Key concepts

Question 1

_______ is a form of type 1 DM, with slower progression to insulin dependence in later life

Answer 1

Latent autoimmune diabetes of adults (LADA)

Question 2

In T1DM _______ gene detrmines Islets sensitivity to damage from viruses or cross-reactivity from cows’ milk-induced antibodies.

Answer 2

6Q

Question 3

Maturity onset diabetes of the young (MODY) is a rare autosomal dominant form of ____ affecting young people

Answer 3

T2DM

Question 4

What are the indicators of Impaired glucose tolerance?

Answer 4

• Fasting plasma glucose <7mmol/L
• OGTT (oral glucose tolerance) 2h glucose ≥7.8mmol/L but <11.1mmol/L.

Question 5

There may be lower risk of progression to DM in IFG than ___.

Answer 5

Impaired glucose tolerance (IGT).

Question 6

Glycated haemoglobin (HbA1c) relates to mean glucose level over previous____ period

Answer 6

8 weeks.

Question 7

Cotton wool spots and Blot haemorrhages are caused by _______.

Answer 7

Microvascular occlusion at the interfaces with perfused retina

Question 8

What is Rubeosis iridis seen in diabetes ?

Answer 8

New vessels on iris that occurs late in the disease and may lead to glaucoma

Question 9

What are the BP Tx indications in T1DM ? (NICE 2015)

Answer 9

Treat BP if >135/85mmHg, unless albuminuria or two or more features of metabolic syndrome, in which case it should be 130/80mmHg

Question 10

What are the BP targets in T2DM ? (NICE 2015)

Answer 10

Target BP <140/80mmHg or <130/80mmHg if kidney, eye, or cerebrovascular damage.

Question 11

in diabetes loss of transverse arch and
rocker-bottom soles are caused by ?

Answer 11

loss of pain sensation, leading to > mechanical stress and repeated joint injury leading to these two deformities.

Question 12

what are the steps of diabetic foot care?

Answer 12

1 Neuropathy (clinically).
2 Ischaemia (clinically + Doppler ± angiography).
3 Bony deformity, eg Charcot joint (clinically + X-ray).
4 Infection (swabs, blood culture, X-ray for osteomyelitis, probe ulcer to reveal depth)

Question 13

what are the non-diabetic causes of Charoct’s joints ?

Answer 13

Tabes dorsalis, spina bifi da, syringomyelia, and leprosy.

Question 14

what is the course of drug therapy escalation in diabetic neuropathy ?

Answer 14

paracetamol
 tricyclic (amitriptyline 10–25mg nocteurnal ; gradually > to 150mg)
 duloxetine, gabapentin, or pregabalin
 opiates

Question 15

What is diabetic amyotrophy ?

Answer 15

Painful wasting of
quadriceps and other pelvifemoral muscles

Question 16

What is gustatory sweating?

Answer 16

Gustatory hyperhidrosis is a form of focal hyperhidrosis that presents with facial flushing and excessive sweating of the forehead, face, and scalp after smelling or ingesting certain food products, such as sour or spicy foods, coffee, and chocolate. The causes are diabetes and fray syndrome.

Question 17

What are the features of diabetic autonomic neuropathy ?

Answer 17

Postural BP drop
 < cerebro vascular autoregulation
loss of respiratory sinus arrhythmia (vagal neuropathy)
 gastroparesis, urine retention; erectile dysfunction; and gustatory sweating

Question 18

What is the acronym EXPLAIN stands for in non- diabetic hypoglycaemia?

Answer 18

*Exogenous drugs
*Pituitary insuffi ciency.
*Liver failure, + some inherited enzyme defects.
*Addison’s disease.
*Islet cell tumours (insulinoma) and immune hypoglycaemia (eg anti-insulin
receptor antibodies in Hodgkin’s disease).
*Non-pancreatic neoplasms, eg fibrosarcomas and haem angiopericytomas

Question 19

what is Whipple’s triad of hypoglycaemia?

Answer 19

symptoms or signs of hypoglycemia +
low plasma glucose + resolution of symptoms or signs post glucose rise.

Question 20

What are the findings in hypoglycaemia due to non-pancreatic neoplasm/ anti-insulin receptor antibodies?

Answer 20

Insulin low or undetectable with no excess ketones

Question 21

What causes hypoglycaemia with low insulin and increased ketones ?

Answer 21

alcohol, pituitary insuffi ciency, or Addison’s disease

Question 22

In Hypoglycaemic hyperinsulinaemia ____ only detectable, if the insulin is endogenously released.

Answer 22

C-peptide.

Question 23

What are the causes of ? Hypoglycaemic hyperinsulinaemia

Answer 23

• Insulinoma ( C-peptides elevated).
• sulfonylureas ( C-peptide elevated)
  *insulin injection ( C-peptide undetectable).

Question 24

What are the causes of dumping syndrome or post prandial hypoglycaemia ?

Answer 24

• gastric/bariatric surgery.
• T2DM

Question 25

What is insulinoma ?

Answer 25

*This often benign (90–95%) pancreatic islet cell tumour is sporadic or seen with MEN-1.

Question 26

What is the screening test for insulinoma ?

Answer 26

Hypoglycaemia + > plasma insulin during a long fast.

Question 27

What is the C-peptide suppression test in insulinoma ?

Answer 27

Give IV insulin and measure C-peptide. Normally exogenous insulin suppresses C-peptide production, but this does not occur in insulinoma.

Question 28

What is nesidioblastosis ?

Answer 28

It is a hyperinsulinaemic hypoglycaemia in which there is no evidence of insulinoma but beta cells of the islets of Langerhans hyperplasia and the treatment is distal pancreatectomy which is curative.

Question 29

Most T3 and T4
in plasma is bound to what protein ?

Answer 29

thyroxine-binding globulin (TBG)

Question 30

Free T4 and T3 are more useful than total T4 and T3 as the latter are affected by____ concentration.

Answer 30

TBG

Question 31

What are the causes of reduction in TBG?

Answer 31

*nephrotic syndrome and malnutrition
* chronic liver disease, and acromegaly
* drugs (androgens, corticosteroids, phenytoin)

Question 31

What is the hyperthyroid condition that causes increase in TSH ?

Answer 31

TSH-secreting pituitary adenoma

Question 32

What is Sick euthyroidism?

Answer 32

In any systemic illness, TFTS may become deranged. The typical pattern is for ‘everything to be low’. The test should be repeated after recovery.

Question 33

In factitious hyperthyroidism ____ will be low ?

Answer 33

Serum thyroglobulin

Question 34

What is the presentation of ovarian teratoma with thyroid tissue?

Answer 34

Hyperthyroidism

Question 35

What is the cause of Primary atrophic hypothyroidism?

Answer 35

Diff use lymphocytic infiltration of the thyroid, leading to atrophy, hence no goitre.

Question 36

what is the effect of pregnancy on TBG, T3 and T4?

Answer 36

• The hyperestrogenic state during pregnancy stimulates the synthesis of thyroid-binding globulin (TBG) and increases TBG’s glycosylation. This process slows the clearance of TBG, increasing its serum level.
• As more free T3 and T4 bind to TBG, the level of free thyroid hormones decreases.
• Consequently, the pituitary gland secretes more TSH, enhancing the production and secretion of thyroid hormones. This achieves a new equilibrium in which the total T3 and T4 levels (i.e., bound and unbound T3 and T4) are increased while the free T3 and T4 levels are normal.

Question 37

In the kidney, PTH promotes Ca2+ reabsorption from the ____ convoluted tubule.

Answer 37

distal

Question 38

In a thyroid specimen large pleomorphic and spindle-shaped cells, favouring the diagnosis of _______carcinoma.

Answer 38

Anaplastic

Question 39

A unilateral adenoma is treated with surgical resection, while bilateral adenomas are treated with ________________ such as eplerenone and spironolactone.

Answer 39

aldosterone antagonists