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Diabetic/ endocrine Flashcards

1
Q

Diabetic med to not cause hypos?

A

Pioglitazone
SE: Hf, Weight gain, fractures, bladder cancer

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2
Q

Gliclazide is a ?

A

Sulfonylurea (surlf and glide):
SE: weight gain, hypoglycaemias, decrease warfarin effect (PCBRAS), caution in renal impairment for sulfonylureas. Gliclazide is metabolised in liver.

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3
Q

Pioglitazone is a?

A

no hypos, has heart failure, weight gain, fractures,thiazolidinedione, works by increasing insulin sensitivity

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4
Q

Sitagliptin is a?

A

sit on 4 legs
DPP4inhibitor. small risk pancreatitis. linagliptin is renal safe. reduce the peripheral breakdown of incretins such as GLP-1

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5
Q

What is SGLT2?

A

dapagliflozin - flows through urine. hypos. used for heart failure after metformin established or as monotherapy if CI to metformin. recurrent UTIs, fournier’s gangrene

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6
Q

Dx of diabetes

A

FBG 7+ or random 11.1+ x2 in asymptomatic
Sx- Hba1c 48+

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7
Q

Dx of IFG?

A

FBG 7.1 - 7 do OGTT
OGTT <7 then post glucose 7.8-11.1

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8
Q

Pernicious anaemia, DM, High TSH, low t4?

A

Hashimotos (common), painless goitre

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9
Q

DM2 - 2nd line/ dual therapy?

A

metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor (if NICE criteria met)

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9
Q

DM2 tripple therapy options?

A

metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
metformin + (pioglitazone or sulfonylurea or DPP-4 inhibitor) + SGLT-2 if certain NICE criteria are met
insulin-based treatment

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10
Q

Normal T3/T4 TSH is 5.7. Mx?

A

Subclinical hypothyroidism.
if TSH 5.5-10 (x2 3 months apart, with sx, <65YO) then trial 6 months levo
If TSH 10+ then consider levothyroxine (if x2 3 months apart)

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10
Q

When to consider GLP1 mimetic?

A

BMI 35+, psyhcosocial issues related to obesity. BMI < 35 and occupational related. Only keep on if WL 3% in 6 months and if Hba1c reduces by 11.
Works by increase insulin secretion and inhibit glucagon secretion

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11
Q

Aldosterone: renin test:
High aldosterone, low renin meaning? HTN, low K, alkalosis?

main causes?

A

Primary hyperaldosterone. Adrenal gland makes too much, suppressed renin bc high BP.
Bilateral adrenal hyperplasia (most common)
Adrenal adenoma secreting aldosterone (Conn’s syndrome)
Familial hyperaldosteronism (rare)

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12
Q

HTN, low K+, alkalosis?
Aldosterone: renin test: High aldosterone, High renin meaning?

TX?

A

Secondary hyperaldosteronism.
Excessive renin is released due to disproportionately lower blood pressure in the kidneys, usually due to:
Renal artery stenosis -doppler USS, Ct angio, MRA
Heart failure
Liver cirrhosis and ascites

TX: percutaneous renal artery angiogrplasty

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13
Q

Sx of HTN, low K, alkalosis? other IX?

A

Hyperaldosteronism - do aldosterone:renin ratio.
Do CT adrenals, renal artery imaging, adrenal venous sampling

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14
Q

Short synacthen test - Cortisol does not double after synacthen given (ACTH). ACTH is high

A

primary adrenal insufficiency.
Pituitary is producing lots of ACTH, cortisol is not released for neg feedback. destruction to adrenal cells - addisons

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15
Q

Short synacthen test - cortisol is low and ACTH is also low

A

ACTH level is low in secondary adrenal failure. Low ACTH release due to pituitary gland damage - trauma, sheehan’s, tumour.

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16
Q

What is tertiary adrenal insufficiency cx?

A

Failure of adrenals due to low CRT from hypothalamus due to long term suppression from exogenous steroids.

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17
Q

headache, sweating and palpitations HTN IX? TX?

A

Do urinary metanephrines
PHaeochromocytoma - give PHenoxybenzamine before beta-blockers

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18
Q

Pre DM values?

A

HBa1c 42-47
FBG 6-7

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19
Q

Impaired glucose intolerance values?

A

OgTT <7 then 7.8-11.1
FBG 6.1-7

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20
Q

What is glimerperide

A

sulfonylurea

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21
Q

Kallman’s syndrome/ klinfelter’s syndrome levels of hormones?

A

Kallman - low FSH/LH and low testosterone
Kleinfelter’s - high FSH and LH, low test (small testes, tall, gynacomastia)

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22
Q

Confusion, hypothermia, non pitting oedema, dry skin, course hair?

A

Myxoedema coma

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23
Why does hypercalcaemia cause peptic ulcers ad HTN?
increased gastrin production and vasoconstrion. Also AF: pancreatitis, MEN 1 and 2
24
Raised calcium, low phosphate, Normal/ raised PTH? when would you conservatively manage?
Primary hyperparathyroidism. caused by pituitary tumour conservative mx: if Ca is less than 0.25, patient 50YO+ , no evidence of organ damage trial calcimimetic (cinacalcet)
25
Acromegaly: if patients are not suitable for trans-sphenoidal surgery, or have residual symptoms, then treatment is?
Octreotide
26
Secondary hyperparathyroidism presents?
High PTH, Low/ normal Ca. Low Ca caused by CKD, vitamin D deficiency, positive feedback.
27
Tertiary parathryoidism presents as?
Chronic CKD, low vit D, increased PTH production to compensate, leads to hyperplasia of parathyroid gland. (Secondary to tertiary) hyperplasia remains
28
Causes of SIADH mnuemonic? IX: Explain SIADH?
post pit releases ADH (and ectopic) so collecting ducts, H20 retention, Na dilutional low in blood. urine more concentrated. SCEPTICS - for P its the cancers and for T its the lung pathology starting with TB. I've done lung cancer SCC twice as its a big one SSRI/TCA Carbamaz Encephalitis/Meningitis Prostate/Panc/Lung TB/Pneumonia/SCC Lung Intracranial - Stroke/SAH/Subdural Cyclophosphamide/Vincristine Sulphonureas IX- exclude other cx of hyponatraemaia. do short synacthen to exlude adrenal insufficiency. CXR
29
Sulfonylureas profile?
increase insulin secretion from pancreas. risk -hypos, SIADH CI breastfeed and pregnancy, bone marrow suppression
30
Hypercalcaemia causes? main cause in hospitalised and non-hospitalised?
Hyperparathyroidism malignancy in hospitalised patients Other: sarcoid, thyrotoxicosis, acromegaly, thiazide, pagets, addisions, vit D intoxication, milk-alkali syndrome, thiazides, dehydration
31
Confusion, post CT contrast/ trauma/ with jaundice, fever, N+V, heart failure, Graves disease Hx? DX? TX?
Thyrotoxic storm - TX treatment of underlying precipitating event beta-blockers: typically IV propranolol anti-thyroid drugs: e.g. methimazole or propylthiouracil Lugol's iodine dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3
32
What tablet reduces the absoption of levothyroxine?
Ferrous sulphfate/ calcium carbonate. should be given 4 hrs apart.
33
Graves disease features? Antibodies involved?
eye signs (30% of patients) exophthalmos ophthalmoplegia pretibial myxoedema thyroid acropachy, a triad of: digital clubbing soft tissue swelling of the hands and feet periosteal new bone formation . Anti TSH and anti TPO
34
amenorrhoea, reduced libido, and galactorrhoea? Causes?
Causes of raised prolactin - the p's pregnancy prolactinoma physiological polycystic ovarian syndrome primary hypothyroidism phenothiazines, metoclopramide, domperidone
35
Normal TSH, low/normal T3/T4 with illness?
Sick euthyroid
36
Other causes of hypoadrenalism/ adrenal insufficiency? which is most common? IX? SX?
Addisons : specific damage to adrenals, low cortisol and aldosterone TB- worldwide, autoimmune - uk metastases (e.g. bronchial carcinoma) meningococcal septicaemia (Waterhouse-Friderichsen syndrome) HIV antiphospholipid syndrome, Sheehan's, IX: 9am cortisol - 500+ unlikely addisions.100-500 - do ACTH test sx: hyperpigmentation, fatigue, salt craving, WL, cramps
37
Urine osmolality <300, urine 24 hrs 3L+. Post water deprivation test urine osmol 800+
Primary polydipsia
38
Urine osmolality <300, urine 24 hrs 3L+. Post water deprivation test, osmol is <300
Nephrogenic/ cranial diabetes insipidus. Reduced ADH release from post pit/ production. Reduced water reabsoprtion in collecting ducts.
39
Nephrogenic diabetes - Cx? IX? result on desmopressin suppression test?
Urine osmol <300, post deprivation and post vasopression is <300. Kidneys not responding to ADH. Cx:genetic: hypercalcaemia hypokalaemia lithium demeclocycline tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis
40
Cranial Diabetes insipidus cx? result on desmopressin suppression test?
histiocytosis X sarcoidosis DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram's syndrome) haemochromatosis, infection, bleed, trauma etc tx: desmopressin urine osmol post deprivation: <300, post vasopression improves
41
severe hypokaalemia, normotensive, childhood FTT, weakness?
autosomal recessive condition. Bartter's syndrome
44
Insulinoma Ix? AF?
supervised fast, c peptide high, B hydroxybutyl low insulin, low BM features 50% have MEN-1
45
Antibodies to do when differentiating T1DM/ T2DM?
Anti-islet cell antibodies Anti-GAD antibodies Anti-insulin antibodies
46
Risk of replacing Na too fast
Osmotic demyelination syndrome is also known as central pontine myelinolysis (CPM)
47
explain RAAS system ? function of ang 2? effects of aldosterone?
low BP, renin release from kidney. renin converts angiotensinogen (liveR) to angiotensin 1. ACE (from lung) converts ang 1 to ang 2 (in lungs). ang 2 - causes vasoconstriction, aldosterone release from adrenal gland, hypertrophy of heart cells. aldosterone acts on CD t increase H+ secretion and DCT to increased Na reabsorption and K+ secretion. water follows Na and BP rises.
48
Hyperthyroidism cx? GIST primary and secondary? TSH/ T4 values? secondary TSH/T4 valus? TX:
primary hyperthyroidism: TSH low, T4 high G - graves (exopthalmos, diplopia, autoimmue, pretibial myxoedma, anti TSH receptor antibodies) I - inflammatory (thyroiditis S - solitary nodule T - TMG A - amiodarone secondary cx: TSH high, t4 high.
49
Thyroid antibodies? specific to?
Anti-thyroid peroxidase (anti-TPO) antibodies - graves an dhastomotos TSH receptor antibodies - specific to graves Thyroglobulin antibodies - graves, hastimotos and cancer
50
CX of hypothyroid HITLR's Mam?
Hastimotos - antibodies Iodine deficiency (worldwide) Thyroiditis - de quervain's Lithium Riedel's thyroiditis - painless goitre, fibrous tissue replacing mum - post natal/ post partum. A - amiodarone
51
what is hba1c and when can't it be used?
depends on RBC lifespan. low HBA1c caused by increased turnover dont use in <18YO, pregnant/ 2 months post partum, sx <2months, ill, C/S, renal disease end, HIV, anaemia, splenectomy, ahemoglobinopathy
52
short, short neck, shot 4th and 5th metacarpals, no other sx? DX?
pseudohypoparathyroidism resistance to PTH, low Ca, high Po4, raised PTH DX: urine CAMP, po4 following infusion of PTH, po4 does not rise. (in hypoparathyroidism, both rise)
53
skin complications of T1DM?
necobiosis lipoidica diabeticorum
54
pre diabetes IFG? IGT ( impaired glucose tolerance?
hba1c 42-47 (pre dm) IFG: FG 6.1-7.0 IGT: FBG<7 and OGTT fter 7.8-11.1
55
cushings sx that stop after alcohol abstinence?
pseudocushings
56
cushing features?
buffalo hump, central obesity, htn, hirsutism, IGT, acne, thin skin, proximl myopathy, OP, psych sx, insomnia
57
hallmark of diabetes inspidus?
urine specific gravity <1.005 and urine osmol <200
58
diabetes, skin pigmentation, liver cirrhosis?
haemochromatosis (A rec, most common) SX: ED, arthralgia, fatigue. TX: venesection/ irone chelation
59
excessive abdo pain after eating with fatty stools. pain better when lying on left side and flexing spine, drawing knees up?
chronic pancreatitis
60
test to dx cushings syndrome?
overnight dex suppression or 24 hr urinary free cortisol then can do 48 hr dex suppression test to confirm
61
Dx of DKA? (adults) equation for osmolality? values in DKA vs HHS? Anion gap equation? for DKA? Rate to start insulin at?
BG 11+, ketone 2+ or 2+ on urine, PH <7.3/ HCO3 <15 2Na+urea+glucose 290+ in DKA, HSS is 320+ Anion gap (Na - (cl+HCO3) 13+ insulin - at 0.1/kg/hr fixed rate. IV glucose when BM <12
62
DX HSS adults? MX? which fluids? what type of insulin?
Hypovolaemia, BG 30+, no ketones or acidosis ph 7.3+, osmolality 320+ replace with 0.9 Nacl, insulin 0.05 units/kg/hr
63
DKA bolus in children?
10ml/kg 0.9% saline 15mins up to 40ml/kg repeated total maintenance: 100ml/kg/day 1st 10 kg, 50ml/kg/day 10-20 kg, hen 20ml/kg/day for every kg 20+ insulin infusion rate: 0.05-0.1unit/kg/hr. 2 hrs after IV fluids/K+
64
SIADH values?
urine osmol 500+ urine Na 20+ hyponatraemia <125 serum osmol <260
65
cx of low calcium?
vit Deficiency, Di-george's (congenital), low Mg, post surgery, pseudohypoparathyroidism,
66
young patient, fatigued, father had lots of kidney stones, and died from gastrinoma?
MEN1
67
postural hypotension, salt craving, hyperpigmentation?
addisons
68
driving with t1dM?
stop i safe space, bm needs to be 5+. eat something sugary if low and wait 45 mins after glucose returns to normal to continue
69
demeclocyclin can cause?
nephrogenic diabetes insipidus but also used to treat siadh
70
When to star SGLT2i in T2DM?
at any point if CVD risk or QRISK 10% start in someone straight away as soon as metformin is tolerated
71
examples of sulfonylureas?
Glibenclamide Glimepiride Glipizide Tolbutamide Gliclazide
72
normal T4, high TSH?
subclinical hypothryoid
73
normal t4, low TSH?
subclinical hyperthyroid
74
phaeochromocytoma is also associted with?
von hippel lindau, MFT1 MEN 2, 3
75
features of men 1? (3Ps)
mainly hyperparathyroidism/ hyperplasia pancreas tumours - insuloma/ gastrinoma/ reucrent peptic ulcers) pituitaryFh/ first degree relative
76
Features of MEN 2 (2Ps)
medullary thyroid cancer (most common - flushing, FH, calcitonon high, diarrhoea) phaeochromocytoma parathyroid - prolactinoma
77
features of MEN3 (1P)
phaechromocytoma medullary thyroid cancer neuromafe
78
caused of raised prolcatin? Features?
sx: amen, loss of libido, impotence galactorrhoea Pregnancy prolactinoma PCOS primary hypothyroid metroclopramide, domperidone phenothiazones haloperidol TX: bros dont lactate - bromocriptine
79
how to congenital adrenal hyperplasia present?
autosomal recessive, adrenal criss at birth, post puberal amenhoorea, hypoglycaemia - tx fludrocortisoe
80
volume depletion, low BP, congestive HF, confusion, N+V, agitaed. known thyroid disease?
thyroitoxic storm
81
low T3 and low T4, normal TSh, seriously ill patient?
sick euthyroidism
82
diabetic nephropathy, earliest indicator?
microalbuminuria
83
woman with hypercalcaemia after ingesting large amounts of antacids/ vit D supplements?
milk-alkali syndrome (high Ca, renal failure, metabolic alkalosis)
84
risk of untreated hypothyroidism?
mtabolic syndrome (decreased insulin sensitivity)
85
drugs causing gynacomastia?
Digoxin Isoniazid Spironolactone,steroids anabolic Cimetidine,cannabis Other (e.g. oestrogens) GnRH agonists Finastride

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