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Medical Finals > Endo > Flashcards

Endo Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the HLA associations for T1DM?

A

HLA-D3 and -D4

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2
Q

Which antibodies are found in T1DM?

A

Anti-islet, anti-GAD

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3
Q

What are the criteria for diagnosing diabetes/IFG/IGT?

A
  • Diabetes
    • Fasting 7, or 11.1 2 hrs after OGTT
    • HbA1c 48 or 6.5%
  • IFG: 5.6-7.0
  • IGT: 7.8-11
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4
Q

What are the secondary causes of DM?

A
  • Drugs: steroids, anti-HIV, atypical neuroleptics, thiazides
  • Pancreatic: CF, chronic pancreatitis, HH, pancreatic Ca
  • Endo: phaeo, cushings, acromegaly, T4
  • Glycogen storage diseases
  • Klinefelter’s, Turner’s, Down’s, Wolfram
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5
Q

What are the aims for capillar blood glucose in DM?

A

Fasting: 4.5-6.5

2h post prandial: 4.5-9

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6
Q

What is the goal for HbA1c in DM?

A

<45-50 (7.5-8%)

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7
Q

What are the stages of diabetic retinopathy?

A
  • Background
    • Dots: microaneurysms
    • Blot haemorrhages
    • Hard exudates: yellow lipid patches
  • Pre-proliferative
    • Cotton wool spots (retinal infarcts)
    • Venous beading
    • Haemorrhage
  • Proliferative
    • New vessels
    • Pre retinal or vitreous haemorrhage
  • Maculopathy
    • Decreased acuity may be the only sign
    • Hard exudates within one disc width of macula
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8
Q

What is Whipple’s triad?

A

Hypoglycaemia if:

  1. Low plasma glucose (3mM or less)
  2. Symptoms consistent with hypoglycaemia
  3. Relief of symptoms with glucose administration
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9
Q

What are the causes of fasting hypoglycaemia?

A
  • EXPLAIN
  • Exogenous drugs
  • Pituitary insufficiency
  • Liver failure
  • Addison’s
  • Islet cell tumours (insulinomas)
  • Immune (insulin receptor antibodies e.g. Hodgkin’s)
  • Non pancreatic neoplasms e.g. fibrosarcomas
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10
Q

Which MEN has insulinomas?

A

MEN1

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11
Q

What are the features of MEN1?

A
  • Pituitary adenoma: prolactin or GH
  • Parathyroid adenoma/hyperplasia
  • Pancreatic tumours: gastrinoma or insulinoma
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12
Q

What are the features of MEN2?

A
  • Thyroid medullary carcinoma
  • Adrenal phaeochromocytoma
    • Hyperthyroidism
    • Marfanoid habitus
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13
Q

What are the adverse effects of Thiazolidinediones e.g. pioglitazone?

A
  • weight gain
  • liver impairment: monitor LFTs
  • fluid retention - therefore contraindicated in heart failure. The risk of fluid retention is increased if the patient also takes insulin
  • recent studies have indicated an increased risk of fractures
  • bladder cancer: recent studies have shown an increased risk of bladder cancer in patients taking pioglitazone
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14
Q

Most common cause of thyrotoxicosis?

A

Grave’s

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15
Q

Which glucose/HbA1c level defines pre diabetes?

A

Fasting plasma glucose of 6.1-6.9 mmol/l

HbA1c 42-47 mmol/mol (6.0-6.4%)

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16
Q

What is the T2DM blood pressure target?

A

no organ damage: < 140 / 80

end-organ damage: < 130 / 80

17
Q

What are the drug causes of raised prolactin?

A

metoclopramide, domperidone

phenothiazines

haloperidol

very rare: SSRIs, opioids

18
Q

What do Thiazolidinediones do?

A

agonists to the PPAR-gamma receptor - reduce peripheral insulin resistance

19
Q

What are the indications for treatment of subclinical hypothyroidism?

A

TSH > 10

thyroid autoantibodies positive

other autoimmune disorder

previous treatment of Graves’ disease

20
Q

What should you do to the steroid doses in Addison’s with an intercurrent illness?

A

Double the hydrocortisone only

21
Q

Which diabetic drugs can cause DKA?

A

Serious and potentially life-threatening cases of diabetic ketoacidosis (DKA) have been reported in patients taking SGLT2 inhibitors canagliflozin, dapagliflozin or empagliflozin for type 2 diabetes.

22
Q

Which has a tender goitre, Hashimoto’s or De Quervain’s?

A

De Quervain’s

23
Q

Which drug interacts with levothyroxine?

A

Ferrous sulphate - decreases absorption

24
Q

What are the contraindications to SGLT2 inhibitors?

A

Recurrent thrush - because it increases glucose in the urine

25
Q

Which ECG changes are seen in hypocalcaemia?

A

Common: Corrected QT interval prolongation

Rare: Atrial fibrillation or torsade de pointes

26
Q

What electrolyte/pH abnormality is seen in Cushings?

A

hypokalaemic metabolic alkalosis

27
Q

At what HbA1c threshold should you add a second drug for a patient on metformin?

A

only add a second drug if the HbA1c rises to 58 mmol/mol (7.5%)

Medical Finals (11 decks)

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