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Finals > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is most common cause of hypopituitarism

A

Non secretory pituitary macroadenoma

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2
Q

What do if multiple painkillers have not worked for neuropathic pain from diabetic neuropathy

A

Refer to pain clinic

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3
Q

What is management first line of acromegaly

A

Transsphenoidal surgery

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4
Q

Medication options for treating acromegaly if surgery fails

A

Somatostatin analogues- octreotide
Pegvisomat- GH receptor antagonist
Dopamine agonist- bromocriptine

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5
Q

What is pegvisomat

A

GH receptor antagonist

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6
Q

Blood findings in cushings

A

Blood gas
- hypokalaemia metabolic alkalosis
- hypernatraemia
High glucose

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7
Q

Causes of cushings

A

Iatrogenic steroid use
ACTH dependant
- pituitary tumour (cushings disease)
- ectopic ACTH
ACTH independant
- adrenal adenoma

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8
Q

First line tests- gold standard+what else can be used for cushings

A

Gold standard first line- low dexamethasone test
Can use 24 hr urinary cortisol and evening salivary cortisol

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9
Q

How investigate cause of cushings

A

Inferior petrosal sinus sampling is preferred
Can also use high dose dexamethasone test

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10
Q

Management of hypokalaemia

A

Above 2.5 and asymptomatic= sando k tablets
Below 2.5 or symptomatic= cardiac monitoring and IV potassium chloride

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11
Q

What is maxium infusion rate for saline with potassium chloride

A

Should not exceed 20mmol/hour as irritant to veins
Have to do rates above 10mmol on ITU

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12
Q

What should every person on insulin be given

A

Glucagon emergency kit if swallow impaired

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13
Q

What is risk of continuous inuslin injections in the same place

A

Lipodystrophy which presents as lumps or atrophy of fat

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14
Q

Education points for patients on insulin

A

Advise about rotation of sites to avoid lipodystrophy
Safety net about signs of hypoglycaemia
- anxiety
- confusion
- sweating
- blurred vision
If swallow intact-> glass of lucozade or 15-20g glucose gel
If swallow impaired-> glucagon emergency kit

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15
Q

MOA of sulphonylureas

A

Increase pancreatic insulin production

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16
Q

Common side effects of sulphonylureas

A

Hypos
Weight gain

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17
Q

Rarer side effects of sulphonylureas

A

SIADH
BM suppression
Hepatotoxic
Peripheral neuropathy

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18
Q

When avoid sulphonylreas

A

Breastfeeding and pregnancy

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19
Q

Investigating de quervains

A

Globally reduced iodine uptake on thyroid scintigraphy
Raised ESR in initial stage

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20
Q

Painful goitre and hyperthyroid

A

De quervains

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21
Q

How long do phases to de quervains last

A

weeks

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22
Q

What can cause a ketoacidosis that isnt diabetic

A

Alcohol

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23
Q

Blood findings of alcoholic ketoacidosis

A

Metabolic acidosis
Elevated anion gap
Elevated serum ketone levels
Normal or low glucose concentration

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24
Q

Management of alcoholic ketoacidosis

A

Saline and thimaine infusion

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25
Q

Risk factors for small bowel bacterial overgrowth syndrome

A

DM
Scleroderma

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26
Q

Presentation of small bowel bacterial overgrowth syndrome

A

Chronic diarrhoea
Bloating, flatulence
Abdominal pain

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27
Q

Management of Small bowel bacterial overgrowth syndrome

A

Correct underlying DM
Antibiotic therapy- rifamixin

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28
Q

How is T2DM diagnosed

A

1 reading of if symptomatic
2 readings of if asymptomatic
- Fasting glucose >7
- Random glucose >11.1
- HbA1c > 48

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29
Q

What is defined as impaired glucose tolerance

A

Fasting glucose under 7 but OGTT 2 hour= 7.8-11.0

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30
Q

What is defined as impaired fasting glucose

A

Fasting glucose 6.0-6.9

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31
Q

Complication of hashimotos

A

MALT lymphoma

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32
Q

What can lower HbA1c levels

A

Haemodialysis
Haemolysis
- Hereditary spherocytosis
- G6PD
- SCD

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33
Q

What is glucagon like peptide

A

Hormone secreted by small intestine in response to glucose load which increases insulin release

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34
Q

MOA of GLP 1 mimetics

A

Increase insulin release
Reduce appetite
Suppress glucagon

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35
Q

What is GLP broken down by

A

Dipetidyl-peptidase-4

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36
Q

Advantage of liraglutide over exenatide

A

Liraglutide has to be taken once a day whereas exenatide is taken within 1 hour before morning and evening meal as a subcut injection

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37
Q

What are gliptins

A

DPP 4 inhibitors which decrease peripheral breakdown of GLP1

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38
Q

What is main advantage of gliptins compared to other anti-diabetic agents

A

Cause weight loss

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39
Q

Drug causes of gynaecomastia

A

spironolactone (most common drug cause)
cimetidine
digoxin
cannabis
finasteride
GnRH agonists e.g. goserelin, buserelin
oestrogens, anabolic steroids

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40
Q

Poor thyroxine adherance TSH and T4 results

A

Elevated TSH
Can be normal T4

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41
Q

If have addisons and an intercurrent illness, what do with steroids

A

Mineralcorticoid dose remains same
Glucocorticoid doubles

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42
Q

What use to treat addisons

A

Both glucocorticoid and mineralcorticoid

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43
Q

Dose of hydrocortisone required/day in addisons

A

20-30mg

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44
Q

How is hydrocortisone dose given in a day

A

Majority of dose given in the first half of day
For example if on 30mg
- 20mg in morning
- 10mg in afternoon

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45
Q

What do people with addisons needs to be given

A

Steroid card and medicalert bracelet
Hydorcortison injection kits for addisonian emergency

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46
Q

Patchy uptake on iodine scintigraphy

A

Toxic multinodular goitre

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47
Q

Management of Toxic multinodular goitre

A

Radioiodine unless compression sx then would do surgery

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48
Q

What is sick euthyroid

A

In patients who are ill they can have reduced thyroid function
Seen in elderly

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49
Q

Management of sick euthyroid

A

Ask GP to review TFTs in 6 weeks post illness
Do not need thyroxine replacement unless severe

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50
Q

What tends to happen to TFTs in sick euthyroid

A

TSH normal
T3 and T4 tend to be low

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51
Q

Common causes of polyuria

A

Diuretics
Alcohol and caffeine
Lithium
HF

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52
Q

Can you drive a HGV if on insulin

A

Yes if meet strict DVLA criteria

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53
Q

Definitive test for addisons

A

Short Synacthen test

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54
Q

If short synacthen test is not available what do instead

A

Morning cortisol 9am

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55
Q

What antibodies may be seen in addisons

A

Anti 21 hydroxylase

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56
Q

Eye signs of graves

A

Opthalmoplegia
Exopthalmos

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57
Q

What are blood findings of tertiary hyperparathyoidism

A

Ca elevated
PTH very elevated
ALP up
Phosphate high

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58
Q

When add 10% dextrose infusion in DKA

A

When glucose is less than 14

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59
Q

What is insulin infusion rate in DKA management

A

0.1 units/kg/hour

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60
Q

Fluids used for DKA

A

Isotonic saline

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61
Q

BP aimed for in T2DM

A

Under 80 ABPM= 135/85
Over 80 ABPM= 145/85

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62
Q

What is nesidioblastosis

A

Beta cell hyperplasia

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63
Q

Causes of hypoglycaemia

A

Insulinoma
Insulin/sulphonylureas OD
Liver failure
Addisons
Alcohol
Nesidioblastosis

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64
Q

What do if someone on insulin becomes unwell

A

Keep taking insulin as normal but check levels more frequently

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65
Q

What is most common cause of primary hyperaldosteronism

A

Bilateral idiopathic adrenal hyperplasia

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66
Q

When start to get symptoms with carcinoid tumours

A

When get metastases to liver which release serotonin to systemic circulation

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67
Q

Carcinoid syndrome presentation

A

Flushing (earliest)
Diarrhoea
Arrythmias
Bronchospasm

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68
Q

How investigate carcinoid tumours

A

Urinary 5-HIAA

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69
Q

What drug can be used for carcinoid syndrome

A

Octreotide

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70
Q

How differentiate conns from bilateral renal artery stenosis

A

Renin levels are high in renal artery stenosis

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71
Q

What is main danger of HHS compared to DKA

A

Onset slower so volume depletion and metabolic abnormalities more pronounced

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72
Q

Presentation of HHS

A

Volume loss sx
- polyuria
- polydipsia
Lethargy
Nausea and vomiting
LOC
Hyperviscosity complications
- MI
- stroke
- peripheral arterial disease

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73
Q

Diagnostic criteria for HHS

A

Hyperglycaemia in range over 30
Raised serum osmolality
No ketonaemia

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74
Q

Management of HHS

A

Aggressive fluid resus
Insulin if glucose not dropping
VTE prophylaxis

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75
Q

When give insulin in HHS

A

If glucose not responding to IV fluids

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76
Q

Complications of HHS

A

Hyperviscosity problems
- MI
- CVA
- PAD
- VTE

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77
Q

If driving and on insulin, when check blood glucose

A

Before and every 2 hours

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78
Q

What is pseudocushings

A

Mimic of cushings
Get all signs and biochemical results of cushings but no malignant cause

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79
Q

Causes of pseudo-cushings

A

Alcohol excess
Depression

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80
Q

What initial fluids regime give to someone in DKA

A

Haem stable
- 1L saline over 1 hour
Haem unstable
- 500ml STAT

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81
Q

What is most important test for determining response to thyroxine

A

TSH

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82
Q

Insulinoma presentation

A

Whipples triad
1- hypoglycaemia post exercise
2- quick reversal with food
3- low BMs at time of symptoms
Rapid weight gain

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83
Q

What is in whipples triad

A

1- hypoglycaemia post exercise
2- quick reversal with food
3- low BMs at time of symptoms

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84
Q

Management of insulinoma

A

Surgery
If not candidate then somatostatin

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85
Q

What can be used for insulinoma if not candidate for surgery

A

Somatostatin

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86
Q

If T1DM, what do about driving

A

Must inform DVLA but can drive if adequate hypoglycaemia awareness

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87
Q

How long should acidosis and ketonaemia take to resolve in DKA

A

24 hours if not then needs to be reviewd by senior endocrinologist

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88
Q

What do if acidosis and ketonaemia in DKA have not resolved after 24 hours

A

Get review by a senior endocrinologist

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89
Q

When is DKA defined as being resolved

A

pH>7.3
Ketones< 0.6
Bicarbonate >15

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90
Q

When can switch to subcut insulin in DKA

A

Once eating and drinking again
DKA resolution criteria met
- pH>7.3
- ketones< 0.6
- bicarbonate >15

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91
Q

Whats in MEN 1

A

3 Ps
- parathyroid adenoma
- pituitary tumour
- pancreatic tumour

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92
Q

What are examples of pancreatic tumours in MEN 1

A

Insulinoma
Gatrinoma
Somatostatinoma
Glucagonoma

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93
Q

How do gastrinomas present

A

Zollinger Ellison disease
- severe peptic ulceration
- diarrhoea

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94
Q

Whats in MEN2a

A

2 Ps
Parathyroid disease
Phaeochromocytoma
Medullary thyroid cancer

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95
Q

Whats in MEN 2b

A

Phaeochromocytoma
Marfanoid habitus
Neuromas

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96
Q

Test for phaeochromocytoma

A

Urinary metanephrines 24 hr collection
This has superceded urinary catecholamines

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97
Q

Management of phaeochromocytoma

A

Blood pressure mangement intially
- phenoxybenzamine
- beta blocker (propanolol)
Then surgery is definitive

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98
Q

Patient on steroids has illness then develops abdo pain and low grade fever

A

Addisons

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99
Q

Addisonian crisis presentation

A

Abdo pain
Fever
Lightheaded
Hyperkalaemia metabolic acidosis

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100
Q

What is first line investigation for acromegaly

A

Serum IGF-1

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101
Q

What test confirms acromegaly post IGF 1

A

OGTT with serial GH measurements then MRI

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102
Q

What is subclinical hypothyroidism

A

TSH raised but T3 and T4 normal
No symptoms

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103
Q

When treat subclinical hypothyroidism

A

TSH>10 with normal thyroxine
This recorded twice 3 months apart
ALSO TREAT if under 65 with TSH 5.5-10 twice 3 months apart and there are symptoms of hypothyroidism

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104
Q

What do if identify subclinical hypothyroidism on 1 blood test

A

If see TSH up with normal T4 then repeat in 3 months
If this still high then may consider thyroxine

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105
Q

Cause of arrythmia post starting DKA treatment

A

Hypokalaemia

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106
Q

What is subacute thyroiditis

A

De quervains

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107
Q

What is pepper pot skull seen in

A

Primary hyperparathyroidism

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108
Q

Myxoedema features

A

Hyporeflexia
Hypothermia
Seizures
Bradycardia
Drowsy

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109
Q

Precipitating features of thyrotoxic storms

A

Typically in people with established hyperthyroidism and isnt usually first presentation
Triggers
- trauma
- infection
- surgery
- pregnancy

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110
Q

Presentation of thyroid storm

A

fever > 38.5ºC
tachycardia
confusion and agitation
nausea and vomiting
hypertension
heart failure
abnormal liver function test - jaundice may be seen clinically

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111
Q

Management of thyroid storm

A

Hydrocortisone
IV propanolol
Anti thyroid drugs- propylthiouracil

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112
Q

Which thyroid cancer spreads early to lymph nodes

A

Papillary

113
Q

Which thyroid cancer secretes calcitonin

A

Medullary

114
Q

Which thyroid cancer is most likely to cause pressure symptoms

A

Anaplastic

115
Q

What thyroid cancer is hashimotos associated with

A

MALT Lymphoma

116
Q

What is plasma osmolality in psychogenic, nephrogenic and central diabetes insipidus

A

Psychogenic is low
Cranial and nephrogenic is high

117
Q

Features of klinefelters

A

Tall
Gynaecomastia
Small testes
Lack of pubic hair

118
Q

Gonadotrophin and testosterone levels in klinefelters

A

Low testosterone
High gonadotrophin

119
Q

How is klinefelters diagnosed

A

Karyotyping- 47 XXY

120
Q

Metabolic cases of polyuria

A

Diabetes
Hypokalaemia
Hypercalcaemia

121
Q

Hypoglycaemia management in hospital

A

Conscious- oral glucose gel
Unconscious or combative- IM glucagon

122
Q

How do pituitary adenomas present

A

Functional
- excess of a hormone
Non-functional
- panhypoituitarism
All can present with bitemporal hemianopia and headache

123
Q

What can cause dyspepsia symptoms in diabetic

A

Gastroparesis

124
Q

Presentation of gastroparesis in diabetic

A

Dyspepsia- bloating, etc
Erratic glucose measurements

125
Q

How manage gastroparesis in diabetic

A

Prokinetic agents like metoclopramide

126
Q

If on insulin and have DKA, what do with everyday insulin during admission

A

Stop short acting
Continue long acting

127
Q

Investigation of choice for small bowel overgrowth syndrome

A

Hydrogen breath test

128
Q

What does vitamin B2 (riboflavin) deficiency lead to

A

Angular cheilitis

129
Q

How is diabetic neuropathy screened for

A

10g monofiliment

130
Q

What is an adrenal mass with a rich lipid core, asymptomatic patient too

A

Benign adenoma

131
Q

What is waterhouse friederichsen syndrome

A

In meningococcal sepsis get an adrenal haemorrhage

132
Q

Metabolic alkalosis with hypokalaemia

A

Excess vomiting (or cushings)

133
Q

If develop gynaecomastia on spironolactone, what switch to

A

Epleronone

134
Q

Hormone profile of kallmans

A

Low testosterone and low gonadotrophins as hypothalamic problem

135
Q

Management in primary care of graves

A

generally managed by secondary care but carbimazole may sometimes be started for troublesome symptoms whilst waiting

136
Q

First line investigation for thyroid nodules/lumps

A

USS

137
Q

What do with levothyroxine dose if become pregant

A

Increase dose by up to 50%

138
Q

Presentation of conns

A

HTN
Muscle weakness in exams as a symptoms of hypokalaemia

139
Q

If get given 9am cortisol and ACTH and shows;
high cortisol
low ACTH
What is next investigation

A

CT adrenal glands

140
Q

MSK side effects of corticosteroids

A

Osteoprosis
Proximal mopathy
Avascular necrosis of femoral head

141
Q

When do you test for T1DM with C peptide and autoantibodies

A

Diagnostic uncertainty where atypical features
- 50 or older
- BMI over 25
- slow evolution of symptoms
- long prodrome

142
Q

How test for T1DM when diagnostic uncertainty

A

C peptide levels
Diabetes autoantibodies

143
Q

What happens to thyroid levels during pregnancy

A

Total levels rise however free T3 and T4 remain the same
The increase is due to increased thyroid binding globulin which increases during pregnancy

144
Q

Management of hypoglycaemia if impaired swallow

A

If IV access then IV 20% glucose
If not then IM glucagon

145
Q

What is risk of giving insulin in HHS

A

Get massive compartment shift of fluid which may lead to central pontine myelinolysis

146
Q

Causes of primary hyperaldosteronism

A

Bilateral adrenal hyperplasia
Adrenal adenoma

147
Q

How determine cause of conns

A

CT scan of abdomen after RA ratio

148
Q

If CT scan normal when determining cause of conns, what do

A

Venous sampling from both adrenals

149
Q

How manage Conns

A

Depends on cause
If bilateral adrenal hyperplasia spironolactone
If unilateral adenoma then surgical removal

150
Q

How manage thyrotoxicosis in pregnancy

A

First trimester- PTU
Second and third- carbimazole
Keep it PC

151
Q

What use to control symptoms of a graves patient awaiting secondary care attention

A

Propanolol

152
Q

What do if on long term steroids for PMR and becomes unwell

A

Double the dose

153
Q

What give first line anti HTN if black and diabetes

A

ARB

154
Q

What interacts with and affects efficacy of levothyroxine

A

Oral iron tablets due to preventing its absorption

155
Q

What is nelsons syndrome

A

When have bilateral adrenectomy, can get growth of corticotrophs in the pituitary gland due to unchecked inhibition

156
Q

How does nelsons syndrome present

A

Post bilateral adrenectomy
Pituitary tumour compressive symptoms
Increased skin pigmentation due to increased MSH production

157
Q

What is pretibial myxoedema and what seen in

A

Erythematous and oedematous lesions seen on the lower leg in graves disease

158
Q

What is thyroid acropachy

A

Triad of
- clubbing
- new bone formation
- soft tissue swellings

159
Q

What can stop a diabetic from being able to drive

A
  • More than 2 episodes of hypoglycaemia which required help
  • not having hypoglycaemic awareness
  • the mcdonalds drive thru queue
160
Q

How screen for diabetic nephropathy

A

Early morning ACR urine sample

161
Q

Management of de quervains

A

NSAIDs- Naproxen specifically

162
Q

What does blood glucose being “unrecordable” indicate

A

That it is very high not low

163
Q

How monitor response to treatment in HHS

A

Serum osmolality

164
Q

First line antibiotic for small bowel overgrowth syndrome

A

Rifamixin

165
Q

Drug causes of galactorrhoea from raised prolactin

A

metoclopramide, domperidone
phenothiazines- prochlorperazine
haloperidol
SSRIs, opioids

166
Q

Side effects of thyroxine therapy

A

Osteoporosis
AF
Worsening angina
Hyperthyroidism

167
Q

How manage a diabetic ulcer

A

Check for gangrene
If not provide education about foot care and arrange an appt with diabetic foot clinic

168
Q

How does alcohol cause polyuria

A

Suppresses ADH suppression therefore like a cranial diabetes insipidus

169
Q

How does alcohol causing polyuria present with
- urine osmolality
- serum osmolality
- water deprivation test

A

Urine osmolality = low
Serum osmolality= high
Water deprivation= like cranial

170
Q

How differentiate between primary and secondary hypoadrenalism symptomatically

A

Skin hyperpigmentation in primary
In primary there will be increased ACTH release which increases MSH

171
Q

How treat cranial DI

A

Desmopressin

172
Q

How treat nephrogenic DI

A

Thiazide diuretics

173
Q

How long need to treat graves with carbimazole for

A

Only 12-18 months
No need for lifelong as carbimazole induces remission

174
Q

What do if addisons patient on long term steroids starts vomiting illness

A

Give IM glucocorticoid until resolves

175
Q

Causes of cranial DI

A

Idiopathic
Head injury
Pituitary tumours/surgery
Sarcoidosis
Haemochromatosis

176
Q

Complications of acromegaly

A

Cardiomyopathy
HTN
DM
Colorectal cancer

177
Q

How diagnose osteoporosis

A

DEXA scan T score over -2.5
OR
Post menopausal woman has fracture

178
Q

What do if patient on metformin having a scan with contrast

A

Withold for 2 days afterwards

179
Q

Mental side effects of steroids

A

Insomnia
Psychosis
Depression
Mani(l)a 🇵🇭

180
Q

First line medication for acromegaly

A

Octreotide

181
Q

How manage if change in vision in TED patient

A

Urgently refer to opthalmology ED

182
Q

Menstrual problems associated with hyperthyroidism vs hypothyroidism

A

Hyperthyroidism- Oligomenorrhoea or amenorrhoea
Hypothyroidism- menorrhagia

183
Q

If someone recently migrated to the UK and has hypothyroidism, what is likely cause

A

Iodine deficiency

184
Q

With pituitary tumours, what quadrantopia is seen

A

Superior

185
Q

What tests to confirm T1DM

A

Random glucose

186
Q

What are C peptide levels in T1DM

A

Low

187
Q

How can carcinoid syndrome affect the heart

A

Pulmonary stenosis and tricuspid insufficiency

188
Q

What do if ACR raised on spot urine sample

A

Repeat with first pass morning specimen

189
Q

HbA1c target if on metformin

A

48

190
Q

HbA1c target if taking a drug which can cause hypos (sulphonylureas)

A

53

191
Q

HbA1c target if on 2 drugs and HbA1c has reached 58

A

53

192
Q

When does HbA1c target become 53

A

Taking an antidiabetic which causes hypos
Taking 2 antidiabetics and have gone above 58

193
Q

When add SGLT2i to diabetes regime

A

Develop at any time or history of CVD or HF
Q-risk >10%

194
Q

What is important thing to do when prescribing metformin and SGLT2i

A

Make sure metformin is fully titrated up

195
Q

When add a second antidiabetic

A

If HbA1c rises above 58

196
Q

Dietary advice for DM

A

Low glycaemic food
Oily fish
Discourage food aimed at people with DM

197
Q

What weightloss aim for in T2DM

A

5-10%

198
Q

2nd line options for T2DM after metformin

A

Sulphonylureas
Pioglitazone
DPP4 inhibitors

199
Q

When is pioglitazone CI

A

Heart failure or CVD
Bladder Ca history

200
Q

MOA of pioglitazone

A

PPAR gamma agonist which increases insulin sensitivity peripherally

201
Q

When is only time can offer GLP1 agonists

A

If triple therapy unsuccessful therefore switch one of them to GLP1 if overweight or
Low BMI but insulin lowering therapy would be inappropriate due to occupation or weight loss would be key for controlling rfx for other diseases like CVD

202
Q

After triple therapy what are options

A

Insulin therapy or GLP1 mimetics
- use GLP1 if BMI over 35
- under 35 but insulin not appropriate for occupation or would want weight loss for controlling other diseases

203
Q

Triple therapy options for T2DM

A

Metformin+sulphonylurea+pioglitazone
Metformin+ sulphonylurea+DPP4i
Metformin+ (DPP4i or sulphonylurea or pioglitazone) + SGLT2i

204
Q

Third line options for T2DM

A

Metformin+sulphonylurea+pioglitazone
Metformin+ sulphonylurea+DPP4i
Metformin+ (DPP4i or sulphonylurea or pioglitazone) + SGLT2i
Insulin therapy

205
Q

How start insulin for T2DM

A

Use human insulin
Taken at bedtime or BD

206
Q

What is function of DPP4i

A

Increases levels of incretins- GLP1 etc

207
Q

What is most likely cause of impaired hypo awareness in long term T1DM

A

Neuropathy in ANS

208
Q

What antidiabetic avoid in severe renal impairment

A

Sulphonylureas

209
Q

What is exenatide

A

GLP1 agonist

210
Q

What is a long acting sulphonylurea

A

Glibenclamide

211
Q

Inheritance of MODY

A

AD

212
Q

What happens when TED patients are not able to close eyelids

A

Exposure keratopathy from dry eyes

213
Q

What thyroid treatment can worsen TED

A

Radioiodine

214
Q

How does MODY typically present

A

Non ketotic hyperglycaemia detected incidentally
Not overweight nor signs of insulin resistance

215
Q

Key differentiators of MODY from T1DM and T2DM

A

T1DM- no ketosis with hyperglycaemia
T2DM- normal weight, aged under 25

216
Q

Indications for orlistat in obesity

A

BMI over 28 with CVD rfx or BMI over 30

217
Q

When can give liraglutide for obesity

A

BMI over 35
Prediabetic hyperglycaemia 42-47

218
Q

When must diabetics give up their license

A

Over 2 hypoglycaemic episodes where assistance needed

219
Q

Which antidiabetics causes weight gain

A

Sulphonylureas
Pioglitazone

220
Q

Which is best 2nd line antidiabetic to give if want to avoid weight gain

A

DPP4i

221
Q

What is max metformin dose

A

500mg QDS

222
Q

When determining 3rd choice antidiabetic, what consider if overweight

A

SGLT2i
DPP4i

223
Q

Which antidiabetics are best for weight

A

SGLT2i
DPP4i
GLP1 agonists

224
Q

Which drugs impair levothyroxine absorption

A

Iron and calcium replacements

225
Q

It taking gliclazide when can add another antidiabetic

A

If HbA1c goes above 53

226
Q

Presentation of latent autoimmune diabetes of adults

A

T1DM but when adult

227
Q

SEs of SGLT2i

A

Increased risk of amputation
Recurrent UTI
Euglycaemic ketoacidosis

228
Q

Treatment of MODY with HNF1 mutation

A

Sulphonylureas

229
Q

What can use to treat T1DM on top of insulin

A

Metformin if BMI over 25

230
Q

What do with antidiabetics in T2DM if ill

A

Metformin- stop if dehydration risk
Sulphonylureas- stop if acutely unwell or at risk of dehydration
GLP-1- stop if dehydration

231
Q

How many units of insulin in 1ml

A

100

232
Q

What use to draw up insulin

A

Do not use a standard syringe- use an insulin syringe

233
Q

Examples of each type of insulin

A

Rapid- Insulin aspart (NovoRapid), Insulin lispro (Humalog)
Short- Actrapid (soluble)
Intermediate- isophane insulin
Long- insulin determir (Levemir), insulin glargine (Lantus)

234
Q

What insulin start in DKA

A

Fixed rate insulin while continuing long acting insulin but stop short acting

235
Q

Blood glucose target on waking in T1DM

A

5-7

236
Q

Blood glucose target before meals in T1DM

A

4-7

237
Q

When need to measure glucose more regularly

A

Illness
Sport
Pregnancy
Breastfeeding

238
Q

How often measure HbA1c in T1DM

A

3-6 months

239
Q

How often measure glucose/ day in T1DM

A

4 times a day including before each meal and before bed

240
Q

In adults what is recommended regime for T1DM adults

A

Injection of basal bolus insulin
Twice daily detemir
Rapid acting insulin before meals

241
Q

Basal options for T1DM

A

Twice daily detemir first line
Alternative include- OD glargine or detemir

242
Q

How take metformin perioperatively

A

Day before= take
Day of surgery= only ever stop it take TDS where omit lunchtime dose
Consider stopping if risk of AKI

243
Q

How take sulponylureas perioperatively

A

Day before= take as normal
Day of surgery= if once daily omit, if BD omit morning if morning op and omit both if pm operation

244
Q

How take SGLT2i perioperatively

A

Day before= take as normal
Day of operation= omit dose

245
Q

What do with once daily insulins perioperatively

A

Day before= reduce dose by 20%
Day of operation= reduce dose by 20%

246
Q

When would you stop metformin for a surgery

A

High risk of AKI

247
Q

If taking insulin, what will determine operative period management

A

Minor procedure
- If good glycaemic control (less than 69 HbA1c) then can adjust normal regime (reduce by 20%)
- poorly controlled then variable rate
Major (missing 1 or more meal)
- variable rate insulin infusion

248
Q

Side effects of pioglitazone

A

Fracture risk
Fluid retention
Weight gain
Liver dysfunction

249
Q

Side effects of sulphonylureas

A

Hypoglycaemic episodes
Increased appetite and weight gain
SIADH
Liver dysfunction (cholestatic)

250
Q

What antidiabetic drug can cause pancreatitis

A

Gliptins

251
Q

Main problems if subclinical hyperthyroidism

A

Osteoporosis
AF

252
Q

Main cause of subclinical hyperthyroidism

A

Multinodular goitre in elderly women

253
Q

Management of subclinical hyperthyroid

A

Review in 6 mths as often revert to normal
Can consider treatment if persistent due to risk of osteoporosis and AF

254
Q

Causes of hypothyroidism

A

Primary
- hashimotos
- iodine defic
- thyroiditis
- drugs- lithium and amiodarone
Secondary
- panhypopituitarism
- trauma to thyroid (eg surgical)

255
Q

Myxoedema coma management

A

IV fluids
IV thyroid replacement
IV steroids until adrenal failure been ruled out

256
Q

Management of papillary and follicular thyroid cancer

A

Thyroidectomy
Treat with radioiodine afterwards
Follow up with annual thyroglobulin

257
Q

Management of single thyroid nodule

A

Surgical removement (benign adenoma)

258
Q

Where is hypothyroidism treated

A

Provided no indication of secondary aetiology or cocontaminant adrenal disease then do so at GP

259
Q

Main side effects of carbimazole and PTU

A

Carbimazole
- pancreatitis
- agranulocytosis
PTU
- agranulocytosis too

260
Q

Investigations for thyroid cancer

A

USS then guided FNA

261
Q

Addisonian crisis management

A

IV hydrocortisone
IV fluids
Correct hypoglycaemia and hyperkalaemia if necessary

262
Q

If have addisons from stopping long term steroids, what type of adrenal insufficiency is it

A

Tertiary
If take for over 3 weeks then lose endogenous hypothalamic CRH production

263
Q

Investigations for addisons

A

Short synacthen- 9am cortisol if not available
Anti 21 alpha hydroxylase antibodies

264
Q

Cushings presentation

A

Centripetal obesity
Moon face
Striae
Acne
HTN
Myopathy
Osteoporosis and AVN
Psychiatric complications

265
Q

Management of cushings

A

Treat cause
- first line normally surgery
For reducing cortisol
- metyrapone
- ketoconazole

266
Q

What does skin pigmentation in cushings indicate about cause

A

If hyperpigmentation is cushings disease

267
Q

Causes of secondary hyperaldosteronism

A

Liver failure
Heart failure
RAS

268
Q

Rfx for phaeo

A

MEN2
Von hippel lindau
NF

269
Q

Acromegaly presentation

A

HTN and DM
Prognathism
Coarse facial features
Big hands and feet
Oily sweaty skin
Compressive sx- prolactin signs, headache and bitemp

270
Q

Panhypopituitarism causes

A

Non-functioning adenomas- most common
Prolactinomas
Infiltrative diseases- sarcoid, haemochromatosis
Craniopharyngioma
Sheehans
Trauma

271
Q

Investigations for panhypopituitarism

A

MRI
Combined pituitary testing

272
Q

What skin lesion can precipitate T1DM diagnosis

A

Necrobiosis lipoidica- waxy, yellow lesions in pretibial distribution with telengiectasia present

273
Q

If someone has suspected T1DM diagnosis in GP what do

A

Refer for same day endo referral

274
Q

How diagnose T1DM in GP

A

Random glucose >11 with 1 of following
- Ketosis
- Rapid weight loss
- Age of onset younger than 50 years
- Body mass index (BMI) below 25 kg/m2
- Personal and/or family history of autoimmune disease

275
Q

What do if discover someone as prediabetic

A

Refer for local lifestyle change programme

276
Q

What are options to monitor blood glucose in T1DM

A

Standard use is capillary blood glucose
Can use libre which is circular device on arms which continuously monitor however 5 minute lag so if suspect hypo then use CBG and also need to replace every 2 weeks

277
Q

When can refer T1DM for islet cell/pancreatic transplant

A

Recurrent severe hypos refractory to medical treatment

278
Q

When consider continuous insulin pump

A

Poorly controlled HbA1c- above 69 despite daily injections
Attempts to achieve target HbA1c levels with insulin result in the person experiencing disabling hypoglycaemia

Finals (29 decks)

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