endo important

Question 1

insulin actions

Answer 1

fasting state- regulates glucose release by the liver

postprandial state- promotes glucose uptake by fat and muscle

Question 2

hormones which act in opposition to insulin (are counterregulatory)

Answer 2

glucagon, adrenaline, GH and cortisol- they all increase glucose production by the liver and reduce its utilisation in fat and muscle for a given level of insulin

Question 3

cells which produce insulin

Answer 3

beta cells in the pancreatic islets

Question 4

cells which produce glucagon

Answer 4

alpha cells

Question 5

sign of severe insulin resistance

Answer 5

acanthosis nigricans- blackish pigmentation at the nape of the neck and in the axillae

Question 6

diagnostic criteria for diabetes mellitus

Answer 6

1- random blood glucose measurement >11mmol/L
2- fasting plasma glucose>7mmol/L
3- HbA1c>48mmol/L (6.5%)
4- OGTT: fasting>7mmol/L, 2 hours after glucose >11mmol/L

Question 7

Type 2 DM management- someone who can tolerate metformin

Answer 7

1 - upon diagnosis, if lifestyle measures still do not get HbA1c <48mmol/L then ofer metformin

2- if HbA1c >58mmol/L then add second drug- sulfonylurea/glitpin/pioglitazone/SGLT-2 inhibitor

3- If HbA1c still rises to or remains above 58mmol/L, then triple therapy should be offered metformin +: 
- glitpin & sulfonylurea
- pioglitazone & sulfonylurea 
- sulfonylurea & SGLT-2 inhibitor
- pioglitazone & SGLT-2 inhibitor 
OR insulin therapy

Question 8

Type 2 DM management- someone who cant tolerate metformin

Answer 8

1- upon diagnosis if lifestyle measures do not get HbA1c <48mmol/L, consider a sulfonylurea/glitpin/pioglitazone

2- if the HbA1c rises to above 58mmol/L, then one of the following combinations should be used:

• gliptin + pioglitazone
• gliptin + sulfonylurea
• pioglitazone + sulfonylurea

3- If HbA1c rises to/remains above 58mmol/L then consider insulin therapy

Question 9

Hypertension management in T2DM

Answer 9

• ACE inhibitors are first line
  Same targets as patients without T2DM (140/90 in clinic, 135/85 at home)
• Patients with a 10 year cardiovascular risk >10% should be offered a statin (first line atorvastatin)

Question 10

T1DM management

Answer 10

• target HbA1c<48mmol/L. HbA1c should be monitored every 3-6 months
• blood glucose should be self-monitored at least 4 times a day, including before each meal and before bed
• blood glucose targets 5-7mmol/l on waking and 4-7mmol/l before meals and at other times of day
• treatment of choice= mixed basal-bolus insulin regimen. Twice daily insulin detemir, and offer rapid-acting insulin analogues injjected before meals
• consider adding metformin if BMI>25

Question 11

hormones produced in the anterior pituitary

Answer 11

• GH
• ACTH
• Prolactin
• thyroid stimulating hormone
• LH
• FSH

Question 12

treatment hypercalcaemia

Answer 12

• Bisphosphonates- prevent bones releasing calcium
• calcimimetic agents e.g. cinacelcet reduce production of PTH
• calcitonin IV/subcut- given to control very high levels of calcium

Question 13

• adrenal cortex hormones

- adrenal medulla hormones

Answer 13

• cortex: glucorticoids, mineralcorticoids (aldosterone), sex hormones (androgens)
• medulla: adrenaline (increases heart rate and converts glucose to liver), noradrenaline (vasoconstriction, increases blood pressure)

Question 14

Phaechromocytoma

symptoms

Answer 14

PHEochromocytoma;
Palpitations
Headache
Episodic sweating

Question 15

posterior pituitary hormones

Answer 15

vasopressin and oxytocin

Question 16

Grave’s treatment

Answer 16

• Propanolol to block adrenergic effects
• carbimazole to manage normal thyroid function
• Thyroxine is added when patient is euthyroid

Question 17

major complication of carbimazole therapy

Answer 17

agranulocytosis- low level of white cells, most commonly neutrophils

Question 18

Hashimoto’s thyroiditis

Answer 18

• Antibodies against thyroid peroxidase (TPO) and/or thyroglobulin
• Type IV hypersensitivity reaction

Question 19

medication which can Cushing’s

Answer 19

Steroids

Question 20

tests most commonly used to diagnose cushing’s

Answer 20

overnight dexamethasone

24h urinary free cortisol

Question 21

diagnostic test for acromegaly

Answer 21

serum IGF-1

Question 22

symptoms of Conns ( hyperaldosteronism)

Answer 22

general hyperaldosteronism:
Headaches + facial flushing (high BP)
- Constipation, weakness + heart rhythm changes (due to hypokalemia)
Consider Primary hyperaldosteronism if hypertension, hypokalaemia or
alkalosis in someone not on diuretics

Question 23

treatment for hyperaldosteronism

Answer 23

• spironolactone

- treatment of underlying cause: if conns/carcinoma remove the adrenal tumour, treat heart failure/cirrhosis

Question 24

test for adrenal insufficiency

Answer 24

ACTH (synacthen) test: give synthetic ACTH and measure cortisol and aldosterone produced:

• if cortisol is low and plasma ACTH is high, then is primary adrenal insufficiency
• If cortisol and plasma ACTH are both low, then is secondary/tertiary adrenal insufficiency

Question 25

hypocalcaemia signs/symptoms:

Answer 25

• Chvostek’s sign- tap facial nerve in front of mastoid bone to trigger facial twitching on one side of the mouth, nose and cheek
• Trosseau’s sign: keep bp cuff elevated above patient’s systolic for 1-4 mins. positive sign if hands and fingers go into spasm in palmar flexion
• anxious/irritable/irrational
• Muscle spasms
• Tetany
• QT PROLONGATION ON ECG

Question 26

hyperkalaemia ECG

Answer 26

• tall, tented T waves
• wide QRS
• depressed ST segment
• prolonged PR

Question 27

Addisons disease mnemonic

Answer 27

tanned, tired, tearful, thin, throwing up