Endo - useful passmed facts

Question 1

Which T2DM drug increases insulin sensitivity?

Answer 1

Pioglitazone

Question 2

Side effects of Thiazolidinediones (like pioglitazone)

Answer 2

Adverse effects:

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 (hazard ratio 2.64)

Question 3

Diabetes drugs with side effects of weight gain

Answer 3

Thiazolidinediones (Pioglitazone) causes weight gain

Sulphonylureas

Insulin

Question 4

What drug is weight neutral?

Answer 4

DPP-4 inhibitors are weight neutral

Examples - sitagliptin, Vildagliptin

Question 5

What T2DM causes weight loss?

Answer 5

Patients taking SGLT-2 (sodium-glucose transport protein 2) drugs often lose weight, which can be beneficial in type 2 diabetes mellitus

Example - Dapagliflozin

SGLT2 inhibitors prevent the resorption of glucose from the proximal renal tubule, resulting in more glucose being secreted in the urine

Question 6

Key info about thyroid cancers

Answer 6

Most to least common: Paul’s (Hollywood) Focaccia Most Awarded Loaf
Papillary > Follicular > Medullary > Anaplastic > Lymphoma

Papillary: good prognosis, young women, cervical lymphadenopathy

Medullary: Associated with MEN type II

Anaplastic: very bad prognosis

Question 7

Calcitriol, also known as?

Answer 7

Calcitriol, also known as 1,25-dihydroxycholecalciferol is the active form of vitamin D

Calcitriol results in an increased uptake of calcium from the intestines and therefore increases serum calcium level. As such it is used in the management of conditions resulting in hypocalcaemia including hypoparathyroidism and osteomalacia.

Question 8

What is sick euthyroid syndrome?

Answer 8

In sick euthyroid syndrome (now referred to as non-thyroidal illness) it is often said that everything (TSH, thyroxine and T3) is low. In the majority of cases however the TSH level is within the >normal range (inappropriately normal given the low thyroxine and T3).

Question 9

T2DM blood glucose ranges

Answer 9

Question 10

Cortisol effect on glucose

Answer 10

Cortisol acts on the liver, muscle, adipose tissue, and pancreas

In the liver, high cortisol levels increase gluconeogenesis and decrease glycogen synthesis

Question 11

Diabetes Insipidus clinical features and effect on sodium

Answer 11

Polyuria

Polydipsia

HYPERnatraemia

Postural HTN

Nocturia

Question 12

Mechanism of how the T2DM drugs work

Answer 12

Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1 increTIN = glipTIN (sitagliptin)

Metformin increases peripheral insulin sensitivity and reduces hepatic gluconeogenesis

Sulfonylureas augment pancreatic insulin secretion, Increased insulin secretion can lead to hypoglycaemia

GLP mimetics, e.g. exenatide, augment pancreatic insulin secretion, suppress glucagon release, slow gastric emptying and promote satiety

Question 13

Klinefelter’s and Kallman’s FSH/LH levels

Answer 13

FSH/LH Climb in Klinefelter’s

FSH/LH Fall in Kallman’s

Question 14

What blood picture do you get with Cushing’s Syndrome?

Answer 14

A hypokalaemic metabolic alkalosis

Cushing’s syndrome causes hypokalaemic metabolic alkalosis because when the levels of cortisol are high, the cortisol that is not inactivated by 11β-hydroxysteroid dehydrogenase is free to bind to mineralocorticoid receptors. This causes an increase in water and sodium retention, increased potassium excretion, and increased hydrogen ions excretion, (like what aldosterone does) Lower levels of hydrogen ions cause alkalosis and less potassium causes hypokalemia

Question 15

Which drug can you give in Phaeochromocytoma that blocks both alpha and beta receptors?

Answer 15

Labetalol blocks both alpha and beta receptors

lABetalol

Question 16

How does myoxedema coma commonly present?

Answer 16

Myxoedema coma typically presents with confusion and hypothermia

treatment with:

• IV thyroid replacement
• IV fluid
• IV corticosteroids

Question 17

Method to help remember multiple endocrine neoplasia?

Answer 17

MEN 1 - 3Ps
MEN 2a - 2Ps 1M - PTH, phaeo, Medullary Ca
MEN 2b - 1P 2M - Phaeo, Marfan, Medullary

1 pancreas, 1 pituitary = MEN-1
2 adrenals :. phaeochromocytoma = MEN-2

Question 18

Causes of hypoglycaemia can be remembered by the mnemonic EXPLAIN

Answer 18

• Exogenous drugs (typically sulfonylureas or insulin)
• Pituitary insufficiency
• Liver failure
• Addison’s disease
• Islet cell tumours (insulinomas)
• Non-pancreatic neoplasms

Question 19

hyperosmolar hyperglycaemic state (HHS) is characterised by:

Answer 19

hyperosmolar hyperglycaemic state (HHS). HHS is characterised by:

• 1.) Severe hyperglycaemia
• 2.) Dehydration and renal failure
  
  • 3.) Mild/absent ketonuria
• 1. Hypovolaemia
• 2. Marked Hyperglycaemia (>30 mmol/L) without significant ketonaemia or acidosis
• 3. Significantly raised serum osmolarity (> 320 mosmol/kg)
• Note: A precise definition of HHS does not exist, however the above 3 criteria are helpful in distinguishing between HHS and DKA. It is also important to remember that a mixed HHS / DKA picture can occur

Question 20

Phaeochromocytoma triad

Answer 20

Phaeochromocytoma typically presents with a triad of sweating, headaches, and palpitations in association with severe hypertension

Question 21

Sick euthyroid syndrome T3, T4 and TSH levels

Answer 21

Sick euthyroid syndrome = low T3/T4 and normal TSH with acute illness

Question 22

Causes of a normal anion gap metabolic acidosis are ABCD:

Answer 22

• Addison’s
• Bicarb loss
• Chloride
• Drugs

Question 23

Pack years and smoking

Answer 23

1 pack year is defined as 20 cigarettes per day for 1 year,

Example: patient has smoked for 25 years, 40 cigarettes per day for 1 year is equivalent to 2 pack years, 2 pack years x 25 years = 50 pack years

Question 24

HbA1c levels patients should aim for in T2DM?

Answer 24

Aim for Lifestyle/Metformin monotherapy < 48
Aim for multitherapy/hypoglycaemia drug < 53

Question 25

What drugs are oto