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MSRA my cards > Diabetic/ endocrine > Flashcards

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?

A

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

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12
Q

High aldosterone, High renin meaning?

A

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

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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.

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.

17
Q

headache, sweating and palpitations HTN IX? TX?

A

Do urinary metanephrines
PHaeochromocytoma - give PHenoxybenzamine before beta-blockers

18
Q

Pre DM values?

A

HBa1c 42-47
FBG 6-7

19
Q

Impaired glucose intolerance values?

A

OgTT <7 then 7.8-11.1
FBG 6.1-7

20
Q

What is glimerperide

A

sulfonylurea

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

22
Q

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

A

Myxoedema coma

23
Q

Why does hypercalcaemia cause peptic ulcers ad HTN?

A

increased gastrin production and vasoconstrion. Also AF: pancreatitis, MEN 1 and 2

24
Q

Raised calcium, low phosphate, Normal/ raised PTH?
when would you conservatively manage?

A

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
Q

Acromegaly: if patients are not suitable for trans-sphenoidal surgery, or have residual symptoms, then treatment is?

A

Octreotide

26
Q

Secondary hyperparathyroidism presents?

A

High PTH, Low/ normal Ca.
Low Ca caused by CKD, vitamin D deficiency, positive feedback.

27
Q

Tertiary parathryoidism presents as?

A

Chronic CKD, low vit D, increased PTH production to compensate, leads to hyperplasia of parathyroid gland.

28
Q

Causes of SIADH mnuemonic?

A

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

29
Q

Sulfonylureas profile?

A

increase insulin secretion from pancreas.
risk -hypos, SIADH CI breastfeed and pregnancy, bone marrow suppression

30
Q

Hypercalcaemia causes?
main cause in hospitalised and non-hospitalised?

A

Hyperparathyroidism
malignancy in hospitalised patients
Other: sarcoid, thyrotoxicosis, acromegaly, thiazide, pagets, addisions, vit D intoxication, milk-alkali syndrome, thiazides, dehydration

31
Q

Confusion, post CT contrast/ trauma/ with jaundice, fever, N+V, heart failure, Graves disease Hx? DX?
TX?

A

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
Q

What tablet reduces the absoption of levothyroxine?

A

Ferrous sulphfate/ calcium carbonate. should be given 4 hrs apart.

33
Q

Graves disease features?
Antibodies involved?

A

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
Q

amenorrhoea, reduced libido, and galactorrhoea?
Causes?

A

Causes of raised prolactin - the p’s
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

35
Q

Normal TSH, low/normal T3/T4 with illness?

A

Sick euthyroid

36
Q

Other causes of hypoaldosteronism?

A

Primary causes
tuberculosis
metastases (e.g. bronchial carcinoma)
meningococcal septicaemia (Waterhouse-Friderichsen syndrome)
HIV
antiphospholipid syndrome

37
Q

Urine osmolality <300, urine 24 hrs 3L+. Post water deprivation test urine osmol 800+

A

Primary polydipsia

38
Q

Urine osmolality <300, urine 24 hrs 3L+. Post water deprivation test, osmol is <300

A

Nephrogenic/ cranial diabetes insipidus. Reduced ADH release from post pit/ production. Reduced water reabsoprtion in collecting ducts.

39
Q

Nephrogenic diabetes - Cx? IX?

A

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
Q

Cranial Diabetes insipidus?

A

histiocytosis X
sarcoidosis
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)
haemochromatosis

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