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Phase 3a > GP - Endo > Flashcards

GP - Endo Flashcards

1
Q

What are the clinical features of T1DM/diabetic ketoacidosis (DKA)?

A
  • Recent weight loss
  • Acute onset (hours to days)
  • Abdominal pain
  • Polyuria/polydipsia/dehydration
  • Kussmaul respiration
  • Acetone (pear drop) smelling breath
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2
Q

What are the investigations for T1DM?

A
  • Urine dipstick (glucose/ketones)
  • Fasting glucose (>7) and random glucose (>11.1)
  • Diabetes-specific autoantibodies (anti-GAD/ICA/IAA/IA-2A)
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3
Q

What is the management for T1DM?

A
  • HbA1c monitoring every 3-6 months
  • Self-monitoring of blood glucose (target = 4-7)
  • Insulin
  • Metformin (consider adding if BMI >25)
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4
Q

What are the clinical features of T2DM?

A
  • Often picked up incidentally on routine bloods
  • Polydipsia/polyuria
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5
Q

What are the investigations for T2DM?

A
  • Fasting glucose >7
  • Random glucose >11.1
  • HbA1c >48
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6
Q

What is the management for T2DM?

A
  • Dietary advice = high fibre/low glycaemic index carbs/low-fat dairy products/oily fish/reduce saturated fats
  • HbA1c monitoring every 3-6 months
  • FIRST LINE = Metformin (biguanide)
  • SGLT-2 inhibitors e.g. dapagliflozin (if risk of CVD/CVD/chronic HF)
  • DPP-4 inhibitor (e.g. sitagliptin)/pioglitazone/sulfonylurea (e.g. gliclazide)
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7
Q

What are complications of T2DM?

A
  • ED
  • Diabetic neuropathy
  • Diabetic retinopathy
  • Increased risk of infection
  • Increased risk of dementia
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8
Q

What findings are seen in DKA?

A
  • Acideaemia (metabolic acidosis)
  • Hyperglycaemia
  • Ketonaemia
  • Raised creatinine
  • Low bicarbonate
  • High potassium
  • Normal/high sodium
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9
Q

What is the management for DKA?

A
  • Fluid replacement = 0.9% sodium chloride with potassium chloride
  • Long-acting insulin continued, short-acting insulin stopped
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10
Q

Describe the most common cause of hypothyroidism

A

Hashimoto’s thyroiditis
- Autoimmune disease
- Anti-TPO antibodies
- More common in women
- High TSH, low /T3T4
- Give levothyroxine

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11
Q

What are the clinical features of hypothyrodism?

A
  • Cold intolerance
  • Weight gain
  • Lethargy
  • Dry skin/hair
  • Non-pitting oedema
  • Constipation
  • Menorrhagia
  • Carpal tunnel syndrome
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12
Q

Describe the most common cause of hyperthyroidism

A

Grave’s disease
- Autoimmune disease
- IgG autoantibodies bind to and activate thyrotropin receptors (TSH receptor antibodies)
- Low TSH, high T3/T4

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13
Q

What is the management for hyperthyroidism?

A
  • Propranolol = often used at time of diagnosis to control thyrotoxic symptoms
  • Carbimazole = reduces thyroid hormone production
  • Radioiodine
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14
Q

What are the clinical features of hyperthyrodism?

A
  • Heat intolerance
  • Weight loss
  • Restlessness
  • Palpitations/tachycardia
  • Increased sweating
  • Clubbing
  • Oligomenorrhoea
  • Anxiety/tremor
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15
Q

What are some ACTH dependent causes of Cushing’s syndrome?

A
  • Cushing’s disease = ACTH-secreting pituitary tumour –> adrenal hyperplasia
  • Ectopic ACTH production e.g. small cell lung cancer
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16
Q

What are some ACTH independent causes of Cushing’s syndrome?

A
  • Iatrogenic e.g. steroids (most common)
  • Adrenal adenoma
  • Adrenal carcinoma
17
Q

What is pseudo-Cushing’s?

A
  • Mimics Cushing’s (high cortisol)
  • Often due to alcohol excess or severe depression
  • Causes false positive dexamethasone suppression test or 24 hour urinary free cortisol
  • Insulin stress test used to differentiate
18
Q

What are the investigations for Cushing’s syndrome?

A
  • Hypokalaemia metabolic alkalosis
  • Impaired glucose tolerance
  • Ectopic ACTH secretion = low potassium
  • Overnight dexamethasone suppression test = cortisol not suppressed
  • 24 hour urinary free cortisol
  • Bedtime salivary cortisol
19
Q

What is the investigation for determining the cause of Cushing’s syndrome?

A

High-dose dexamethasone suppression test
- Cushing’s disease = cortisol and ACTH suppressed
- Ectopic ACTH syndrome = cortisol and ACTH not suppressed
- Other causes = cortisol not suppressed and ACTH suppressed

20
Q

What are some causes of acromegaly?

A
  • Excess growth hormone secondary to pituitary adenoma (most common)
  • Ectopic GHRH
  • GH production by tumours e.g. pancreatic
21
Q

What are the investigations for acromegaly?

A
  • Serum IGF-1 levels = raised
  • Oral glucose tolerance test = no suppression of GH with hyperglycaemia
  • Pituitary MRI = pituitary tumour
22
Q

What is the management for acromegaly?

A
  • Trans-sphenoidal surgery (first line)
  • Somatostatin analogue e.g. octreotide = directly inhibits GH release
  • GH receptor antagonist e.g. pegvisomant
  • Dopamine agonist e.g. bromocriptine
23
Q
A

Phase 3a (21 decks)

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