Endocraniology

Question 1

DKA

insulin and glucose when to add

Answer 1

glucose < 12 replace N/S with 5% dextrose and

if glucose < 8 replace N/S with 10% dextrose.

Question 2

HBA1C target

Answer 2

The target HbA1c of one drug is <48. If HbA1c> 58, start two drugs. The aim of 2 drugs is HbA1c< 53, with no hypoglycaemic attacks. If there were attacks, stop the second drug.

Question 3

Cushing syndrome and test
Screening
Acth dependent or independent
Pituitary or Ectopic cause

Answer 3

Cushing’s Syndrome
Step 1) SCREENING: 24h urine free cortisol

Step2) CONFIRMATION: Overnight (low dose 1mg) Dexa Suppression —> suppressed is normal but if fails its confirmed Cushing- go to step 3)

Step 3) ACTH level (low is adrenal tumor or if high go to step 4)

Step 4) High dose DEXA suppression (if suppressed is pituitary adenoma, if not suppressed is ectopic)

Question 4

Addison crisis 5s

Answer 4

Five S’s of adrenal crisis:
S - support (IV 0.9% NS) S -
steroid (IV 100mg Hydrocortisone)
S - sugar (5% glucose IV)

S - salt (fludrocortisone - can give in delay)
S - search for the causative event

Question 5

Diabetic drugs and contraindications

Answer 5

Drugs causing weight gain: SPR (Sulphonylurea, Pioglitazone, Repaglinide)

Drugs safe in renal failure: PRL (Pioglitazone, Repaglinide, Linagliptin)

Drugs CI in heart failure: GP (Gliptins and Pioglitazone)

Drugs CI in renal failure: BSS (Biguanide, Sulphonylurea, SGLT2 inhibitors)

Cancers: Bladder = Pioglitazone Breast = GLP-1 agonist

Question 6

Blood glucose values

Answer 6

7/11 is open for 48 hours. fasting 7 . random 11. hba1c 48

Normal:
FBG- <6.1
2hrPP- <7.8
HBA1C- <42mmol

Prediabetic:
FBG–. 6.1-6.9(impaired fasting glucose) If
FBG- <7 and 2hrPP- 7.8-11.1 (impaired glucose tolerence)
HbA1C- 42-47mmol (6-6.5%)

DIABETIC :
FBG- >=7
2hrPP- >=11.1
HbA1C- >48mmol (>6.5%)

Question 7

Pain and Proximal muscle weakness

Answer 7

Polymyositis elevates creatine kinase with weakness PMR elevated ESR with normal Creatine kinase but more of stiffness of proximal muscles and joints.

Osteomalacia elevated ALP with low Calcium and phosphate

Paget’s disease elevated ALP only, normal calcium and phosphate

Osteoporosis usually normal ALP, calcium and phosphate

Multiple Myeloma elevated Calcium and normal ALP

Question 8

Hard painless neck nodule which moves with deglutition
Initial investigation
FNAC

Answer 8

Any lump/mass more than 1 cm(either thyroid or mandibular)–>go for FNAC .

For thyroid initial is USG to differentiate b/w solid and cystic lesions.

For PLAB:

Punch biopsy: Paget’s disease of breast.

Excisional biopsy of a lymph node : Hodgkin’s lymphoma,

Core biopsy: Breast Ca(usually in strong suspicion of malignancy as it takes sample of bunch of tissues as compared to FNAC).

Others (as stated above): FNAC

Question 9

Txment for Hyper kalaemia

Answer 9

Treatment of hyperkalemia in chronological order

1. Stop any ACEi like Ramipril or spironolactone (if already taking)
2. Calcium gluconate (ECG changes)
3. Insulin+dextrose (glucose) for reabsorption of K into cells
4. Calcium resonium
5. Loop diuretics
6. DialYsis Mnemonics

SCI-CLY Hope this helps!

Question 10

MODY Age < 25
Polyuria Polydipsia and weight loss
with 2 family members of DM

REFER TO SECONDARY

Answer 10

DM1- Autoimmune, early onset

MODY- Non-autoimmune,
FHx, <25yrs LADA- Autoimmune, slower than type 1,

Shares Sx of DM1 n 2,
Rare, 30-40 years
DM2- Late onst, 40-60 years,
non autoimmune

Question 11

Addison disease

Answer 11

Addisonian Clincher = Hyponatremia + Hyperkalemia.

Question 12

Anti glycemic agents Contraindications

Answer 12

Remember: with bad kidneys, do not use MS (Metformin, Sulphonylureas) •

Also, Heart has 4 chambers, so with HF (and pancreatitis), do not use DDP4 inhibitors (gliptins) •

Also, the Pie (pioglitazone) comes with the die (Risk of bladder cancer and HF) •

Hypoglycemics that cause weight gain are SPR (Sulphonylureas, Pioglitazone, Repaglinide).

The rest cause wt loss except DDP4 inhibitors Which have no effect.

• SPR without the P have risk of hypoglycemia: Sulphonylureas and Repaglinide.