Week 23 - endocrine

Question 1

What is C peptide ?

Answer 1

a by-product of insulin synthesis

used to measure endogenous insulin production

Question 2

What is C peptide used to measure ?

Answer 2

endogenous insulin production

because it is a by-product of insulin synthesis in pancreas

Question 3

Where is ADH produced ?

Answer 3

posterior pituitary

Question 4

Where is LH produced ?

Answer 4

anterior pituitary

Question 5

Where is growth hormone (GH) produced ?

Answer 5

anterior pituitary

Question 6

Where is prolactin produced ?

Answer 6

anterior pituitary

Question 7

Where is adrenocorticotropic hormone (ACTH) produced ?

Answer 7

anterior pituitary

Question 8

Which of these is not a function of glucagon …
a) gluconeogenesis ?
b) glycolysis ?
c) glycogenolysis ?

Answer 8

glucagon inhibits glycolysis

Question 9

which conditions are associated with graves’ disease ?

Answer 9

• T1DM
• alopecia areata
• vitiligo

Question 10

What can cause candidal balanitis

Answer 10

• diabetes
• oral antibiotics
• poor hygiene in uncircumcised males
• immunosuppression (inc. HIV infection)

Question 11

What does candidal balanitis present like?

Answer 11

• swollen and tender glans penis
• thick white exudate/discharge under foreskin
• erythema under foreskin

Question 12

what result of a random glucose test in a patient with polyuria would be diagnostic of diabetes ?

Answer 12

random blood glucose of 14 in a patient with polyuria

Question 13

what result of a fasting glucose test in a patient with polyuria would be diagnostic of diabetes ?

Answer 13

a fasting glucose test of 7.2 in a patient with polyuria

Question 14

what result of a random glucose test in a patient with no symptoms would be diagnostic of diabetes ?

Answer 14

a fasting glucose test of 12 in a patient with no symptoms, repeated found to be 11.5

Question 15

what is the diagnostic criteria for diabetes regarding blood glucose testing ?

Answer 15

a blood glucose result of
- fasting 7+
- random 11.1+
in symptomatic patients

if asymptomatic then above criteria must be met on 2 separate occasions

Question 16

what is the diagnostic criteria for diabetes regarding HbA1c testing ?

Answer 16

HbA1c of 48 or more in symptomatic patients

if asymptomatic then a second HbA1c is required and 2 consecutive tests of 48+ is diagnostic

Question 17

what age range can you not use HbA1c as diagnostic criteria for diabetes ?

Answer 17

younger than 18

Question 18

What are the hall mark symptoms of T2DM?

Answer 18

• tiredness
• polyuria/polydipsia
• recurrent infection e.g thrush
• unintentional weight loss
• blurred vision (retinopathy)
• foot ulcers/sores (neuropathy)
• acanthosis nigricans (dark skin in armpits/neck due to insulin resistance)

Question 19

What are the symptoms of hyperglycaemia ?

Answer 19

• increased thirst (polydipsia)
• increased urine frequency/urgency
• weight loss
• tiredness

Question 20

What is the main hyperglycaemic emergency seen in T1DM ?

Answer 20

DKA

Question 21

What is the main hyperglycaemic emergency seen in T2DM ?

Answer 21

hyperosmolar hyperglycaemic state

Question 22

What are there risk factors for developing T2DM ?

Answer 22

• Fx
• obesity (truncal distribution)
• poor diet (high in sugar and fat)
• inactivity
• age >45
• high lipid levels
• ethnicity (not caucasian)
• history of gestational diabetes
• PCOS (can cause insulin resistance)

Question 23

what is checked at an annual diabetic review ?

Answer 23

• blood sugars
• HbA1c
• cholesterol
• blood pressure
• urine
• eye tests
• foot examination
• height and weight

Question 24

When is medication considered in T2DM ?

Answer 24

if lifestyle measures aren’t helping HbA1c get lower than 48

(HbA1c checked every 3-6 months)

Question 25

what is the scoring system called that scores a persons risk of cardiovascular disease ?

Answer 25

QRISK2

Question 26

what is the most common side effect of metformin ?

Answer 26

gastro disturbance

Question 27

what can be done to reduce a patients GI upset on metformin ?

Answer 27

• take with a meal
• swap to modified release tablets

Question 28

what is the initial starting regime for metformin ?

Answer 28

500mg OD

titrated up to 1g BD if needed

Question 29

When is insulin therapy considered in T2DM ?

Answer 29

when a combo of 3 meds aren’t reducing HbA1c below target range

Question 30

What other types of medication should be considered in diabetic patients ?

Answer 30

• ACE inhibitors (antihypertensives)
• statins (if QRISK over 10%)

Question 31

what is the BP target in diabetic patients ?

Answer 31

below 140/80

below 130/80 in patients with ‘end organ damage’

Question 32

what is the diagnostic criteria for DKA ?

Answer 32

• BM >11 (or known diabetes)
• capillary ketones >3mmol/L (or urinary >2+)
• venous pH <7.3 or bicarb <15 (acidosis)

must have all 3 for diagnosis

Question 33

What is the typical presentation of DKA ?

Answer 33

confusion, vomiting and abdo pin

Question 34

what are signs of DKA ?

Answer 34

• abdo pain
• vomiting / diarrhoea
• confusion
• lethargy
• weight loss
• fruity smelling breath
• increased thirst/urinary frequency
• kussmal breathing (deep sighing respiration)
• dehydration
• features of shock
• visual disturbances
• inability to tolerate fluids

Question 35

What is immediate treatment of DKA ?

Answer 35

• fixed rate insulin (0.1 units/kg/hr)
• fluid replacement
• correct electrolyte imbalances (K+)

Question 36

is sliding scale insulin used in DKA ?

Answer 36

no ! fixed rate is treatment and sliding scales is for patients being kept nil by mouth, with poor control in hospital or going into surgery

Question 37

which electrolyte is most important to monitor and control in DKA therapy ?

Answer 37

potassium

Question 38

what happens to potassium when insulin is given ?

Answer 38

potassium drops as well as blood sugar

that’s why insulin/dextrose is a treatment for hyperkalaemia !

Question 39

as a junior doctor, when would you involve a senior during DKA ?

Answer 39

from the start, always - every patient is different and DKA deteriorates quickly !