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DISEASE - endocrine and haem > Type 2 diabetes > Flashcards

Type 2 diabetes Flashcards

1
Q

A patient with uncomplicated type 2 diabetes attends for review. His Blood pressure is 170/90mmHg?

A

140/80

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2
Q

A patient with previously uncomplicated T2DM attends for review 12 months later. He has had a Acute MI and angioplasty since his last attendance. What is an appropriate BP target?

A

130/80

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3
Q

What is the first line antihypertensive of choice?

A

ACE inhibitor

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4
Q

What is the target LDL Cholesterol for all patients with Type 2 diabetes?

A

2.0 mmol/l

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5
Q

What proportion of patients with type 2 diabetes will succumb to cardiovascular complications?

A

75%

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6
Q

Which of the following risk factors is most important in terms of reducing cardiovascular risk in a patient with Type 2 diabetes?

A

Cholesterol

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7
Q

A 65 year old male attend diabetes clinic. He reports pain in the lower limbs. The pain specifically occurs in the calf after walking approximately 50 yards and is relieved by rest. His co-morbidity includes Hypertension and dyslipidaemia, he smokes 10 cigarettes per day.
What is the likely diagnosis?

A

Intermittent claudication

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8
Q

Which study showed long term benefit of reduced ischaemic heart disease from early intensive glycaemic control in patients with type 2 Diabetes?

A

UKPDS - UK prospective diabetes study

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9
Q

In a patient newly diagnosed with type 2 Diabetes, following lifestyle intervention what is the first line anti-diabetic treatment?

A

Metformin

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10
Q 
Which of these treatments is associated with hypoglycaemia as a potential side effect?
A.Gliclazide
B.Pioglitazone
C.Metformin
D.Sitagliptin
E.GLP-1 receptor agonist
A

Gliclazide

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11
Q 
A 21 year old with Type 2 diabetes attend clinic. She has a BMI of 36 and you note hyperpigmentation of the skin in the axilla bilaterally. What is the likely diagnosis?
A.Acanthosis Nigricans
B.Malignant melanoma
C.Necrobiosis Lipoidica diabeticatorum
D.Granuloma annulare
E.Linea nigra
A

Acanthosis Nigricans

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12
Q 
Which agent is associated with potential weight gain as an adverse effect?
A.Liraglutide
B.Pioglitazone
C.Metformin
D.Sitagliptin
E.Exenatide
A

Pioglitazone

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13
Q

What causes weight gain in pioglitazone?

A

Salt and water production

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14
Q

Which agent is theoretically associated with a risk of lactic acidosis?

A

Metformin

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15
Q

At what level of eGFR should one stop

Metformin?

A

30ml/min/1.73m2

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16
Q 
Which of the following studies suggested an adverse outcome from intensive glucose lowering in patients with longstanding type 2 Diabetes?
A. ACCORD
B. ADVANCE
C. Veteran’s study
D. Steno 2
E. HOPE
A

ACCORD

17
Q 
Which of the following findings would cause you to discontinue ACE inhibitor treatment?
A.Albumin:creatinine ratio 30mg/mmol
B.Serum creatinine 215 μmol/l
C.Serum potassium 5.5mmol/l
D.Serum sodium 132mmol/l
E.HbA1c 9.0%
A

Serum creatinine 215 μmol/l

18
Q

Which of the following findings is suggestive of cardiac autonomic neuropathy?
A. Absent beat to beat variation in pulse rate with deep respiration
B. A QT interval of 390 milliseconds (0.39 seconds)
C. Tachycardia during Valsalva manouver
D. Increase in systolic BP of 10mmHg on standing
E. Resting pulse rate of 60

A

Absent beat to beat variation in pulse rate with deep respiration

19
Q 
A patient is complaining of erectile dysfunction. Investigations show normal gonadotrophin levels and normal testosterone levels. You are considering treatment with a PD 5 inhibitor (Viagra). He has a history of ischaemic heart disease. Which of his regular medications is a contraindication to PD 5 inhibitor treatment?
A. Aspirin
B. Beta blockers
C. ACE inhibitor
D. Statin
E. Isosorbide mononitrate
A

Isosorbide mononitrate - angina meds

20
Q 
Which electrolyte disturbance is a potential concern when dosing ACE inhibitors?
A.Hyperkalaemia
B.Hypernatraemia
C.Hypokalaemia
D.Hypomagnaesaemia
E.Hypercalcaemia
A

Hyperkalaemia

21
Q 
What level of HbA1c do we aim to achieve to reduce the microvascular complications of diabetes?
A.10mol/mmol (1.0%)
B.48mol/mmol (6.5%)
C.53mol/mmol (7.0%)
D.64mol/mmol (8.0%)
E.70mol/mmol (8.5%)
A

53mol/mmol (7.0%)

22
Q 
At what time of day are basal levels of insulin at their highest?
A.Midnight to 4am
B.4am to 10am
C.Midday to 4pm
D.4pm to 8pm
E.8pm to midnight
A

4am until 10am

23
Q 
Which gut peptides are associated with the incretin effect
A.Gastrin
B.Glucagon Like Polypeptide 1
C.Somatostatin
D.Glucagon
E.Polypeptide P
A

GLP 1

24
Q 
what levels of the following would you need to diagnose T2DM?
random plasma glucose
fasting plasma glucose
oral glucose tot. test
HbA1C
A

random plasma glucose >11.1 with symptoms
fasting plasma glucose >7
oral glucose tot. test 75gm after 10hr fast
HbA1C >6.5

25
Q

what problems are there with HbA1c testing? what else modifies the score?

A 
pregnancy
haemolysis
iron deficiency anaemia
renal impairment
blood transfusion
26
Q

what is the pathophysiology of T2DM?

A

insulin insufficiency - insulin resistance (B cell dysfunction)

27
Q

why is cellular glucose uptake inhibited in DM?

A

insulin cannot get into the cells as glucose transporter proteins (GLUTs) are stimulated by insulin

28
Q

what is getting glucose form non-carbs?
gycogenolysis
gluconeogenesis

A

gluconeogenesis

29
Q

what is getting glucose from glycogen?
glycogenolysis
gluconeogenesis

A

glycogenolysis

30
Q

what causes insulin release from B cells?

A

glucose into b cell - glycolysis into atp - atp closes K+ channel - Ca2+ channel opens - Ca2+ floods into cells - insulin released

31
Q

glucagon and incretins - inc or dec in DM?

A 
glucagon = inc
incretins = dec
32
Q

what normally happens to glucose in the kidneys?

A

reabsorbed in the proximal tubule

33
Q

how is glucose reabsorbed in the kidneys - which transporter?

A

sodium-glucose linked transporters in nephron

34
Q

what happens to the SGLT2 transporters in DM?

A

there is an inc in SGLT2 therefore inc glucose resorption - inc blood glucose

35
Q

what is a good example of an incretin in DM?

A

GLP-1 - dec secretion in DM

36
Q

what 4 mechanisms mean that there is raised blood glucose in DM?

A

1 - insulin resistance
2 - inc SGLP2
3 - dec GLP-1 = dec insulin
4 - inc glucagon

DISEASE - endocrine and haem (5 decks)

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