Endocrine Flashcards
What is the difference pathologically between T1 and T2 diabetes?
T1-absolute lack of insulin due to autoimmune destruction of beta cells in pancreas
T2-decreased insulin secretion +/- increased insulin resistance
Give a definition of diabetes?
Symptoms of hyperglycaemia AND high venous glucose detected once (fasting >7mmol/L or random >11.1mmol/L)
What are the symptoms of T1 diabetes?
Polydipsia
Polyuria
Weight loss
?Ketosis
What are the symptoms of T2 diabetes?
Asymptomatic/complications eg. MI
Suggest 2 tests you could do to confirm T1 diabetes?
Random glucose level
Fasting glucose level
Oral glucose tolerance test
Urine dip for ketones
Give 2 possible drug treatments for T2 diabetes?
Biguanides-metformin
Sulphonylureas-gliclazide
Insulin
Give 3 lifestyle changes for diabetes?
Lose weight Increase exercise Stop smoking Reduce alcohol intake Low fat diet
How can you monitor long term diabetes control? What is it measuring?
HbA1c levels
Glycosylated haemoglobin over approx. 60 days
Name 3 systems that need to be monitored in patients with diabetes?
Eyes
Feet
Kidneys
CVS
What is the ideal BP in T2 diabetics?
140/80
Define hypoglycaemia?
Plasma glucose <3mmol/L
Give 5 symptoms of hypoglycaemia?
Sweating Dizziness Palpitations Confusion Drowsiness Seizures Coma
How do you treat a hypoglycaemic attack?
Oral sugar and long acting starch
If unable to swallow the IV glucose
Give 3 symptoms of DKA?
Vomiting Drowsiness Dehydration Lethargy Ketotic breath
Give 2 triggers of DKA?
Infection Surgery MI Wrong insulin dose/noncompliance Chemotherapy
What are the 3 parameters used to diagnose DKA?
Acidosis
Hyperglycaemia
Ketosis
What makes HONK different from DKA?
Longer history
Marked dehydration, glucose >35mmol/L
Acidosis absent
Name the first 3 steps in management of neuropathic pain?
Paracetamol
Amitrypitilline
Gabapentin
What is the initial management of DKA?
Set up IV access
Aggressive fluids whilst monitoring potassium
Soluble insulin IV
Add potassium when urine output is >30ml/hr
Give 2 triggers of HONK?
Infection
MI
Drugs (steroids, beta blockers)
Give 3 symptoms of HONK?
Malaise
Confusion
Drowsiness
Polydipsia
Name a complication that can develop from HONK?
Thrombosis
Seizures
Focal CNS signs
How do you treat HONK?
Rehydrate with saline over 48hrs
Replace K+ when urine starts flowing
What can precipitate a thyrotoxic storm?
Recent thyroid surgery
Infection
MI
Trauma
If a patient is unconscious from hypoglycaemia, how might you administer treatment and with what?
Glucose gel-Buccal
Dextrose-IV
Glucagon-IM
What is the skin condition caused by insulin resistance?
Acanthosis Nigricans
How is diabetic retinopathy classified?
Background
Preproliferative
Proliferative
Advanced
How can you treat diabetic nephropathy?
ACE i
What is the typical presentation of diabetic neuropathy?
Glove and stocking distribution of tingling and pain. Worse at night.
What is the most common cause of Cushing’s syndrome and name 3 other causes?
Oral steroids
Cushing’s disease- pituitary adenoma
adrenal hyperplasia
Ectopic ACTH production-lung cancer
Adrenal cancer
Give 5 symptoms of Cushing’s syndrome?
Weight gain Mood changes (depression, irritability) Proximal weakness Gonadal dysfunction (irregular menses, hirtutism) Acne Recurrent Achilles' tendon rupture
Name 4 signs seen in Cushing’s syndrome?
Central obesity Moon face Buffalo neck hump Purple striae Bruises Skin & muscle atrophy
Why may random plasma cortisol levels mislead when trying to test for Cushing’s syndrome?
Illness, time of day and stress (being in hospital) can influence the results.
What is the diagnostic test for Cushing’s syndrome?
Dexamethasone suppression test
Give 5 side effects of corticosteroid therapy?
Hyperglycaemia Osteoporosis Cataracts Depression Hypertension Weight gain Amenorrhea
Name 4 symptoms of hyperthyroidism?
Diarrhoea Weight loss Increased appetite Over active Heat intolerance Palpitations Tremor
Suggest 4 symptoms of hypothyroidism?
Tired Lethargic Low mood Cold intolerance Weight gain Constipation Hoarse voice
What value of HbA1c should diabetics be aiming for?
<7%
Name 4 actions of cortisol?
Increase plasma glucose
Immunosuppressive
Slows bone formation
Catabolism
