Medicine Flashcards

1
Q

Acromegaly
Investigations:
management:

A

Serum IGF-1 levels
OGTT only recommended to confirm the diagnosis if IGF-1 levels are raised
Serum IGF-1 may also be used to monitor disease

Trans-sphenoidal surgery is first line
if unsuccessful: Octreotide
Pegvisomant (does not reduce tumour size)

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2
Q

Addisons disease

Electrolyte disturbance:

Investigation:

Management:

Management with intercurrent illness

A

Hyponatraemia and hyperkalaemia and Hypoglycaemia

Short-SYNACTHEN test

Hydrocortisone: usually around 30 mg/day
Fludrocortisone

Glucocorticoid dose should be doubledwith fludrocortisone staying the same. In crisis, patients may require IM formulation

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3
Q

Carbimazole:

Mechanism of action

Adverse effects

A

Blocks thyroid peroxidase from coupling and iodinating residues on thyroglobulin -> reducing thyroid hormone

Agranulocytosis
Crosses the placenta - may be used in only low doses in pregnancy

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4
Q

Glucocorticoid side effects:

endocrine:

MSK:

Immunosuppression:

Psychiatric:

Gastrointestinal:

Ophthalmic:

A

Impaired glucose regulation, increased appetite and weight gain, hirsutism, hyperlipidaemia

Osteoporosis, proximal myopathy, AVN of femoral head

Increased susceptibility to severe infection, reactivation of TB

Mania, insomnia, depression

Peptic ulceration, acute pancreatitis

Glaucoma, cataracts

Misc: suppression of growth in children, intracranial hypertension, neutrophilia

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5
Q

Cushing’s syndrome:

Tests:

First line localisation test:

Explain high-dose dexamethasone suppression test

Other tests:

Insulin stress test:

A

1) Overnight (low-dose) dexamethasone suppression test (1st line) -> Patient’s with Cushing’s do not have their morning cortisol spike suppressed.
2) 24 hr urinary cortisol
3) Bedtime salivary cortisol

9am and midnight plasma ACTH (and cortisol) levels

Cortisol (not suppressed) ACTH (suppressed) = Cushing’s syndrome

Cortisol (suppressed) ACTH (suppressed) = Cushing’s disease (Pituitary ACTH secretion)

Cortisol (not suppressed) ACTH (not suppressed) = ectopic ACTH syndrome

Petrosal sinus sampling of ACTH may be needed to differentiate between pituitary and ectopic ACTH secretion

Used to differentiate between true Cushing’s and pseudo-cushing’s

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6
Q

Diagnostic criteria for T1DM:

C-peptide levels in T1DM

A

Fasting glucose greater than or equal to 7
Random glucose greater than or equal to 11.1 (or after 75g OGTT)

If asymptomatic this must be demonstrated on at leats 2 occasions

Low

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7
Q

Diagnostic criteria for T2DM:

If HbA1c used:

A

Fasting glucose greater than or equal to 7
Random glucose greater than or equal to 11.1 (or after 75g OGTT)

HbA1c of greater than or equal to 48 (6.5%)
In patients without symptoms, the test must be repeated to confirm the diagnosis.

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8
Q

T2DM management:

HbA1c to aim for:

HbA1c to add drug:

HbA1c target if on hypoglycaemic drug

Drug regime:

If missing targets on triple therapy:

If starting insulin, which drug should be continued

Risk-factor modification: Htn:

Should statins be offered:

A

48 (6.5)

58

53 (7)

Metformin
Metformin plus SGLT2i (if any cardio risk, CVD, CHF)

If metformin contraindicated: (CV risk) SGLT2i
if no CV risk - DPP-4, sulphonylurea or pioglitazone

switch one of the drugs to a GLP-1 mimetic (liraglutide) - BMI >35 or BMI <35 if insulin would have significant occupational implications

Metformin

ACEi first line

only if QRISK >20%

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