endo Flashcards
conditions that gives Lower-than-expected levels of HbA1c
Sickle-cell anaemia
GP6D deficiency
Hereditary spherocytosis
Haemodialysis
due to reduced red blood cell lifespan
conditions that give Higher-than-expected levels of HbA1c
Vitamin B12/folic acid deficiency
Iron-deficiency anaemia
Splenectomy
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?
If starting an SGLT-2 as initial therapy for T2DM then ensure metformin is titrated up first
SGLT2 inhibitor
canagliflozin, dapagliflozin, and empagliflozin
indicative of prediabetes.
42-47 mmol/mol
Addisons’ who vomits- what should she do about hydrocortisone meds?
A person with Addisons’ who vomits should take IM hydrocortisone until vomiting stops
diagnosis of diabetes T2 from fasting vs random readings?
Diabetes meliitus diagnosis: fasting > 7.0, random > 11.1
if asymptomatic need two readings
tx for primary hyperalsodertonism
sprionolactone
SGLT-2 inhibitors s/e?
Dapaglifozin
necrotising fasciitis of the genitalia or perineum (Fournier’s Gangrene)
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?
if metformin is contraindicated + patient has a risk of CVD, established CVD or chronic heart failure → SGLT-2 monotherapy
target HBA1C fro Lifestyle + metformin?
Includes any drug which may cause hypoglycaemia (e.g. lifestyle + sulfonylurea)?
target 48 6.5
target 53 (7.0)- but only add if HBA1C is 58
hypoglycemia tx?
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.
Patients on long-term steroids plus intercurrent illness. what to do with the steroid dose?
Patients on long-term steroids should have their doses doubled during intercurrent illness
only double glucocorticoid i.e hydrocortisone
hypothyroidism- what features distinguish hashimotos vs subacute thyroditis?
Subacute thyroiditis can be distinguished from Hashimoto’s as a cause of hypothyroid by tenderness of the thyroid gland
pioglitazone s/e
fluid retention
antibodies in graves
TSH receptor stimulating antibodies (90%)
anti-thyroid peroxidase antibodies (75%)
DKA- inital managment?
IV 0.9% SALINE BOLUS
impaired glucose tolerance (IGT) is defined in asymptomatic vs symptomatic as
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
cushings — electrolytye inbalance pulse resp/metabolic acidosis/alkolosis?
hypokalaemic metabolic alkalosis
chlorpromazine s/e?
galacterrihea
Long-term corticosteroid use is linked to
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
Pioglitazone contraindicated in…
Pioglitazone can cause fluid retention and is therefore contraindicated in patients with heart failure.
bladder cancer
Diabetic neuropathy is now managed with…
amitriptyline, duloxetine, gabapentin or pregabalin
assess for diabetic neuropathy in the feet…
10 g monofilament
Sulfonylureas s/e
ie gliclazide
weight gain
tsh and fre t4 levels in sick euthyroid syndrome
dka insulin management?
insulin should be fixed rate whilst continuing regular injected long-acting insulin but stopping short actin injected insulin
goserelin- what is it used for and s/e?
GnRH agonists (e.g. goserelin) used in the management of prostate cancer may result in gynaecomastia
Primary hyperaldosteronism levels k, na,?
Primary hyperaldosteronism can present with hypertension, hypernatraemia, and hypokalemia
Myxoedema coma
Cause?
Presention?
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.
diagnose Addison’s disease
short synacthen test
hypothyroidism and on levothyroxine 75 mcg od.
What is the single most important blood test to assess her response to treatment?
TSH
Pioglitazone CONTRA
BLADDER CANCER
DPP-4 inhibitor
sitagliptin
s/e sulfanylurea i.e gliclazise
weight gain
moa Sulfonylureas
bind to an ATP-dependent K+(KATP) channel on the cell membrane of pancreatic beta cells.
most likely adverse effect of radioiodine therapy for thyrotoxicosis.
hypothyroidism
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?
iv propranolol
