ILA 6 - Weight gain and TATT

Question 1

Where should you go for guidelines on contraception?

Answer 1

UK MEC

Faculty of Sexual and Reproductive Health:
https://www.fsrh.org/home/

Question 2

Emergency contraception.

a) The 2 pills
b) Time window for each
c) Other form

Answer 2

a)
b)
c)

Question 3

Diabetes - treatment targets

a) If on drug that doesn’t cause hypoglycaemia
b) If on drug that can cause hypoglycaemia

Answer 3

a) HbA1c < 48

b) HbA1c < 53

Question 4

Diabetes - diagnostic thresholds

a) Pre-diabetes - fasting, OGTT, HbA1c (random glucose not suitable for pre-diabetes diagnosis)
b) Diabetes - fasting, random, OGTT, HbA1c
c) How many readings are necessary? (exception)
d) How long after OGTT do you take readings?
e) Who is HbA1c not suitable for?

Answer 4

a) fasting (5.5 - 7.0), random (), OGTT (7.8 - 11.1), HbA1c (42 - 47)
b) fasting (> 7.0), random (), OGTT (> 11.1), HbA1c (> 47)
c) 2 readings on 2 separate days (unless symptomatic)
d) 2 hours
e) T1DM, gestational diabetes, children, sickle cell/other haemoglobin disorders

Question 5

Pre-diabetes: management.

a)

Answer 5

a)

Question 6

Gestational diabetes.

a) Diagnostic thresholds - fasting, OGTT

Answer 6

a) Fasting - 5.6 or above, OGTT - 7.8 or above

Question 7

NAFLD.

a) Fatty liver disease progression
b) Risk factors
c) Drug causes
d) Presentation
e) How to identify patients at risk of fibrosis
f) Management

Answer 7

a) Steatosis — Steatohepatitis — Fibrosis — Cirrhosis
b) Obesity, diabetes, hyperlipidaemia, hypercholesterolaemia, sudden weight loss
c) Methotrexate, amiodarone, tetracyclines
d) Asymptomatic. Incidental blood test - raised LFTs (if ALT: AST ratio is >0.8, likely to be NAFLD rather than ALD)

e) NAFLD fibrosis score:
https: //www.mdcalc.com/nafld-non-alcoholic-fatty-liver-disease-fibrosis-score

f) Weight loss, etc. Manage their CV risk

Question 8

Liver function tests.

a) Anaemia + raised UCB
b) Raised CB, ALT and AST
c) Which enzyme is most liver specific?
d) Fever, RUQ pain, dark urine. What would you expect from the LFTs?
e) Obstructive jaundice - what would you expect?
f) Alcoholic liver disease - what would you expect?

Answer 8

a) Haemolytic anaemia
b) Intrahepatic causes
c) aLt, (note: AST also produced by muscle- if isolated raised AST, do a CK)
d) Viral hepatitis - raised ALT, raised AST, raised UCB
e) Raised UCB, raised ALP and GGT (if GGT not raised - do a bone profile)
f) AST: ALT ratio >2

Question 9

TATT: establish what they actually mean

Answer 9

• Fatigue/anergia