1 - PM

Question 1

normal fasted glucose

Answer 1

= 7

Question 2

normal random glucose

Answer 2

= 11.1

Question 3

oral glucose tolerance test that indicates diabetes

Answer 3

after 2 hours >11.1

Question 4

normal HbA1c

Answer 4

= 6.5

Question 5

Pancreatic cells that produce insulin

Answer 5

Beta cells

Question 6

metformin works by

Answer 6

increasing insulin sensitivity

Question 7

sulfonylureas work by

Answer 7

increasing insulin secretion (hence why it can cause hypoglycaemia and weight gain)

Question 8

sulfonylurea example

Answer 8

gliclazide

Question 9

who might you avoid sulfonylureas in and why

Answer 9

BMI > 35 because they can cause weight gain

Question 10

common side effects of metformin

Answer 10

GI upset

Question 11

if metformin and sulfonylureas don’t work/side effect what might you use

Answer 11

glitazones or insulin

Question 12

what monitoring must be done with glitazones

Answer 12

LFTs, every 8 weeks in 1st year

Question 13

Glitazone side effect

Answer 13

hypoglycaemia (increases insulin sensitivity), oedema, oesteperosis (fracture risk)

Question 14

insulin intake when sick

Answer 14

require MORE insulin even if not eating

Question 15

hypoglycaemia defined as

Answer 15

< 3

Question 16

hypoglycaemia treatment in someone who cannot swallow

Answer 16

25-50 ml of 50%glucose IV with saline flush

If no IV access, give 1mg of glucagon IM (needs repeats every 20 mins if they do not take on oral carbs)

Question 17

C peptide in diabetes

Answer 17

if present it indicates insulin production = type 2

if absent = proinsulin is not being made = type 1

Question 18

thyroid axis

Answer 18

hypothalamus > TRH >anterior pit > TSH > thyroid > T4 & T3 (some bound to thread binding globing and free T3 and T4) > free act on nuclear receptors

Question 19

TSH: up T4: down

Answer 19

hypothyroidism

Question 20

TSH: down T4: up T3: up

Answer 20

hyperthyroidism

Question 21

TSH: up T4: up

Answer 21

TSH secreting tumour or TSH resistance

Question 22

thyroid US: cystic

Answer 22

benign

Question 23

thyroid US: solid

Answer 23

malignant

Question 24

multi-nodular goitre think

Answer 24

cancer

Question 25

thyroid iodine uptake: hot (increased uptake)

Answer 25

not malignant

Question 26

thyroid iodine uptake: cold (reduced uptake)

Answer 26

malignant

Question 27

causes of hypothyroidism

Answer 27

``` hashimotos lithium post partum iodine deficiency sub-acute thyroiditis ```

Question 28

causes of hyperthyroidism

Answer 28

graves toxic multi nodular amiodarone

Question 29

pigmented palmar creases and ducal mucosa

Answer 29

addisons

Question 30

Addison's disease management

Answer 30

hydrocortisone + fludrocortisone

Question 31

what should happen to glucocorticoid dose when someone with addisons is sick

Answer 31

should be doubled

Question 32

what is addisons

Answer 32

glucocorticoid (cortisol) and mineralocorticoid (aldosterone) deficiency

Question 33

what does aldosterone do

Answer 33

activates Na+/K+ pumps on distal convoluted tubule (K+ out and Na+ in) lowers K+ levels increases Na+ levels (which increases water = increases BP)

Question 34

what does cortisol do

Answer 34

* * think opposite of insulin** - used during times of stress - glucose release via gluconeogenesis - muscle and adipose break down to be used in gluconeogensis

Question 35

what happens to Na and K levels in addisons

Answer 35

low Na and high K

Question 36

Diagnosis of Addison's disease

Answer 36

short synacthen test is the best test (inject ACTH which should cause a double in cortisol levels, in addisons this will not happen)

Question 37

The diagnostic test for acromegaly is

Answer 37

oral glucose tolerance with growth hormone measurements

Question 38

why can't you just look at growth hormone as the diagnostic test for acromegaly?

Answer 38

growth hormone release is pulsatile and therefore not reliable

Question 39

Oral glucose tolerance test: normal result

Answer 39

in normal patients GH is suppressed to < 2 mu/L

Question 40

Oral glucose tolerance test: suggest acromegaly

Answer 40

in acromegaly there is no suppression of GH

Question 41

why do you do glucose tolerance test for acromegaly?

Answer 41

high glucose should inhibit GH release - if this doesn't happen = acromegaly

Question 42

DKA management

Answer 42

- fluid replacement: most patients with DKA are deplete around 5-8 litres. Isotonic saline is used initially. - insulin: an intravenous infusion should be started at 0.1 unit/kg/hour. Once blood glucose is < 15 mmol/l an infusion of 5% dextrose should be started - correction of hypokalaemia

Question 43

what is duloxatine

Answer 43

anti depressant used for neurogenic pain

Question 44

Type 2 diabetes blood pressure target NO organ damage:

Answer 44

< 140 / 80

Question 45

Type 2 diabetes blood pressure target with end organ damage:

Answer 45

< 130 / 80

Question 46

Chlorpromazine can cause what side effect

Answer 46

galactorrhoea

Question 47

Diagnosis: high BP, high HCO3, low K

Answer 47

primary hyperaldosteronism

Question 48

HbA1c that is diagnostic of diabetes

Answer 48

6.5 or more