Oxford Clinical Medicine Flashcards
What is the diagnosis?
- Hair loss
- pretibial myxoedema
- onycholysis
- exophthalmos
Thyrotoxicosis
What is the diagnosis?
- Central obesity and wasted limbs
- Moon face
- Buffalo hump
- supraclavicular fat pads
- striae
Cushing’s syndrome
What is the diagnosis?
- Hyperpigmentation of face, neck, buccal mucosa and palmar creases
Addison’s disease
What is the diagnosis?
- pale or yellow tinged thinned skin, resulting in fine wrinkling around the eyes and mouth, making the patient look older
- decreased strength
- central obesity
- osteoporosis
- decreased glucose
Hypopituitarism
What is the diagnosis?
- Hair loss
- eyebrow loss
- cold, pale skin
- characteristic face
Hypothyroidism
What is the diagnosis?
- Hirsutism
- temporal balding
- acne
Hyperandrogenism
What is the diagnosis?
- Short statue
- short neck
- Short 4th and 5th metacarpals
Pseudohypoparathyroidism
What is the diagnosis?
- acral (distal) + soft tissue overgrowth
- big jaws (macrognathia), hands and feet
- the skin is thick, facial features are coarse
Acromegaly
Besides being an endocrine condition, what other body system is Diabetes also highly associated with?
cardiovascular system
What is the target blood glucose levels before meals and 2 hours after meals?
Before meals, blood glucose level target is 3.5 to 5.5 mmol/L.
2 hours after meals, targeted blood glucose level is <8mmol/L
What is the target of HbA1c?
<48mmol/mol (<6.5%)
or <53mmol/mol (<7.0%)
Give an example of a long-acting insulin and a short acting insulin
Long-acting insulin: Insulin glargine or insulin detemir
Ultra-fast acting insulin: Humalog, or Novorapid
What is the action of Metformin?
Metformin increases the sensitivity of insulinand helps with weight
What is the action of Sulfonylurea?
Give an example of a drug in the Sulfonylurea group.
Sulfonylurea increases insulin secretion.
Gliclazide
What is Hypoglycaemia?
Hypoglycaemia is when blood glucose level is <3mmol/L
What are the 2 types of hypoglycaemia?
Fasting hypoglycaemia and Post-prandial hypoglycaemia
What is the chief cause of fasting hypoglycaemia?
Insulin or sulfonylurea treatment in a known diabetic.
In non-diabetic patients, it is EXPLAIN:
1. EXogenous drugs: insulin, oral hypoglycaemics, body builders may misuse insulin to help stamina
2. Pituitary insufficiency
3. Liver failure, plus some rare inherited enzyme defect
4. Addison’s disease
5. Islet cell tumours (insulinoma) and immune hypoglycaemia (eg anti-insulin receptor antibodies in Hodgkin’s disease)
6. Non-pancreatic neoplasms, eg fibrosarcomas and haemangiopericytomas
What is suggested if the insulin level is high but there is an absence of C-peptide?
Patient has injected insulin.
C-peptide is produced only with endogenous insulin.
When does post-prandial hypoglucaemia occur?
May occur after bariatric/gastric surgery
What is the treatment for post-prandial hypoglycaemia?
For patients who can swallow and those who cannot swallow
Patients who can swallow: give oral sugar and a long-acting starch
Patients who cannot swallow: 25-50ml of 50% IV glucose. (via large vein with 0.9% saline flush to prevent phlebitis), or glucagon 1MG IM if no IV access
How long is the action of 1MG IM glucagon? Elaborate.
Short duration of effect. Hence, need to repeat after 20mins and follow with oral carbohydrates.
What is Whipple’s triad?
Whipple’s triad is a collection of 3 criteria that suggest a patient’s symptoms results from hypoglycaemia that may indicate insulinoma.
Describe the Suppressive test for Insulinoma
Give IV insulin and measure C-Peptide. Normally exogenous insulin will suppress C-Peptide production, but this does not occur in insulinoma.
What are the clinical signs of hypoparathyroidism?
Clinical signs are those of hypocalcaemia: [SPASMODIC]
S - Spasms - Trousseau’s sign due to carpopedal spasms
P - Perioral paraesthesia
A - Anxiety and irritability
S - Seizures
M - Muscle tone increases in smooth muscles: causing dysphagia, wheeze
O - Orientation impaired and confusion
D - Dermatitis
I - Impetigo herpetiformis
C - Chvostek’s sign (corner of the mouth twitches when the facial nerve is tapped over the parotid), cardiomyopathy (long QT interval), Cataract
Why does hypomagnesaemia lead to hypocalcaemia?
Magnesium is required for Parathyroid hormone release. Low Magnesium leads to Secondary Hypoparathyroidism.
What triggers the release of PTH and what it does?
Parathyroid hormone is released in response to low ion calcium levels. It cause an overall increase in ion calcium levels and a decrease in phosphate levels.
