Endocrinology LC

Question 1

Diagnosis of diabetes

Answer 1

Random BSL >11
Fasting BSL >7
OGTT >11
HbA1c >6.5

Question 2

HbA1c target for patients with reduced hypoglycemia awareness

Answer 2

8.0

Question 3

Most important risk factors for diabetic retinopathy

How often should diabetic patients have eye checks?

Answer 3

HTN, hyperglycemia

Every 1-2 years

Question 4

Conditions that falsely increase HbA1c

Answer 4

Reduced RBC turnover - Iron/B12 deficiency, Splenectomy

Drugs - Aspirin, opiates, alcohol, hydroxyurea

Disease states - Hyperbilirubinaemia

Question 5

Conditions that falsely decrease HbA1c

Answer 5

BSL control - recurrent hypoglycemias (inaccurate measure of control)

Increased red cell turnover - Iron/vitamin B12 administration, EPO, Haemoglobinopathies, splenomegaly

Disease states - Chronic liver disease and CKD, RA, Hypertriglyceridemia, pregnancy

Drugs - Antiretrovirals,, Dapsone

Question 6

indications for OP screening

Answer 6

Minimal trauma fracture
Males >70yo, female >65yo
Premature menopause/hypogonadism
Major risk factors
- medications (steroids >3 months, anti-androgens)
- disorder (CKD, RA, hyperparathyroidism, chronic liver disease, celiac)
- cumulative risk factors

Question 7

indications for OP treatment

Answer 7

Scores - BMD ≤ 2.5 SD

Fractures - minimal trauma fracture in post menopausal woman or man >50yo, asymptomatic vertebral trauma

Risks - 3-5 times more likely to have a further fracture, absolute fracture risk >3% (hip) or >20% (any site)

Steroids - osteopenia in postmenopausal women or men >50yo + chronic corticosteroid if high FRAX risk OR if on >7.5mg pred for >3 months

Question 8

PBS indications for teriparetide

Answer 8

T score: severe established osteoporosis (T score -3.0 or loss)

Fracture: continued high risk of fracture + 2 or more fractures due to minimal trauma,

Previous treatments: at least 1 fracture after min 12 months continuous therapy with an anti-resorptive AND cannot have used Romosozumab prev (or be intolerant after 6/12 treatment)

Max 18 months

Question 9

Indications for screening for diabetes

Answer 9

Non-Modifiable Risk Factors
• Increasing age
• Certain ethnic backgrounds including Aboriginal, Torres Strait Islander, Middle Eastern,
South Asian, Pacific Islander and North African
• Family history of prediabetes or type 2 diabetes
• Personal history of GDM
• Polycystic Ovary Syndrome (PCOS)

Modifiable Risk Factors
• Overweight/obesity
• Waist circumference (Caucasian Men: > 94cm, Asian Men: > 90cm, Women: > 80cm)
• Unhealthy eating patterns
• Insufficient physical activity and/or excessive sedentary behaviour
• Smoking
• Poor sleep
• High blood pressure
• Metabolic syndrome
• Medications that can induce hyperglycaemia including steroids