ENDOCRINE 2

Question 1

type 1 DM is absolute wat 
what 
symptoms 
risk 
ix

Answer 1

absolute insulin deficiency
beta cell failure, anti GADI and anti islet ABs
young, polyuria, polydipsia, decrease weight, lean DKA, no evidence of micro dx
Genetic, FH, young
decrease in C peptide, decrease ketones, GAD/islet ABs

Question 2

treatment of type 1

Answer 2

monster HBA1C 3-6m target 48 mol 6.5%
self monitor on waking 5-7 before meals 4-7
usually BD insulin regime
add metaformin if BMI 25 or over

Question 3

diabetes Type 2 is relative what
characterised by what
symp
risk factors

Answer 3

insulin deficiency
insulin resistant and beta cell dysfunction
middle age, obese, insidious onset, no/little ketonuria, micro cx in 20%
central obesity, FH, gestational DM, age, ethnicity, PMH of MI/stroke, anti psychotics

Question 4

ix and dx of type 2 DM HBA1C
fasting
2h OGTT
random

Answer 4

HBA1x 48 or over

7. 8 or over
8. 1 or over
9. 1 or over

Question 5

pancreatic disease in type 3 DM
endocrine
drug induced
genetic

Answer 5

chronic/recurrent pancreas’s, haemachromatosis, cystic fibrosis
cushings, acromegaly, phaeo, glycoganoma
steroids , diuretics
Cf, turners, myotonic dystrophy

Question 6

diabetes type 4

Answer 6

gestational - glucose intolerance during pregnancy

Question 7

IM insulin factors affecting absorption

Answer 7

temperature
site - lipohypertrophy
injection depth
exercise

Question 8

MODY stands for what 
what is it
in who genetics
risk factor 
ix
treatment

Answer 8

maturity onset DM of young
defective glucose sensing in pancreas and/r loss of insulin secretion
<25 ADom
strong FH
assoc features like renal cysts, GAD neg, C peptide pos
SUs

Question 9

transcription factor mutation v

glucokinase mutation

Answer 9

transcription: young, progressive hyperglcyaemia, 1/3 diet 1/3 OHD 1/3 insulin, cx frequent
glucokinase: onset at birth, stable hyperglycaemia, diet control, rare cx

Question 10

LADA is what 
commonly mis dx as what
symptoms 
ix
rx

Answer 10

late onset T1DM
type 2
slower course of onset, mild, non obese, assoc with other AI disease
auto AB pos
control on oral agents

Question 11

neonatal DM diagnosed within first what
transient
permenant

Answer 11

3m of line
dx <1w old, resolves within 12w
dx 0-6w, lifelong treatment w insulin

Question 12

what is DKA
causes
symptoms
cx adults and kids

Answer 12

absolute/relative insulindefic and increase in counter regulatory hormones
infection, ichaemia, infarction, ignorance
thirst, polyuria, flushed, vom, SOB, and pain
adults: decreased K, aspiration pneumonia, ARD
kids: cerebral oedema

Question 13

dx of DKA

treatment

Answer 13

ketonaemia >3 or significant ketonuria >2 on sip
BG >11 or known DM
bicarb <15 or venous ph<7.3
increase in amylase, increase WCC, decrease Na, increase lactate, increase Cr

fluids, potassium, insulin 0.1 unit/kg/h when BG 15 switch to infusion of 5% dextrose. can also give phos/bicarb

Question 14

lactic acidosis lactate originates where 
normal range 
symptoms 
ix
rx

Answer 14

RBC, skeletal muscle, brain and renal medullar
0.6-1.2
hyperventillatio, mental confusion, stridor, coma
decrease in bicarb, increased anion gap (normal 10-18), increase glucose and phosphate
fluids, ABs, underlying

Question 15

type a lactic acidosis

type b lactic acidosis

Answer 15

tissue hyperaemia, infarcted tissue, cariogenic shock, hypovalaemic acid

liver disease, leukaemia states, assoc with DM, metaformin

Question 16

HHS in who 
DM often what 
symp/signs and ix
treatment 
higher what compared to DKA

Answer 16

Type 2 DM, elderly

often known

glucose >30, renal impairment, increased sodium, dehydration, ph>7.3, bicarb >15, increased osmolarity >320

slowly fluids - risk of overload. slowly insulin or none. Na avoid rapid fluctuations, screen for vascular events and LMHW for all

high mortality

Question 17

IV insulin in who
monitering
free of what
daily what

Answer 17

DKA, HHS, acute insulin
hourly BG monitoring keep 5-12, check ketones if >12
free of hypo
daily U&Es

Question 18

types of neuropathy

Answer 18

peripheral
autonomic - bowe, bladder, erectile
proximal - thighs, buttocks, hips
focal - one nerve or group of nerves

Question 19

symptoms of neuropathy

risk factors for neuropathy

Answer 19

numbness tingling. foot ulcers. wasting of muscle. indigestion. N/V. dizzy. urine issues. htn. erectile dysfunction, vaginal dryness

long period of DM, poor glycemic control, type 2>type 1, increased cholesterol, smoking, alcohol

Question 20

peripheral nerve neuropathy complications

rx

Answer 20

infections/ulcers, deformities, amputations

analgesia, gabapentin/pregablinc, TCAs, opiodes

Question 21

autonomic neuropathy symptoms
ix
treatment for gatroperesis

Answer 21

gastric slowing, constipation and diarrhoea, gastropereiss, dysphagia, decreased weight, increased sweat, hypoglycaemic unawareness, hypotension, HR stays high

USS of bladder and urinary tract. gastric emptying studies

metoclorpirimide, domperidone, erythromycin

Question 22

nephropathy risk factors 
microalbuminaemia dx
proteinuria dx
treatment for proteinuria 
why should it be repeated 2/3 times

Answer 22

htn, cholesterol, smoking, glycemic control, albuminuria
ACR<30 PCR <50
ACR<30 PCR>50
ACE/ARB
varies night.day, exercise, protein/water load. false pos: preg, period, UTI, vaginla dc

Question 23

retinopathy mild NP
mod NP
severe NP
proliferation
complicaition 
ix
rx

Answer 23

haem and microaneurysms
H, MA and hard exudates
H, IRMA, venous beading 
new vessel formation 
secondary glaucoma - retinal detachment 
optic clearance tomography 
laser, vitrectomy, anti VEGF

Question 24

erectile dysfunction in how many DM age

RF

Answer 24

50% DM 55%>60
CRF, hepatic failure, MS, depression, spinal cord injuries, pelvic irradtiaon/ surgery, smoking, drugs, alcohol, bicycle riding

Question 25

treatment of erectile dysfunction

CI to drug

Answer 25

improve glycamic control, decrease alcohol, withdraw causative drugs, viagra levita 4-5h cialus 24-48h

nitrates/nicorandil, recent stroke/MI within 3m, hypotension, severe hepatic failure