Endocrinology

Question 1

Why does T1DM commonly present with DKA but not T2DM?

Answer 1

T1DM - absolute insulin deficiency –> fatty acid oxidation to burning fatty acids as energy source, acidic ketone bodies as byproduct
T2DM - relative insulin deficiency –> minimal insulin levels enough to suppress ketogenesis

Question 2

Under what circumstances will DKA occur DM other than T1DM?

Answer 2

Infection, sepsis
Inadequate insulin therapy
Stroke
AMI
Pancreatitis
Pregnancy
Medications (steroids, SGLT2)

Question 3

Difference between DKA and HHNK

Answer 3

DKA is characterized by ketoacidosis and hyperglycemia, while HHS usually has more severe hyperglycemia but no ketoacidosis

Question 4

HHNK full name

Answer 4

Hyperosmotic hyperglycemic nonketotic state

Question 5

DKA mechanism, how it leads to Kussmaul breathing, how situations precipitate dka?

Answer 5

lack insulin –> increased glucagon –> liver glycogenolysis and gluconeogenesis –> high glucose levels –> osmotic diuresis –> polyuria, dehydration, polydipsia
lack insulin –> lipolysis –> liver B oxidation –> ketone bodies –> metabolic acidosis –> initially compensated by bicarbonate buffer system –> overwhelmed –> hyperventilation as compensatory respiratory alkalosis ie Kussmaul

infection –> increased insulin demands but not matched by failing pancreas –> hyperglycemic, dehydration, further resistance to insulin –> vicious cycle

Question 6

Symptoms of hyperparathyroidism

Answer 6

bones (osteoporosis, fracture)
stones (renal)
groans (ab. anorexia, nausea, constipation)
overtones (psych. fatigue, weakness, depressed, psychosis, confusion)
others: polyuria

Question 7

DDx of monoclonal gammopathy

Answer 7

• plasma cell dyscrasia causing MGUS, SMM, MM
• lymphoproliferative disease
• Primary AL Amyloidosis