Diabetic / Thyroid Flashcards by Olivia James

MOA of orlistat

Pancreatic lipase inhibitor

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

How well did you know this?

Not at all

Perfectly

How does hypothyroidism present on TFT

Elevated TSH level and normal free thyroxine level

How well did you know this?

Not at all

Perfectly

Management of subclinical hypothyroidism

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

If >65 and symptomatic then trial thyroxine for 6 months

How well did you know this?

Not at all

Perfectly

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

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

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

How well did you know this?

Not at all

Perfectly

How often should T1 diabetics monitor blood glucose

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

How well did you know this?

Not at all

Perfectly

T1 diabetics blood glucose targets

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

How well did you know this?

Not at all

Perfectly

High dose dexamethasone suppression tests for pituitary adenomas

Cortisol: suppressed
ACTH: suppressed

How well did you know this?

Not at all

Perfectly

Common side effects of DPP-4 inhibitors

URTI
Headaches

How well did you know this?

Not at all

Perfectly

Management of diabetes with pre existing CVD

Metformin and empagliflozin (SGLT2 inhibitor)

How well did you know this?

Not at all

Perfectly

Addisonian crisis on blood test results

Low sodium
High potassium
Low glucose

How well did you know this?

Not at all

Perfectly

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

C peptide

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

How well did you know this?

Not at all

Perfectly

TFT results in Graves’ disease

TSH reduced
T3 and T4 elevated

How well did you know this?

Not at all

Perfectly

4 signs of myxoedemic coma

Hypothermia
Hyporeflexia
Bradycardia
Seizures

How well did you know this?

Not at all

Perfectly

Associations of subclinical hyperthyroidism

AF
Osteoporosis
Dementia

How well did you know this?

Not at all

Perfectly

Hyperthyroidism on TFTs

Suppressed TSH
Normal T4

How well did you know this?

Not at all

Perfectly

Symptoms of thyrotoxic storm

Fatigue
Palpitations
Nausea
Vomitting
Severe sweats

Sinus tachycardia on ECG

Reduced TSH
Elevated T4

How well did you know this?

Not at all

Perfectly

Treatment of thyrotoxic storm

Beta blockers
Propylthiouracil
Hydrocortisone

How well did you know this?

Not at all

Perfectly

What blood glucose test is used to investigate T1 diabetes

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

How well did you know this?

Not at all

Perfectly

What is a complication of fluid resuscitation in DKA

Cerebral oedema leading to seizures

Especially in young patients

How well did you know this?

Not at all

Perfectly

What is the most common cause of cushings disease

Pituitary adenoma

How well did you know this?

Not at all

Perfectly

First line imaging choice for thyroid nodules

Ultrasonography

How well did you know this?

Not at all

Perfectly

Blood test results for parathyroid adenoma

Elevated calcium
Decreased phosphate
Normal parathyroid hormone

How well did you know this?

Not at all

Perfectly

When is metformin contraindicated

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

How well did you know this?

Not at all

Perfectly

Tertiary hyperparathyroidism on blood test

Extremely high serum PTH
Moderately raised serum calcium
Elevated alkaline phosphatase

How well did you know this?

Not at all

Perfectly

Secondary hyperparathyroidism on blood test

PTH elevated Ca low or normal Vit D low Phosphate elevated

Primary hyperparathyroidism on blood test

Elevated PTH Elevated Ca Low phosphate

Which hormones are reduced in stress response

Insulin Testosterone Oestrogen

What is the most suggestive feature of Graves’ disease

Diplopia

Management of hypoglycaemia with impaired GCS

Give IV glucose if there is access

Initial management of Graves’ disease

Propranolol to help block the adrenergic effects Of not tolerated or not controlled use carbimazole

What is de quervains thyroiditis

Presents with hyperthyroidism following viral infection

Management of de quervains thyroiditis

Naproxen - self limiting only requires simple analgesia

Investigation results in de quervains thyroiditis

Initial hyperthyroidism Painful goitre Reduced iodine uptake Raised ESR and CRP Raised T3 and T4 Reduced TSH

Acute management of DKA

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

MOA of SGLT2 inhibitors

Increase urinary glucose excretion Causes increased urine output, weight loss and UTI)

Hyperthyroidism management in pregnancy

Propylthiouracil is preferred over carbimazole

Management of neuropathic pain in diabetic neuropathy

Duloxetine

Pathophysiology of thyroid eye disease

Autoimmune response against an autoantigen Results in retro orbital inflammation which results in glycosaminoglycan and collagen deposition in the muscles

Features of thyroid eye disease

Exophthalmos Conjunctival oedema Optic disc swelling Ophthalmoplegia

Management of thyroid eye disease

Topical lubricants Steroids Radiotherapy Surgery

Drug causes of raised prolactin

Metoclopramide Domperidone Phenothiazines Haloperidol

How can a splenectomy alter HbA1c results

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

What is a key parameter to monitor in patients with HHS

Serum osmolality

What can cause proximal myopathy

Corticosteroids

Causes of hypothyroidism

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

Causes of hyperthyroidism

Graves’ disease Toxic multinodular goitre

Features of hashimotos thyroiditis

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

TFT for hypothyroidism

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

TFT results from poor compliance with thyroxine

TSH: high T4: normal

MOA of metformin

Increases insulin sensitivity Decreases hepatic gluconeogenesis

What plasma osmolality results would you expect in cranial diabetes insipidus

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

What is the range of pre diabetes

HbA1c of 42-47

In DKA when should 10% dextrose be added

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

Advice for pregnant women with hypothyroidism

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

Myxoedema coma presentation

Confusion and hypothermia

Management of myxoedema coma

IV thyroid replacement IV fluid IV corticosteroids Electrolyte imbalance correction Rewarming

What is the difference between HHS and DKA

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

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

Increased homogenous uptake

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

Management of primary hyperparathyroidism

Parathyroidectomy

What does normal pregnancy do to TFT results

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

Causes of thyroid storm

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

CF of thyroid storm

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

Management of thyroid storm

Paracetamol IV propranolol Anti thyroid drugs Lugol’s iodine Dexamethasone

Important blood test when starting carbimazole

FBC Carbimazole is associated with agranulocytosis

Important blood test when starting carbimazole

FBC Associated with agranulocytosis

TFT results that indicate poor compliance with medication

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

Presentation of subacute thyroiditis

Tender goitre Hyperthyroidism Raised ESR Reduced uptake on technetium thyroid scan

Contraindication of pioglitazone

Heart failure Pioglitazone causes fluid retention

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

Diabetic foot ulcers