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Endocrinology 🧪 > DM > Flashcards

DM Flashcards

1
Q

If you will start a type 2 DM ptn on Canagliflozin (antidiabetic medication of type 2 sodium-glucose transport inhibitors class ) { SGLT-2} what should you evaluate before you start?

A

Check serum creatinine (it acts on the kidneys so renal function should be checked before and periodically thereafter )

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2
Q

Diabetic prn presented with sore throat and painful swallowing,what’s your diagnosis and what’s the most likely organism to cause it? And what’s the ttt?

A

Thrush, candida

Treatment is Ketoconazole

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3
Q

In young ( child ) ptn with maturity onset of diabetes ( MODY) what’s the most likely mutated protein ?

A

Glucokinase cell surface protien

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4
Q

Name counterregulatory hormones ( protect against hypoglycemia ) ?

A

They work by ⬆️ hepatic glucose production & ⬇️ utilization in nonhepatic tissues

Glucagon : secreted by pancreatic alpha cells

Epinephrine & norepinephrine : released from Adrenal medulla & sympathetic nervous system

Cortisol & growth hormones are important in prolonged fasting

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5
Q

How can Nicotine & caffeine affect glucose tolerance test?

A

It can ⬆️ it ( false hyperglycemia)

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6
Q

How can Ethanol & aspirin affect glucose tolerance test?

A

It can ⬇️ it ( low glucose)

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7
Q

Causes of hypoglycemia in non diabetic ptn?

A

Alcohol ( by ⬇️ hepatic gluconeogenesis )

Cancer ( eg. Sarcomas )

Insulin

Postprandial ( eg. After gastrectomy)

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8
Q

What’s the effect of Cushing disease on glucose level?

A

⬆️ glycocorticoid ➡️ hyperglycemia

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9
Q

Name drugs that work on diabetes by ⬆️ insulin sensitivity?

A

Rosiglitazone

Thiazolidinediones as pioglitazone

Metformin

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10
Q

Name DM medications that boost insulin secretion?

insulin secretagogues

A

Gliclazide

Glimepiride

Repaglinide

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11
Q

Rosiglitazone is a DM treatment is contraindicated in what ptn?

A

In Ptn with Heart failure ( because it causes fluid retention which may cause mild dilutional anemia and ankle edema)

Also contraindicated in hepatic failure

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12
Q

What’s the contraindications for sulphonylureas ?

A

Renal failure ( it should be replaced by insulin if creatinine > 250 )

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13
Q

Name the contraindications for metformin? (A)

A

All major organ failure as:

Renal ( stop if serum creatinine >150 )
Hepatic
Cardiac
Respiratory

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14
Q

Name the most comon side effect of Acarbose ? DM ttt

A

Abdominal bloating and gassy Diarrhea due to carbohydrate malabsorption

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15
Q

Diabetic ulcer is mostly seen on heels, while ischemic ulcer (atherosclerosis or embolizaion ) seen at …………?

A

Tip of the toes ( as far away from the heart)

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16
Q

What’s the specific lesion seen on renal biopsy for diabetic ptn with diabetic glomerulosclerosis? ( pathognomonic for diabetes )

A

Kimmelstiel-Wilson nodule (ovoid, hyaline, PAS positive structures found in the mesangial core at the edge of the glomerulus) but it’s not seen in all diabetic ptns

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17
Q

A- if ptn is on sulphonylureas but it’s not effective enough, will changing to metfomin help?

A

No, it has the same effect. In such cases try adding metformin to the regimen with sulphonylureas

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18
Q

Why metformin is preferred to use in DM? And when its contraindicated?

A

It has good slimming effect
It doesn’t cause hypoglycemia

It’s contraindicated in Renal failure ( > creatinine)

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19
Q

A- what is the % for ptn with impaired glucose tolerance to become type 2 DM?

A

33% over 6 years

20
Q

For ptn who is using metformin but his HbA1C is still high. What drug can be added?

A

New sulphonylureas as ( Glipizide, Glimepiride, Glicazide )

21
Q

When do you decide to stop metformin?

A

If serum creatinine is high >150ųmol/l

And GFR < 30ml/min

22
Q

A- In diabetic ptn with heart problems wich oral hypoglycemic drugs are contraindicated?

A

Rosiglitazone & pioglitazone

23
Q

A- name the shorter acting sulphonylureas?

A

Glicazide

24
Q

A- What are the disadvantages of using Glicazide ( sulphonylureas) ?

A

Weight gain

Risk of hypoglycemia

25
Q

When diabetic ptn who is on metformin has HbA1C > 9, what can be added to better glucose control?

A

Either sulphonylureas

Or insulin :
morning or evening long acting insulin
Or
( bedtime intermediate acting insulin)

26
Q

What is exenatide drug? And what are the most known side effects?

A

Its a new drug for DM type 2 it mimic the action of the gut hormone GLP-1 ( Glucagon-like peptide 1 )

Side effects:
Weight loss, nausea and GIT effects

27
Q

Name the drugs that when taken might cause DM or diabetic ketoacidosis?

A

Olanzapine ( anti-psychotic ) /
Thiazide diuretic /
Beta-sympathomimetics /
Steroids

28
Q

N. What’s the pre diabetic range ? Fasting, postprandial, Ha1C

A

Fasting 100-125 / postprandial 140-199 / HA1C 5.7-6.4

29
Q

N. What’s the diagnostic test for diabetic ketoacidosis?

A

Look for Keaton bodies ( beta hydroxybutayrate, acetoacetate, acetone )

30
Q

N. Proinsulin secreted from pancreas are……..&………

A

C peptide, insulin

31
Q

What’s the test used to diagnose immune form of diabetes type 1?

A

Autoantibodies GAD 65 ( persist longer ) and IA-2

32
Q

What’s the honeymoon phase ass. With DM type 1?

A

This is where the ptn just started taking insulin and then start experiencing hypoglycemia ( what happened is that after taking exogenous insulin the beta cell will be motivated to produce endogenous insulin but it’s not permanent therefore the insulin dose should be lowered for a temporary time.

33
Q

N. A woman can be diagnosed with gestational diabetes if her FBS >…….. and her 1 hour glucose >……. And her 2 hour glucose >…….?

A

FBS >92 / 1h glucose > 180 / 2h glucose > 153

34
Q

N. Weight gain, HF, macular edema, osteoporosis, bladder cancer are side effects of which DM drug?

A

Glitazones ( thiazolidinediones )

35
Q

Q. In ptn with DKA, at what PH level a bicarbonate infusion should be given to correct ketoacidosis?

A

PH less than 7

36
Q

Q. Sever hypoglycemia in non-diabetic ( insulinoma is suspected ) what are the appropriate investigation to request?

A

Prolonged 72 h Fast, measure insulin & C-peptide

37
Q

Q. Name the hypoglycemic drug that is contraindicated in heart diseases?

A

Rosiglitazone or pioglitazone

38
Q

Q. Diabetic Ptn presented with nephropathy. What is the best drug to give her for that?

A

ACEI ( lisinopril )

39
Q

Q. A pregnant ptn. With thyrotoxicosis ( Graves’ disease) what’s the drug that is safe to be given to her?

A

Propylthiouracil, carbimazole

40
Q

Q. Acromegaly can be treated with …….. drug.

A

Somatostatin analogue

41
Q

Q. Pregnancy and oral contraceptives both…….transferrin and TIBC.

A

Elevate

42
Q

Q. Postural hypotension + hyperkalemic acidosis is suggestive of …..?

A

Addison disease

43
Q

A. Hypertension + hypokalemia suggest …….&…….. diseases.

A

Con’s syndrome, Cushing syndrome

44
Q

Q. Metformin can improve fertility in ptn with polycystic ovary disease. True or false?

A

True

45
Q

Q. What’s the drug used for ptn with Cushing disease who is unfit for surgery?

A

Ketoconazole

Endocrinology 🧪 (10 decks)

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