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AKT Prep > Metabolic and Endocrine > Flashcards

Metabolic and Endocrine Flashcards

1
Q

A 41-year-old trans woman requires long-term oestrogen therapy.

Which is the SINGLE MOST appropriate preparation?

A

Estradiol patch

All oestrogens associated with increased VTE risk but evidence transdermal may be safer

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2
Q

What is subclinical hypothyroid? How should it be managed?

A

TSH rasied but T4 normal

Start treatment if TSH > 10 (on 2 occasions, 3 months apart)

OR if symptomatic and TSH above reference but below 10 (on 2 occasions 3 months apart)

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3
Q

What is the most sensative serological test for autoimmune hypothyroidism?

A

anti-TPO antibodies

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4
Q

What is the role of testing for TBG? (Thyroid binding globulin)

A

If a patient appears to have normal thyroid function but an unexplained high or low T4, or T3, it may be due to an increase or decrease of TBG. Direct measurement of TBG can be done in such cases to avoid incorrectly diagnosing these patients with hypo or hyperthyroidism.

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5
Q

How should subclinical HYPERthyroidism be managed?

A

If asymptomatic - rpt in 3 months

Around 5% convert to hyperthyroidism each year

If 2 readings <0.1, goitre, antibody positive or any symptoms - refer to endocrine

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6
Q

Presence of vanillylmandelic acid (VMA) in a 24 hour urine sample is diagnostic for which condition?

A

Phaeochromocytoma

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7
Q

What 4 aspects of dietary advice should be given to diabetics?

A

Healthy balanced diet that includes
- High fibre
- Low-glycaemic index sources of carbohydrate (such as fruit, vegetables, wholegrain, and pulses)
- Low-fat dairy products
- Oily fish.

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8
Q

What is the name of the scale that assesses likelihood of thyrotoxicosis?

A

Burch-Wartofsky scale

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9
Q

Name 5 presenting features of thyrotoxicosis?

A

Fever/ hyperthermia
Tachycardia, agitation,
Hypertension
Atrial fibrillation
Heart failure
Jaundice
Delirium and/ or coma

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10
Q

Name 3 possible precipitants of thyrotoxicosis?

A

Stopping medication/ new diagnosis
Trauma
Acute illness
Pregnancy
Surgery

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11
Q

How does amiodarone affect thyroid function?

A

Around 13% of those taking amiodarone get amiodarone induced hypothyroidism

If TSH >15 - Start levothyroxine
(Note dose amiodarone is independant of thyroid effects)

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12
Q

Neonatal diabetes is associated with which main risk factor?

A

IUGR

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13
Q

Type 1 diabetes:
1) When most commonly diagnosed seasonally?
2) Inhertited more from dad or mum?

A

1) More commonly diagnosed in the winter months

2) 2-3x more common in children of diabetic men than women

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14
Q

What are the fasting and 2hr OGTT cut off’s for diagnosis of gestational diabetes?

A

A fasting plasma glucose level of 5.6 mmol/l or above or

A two hour plasma glucose level of 7.8 mmol/l or above.

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15
Q

OGTT is recommended for women with risk factors and what urine results?

A

Glucose 2+ or more on one occasion

Glucose 1+ on 2 or more occasions

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16
Q

Which antibody is associated with graves disease?

A

Thyroid stimulating hormone receptor antibodies (TRAbs)

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17
Q

Who is eligable for diabetic retinopathy screening?

A

All people aged 12 years and over with diabetes (type 1 and 2) are offered annual screening appointments for diabetic retinopathy. The only exceptions are people with diabetic eye disease who are already under the care of an ophthalmology specialist.

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18
Q

What is the PREFERRED FORMAT for delivery of structured patient education for patients with newly diagnosed type 2 diabetes?

A

Group
(Recommendation is all people should be offered this at time of diagnosis)

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19
Q

Diabetic hba1c targets:
a) Lifestyle controlled
b) SIngle, low hypo risk drug controlled
c) Multiple drugs or drug with hypo risk controlled

A

a+b) 48mmol
c) 53mmol

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20
Q

At which SINGLE THRESHOLD birth weight of a previous baby should an expectant mother be offered a screening test for gestational diabetes mellitus?

A

4.5kg

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21
Q

When considering MODY, what age at diagnosis and length to insulin treatment raise suspicion of this diagnosis rather than T2DM?

A

Age diagnosed under 35
Require insulin within the first 6 months

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22
Q

Renal stones are most commonly composed of what?

A

Calcium oxalate

(So hypercalcaemia etc is RF, as well as berry/ spinach intake etc)

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23
Q

What calcium cut off would require same day hosptial admission?

What is the most common underlying cause?

A

> 3.5mmol

(Malignancy most common underlying cause)

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24
Q

How do you decide starting dose of levothyroxine in hypothyroid patients?

A

NICE guidelines suggest starting levothyroxine at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms)

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25
Q

How common is post-partum thyroiditis? How does it present?

How is it managed?

A

Occurs in 10% of all pregnancies and may be biphasic (i.e. it may involve a period of hyperthyroidism followed by a period of hypothyroidism).

Symptomatic treatment with a beta-blocker is usually all that is required.

26
Q

What is microvascular angina?

A

Microvascular angina (previously known as Cardiac syndrome X) is characterised by angina-like chest discomfort, ST-segment depression during exercise, and normal coronary arteries at angiography.

27
Q

What characterises HHS?

A

Hyperosmolar hyperglycaemic state (HHS) is characterised by hyperosmolarity, hyperglycaemia and dehydration without significant ketosis.
Seen in Type 2 diabetes and most often in the elderly.
Although not as common as diabetic ketoacidosis, it has a higher mortality rate. It often develops gradually whereas diabetic ketoacidosis (DKA) is often more sudden onset.

28
Q

What happens to thyroid markers in hyperemesis gravidarum?

How do you distinguish this with graves disease?

A

Thyroid function is abnormal in 50–60% of patients with hyperemesis gravidarum.
- Correlates with human chorionic gonadotrophin (HCG) levels and the severity of the hyperemesis.

Differentiation from thyrotoxicosis is based on the pre-pregnancy history, presence or absence of thyroid antibodies and the lack of other features of Graves’ disease in hyperemesis.

29
Q

Patients with renal failure commonly have what calcium abnormality? What parathyroid changes does this cause?

A

Renal failure commonly have low calcium

This stimulates increase PTH = Secondary hyperparathyroidism

30
Q

A 64-year-old gentleman whose type 2 diabetes mellitus has recently been declared in remission is asking for advice about future management plans for his diabetes. What do you advise?

A

Maintain annual diabetic reviews (Full)

Don’t just do HbA1c, need continuing to screen for complications

31
Q

A patient taking 125mcg of levothyroxine becomes pregnant. You arange bloods and referral to endocrine, what else should be done regarding her levothyroixine dose?

A

All hypothyroid patients who become pregnant -

Increase levothyroxine 25-50mcg or 30-50% before waiting for bloods when becomes pregnantY

32
Q

Your patient has CKD and hypertension. What ACR cut off’s would change your decision on ACEI vs. CCB?

A

ACR > 30 = ACEI
ACR <30 = CCB

(Assuming no other reasons to choose alternative)

33
Q

What are the main contraindications and risks with pioglitazone?

A

Avoid in heart failure and acute porphyria

small increased risk of bladder cancer, bone fractures and liver toxicity

34
Q

What Na and K abnormalities are seen in addisons disease?

A

Hyponatraemia is present in 90% and hyperkalaemia in 65% of people with established Addison’s disease.

35
Q

What test can be used to distinguish between T1DM and MODY in a patient who has had diabetes for > 5yrs?

A

C-peptide

C peptide is co-secreted with insulin from the β cell and can be measured in blood or urine. Levels gradually reduce in type 1 diabetes and after 3–5 years should be undetectable. In contrast, this test will be near normal in MODY as the pancreas remains active.

36
Q

A 52-year-old man has poorly controlled type 2 diabetes despite good concordance with both diet and lifestyle. He is on maximal oral therapy, but, despite this, his HbA1c level is 86 mmol/mol and his blood sugars average 14 mmol/l. He also has a total cholesterol of 9 mmol/l and a triglyceride level of 20 mmol/l.

Which is the SINGLE MOST effective drug intervention to correct both his dyslipidaemia and glycaemic control?

A

For people with diabetes, the most effective method of reducing mixed hyerlipidaemia is good glycaemic control.

Hypertriglyceridaemia secondary to poor diabetic control does not respond well to lipid lowering agents. Treating the diabetes is the first priority

37
Q

Addisons disease is most commonly caused by:
a) In the developed world
b) Developing world

A

a) Autoimmune
b) TB

38
Q

You suspect a patient has post-partum thyroiditis. What is the most important first investigation to perform?

A

Thyroid antibodies

(Two types, one settles spontaneously, the other is exacerbation of autoimmune/ graves)

A quarter of patients with post-partum thyroiditis progress to hypothyroidism in five years.

39
Q

Which investigation is MOST likely to confirm the diagnosis of Addison’s disease?

A

Short synacthen test

40
Q

What is the estimated PERCENTAGE of people with both diabetes and peripheral arterial disease who will EVENTUALLY require a lower limb amputation?

A

Of patients with intermittent claudication, 1–2% will eventually undergo amputation. The risk of amputation is higher (about 5%) in patients with diabetes.

41
Q

Metformin eGFR cut off’s:

A

45 - with caution/ reduce
< 30 - Stop

42
Q

T1DM HbA1c target (assuming no hypoglycemia problems)?

A

48mmol
(Aiming to reduce vascular complications)

43
Q

Which is the SINGLE BEST method of assessing proteinuria in a patient with type 2 diabetes and chronic kidney disease (CKD)?

A

Urine ACR

44
Q

What treatment options are used in gestational diabetes?

A

Metformin
Insulin

45
Q

What level of 9am serum cortisol would prompt immediate discussion with endocrine team?

A

A 9am serum cortisol of <150 nmol/L needs immediate discussion with the endocrinology team as deficiency is highly likely. The most likely cause of primary cortisol deficiency is Addison’s disease.

46
Q

A 40-year-old woman has mild thyroid eye disease. Which SINGLE supplement is the MOST likely to slow disease progression?

A

Selenium slows disease progression and improves quality of life in mild thyroid eye disease.

47
Q

A patient has a new eGFR of 56 (previously 70). When should you repeat?

A

Repeat the renal profile within two weeks if the eGFR is less than 60 mL/min/1.73 m2.

ACR and MSU should also be checked

48
Q

Name 3 signs specific to Graves disease?

A

Graves Ophthalmopathy
Pretibial myxoedema
Thyroid acropachy

49
Q

Name 4 possible symptoms of high calcium (and therefore also conditions like hyperparathyroid which raise calcium)

A

Bones, stones, abdominal groans and psychological moans
(Also dehydration - polyuria, polydipsia)

Osteoporosis, kidney stones, gastrointestinal upset and tiredness or depression can be present.
Acute pancreatitis can be a rarer result of hypercalcaemia.

50
Q

Name 3 features of possible addisonian crisis?

A

Hypotension/ shock,
Delirium/ reduced consciousness
Acute abdominal pain/ vomiting
Headache/ low-grade fever
Muscle weakness

Low sodium/ high potassium on bloods

51
Q

What are the recommended tests for cushing syndrome?

A

24 hour urine free cortisol (ideally 3x, diagnostic if 2/3 are abnormal)

Dexamethasone suppression test (1mg overnight)

52
Q

What is the recommended initial screening test for acromegaly? How is a positive result managed?

A

IGF-1
(Normal levels exclude)

If raised proceed to OGTT

53
Q

A 68-year-old woman had diffuse muscular aches and proximal muscle weakness, with a low serum 25 hydroxyvitamin D. Since starting oral vitamin D one month ago her symptoms have resolved.

Which is the SINGLE MOST appropriate blood investigation to NOW recommend and why?

A

Adjusted serum Ca

Adjusted serum calcium should be checked one month after starting vitamin D supplementation in case primary hyperparathyroidism has been unmasked

54
Q

What is the relationship between prolactin and dopamine?
What conditions can therefore cause a raised prolactin?

A

Secretion of prolactin is inhibited by dopamine so anything that decreases the level of dopamine presenting to the anterior pituitary can cause hyperprolactinaemia.

I.e. pregnancy, many drugs, PCOS can all raise prolactin levels

55
Q

Name the three most common drug causes of hyponatremia?

A

SSRI’s
Diuretics
Antipsychotics

56
Q

Best estimate of current gestational diabetes incidence in UK?

A

5%

57
Q

What is the target blood pressure for patients with established diabetic nephropathy with an albumin:creatinine ratio of > 70 mg/mmol?

A

<130/80

58
Q

In adults, what is the SINGLE MOST common complication of severe and prolonged vitamin D deficiency?
Why?

A

Osteomalacia

PTH becomes chronically elevated resulting in demineralisation of bone

59
Q

How does osteomalacia mainly present?

A

Weakness of pelvic girdle muscles (30%)

60
Q

Name 3 indications for c-peptide testing?

A

1) Unexpected features e.g. BMI > 25 kg/m2, age > 50 years, slow evolution of hyperglycaemia or a long prodrome

2) Suspected MODY and would guide genetic testing

3) Diagnosis uncertain

AKT Prep (22 decks)

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