Other Flashcards
What is indicated by the arrow?
Lateral limb of adrenal gland
What are the restrictive options for bariatric surgery?
Gastric banding, sleeve gastrectomy
What is adaptive thermogenesis?
Resting metabolic rate of someone who is overweight will adjust down by more than you would expect simply on the basis of change in body composition
Body perceives weight loss as a threat to survival, so adaptive thermogenesis acts as a brake on further weight loss
What is indicated by the arrow?
Sella turcica
What dietary changes are necessary to prevent side effects of orlistat?
Hypocaloric and low fat diet
What is the target BG level for a diabetic individual before exercise?
7 and 15 mmol/L before exercise
Name two observational interventional designs
Interrupted time series, non-randomised cohort
What are the blood glucose targets for pregnant women with diabetes?
Fasting: <5.4 mmol/l
1 hour after meals: below 7.8 mmol/l
2 hours after meals: below 6.4 mmol/l
Intrapartum: 4-7 mmol/l (reduces risk of neonatal hypoglycaemia post delivery)
What is the mechanism of action of orlistat?
Lipase inhibitor - blocks absorption of dietary fat
When is the maximum period of time orlistat can be prescribed?
Prescribing guidance says 2 years
Evidence of safety for 4 years
What is indicated by the arrows?
Hypothalamus
What is a critical appraisal?
Interpreting conflicting conclusions in the literature to obtain consensus, ultimately to inform guidelines e.g. SIGN
What is an non-randomised cohort design?
Main design before and after, can be improved with addition of controls but always have unknown confounding variables so difficult to determine causality
What is indicated by the arrow?
Oesophagus
What is intention-to-treat analysis?
Patient is analysed in the group they were randomised to irrespective of subsequent changes - reflects the real clinical world
What is indicated by the arrow?
Trachea
What is indicated by the arrows?
Common carotid arteries
What is the strongest form of scientific evidence?
Meta-analyses and systemic reviews
What is indicated by the arrow?
Medial limb of adrenal gland
How can an individual prevent hyperglycaemia during/after exercise?
Avoid exercise if BG > 14 mmol/L or ketones present
What is the aim of ketone monitoring?
Aim to detect risk of diabetic ketoacidosis
Discuss the 4 phases of drug development
Phase 1: safety, dose finding, volunteers (3-30)
Phase 2: safety, how effective, how often? (30-50)
Phase 3: efficacy, safety (100+)
Phase 4: post approval in large population (1000+)
What are the blood glucose targets for T2DM?
Before meals: 4-7 mmol/l
Two hours after meals: <8.5 mmol/l
Discuss the genes implicated in obesity
In an evolutionary context being able to optimise response to feeding opportunities was an advantage (‘thrifty genotype’), however this is maladaptive in today’s environment - a subset of the population may have a stronger ‘thifty genotype’ (e.g. insulin resistance) and therefore be more susceptible to put on weight
How can an individual with T1DM reduce the risk of hypoglycaemia?
Carry an emergency supply of CHO and diabetic ID
Check BG frequently (especially before bed)
Never consume alcohol on an empty stomach
Be aware that stress, illness and exercise can affect BG levels
What is indicated by the arrow?
Pituitary stalk
What is a parallel group RTC?
Each subject is randomized to one of two or more distinct treatment/intervention groups
Stratification is the partitioning of subjects and results by a factor other than the treatment given
What are the blood glucose targets for children with T1DM?
On waking and before meals: 4-7 mmol/l
After meals: 5-9 mmol/l
What is HbA1c?
Formed by non-enzymatic glycation of haemoglobin on exposure to glucose
Increases in a predictable way in response to prevailing glucose, and can be used to measure average glycaemic control over a prolonged period of time (6-8 weeks)
Name the gold standard method to assess efficacy of treatment or develop causal relationship
Randomised controlled trials
How would you manage early hypoglycaemia?
15-20g rapidly absorbed carbohydrate
What is a cluster randomisation RTC?
Intervention at the group level e.g. new appointment system in general practice
What is the HbA1c target for diabetic individuals?
< 53 mmol/mol
What is a contract?
Agreement to do something or allow someone to do something to them
Name the most effective long-term intervention for weight loss
Bariatric surgery
Discuss the dietary and lifestyle recommendations for a patient with T1DM
Adjusting insulin to carbohydrate intake (‘carbohydrate counting’)
Fixed insulin regimes - aim for consistent quantities of carbohydrates on a day-to-day basis
Increased physical activity
Define consent
Agreement to do something or allow someone to do something to them
Can be withdrawn by the consented anytime without penalties
What is a retrospective cohort study?
Cohort formed in the past and followed up to the present
What is indicated by the arrow?
Isthmus
What is indicated by the arrows?
Internal jugular veins
What percentage weight loss would a patient on orlistat need to loose in order for continued therapy to be indicated?
Patients lose ≳5% of bodyweight in first 3 months
Patients lose ≳10% of bodyweight in first 6 months
What are the restrictive and malabsorptive options for bariatric surgery?
Gastric bypass
Discuss the dietary and lifestyle recommendations for an overweight patient with T2DM
600kcal deficit, ≳150 mins per week of moderate to vigorous physical activity over at least 3 days per weak
Name 3 methods of blood glucose monitoring
Self-monitoring of blood glucose, continuous glucose monitoring, flash glucose monitoring
What is indicated by the arrows?
Carotid arteries
What is indicated by the arrow?
Inferior vena cava
What are the blood glucose targets for hospitalised patients?
6-10 mmol/L
What is the most common insulin regimen?
Basal (long acting - between meals) bolus (rapid acting - glucose from meals)
Why are diabetics who use insulin/SUs at risk of a hypo if they consume alcohol?
Alcohol increases activity of insulin
While the liver is processing alcohol it cannot release glucagon to reverse a hypo
What does this scan indicate?
Thyroiditis - homogenously reduced tracer uptake
How does carbohydrate counting work?
Identify which foods contain carbohydrate (CHO)
Calculate/estimate the CHO content of the meal
Calculate insulin dose needed to ‘cover’ CHO eaten (e.g. ratio 10:1)
What is a crossover RTC?
Each patient receives all treatments
Order of receipt is randomised
What does a p-value at least <0.05 mean?
The result is statistically significant and the null hypothesis can be rejected
What is a case-control design?
Group of subjects with disease or condition are identified (cases)
A suitabe control group is identified without the condition (controls)
Frequency of exposure or risk factor extracted and compared in cases and controls
What is a cross-sectional design?
Carried out at a single point in time, so exposure and outcome measured at same time e.g. census
What is a prospective cohort study?
Cohort followed forward in time from present
What are the blood glucose targets for adults with T1DM?
On waking 5-7 mmol/l
Before meals at other times of the day: 4-7 mmol/l
90 mins after meals: 5-9 mmol/l
6-8 mmol/l before bedtime
What is per-protocol analysis?
Patient analysed in the treatment group they actually received (not necessarily randomised group) - may not reflect the real clinical world, more concerned with science
What is indicated by the arrow?
Sphenoid sinus
What clinical features would indicate a hereditary endocrine disease?
Young age of onset
Tumour multiplicity
Positive FHx
Pathognomonic clinical features
What does this scan indicate?
Graves - homogenously increased tracer uptake
What is a stepped wedge RTC?
Form of cluster randomisation in which order in which each unit receives intervention is randomised, like in crossover design
Used with cluster randomised studies where efficacy already fairly established
What is indicated by the arrow?
Diaphragmatic crus
What is indicated by the arrows?
Strap muscles
What is an interrupted time series design?
Method of statistical analysis involving tracking a long-term period before and after a point of intervention to assess the intervention’s effects
What is a randomised factorial trial RTC?
Two (or more) intervention comparisons are carried out simultaneously e.g. participants may be randomized to receive aspirin or placebo, and also randomized to receive a behavioural intervention or standard care
What is indicated by the arrow?
Aorta
What does this scan indicate?
Multinodular goitre with dominant nodule
When would you prescribe orlistat?
BMI ≳30 kg/m² or ≳28 kg/m² with co-morbid conditions
In Tayside patient must be attending Adult Weight Management Service
How can an individual on insulin prevent a hypo after exercise?
Prevent by adjusting insulin and/or CHO (1g CHO/ky body weight per hour of exercise
What are the ‘sick day rules’ for diabetics?
Take plenty of fluid
Check ketones and BG regularly
Continue taking insulin, even if not eating, may require more insulin than normal
What is indicated by the arrow?
Optic chiasm
