Endocrinology Flashcards by Megan McStay

70% of patients with MODY (<25yrs, FHx) involve which gene mutation?

HNF1- alpha

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Diagnosis of Diabetes?

Symptomatic:
FBG > 7mmol/L
Random BG > 11.1mmol/L
HbA1C > 48mmol/mol

Asymptomatic:
Increased random/fasting or HbA1C on two ocassions
OR
Increase random/fasting and HbA1C at same testing

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Pre-diabetes?
FBG 6.1-7
HbA1C 42-47

Risk factor for DM(4%/yr) and CVD

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How often should you measure HbA1C in DM?

2x/yr

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How often should diabetics be reviewed?

Routine diabetic review - 6mnthly

Review of complications - annually

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Fingerprick cappillary glucose monitoring is recommended for?

Patients taking insulin

Patients on sulfonylureas/ glinides

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Diabetics, if driving, must check their blood glucose 2x/day when taking which medications(2)?

Sulfonylureas

Glinides

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Non-Pharmacological management of diabetes includes?

Education

Diet
Vaccinations
Exercise
Psychological
Smoking
Driving
Employment
Travel

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Consider Patients with type 1 DM to be high risk for complications if; (8)

> 35yrs
Indian Subcontinent
FHx premature heart disease
Preexisting CVD
> /= 2 features of metabolic syndrome
Abnormal Lipids
Increased BP
Microalbuminaemia/ Proteinuria

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Consider T2DM patients to be high risk for complications unless all (7) apply;

not overweight
normotensive
no microalbumonaemia
non-smoker
no high risk lipid profile
no PMHx CVD
no FHx CVD

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Treatment of severe hypoglycaemia?

Glucose < 4mmol/L

Glucagon injection

oral glucose when conscious- effect of injection short lived

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Driving is not permitted in diabetes if?

> 1 hypoglycaemic episode in the pasr year

No episodes for group 2 drivers

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Aspirin is given to diabetic patients in what circumstances?

Hx of CVD

Not primary prevention

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Statins are given to diabetic patients who?

All T1 w/t increased risk of arterial disease
All T2 >75yrs
T2 any age with any high risk factors
T2 >40yrs no risk factors but CVD risk >20% over 10yrs

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If TGs are > 4.5mmol/L despite good glycaemic control how should you proceed?

Prescribe a fibrate
Reduce risk of pancreatitis
Ineffective- high concentration omega 3 fish oils

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In what other instance should you prescribe a fibrate to a diabetic?

TGs betweeen 2.3-4.5 but high CVD risk

Also decresease risk of diabetic retinopathy

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Recurrent UTIs in DM, you should consider? and why?

Papillary necrosis

more common in DM

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Nephropathy is characterized by(3)

Proteinuria
Increased BP
Decreased Renal Function

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Microalbuminuria?

albumin:creatinine ratio
>2.5mg/mmol Males
>3.5mg/mmol Women

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If abnormal albumin:creatinine ratio how should you proceed?

Repeat the test 2x over the next 2-3mnths

Confirmed of >/=1 abnormal repeat result

How do you treat DM with microalbuminemia/CKD?

ACE inhibitor e.g perindopril

Referal to a Nephrologist if;

a:c ratio >70mg/mmol or p:c ratio >100mg/mmol (UTI exclude)
eGFR <30 or drops by >15% between tests

The fraction of diabetics that have eye problems at presentation?

1/3rd

Eye Problems seen in DM include:

Blurred Vision: osmotic changes- corrects with glucose control
Cataract-juvenille snowflake cataracts develop rapidly
Glaucoma-Pressure
Retinopathy

Senile cataracts develop approximately how many years earlier in DM?

Risk of developing Retinopathy in diabetic patients?

20x

Refer Diabetic patient to ophthomalogist if;

- Sudden loss of vision - Rubeosis iridis - Pre-retinal or vitreous haemorrhage - Retinal detatchment - New vessel formation - Maculopathy - Pre-proliferative retinopathy - Cataract affecting visual-acuity - Unexplained drop in visual acuity

Laser treatment (photo-coagulation) is used to treat retinopathy?

Halts progression, does not retsore vision

Symmetrical Sensory Progressive Polyneuropathy affects what percentage of patients with DM?

40-50% | Numbness, tingling, neuropathic pain in feet> hands

Mononeuropathies/mononeuritis multiplex is particularly associated with which cranial nerves?

CN3 occulomotor: ptosis, large pupil, eye looks down and outwards CN6 abducens:horizontal diplopia (double vision) on looking outward s

What is amyotrophy?

Painful wasting of quadricep muscles | Reversible with good BG control

Features of autonomic neuropathy?(6)

- Postural Hypotension - Urinary Retention - Diabetic Diarrhoea - Erectile Dysfunction - Gastric Paresis (tx:tetracycline) - Gustatory Sweating (tx: propantheline bromide)

Risk Factors for development of diabetic foot?

``` Peripheral Neuropathy Peripheral Vascular Disease Hx. Ulceration/amputation >70yrs Plantar Callus Foot Deformities Poor Footwear Long Duration- DM Social Deprivation Poor Vision Smoking ```

Classification of foot risk?

Low:Normal senstation, palpable pulses Increased:Neuropathy, absent pulses or other RF High: Neuropathy/absent pulses + deformity/skin changes/ previous ulcer

Charcot's Osteoarthropathy (Charcot's Joint)

Neuropathic foot damaged because of trauma secondary to loss of pain sensation Refer immediately if suspected

Refer a patient with a thyroid lump immediately if;

Signs of tracheal compression, inc. stridor

Refer a patient with a thyroid swelling urgently if;

- >/=65yrs - Solitary Nodule increasing in size - Hx of neck irradiation - FHx -endocrine tumour - Unexplained hoarseness/voice changes - Cervical Lymphadenopathy - Very young (pre-pubertal)

Investigation of patients not requiring urgent referral?

TFTs If hypo or hyperthyroid- referral to endo If goitre alone - refer to surgeons

With relation to screening, check TFTs in patients who;

- with persistent symptoms of tiredeness/lethargy - On amiodarone or w/t hx of radioactive iodine therapy - with hypercholesterolameia, infertility, turner's/Down's syndrome, depresssion, dementia, obesity, DM, other AI disease

In elderly patients, hyperthyroididm may present as?

Confusion Dementia Apathy Depression

Tx hyperthyroidism?

B Blockers: symptoms Carbimazole: RAI:monitor TFTs long term Surgery:

When should a patient be warned to stop carbimazole?

If they experience sore throat or other infection

3/1000 patients on carbimazole have adverse effects, these are?

Agranulocytosis Hepatitis Aplastic Anaemia Lupus like syndromes

How long after RAI treatment should a women avoid pregnancy?

4mnths

What percentage of women >60yrs have hypothyroidism?

10%

Beginning Thyroxine therapy in a healthy patient <65yrs

Recheck TFTs 4-6wks Adjust until TSH in normal range monitor annually

Over-replacement with thyroxine is associated with?

AF | Osteoporosis

Levothyroxine can provoke what? and what should you consider adding to treatment?

Angina in elderly/preexisting CHD | Propranolol