on insulin requirements

A

increases insulin requirements (despite reduced food)

86
Q

[diabetes][Tx]: DM1: if ill how frequently should you check blood glucose

A

4 times a day

87
Q

[diabetes][Tx]: DM1: in illness what may be a sign of rising glucose levels other than blood glucose

A

ketouria

88
Q

[diabetes][Tx]: DM2: what class of drug is metformin

A

biguanide

89
Q

[diabetes][Tx]: DM2: what SE does metformincrucially not have

A

hypoglycaemia

90
Q

[diabetes][Tx]: DM2: what SE does metformin have (3)

A

Nausea
diarrhoea
abdominal pain

91
Q

[diabetes][Tx]: DM2: metformin CI is an eGFR of …

A

<36mL/min

92
Q

[diabetes][Tx]: DM2: what is the worry with using metformin if the is reduced eGFR?

A

lactic acidosis

93
Q

[diabetes][Tx]: DM2: what and when is the dose with metformin (2)

A

500mg

after food

94
Q

[diabetes][Tx]: DM2: what indications are the which make you stop metformin (3)

A

Tissue hypoxia (MI/sepsis for e.g.)
morning of GA
iodine contrast

95
Q

[diabetes][Tx]: DM2: for how long is metformin alone given before you give another drug

A

16 weeks

96
Q

[diabetes][Tx]: DM2: after 16 weeks on metformin what is measured to learn if another drug is required

A

HbA1c

97
Q

[diabetes][Tx]: DM2: after 16 weeks what is the HbA1c cut off for adding another drug on top of metformin

A

=>53mmol/L

98
Q

[diabetes][Tx]: DM2: what drug is added is after 16 weeks HbA1c is too high

A

Gliclazide 40mg/d

99
Q

[diabetes][Tx]: DM2: what class is gliclazide

A

sulfonylurea

100
Q

[diabetes][Tx]: DM2: how does gliclazide work

A

Binds to sulfonylurea-r on beta cells
closes K+ channels = depolarisation
Ca++ open, exocytosis of insulin

101
Q

[diabetes][Tx]: DM2: how does metformin work

A

supresses hepatic gluconeogenesis

102
Q

[diabetes][Tx]: DM2: what is a SE of gliclazide (2)

A

hypoglycaemia

increased weight

103
Q

[diabetes][Tx]: DM2: After metformin and sulfonylurea when next do you measure HbA1c?

A

6 months

104
Q

[diabetes][Tx]: DM2: what is the HbA1c cut off for addition of a 3rd anti-diabetic drug (post metformin+gliclazide)?

A

=>57 mmol/L

105
Q

[diabetes][Tx]: DM2: if HbA1c after 2 drugs reaches the cut off for a 3rd drug, what 2 drugs might you try?

A

Insulin

Pio-Glitazone 15-45 mg/24hrs

106
Q

[diabetes][Tx]: DM2:how does glitazone work?

A

increase insulin sensitivity

107
Q

[diabetes][Tx]: DM2: does using glitazone for DM2 after 6 months mean you stop metformin and sulfonylurea?

A

YES

108
Q

[diabetes][Tx]: DM2: if after 6 months you do not use a glitazone but insulin, in what case can you keep metformin

A

if unable to use BD regimens

109
Q

[diabetes][complications]: what effect does exercise have on cells with regard to insulin?

A

increase their sensitivity

110
Q

[diabetes][complications]: what is the target BP

A

<140/80

111
Q

[diabetes][complications]: what is the target BP if renal disease (microalbuminuria)

A

<75

ensure ACEi

112
Q

[diabetes][complications]: what effect may insulin have at the injection site (apart from ^risk of infection)

A

lipohypertrophy

113
Q

[diabetes][complications]: chief cause of death is

A

Vascular event

114
Q

[diabetes][complications]: what should ALL DM patients be put on regardless of blood levels of triglycerides

A

Statin (simvastatin unless > 4.5 mmol/L: bezalip)

115
Q

[diabetes][complications]: … mg aspirin is prescribed to reduce vascular event

A

75mg

116
Q

[diabetes][complications]: define microalbuminuria

A

urine dipstick -ve for protein

urineACR is =>3 mmol

117
Q

[diabetes][complications]: what does microalbuminaemurea indicate

A

early renal damage/disease

118
Q

[diabetes][complications]: when is an ACEi indicated even if BP is normal

A

if urine ACR is >3 mmol

119
Q

[diabetes][complications]: why is an ACEi indicated even if BP is normal?

A

Renal protective

120
Q

[diabetes][complications]: Diabetic retinopathy: how frequent is mandatory screening?

A

annual

121
Q

[diabetes][complications]: retinopathy: if pre-symptomatic and cotton wool spot/haemorrhages/aneurysms seen what intervention is used to prevent retinopathy?

A

laser photocoagulation

122
Q

[diabetes][complications]: Diabetic retinopathy: what does laser photocoagulation do?

A

stops angiogenic factor production from ischaemic retina

123
Q

[diabetes][complications]: what happens in retinopathy

A

angiogenic proliferation

124
Q

[diabetes][complications]: diabetic retinopathy: what are the hard exudates seen early on?

A

lipid deposits

125
Q

[diabetes][complications]: diabetic retinopathy: what would a retinal infarct look like/be described as?

A

cotton wool spot

126
Q

[diabetes][complications]: diabetic retinopathy: if new vessel formation is seen what should you do?

A

urgent referral to ophthalmologist - blindness.

127
Q

[diabetes][complications]: diabetic retinopathy: what is responsible for new vessel formation

A

ischaemia

128
Q

[diabetes][complications]: diabetic retinopathy: hyperglycaemia causes high blood flow and capillary pericyte damage leading to aneurysms and occlusion T/F?

A

t

129
Q

[diabetes][complications]: diabetic retinopathy: new vessel formation proliferate, bleed and fibrose and can cause the retina to ….

A

detach

130
Q

[diabetes][complications]: diabetic retinopathy: is aspirin safe to take?

A

yes

131
Q

[diabetes][complications]: diabetic retinopathy: what is new vessel formation on iris called

A

rubeosis iridis

132
Q

[diabetes][complications]: diabetic retinopathy: what may rubeosis iridis lead to

A

glaucoma

133
Q

[diabetes][complications]: diabetic retinopathy: Class of drug for Tx for maculopathy if surgery not an option?

A

intra-vitreal steroids

134
Q

[diabetes][complications]: diabetic retinopathy: cataracts can be reversed with normoglycaemia? T/F

A

T

135
Q

[diabetes][complications]: if the pt has reached the target BP of <140/80 and no microalbuminurea how frequently should BP check be

A

every 6 months

136
Q

[diabetes][neuropathy]: how would you identify peripheral foot neuropathy cf. ischaemia

A

infection or injury over pressure points = neuropathy

137
Q

[diabetes][neuropathy]: how would ischaemia present cf. neuropathy

A

absent dorsalis pedis

138
Q

[diabetes][neuropathy]: what is the classical distribution of peripheral neuropathy

A

glove and stocking

139
Q

[diabetes][neuropathy]: how would you measure sensation in the foot

A

10g monofilament

140
Q

[diabetes][neuropathy]: decreased sensation and absent jerks indicates neuropathy or ischaemia

A

peripheral neuropathy

141
Q

[diabetes][neuropathy]: if there is an absent dorsalis pedis what is the ext step?

A

doppler to measure flow

142
Q

[diabetes][neuropathy]: is foot ulceration painful or painless

A

painless

143
Q

[diabetes][neuropathy]: what investigation is specific to ulcers

A

depth probe (osteomyelitis/cellulits risk)

144
Q

[diabetes][neuropathy]: Mx of foot non-pharm? (2)

A 
regular chiropody (remove calluses)
comfortable shoes
145
Q

[diabetes][neuropathy]: 1st line empirical drug Mx of cellulitis

A 
benzylpenicillin 1.2g/6hr IV
\+
Flucloxacillin 1g/6hrs IV
\+-
metronidazole 500mg/8hrs IV
146
Q

[diabetes][neuropathy]: what are the 4 indications for amputation/surgery?

A

abscess/deep infection
gangrene (pain at rest)
suppurative arthritis
spreading anaerobic infection

147
Q

[diabetes][neuropathy]: diabetic neuropathy symptoms (2)

A

pain

numbness

148
Q

[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 1st line Tx?

A

paracetamol

149
Q

[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 2nd line Tx?

A

amitriptyline 10-25mg at night (TCA)

150
Q

[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 3rd line Tx? (2)

A

Duloxetine (SNRI)

Gabapentin

151
Q

[diabetes][neuropathy]: Symmetrical sensory polyneuropathy 4th line Tx?

A

opiates

152
Q

[diabetes][neuropathy]: Mononeuritis multiplex Tx (3 and 6 CNs can be affected)

A

corticosteroids

153
Q

[diabetes][neuropathy]: what is amyotrophy?

A

painful wasting

of quadriceps

154
Q

[diabetes][neuropathy]: autonomic neuropathy may present with? (5)

A 
Postural BP drop
urine retention
erectile dysfunction
diarrhoea
gastroparesis
155
Q

[diabetes][neuropathy]: 1st line drug Tx for autonomic induced postural BP drop?

A

fludrocortisone

156
Q

[diabetes][neuropathy]: 1st line drug Tx for autonomic induced diarrhoea?

A

Codeine phosphate 15mg/8hrs

157
Q

[diabetes][neuropathy]: what is charcots joint

A

neuropathy –> loss of pain sensation.

repeated unimpeded mechanical stress –> deformity.

158
Q

[diabetes][neuropathy]: 1st line Tx for charcots ?

A

total rest of joint

ENDOCRINOLOGY (19 decks)

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