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endo Flashcards

1
Q

For patients with T2DM, HbA1c should be checked every 3-6 months until stable, then how often

A

6 monthly

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2
Q

What is the HbA1c target for patients with T2DM receiving management of lifestyle

A

48mmol/mol
6.5%

n.b. this is the same for those on metformin only

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3
Q

What is the HbA1c target for patients with T2DM receiving management of metformin

A

48mmol/mol
6.5%

n.b. this is the same for those on lifestyle only

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4
Q

What is the HbA1c target for patients with T2DM receiving management of any drug which may cause hypoglycaemia e.g. sulfonylureas

A

53mmol/mol
7.0%

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5
Q

What is the HbA1c target for patients with T2DM receiving management of any ONE drug, but now their HbA1c has risen to 58mmol/mol (7.5%)

A

53 mmol/mol
7.0%

This is the same for T2DM on sulfronyureas

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6
Q

Patients on ONLY metformin for T2DM (target = 48mmol/mol (6.5%), should only have a second diabetic drug added if the HbA1c rises to…

A

58mmol/mol
7.5%

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7
Q

First line drug in T2DM

A

Metformin

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8
Q

Second line drug in T2DM
After metformin established and uptitrated

(or if CVD, chronic heart failure, QRISK >10%)

A

SGLT-2 inhibitor

e.g. empaglifozin, canagliflozin, dapaglifozin

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9
Q

If metformin is contraindicated in T2DM, what medications can be given in a patient WITH risk of CVD, established CVD, or heart failure

A

SGLT-2 monotherapy

e.g. empaglifozin, canagliflozin, dapaglifozin

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9
Q

If metformin is contraindicated in T2DM, what medications can be given in a patient WITH risk of CVD, established CVD, or heart failure

A

SGLT-2 monotherapy

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10
Q

If metformin is contraindicated in T2DM, what medications can be given in a patient WITHOUT risk of CVD, established CVD, or heart failure

A

DPP-4 inhibitor (sitagliptin, linagliptin)
Or pioglitazone
Or sulfonylurea (gliclazide)

SGLT-2 may be used if certain NICE criteria are met.

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11
Q

Examples of DPP-4 inhibitors

A

GLIPTINS
linagliptin
sitagliptin

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12
Q

Examples of sulfonyureas

A

Glimepiride
Gliclazide
Glipizide
Tolbutamide

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13
Q

Examples of SGLT-2 inhibitors

A

empaglifozin
canagliflozin
dapaglifozin

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14
Q

Stepwise T2DM medications

A
  1. Metformin
  2. Add one of: DPP-4 inhibitors, pioglitazone, sulfonyurea, SGLT-inhibitor (if NICE criteria met of CVD/IHD/QRISK >10%)
  3. Add another from the list above OR start insulin treatment
  4. If triple therapy is not tolerated/effective then switch one for a GLP-1 mimetic if BMI >35 - specialist referral if on insulin too
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14
Q

If triple therapy for T2DM (metformin + two other drugs or addition of insulin) is not effective or tolerated, consider switching one of the drugs for…:

A

GLP-1 mimetic
e.g. liraglutide, dulaglutide, semaglutide

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15
Q

If triple therapy for T2DM (metformin + two other drugs or addition of insulin) is not effective or tolerated, consider switching one of the drugs for what class…?

A

GLP-1 mimetic
e.g. exenatide

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15
Q

Second-line therapy for T2DM if on metformin already, what can you add on

A

metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor (if NICE criteria met - CVD/IHD/QRISK >10%)

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16
Q

If metformin is not tolerated e.g. due to GI side effects, what should it be switched to

A

Metformin modified-release

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17
Q

If triple therapy for T2DM (metformin + two other drugs or addition of insulin) is not effective or tolerated, consider switching one of the drugs for GLP-1 mimetics. These can only be done for patients with:

A

BMI >35
BMI <35 but insulin havs occupational implications
Reduction of at least 11mmol/mol (1%) in HbA1c and weight loss of >3% in 6 months

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18
Q

When GLP-1 mimetics are added (after triple therapy for T2DM), can this be done in primary care

A

ONLY add GLP-1 mimetics to INSULIN in SPECIALIST care

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19
Q

When GLP-1 mimetics are added (after triple therapy for T2DM), can this be done in primary care

A

ONLY add GLP-1 mimetics to INSULIN in SPECIALIST care

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20
Q

NICE recommend starting with human NPH insulin - what type and when

A

Isophane, intermediate-acting
Bedtime or twice daily according to need

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21
Q

Blood pressure targets in T2DM

A

SAME as people without T2DM

<80 years: clinic 140/90, home 135/85
>80 years: clinic 150/90, home 145/85

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22
Q

Patients with subclinical hypothyroidism should have what treatment
normal T4/T3
high TSH 5.5-10

A

If <65 years, high TSH 5.5-10 on 2 separate occasions 3 months apart AND symptoms - consider 6 month trial of levothyroxine
If >80 years - watch and wait
Asymptomatic - watch and wait, repeat in 6 months

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23
Q

T1DM HbA1c should be monitored how often

A

Every 3-6 months

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24
Q

What is the T2DM HbA1c target

A

48mmol/mol (6.5%)

  • same as T2DM
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25
Q

Blood glucose targets for T1DM:
(a) on waking
(b) before meals at other times of day

A

(a) on waking: 5-7
(b) before meals at other times of day: 4-7

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26
Q

When do NICE recommend adding metformin in T1DM

A

If BMI >25

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27
Q

for mealtime insulin replacement for adults with type 1 diabetes, what insulin should be offered

A

rapid-acting insulin ANALOGUES

injected before meals
(NOT rapid-acting soluble human or animal insulins)

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28
Q

what insulin should T2DM patients be started on

A

NPH insulin [aka isophane insulin] (injected once or twice daily according to need) should be offered

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29
Q

Kallman’s syndrome
What is high/low/normal for androgens

A

LH and FSH = low/normal
Testosterone = low

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30
Q

Klinefelter’s syndrome
What is high/low/normal for androgens

A

LH and FSH = high
Testosterone = low

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31
Q

Diabetes sick day rules
T1DM
How much fluid should be drank in one day

A

Encourage fluid intake at least 3 litres/day

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31
Q

Diabetes sick day rules
T1DM
How many times should blood sugars be checked, and insulin taken

A

Continue normal insulin regime but ensure checking blood sugars regularly (every 1-2 hours including night)

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32
Q

SGLT-2 inhibitors (dapagliflozin) has risks of which kind of infections

A

UTIs
Genital (candida)

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33
Q

Impaired fasting glucose (IFG)
Glucose levels and HbA1c levels

A

Glucose: 6.1-6.9 mmol/l
HbA1c: 42-47 mmol/mol (6-6.4%)

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33
Q

hyperthyroidism can lead to what bone disorder

A

osteoporosis

due to increased bone turnover from excess thyroid hormones

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34
Q

Type 2 diabetes
Glucose (fasting + 2 hours) and HbA1c levels

A

Fasting: 7.0 mmol/l
2 hours: >11.1 mmol/l
HbA1c: 48mmol/l (6.5%)

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34
Q

Patients with subclinical hypothyroidism should have what treatment if bloods show:
normal T4/T3
high TSH >10

A

levothyroxine if TSH >10 on 2 separate occasions 3 months apart

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35
Q

Normal/above average height
Delayed puberty
Hypogonadism
Anosmia
Low/normal LH/FSH
Low testosterone

what is the defect

A

Kallman’s syndrome

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35
Q

Klinefelter’s syndrome
what karyotype

A

47XXY

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36
Q

Patients with subclinical hypothyroidism (normal T4/T3, high TSH) should have what test

A

Thyroid peroxidase antibodies

Can indicate patients who can progress to hypothyroidism

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37
Q

Impaired glucose tolerance
Glucose levels at 2 hours

A

2 hours: 7.8-11.1 mmol/l

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37
Q

Diabetes sick day rules
T1DM
If struggling to eat, how can you maintain carb intake

A

Sugary drinks

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38
Q

When choosing between liraglutide (GLP-1 mimetic) vs orlistat (pancreatic lipase inhibitor) for obesity, which is preferential for patients with T2DM too?

A

Liraglutide (GLP-1 memetic)

n.b. BMI at least >35 and/or prediabetic hyperglycaemia (HbA1c 42-47) is criteria

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39
Q

Kallman’s syndrome - delayed puberty secondary to hypogonadotropic hypogonadism. What is its inheritance

A

X-linked recessive

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40
Q

Lack of smell (anosmia)
Delayed puberty
Inappropriately low/normal FSH and LH
Normal or above-average height

what is the condition

A

Kallman’s syndrome

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40
Q

Management of Kallman’s syndrome
What two things can be supplemented

A
  1. Testosterone
  2. Gonadotrophins - can result in sperm production if fertility is desired later on
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41
Q

Are patients with impaired glucose tolerance or impaired fasting glycaemia more likely to develop diabetes?

A

impaired glucose tolerance

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42
Q

What is the mechanism of action of SGLT-2 inhibitors (empagliflozin)

A

increasing urinary excretion of glucose

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43
Q

mechanism of action of sulphonylureas e.g. gliclazide.

A

Increase insulin release from pancreas

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44
Q

DPP4-inhibitors (GLIPTINS) e.g. sitagliptin, linagliptin, mechanism of action

A

reduce breakdown of incretins, decreases glucagon secretion from pancreas

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45
Q

Diabetic ketoacidosis criteria
Glucose >11
ketones >3
bicarb <15
pH is …?

A

pH <7.3

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46
Q

DKA is caused by uncontrolled…

A

LIPOLYSIS

leads to excess free fatty acids that convert to ketone bodies

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47
Q

3 most common precipitating factors of DKA

A

Infection
Missed insulin doses
Myocardial infarction

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48
Q

deep hyperventilation in DKA is called

A

Kaussmaul respiration

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49
Q

Diabetic ketoacidosis criteria
pH 7.3
Glucose >11
ketones >3
bicarb is …?

A

<15

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50
Q

Diabetic ketoacidosis criteria
bicarb <15
pH <7.3
Glucose >11
What are ketones?

A

ketones >3

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51
Q

Diabetic ketoacidosis criteria
bicarb <15
pH <7.3
Ketones >3 (or urine ++)
what is glucose?

A

Glucose >11

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52
Q

In DKA, fluids, insulin and K+ are given.
Insulin IV infusion should be started at what rate?

A

0.1unit/kg/hour

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53
Q

In DKA, fluids, insulin and K+ are given.
Insulin IV infusion is started at 0.1unit/kg/hour. When should dextrose be given?

A

When blood glucose reaches <14, 10% dextrose at 125mls/hr should be given along with 0.9% NaCl

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54
Q

Potassium infusions should not be given faster than…

A

20mmol/hour

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55
Q

What insulins should be stopped/continued during a patient’s DKA

A

Continue long-acting insulin
Stop short-acting insulin

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56
Q

Three criteria that define DKA resolution

A

pH >7.3
Ketones <0.6
Bicarb >15

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57
Q

When can patient’s with DKA be switched from IV to subcut insulin

A

When patient is eating and drinking

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58
Q

Addison’s disease (high ACTH, low cortisol, low aldosterone) leads to what electrolyte disturbance

A

Hyponatraemia
Hyperkalaemia

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59
Q

Aldosterone effects on Na/K levels

A

Retains (increases) Na+
Excretes K+

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60
Q

Hyperpigmentation is associated with one of the following - which one:
Primary’s hypoadrenalism - Addisons
Secondary adrenal insufficiency

A

Addison’s (primary hypoadrenalism)

Due to pituitary increased ACTH which breaks down into MSH and melatonin precursors

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61
Q

people with change in levothyroxine dose should recheck TFTs after how long

A

8-12 weeks

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62
Q

women who have hypothyroidism and then become pregnant should have levothyroxine dose changed by how much

A

increased by at least 25-50mcg of levothyroxine

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63
Q

levothyroxine can worse heart disease by which 2 side effects

A

worsens angina
atrial fibrillation

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64
Q

levothyroxine interacts with which 2 medications

A

iron and calcium carbonate

reduces the absorption of levothyroxine; give at least 4 hours apart

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65
Q

In type 1 diabetics, how many times should you aim to monitor blood glucose

A

at least 4 times a day

including before each meal and before bed

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66
Q

What HbA1c indicates pre-diabetes

A

42-47 mmol/mol (6-6.4%)

67
Q

For a child with a palpable abdominal mass or unexplained enlarged abdominal organ, should they be referred urgently or routinely

A

48hr urgent review
For specialist assessment for neuroblastoma and Wilm’s tumour

68
Q

Neuroblastoma is one of the top 5 causes of cancer in children. What tissue does the tumour arise from

A

Arises from neural crest tissue of adrenal medulla and sympathetic nervous system

69
Q

Investigations for neuroblastoma may show raised levels of what

A

VMA
HVA

70
Q

Persistent vomiting and bloating in a poorly controlled diabetic can be due to what condition …?

A

gastroparesis

(in gastrointestinal autonomic neuropathy)

71
Q

Gastroparesis in diabetic patients can be treated with which 2 drugs

A

Metoclopramide
Domperidone

72
Q

Diabetics can get gastrointestinal autonomic neuropathy. What are the 3 main symptoms they get in this

A
  1. Gastroparesis
  2. chronic diarrhoea - at night
  3. GORD - reduced sphincter pressure
73
Q

which diabetic medication is contraindicated in heart failure

A

pioglitazone

74
Q

Causes of raised prolactin - the 6 p’s

A
  1. pregnancy
  2. prolactinoma
  3. physiological [stress, exercise, sleep]
  4. PCOS
  5. primary hypothyroidism [acromegaly]
  6. Phenothiazines, metocloPramide, domPeridone

+ haloperidol

75
Q

Patients on insulin may now hold a HGV licence if they meet strict DVLA criteria relating to..

A

hypoglycaemia

76
Q

The body’s response to hypoglycaemia

A
  • Insulin secretion decreases
  • Glucagon secretion increases
  • GH and cortisol are released
77
Q

Insulin increase has what effect on growth hormone and cortisol

A

INVERSE RELATIONSHIP
Insulin increase = GH and cortisol decrease

78
Q

Hypoglycaemia management in the community

A

Oral glucose 10-20g in liquid, gel or tablet
Or Glucogel

79
Q

Hypoglycaemia management in hospital:
are they alert?
(a) yes
(b) no

A

(a) If alert - then quick acting carbohydrate e.g. oral glucose 10-20mg or glucogel
(b) If unconscious or unable to swallow - SC or IM glucagon or IV 20% glucose solution through large vein

80
Q

what is the most common cause of thyrotoxicosis in the UK

A

Graves’ disease

81
Q

exenatide can be useful in obese diabetes, what is the NICE BMI criteria for its use

A

Patient on metformin + sulfonylurea and:
- BMI >35 or
- BMI <35 and insulin cannot be used

82
Q

Patients diagnosed with prediabetes need follow up when …

A

every 12 months for HbA1c

83
Q

How often should Insulin-dependent diabetics must check their blood glucose while driving

A

Every 2 hours

84
Q

Patients with diabetes cannot drive if they have had a hypoglycemic episode that required the assistance of another person in the past what timeframe

A

In the past year

85
Q

Diabetic foot disease occurs secondary to which two main factors

A
  1. neuropathy - 10g monofilament to test sensation
  2. peripheral arterial disease - macro and microvascular ischaemia - palpate pulses
86
Q

All patients with diabetes should be screened for diabetic foot disease at least…

A

annually

87
Q

Diabetics who are moderate/high foot risk (micro/macro vascular issues or neuropathy) should have what management

A

Referral to local diabetic foot centre

88
Q

Anti-thyroid peroxidase antibodies are seen in which conditions

A

Graves’ disease (75%)
Hashimoto’s disease (90%)

89
Q

What medication should be used in new cases of Graves’ disease to help control symptoms (to block adrenergic effects) while patient is awaiting endocrinologist review

A

Propranolol

90
Q

If patient’s symptoms from hyperthyroidism (Graves’ disease) are not controlled well in primary care with propranolol, what should be considered

A

Carbimazole

but usually is initiated by endocrinologist

91
Q

Major complication of carbimazole therapy is…

A

agranulocytosis

92
Q

Radioiodine treatment for hyperthyroidism (Graves’ disease) patients is often used in what 2 groups of patients

A
  1. Patients who relapse after anti-thyroid drug treatment e.g. carbimazole
  2. Patients who are resistant to primary anti-thyroid drug treatment
93
Q

Contraindications to radioiodine treatment with Graves’ disease

A

Pregnancy (avoid 4-6 months after treatment)
Age <16 years
Relative contraindication - thyroid eye disease

94
Q

How do Sulfonylureas affect weight

A

Weight gain

95
Q

Addison’s disease has what hormone profile

A

High ACTH
Low cortisol
Low aldosterone

Primary hypoadrenalism

96
Q

PTH level in primary hyperparathyroidism is

A

Inappropriately normal
Or high

(with low phosphate)

97
Q

4 causes of primary hyperparathyroidism

A

85% solitary adenoma
10% hyperplasia
4% multiple adenoma
1% carcinoma

98
Q

X-ray findings:
pepperpot skull
osteitis fibrosa cystica

A

Primary hyperparathyroidism

99
Q

Management for primary hyperparathyroidism

A
  1. Curative = total parathyroidectomy
  2. If not suitable for surgery, treat with cinacalcet (this mimics action of calcium on tissues)
100
Q

Long term steroids should not be withdrawn abruptly as this may lead to

A

Addisonian crisis

101
Q

Gradual withdrawal of systemic steroids is needed if patients has one of 3 criteria:

A
  1. Over 40mg prednisolone OD for >1 week
  2. Over 3 weeks treatment
  3. Recent repeated courses
102
Q

primary hyperaldosteronism is also called

A

Conn’s syndrome

103
Q

Conn’s syndrome (primary high aldosterone) - how does this present with electrolytes and on a blood gas

A

High/normal sodium
Low potassium
Metabolic alkalosis

HYPERTENSION

104
Q

First-line screening test for Conn’s syndrome (primary hyperaldosteronism)

A

Renin-aldosterone ratio
(shows high aldosterone, low renin due to negative feedback)

105
Q

What is the most common cause of primary hyperaldosteronism (Conn’s syndrome)

A

Bilateral idiopathic adrenal hyperplasia

106
Q

Renin-aldosterone ratio in Conn’s syndrome shows…

A

HIGH ALDOSTERONE
LOW RENIN

107
Q

What 2 methods can be used to differientiate between unilateral adenoma and bilateral adrenal hyperplasia causing aldosterone excess (i.e. Conn’s syndrome)

A

CT abdomen
Adrenal venous sampling

108
Q

What is the management for adrenal unilateral adenoma (causing Conn’s syndrome through primary hyperaldosteronism)

A

Surgery

109
Q

What is the management for bilateral adrenal hyperplasia (causing Conn’s syndrome through primary hyperaldosteronism)

A

Aldosterone antagonist
e.g. spironolactone

110
Q

Before diagnosing T2DM, asymptomatic patients with an abnormal HbA1c or fasting glucose must be confirmed with

A

A second abnormal reading

111
Q

Patients with Addison’s should be given what for adrenal crises

A

Hydrocortisone injection kit (intramuscular)

112
Q

Addison’s disease need both glucocorticoid and mineralocorticoid replacement therapy. They therefore take a combination of which 2 meds:

A
  1. Hydrocrtisone (GC) - doubles in illness
  2. Fludrocortisone (MC) - stays same in illness
113
Q

Which T2DM medications is associated with an increased risk of severe pancreatitis and renal impairment?

A

GLP-1 agonists
e.g. exenatide

114
Q

what should be used to assess for diabetic neuropathy in the feet

A

10g monofilament

115
Q

orlistat mechanism of action

A

inhibits gastric and pancreatic lipase to reduce digestion of fat

116
Q

which diabetic medication can cause jaundice

A

sulfonylureas

117
Q

treatment of prolactinoma

A

FIRST LINE = dopamine agonists
e.g. cabergoline, bromocriptine
(even if significant neuro complications)

these stop prolactin release from pituitary gland

118
Q

what type of medication are cabergoline, bromocriptine

A

dopamine agonists

stop prolactin release from pituitary gland

119
Q

what anti-thyroid drug treatment in hyperthyroidism (i.e. Graves) can be used in pregnancy in the first trimester

A

propylthiouracil

then can be switched back to carbimazole at start of 2nd trimester

120
Q

best diagnostic test for hypothyroidism

A

MRI pituitary gland

121
Q

Which T2DM medication would increase insulin sensitivity?

A

pioglitazone
it acts to reduce peripheral insulin resistance

122
Q

HbA1c is not as useful for patients with a possible or suspected diagnosis of T1DM as it may not accurately reflect a recent rapid rise in serum glucose. What are four useful indicators?

A
  1. Urine dip - for glucose + ketones
  2. Fasting/random glucose - venous - DIAGNOSTIC
  3. C-peptide levels - low
  4. Diabetes antibodies
123
Q

What 4 antibodies can be seen in diabetes (usually T1DM)

A
  1. Antibodies to glutamic acid decarboxylase (anti-GAD)
  2. Anti-islet cell Abs (ICA)
  3. Insulin autoantibodies (IAA)
  4. Insulinoma-associated 2 auto Abs (IA-2A)
124
Q

which medications used in management of prostate cancer can cause gynaecomastia

A

GnRH agonists
e.g. goserelin

125
Q

which medication should be considered as an adjunct for weight loss in obese class II (BMI >35) patients who are prediabetic

A

LIRAGLUTIDE

126
Q

pioglitazone is associated with which bone issues

A

osteoporosis and fractures

127
Q

what blood test in U+Es is associated with metabolic syndrome

A

raised uric acid

128
Q

Hypoglycaemia: A child with a body-weight <=25kg should be administered

A

IM 500mcg glucagon

129
Q

Patients over the age of 60 with new onset diabetes and weight loss should be referred for

A

urgent CT abdomen
to exclude pancreatic cancer

130
Q

Over-replacement with thyroxine increases the risk for what bone disorder

A

osteoporosis

131
Q

maturity onset diabetes of the young inheritance pattern

A

autosomal dominant

132
Q

For diagnosis of metabolic syndrome, at least 3 of the following should be identified:

A
  1. Increased waist circumference
  2. High TGs
  3. Reduced HDL
  4. High BP
  5. High fasting plasma glucose
133
Q

Main pathophysiological factor of metabolic syndrome

A

Insulin resistance

134
Q

Liraglutide (GLP-1) requires HbA1c reduction and weight loss of how much after 6 months

A

HbA1c reduction of 11mmol/mol (1%) and weight loss of >3%

135
Q

Orlistat requires how much weight loss

A

5% in 3 months

136
Q

what is the best test to diagnose Addison’s disease

A

Short synACTHen test

137
Q

during ramadan, what metformin doses should be split

A

1/3 of normal metformin dose before sunrise

2/3 after sunset

138
Q

inability to close the eye in exopthalmos can lead to what risk

A

exposure keratopathy

139
Q

Target cholesterol for type 2 diabetics (NICE)

A

40% reduction in non-HDL cholesterol

140
Q

paget’s disease - what happens in terms of osteoblasts and osteoclasts

A

Increased osteoblast activity
Decreased osteoclast

Increased and uncontrolled bone turnover

141
Q

Older male with bone pain
Raised ALP
Normal calcium and phosphate

What is the diagnosis

A

Pagets disease!

142
Q

X-ray showing osteolysis, sclerotic lesions
Skull x-ray = thickened vault, osteoporosis circumscripta

What is the diagnosis?

A

Paget’s disease

Raised ALP only

143
Q

Management for Paget’s disease

A
  1. Bisphosphonate (oral risderonate or IV zoledronate)
  2. Calcitonin - used less now
144
Q

What are the 4 indications for treatment of Paget’s disease

A
  1. bone pain
  2. skull or long bone deformity
  3. fracture
  4. periarticular Paget’s
145
Q

Five complications of Paget’s disease

A
  1. Deafness - cranial nerve entrapment
  2. Bone sarcoma
  3. Fractures
  4. Skull thickening
  5. High output cardiac failure
146
Q

priapism is persistent erection defined lasting longer than how long

A

4 hours

147
Q

investigations for priapism

A
  • cavernosal blood gas analysis - differentiates between ischaemic vs non-ischaemic
  • doppler or duplex USS
  • FBC, toxicology screen to find cause
148
Q

Management of ischaemic priapism
(n.b. non-ishaemic priapism is suitable for observation)

A

Medical emergency

1st line = aspiration of blood rom cavernosa, while injecting saline flush to clear viscous blood that has blood

Or inject vasoconstrictive agent e.g. phenylephrine

Surgery can be considered if above fail

149
Q

Chronic fatigue syndrome has a diagnosis after what timeframe

A

3 months

150
Q

Denosumab is a treatment for osteoporosis

what is its category and mechanism of action

A

Human monoclonal antibody
Prevents development of osteoclasts by inhibiting RANKL

151
Q

the 6 A’s of ankylosing spondylitis

A

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

152
Q

Plain XR of sacroiliac joints in ankylosing spondylitis may be normal, but later changes, what 5 things may be seen?

A
  1. Sacroilitis - subcondral erosions, sclerosis
  2. Squaring of lumbar vertebrae
  3. Bamboo spine
  4. Syndesmophytes
  5. Apical fibrosis on CXR
153
Q

If the xray is negative for sacroiliac involvement but suspicion for ankylosing spondylitis is still high, what is the next step?

A

MRI

  • early inflammation may show oedema
154
Q

what BMI warrants referral for bariatric surgery

A

over BMI 40

155
Q

3 categories of bariatric surgery and the subtypes

A
  1. Restrictive operations
    - laparoscopic-adjustable gastric banding (LAGB)
    - sleeve gastrectomy
    - intragastric balloon
  2. Malabsorptive operations
    - biliopancreatic diversion with duodenal switch - usually if BMI >60
  3. Mixed (restrictive + malabsorptive) operations
    - Roux-en-Y gastric bypass
156
Q

Taller than average
Lack of secondary sexual characteristics
Small bilateral testes
Chr XXY
Infertility
High FSH, low testosterone

what is the condition

A

Klinefelter’s syndrome

157
Q

Acromegaly is abnormality of what hormone

A

Increased growth hormone

158
Q

What is the commonest cause of acromegaly

A

Pituitary adenoma

results in increased GH

159
Q

what is subclinical hypothyroidism defined as

A

normal T3/T4
high TSH

no obvious symptoms

160
Q

What HbA1c levels indicate pre-diabetes/high risk

A

42-47mmol/mol
(6.0-6.4%)

161
Q

black patient with T2DM and hypertension
what is first line anti-hypertensive

A

Angiotensin receptor blocker (ARB)

162
Q

in pregnancy what changes of thyroid occur (for hyper and hypothyroidism)

A

Hyper/thyrotoxicosis:
- Increases thyroxine-binding globulin which increases total thyroxine (not free)
- Also activation of TSH receptor by hCG can occur

Hypothyroid:
- Increased doses of levothyroxine are needed

163
Q

what is the most common cause of thyrotoxicosis in the pregnancy

A

Grave’s disease

  • it is also the commonest for the UK!
164
Q

Maternal thyroid levels should be kept to what in terms of the reference ranges to avoid foetal hypothyroidism

A

Upper third of normal free thyroxine levels

165
Q

Diabetes sick day rules
T2DM
What should be done about medication?
If taking oral hypoglycaemics

A

STOP some of these
Risk of hypoglycaemia

166
Q

Diabetes sick day rules
T1DM and T2DM
What should be done about insulin?

A

Continue insulin!

Do not stop otherwise risk of DKA

167
Q

Diabetes sick day rules
T2DM
What should be done about medication if taking metformin?

A

Stop metformin

Risk of dehydration and lactic acidosis

168
Q

Diabetes sick day rules
T2DM
What should be done about medication if taking SGLT-2 inhibitors?

A

Check for ketones
Stop if acutely unwell or at risk of dehydration due to risk of DKA

169
Q

Diabetes sick day rules
T2DM
What should be done about medication if taking GLP-1 receptor agonists?

A

Stop treatment if risk of dehydration
To reduce risk of AKI

170
Q

what diabetic medication should be avoided in pregnancy and breastfeeding?

A

sulfonylureas

remember only metformin + insulin are given in pregnancy!

171
Q

dopamine effect on prolactin

A

dopamine inhibits prolactin

172
Q

NICE advises that you risk stratify patients in terms of diabetic foot into:
(a) low risk
(b) moderate risk
(c) high risk
what are the criteria of each?

A

(a) low risk - only callus
(b) moderate risk - deformity, neuropathy or non-critical limb ischaemia
(c) high risk - previous ulcer, amputation, RRT, non-critical limb ischaemia with any of the above issues

173
Q

what medication class reduce hypoglycaemic awareness

A

b-blockers

174
Q

thiazolidinediones e.g. pioglitazone, mechanism of action

A

reduce peripheral insulin resistance

175
Q

adverse effects and contraindications of thiazolidinediones e.g. pioglitazone

A

weight gain
liver impairment
fluid retention - contraindicated in heart failure
bladder cancer

176
Q

what makes HbA1c result unreliable

A

anaemia (haemolytic + IDA)
haemoglobinopathies
HIV

177
Q

What is the mechanism of 5 a-reductase deficiency syndrome?

A

inability to convert testosterone to 5 alpha-DHT

178
Q

Hypothyroidism
Painless goitre
Anti-TPO antibodies

what is the diagnosis

A

Hashimoto’s thyroiditis disease

AKT (25 decks)

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