Endocrine Flashcards
Which diabetic medication should be avoided if cardiac impairment?
Pioglitazone is contraindicated as it causes fluid retention
Chvostek and Trousseau signs indicate what?
Hypocalcaemia
Chvostek = tap facial nerve and facial muscles contract
Trousseau = BP cuff will cause contract of muscles in hand & wrist
What is the first management step in diabetic ketoacidosis?
Bolus with 0.9% NaCl over 1hr to fluid replete even before starting insulin sliding scale
What rate should an insulin infusion be started at for DKA?
0.1 unit/kg/hr
What is the antidote for overdose of benzodiazepines?
Flumazenil (however only use if severe due to risk of seizures)
Which diabetic medication has a side effect of weight loss?
Exenatide (GLP1 agonist)
3rd line treatment and if BMI >35
How does C peptide level differentiate between T1DM & T2DM?
T1: low or undetectable C peptide levels
T2: elevated levels
What is subacute (De Quervain’s) thyroiditis?
Hypothyroidism typically following viral infection
Self limiting
Classical presents with a tender goitre
What values of HbA1c / fasting glucose / random glucose can be used to diagnose diabetes?
HbA1c 48mmol or above
Fasting glucose 7mmol or above
Random (or 75g OGTT) glucose 11.1mmol or above
If asymptomatic needs to be demonstrated on 2 separate readings
Which electrolyte abnormalities are associated with Addison’s disease?
HypoNa
HyperK
Hypoglycaemia
(Can have metabolic acidosis)
Which investigation is used to diagnose Addison’s disease?
Short synacthen test
(Measures cortisol after synthetic ACTH is given)
For a patient with T2DM on metformin, which HbA1c reading would indicate a 2nd drug needs adding?
58mmol/mol (7.5%)
Unless CVD/ high risk of CVD then already add SGLT2 inhibitor eg empaglifozin
If a patient with Cushing’s syndrome had an overnight dexamethasone suppression test, what would the result show?
Cushing’s syndrome: High cortisol (not responded to dexamethasone suppression), low ACTH (doesn’t act on the adrenals)
What is the difference between Cushing’s syndrome and Cushing’s disease?
Syndrome: high levels of cortisol in the blood (eg exogenous glucocorticoid, adrenal adenoma, tumours)
Disease: Adenoma of anterior pituitary causing excess ACTH hence excess cortisol
What is Conns syndrome?
Excess aldosterone secretion from the adrenals which suppresses renin activity causing HTN and hypoK
Most common cause of secondary hypertension
What is the HbA1c target for diabetics patients?
48mmol
Or if one more than one antidiabetic med/ one that has risk of hypo’s then 53mmol target
What are some side effects of sulphonylureas?
Eg gliclazide
Hypoglycaemia
Weight gain
GI side effects
Allergic skin reaction
Subacute thyroiditis presents with a tender goitre and what affect on thyroid function?
Hypothyroidism
What is the calculation for osmolarity?
2Na + urea + glucose
What are some adverse effects of pioglitazone?
Weight gain
Fluid retention (CI in HF)
Increased risk of bladder Ca
Liver impairment (monitor LFTs)
What is the treatment of hyperaldosteronism due to adrenal hyperplasia?
Spironolactone (aldosterone antagonist)
Whereas adrenal adenoma would require surgical treatment
How are the thyroid hormones affected in sick euthyroid syndrome?
All low
Normal T4 but a high TSH level is indicative of what?
Sub clinical hypothyroidism
How is the serum copper level affected in Wilson’s disease?
Serum copper and reduced caeruloplasmin (which carries copper)
Increased deposition within body tissues
