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HSC2008 Pathology & Pharmacology > Week 5 > Flashcards

Week 5 Flashcards

1
Q

what is used as a screening test for DM

A

HbA1c

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2
Q

DM treatment

A

lifestyle = diet, exercise, weight loss

pharma = glucose lowering like insulin

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3
Q

acute diabetes related complications

A

diabetic emergencies, hypoglycemia, infections

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4
Q

chronic diabetes related complications

A

macrovascular = IHD, stroke, peripheral arterial disease

microvascular = retinopathy, nephropathy, neuropathy

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5
Q

during foot examinations for DM, what do u inspect for

A

foot ulcers
palpate pedal pulses
sensations

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6
Q

Hb1Ac indicates

A

glycated hemoglobin

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7
Q

pre-meal glucose target should be __

A

4.4 - 7.2 mmol/L

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8
Q

2H post meal glucose target should be __

A

<10.0 mmol/L

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9
Q

ABC targets

A

Hb1Ac < 7.0%

Blood pressure <140/80mmHg

LDL cholesterol <2.6mmol/L

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10
Q

how to manage macrovascular diabetes complications

A

blood pressure monitoring, lipid management, smoking cessation

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11
Q

how to manage microvascular diabetes complications

A

urine albumin / creatinine ratio

retinal photo

diabetes foot screening

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12
Q

diet for diabetics

A

lots of fruits & veg, low GI carbs, lean protein & fish, water

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13
Q

effects of exercise

A

stimulates glucose transport & metabolism

increases blood flow to muscles

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14
Q

exercise recommendations

A

> 150 mins per week of moderate activity

> 75 mins per week of vigorous activity

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15
Q

ideal characterisitcs of diabetes drug

A

efficacy, safe, cheap, no side effects + hypoglycemia, weight gain

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16
Q

what is insulin associated with

A

painful, weight gain, hypoglycemia, visual impairment

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17
Q

glucose toxicity leads to

A

beta cell dysfunction & insulin resistance

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18
Q

when to use early insulin therapy

A

diabetic emergencies, uncontrolled hyperglycemia, symptomatic hyperglycemia, catabolic features

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19
Q

diabetic emergencies

A

diabetic ketoacidosis, hyperglycemic hyperosmolar state

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20
Q

diagnostic criteria for diabetes ketoacidosis

A

glucose > 14mmol/L

urine ketones 3/4+
blood ketones > 1

HCO3 < 18mmol/L
pH<7.3

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21
Q

diagnostic criteria for hyperglycemic hyperosmolar state

A

glucose > 33.3 mmol/L

effective serum osmolarity > 320mOsm/kg

altered sensorium

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22
Q

Symptomatic hypoglycaemia

A

symptoms & CBG < 4 mmol/L

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23
Q

Asymptomatic hypoglycaemia

A

no symptoms & low CBG < 4 mmol/L

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24
Q

Severe hypoglycaemia

A

another person needed to administer treatment

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25
Q

relative hypoglycaemia

A

symptoms but CBG > 3.9 mmol/L

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26
Q

symptoms of autonomic hypoglycemia

A
  • Palpitations
  • Tremors
  • Anxiety
  • Sweating
  • Hunger

PATHS

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27
Q

symptoms of neuroglycopenic hypoglycemia

A
  • Cognitive impairments
  • Behavioural changes
  • Blurring of vision
  • Seizure
  • Coma
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28
Q

hypoglycemia consequences

A

IQ drop, sudden death due to QT interval abnormality & MI

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29
Q

if hypoglycemic patient alert, give them __

A

glucose drink (15 - 20g)

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30
Q

if hypoglycemic patient drowsy or vomitting, give them __

A

IV D50% bolus 40 mls

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31
Q

when to begin monitoring of hypoglycemic patient

A

capillary glucose 30 mins after correction & every 2-4 hourly thereafter

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32
Q

hyperthyroidism TSH & T4 levels

A

TSH low
T4 high

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33
Q

hypothyroidism TSH & T4 levels

A

TSH high
T4 low

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34
Q

hypothyroidism secondary TSH & T4 levels

A

TSH low
T4 low

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35
Q

primary hyperthyroidism causes

A

graves’ disease, toxic adenoma, toxic multinodular goitre, subacute thyroiditis, medicated induced thyrotoxicosis

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36
Q

fasting plasma glucose for diabetes according to MOH

A

> 7 mmol/L

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37
Q

2 hr plasma glucose after 75g according to MOH

A

> 11.1 mmol/L

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38
Q

random plasma glucose according to MOH

A

> 11.1 mmol/L

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39
Q

skin examination for DM includes

A

acanthosis nigricans & insulin injection sites

40
Q

CGM glucose sensor measures __

A

interstitial glucose

41
Q

medication factors influencing aherence

A

1) side effect & safety profile
2) costs
3) route & frequency of administration

42
Q

fruity scented breath associated with

A

diabetic ketoacidosis

43
Q

capillary glucose “HI” or > 33.3 mmol/L associated with

A

hyperglycemic hyperosmolar syndrome

44
Q

diff between DKA & HHS in terms of patient profile

A

DKA = may occur in both but T1 prone to DKA

HHS = usually T2 and elderly

45
Q

diff between DKA & HHS in terms of rate of development

A

DKA: fast - hours to days

HHS: days to weeks

46
Q

diff between DKA & HHS in terms of degree of dehydration

A

DKA: ~100ml/kg

HHS: ~100 - 220ml/kg

47
Q

diff between DKA & HHS in terms of mortality

A

DKA < 1%

HHS 5 - 20%

48
Q

what hormones lead to hyperglycemia

A

decreased glucose utilization, increased gluconeogenesis & glycogenolysis

49
Q

DM confirmed diagnosis is done via

A
  • serum glucose
  • arterial blood gas
  • urine + blood ketones
50
Q

DM investigation for precipitating factor

A
  • blood + urine cultures
  • ECG + cardiac enzymes
  • CXR
  • lipids, amylase
51
Q

DM management includes

A

hydration, decrease serum glucose + blood + ketones, correct electrolyte imbalances, treat precipitating event

52
Q

role of TSH & T4

A

TSH stimulates thyroid and T4 turns off TSH in pituitary gland

53
Q

hyperthyroidism effects

A
  • atrial fibrillation
  • heart failure
  • osteoporosis
  • neuropsychiatric effects
  • diarrhea & abdominal cramps
  • menstrual irregularities
54
Q

hypothyroidism effects

A
  • atherosclerosis
  • pericardial effusion
  • cognitive impairment
  • muscle cramps
  • menstrual irregularities
55
Q

thyroid eye disease indicates __

A

graves’ disease

56
Q

pain & tender thyroid + preceding URTI / fever indicates __

A

subacute thyroiditis

57
Q

enlarged thyroid nodule indicates __

A

toxic MNG/adenoma

58
Q

graves’ ophthalmopathy includes __

A
  • proptosis
  • exophthalmos
  • lid retraction & lag
  • restricted extraocular muscle movement
59
Q

thyroid examination includes __

A

enlargement, tenderness

60
Q

if Graves’ disease suspected, use __

A

FT4, TSH & TSH receptor ab

61
Q

if toxic nodule/MNG suspected, use __

A

FT4, TSH + thyroid US & uptake scan

62
Q

graves’ disease treated using __

A
  • thioamides: start high & taper down
  • treat for 12-18 months KIV withdraw
63
Q

thioamides act on

A

peroxidase

64
Q

iodides act on

A

proteolysis

65
Q

side effects of thioamides

A

rashes commonly but serious cases include
- agranulocytosis
- hepatotoxicity
- vasculitis

66
Q

thyroid storm tests assesses for

A

CVS, gastrointestinal-hepatic, CNS, thermoregulation, history

67
Q

patient stabilization includes

A

ABC = airway, breathing, circulation

68
Q

what drug decreases thyroid hormone synthesis

A

thioamides

69
Q

what drug prevents thyroid hormone release

A

Lugol’s iodine

70
Q

what drug decreases peripheral actions of thyroid hormone

A

corticosteroids, beta-blockers

71
Q

physical examination for thyroidism

A

weight, thyroidectomy scar, bradycardia, goitre, dry skin

72
Q

primary hypothyroidism caused by

A
  • hashimoto thyroiditis
  • other thyroiditis
  • drugs
  • post RAI / thyroidectomy
73
Q

if hashimoto thyroiditis suspected, use __

A

FT4, TSH, thyroid peroxidase antibody

74
Q

__ empirically cover for adrenal insufficiency

A

IV glucocorticoids

75
Q

thyroid storm

A

life threatening endocrine emergency by exaggerated symptoms of hyperthyroidism & evidence of multiorgan decompensation

76
Q

ABCs of patient stabilization

A

airway, breathing, circulation

77
Q

hashimoto’s thyroiditis treatment involves __

A

thyroxine which is titrated to keep TSH normal

78
Q

myxedema coma

A

decompensated hypothyroidism

79
Q

tested criteria for myxedema coma

A

thermoregulation dysfunction, CNS effects, GI findings, precipitating events, CVS dysfunction, metabolic disturbances

80
Q

thyroid specific therapy for myxedema coma involves the use of __

A

IV glucocorticoids for adrenal insufficiency

IV levothyroxine; switch to oral when patient more alert

81
Q

empirical cover for hypocortisolism includes

A

IV hydrocortisone

82
Q

IV levothyroxine loading dose of ___ to saturate receptors followed by maintenance

A

200 - 400 mcg

83
Q

primary hypothyroidism treatment is ___

A

levothyroxine replacement therapy

84
Q

when is levothyroxine replacement therapy taken

A

1 hr before meal / 4 hrs after last meal

85
Q

things that interfere with levothyroxine absorption

A

diet (meals, Ca2+, grapefruit juice)

bile acid sequestrants (cholestyramine)

oral bisphosphonates, ferrous sulphate, calcium carbonate/citrate/acetate

86
Q

thyroid storm treatments include

A

decrease thyroid hormone synthesis using thioamides

prevent thyroid hormone release using Lugol’s iodine

decrease peripheral action of thyroid hormone using corticosteroids & beta-blockers

87
Q

thioamide solution for thyroid storm includes

A

propylthiouracil 400 mg stat then 200 mg Q6H

88
Q

propylthiouracil inhibits __

A

T4 to T3 conversion in thyroid & peripheral tissues

89
Q

wolff chaikoff effect

A

autoregulatory phenomenon where large amount of ingested iodine inhibits thyroid hormone synthesis

90
Q

Lugol’s idoine is administered __

A

1H after 1st dose of PTU to prevent iodine from being a substrate for synthesis

91
Q

corticosteroids work by __

A

inhibiting peripheral conversion of T4 to T3

92
Q

definitive therapy includes __

A

thyroidectomy & radioiodine

93
Q

major toxicities of anti-thyroid drugs

A

agranulocytosis, liver toxicities, ANCA positive vasculitis

94
Q

metabolic syndrome diagnosis criteria

A
  1. waist circumference
  2. plasma triglycerides
  3. plasma HDL cholesterol
  4. BP
  5. FPG
95
Q

key features of metabolic syndrome

A

significant abdominal fat, changes in glucose & lipoprotein metabolism

96
Q

treating hypoglycemia using __

A

15g of fast acting carbs and recheck glucose levels 15 mins after ingestion

HSC2008 Pathology & Pharmacology (14 decks)

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