Endo- diabetes

Question 1

what is type 1 diabetes

Answer 1

autoimmune destruction of pancreatic beta cells resulting in beta cell deficiency and therefore absolute insulin deficiency

Question 2

type 1A diabetes is immune mediated/non-immune mediated

Answer 2

immune mediated

Question 3

type 1B diabetes is immune mediated/non-immune mediated

Answer 3

non-immune mediated

Question 4

type 1B diabetes common nationalities

Answer 4

African/asian

Question 5

peak age group for type 1 diabetes

Answer 5

10-14 years

Question 6

HLA genotypes of type 1 diabetes

Answer 6

DR3-DQ2 and DR4-DQ8

Question 7

type 1 diabetes environmental risk factors

Answer 7

maternal factors (gestational infection, older age)
viral infection eg coxsackie virus b
exposure to dietary constituents such as early introduction to cows milk and vitamin d deficiency
environmental toxins
childhood obesity
psychological stress

Question 8

insulin deficiency symptoms

Answer 8

polyuria
polydipsia
weight loss

Question 9

fasting glucose in diabetes

Answer 9

> /= 7mmol/l

Question 10

random glucose in diabetes

Answer 10

> /= 11.1mmol/l

Question 11

basal

Answer 11

long acting once daily

Question 12

bolus

Answer 12

short acting with meals

Question 13

what is type 2 diabetes

Answer 13

combination of insulin resistance and less severe insulin deficiency

Question 14

main risk factor for type 2 diabetes

Answer 14

obesity

Question 15

first line treatment in type 2 diabetes

Answer 15

metformin and lifestyle management

Question 16

what is MODY

Answer 16

early onset (<25) on non-insulin dependent diabetes

Question 17

MODY is monogenetic true/false

Answer 17

true

Question 18

glucokinase mutations in MODY clinical features

Answer 18

onset at birth
stable hyperglycaemia

Question 19

transcription factor mutations in MODY clinical features

Answer 19

adolescence/YA
progressive hyperglycaemia

Question 20

oral glucose tolerance test for MODY results

Answer 20

glucokinase mutation respond well
transcription factor do not respond well

Question 21

management for glucokinase mutation MODY

Answer 21

diet alone

Question 22

management for transcription factor mutation MODY

Answer 22

diet and treatment with insulin/sulphonylureas

Question 23

is neonatal diabetes monogenetic

Answer 23

yes

Question 24

T1 and T2DM complications during pregnancy

Answer 24

congenital malformation
prematurity
IUGR

Question 25

gestational diabetes complications during pregnancy

Answer 25

intra uterine death macrosomia (big baby) polyhydromnios

Question 26

diabetes complications in neonates

Answer 26

respiratory distress (immature lungs) hypoglycaemia/hypocalcaemia- fits skeletal abnormalities CNS defects- spina bifida eg genital and GI abnormalities seizures

Question 27

diabetes in pregnancy medication

Answer 27

folic acid 5mg at least 3months prior to conception start aspirin 150mg at 12 weeks

Question 28

DIDMOAD/wolfram syndrome

Answer 28

genetic condition characterised by- diabetes insipidus childhood onset diabetes mellitus gradual loss of vision- optic atrophy deafness

Question 29

diabetic nephropathy- if ACR<30 or PCR<50=

Answer 29

microalbuminuria

Question 30

diabetic nephropathy- if ACR>30 or PCR>50=

Answer 30

proteinuria

Question 31

microalbuminuria treatment

Answer 31

ACEi/ARB SGLT2i

Question 32

diabetic neuropathy risk factors

Answer 32

> length diabetes poor glycemic control more common in T1DM smoking alcohol genetics mechanical injury

Question 33

symptoms of diabetic peripheral neuropathy

Answer 33

pain/loss of feeling in feet/hands 'glove and stocking' distribution distal symmetrical numbness/tingling

Question 34

management of painful neuropathy

Answer 34

amitriptyline, duloxetine, gabapentin, or pregabalin

Question 35

which cell mediates the autoimmune destruction of beta cells in T1DM

Answer 35

T cells

Question 36

if both patients have HLA alleles for T1DM, risk of offspring developing diabetes is _%?

Answer 36

30%

Question 37

what is more strongly genetic, type 1 or type 2 diabetes

Answer 37

type 2 diabetes

Question 38

non-modifiable risk factors of T2DM

Answer 38

age- increasing age genetics ethnicity- south asian, African, afro-carribean

Question 39

modifiable risk factors of T2DM

Answer 39

obesity diet- fats, red and processed meat, sugary drinks, white rice, fried food physical inactivity and sedentary behaviour

Question 40

what is acanthosis nigricans

Answer 40

sign seen in T2DM- insulin-driven epithelial overgrowth seen in hyperinsulinaemic states dry dark patches on skin usually appear on neck, armpits, groin

Question 41

what is the most common form of monogenetic diabetes

Answer 41

MODY

Question 42

what is more common, glucokinase MODY or transcription factor MODY

Answer 42

transcription factor MODY (75%)

Question 43

neonatal diabetes caused by mutation in which mechanism

Answer 43

glucose sensing mechanism eg atp sensitive k channel

Question 44

neonatal diabetes diagnosed under how old

Answer 44

<6 months

Question 45

associated conditions of diabetes

Answer 45

cystic fibrosis DIDMOAD barget-biedl syndrome

Question 46

autoimmune conditions associated with T1DM

Answer 46

thyroid disease coeliac disease pernicious anaemia Addisons disease IgA deficiency

Question 47

how do pregnant woman develop gestational diabetes

Answer 47

if mother is insulin resistant before pregnancy, developing further insulin resistance during pregnancy will raise blood glucose too high and result in gestational diabetes

Question 48

normal fasting glucose in pregnant women

Answer 48

<5.4mmol/l

Question 49

first line management for pregnant women with fasting glucose >5.6mmol/l but <7mmol/l

Answer 49

2 week trial diet and exercise

Question 50

what is diabetic nephropathy

Answer 50

progressive kidney disease caused by damage to the capillaries in the glomeruli

Question 51

what is diabetic nephropathy characterised by

Answer 51

proteinuria diffuse scarring of glomeruli

Question 52

what is diabetic neuropathy

Answer 52

damage to the peripheral nervous tissue

Question 53

clinical features of Charcot foot (complication of peripheral neuropathy)

Answer 53

acute onset of hot, swollen foot +/- pain, bony destruction

Question 54

which organism is commonly found in diabetic foot ulcers

Answer 54

pseudomonas aeruginosa

Question 55

at diagnosis of T2DM, what % weight loss can result in remission

Answer 55

10-15% weight loss can result in remission, at diagnosis

Question 56

a target of what HbA1c is reasonable in T2DM to reduce micro and macro vascular complications

Answer 56

7% (53mmol/l)

Question 57

in asymptomatic patients, how is T2DM diagnosed

Answer 57

should never be based on a single abnormal HbA1c or fasting plasma glucose level; at least one addition abnormal HbA1c/plasma glucose level needed

Question 58

what is the blood glucose target in T2DM 2 hours after meals

Answer 58

<8.5mmol/l

Question 59

blood glucose targets in pregnant women with diabetes

Answer 59

fasting- <5.4mmol/l 1 hr after meals- <7.8mmol/l 2 hrs after meals- <6.4mmol/l