Endo Flashcards
1
Q
in HRT: progestogen increases the risk of …?
A
increased risk of Breast ca + VTE
2
Q
what other medications might reduce absorption of levothyroxine?
A
iron/ calcium carbonate tablets
- should be given 4h apart from levothyroxine
3
Q
what 2 diabetic medication classes increases GLP-1?
A
GLP-1 analogue / DPP4 inhibitors (inhibiting its breakdown - the gliptins)
4
Q
what are the 2 e.g.s of GLP-1 analogues/mimetics?
A
Exenatide + Liraglutide
5
Q
Benefits of GLP-1 mimetics e.g. (Exenatide, Liraglutide)?
A
weight loss
6
Q
Major Side effects of GLP-1 mimetics?
A
nausea + vomiting, links to severe pancreatitis.
7
Q
When to use GLP-1 mimetic e.g. Exenatide in T2DM?
A
consider adding exenatide to metformin and sulfonylurea if:
- BMI>35
or
- BMI<35 but insulin unacceptable due to other occupational implications or weight loss would benefit other co-morbidities.
8
Q
E.g.s of DPP-4 inhibitor?
A
Sitagliptin, Vildagliptin
9
Q
HbA1c target if pt is on any drug which may cause hypoglycaemia?
A
53 (7%)
10
Q
what worsens thyroid eye disease?
A
smoking + radioiodine treatment (increases the inflammatory symptoms)
11
Q
PreDiabetes: IFG vs IGT
A
- impaired fasting glucose (IFG): due to hepatic insulin resistance
- impaired glucose tolerance (IGT): due to muscle insulin resistance
- patients with IGT are more likely to develop T2DM and cardiovascular disease than patients with IFG
12
Q
Mechanism of HPV causing cervical ca?
A
HPV 16 & 18 produces the oncogenes E6 and E7 genes respectively.
- E6 inhibits the p53 tumour suppressor gene
- E7 inhibits RB suppressor gene
13
Q
Drug causes of SIADH?
A
sulfonylureas* (e.g. gliclazide, glimepiride, glipizide) SSRIs, tricyclics carbamazepine vincristine cyclophosphamide
14
Q
what is the first type of insulin to start someone on according to NICE?
A
- Neutral Protamine Hagedorn (NPH) insulin [aka isophane insulin]
e. g. Humulin I
15
Q
what insulin to start someone on if HbA1c is 75 mmol/mol [9.0%] or higher?
A
NPH + a short-acting insulin
16
Q
when to consider insulin detemir or glargine as 1st line instead of NPH?
A
→ needs assistance from a carer to inject insulin and the use of insulin detemir/ glargine would reduce the frequency of injections from twice to once daily, or
→ recurrent symptomatic hypos, or
→ The person would otherwise need twice-daily NPH insulin injections in combination with oral antidiabetic drugs.
17
Q
what type of thyroid tumour is assoc w Hashimotos?
A
thyroid lymphoma.
Hashimoto’s thyroiditis is characterised by a chronic infiltration of the thyroid gland with B-lymphocytes, which are prone to undergo clonal proliferation.
18
Q
pegvisomant?
A
- used in acromegaly. 2nd line.
- GH receptor antagonist - prevents dimerization of the GH receptor
- once daily s/c administration
- very effective - decreases IGF-1 levels in 90% of patients to normal
- doesn’t reduce tumour volume therefore surgery still needed if mass effect
19
Q
bendroflumethiazide: effect on calcium?
A
causes hyperCa
20
Q
most common cause of hyperaldosteronism?
A
Bilateral idiopathic adrenal hyperplasia
21
Q
diabetes diagnosis cut offs?
A
fasting > 7.0, random > 11.1 - if asymptomatic need two readings
22
Q
inheritance pattern of MODY (maturity onset diabetes of the young)
A
auto dom
23
Q
features of MODY?
A
- typically develops in patients < 25 years
- a family history of early onset diabetes is often present
- ketosis is not a feature
- most commonly very sensitive to sulfonylureas, insulin is not usually necessary
24
Q
MODY 3 - assoc with?
A
increased risk of HCC
25
what gene is involved in MODY 3?
defect in the HNF-1 alpha gene
26
what gene is involved in MODY 2?
glucokinase gene
27
what gene is involved in MODY 5?
defect in the HNF-1 beta gene
28
MODY 5- assoc w?
liver and renal cysts
29
e.g. of SGLT2 inhibitor?
canagliflozin, dapagliflozin and empagliflozin.
30
How do SGLT2 inhibitors e.g. dapagliflozin work?
reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) in the renal PCT -> to reduce glucose reabsorption and increase urinary glucose excretion
31
SEs of SGLT2 inhibitors e.g. dapagliflozin?
- urinary and genital infection (secondary to glycosuria). -- - Fournier’s gangrene
- normoglycaemic ketoacidosis
- increased risk of lower-limb amputation: feet should be closely monitored
32
Management of papillary and follicular thyroid cancer?
- total thyroidectomy
- followed by radioiodine (I-131) to kill residual cells
- yearly thyroglobulin levels to detect early recurrent disease
33
what hormone is monitored to assess for recurrence of thyroid cancer?
thyroglobulin
34
MOA of sulphonylureas?
bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells.
35
Side effects of sulphonylureas?
- hypoglycaemia
| - weight gain
36
when should insulin be started in gestational diabetes?
- fasting glucose > 7
OR
- fasting glucose 6-6.9 + evidence of macrosomia/ polyhydramnios
37
what medication should be considered in GDM in patients who cannot tolerate metformin or decline insulin?
glibenclamide
38
Foods that are high in potassium?
bananas, oranges, kiwi fruit, avocado, spinach, tomatoes
39
Diagnostic criteria for metabolic syndrome?
at least 3:
- high waist circumference
- high triglycerides: > 1.7 mmol/L
- low HDL
- high blood pressure
- high fasting plasma glucose or T2DM
40
indications for urgent eye review in thyroid eye disease?
- unexplained deterioration in vision
- awareness of change in intensity/ quality of colour vision
- history of eye suddenly 'popping out' (globe subluxation)
- obvious corneal opacity
- cornea still visible when the eyelids are closed
- disc swelling
41
management options for gastroparesis?
metoclopramide, domperidone or erythromycin
42
associations of metabolic syndrome?
- raised uric acid levels
- non-alcoholic fatty liver disease
- PCOS
43
What causes increased sweating in patients with acromegaly?
sweat gland hypertrophy
44
Complications of acromegaly?
- HTN
- diabetes (>10%)
- cardiomyopathy
- colorectal cancer
45
features of Kallmans syndrome?
- 'delayed puberty'
- hypogonadism, cryptorchidism
- anosmia
- LOW sex hormone levels -> LH, FSH levels are inappropriately low/normal
- normal/ tall
**Cleft lip/palate and visual/hearing defects also seen
46
what deficiency most commonly causes congenital adrenal hyperplasia?
21-hydroxylase deficiency
47
what electrolyte might cause nephrogenic diabetes insipidus?
hypercalcaemia
48
hormone levels in Klinefelter's syndrome?
HIGH gonadotrophin levels, LOW testosterone
49
what is 1st line medical management of urge incontinence in frail older ladies due to increased risk of delirium, confusion and impaired function?
mirabegron
50
what medication to AVOID in urge incontinence for elderly frail ladies due to the risk of cognitive impairment, falls and general decline?
Oxybutynin
- antimuscarinic/ anticholinergic
51
management of stress incontinence if pelvic floor exercises unhelpful + decline surgery?
Duloxetine
- combined noradrenaline and serotonin reuptake inhibitor
- MOA: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced
contraction
52
gynaecomastia assoc w hyper or hypothyroid?
HYPERthyroidism
53
Management of thyroid storm?
- symptomatic treatment e.g. paracetamol
- treatment of underlying precipitating event
- BB: 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
54
targets for Gestational diabetes glucose control?
- fasting: < 5.3mmol/L
AND
- 1 hour postprandial: < 7.8 mmol/L or
- 2 hours postprandial: < 6.4 mmol/L
55
management of hyperthyroidism in pregnancy?
1st trimester: propylthiouracil
| 2nd trimester onwards: switch to carbimazole
56
Hyperthyroidim in pregnancy - what management options are contraindicated?
- block-and-replace regimes should not be used
| - radioiodine therapy contraindicated
57
features of complete androgen insensitivity syndrome?
- 'primary amennorhoea'
- undescended testes causing groin swellings
- breast development may occur as a result of conversion of testosterone to oestradiol
58
diagnosis of complete androgen insensitivity syndrome?
buccal smear or chromosomal analysis to reveal 46XY genotype
59
management of complete androgen insensitivity syndrome?
- counselling - raise child as female
- bilateral orchidectomy (increased risk of testicular cancer due to undescended testes)
- oestrogen therapy
60
management of toxic multi nodular goitre?
radioiodine
61
Advice for patients with hypercalcaemia in malignancy?
- FLUIDS 3-4L / day if no CI
- low calcium diet NOT necessary
- avoid vitamins/ drugs with calcium
62
Changes to make to metformin dose during fasting (Ramadan)?
1/3 of the normal metformin dose before sunrise and 2/3 after sunset
63
what electrolyte derangement is most likely in refeeding syndrome?
low phosphate
64
While investigating for Addison's, what is the benefit of a 9am cortisol level?
- > 500 nmol/l -> Addison's very unlikely
- < 100 nmol/l is definitely abnormal
- 100-500 nmol/l -> should prompt a ACTH stimulation test to be performed
65
MOA of mirabegron?
beta-3 agonist
66
rash after use of prednisolone?
drug induced acne
| -> manage by discontinuing the steroids
67
features of insulinoma?
- hypoglycaemia
- rapid weight gain may be seen
- high insulin, raised proinsulin:insulin ratio
- high C-peptide
- assoc MEN 1
68
diagnosis of insulinoma?
- supervised, prolonged fasting (up to 72 hours)
| - CT pancreas
69
management of insulinoma?
- surgery
| - diazoxide and somatostatin if patients are not candidates for surgery
70
features of type 1 renal tubular acidosis?
- inability to generate acid urine (secrete H+) in distal tubule
- hypokalaemia
- nephrocalcinosis and renal stones
- normal anion gap hyperCl met acidosis
71
features of type 2 renal tubular acidosis?
- decreased HCO3- reabsorption in proximal tubule
- hypokalaemia
- osteomalacia
- normal anion gap hyperCl met acidosis
72
features of type 3 renal tubular acidosis?
- caused by carbonic anhydrase II deficiency
- hypokalaemia
- normal anion gap hyperCl met acidosis
73
features of type 4 renal tubular acidosis?
- reduction in aldosterone -> reduction in proximal tubular ammonium excretion
- hyperkalaemia
- normal anion gap hyperCl met acidosis
74
causes of type 1 (distal) renal tubular acidosis?
idiopathic, rheumatoid arthritis, SLE, Sjogren's, analgesic nephropathy,
- drugs: amphotericin B, lithium
75
causes of type 2 (proximal) renal tubular acidosis?
- Fanconi Syndrome: also causes loss of phosphate, uric acid, glucose, a.as, protein in urine
- idiopathic, Wilson's disease, cystinosis
- Drugs: tetracyclines, carbonic anhydrase inhibitors (acetazolamide, topiramate)
76
causes of type 4 renal tubular acidosis?
*hyperkalaemic acidosis
- aldosterone deficiency (Addisons) / resistance
- diabetes
- SLE
- medications: amphotericin B, lithium
77
what is used as adjunct to transsphenoidal surgery for acromegaly?
octreotide
- a somatostatin analogue often used as an adjunct to surgery -> reduced growth hormone levels and reduction in tumour size.
78
which diabetic medication may predispose to normoglycemic ketoacidosis?
SGLT2 inhibitors e.g. dapagliflozin
79
in Hypocalcaemia, which sign is most sensitive and specific?
Trousseau's sign
| - carpal spasm if brachial artery occluded
80
management of De quervain's thyroiditis?
self limiting, if painful - aspirin/ NSAIDs.
| if severe, particularly if hypothyroidism develops, steroids can be used
81
Causes of Hypokalaemia with acidosis?
- diarrhoea
- renal tubular acidosis
- acetazolamide
- partially treated diabetic ketoacidosis
82
Causes of Hypokalaemia with alkalosis?
- vomiting
- thiazide and loop diuretics
- Cushing's syndrome
- Conn's syndrome (primary hyperaldosteronism)
83
features of Pendred's syndrome?
- auto recess
| - bilateral sensorineural deafness + mild hypothyroidism + goitre
84
diagnosis of Pendred syndrome?
- genetic testing: PDS gene, chromosome 7
- MRI imaging to look for characteristic one and a half turns in the cochlea, compared to the normal two and a half turns.
- audiometry
85
treatment of Pendred syndrome?
Thyroid hormone replacement + cochlear implants
86
MOA of pegvisomant?
GH receptor antagonist
- very effective, decreases IGF-1 levels in 90% of patients to normal
- no effect on tumour volume
87
what diabetic medication may cause euglycaemic DKA?
SGLT2 inhibitor: e.g. canagliflozin, dapaglifozin, empa-
- raised anion gap acidosis + normal blood sugar
88
Where in the kidney do SGLT-2 inhibitors work on?
proximal convoluted tubule: inhibits SGLT-2
| to reduce glucose reabsorption and increase urinary glucose excretion
89
complications of acromegaly?
- hypertension
- diabetes (>10%)
- cardiomyopathy
- colorectal cancer
90
features of Type 1 Autoimmune polyendocrine syndrome?
2 out of 3 needed:
- Addisons disease
- primary HYPOparathyroidisim
- chronic mucocutaneous candidiasis (typically the 1st feature)
91
Genetics of Type 1 Autoimmune polyendocrine syndrome?
autosomal recessive, mutation of AIRE1 gene on chromosome 21
92
what is usually the first presenting feature of Type 1 Autoimmune polyendocrine syndrome?
chronic mucocutaneous candidiasis
93
features of Type 2 Autoimmune polyendocrine syndrome?
- Addisons
+
- T1DM OR Autoimmune thyroid disease
94
genetics of type 2 Autoimmune polyendocrine syndrome?
polygenic inheritance, linked to HLA-DR3/4
95
development of type 2 diabetes mellitus in patients < 25 years old. typically inherited as an autosomal dominant condition.
MODY (Maturity onset diabetes of the young)
96
features of MODY?
- typically <25yo
- family hx of early onset diabetes
- ketosis not a feature
- most common form: v sensitive to sulfonylureas, insulin not usually necessary
97
Most common form of MODY?
MODY 3: 60%
- defect of HNF-1 alpha gene
- assoc w increased risk of HCC
98
defect in glucokinase gene?
MODY 2 - 20% of cases
99
defect in HNF-1 beta gene?
rare, MODY 5.
| - assoc w liver + renal cysts
100
what type of cancer is of increased risk in patients with MODY? (most commonly- MODY 3)
HCC
101
which diabetic medication is assoc with excessive flatulence?
acarbose
- inhibitor of intestinal alpha glucosidases -> decreased absorption of starch and sucrose
102
MOA of meglitinides?
increase pancreatic insulin secretion
- like sulfonylureas, they bind to ATP-dependent K+ channels on the cell membranes of pancreatic beta cells
103
Very high glucocorticoid activity, minimal mineralocorticoid activity
Dexamethasone, Betmethasone
104
Predominant glucocorticoid activity, low mineralocorticoid activity
prednisolone
105
Glucocorticoid activity, high mineralocorticoid activity,
hydrocortisone
106
Minimal glucocorticoid activity, very high mineralocorticoid activity,
fludrocortisone
107
1st line treatment of Graves disease?
- propranolol for symptom control
| - carbimazole (for approx 12-18 months)
108
Treatment of Graves disease: block and replace regime vs titration regime?
Titration regime:
carbimazole 40mg and reduced gradually to maintain euthyroidism, typically 12-18 months.
- fewer side effects but longer.
Block and replace:
- carbimazole 40mg, thyroxine added when pt euthyroid.
typically 6-9 months.
109
Ix of pseudohypoparathyroidism?
infusion of PTH followed by measurement of urinary phosphate and cAMP measurement - helps differentiate between type I (neither phosphate or cAMP levels rise) and II (cAMP rises but phosphate levels do not change)
110
cause of low libido/ loss of pubic hair in Addisons disease?
DHEA (dehydroepiandrosterone) deficiency
- adrenal glands are main source of DHEA in females.
111
what test can help to differentiate between true Cushings and pseudo-Cushing's?
insulin stress test
*can also do midnight cortisol (this will be high in true Cushings syndrome)
112
What tests can be used to differentiate between pituitary and ectopic ACTH secretion?
1. high dose dexamethasone suppression test:
- Cortisol and ACTH suppressed if Cushing's disease,
neither suppressed if ectopic
2. CRH stimulation: if pituitary source, cortisol rises, if ectopic/ adrenal: no change
3. Petrosal sinus sampling of ACTH
113
Management of acute severe hypocalcaemia?
IV Calcium gluconate 10% 10mL over 10 mins
| - not calcium chloride
114
genetic inheritance of MODY
auto dominant
115
MOA of carbimazole?
blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin → reducing thyroid hormone production
116
cryptorchidism suggests which genetic condition?
kallmans
| - X linked recessive, delayed puberty secondary to hypogondatrophic hypogonadism
117
diagnosis of insulinoma?
- supervised, prolonged fasting (up to 72h)
| - CT pancreas
118
management of insulinoma?
surgery.
| - diazoxide and somatostatin if not suitable for surgery
119
most common cause of primary hyperaldosteronism?
Bilateral idiopathic adrenal hyperplasia
- in up to 70%
(prev thought to be adrenal adenoma)
120
Criteria for GLP1 mimetic e.g. exenatide?
- if triple therapy not effective/ CI/ not tolerated
-> then consider metformin, sulfonylurea + GLP1 mimetic if:
1. BMI>/=35 + obesity related comorbidities
or
2. BM <35 and insulin unacceptable
121
Fibrates MOA? e.g. fenofibrate
activating PPAR alpha receptors -> increase in LPL activity and reducing triglyceride levels
122
Side effects of fibrates?
GI side effects,
| Increased VTE Risk
123
first line management of remnant hyperlipidaemia?
Fibrates
124
causes of tunnel vision?
- papilloedema
- glaucoma
- retinitis pigmentosa
- choroidoretinitis
- optic atrophy secondary to tabes dorsalis
- hysteria
125
Features of bartters syndrome?
- autosomal recessive, typically neonates
- like too much furosemide
- hypoCl, hypoK alkalosis
- high renin aldosterone ratio
- hypercalciuria
- normal or low BP
126
Features of gitelman syndrome?
Like too much thiazide diuretics
- normotension
- hypokalaemia, hypoMg
- hypocalciuria
- metabolic alkalosis
127
Causes of sub clinical hyperthyroidism?
- multinodular goitre, particularly in elderly females
| - excessive thyroxine may give a similar biochemical picture
128
Causes of sub clinical hyperthyroidism?
- multinodular goitre, particularly in elderly females
| - excessive thyroxine may give a similar biochemical picture
129
Risks of subclinical hyperthyroidism?
increased risk of atrial fibrillation and hip fractures
130
When would you treat sub clinical hyperthyroidism?
if older than 65 years or are at risk of osteoporosis or heart disease.
131
Management of subclinical hyperthyroidism if TSH levels do stay persistently low?
therapeutic trial of low-dose antithyroid agents for approximately 6 months in an effort to induce a remission
132
What diagnostic test can be used to test for Growth hormone deficiency, if oral glucose tolerance test is contraindicated (ie pts with IHD or seizures)?
arginine-GHRH stimulation test
133
Pathophysiology of familial hypocalciuric hypercalcaemia?
calcium-sensing receptors of the parathyroid and thyroid experience a loss of function
- > PTH continues being released despite appropriate calcium levels. (Not suppressed bc of decreased sensitivity to increases in extracellular Ca)
- > Ca reabsorption in the kidney is not inhibited despite increased serum Ca and thus Ca is reabsorbed from the urine leading to hypocalciuria
134
Features of familial hypocalcuric hypercalcaemia?
Hypercalcaemia
normal phosphate + PTH
+ low urinary calcium
135
What is used to differentiate between true Cushing's and pseudo-Cushing's (ie 2’ alcohol use)?
insulin stress test
136
When to consider thyroidectomy instead of thyroid lobectomy in thyroid cancers?
any lump greater than 1cm in size or has any signs of metastatic spread to LNs
137
Which patients with thyroid cancer should have radioiodine ablation after?
1. thyroid lumps > 4cm regardless of extrathyroid disease;
2. lumps 1 - 4cm + extra-thyroid disease
3. high-risk histology such as aggressive histological subtypes
138
Causes of excessive endogenous insulin secretion?
| Ie both insulin + c peptide high
insulinoma and sulphonylurea overdose
139
Mx of sulphonylurea OD?
if remains hypoglycaemic despite the infusion of sufficient glucose, consider administration of octreotide* IM
* somatostatin analogue that inhibits insulin release from pancreatic beta-islet cells.
140
11-beta hydroxylase deficiency features
virilisation of female genitalia
precocious puberty in males
Like excess aldosterone: hypertension +
hypokalaemia
141
why does osteomalacia develop in type 2 renal tubular acidosis?
failure of conversion of 25(OH)-cholecalciferol to 1,25 (OH)2 cholecalciferol in the proximal tubule
142
what medication can you use in SIADH resistant to fluid restriction?
demeclocycline:
| reduces the responsiveness of the collecting tubule cells to ADH
143
what monoclonal antibody could you use in treatment of acute gout in patients intolerant to steroids/ nsaids/ colchicine?
Canakinumab: selectively inhibits IL-1 beta Receptor binding
144
management of hypertriglyceridaemia?
1st line: fibrates e.g. fenofibrate
2nd: statins have a role in mixed hyperlipidaemia
145
what tumour marker can you monitor for Medullary thyroid carcinoma in MEN type II ?
calcitonin
| - yearly monitoring
146
what is the most common initial manifestation of MEN1 syndrome?
hyperparathyroidism is by far the most common initial manifestation and will eventually develop in 90% of MEN1 patients
147
Mx of Refractory hypercalcaemia of malignancy if therapy with fluids and pamidronate fails?
S/c calcitonin
- Calcitonin acts by increasing the excretion of renal calcium and decreasing bone resorption.
148
Denosumab in malignancy related hypercalcaemia?
Denosumab can be repeated weekly
149
Management of medications in Addison’s disease if undertaking significant strenuous activity e.g. marathon?
double the dose of both glucocorticoid and mineralocorticoids
150
what is the most common electrolyte abnormality in alcohol withdrawal and may often cause seizures?
hypophosphataemia
151
Long synacthen test differentiates between?
primary and secondary adrenal insufficiency
Long synacthen test: rise of cortisol in SECONDARY adrenal insufficiency
- chronic low lvls of ACTH > atrophy of adrenals
- Prolonged stimulation by ACTH in the long synacthen test > significant rise on cortisol as there is a degree of recovery by adrenals
152
thyroid storm post CT scan?
Iodine in CT contrast media can precipitate thyrotoxicosis or thyroid storm
153
first line medical management for mixed urinary incontinence?
tolterodine, oxybutynin or darifenacin
153
first line medical management for mixed urinary incontinence?
tolterodine, oxybutynin or darifenacin
154
diabetes mellitus, venous thrombo-embolism and the classical rash of necrolytic migratory erythema - a red, blistering rash?
Glucagonoma
155
Mx of glucagonoma?
Surgical resection and octreotide
156
struma ovarii?
Ovarian teratomas that can produce exogenous TSH
156
struma ovarii?
Ovarian teratomas that can produce exogenous TSH
157
Liddle syndrome?
hypertension and hypokalaemic alkalosis
suppressed renin and aldosterone levels
caused by disordered Na channels in the distal tubules leading to increased reabsorption of Na
158
Management of Liddle syndrome?
amiloride or triamterene
- amiloride acts directly on the sodium channel
159
When will you treat subclinical hypothyroidism?
If pt <70 and TSH> 10 even if asymptomatic
160
Which anti thyroid drug do you typically give first in a thyroid storm?
Propylthiouracil
- more rapid onset of action
- can inhibit peripheral conversion of T4 to T3
161
Rate of fluid replacement in HHS?
replace approximately 50% of estimated fluid loss within the first 12 hours and the remainder in the following 12 hours
162
Safe rate of glucose reduction in HHS?
fall of plasma glucose of between 4 and 6 mmol/hr
163
Safe rate of decrease in sodium in HHS?
should not exceed 10 mmol/L in 24 hours
164
When to start insulin infusion in HHS?
If BOHB >1 mmol/L: indicates relative hypoinsulinaemia and insulin should be started (e.g. mixed DKA / HHS picture)
-> fixed rate IV insulin infusion at 0.05 units/ kg/ h.
165
What common drug to stop in acute thyrotoxicosis?
Aspirin
Aspirin binds to thyroxine-binding globulin and displaces bound T4, thereby increasing the levels of free T4.
166
What is abnormally raised in 11-beta hydroxylase deficiency?
11-deoxycortisol
167
Abetalipoproteinaemia: features of?
```
failure to thrive + developmental delay
steatorrhoea
retinitis pigmentosa
cerebellar signs
deep tendon reflexes are absent
acanthocytosis
hypocholesterolaemia
```
168
Abetalipoproteinaemia: management?
dietary restriction of fats, and high-dose vitamin E therapy.
169
Abetalipoproteinaemia: pathophysiology?
- mutation in the microsomal triglyceride transfer protein -> deficiencies in apolipoproteins
- Apolipoproteins are essential in the synthesis and exportation of chylomicrons and VLDL.
- > malabsorption of dietary fats, cholesterol, and fat soluble vitamin (e.g. vitamins K, A, D and E).
170
How long after a CT scan do you have to wait before giving radioiodine therapy?
8 weeks
171
Which diabetic medication increases risk of bladder cancer?
Pioglitazone
172
Conn’s adenoma vs adrenal hyperplasia: how to differentiate using aldosterone levels on standing?
Adrenal hyperplasia: aldosterone increases on prolonged standing,
Conn's adenoma: aldosterone same/ drops on standing.
173
what are the glucose targets for T1DM 90 minutes after eating?
5-9 mmol/L
174
Follow up of gestational diabetes following delivery of baby?
fasting blood glucose test 6-13 wks postpartum
