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Junior Medicine > Diabetic / Thyroid > Flashcards

Diabetic / Thyroid Flashcards

1
Q

MOA of orlistat

A

Pancreatic lipase inhibitor

Works by inhibiting gastric and pancreatic lipase to reduce the digestion of fat

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2
Q

How does hypothyroidism present on TFT

A

Elevated TSH level and normal free thyroxine level

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3
Q

Management of subclinical hypothyroidism

A

If less than 65 and asymptomatic then observe with repeat TFT at 3 months

If >65 and symptomatic then trial thyroxine for 6 months

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4
Q

How to decide between sulphonylurea (gliclazide) and DPP-4 inhibitor (sitagliptin) in addition to metformin

A

If obese choose DPP-4 inhibitor as sulphonylurea can increase weight

Sulphonylurea is better at reducing blood glucose but can increase risk of hypoglycaemia

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5
Q

How often should T1 diabetics monitor blood glucose

A

At least 4 times a day including before each meal and before bed

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6
Q

T1 diabetics blood glucose targets

A

5-7 mmol/l on waking
4-7 mmol/l before meals and at other times of the day

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7
Q

High dose dexamethasone suppression tests for pituitary adenomas

A

Cortisol: suppressed
ACTH: suppressed

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8
Q

Common side effects of DPP-4 inhibitors

A

URTI
Headaches

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9
Q

Management of diabetes with pre existing CVD

A

Metformin and empagliflozin (SGLT2 inhibitor)

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10
Q

Addisonian crisis on blood test results

A

Low sodium
High potassium
Low glucose

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11
Q

What test should be done if there is difficulty distinguishing between T1 diabetes and t2

A

C peptide

Will be low in T1 as the pancreas is not making enough insulin precursor
Will be normal or high in T2

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12
Q

TFT results in Graves’ disease

A

TSH reduced
T3 and T4 elevated

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13
Q

4 signs of myxoedemic coma

A

Hypothermia
Hyporeflexia
Bradycardia
Seizures

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14
Q

Associations of subclinical hyperthyroidism

A

AF
Osteoporosis
Dementia

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15
Q

Hyperthyroidism on TFTs

A

Suppressed TSH
Normal T4

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16
Q

Symptoms of thyrotoxic storm

A

Fatigue
Palpitations
Nausea
Vomitting
Severe sweats

Sinus tachycardia on ECG

Reduced TSH
Elevated T4

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17
Q

Treatment of thyrotoxic storm

A

Beta blockers
Propylthiouracil
Hydrocortisone

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18
Q

What blood glucose test is used to investigate T1 diabetes

A

Random plasma glucose
>11 is diagnostic for T1
Fasting >7 can also be diagnostic

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19
Q

What is a complication of fluid resuscitation in DKA

A

Cerebral oedema leading to seizures

Especially in young patients

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20
Q

What is the most common cause of cushings disease

A

Pituitary adenoma

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21
Q

First line imaging choice for thyroid nodules

A

Ultrasonography

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22
Q

Blood test results for parathyroid adenoma

A

Elevated calcium
Decreased phosphate
Normal parathyroid hormone

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23
Q

When is metformin contraindicated

A

In an eGFR of lower than 30 (chronic kidney disease)

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24
Q

Tertiary hyperparathyroidism on blood test

A

Extremely high serum PTH
Moderately raised serum calcium
Elevated alkaline phosphatase

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25
Q

Secondary hyperparathyroidism on blood test

A

PTH elevated
Ca low or normal
Vit D low
Phosphate elevated

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26
Q

Primary hyperparathyroidism on blood test

A

Elevated PTH
Elevated Ca
Low phosphate

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27
Q

Which hormones are reduced in stress response

A

Insulin
Testosterone
Oestrogen

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28
Q

What is the most suggestive feature of Graves’ disease

A

Diplopia

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29
Q

Management of hypoglycaemia with impaired GCS

A

Give IV glucose if there is access

30
Q

Initial management of Graves’ disease

A

Propranolol to help block the adrenergic effects

Of not tolerated or not controlled use carbimazole

31
Q

What is de quervains thyroiditis

A

Presents with hyperthyroidism following viral infection

32
Q

Management of de quervains thyroiditis

A

Naproxen - self limiting only requires simple analgesia

33
Q

Investigation results in de quervains thyroiditis

A

Initial hyperthyroidism
Painful goitre

Reduced iodine uptake
Raised ESR and CRP
Raised T3 and T4
Reduced TSH

34
Q

Acute management of DKA

A

IV 0.9% sodium chloride
Insulin fixed rate
Continue regular injected long acting insulin
Stop short acting injected insulin

35
Q

MOA of SGLT2 inhibitors

A

Increase urinary glucose excretion

Causes increased urine output, weight loss and UTI)

36
Q

Hyperthyroidism management in pregnancy

A

Propylthiouracil is preferred over carbimazole

37
Q

Management of neuropathic pain in diabetic neuropathy

A

Duloxetine

38
Q

Pathophysiology of thyroid eye disease

A

Autoimmune response against an autoantigen

Results in retro orbital inflammation which results in glycosaminoglycan and collagen deposition in the muscles

39
Q

Features of thyroid eye disease

A

Exophthalmos
Conjunctival oedema
Optic disc swelling
Ophthalmoplegia

40
Q

Management of thyroid eye disease

A

Topical lubricants
Steroids
Radiotherapy
Surgery

41
Q

Drug causes of raised prolactin

A

Metoclopramide
Domperidone
Phenothiazines
Haloperidol

42
Q

How can a splenectomy alter HbA1c results

A

Can give a falsely high HbA1c due to increased lifespan of RBC

43
Q

What is a key parameter to monitor in patients with HHS

A

Serum osmolality

44
Q

What can cause proximal myopathy

A

Corticosteroids

45
Q

Causes of hypothyroidism

A

Hashimotos thyroiditis
Subacute thyroiditis (de quervains)
Riedel’s thyroiditis
Iodine deficiency
Lithium
Postpartum thyroiditis
Amiodarone

46
Q

Causes of hyperthyroidism

A

Graves’ disease
Toxic multinodular goitre

47
Q

Features of hashimotos thyroiditis

A

Features of hypothyroidism
Firm, non tender goitre
Anti thyroid peroxidase and anti thyroglobulin antibodies

48
Q

TFT for hypothyroidism

A

Subclinical: high TSH, normal T4
Primary eg hashimotos: high TSH, low T4
Secondary : low TSH, low T4

49
Q

TFT results from poor compliance with thyroxine

A

TSH: high
T4: normal

50
Q

MOA of metformin

A

Increases insulin sensitivity
Decreases hepatic gluconeogenesis

51
Q

What plasma osmolality results would you expect in cranial diabetes insipidus

A

Starting plasma osmolality: high
Urine osmolality after fluid deprivation: low
Urine osmolality after desmopressin: high

52
Q

What is the range of pre diabetes

A

HbA1c of 42-47

53
Q

In DKA when should 10% dextrose be added

A

Once blood glucose is <14 mmol/l add dextrose in addition to saline regime

54
Q

Advice for pregnant women with hypothyroidism

A

Increase their thyroid hormone replacement dose by up to 50% as early as 4-6 weeks of pregnancy

55
Q

Myxoedema coma presentation

A

Confusion and hypothermia

56
Q

Management of myxoedema coma

A

IV thyroid replacement
IV fluid
IV corticosteroids
Electrolyte imbalance correction
Rewarming

57
Q

What is the difference between HHS and DKA

A

HHS has no acidosis / significant ketosis
HHS has a longer history
HHS glucose is significantly raised eg >30

58
Q

What will the radioactive iodine uptake test results be in Graves’ disease

A

Increased homogenous uptake

59
Q

What is the target HbA1c for someone on sulfonylurea (or a drug that may cause hypoglycaemia)

A

53

60
Q

Management of primary hyperparathyroidism

A

Parathyroidectomy

61
Q

What does normal pregnancy do to TFT results

A

Raises total T3 and T4 but leaves fT3 and fT4 normal level

62
Q

Causes of thyroid storm

A

Thyroid or non thyroidal surgery
Trauma
Infection
Acute iodine load eg CT contrast media

63
Q

CF of thyroid storm

A

Fever >38.5
Tachycardia
Confusion and agitation
N&V
HTN
Heart failure
Abnormal LFT

64
Q

Management of thyroid storm

A

Paracetamol
IV propranolol
Anti thyroid drugs
Lugol’s iodine
Dexamethasone

65
Q

Important blood test when starting carbimazole

A

FBC
Carbimazole is associated with agranulocytosis

66
Q

Important blood test when starting carbimazole

A

FBC
Associated with agranulocytosis

67
Q

TFT results that indicate poor compliance with medication

A

Increased TSH and normal T4

Usually because patient starts taking thyroxine properly before blood test so corrects thyroxine level by TSH takes longer to normalise

68
Q

Presentation of subacute thyroiditis

A

Tender goitre
Hyperthyroidism
Raised ESR
Reduced uptake on technetium thyroid scan

69
Q

Contraindication of pioglitazone

A

Heart failure

Pioglitazone causes fluid retention

70
Q

What is one of the main risks of SGLT2 inhibitors (flozins)

A

Diabetic foot ulcers

Junior Medicine (6 decks)

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