Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCGP > Diabetes And Endocrinology > Flashcards

Diabetes And Endocrinology Flashcards

1
Q

What are the 10 key checks for annual review in diabetes?

A

Diabetic eye screening-retinopathy
Diabetic foot screening
BMI
Blood pressure
HbA1c
U+E
Lipids
Urine ACR
Smoking cessation advice
Influenza vaccine single pneumococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lifestyle modification advice in diabetes

A

NERS
Dietician
Weight loss if overweight
Stop smoking
Exercise/activity
Cardio risk: BP, statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which diabetic patients should be offered a statin?

A

T2DM if QRISK>10%
T1DM age >40 or diabetes>10 years, nephropathy, obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should HbA1c targets be?

A

48 if planning pregnancy (+5mg folic acid)
48 if lifestyle management
48 if lifestyle + metformin
53 if drug treatment associated with hypoglycaemia (such as gliclazide)
53 if risen to 58+ so added 2nd drug
64 mild frailty(de-escalate meds if 58), 69 severe frailty (de-escalate meds if 64)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the sick day rules?

A

If unwell and sugars>13 mmol/L (on insulin pump) or 15 mmol/L, check for ketones in blood:
If ketones>1.5 mmol/L, or confusion or drowsiness, call 999.

Do not stop taking insulin.
Stop ACEi/NSAIDs/diuretics
Stop metformin/SGLT2/gliclazide/GLP-1 if risk dehydration
One glass of fluid per hour.

Seek GP help:
ketones 0.6-1.5 mmol/L.
persistent vomiting.
breath smells like pear drops.
new-onset abdominal pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Group 1 drivers DVLA regulations

A

If insulin/gliclazide inform DVLA + you can drive if:
-You have adequate awareness of the onset of hypoglycaemia.
* You should inform the DVLA if you have more than one severe hypo within
the preceding 12 months. Severe hypoglycaemia is defined as requiring the
assistance of another person.
* You should practice appropriate blood glucose monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Group 2 drivers DVLA regulations

A

-You have full awareness of hypoglycaemia.
* No episode of severe hypoglycaemia in the preceding 12 months.
* You should use a blood glucose meter with sufficient memory to store 3 months
of continuous readings . You must practice appropriate blood
glucose monitoring before driving + 2hrly
* You can demonstrates an understanding of hypoglycaemia risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you diagnose diabetes?

A

Random blood glucose>11.1
fasting blood glucose> 7.0
HbA1c>48
If asymtommatic rpt in 2 weeks to confirm diagnosis

If HbA1c 42-47.9 or FBG 5.5-6.9, diagnose as prediabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you consider MODY?

A

Age<30 years.
Age 30-45, not requiring insulin, with:
no metabolic syndrome, or
mild fasting hyperglycaemia (5.5-8 + HbA1c<65 mmol/mol), or
extra-pancreatic features, deafness, neurological abnormalities, urinary tract abnormalities, cardiac hypertrophy, optic atrophy, short stature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to reduce GI side effects with metformin

A

Start at 500mg OD, increasing to 500 mg twice a day after 2 weeks then to 1g BD
taking with or after food.
using MR if ongoing symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dosing for metformin

A

eGFR 15 -30 -Avoid metformin

30-60- max 1g daily

60-120-max 2g daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

1st line management T2DM

A

Metformin 500mg OD- titrate up to 1g BD (if eGFR>60)
4 weeks later add in dapagliflozin if QRISK>10% or CKD or IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If metformin is not tolerated or contra-indicated and low cardiovascular risk?

A

DPP-4 inhibitor- sitagliptin/linagliptin
Pioglitazone
A sulfonylurea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give examples of DPP4-i and pros/cons/when to use

A

Sitagliptin/linagliptin/saxagliptin
weight neutral
low risk hypos
mild effect on hba1c (6-8 drop)
good in frailty
avoid in pancreatitis. Saxagliptin avoid in heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pioglitazone, pros/cons/when to use

A

Good in metabolic syndrome, takes 3m to work, reduced lipids
Causes weight gain and incr fracture risk
Contraindicated in heart failure, macular oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give example of sulphonylurea and pros/cons/when to use

A

Gliclazide
Good in marked osmotic symptoms and steroid induced hyperglycaemia
Incr risk of hypoglycaemia, take with meals
Blood glucose monitoring mornings + before driving
Weight gain so use if BMI<28
Poor durability of effect
Can be used as rescue therapy for 4 weeks if v high HbA1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If monotherapy is ineffective, what to add?

A

A DPP-4 inhibitor (sitagliptin)
Pioglitazone.
A sulfonylurea. (gliclazide)
An SGLT-2 inhibitor (if not already on and risk of hypos)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give examples of SGLT2i and pros/cons/when to use

A

Dapagliflozin/canagliflozin/empagliflozin
Caution in amputation, PVD,
frequent urogenital infections.
frailty at risk of hypovolaemia, prev DKA, ketogenic diet
Risk of normoglycaemic DKA
Improves cardiovascular + CKD outcomes
If eGFR<45, loses glycaemic beneift but still has CKD/CCF benefit
Stop 48hrs prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

For triple therapy what combinations are good and which are bad?

A

Good:
metformin+ dapagliflozin + gliclazide
Metformin + ertugliflozin + sitagliptin
Bad:
Dapagliflozin not with pioglitazone

Instead of triple therapy, consider insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If triple therapy ineffective?

A

Switch one drug for a GLP-1 (need to stop gliptin DPP4)
GLP-1 if:
BMI>35+ medical conditions associated with obesity, or
BMI<35+ insulin therapy would have significant occupational implications, or weight loss would benefit other comorbidities.

Should only be continued if reduction>11 in HbA1c and a weight loss of at least 3% in 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Give examples of GLP-1 and pros/cons/when to use

A

Semaglutide (Ozempic) weekly SC, dulaglutide (Trulicity) weekly SC, liraglutide (Victoza) OD SC
Low risk hypo
Cardiovascular protection
Expensive
Interacts w/levothyroxine, slows gastric emptying, can worsen gallstone disease and retinopathy
Oral semaglutide specialist recommended
Not with DPP4-i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management diabetes + CKD?

A

Control BP, lipids, sugars
If ACR>3 start ACE-i
Specialist reccomended- dapagliflozin/ consider finerenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

BP management in T2DM

A

ACEi 1st line or ARB if black/african

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Steroid induced hyperglycaemia management

A

Mostly post-prandial hyperglycaemia
If glucose<15 monitor
If glucose>15 and no diabetic meds, consider starting gliclazide short term
If already on insulin, titrate dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Symptoms of hypoglycaemia

A

Hunger, sweating, tremor, anxiety
Dizziness or light-headedness
Sleepiness, confusion
Difficulty speaking, weakness
Usually symptoms when sugar<4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Management hypoglycaemia

A

If blood glucose (BG)<4 and able to swallow:
170 mL of lucozade
4 glucotabs
3 jelly babies
150 mL juice/pop
Retest BG in 15 mins, bread/2xdigestive biscuit

IM glucagon 1mg if:
unconscious
having a seizure
unable to take anything PO
no change in BG after PO sugar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Risks of poorly controlled GDM (gestational diabetes) + poorly controlled diabetes in pregnancy

A

Macrosomia
Neonatal hypoglycaemia
Hyperbilirubinaemia
Respiratory distress syndrome

miscarriage.
congenital malformations.
stillbirth and neonatal death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Risk factors for GDM

A

BMI>30
Previous macrosomic baby>4.5 kg
Previous GDM
1º relative with diabetes
Black, Asian, and other ethnic minority family origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management post-natal period GDM

A

HBA1c at 13 weeks (preferred), or
fasting blood glucose (FBG) at 6 to 13 weeks
If FBG<6, low risk T2DM
If FBG 6-6.9 pre-diabetes
If FBG>7 then has T2DM
All GDM pts will need annual screening HbA1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Diagnostic criteria GDM and BG aim

A

FBG>5.6 or OGTT BG>7.8
Target levels are 5.3 fasting, and 7.8 1 hour after meals, or 6.4 2 hours after meals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Management prediabetes

A

Smoking cessation
Healthy eating
Increasing physical activity
Weight reduction
Manage cardiovascular risk- eg statins, BP
Consider metformin off label if BMI>35 and deterioration HbA1c despite lifestyle changes
Refer dietician (or low cal diet if England)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Ix for primary amenorrhoea

A

Check BMI, growth
Pubic/axillary hair, breast development
Bloods: LH, FSH, oestrogen, TSH, prolactin,
testosterone, sex hormone binding globulin (SHBG), if ?androgen excess.
USS pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What should you look for on inspection ?diabetic foot

A

Ulcers or infection.
nail infection or impingement on adjacent toes.
interdigital infections
Fissured skin, skin atrophy, callus or corn formation, blisters
structural changes-high arch, clawed toes, bunions.
foot swelling.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Features and complications ischaemic foot

A

Cool, hairless, with diminished or absent pulses
Pale or dependent rubor with atrophic skin
Painful
Ulcers
Intermittent claudication, rest pain, gangrene, and amputation

35
Q

Signs of diabetic foot attack

A

Ulceration
Spreading infection
Critical limb ischaemia
Gangrene
Charcot foot:
-Localised swelling, erythema, and increased skin temperature without trauma.
-Rocker‑bottom foot deformity.
-with or without pain

36
Q

Referral criteria diabetic feet

A

Admit vascular: critical limb ischaemia
Same day podiatry assessment or, if OOH admit T+O
Active crisis, request urgent (within 24 hours) podiatry assessment or advise patient self-referral to the Podiatry DFEET (Diabetic Foot Early Emergency Triage) Clinic.
Routine podiatry if moderate risk of crisis.

37
Q

Ix for secondary amennorhoea

A

Check BMI
Bloods: LH, FSH, oestrogen, TSH, prolactin,
testosterone, sex hormone binding globulin (SHBG), if ?androgen excess.

38
Q

4 main causes secondary amenorrhoea

A

PCOS
Premature ovarian insufficiency
Hyperprolactinaemia
Hypothalamic amenorrhoea (eg low BMI)

39
Q

Definitions of primary vs secondary amenorrhoea

A

primary amenorrhoea – absence of menarche by age 15 years, or age 13 years if absent secondary sexual characteristics.
secondary amenorrhoea – no menstruation for 3-6 months in a woman with previously normal and regular menses, or 6-12 months in a woman with previous oligomenorrhoea

40
Q

When to refer primary amenorrhoea

A

Urgent gynae if lower outlet tract obstruction (imperforate hymen or transverse vaginal septum) is suspected
Routine paeds: If amenorrhoea persists past aged 13 (if secondary sexual characteristics are absent) or past aged 15 years (if secondary sexual characteristics are present) Refer sooner and urgently if any concerning features (growth retardation/thyroid disease/genital malformation/puberty 5 yrs without menarche)

41
Q

Blood results suggestive of secondary amenorrhoea cause

A

PCOS- normal FSH, LH, oestrogen, slightly ↑testosterone/prolactin
Premature ovarian insufficiency - ↑FSH, ↑LH, ↓oestrogen, normal testosterone/prolactin
Hyperprolactinaemia- normal/low FSH LH oestrogen testosterone, ↑prolactin
Hypothalamic/pituitary amenorrhoea- normal/low FSH LH, low oestrogen, normal testosterone/prolactin

If very raised testosterone ?adrenal hyperplasia

42
Q

Define asherman syndrome

A

acquired condition, scar tissue forms inside the uterus and/or the cervix
Variable scarring inside the uterine cavity, front and back walls of the uterus may adhere to one another

43
Q

Causes of raised prolactin

A

Prolactinoma
Medication:
Antipsychotics, Antiemetics, Antidepressants, Opiates
Stress
Pregnancy
Hypothyroidism
Recent breast examination
If no clear cause and >1000 refer urgent endo

44
Q

Possible causes of premature ovarian insufficiency

A

Age<40 for premature, refer routine gynae (unless endocrine disorder)

Turner’s syndrome
Fragile X syndrome
Empty sella syndrome
Ovarian or pelvic surgery, chemotherapy, or radiotherapy
Autoimmune disorders

45
Q

Causes of hypercalcaemia

A

Primary hyperparathyroidism
Malignancy – myeloma, (breast ca, lung ca, kidney ca)
Medications (lithium, thiazide diuretics, vitamin D toxicity)
Sarcoidosis
Thyrotoxicosis
Cortisol deficiency
Milk-alkali syndrome

46
Q

Symptoms of hypercalcaemia

A

Nausea Vomiting
Constipation
Abdominal pain
Thirst
Polyuria
Confusion

47
Q

Ix for hypercalcaemia

A

Bloods: U+E, LFT, Bone profile, PTH, vitamin D
If age>60, myeloma screen
(PTH should be low if calcium raised)

If the above is normal consider:
FBC, ESR, chest X‑ray, X‑ray of spine or painful sites (sarcoidosis, malignancy)
Radionuclide bone scan
Serum electrophoresis + paraprotein + immunoglobulins
Thyrotoxicosis – TFT
Cortisol deficiency – 9am cortisol + ACTH

48
Q

Referral criteria for hypercalcaemia

A

Admit if:
calcium>3.5
calcium> 3 + n+v
calcium>3 + dehydration
Routine endocrinology if:
primary hyperparathyroidism, medication/surgery.
Osteoporosis

49
Q

Features of hyperkalaemia

A

arrhythmias/palpitations/syncope
n+v
paraesthesia
ascending muscle weakness legs->trunk->arms.
muscle pain

50
Q

Medication causes of hyperkalaemia

A

Spironolactone
ACEi/ARB
Propranolol
Digoxin toxicity
NSAIDs
Trimethoprim
Tacrolimus, ciclosporin
Heparins
LoSalt
Alfalfa, dandelion, nettle

51
Q

Non medication causes of hyperkalaemia

A

False reading, haemolysis of sample
AKI/CKD
Aldosterone deficiency
Rhabdomyolysis, burns, tumour lysis syndrome, crush injuries
Massive haemolysis
Acidosis, low insulin levels, or medications (shift from cells)
Massive blood transfusion

52
Q

Referral criteria hyperkalaemia

A

999 if acutely unwell
Admit if:
potassium>6.5
symptomatic hyperkalaemia
AKI
ECG changes (do ECG if K>6)
K rising rapidly.

Chronic hyperkalaemia routine ref cardio/renal for consideration of potassium binders.

53
Q

Symptoms hypokalaemia

A

hypotension, brady/tachycardia, arrhythmia
Weakness, fasciculations, tetany
Lethargy, paraesthesia, mental status change
Constipation

54
Q

Medication causes of hypokalaemia

A

Diuretics (furosemide, thiazides)
Salbutamol, theophylline
Insulin
Steroids

55
Q

Non medication causes hypokalaemia

A

D+V
Anorexia, bulimia, alcoholism
Excessive sweating, DKA, polydipsia.
Liquorice
Intestinal fistula, hypothermia, burns Hyperaldosteronism, Cushing’s, Conn’s syndrome, refeeding syndrome, diabetes insipidus

56
Q

Ix hypokalaemia

A

Blood sugar if diabetic
Mg if GI losses
ECG if K<3

57
Q

ECG changes with hyperkalaemia

A

Peaked T waves
PR prolongation
P wave loss
QRS widening
Sine wave
Ventricular arrhythmias, asystole

58
Q

Referral criteria for hypokalemia

A

Admit if:
K<2.5
ECG changes.
low magnesium (IV replacement)
significant symptoms
K<3 and decreasing

Routine endo:
?hyperaldosteronism or Conn’s
Nephrology advice if ↑urine potassium excretion, normal BP, no vomiting/diuretics

59
Q

Underlying conditions causing low magnesium levels

A

Malabsorption, malnutrition, Crohn’s, coeliac, refeeding syndrome, pancreatitis and cirrhosis
T2DM, DKA
Renal disorders
Hyperthyroidism, hypoparathyroidism, hyperaldosteronism

60
Q

Medications that can cause low magnesium

A

PPI
Loop and thiazide diuretics
Insulin
Digoxin
Cisplatin
Gentamicin
Ciclosporin, tacrolimus

61
Q

Features of low magnesium levels

A

Arrhythmia
Tremor
Confusion
Tetany
Seizure
Coma

62
Q

Referral criteria low magnesium

A

Admit if:
arrhythmia, tetany or seizure.
magnesium<0.7
hypokalaemia + low magnesium.

63
Q

When should steroid sick day rules be used and what are they?

A

At risk if>5 mg prednisolone daily for >3 weeks
Double usual dose for 2 to 3 days, then back to normal maintenance dose if minor illness
If vomiting/unable to absorb meds- admit

64
Q

Long term steroids monitoring + prophylaxis

A

Monitor BP, HbA1c, weight
Consider PPI
Yearly optometry for cataract/intraocular pressure
Calci-D
Alendronate if age>65 dependent on FRAX if age<70
Avoid live vaccinesI

65
Q

Baseline Ix after low impact fracture/concerns over bone health

A

FBC, Bone profile, U+E, LFT, GGT, TFT
Vitamin D, PTH, paraprotein/electrophoresis/immunoglobulins
Anti-TTG

66
Q

Management of osteoporosis

A

As per FRAX score/DXA
Weight bearing exercise
Stop smoking/alcohol
Avoid being underweight
Calci-D
Alendronic acid 70mg once weekly or ibandronic acid 150 mg once a month (specialist recommended)
HRT if age<60 (but benefit lost once stopped)

67
Q

Causes of low testosterone in men

A

Pituitary and hypothalamic diseases.
Opiates
testicular pathology (trauma, radiation, infection).
Klinefelter syndrome.
Obesity, OSA, T2DM
Anabolic steroid abuse

68
Q

Referral criteria low testosterone

A

Routine endo if 2 morning testosterone levels are low (<8) or borderline low (8-12),
USC urology if abnormal PSA in testosterone therapy/abnormal DRE

69
Q

What is Graves?

A

Autoimmune hyperthyroidism
Women>Men
Most common cause of hyperthyroidism
Diffuse goitre
Thyroid eye disease
Thyroid antibodies +ve in 90%

70
Q

What is thyroiditis

A

Subacute (de Quervain) thyroiditis:
Tender diffuse goitre, transient hyperthyroidism then hypothyroidism then normal
?viral
Doesn’t respond to carbimazole.

Postpartum thyroiditis (painless).
Medications (amiodarone, lithium)
external radiation

71
Q

Symptoms hyperthyroidism

A

Palpitations, tachycardia
Sweating
Tremor
Weight loss despite increased appetite
Symptoms of heart failure
Symptoms of goitre

72
Q

Ix for hyperthyroidism

A

TFT
TSH receptor antibodies
FBC, LFT, U+E
CRP, ESR if thyroiditis is suspected.
ECG if arrhythmia.

73
Q

Management hyperthyroidism

A

Admit if psychosis, fast AF, CCF

Urgent endo + same day ophthalmology if drop in visual acuity, or altered colour perception

Routine endo ref for everyone else for advice re carbimazole 20-40mg OD (risk agranulocytosis)
Start propranolol 20-40mg BD
Stop smoking
Contraception

74
Q

Management mild thyroid eye disease

A

Lubricating tear drops
Elevation of head of bed
Cold packs to eyes
Wearing dark glasses
NSAIDs
Selenium – OTC 200mcg OD

75
Q

Causes of hypothyroidism

A

Auto-immune hypothyroidism (Hashimoto’s) – most common cause in iodine-sufficient areas of the world.
Post radioiodine, thyroidectomy, or external radiation therapy.
Medications (lithium or amiodarone)
Sub-acute thyroiditis or postpartum thyroiditis
Central cause (very rare)

76
Q

Symptoms hypothyroidism

A

Tiredness
Sensitivity to cold
Weight gain
Constipation
Depression
Muscle aches and weakness
Dry and scaly skin, brittle hair and nails
Loss of libido
Irregular or heavy periods

77
Q

When should you suspect central cause of hypothyroidism?

A

Low or normal TSH with low FT4
Pituitary symptoms:
menstrual cycle.
cortisol deficiency.
hypogonadism.
visual fields.

78
Q

Management subclinical hypothyroidism

A

TSH>10: treat if symptommatic, or rpt 3-6 months and treat if still raised

TSH 4-10: rpt 3-6 months with TPO Ab, if positive + TSH still raised treat for 6m, if not treating monitor annually

79
Q

Management thyroid lump

A

Thyroid lump if moves on swallowing, central lower neck

USC endo if TSH raised or normal
Routine endo if TSH is low

USC if hypothyroid patient with goitre that persists once the patient is euthyroid.

80
Q

Management vitamin D deficiency

A

Loading:
Stexerol (colecalciferol) 25,000 unit tablets, take 2 once a week for 6 weeks.
Or- InVita D3 (colecalciferol) oral solution 25,000 units/mL, take 2 mL once a week for six weeks.
Check serum calcium 4 weeks after loading complete

81
Q

Symptoms of Addison’s crisis and Addison’s disease

A

Crisis: hypotension, hypovolaemic shock, delirium, reduced consciousness, acute abdominal pain, vomiting, headache, low-grade fever, and muscle weakness.

Fatigue
Hyperpigmentation
Weight loss, cravings for salt.

82
Q

Ix for Addison’s

A

9am cortisol
U+E: Na low K high
Glucose
Cortisol<100- admit
100-500- refer for Synacthen test.

83
Q

Features of Conn’s

A

Hyperaldosteronism
Low K, raised BP
Treatment resistant hypertension

84
Q

Features of carcinoid syndrome

A

When neuroendocrine tumours produce serotonin, usually when spread to liver
diarrhoea, tummy pain and loss of appetite
flushing of the skin, particularly the face
fast heart rate
breathlessness and wheezing

MRCGP (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions