passmed Flashcards
kleinfeleter low testoesteorne in men undiagnosed
osteoporosis if present late
agdha score
The score of the QoL-AGHDA is used to determine the extent to which growth hormone deficiency has affected the patient’s quality of life, and what treatment can then be administered. A high score on the QoL-AGHDA indicates that the patient suffers from many symptoms and therefore has a lower quality of life.
moa of orlistat
The primary mode of action of orlistat is to inhibit pancreatic lipases, which in turn will decrease the absorption of lipids from the intestine
A 45-year-old woman presents to her GP with 2 weeks history of feeling constantly weak. She has noticed that she now struggles with climbing stairs and combing her hair.
Her past medical history includes poorly controlled type-2 diabetes and a recent admission for severe pneumonia, in which she was started on a reducing course of steroids.
Observations are normal. Examination reveals bilateral reduced power of the shoulders, biceps and hip flexors/extensors. Tone, sensation, reflexes and cranial nerves are normal, with no fatiguability of speech.
What is the most likely cause of her weakness?
proximal myopathy
patient is complaining of a proximal muscle weakness that matches a proximal myopathy. The prolonged course of steroids could be causing this.
what causes proximal myopathy
prolonged course of steriods
Raised total T3 and T4 but normal fT3 and fT4 suggest
high concentrations of thyroid binding globulin, which can be seen during pregnancy
when is thyroid globulin high
in pregnancy
two most common causes of high Ca therefore what would be the best test
malignancy and hyperparathyroidism
so PTH
addisonian characteristics
An Addisonian crisis is characterised by hyperkalaemic metabolic acidosis. Symptoms include abdominal pain, confusion, nausea, and vomiting. In this case, it is likely that the patient had suffered from undiagnosed Addison’s disease, as supported by the history of fatigue, dizziness, and weight loss - most likely due to immune-regulatory changes following pregnancy
Peptic ulceration, galactorrhoea, hypercalcaemia
MEN 1
Multiple endocrine neoplasia type 1 is a genetic disorder that affects the endocrine system through development of neoplastic lesions in the pituitary gland, parathyroid gland and pancreas.
The milky white discharge is suggestive of hyperprolactinaemia which can occur to due a prolactinoma.
The excessive thirst and urination could be explained by hypercalcaemia which can occur due to primary hyperparathyroidism.
The chronic and unresponsive peptic ulceration is suggestive of Zollinger-Ellison syndrome. Zollinger-Ellison syndrome is a rare condition caused by a gastrin-secreting tumour found either in the islet cells of the pancreas or in the duodenal wall. The high levels of gastrin leads to stimulation of hydrochloric acid production in the gastric antrum resulting in predominantly duodenal ulceration.
what diuretics worsen hypercalcaemia
indapamide and thiazides
hypercalcaemia, normocytic anaemia and renal failure suppressed PTH
multiple myeloma
treatment of choice for toxic mutlinodular goitre
radioactive iodine
suspected type 1 diabetes on fasting glucose what next
Arrange C-peptide and diabetic autoantibodies
Thyroid acropachy
feature of Graves disease where there is clubbing of the fingernails.
what tests are best way to distinguish between T1DM and T2DM
C-peptide levels and diabetes-specific autoantibodies are useful to distinguish between type 1 and type 2 diabetes
A low level of C-peptide indicates the body is not producing enough insulin and may suggest type 1 diabetes. A high level of C-peptide indicates that the body is producing more than the required levels of insulin and may suggest type 2 diabetes.
what is c peptide a measure of
Measuring C-peptide is an accurate way to find out how much insulin your body is making
is addisons disease a cause of hypoglycaemia
yes
what is the key parameter to monitor in peope with HHS
serum osmolality
This patient has a hyperosmolar hyperglycaemic state (HHS). The diagnostic criteria for HHS include hypovolaemia, hyperglycaemia (blood sugar > 30mmol/L) and a serum osmolality > 320mosmol/kg. This patient’s estimated serum osmolality is (2x148) + 32 + 8 = 336mosmol/kg, with a blood sugar of 31mmol/L and therefore meeting the criteria. Clinical features are commonly secondary to hypovolaemia and include fatigue, lethargy, altered consciousness, hypotension and tachycardia. HHS has a high risk of morbidity and mortality secondary to complications associated with a raised serum osmolality (e.g. thrombosis) or from rapid correction of serum osmolality (cerebral oedema). Therefore, it is vitally important that during a patient’s treatment of HHS, that serum osmolality is monitored.
dx od diabtes over what value and does it depend whether they are symptomatic or asymptomatic
Diabetes meliitus diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic need two readings
every person with insulin should have what kind of kit for emergencies
glucagon kit
adrenal insufficeny requires IV hydrocortisone - it is common in HIV patients with what potential potentiator
CMV
addisons disease - what do you do when ill with hydrocortisone and fludrocortisone
Addison’s patient with intercurrent illness → double the glucocorticoids, keep fludrocortisone dose the same
ludrocortisone, on the other hand, is a mineralocorticoid that regulates electrolyte balance and blood pressure; it does not need to be adjusted during acute illness.
do wCC count go up in DKA
yes
infection or any physiological stress could precipitate dka
Anything not enough glucose left
Salt-2 inhibitor cause secretion of what
therfore in what type of diabetes can we not use them
sodium ketones and glucose in urine
Risk for DKA in type 1 so cannot use in 1
Water follows sodium so diuretic effect
dianostic criteria for DKA
ph below 7.3
bicarb below 15
keotnes over 3
sugars over 14
how to we measure capillary ketones
Capillary ketones much better than urinary ketones
Klinefelter’s syndrome causes what gonadotrophin results
high LH and low testosterone
Radioiodine treatment may lead to the development / worsening of thyroid eye disease in up to 15% of patients with
graves
Subclinical hypothyroidism with TSH level of level is 5.5 - 10mU/L: offer patients < 65 years a 6-month trial
of thyroxine if TSH remains at that level on 2 separate occasions 3 months apart and they have hypothyroidism symptoms
addisons disease people should be giving a injecting resus kit contianign what
hydrocortisone
subclinical hypothyroidism what shoudl you test for and why
Check thyroid peroxidase antibodies in patients who have subclinical hypothyroidism as this can indicate patients who are more likely to progress to overt hypothyroidism
Diplopia and eye pain in the context of hyperthyroidism are suggestive of thyroid eye disease. specific to what condition
graves
adverse affect of radioiondine thrapy
hypothyroidism
Thyrotoxicosis with tender goitre
subacute (De Quervain’s) thyroiditis
TD2M: if a triple combination of drugs has failed to reduce HbA1c then switching one of the drugs for a
GLP-1 mimetic is recommended, particularly if the BMI > 35 - zone
Sick euthyroid is common in unwell, elderly patients and often needs no treatment
Water deprivation test: primary polydipsia
urine osmolality after fluid deprivation: high
urine osmolality after desmopressin: high
In cranial diabetes insipidus, the body is incapable of producing any antidiuretic hormone. As a result, the urine would not concentrate and the urine osmolality would not increase in response to water deprivation. Following injection of desmopressin, however, the kidneys would then suddenly be able to concentrate the urine, and we would see a sudden rise in the urine osmolality.
Nephrogenic diabetes insipidus is incorrect. In nephrogenic diabetes insipidus, the kidneys cannot respond to the antidiuretic hormone and therefore cannot concentrate the urine; the urine will be diluted. Urine osmolality will be low and will remain low after water deprivation and after desmopressin injection.
Corticosteroids can induce what white blood cells to go up
neutrophilia
Thyrotoxicosis with tender goitre = subacute (De Quervain’s) thyroiditis
Important for meLess important how do we manage
ibuprofen
if takign both levothyroxine and calcium tablets when do you take
levy 4 hours before calcium as cna reduce absorption
