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Core conditions Flashcards

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1
Q

What is the triad of symptoms seen with T1DM?

A
  1. Polyuria
  2. Polydipsia
  3. Weight Loss
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2
Q

What are the long term complications of T1DM + T2DM?

A
  1. Retinopathy
  2. Nephropathy
  3. Neuropathy (glove + stocking, postural hypotension/gastroparesis)
  4. Macrovascular complications
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3
Q

What Ix are done for someone with suspected T1DM/T2DM? (5)

A
  1. Fasting plasma glucose (>6.9mmol/L) !!
  2. Random plasma glucose (>11.1 mmol/L)
  3. HbA1c (>48mmol/L) !!
  4. Plasma/urine ketones (T1)
  5. Autoimmune markers (T1)
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4
Q

What is the main RF for T1DM?

A

HLA D3 + D4 association

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5
Q

What is the management for T1DM?

A
  1. Dietary modifications (keep lipid profile and BP low)
  2. Insulin
  3. ACEi (for BP control)
  4. Statins (for lipid control)
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6
Q

What are the diabetic emergencies for T1DM? (3)

A
  1. Diabetic ketoacidosis
  2. Hyperosmolar hyperglycaemic state (HHS)
  3. Insulin-induced hypoglycaemia
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7
Q

How do you differentiate between T1DM and T2DM? (3)

A
  1. Presence of islet cell and anti-glutamic acid decarboxylase auto-antibodies in T1DM
  2. T1 has serum/urine ketones
  3. T2 can be asymptomatic and usually later onset in overweight people
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8
Q

What are the RFs for T2DM? (5)

A
  1. Obesity
  2. Gestational T2
  3. Pre-diabetes
  4. FHx
  5. Ethnicity (black + hispanic)
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9
Q

What is the conservative management for T2DM?

A
  1. Education
  2. Diet + Exercise (reduce weight to reverse insulin sensitivity and glucose to prevent hyperglycaemia)
  3. Smoking cessation
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10
Q

What is the medical management for T2DM? (4)

A
  1. Mono-metformin treatment
  2. Dual - Metformin + DPP4 inhibitor/Sulphonylurea/SGLTi/Pioglitazone
  3. Tri - Metformin + SU + DPP4 inhibitor/SGLTi/Pioglitazone
  4. Insulin for very poorly controlled late stage T2DM

ACEi and statins will also be prescribed for reducing vascular risk

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11
Q

What are the symptoms of thyrotoxicosis? (6)

A

Graves’:

  1. Weight loss
  2. Increased appetite
  3. Heat intolerance/sweating
  4. Fatigue
  5. Fine tremor
  6. Palpitations
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12
Q

What are the signs of thyrotoxicosis? (6)

A
  1. Tachycardia (+AF)
  2. Lid lag + Exophthalmos
  3. Pretibial myxoedema (non-pitting oedema)
  4. Warm moist skin
  5. Thin hair
  6. Goitre
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13
Q

What Ix are done for someone with suspected thyrotoxicosis?

A

TFTs:

  1. TSH (low)
  2. T3+T4 (raised)
  3. TSH receptor antibodies (Graves’)
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14
Q

What are the causes of thyrotoxicosis? (3)

A
  1. Graves’ (autoimmune antibody activation of TSH receptor)
  2. Toxic Multinodular Goitre (many autonomously functioning nodules free of TSH control - iodine deficient areas)
  3. Toxic Thyroid Adenoma (single nodule causing hyperthyroidism)
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15
Q

What will be seen on thyroid US for the three different causes of thyrotoxicosis?

A

Graves’ = enlarged diffuse + highly vascular

TMG = many hot + cold nodules

TTA = single hot nodule

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16
Q

What are the RFs for the three causes of thyrotoxicosis?

A

Graves’ = Smoking, FHx + Female

TMG = Iodine deficiency

TTG = Iodine deficiency

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17
Q

What is the management for Graves’? (3)

Study These Flashcards
A

1st= Carbimazole (anti-thyroid)

2nd = Carbimazole/propylthiouracil + levothyroxine

B-blockers for symptom control (AF mainly)

18
Q

What is the management for TMG?

Study These Flashcards
A

I-131 therapy

19
Q

What is a thyroid storm?

Study These Flashcards
A

Emergency situation with severe rise in thyroid hormone quantity which massively increases the severity of the hyperthyroid symptoms

20
Q

Are hot or cold nodules cancerous?

Study These Flashcards
A

Cold - show areas of non-functioning nodules

21
Q

Why shouldn’t you give thyroid blocking medication to a woman with post-partum thyroiditis?

Study These Flashcards
A

Caused by inflammation of thyroid related to pregnancy.

Surge in T3 initially but depletes quickly to become hypothyroid so you don’t want to block this further

22
Q

What is the main cause of hypothyroidism?

Study These Flashcards
A

Hashimoto’s thyroiditis (autoimmune destruction of thyroid)

23
Q

What are the causes of a diffuse thyroid goitre? (3)

Study These Flashcards
A
  1. Physiological
  2. Graves’
  3. Hashimoto’s thyroiditis
24
Q

What are the causes of a nodular thyroid goitre?

Study These Flashcards
A
  1. TMG
  2. Adenoma (TTA)
  3. Carcinoma
25
What are the symptoms of hypothyroidism? (5)
1. Tiredness 2. Depression 3. Weight gain 4. Cold intolerance 5. Constipation
26
What are the signs of hypothyroidism? (6)
1. Bradycardia 2. Slow relaxing reflexes 3. Ataxia 4. Dry skin + hair 5. Eye lid oedema 6. Loss of outer 1/3 eyebrow
27
What is primary hypothyroidism? What are the two main causes
Thyroid doesn't make enough T3/T4 so rise in TSH to compensate 1. Primary atrophic hypothyroidism (lymphocyte infiltration = atrophy - no goitre) 2. Hashimoto's thyroiditis (lymphocyte and plasma cell infiltration = goitre)
28
What investigations are done for someone with suspected hypothyroidism?
1. Serum T4 (low) 2. Serum TSH (raised in primary, low in secondary hypo) 3. Antithyroid peroxidase antibody (raised in 90% suggests autoimmune thyroid issue)
29
What are the main RFs for hypothyroidism?
1. Female 2. Middle aged 3. FHx of autoimmune conditions 4. Head and neck radiotherapy
30
What is the management for someone with hypothyroidism?
Daily levothyroxine (don't over-treat = risk of AF + osteoporosis)
31
What is the target BP for diabetics with/without end organ damage?
``` With = 130/80 Without = 140/80 ```
32
What are the biochemical signs of Addison's? (2)
1. Hyperkalemia | 2. Hyponatremia
33
What is the test for Addison's on a well and sick patient? (2)
``` Well = 9am cortisol Unwell = Short synacthen test (ACTH injection) ```
34
What are the clinical signs of Addison's? (3)
1. Lethargy 2. Giddiness 3. Hyperpigmentation
35
What are the different diagnostic criteria for DM? (3)
1. Symptoms of hyperglycaemia or once detected impaired fasting/random glucose 2. Raised HBA1c (not pregnant women, children, T1DM) 3. Oral glucose test with raised random/fasting glucose on two separate occasions
36
What is latent autoimmune diabetes of adults?
A late onset of T1 DM in adults with few RFs for T2DM
37
What is metformin? When should it be avoided?
A biguanide which increases insulin sensitivity When eGFR <36 due to increased risk of lactic acidosis
38
What are DPP4 inhibitors?
E.g. stigalipitin - block the action of DPP4 which destroys incretin (hormone which decreases BM after eating)
39
What is glitazone?
Increases insulin sensitivity
40
What is sulphonylurea?
E.g. gliclazide - increases insulin secretion
41
What is SGLTi?
A selective sodium-glucose co-transporter-2 inhibitor which blocks the re-absorption of glucose in the kidneys and promotes urinary excretion

Endocrine (3 decks)

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