Endocrine

Question 1

T1D - HbA1c

Answer 1

monitor every 6 months - 48mol/mol target

Question 2

T1D - glucose monitoring

Answer 2

4 times a day - before each meal and before bed

more if ill, sport. pregnant, breast feeding, hypos

Question 3

T1D - blood glucose targets

Answer 3

Waking - 5-7

Before meals - 4-7

Question 4

T1D - Insulin regimen

Answer 4

Basal bolus

2x daily levemir plus rapid acting before meals

metformin if BMI >25

Question 5

T2D

Answer 5

1. lifestyle –> metformin
2. sulphonylurea (gliclazide)
   gliptin

Question 6

T2D HbA1c

Answer 6

48mmol, but only add other drugs if 58mmol (target 53)

Question 7

action of gliclazide

Answer 7

inc insulin secretion

Question 8

action of gliptin

Answer 8

DDP4 inhib - inc incretin release - inc insulin, reduce glucagon

Question 9

thyrotoxicosis

Answer 9

propranolol and carbimazole

radioiodine

Question 10

action and side effect of carbimazole

Answer 10

blocks TPO, agranulocytosis

Question 11

Hypothyroid

Answer 11

Levothyroxine - monitor tfts 8-12 eks later

Question 12

levothyroxine interactions

Answer 12

iron

Question 13

DKA criteria

Answer 13

glucose >11
ph<7.3
bicarb<15
ketones >3/++ on dipstick

Question 14

DKA treatment

Answer 14

1. Gastric aspriation - NBM and drain
2. Rehydration - 0.9% saline (1L stat in first hr)
3. Insulin IV - once glucose <15, add 5% dextrose
4. Potassium - correct if >5

Question 15

Diabetic foot

Answer 15

Sugar control and advice
Pain - amitryptulline, pregabalin, gabapentin
tramadol
topical capsaicin

Prevention / Conservative / No Infection

Optimise diabetic control.

Patient education – self-care, self-examination

Refer to podiatry to optimize footwear, reduce pressure areas.

Dry gangrene – allow auto-amputation + healing by 2º intention.

Infected Diabetic Foot

Debridement & Revascularisation

Angioplasty / bypass

Wet gangrene - Amputation

Below knee – preserve mobility in young / active patient.

Above knee – absent femoral pulse; some mobility.

Through knee – already immobile patient.

Empirical antibiotics

Question 16

Hyponatremia

Answer 16

not more than 0.5mmol/L/hr - central pontine myelinolysis

acute symptomatic e.g. seizures - 3% saline 150ml over 15mins. recheck after 20 mins (max 8-10mmol in 24hrs)

not symptomatic - 0.9% saline

Question 17

Hypoglycaemia - conscious

Answer 17

oral glucose

Question 18

Hypoglycaemia - unconscious

Answer 18

IM glucagon

iv 20% dextrose