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Endocrinology Flashcards

1
Q

characteristic cutaneous signs of thyrotoxicosis

A

hair loss
pretibial myxoedema
onycholysis
bulging eyes (exophthalmos/proptosis)

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2
Q

characteristic cutaneous signs of hyothyroidism

A

hair loss
eyebrow loss outer part
cold, pale skin
characteristic face

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3
Q

characteristic cutaneous signs of cushing’s syndrome

A 
central obesity
wasted limbs ('lemon on sticks')
moon face
buffalo hump
supraclavicular fat pads
striae
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4
Q

characteristic cutaneous signs of addisons disease

A

hyperpigmentation (face, neck, palmar creases, mouth)

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5
Q

characteristic cutaneous signs of acromegaly

A

acral (distal) and soft tissue overgrowth
big jaws (macrognathia), hands and feet
skin is thick
facial features are coarse

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6
Q

characteristic cutaneous signs of hyperandrogenism (females)

A

hirsutism
temporal balding
acne

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7
Q

characteristic cutaneous signs of hypopituitarism

A

pale or yellow tinged thinned skin

fine wrinkling around eyes and mouth

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8
Q

characteristic cutaneous signs of pseudohypoparathyroidism

A

short stature
short neck
short 4th and 5th metacarpals

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9
Q

characteristic cutaneous signs of hypoparathyroidism

A

dry, scale, puffy skin
brittle nails
coarse hair

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10
Q

microvascular complications of hyperglycaemia

A

retinopathy
nephropathy
neuropathy

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11
Q

macrovascular complications of hyperglycaemia

A

stroke
renovascular disease
limb ischaemia
heart disease

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12
Q

symptoms of hyperglycaemia (DM)

A 
polyuria
polydipsia
unexplained weight loss
visual blurring
genital thrush
lethargy
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13
Q

diagnosis of DM if symptomatic

A

fasting BM ≥7 OR
random BM ≥11.1
(only one reading required if symptomatic)

HbA1c ≥48 (6.5%)

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14
Q

diagnosis of DM if asymptomatic

A

fasting BM ≥7 OR
random BM ≥11.1 OR
OGTT 2h value ≥11.1
(need 2 readings if asymptomatic)

HbA1c ≥48 (6.5%)

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15
Q

what is type 1 DM

A

 Insulin deficiency from AUTOIMMUNE DESTRUCTION of insulin-secreting pancreatic beta-cells
 Patients must have insulin, and are prone to ketoacidosis and weight loss

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16
Q

what is LADA

A

o Latent autoimmune diabetes of adults (LADA) is a form of type 1 DM, with slower progression to insulin dependence in later life.

usually have glutamic acid decarboxylase autoantibodies (GADA).

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17
Q

what is type 2 DM

A

 Reduced insulin secretion ± increased insulin resistance
 Associated with obesity, lack of exercise, calorie and alcohol excess
 ≥80% concordance in identical twins, indicating STRONGER GENETIC INFLUENCE THAN IN TYPE 1 DM.

o Typically progresses from a preliminary phase of impaired glucose tolerance or impaired fasting glucose.

18
Q

what is MODY

A

Maturity onset diabetes of the young (MODY) is a rare autosomal dominant form of type 2 DM affecting young people with a positive family history.

19
Q

what is impaired glucose tolerance

A

known as pre-diabetes.
- Fasting plasma glucose <7mmol/l and OGTT 2h glucose ≥7.8mmol/l but ≤11.1mmol/l

OGTT is not used routinely now – this has been replaced by HbA1c which indicates that a HbA1c of 42-47 (6-6.4%) indicates pre-diabetes and therefore a high risk of diabetes.

20
Q

what is impaired fasting glucose

A
  • Fasting plasma glucose between 6.1 and 6.9 mmol/L and;

- A blood glucose of <7.8 mmol/L after a 2h OGTT

21
Q

which factors increase your risk of IGT or IFT

A 
overweight/obese
FHx of diabetes
sedentary lifestyle
hypertension
high cholesterol
gestational diabetes
22
Q

secondary causes of DM

A

steroids, anti-HIV drugs, atypical antipsychotics, thiazides

Pancreatic - pancreatitis, surgery (>90% pancreas removed), trauma, pancreatic destruction (haemochromatosis, CF), pancreatic cancer.

cushing's disease
acromegaly
phaeochromocytoma
hyperthyroidism
pregnancy
23
Q

complications of gestational diabetes

A 
miscarriage
pre-eclampsia
macrosomia
shoulder dystocia
pre-term labour
congenital malformations
worsening of diabetic complications e.g. retinopathy, nephropathy.
24
Q

who is at risk of gestational diabetes

A 
age >25y
FHx positive
weight gain
non-caucasian
HIV positive
previous gestational DM
25
Q

pre-conception advice to prevent gestational DM

A

control/reduce weight
aim for good glucose control
offer FOLIC ACID 5mg OD for 12 weeks

26
Q

how to diagnose gestational DM

A

oral glucose tolerance test - if risk factors at booking visit e.g. previous gestational DM

27
Q

if previously diabetic, how would you change their medications

A

oral hypoglycaemic - stop

metformin - continue

28
Q

features suggesting type 1DM

A

weight loss
persistent hyperglycaemia despite diet and meds

presence of autoantibodies –> islet cell antibody and anti-glutamic acid decarboxylase antibodies.

ketonuria on dipstick

29
Q

what is metabolic syndrome

A

combination of diabetes, high blood pressure and obesity.

CENTRAL OBESITY 
\+ 2 of:
- BP ≥130/85
- triglycerides ≥1.7
- HDL ≤1.03 (male)/ 1.29 (female)
- fasting glucose ≥5.6 or
- DM
30
Q

complications of metabolic syndrome

A 
vascular events (MI)
DM
gallstones
pancreatic cancer
microalbuminuria
neurodegeneration
fertility problems
31
Q

treatment of metabolic syndrome

A 
exercise
weight loss
± mediterranean (?keogenic) diet
- antihypertensives
- hypoglycaemic (metformin)
- statins
32
Q

first line for diabetic who is overweight and

hbA1c to aim for

A

metformin + lifestyle advice
HbA1c of 48 mmol/mol (6.5%)

if GI side effects - try metformin MR

stop metformin if eGFR <30 (lactic acidosis risk)

33
Q

when would you start 2 medications in a diabetic
and
HbA1c aimed for

A 
HbA1c >58 (7.5%)
consider:
- metformin + DPP4 inhibitor (gliptins)
- metformin + pioglitazone
- metformin + gliclazide
- metformin + SGLT-2

aim for HbA1c of 53mmol/mol (7%)

34
Q

when would you start 3 medications in a diabetic patient and what hbA1c to aim for

A

if HbA1c remains above 58 despite dual therapy.

consider:

  • metformin + gliptin + SU
  • metformin + pioglitazone + SU

or

  • start insulin based treatment

aim for HbA1c ≤53 (7%)

35
Q

if metformin is contraindicated, what is first line for type 2 DM

A

DPP4 inhibitor OR
pioglitazone OR
sulphonylurea

36
Q

C/I to pioglitazones

A

heart failure or history of heart failure

hepatic impairment

diabetic ketoacidosis

current, or a history of, bladder cancer

uninvestigated macroscopic haematuria.

37
Q

general advice for DM management

A

structured education programme

offer lifestyle advice

start statin

control BP

give foot-care advice

advise informing DVLA and not to drive if hypoglycaemic episodes not in control

38
Q

if triple therapy is not effective, not tolerates or C/I then NICE advices what

A
  • metformin + sulfonylurea + GLP-1
    o BMI ≥35kg/m2 AND specific psychological or other medical problems associated with obesity OR
    o BMI <35kg/m2 AND for whom insulin therapy would have significant occupational implications or weight loss would benefit other significant obesity related comorbidities (only continue if there is a reduction of at least 11mmol/l in HbA1c and a weight loss of at least 3% of initial body weight in 6 months.
39
Q

sick day rules for diabetics

A
  • Increase frequency of blood glucose monitoring to 4 hourly or more
  • Encourage fluid intake aiming for at least 3 litres in 2h
  • In struggling to eat, may need sugary drinks to maintain carbohydrate intake
  • Continue to take insulin, as increased cortisol levels during stress can increase glucose levels in the body for which insulin is required.
40
Q

2nd line treatment if metformin C/I and DM still not controlled

A

gliptin + pioglitazone
gliptin + SU
pioglitazone + SU

41
Q

3rd life treatment if metformin C/I

A

consider insulin-based treatment

Finals (4 decks)

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