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1 General Practice > Endocrine > Flashcards

Endocrine Flashcards

1
Q

List two aspects of management for foot ulcers in diabetes

A

dressing
control of infection and ischaemia
offloading
wound debridement

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2
Q

List two investigations for diabetic foot infections

A

soft tissue sample or deep swab sample
XRay
MRI if concern for osteomyelitis
Do not offer antibiotics to prevent foot ulcers in those WITHOUT symptoms

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3
Q

Which antibiotic for ‘mild’ diabetic foot infection?

A

flucloxacillin
clari or erythromcin
doxy
7 day course

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4
Q

Treatment of moderate/severe foot infection?

A

managed in hospital
IV antibiotics initially
fluclox +/- gent
co-amoxiclav

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5
Q

Name the rare complication that can arise in diabetics with peripheral neuropathy?

A

Charcot’s arthropathy/neuropathy

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6
Q

What is Charcot’s arthropathy?

A

The bones in the foot can become weak and lead to dislocations, fractures and changes in the shape of the foot or ankle. Charcot arthropathy may develop if you have diabetes and you fracture your foot or ankle. If it is not treated quickly, ulcers or other sores can develop. Symptoms of Charcot arthropathy include the foot feeling hot and painful, and looking swollen or red.

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7
Q

List the three types of diabetic neuropathy

A

sensory
motor
autonomic

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8
Q

When might glyacaemic targets be relaxed in patient with T2D?

A

Frail
Limited life expectancy
Multiple comorbidities
risk from polypharmacy

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9
Q

What is the HbA1c target for lifestyle alone or a singular drug that doesn’t cause hypos?

A

48mmol/mol or 6.5%

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10
Q

Name two hypo-inducing antiglycaemic drugs

A

sulphonylureas
insulin

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11
Q

What is the HbA1c target for someone who is on a hypo drug or more than one drug?

A

53 mmol/mol or
7%

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12
Q

What is the first line drug treatment for T2D?

A

metformin
or metformin + gliflozin if CVD risk

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13
Q

Patient on metformin. They are obese. Which drug can you add to regime?

A

GLP1s
gliflozin

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14
Q

Patient on metformin. They have renal impairment. Which drugs can you add?

A

insulins
pioglitazone
linagliptin

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15
Q

Patient on metformin and has CVD risk factors. Which drug should you add?

A

gliflozin

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16
Q

Which drugs should diabetic patients who are at higher risk of hypos should avoid?

A

insulins and sulfonylureas

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17
Q

What is the MOA of gliflozin?

A

SGLT2 inhibitor

18
Q

Which is the most effective drug at lowering HbA1C?

A

gliclazide BUT risk of hypos and weight gain

19
Q

GLP-1s are reserved for which category of patients?

A

obese

20
Q

Why can metformin not be used in patients with eGFR<30?

A

excreted by kidneys

21
Q

What is the optimal blood pressure in someone over 80?

A

<150/90
compared to <140/90 in under 80’s. Only change to SBP

22
Q

Aside from symptoms of hypothyroidism, name two other conditions that would warrant testing?

A

new onset AF
T1D
Autoimmune disorder
Depression
Unexplained anxiety

23
Q

Name four systems that are affected in hyperthyroidism

A

CDV- palpitations, tachy, AF
Nervous system- anxiety, fatigue, hyperreflexia
Hair- thinning, loss
Thyroid- goitre
Eyes- sorness, eyelid retraction, lid lag
GI- weight loss, diarrhoea, increased appetite
Reproductive system- change in periods, reduced libido
Bones- osteoporosis

24
Q

List three common causes of thyrotoxicosis

A

grave’s disease
multinodular goitre
thyroiditis (e.g. viral)
drug induced
excess exogenous thyroid hormone

25
Q

Name a drug that can cause thyrotoxicosis

A

amiodarone
lithium

26
Q

Can hyperthyroidism be managed in primary care?

A

no, refer to secondary care, unless it is a transient thyrotoxicosis
without hyperthyroidism

hypothyroidism can be managed in primary care

27
Q

Name two antithyroid drugs

A

carbimazole first line
polythiouracil

28
Q

Name two baseline tests required before carbmizaole admin

A

LFTs and FBC

29
Q

What is the most serious side effect of carbimazole and explains why to do FBC

A

bone marrow suppression- neutropenia and agranulocytosis

+ liver dysfunction

30
Q

Other than antithyroid drugs, list two other options for the management of hyperthyroidism in secondary care

A

radioactive iodine
surgery

31
Q

What is the first line, definitive treatment for someone with Grave’s disease

A

radioactive iodine

32
Q

List two contraindications to radioactive iodine treatment

A

compression
malignancy
active thyroid disease
pregnant or planning to be in the next year

33
Q

List one drug to treat obesity

A

orlistat- can be prescribed in primary care
liraglutide= GLP-1 analogue

34
Q

What is the MOA of orlistat?

A

inhibits pancreatic lipases, 30% of ingested triglycerides being excreted in faeces

35
Q

Does orlistat impact on appetite and satiety?

A

no!

36
Q

Which groups are more at risk of obesity and therefore cardiometabolic health consequences?

A

south Asian
Chinese
Arab

37
Q

List three physical conditions that can result in fatigue

A

hypothyroidism
anaemia
addison’s disease
CKD
Liver failure
Coeliac disease
Sleep apnoea
Malignancy

38
Q

List three red flags that can present with fatigue

A

weight loss
lymphadenopathy
Bleeding- hamoptysis, rectal bleeding, postmenopausal bleeding
Sleep apnoea
Cardiorespiratory disease signs

39
Q

Differentials diagnosis for chronic fatigue?

A

depression
obesity
obstructive sleep apnoea
chronic fatigue syndrome
drugs- sedative
physical illness

40
Q

List three investigations for fatigue

A

FBC- anaemia
U+E
Random/fasting blood glucose
LFTs- alcohol misues

Consider:
TFTs
CRP, ESR- e.g. glandular fever
Vit D
Ferritin
Bone profile
IgA TTG- coeliac disease
HIV
Hepatitits
TB

1 General Practice (15 decks)

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