Endo Flashcards
HBA1C target in T1DM
48
CBG targets in T1DM
5-7 waking
4-7 before meals
Clinical triad in Primary Hyperaldosteronism
Hypertension
Hypokal
Metabolic alkalosis (high bicarb)
First line investigation in primary hyperaldosteronism
aldosterone/renin ratio
Impaired fasting glucose levels
> =6.1 < 7.0 = IFG
Impaired glucose tolerance
fasting glucose < 7
OGTT >=7.8 < 11.1
How often should A1C be checked in T2DM
3-6 months > stable > 6 monthly
What are HBA1C targets for lifestyle, lifestyle + metformin, use of nay drug which can cause hypoglycaemia
Lifestyle - 48 (6.5)
Lifestyle + metformin - 48 (6.5)
Hypo drug 53 (7)
Which drug should be added to metformin in the first line management to T2DM and under what circumstances?
SGLT-inhibitor
High risk / established CVD or chronic heart failure
Which are the SGL2 inhibtors
-flozins (think glucose floze out)
Which drug class are ‘the gliptins’
DPP4 inhibitors
How do sGL2 inhibitors work
Blocks SGL2 enzymes in the kidney = no glucose reuptake
DPP4i MOA
blocks incretin > increased insulin secretion
Which diabetic drug class have drugs which end in -ide
sulfonylureas
This drug increases insulin production and secretion from the pancreas by binding K channels
sulfonylureas (-ide)
What is th next step in a patient who is allergic to metformin?
either SLT2 mono therapy if there is CVD/CHF
or
DPP4i , pioglitazone, sulfonyurea
Which drugs end in -tide
GLP1 mimetics
When should GLP1s be used
When insulin is contraindicated due to employment or if bMI > 35
What are the side effects of pioglitazone (thiazolidenediones)
weight gain
lIver impairment
fluid retention > not to be used in heart failure
fracture risk
bladder ca
What are the diagnostic criteria for T2DM
symptomatic FASTING >= 7
symptomatic RANDOM >=11
A1C > 48
Which conditions do not allow for diagnosis of T2DM with A1C only
haemoglobinopathies
haemolytic anaemia
untreated iron def
gestational diabetes
children
hiv
ckd
anything that causes hyperglycaemia
Which drugs can cause gynacomastia
ranitidine
isoniazid
digoxin
spiro (most common cause)
GnRH agonists (goserelin)
Which drug can cause glaactorrhoea
chlorpromazine
metoclopramide
domperidone
haloperidol
From lowest to highest glucocorticoid activity - steroids
Low
fludro
hydro
pred
dex / betamethasone
High
Which patient should be started on 25mcg of levothyroxine?
> 50
Severe hypothyroidism
Cardiac disease
How much should the dose of levo be increased by in pregnancy?
25-50mcg
Side effects of levo
hyperthyroidism
low bone mineral density
angina
AF
How does carbimazole work?
Blocks thyroid peroxidase
Which conditions can increase the A1C level
B12/folate def
iron def
splenectomy
Treatment of proalactinomas
- medical therapy with dopamine agonists (cabergoline, bromocriptine)
2, Surgery if cannot tolerate or fail to respond to medical therapy
Which drug can reduce the absorption of levo
iron/calcium
Why should amitryptiline not be issued if there is BPH
increased risk of urinary retention
Clinical features of Addisons
hyperpigmentation
hyperkalaemia
hypotension
hyponatraemia
jf Kennedy had addisons
Investigation for addisons
short synachten test (ACTH stmulation test)
PTH levels in primary hyperparathyroidism
high or normal
Electrolyte findings in primary hyperPTH
high Ca
low ph
Addisons is also known as what
primary HYPOaldosteronism
Primary Hyperaldosteronism is also known as what
Conn’s
C peptide levels are low in T1DM T or F
True
Typical presentation of myxoedema coma
confusion and hypothermia
Features of addisonian crisis
malaise
nv
ado pain
muscle cramps
paraesthesia
Management of acromegaly
- Trans sphenoidal surgery
- Octreotide (somatostatin analogue)
Pioglitazone should not be prescribed in which situations
heart failure
Which drug can mask the symptoms of hypoglycaemia
beta blockers
sulfonylureas can case weight gain
true
Causes of acanthuses nigrans
type 2 diabetes mellitus
gastrointestinal cancer
obesity
polycystic ovarian syndrome
acromegaly
Cushing’s disease
hypothyroidism
familial
Prader-Willi syndrome
drugs
combined oral contraceptive pill
nicotinic acid
Interpretation of serum 9am cortisol test
> 500 nmol/l makes Addison’s very unlikely
< 100 nmol/l is definitely abnormal
100-500 nmol/l should prompt a ACTH stimulation test to be performed
Anti Jo positive in
Dermatomyositis
Anti Jo antibodies are also known as
Anti histidine tRNA ligase
ANA positive + Anti Jo positive
Dermatomyositis
Antibody test in drug induced lupus
Antihistone
