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UKMLA Prep > Perioperative medicine and anaesthesia > Flashcards

Perioperative medicine and anaesthesia Flashcards

Conditions and Presentations

1
Q

ASA grade

A

normal healthy patients, who are non-smokers and with no/minimal alcohol intake.

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2
Q

ASA grade I

A
  • mild systemic disease
  • well controlled diabetes or hypertension, current smoker, obesity (BMI 30-40), and mild lung disease.
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3
Q

ASA grade III

A

Severe systemic disease
e.g. poorly controlled diabetes or hypertension, COPD, morbid obesity (BMI >40), history of ACS/stroke/TIA >3 months ago.

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4
Q

ASA grade IV

A

*severe systemic disease
* constant threat to life
* MI/stroke/TIA within 3 months

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5
Q

ASA grade V is

A

moribund patients not expected to survive

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6
Q

ASA grade VI

A
  • brain dead
  • used for transplant
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7
Q

Simple airway manouvers

A
  • suction
  • head tilt/ chin lift
  • Jaw thrust
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8
Q

Aiway adjuncts

A
  • Oropharyngeal airway (OPA)
  • Nasopharynx airways
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9
Q

Nasopharyngeal airway

A

Useful in patients with a sensitive gag reflex when using OPA
Contraindicated in base of skull fracture

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10
Q

Supraglottic airway

A
  • Sits over the top of the larynx
  • Can be used with ventilation machine
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11
Q

Surigcal airway managment

A
  • Tracheostomy
  • Cricothyroidotomy
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12
Q

Signs and symptoms of c-spine injurt

A
  • Neck pain
  • Decreased range of motion in the neck
  • Focal neurological deficits, such as weakness or numbness in the arms or legs
  • Signs of spinal shock, including flaccid paralysis and loss of bowel or bladder control
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13
Q

Nexus criteria- what is it

A
  • criteria which suggest c-spine injury is **not likely **
  • All criteria has to be met in Nexus criteria
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14
Q

Nexus criteria

A
  • Normal level of alertness
  • No evidence of intoxication
  • No painful distracting injuries
  • No focal neurological deficit
  • Absence of midline cervical tenderness
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15
Q

What to do if C-spine isnt cleared

A

CT C-spine

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16
Q

Managment of C-spine fracture

A
  • airway managment
  • appropriately sized semi-rigid collar
  • block and tape use
  • full body stabilisation
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17
Q

Signs of post-operative bleed

A
  • mild pyrexia
  • hypotension
  • tachycardia
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18
Q

Managment of hypovolemic shock

A

fluid bolus of a crystalloid

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19
Q

Mild to moderate pain managment

A
  • Paracetamol.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.
  • Aspirin (a salicylate NSAID).
  • Weak opioids, such as codeine, dihydrocodeine, and tramadol.
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20
Q

cluster headaches

A
  • Primarily unilateral and typically more severe around the eye region.
  • occur in clusters,
  • numerous attacks within small time frame (e.g weeks)
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21
Q

epidemiology of cluster headaches

A

more prevalent among middle-aged men

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22
Q

What precipitates cluster headaches

A
  • alcohol consumption
  • smoking
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23
Q

cause of cluster headaches

A

activation of the trigeminal nerve

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24
Q

Signs and symptoms of cluster headaches

A
  • Unilateral, severe headache, often around the eye
  • A bloodshot or teary eye on the affected side
  • Vomiting
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25
Q

Treatment of cluster headaches

A

100% oxygen and sumatriptan

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26
Q

Prophylaxis of cluster headaches

A

verapamil and steroids

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27
Q

compartmental syndrome

A

increase in pressure within the muscle compartments of a limb, typically following trauma.

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28
Q

Signs and symptoms of compartmental syndrome

A
  • Severe pain, particularly evident during passive flexion of the toes
  • Pallor of affected limb
  • Paralysis or weakness of the limb
  • pulselessness
  • Paraesthesia
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29
Q

Managment of compartmental syndrome

A
  • Keep the limb at a neutral level with the patient
  • Oxygen
  • Fluid administration
  • Remove all dressings/splints/casts down to the skin
  • Analgesia for pain management (usually opioids)
  • Fasciotomy
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30
Q

Malignant Hyperthermia

A
  • life-threatening condition
  • occurs due to suxamethonium
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31
Q

Aetiology of malignant hyperthermia

A
  • autosomal dominant mutation in the ryanodine receptor 1 gene
  • Causes hyperkalemia
  • results in increased metabolic rate
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32
Q

Signs and symptoms of malignant hyperthermia

A
  • Rapid increase in body temperature
  • Muscle rigidity
  • Metabolic acidosis
  • Tachycardia
  • Increased exhaled carbon dioxide
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33
Q

Investigation of malignant hyperthermia

A
  • Blood tests: metabolic acidosis and** increased creatine kinase levels.**
  • Core temperature monitoring to detect hyperthermia.
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34
Q

Managment of malignany hyperthermia

A
  • stop drugs
  • supportive measurments
  • agressive cooling treatment
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35
Q

Managment of head trauma

A
  • major trauma- given IV morphine (no IV access, intranasal diamorphine or ketamine)
  • TBI- sit patiet 30*
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36
Q

Managment of ICP

A
  • DO NOT do LP
  • short-term hyperventilation
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37
Q

Confirm positioning of NG tube

A
  • pH (1.5-3.5) aspiration
  • Erect CXR tip should ideally be seen at least 10cm beyond the gastro-oesophageal junction
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38
Q

CPAP

A
  • Type I respiratory failure, providing positive pressure
  • keep the alveoli open for a longer period of time to facilitate gas exchange.
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39
Q

BiPAP

A
  • type II respiratory failure
  • two different levels of positive pressure on inspiration and expiration
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40
Q

Criteria of NIV

A
  • Patient awake and able to protect airway
  • Co-operative patient
  • Consideration of quality of life of patient
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41
Q

Contradictions of NIV

A
  • Facial burns
  • Vomiting
  • Untreated pneumothorax
  • Severe co-morbidities
  • Haemodynamically unstable
  • Patient refusal
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42
Q

Steps of rapid induction sequences

A
  • Airway
  • Drug preparation
  • Monitoring of vital signs
  • Drug administration
  • Cricoid pressure
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43
Q

Pre-operative anaemia managment

A
  • Oral iron if >6 weeks until planned surgery
  • IV iron if <6 weeks until planned surgery
  • B12/folate replacement
  • Erythropoiesis‐stimulating agent (ESA) therapy
  • Transfusion if profound anaemia and surgery cannot be delayed
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44
Q

Post-operative anaemia managment

A
  • Transfusion
  • IV iron
  • Oral iron
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45
Q

Causes of type 1 resp failure

A
  • Decreased atmospheric pressure
  • Ventilation-perfusion mismatch
  • Shunt
  • Pneumonia
  • ARDS
  • Pulmonary embolism
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46
Q

Managment of trigeminal neuralgia

A
  • Decreased atmospheric pressure
  • Ventilation-perfusion mismatch
  • Shunt
  • Pneumonia
  • ARDS
  • Pulmonary embolism
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47
Q

Diabetic drugs and surgery

A
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48
Q

Post-operative poor urinary output

A

output of less than 0.5 mL/kg/hour in adults is considered low.

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49
Q

Post-renal causes of less urine output

A
  • Benign prostatic hypertrophy
  • Effects of drugs such as anticholinergic or alpha adrenoreceptor antagonists, often used in anaesthetics
  • Pain following surgery, particularly hernia operations
  • Psychological inhibition
  • Opiate analgesia
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50
Q

Pre-renal causes of poor urine output

A
  • Hypovolaemia
  • Hypotension
  • Dehydration
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51
Q

Renal causes of poor urine output

A

Acute tubular necrosis

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52
Q

Signs and symptoms of poor urine output

A
  • Decreased urine frequency/volume
  • Hypotension and tachycardia (pre-renal causes)
  • Abdominal pain or discomfort
  • Symptoms of drug side effects such as dry mouth, blurred vision, and constipation (post-renal causes due to anticholinergic drugs)
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53
Q

poor urine output after surgery investigations

A
  • Urine output measuremen
  • Urinalysis
  • U+E
  • Ultrasound of kidneys and bladder: To identify any potential obstructions in the urinary tract.
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54
Q

Managment of poor urine output after surgery

A
  • Correction of any fluid or electrolyte imbalances
  • manage underlying cause
  • urinary catheterisation
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55
Q

Suxamethonium apnoea

A
  • defect in the plasma cholinesterase enzyme
  • Patients will have prolonged period of paralysis
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56
Q

Signs and symptoms of suxamethonium apnoea

A
  • prolonged paralysis
  • make little effort to cough or breathe spontaneously.
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57
Q

Investigations of Suxamethanoium apnoea

A

checking plasma cholinesterase levels to identify any potential defects.

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58
Q

Managment of Suxamethanoium apnoea

A
  • intubated and ventilated until they are able to breathe spontaneously.
  • do not use in future again
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59
Q

Major trauma, first line analgesia

A

IV Morphine
If IV cant be accessed, intranasal diamorphine or ketamine.

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60
Q

Suspected TBI managment

A
  • patient at 30 degrees
  • If ICP is raising, increase rate of ventilation
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61
Q

Systemic inflammatory response syndrome (SIRS)

SIRS

A

Must have one of the following to diagnose
* Temperature >38 or <36 degrees Centigrade
* Heart rate >90
* Respiratory rate >20
* White cell count >12 or <4 x10^9/L

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62
Q

<1 paeds signs

A
  • RR 30-40
  • HR 110-160
  • SBP 70-90
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63
Q

1-2 vital signs

A
  • RR 25-35
  • HR 100-150
  • SBP 80-95
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64
Q

2-5 vital signs

A
  • RR 25-30
  • HR 95-140
  • SBP 80-100
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65
Q

5-12 vital signs

A
  • RR 20-25
  • HR 80-120
  • SBP 90-110
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66
Q

> 12 vital signs

A
  • RR15-20
  • HR 60-100
  • SBP 100-120
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67
Q

Peri op guidance on hypertension

A

Only cancel if BP persistently elevated
•Stage 1 = proceed as normal •Stage 2 = Proceed as normal
•Stage 3 = if no evidence of end-organ damage – consider proceeding with fastidious BP monitoring + A-line. If evidence of end-organ damage or patient is unwell – consider postponing surgery for 4weeks.
•Consider peri-op Beta-blockade – reduces risk of myocardial ischaemia / CVS complications

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68
Q

What are surgical site infections (SSI)?

A

Infections that occur following a breach in tissue surfaces, allowing normal commensals and pathogens to initiate infection

SSI are a major cause of morbidity and mortality, comprising up to 20% of all healthcare-associated infections.

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69
Q

What percentage of patients undergoing surgery will develop an SSI?

A

At least 5%

SSI can significantly impact recovery and hospital stay.

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70
Q

What are common measures that may increase the risk of SSI?

A
  • Shaving the wound with a razor
  • Using non-iodine impregnated incise drapes
  • Tissue hypoxia
  • Delayed administration of prophylactic antibiotics in tourniquet surgery
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71
Q

What is the recommended method for hair removal before surgery?

A

Use electrical clippers with a single-use head

Razors increase infection risk.

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72
Q

When should antibiotic prophylaxis be administered?

A
  • Placement of prosthesis or valve
  • Clean-contaminated surgery
  • Contaminated surgery
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73
Q

What is the preferred method for skin preparation to reduce SSI?

A

Alcoholic chlorhexidine

This method has the lowest incidence of SSI.

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74
Q

True or False: Administration of supplementary oxygen reduces the risk of wound infection.

A

False

A recent meta-analysis confirmed that supplementary oxygen does not reduce the risk of wound infection.

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75
Q

What are the two main types of respiratory failure?

A
  • Type 1: ↓ pO2 with normal or ↓ pCO2
  • Type 2: ↑ pCO2 with normal or ↓ pO2
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76
Q

What causes type 1 respiratory failure?

A
  • Pneumonia
  • Pulmonary embolism
  • Asthma
  • Pulmonary oedema
  • Acute respiratory distress syndrome
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77
Q

What causes type 2 respiratory failure?

A
  • Chronic obstructive pulmonary disease
  • Decompensation in other respiratory conditions
  • Neuromuscular disease
  • Obesity hypoventilation syndrome
  • Sedative drugs (e.g., benzodiazepines, opiate overdose)
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78
Q

What are the key indications for non-invasive ventilation (NIV)?

A
  • COPD with respiratory acidosis (pH 7.25-7.35)
  • Type II respiratory failure due to chest wall deformity, neuromuscular disease, or obstructive sleep apnoea
  • Cardiogenic pulmonary oedema unresponsive to CPAP
  • Weaning from tracheal intubation
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79
Q

What are the recommended initial settings for bi-level pressure support in COPD?

A
  • EPAP: 4-5 cm H2O
  • IPAP: 10-15 cm H2O
  • Back up rate: 15 breaths/min
  • Back up inspiration:expiration ratio: 1:3
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80
Q

What is the mechanism of action of ADP receptor inhibitors?

A

Inhibition of the P2Y12 receptor, leading to reduced platelet aggregation

ADP is a key platelet activation factor.

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81
Q

What are the first-line and second-line treatments for acute coronary syndrome (ACS)?

A
  • 1st line: Aspirin (lifelong) & Ticagrelor (12 months)
  • 2nd line: Clopidogrel (lifelong) if aspirin is contraindicated
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82
Q

What notable adverse effect is associated with Ticagrelor?

A

Dyspnoea

This is due to impaired clearance of adenosine.

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83
Q

What are the contraindications for Prasugrel?

A
  • Prior stroke or transient ischaemic attack
  • High risk of bleeding
  • Prasugrel hypersensitivity
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84
Q

What is necrotising fasciitis?

A

A medical emergency characterized by rapidly progressing infection of the soft tissue

It can be difficult to recognize in the early stages.

85
Q

What are the features of necrotising fasciitis?

A
  • Acute onset
  • Pain, swelling, erythema
  • Rapidly worsening cellulitis
  • Skin necrosis and crepitus/gas gangrene as late signs
86
Q

What is the average mortality rate for necrotising fasciitis?

A

20%

Early recognition and intervention are critical.

87
Q

What is the maximum normal diameter for small bowel obstruction?

A

35 mm

88
Q

What is the maximum normal diameter for large bowel obstruction?

A

55 mm

89
Q

What is the most common cause of large bowel obstruction?

A

Tumor

Tumors account for 60% of cases of large bowel obstruction.

90
Q

What are common clinical features of bowel obstruction?

A
  • Absence of passing flatus or stool
  • Symptoms suggestive of underlying causes (e.g., colorectal cancer)
91
Q

What accounts for 60% of cases of large bowel obstruction?

A

tumour

92
Q

What is the initial presenting complaint of colonic malignancy in approximately 30% of cases?

A

obstruction

93
Q

Which types of tumors tend to obstruct earlier due to smaller lumen diameter?

A

distal colonic and rectal tumours

94
Q

List three underlying causes of bowel obstruction.

A
  • volvulus
  • diverticular disease
  • colorectal cancer
95
Q

What are common clinical features of bowel obstruction?

A
  • absence of passing flatus or stool
  • abdominal pain
  • abdominal distention
  • nausea and vomiting
  • peritonism (if perforation is present)
96
Q

What imaging is still commonly used as the first-line investigation for bowel obstruction?

A

abdominal x-ray

97
Q

What are the normal diameter limits for the caecum, ascending colon, and recto-sigmoid?

A
  • caecum: 10-12 cm
  • ascending colon: 8 cm
  • recto-sigmoid: 6.5 cm
98
Q

What does the presence of free intra-peritoneal gas indicate?

A

colonic perforation

99
Q

What are the sensitivities and specificities of CT scans for identifying bowel obstruction?

A

> 90% each

100
Q

What are the initial management steps for bowel obstruction?

A
  • NBM
  • IV fluids
  • nasogastric tube with free drainage
101
Q

What percentage of patients with bowel obstruction will eventually require surgery?

A

around 75%

102
Q

When is emergency surgery necessary in bowel obstruction management?

A

if there is overt peritonitis or evidence of bowel perforation

103
Q

What is postoperative ileus sometimes referred to as?

A

paralytic ileus

104
Q

List common features of postoperative ileus.

A
  • abdominal distention/bloating
  • abdominal pain
  • nausea/vomiting
  • inability to pass flatus
  • inability to tolerate an oral diet
105
Q

Which electrolytes should be checked as they can contribute to postoperative ileus?

A
  • potassium
  • magnesium
  • phosphate
106
Q

What are the initial management steps for postoperative ileus?

A
  • nil-by-mouth initially
  • nasogastric tube if vomiting
  • IV fluids to maintain normovolaemia
  • additives to correct electrolyte disturbances
  • total parenteral nutrition (occasionally)
107
Q

What is the most common cause of small bowel obstruction?

A

adhesions (following previous surgery)

108
Q

What are common features of small bowel obstruction?

A
  • diffuse, central abdominal pain
  • nausea and vomiting
  • typically bilious vomiting
  • ‘constipation’ with complete obstruction
  • abdominal distension
  • ‘tinkling’ bowel sounds
109
Q

What imaging is generally first-line for suspected small bowel obstruction?

A

abdominal x-ray

110
Q

What diameter is the small bowel considered dilated?

A

> 3 cm

111
Q

What is the definitive investigation for small bowel obstruction?

A

CT scan

112
Q

What initial steps should be taken for the management of small bowel obstruction?

A
  • NBM
  • IV fluids
  • nasogastric tube with free drainage
113
Q

What are the genetic causes of learning difficulties?

A

Fragile X, Down’s syndrome

These are chromosomal abnormalities that can impact cognitive development.

114
Q

Which congenital infections can lead to learning difficulties?

A

Cytomegalovirus, toxoplasmosis, rubella

These infections can affect fetal development and result in cognitive impairments.

115
Q

What birth-related factors can cause learning difficulties?

A

Hypoxia, rhesus haemolytic disease, intraventricular haemorrhage

These conditions can affect brain development during or shortly after birth.

116
Q

Name three metabolic disorders associated with learning difficulties.

A

PKU, maple syrup urine disease, homocystinuria

These disorders affect metabolism and can lead to cognitive impairments if untreated.

117
Q

What is an extradural haematoma?

A

Bleeding into the space between the dura mater and the skull

Often results from trauma and most commonly occurs in the temporal region.

118
Q

What are the features of an extradural haematoma?

A

Raised intracranial pressure, lucid interval

A lucid interval may occur before symptoms worsen.

119
Q

What distinguishes a subdural haematoma from an extradural haematoma?

A

Bleeding into the outermost meningeal layer

Subdural haematomas often have a slower onset of symptoms.

120
Q

What are common risk factors for subdural haematomas?

A

Old age, alcoholism

These factors can increase the likelihood of developing subdural haematomas.

121
Q

What is subarachnoid haemorrhage typically associated with?

A

Ruptured cerebral aneurysm

It may also occur with other injuries in traumatic brain injury cases.

122
Q

What is diffuse axonal injury?

A

Injury from mechanical shearing following deceleration

It results in disruption and tearing of axons.

123
Q

What is the minimum cerebral perfusion pressure in adults?

A

70 mmHg

This is crucial for adequate brain perfusion.

124
Q

What does the Cushing’s reflex indicate?

A

Hypertension and bradycardia

It often occurs late and is usually a pre-terminal event.

125
Q

What is the recommended management for life-threatening rising ICP?

A

Use of IV mannitol/frusemide

This may be required while preparing for surgery or transfer.

126
Q

How are pupils interpreted in head injuries?

A

Unilaterally dilated, sluggish or fixed indicates 3rd nerve compression

Different pupil responses can indicate various types of brain injury.

127
Q

What are the GCS criteria for immediate CT head scan?

A

GCS < 13, GCS < 15 at 2 hours, suspected open or depressed skull fracture

These criteria help determine the need for urgent imaging.

128
Q

What is the management for iron overdose?

A

Whole bowel irrigation, desferrioxamine if serum iron levels are high

Activated charcoal is ineffective in iron poisoning.

129
Q

What is lithium toxicity often precipitated by?

A

Dehydration, renal failure, certain medications

Monitoring is essential in patients on lithium due to its narrow therapeutic range.

130
Q

What is the treatment for paracetamol overdose?

A

Acetylcysteine if plasma concentration is above treatment line

Treatment guidelines have changed to treat all patients similarly regardless of risk factors.

131
Q

What are the common symptoms of superior vena cava obstruction?

A

Dyspnoea, swelling of the face, neck, and arms, headache

These symptoms can indicate serious underlying malignancies.

132
Q

What is the first-line treatment for hiccups in terminal patients?

A

Chlorpromazine

Other options include haloperidol and gabapentin.

133
Q

What is the recommended dosage of paracetamol for patients presenting with overdose symptoms?

A

150 mg/kg of paracetamol

134
Q

What laboratory findings indicate the need to continue acetylcysteine treatment?

A

Paracetamol concentration or ALT remains elevated

135
Q

What is the current infusion duration for acetylcysteine to reduce adverse effects?

A

1 hour

136
Q

What type of reaction is commonly caused by acetylcysteine?

A

Anaphylactoid reaction

137
Q

What are the King’s College Hospital criteria for liver transplantation in paracetamol liver failure?

A

Arterial pH < 7.3, or prothrombin time > 100 seconds, creatinine > 300 µmol/l, grade III or IV encephalopathy

138
Q

What defines a staggered overdose of paracetamol?

A

All tablets were not taken within 1 hour

139
Q

What is the therapeutic range for lithium?

A

0.4-1.0 mmol/L

140
Q

What are common precipitating factors for lithium toxicity?

A
  • Dehydration
  • Renal failure
  • Diuretics
  • ACE inhibitors/angiotensin II receptor blockers
  • NSAIDs
  • Metronidazole
141
Q

What are the features of lithium toxicity?

A
  • Coarse tremor
  • Hyperreflexia
  • Acute confusion
  • Polyuria
  • Seizure
  • Coma
142
Q

What is the recommended management for mild-moderate lithium toxicity?

A

Volume resuscitation with normal saline

143
Q

What are the typical symptoms of diabetic ketoacidosis (DKA)?

A
  • Abdominal pain
  • Polyuria
  • Polydipsia
  • Dehydration
  • Kussmaul respiration
  • Acetone-smelling breath
144
Q

What is the C-peptide level typically seen in patients with type 1 diabetes mellitus (T1DM)?

A

Low

145
Q

What are the diagnostic criteria for type 1 diabetes mellitus if the patient is symptomatic?

A
  • Fasting glucose ≥ 7.0 mmol/l
  • Random glucose ≥ 11.1 mmol/l
146
Q

How can type 1 diabetes mellitus be distinguished from type 2 diabetes mellitus?

A

By features such as age of onset, speed of onset, weight of patient, and presence of ketonuria

147
Q

What should be considered for further investigation in adults suspected of type 1 diabetes?

A

Measurement of C-peptide and/or diabetes-specific autoantibody titres

148
Q

What is the diagnostic HbA1c level for diabetes mellitus?

A

≥ 48 mmol/mol (6.5%)

149
Q

What are conditions where HbA1c may not be used for diagnosis?

A
  • Haemoglobinopathies
  • Haemolytic anaemia
  • Untreated iron deficiency anaemia
  • Suspected gestational diabetes
  • Children
  • HIV
  • Chronic kidney disease
  • Medications causing hyperglycaemia
150
Q

What defines impaired fasting glucose (IFG)?

A

Fasting glucose ≥ 6.1 but < 7.0 mmol/l

151
Q

What is diabetes mellitus?

A

A chronic condition characterised by abnormally raised levels of blood glucose

152
Q

Why is the management of diabetes mellitus important?

A

To reduce the incidence of macrovascular and microvascular complications

153
Q

What is type 1 diabetes mellitus (T1DM)?

A

An autoimmune disorder resulting in absolute deficiency of insulin

154
Q

What characterizes type 2 diabetes mellitus (T2DM)?

A

Relative deficiency of insulin due to excess adipose tissue

155
Q

What is prediabetes?

A

A condition where patients do not yet meet criteria for T2DM but are likely to develop it

156
Q

What are the main symptoms of type 1 diabetes mellitus?

A
  • Weight loss
  • Polydipsia
  • Polyuria
  • May present with diabetic ketoacidosis
157
Q

What are the four main ways to check blood glucose?

A
  • Finger-prick bedside glucose monitor
  • One-off blood glucose
  • HbA1c
  • Glucose tolerance test
158
Q

What is the first-line medication for managing type 2 diabetes?

A

Metformin

159
Q

What are the main side effects of insulin therapy?

A
  • Hypoglycaemia
  • Weight gain
  • Lipodystrophy
160
Q

What is the mechanism of action of metformin?

A

Increases insulin sensitivity and decreases hepatic gluconeogenesis

161
Q

What is the role of thiazolidinediones in diabetes management?

A

Activate PPAR-gamma receptor to promote adipogenesis and fatty acid uptake

162
Q

What is an example of a DPP-4 inhibitor?

A

Gliptins

163
Q

What is the mechanism of action of SGLT-2 inhibitors?

A

Inhibit reabsorption of glucose in the kidneys

164
Q

What is hyponatraemia?

A

A condition characterized by low sodium levels in the blood

Examples include gliclazide and glimepiride

165
Q

What is the effect of thiazolidinediones on adipocytes?

A

Activate PPAR-gamma receptor to promote adipogenesis and fatty acid uptake

Only currently available thiazolidinedione is pioglitazone

166
Q

What is a common adverse effect of thiazolidinediones?

A

Weight gain and fluid retention

167
Q

What do DPP-4 inhibitors do?

A

Increase incretin levels which inhibit glucagon secretion

Examples include vildagliptin and sitagliptin

168
Q

How are DPP-4 inhibitors generally tolerated?

A

Relatively well tolerated but increased risk of pancreatitis

169
Q

What do SGLT-2 inhibitors inhibit?

A

Reabsorption of glucose in the kidney

170
Q

What is the primary route of administration for GLP-1 agonists?

A

Subcutaneous injection

171
Q

What is a common side effect of GLP-1 agonists?

A

Nausea and vomiting

172
Q

What is the target HbA1c reduction for ongoing prescription of GLP-1 mimetics?

A

> 11 mmol/mol (1%) reduction in HbA1c and 3% weight loss after 6 months

173
Q

What is the target blood pressure for type 2 diabetics according to NICE?

A

< 140/90 mmHg

174
Q

What is the recommended first-line antihypertensive for diabetic patients?

A

ACE inhibitors or angiotensin-II receptor antagonists (A2RBs)

175
Q

What are the recommended HbA1c monitoring intervals for adults with type 1 diabetes?

A

Every 3-6 months

176
Q

What is the target HbA1c level for adults with type 1 diabetes?

A

48 mmol/mol (6.5%) or lower

177
Q

What type of insulin regimen is preferred for adults with type 1 diabetes?

A

Multiple daily injection basal-bolus insulin regimens

178
Q

What dietary advice is recommended for diabetes management?

A

High fibre, low glycaemic index carbohydrates, low-fat dairy, oily fish, control saturated fats

179
Q

What is the initial target weight loss for an overweight person with diabetes?

A

5-10%

180
Q

What should be done if a patient’s HbA1c rises to 58 mmol/mol (7.5%)?

A

Further treatment is indicated

181
Q

What are the options for second-line therapy if HbA1c targets are not met?

A

Add one of the following:
* Metformin + DPP-4 inhibitor
* Metformin + pioglitazone
* Metformin + sulfonylurea
* Metformin + SGLT-2 inhibitor (if NICE criteria met)

182
Q

What is the preferred statin for patients with a 10-year cardiovascular risk > 10%?

A

Atorvastatin 20mg

183
Q

What is a significant concern when using beta-blockers in uncomplicated hypertension?

A

They may cause insulin resistance and impair insulin secretion

184
Q

What should be considered when advising Muslim patients about fasting during Ramadan?

A

Chronic conditions may exempt them from fasting or allow for delayed fasting to shorter days

185
Q

Fill in the blank: The incretin effect is largely mediated by _______.

A

GLP-1

186
Q

True or False: GLP-1 mimetics result in weight gain.

A

False

187
Q

What is the primary consideration for Muslim patients regarding fasting during Ramadan?

A

Patients with chronic conditions are exempt from fasting or may delay fasting to shorter days.

188
Q

What percentage of Muslim patients with type 2 diabetes mellitus fast during Ramadan?

A

Around 79%.

189
Q

What meal should patients with type 2 diabetes mellitus eat before sunrise?

A

A meal containing long-acting carbohydrates (Suhoor).

190
Q

What is the recommended adjustment for metformin dosing for patients fasting during Ramadan?

A

Split the dose: one-third before sunrise (Suhoor) and two-thirds after sunset (Iftar).

191
Q

For patients on insulin therapy during Ramadan, what must they not do?

A

They must not stop insulin therapy due to the risk of diabetic ketoacidosis.

192
Q

What is a key recommendation for patients with type 1 diabetes fasting during Ramadan?

A

Check blood glucose more frequently, every 1-2 hours.

193
Q

What are the two main factors leading to diabetic foot disease?

A
  • Neuropathy
  • Peripheral arterial disease
194
Q

What should all patients with diabetes be screened for annually?

A

Diabetic foot disease.

195
Q

What tool is used to screen for neuropathy in diabetic patients?

A

A 10 g monofilament.

196
Q

What is the mechanism of action of metformin?

A
  • Activation of AMP-activated protein kinase (AMPK)
  • Increases insulin sensitivity
  • Decreases hepatic gluconeogenesis
  • Reduces gastrointestinal absorption of carbohydrates
197
Q

What are common adverse effects of metformin?

A
  • Gastrointestinal upsets (nausea, anorexia, diarrhoea)
  • Reduced vitamin B12 absorption
  • Lactic acidosis in severe renal disease
198
Q

What is the prevalence of prediabetes among adults in the UK according to Diabetes UK?

A

Around 1 in 7 adults.

199
Q

What are the two types of impaired glucose regulation (IGR)?

A
  • Impaired fasting glucose (IFG)
  • Impaired glucose tolerance (IGT)
200
Q

What is the definition of impaired fasting glucose (IFG)?

A

A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l.

201
Q

What are the important adverse effects of SGLT-2 inhibitors?

A
  • Urinary and genital infections
  • Normoglycaemic ketoacidosis
  • Increased risk of lower-limb amputation
202
Q

What is the first-line treatment for type 2 diabetes mellitus?

A

Metformin.

203
Q

What should be done if a patient on metformin develops unacceptable side effects?

A

Consider modified-release metformin.

204
Q

True or False: Patients with impaired glucose tolerance (IGT) are more likely to develop T2DM than those with impaired fasting glucose (IFG).

A

True.

205
Q

What is the recommended follow-up for patients identified at high risk for type 2 diabetes?

A

At least yearly follow-up with blood tests.

206
Q

What should be done if a patient with type 2 diabetes is acutely ill?

A

Temporarily stop some oral hypoglycaemics.

207
Q

What is the risk stratification for diabetic foot disease?

A
  • Low risk: no risk factors except callus alone
  • Moderate risk: deformity or neuropathy or non-critical limb ischaemia
  • High risk: previous ulceration or amputation, renal replacement therapy, or combinations of risk factors.
208
Q

What is the action of SGLT-2 inhibitors?

A

Reversibly inhibit sodium-glucose co-transporter 2 (SGLT-2) to reduce glucose reabsorption.

209
Q

What should be monitored for patients taking SGLT-2 inhibitors?

A

Feet should be closely monitored for signs of infection or amputation risk.

UKMLA Prep (39 decks)

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