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Question 1

conditions that gives Lower-than-expected levels of HbA1c

Answer 1

Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis

due to reduced red blood cell lifespan

Question 2

conditions that give Higher-than-expected levels of HbA1c

Answer 2

Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy

Question 3

A 72-year-old woman with newly-diagnosed type 2 diabetes mellitus (T2DM) is started on metformin hydrochloride 500mg OD.

As she has a QRISK-3 score greater than 10%, her GP considers adding an SGLT-2 inhibitor to her treatment regimen.

At which point should this be initiated?

Answer 3

If starting an SGLT-2 as initial therapy for T2DM then ensure metformin is titrated up first

Question 4

SGLT2 inhibitor

Answer 4

canagliflozin, dapagliflozin, and empagliflozin

Question 5

indicative of prediabetes.

Answer 5

42-47 mmol/mol

Question 6

Addisons’ who vomits- what should she do about hydrocortisone meds?

Answer 6

A person with Addisons’ who vomits should take IM hydrocortisone until vomiting stops

Question 7

diagnosis of diabetes T2 from fasting vs random readings?

Answer 7

Diabetes meliitus diagnosis: fasting > 7.0, random > 11.1
if asymptomatic need two readings

Question 8

tx for primary hyperalsodertonism

Answer 8

sprionolactone

Question 9

SGLT-2 inhibitors s/e?

Answer 9

Dapaglifozin
necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)

Question 10

patient stopped taking modified-release metformin due to diarrhoea and nausea.

A QRISK score is calculated which returns as 23%.

next step in his management?

Answer 10

if metformin is contraindicated + patient has a risk of CVD, established CVD or chronic heart failure → SGLT-2 monotherapy

Question 11

target HBA1C fro Lifestyle + metformin?

Includes any drug which may cause hypoglycaemia (e.g. lifestyle + sulfonylurea)?

Answer 11

target 48 6.5

target 53 (7.0)- but only add if HBA1C is 58

Question 12

hypoglycemia tx?

Answer 12

if the patient is conscious and able to swallow the first-line treatment is a fast-acting carbohydrate by mouth i.e.. glucose liquids, tablets or gels

If the patient is unconscious or unable to swallow, subcutaneous or intramuscular injection glucagon may be given.

intravenous 20% glucose solution may be given through a large vein to patients who are unconscious.

Question 13

Patients on long-term steroids plus intercurrent illness. what to do with the steroid dose?

Answer 13

Patients on long-term steroids should have their doses doubled during intercurrent illness

only double glucocorticoid i.e hydrocortisone

Question 14

hypothyroidism- what features distinguish hashimotos vs subacute thyroditis?

Answer 14

Subacute thyroiditis can be distinguished from Hashimoto’s as a cause of hypothyroid by tenderness of the thyroid gland

Question 15

pioglitazone s/e

Answer 15

fluid retention

Question 16

antibodies in graves

Answer 16

TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)

Question 17

DKA- inital managment?

Answer 17

IV 0.9% SALINE BOLUS

Question 18

impaired glucose tolerance (IGT) is defined in asymptomatic vs symptomatic as

Answer 18

Symptomatic: Fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l

random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)

if asymptomatic the above critertia applies on 2 separate occasions

Question 19

cushings — electrolytye inbalance pulse resp/metabolic acidosis/alkolosis?

Answer 19

hypokalaemic metabolic alkalosis

Question 20

chlorpromazine s/e?

Answer 20

galacterrihea

Question 21

Long-term corticosteroid use is linked to

Answer 21

endocrine
impaired glucose regulation
increased appetite/weight gain
hirsutism
hyperlipidaemia
Cushing’s syndrome
moon face
buffalo hump
striae

musculoskeletal
osteoporosis
proximal myopathy
avascular necrosis of the femoral head
immunosuppression
increased susceptibility to severe infection
reactivation of tuberculosis

psychiatric
insomnia
mania
depression
psychosis

gastrointestinal
peptic ulceration
acute pancreatitis

ophthalmic
glaucoma
cataracts

suppression of growth in children

intracranial hypertension

neutrophilia

Question 22

Pioglitazone contraindicated in…

Answer 22

Pioglitazone can cause fluid retention and is therefore contraindicated in patients with heart failure.

bladder cancer

Question 23

Diabetic neuropathy is now managed with…

Answer 23

amitriptyline, duloxetine, gabapentin or pregabalin

Question 24

assess for diabetic neuropathy in the feet…

Answer 24

10 g monofilament

Question 25

Sulfonylureas s/e

Answer 25

ie gliclazide

weight gain

Question 26

tsh and fre t4 levels in sick euthyroid syndrome

Answer 26

Question 27

dka insulin management?

Answer 27

insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin

Question 28

goserelin- what is it used for and s/e?

Answer 28

GnRH agonists (e.g. goserelin) used in the management of prostate cancer may result in gynaecomastia

Question 29

Primary hyperaldosteronism levels k, na,?

Answer 29

Primary hyperaldosteronism can present with hypertension, hypernatraemia, and hypokalemia

Question 30

Myxoedema coma
Cause?
Presention?

Answer 30

potentially fatal complication of longstanding undertreated hypothyroidism.

It may be precipitated by illness, stress, and certain drugs.

Apart from confusion and hypothermia

may have non-pitting periorbital and leg oedema, reduced respiratory drive, pericardial effusions, anaemia, seizures, and other symptoms of hypothyroidism.

Question 31

diagnose Addison’s disease

Answer 31

short synacthen test

Question 32

hypothyroidism and on levothyroxine 75 mcg od.

What is the single most important blood test to assess her response to treatment?

Answer 32

TSH

Question 33

Pioglitazone CONTRA

Answer 33

BLADDER CANCER

Question 34

DPP-4 inhibitor

Answer 34

sitagliptin

Question 35

s/e sulfanylurea i.e gliclazise

Answer 35

weight gain

Question 36

moa Sulfonylureas

Answer 36

bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells.

Question 37

most likely adverse effect of radioiodine therapy for thyrotoxicosis.

Answer 37

hypothyroidism

Question 38

Graves’ disease;- experiencing thyoird storm
12 hours with a temperature of 41ºC, blood pressure 156/91 mmHg and heart rate of 140bpm. Clinically, she is jaundiced, agitated, and confused.

tx?

Answer 38

iv propranolol