Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MRCGP > Diabetes And Endocrinology > Flashcards

Diabetes And Endocrinology Flashcards

(84 cards)

Start Studying
1
Q

What are the 10 key checks for annual review in diabetes?

A

Diabetic eye screening-retinopathy
Diabetic foot screening
BMI
Blood pressure
HbA1c
U+E
Lipids
Urine ACR
Smoking cessation advice
Influenza vaccine single pneumococcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Lifestyle modification advice in diabetes

A

NERS
Dietician
Weight loss if overweight
Stop smoking
Exercise/activity
Cardio risk: BP, statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which diabetic patients should be offered a statin?

A

T2DM if QRISK>10%
T1DM age >40 or diabetes>10 years, nephropathy, obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should HbA1c targets be?

A

48 if planning pregnancy (+5mg folic acid)
48 if lifestyle management
48 if lifestyle + metformin
53 if drug treatment associated with hypoglycaemia (such as gliclazide)
53 if risen to 58+ so added 2nd drug
64 mild frailty(de-escalate meds if 58), 69 severe frailty (de-escalate meds if 64)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the sick day rules?

A

If unwell and sugars>13 mmol/L (on insulin pump) or 15 mmol/L, check for ketones in blood:
If ketones>1.5 mmol/L, or confusion or drowsiness, call 999.

Do not stop taking insulin.
Stop ACEi/NSAIDs/diuretics
Stop metformin/SGLT2/gliclazide/GLP-1 if risk dehydration
One glass of fluid per hour.

Seek GP help:
ketones 0.6-1.5 mmol/L.
persistent vomiting.
breath smells like pear drops.
new-onset abdominal pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Group 1 drivers DVLA regulations

A

If insulin/gliclazide inform DVLA + you can drive if:
-You have adequate awareness of the onset of hypoglycaemia.
* You should inform the DVLA if you have more than one severe hypo within
the preceding 12 months. Severe hypoglycaemia is defined as requiring the
assistance of another person.
* You should practice appropriate blood glucose monitoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Group 2 drivers DVLA regulations

A

-You have full awareness of hypoglycaemia.
* No episode of severe hypoglycaemia in the preceding 12 months.
* You should use a blood glucose meter with sufficient memory to store 3 months
of continuous readings . You must practice appropriate blood
glucose monitoring before driving + 2hrly
* You can demonstrates an understanding of hypoglycaemia risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you diagnose diabetes?

A

Random blood glucose>11.1
fasting blood glucose> 7.0
HbA1c>48
If asymtommatic rpt in 2 weeks to confirm diagnosis

If HbA1c 42-47.9 or FBG 5.5-6.9, diagnose as prediabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should you consider MODY?

A

Age<30 years.
Age 30-45, not requiring insulin, with:
no metabolic syndrome, or
mild fasting hyperglycaemia (5.5-8 + HbA1c<65 mmol/mol), or
extra-pancreatic features, deafness, neurological abnormalities, urinary tract abnormalities, cardiac hypertrophy, optic atrophy, short stature.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to reduce GI side effects with metformin

A

Start at 500mg OD, increasing to 500 mg twice a day after 2 weeks then to 1g BD
taking with or after food.
using MR if ongoing symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dosing for metformin

A

eGFR 15 -30 -Avoid metformin

30-60- max 1g daily

60-120-max 2g daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

1st line management T2DM

A

Metformin 500mg OD- titrate up to 1g BD (if eGFR>60)
4 weeks later add in dapagliflozin if QRISK>10% or CKD or IHD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

If metformin is not tolerated or contra-indicated and low cardiovascular risk?

A

DPP-4 inhibitor- sitagliptin/linagliptin
Pioglitazone
A sulfonylurea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give examples of DPP4-i and pros/cons/when to use

A

Sitagliptin/linagliptin/saxagliptin
weight neutral
low risk hypos
mild effect on hba1c (6-8 drop)
good in frailty
avoid in pancreatitis. Saxagliptin avoid in heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pioglitazone, pros/cons/when to use

A

Good in metabolic syndrome, takes 3m to work, reduced lipids
Causes weight gain and incr fracture risk
Contraindicated in heart failure, macular oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give example of sulphonylurea and pros/cons/when to use

A

Gliclazide
Good in marked osmotic symptoms and steroid induced hyperglycaemia
Incr risk of hypoglycaemia, take with meals
Blood glucose monitoring mornings + before driving
Weight gain so use if BMI<28
Poor durability of effect
Can be used as rescue therapy for 4 weeks if v high HbA1c

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If monotherapy is ineffective, what to add?

A

A DPP-4 inhibitor (sitagliptin)
Pioglitazone.
A sulfonylurea. (gliclazide)
An SGLT-2 inhibitor (if not already on and risk of hypos)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Give examples of SGLT2i and pros/cons/when to use

A

Dapagliflozin/canagliflozin/empagliflozin
Caution in amputation, PVD,
frequent urogenital infections.
frailty at risk of hypovolaemia, prev DKA, ketogenic diet
Risk of normoglycaemic DKA
Improves cardiovascular + CKD outcomes
If eGFR<45, loses glycaemic beneift but still has CKD/CCF benefit
Stop 48hrs prior to surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

For triple therapy what combinations are good and which are bad?

A

Good:
metformin+ dapagliflozin + gliclazide
Metformin + ertugliflozin + sitagliptin
Bad:
Dapagliflozin not with pioglitazone

Instead of triple therapy, consider insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If triple therapy ineffective?

A

Switch one drug for a GLP-1 (need to stop gliptin DPP4)
GLP-1 if:
BMI>35+ medical conditions associated with obesity, or
BMI<35+ insulin therapy would have significant occupational implications, or weight loss would benefit other comorbidities.

Should only be continued if reduction>11 in HbA1c and a weight loss of at least 3% in 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Give examples of GLP-1 and pros/cons/when to use

A

Semaglutide (Ozempic) weekly SC, dulaglutide (Trulicity) weekly SC, liraglutide (Victoza) OD SC
Low risk hypo
Cardiovascular protection
Expensive
Interacts w/levothyroxine, slows gastric emptying, can worsen gallstone disease and retinopathy
Oral semaglutide specialist recommended
Not with DPP4-i

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Management diabetes + CKD?

A

Control BP, lipids, sugars
If ACR>3 start ACE-i
Specialist reccomended- dapagliflozin/ consider finerenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

BP management in T2DM

A

ACEi 1st line or ARB if black/african

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Steroid induced hyperglycaemia management

A

Mostly post-prandial hyperglycaemia
If glucose<15 monitor
If glucose>15 and no diabetic meds, consider starting gliclazide short term
If already on insulin, titrate dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Symptoms of hypoglycaemia
Hunger, sweating, tremor, anxiety Dizziness or light-headedness Sleepiness, confusion Difficulty speaking, weakness Usually symptoms when sugar<4
26
Management hypoglycaemia
If blood glucose (BG)<4 and able to swallow: 170 mL of lucozade 4 glucotabs 3 jelly babies 150 mL juice/pop Retest BG in 15 mins, bread/2xdigestive biscuit IM glucagon 1mg if: unconscious having a seizure unable to take anything PO no change in BG after PO sugar
27
Risks of poorly controlled GDM (gestational diabetes) + poorly controlled diabetes in pregnancy
Macrosomia Neonatal hypoglycaemia Hyperbilirubinaemia Respiratory distress syndrome miscarriage. congenital malformations. stillbirth and neonatal death
28
Risk factors for GDM
BMI>30 Previous macrosomic baby>4.5 kg Previous GDM 1º relative with diabetes Black, Asian, and other ethnic minority family origin
29
Management post-natal period GDM
HBA1c at 13 weeks (preferred), or fasting blood glucose (FBG) at 6 to 13 weeks If FBG<6, low risk T2DM If FBG 6-6.9 pre-diabetes If FBG>7 then has T2DM All GDM pts will need annual screening HbA1c
30
Diagnostic criteria GDM and BG aim
FBG>5.6 or OGTT BG>7.8 Target levels are 5.3 fasting, and 7.8 1 hour after meals, or 6.4 2 hours after meals.
31
Management prediabetes
Smoking cessation Healthy eating Increasing physical activity Weight reduction Manage cardiovascular risk- eg statins, BP Consider metformin off label if BMI>35 and deterioration HbA1c despite lifestyle changes Refer dietician (or low cal diet if England)
32
Ix for primary amenorrhoea
Check BMI, growth Pubic/axillary hair, breast development Bloods: LH, FSH, oestrogen, TSH, prolactin, testosterone, sex hormone binding globulin (SHBG), if ?androgen excess. USS pelvis
33
What should you look for on inspection ?diabetic foot
Ulcers or infection. nail infection or impingement on adjacent toes. interdigital infections Fissured skin, skin atrophy, callus or corn formation, blisters structural changes-high arch, clawed toes, bunions. foot swelling.
34
Features and complications ischaemic foot
Cool, hairless, with diminished or absent pulses Pale or dependent rubor with atrophic skin Painful Ulcers Intermittent claudication, rest pain, gangrene, and amputation
35
Signs of diabetic foot attack
Ulceration Spreading infection Critical limb ischaemia Gangrene Charcot foot: -Localised swelling, erythema, and increased skin temperature without trauma. -Rocker‑bottom foot deformity. -with or without pain
36
Referral criteria diabetic feet
Admit vascular: critical limb ischaemia Same day podiatry assessment or, if OOH admit T+O Active crisis, request urgent (within 24 hours) podiatry assessment or advise patient self-referral to the Podiatry DFEET (Diabetic Foot Early Emergency Triage) Clinic. Routine podiatry if moderate risk of crisis.
37
Ix for secondary amennorhoea
Check BMI Bloods: LH, FSH, oestrogen, TSH, prolactin, testosterone, sex hormone binding globulin (SHBG), if ?androgen excess.
38
4 main causes secondary amenorrhoea
PCOS Premature ovarian insufficiency Hyperprolactinaemia Hypothalamic amenorrhoea (eg low BMI)
39
Definitions of primary vs secondary amenorrhoea
primary amenorrhoea – absence of menarche by age 15 years, or age 13 years if absent secondary sexual characteristics. secondary amenorrhoea – no menstruation for 3-6 months in a woman with previously normal and regular menses, or 6-12 months in a woman with previous oligomenorrhoea
40
When to refer primary amenorrhoea
Urgent gynae if lower outlet tract obstruction (imperforate hymen or transverse vaginal septum) is suspected Routine paeds: If amenorrhoea persists past aged 13 (if secondary sexual characteristics are absent) or past aged 15 years (if secondary sexual characteristics are present) Refer sooner and urgently if any concerning features (growth retardation/thyroid disease/genital malformation/puberty 5 yrs without menarche)
41
Blood results suggestive of secondary amenorrhoea cause
PCOS- normal FSH, LH, oestrogen, slightly ↑testosterone/prolactin Premature ovarian insufficiency - ↑FSH, ↑LH, ↓oestrogen, normal testosterone/prolactin Hyperprolactinaemia- normal/low FSH LH oestrogen testosterone, ↑prolactin Hypothalamic/pituitary amenorrhoea- normal/low FSH LH, low oestrogen, normal testosterone/prolactin If very raised testosterone ?adrenal hyperplasia
42
Define asherman syndrome
acquired condition, scar tissue forms inside the uterus and/or the cervix Variable scarring inside the uterine cavity, front and back walls of the uterus may adhere to one another
43
Causes of raised prolactin
Prolactinoma Medication: Antipsychotics, Antiemetics, Antidepressants, Opiates Stress Pregnancy Hypothyroidism Recent breast examination If no clear cause and >1000 refer urgent endo
44
Possible causes of premature ovarian insufficiency
Age<40 for premature, refer routine gynae (unless endocrine disorder) Turner's syndrome Fragile X syndrome Empty sella syndrome Ovarian or pelvic surgery, chemotherapy, or radiotherapy Autoimmune disorders
45
Causes of hypercalcaemia
Primary hyperparathyroidism Malignancy – myeloma, (breast ca, lung ca, kidney ca) Medications (lithium, thiazide diuretics, vitamin D toxicity) Sarcoidosis Thyrotoxicosis Cortisol deficiency Milk-alkali syndrome
46
Symptoms of hypercalcaemia
Nausea Vomiting Constipation Abdominal pain Thirst Polyuria Confusion
47
Ix for hypercalcaemia
Bloods: U+E, LFT, Bone profile, PTH, vitamin D If age>60, myeloma screen (PTH should be low if calcium raised) If the above is normal consider: FBC, ESR, chest X‑ray, X‑ray of spine or painful sites (sarcoidosis, malignancy) Radionuclide bone scan Serum electrophoresis + paraprotein + immunoglobulins Thyrotoxicosis – TFT Cortisol deficiency – 9am cortisol + ACTH
48
Referral criteria for hypercalcaemia
Admit if: calcium>3.5 calcium> 3 + n+v calcium>3 + dehydration Routine endocrinology if: primary hyperparathyroidism, medication/surgery. Osteoporosis
49
Features of hyperkalaemia
arrhythmias/palpitations/syncope n+v paraesthesia ascending muscle weakness legs->trunk->arms. muscle pain
50
Medication causes of hyperkalaemia
Spironolactone ACEi/ARB Propranolol Digoxin toxicity NSAIDs Trimethoprim Tacrolimus, ciclosporin Heparins LoSalt Alfalfa, dandelion, nettle
51
Non medication causes of hyperkalaemia
False reading, haemolysis of sample AKI/CKD Aldosterone deficiency Rhabdomyolysis, burns, tumour lysis syndrome, crush injuries Massive haemolysis Acidosis, low insulin levels, or medications (shift from cells) Massive blood transfusion
52
Referral criteria hyperkalaemia
999 if acutely unwell Admit if: potassium>6.5 symptomatic hyperkalaemia AKI ECG changes (do ECG if K>6) K rising rapidly. Chronic hyperkalaemia routine ref cardio/renal for consideration of potassium binders.
53
Symptoms hypokalaemia
hypotension, brady/tachycardia, arrhythmia Weakness, fasciculations, tetany Lethargy, paraesthesia, mental status change Constipation
54
Medication causes of hypokalaemia
Diuretics (furosemide, thiazides) Salbutamol, theophylline Insulin Steroids
55
Non medication causes hypokalaemia
D+V Anorexia, bulimia, alcoholism Excessive sweating, DKA, polydipsia. Liquorice Intestinal fistula, hypothermia, burns Hyperaldosteronism, Cushing’s, Conn's syndrome, refeeding syndrome, diabetes insipidus
56
Ix hypokalaemia
Blood sugar if diabetic Mg if GI losses ECG if K<3
57
ECG changes with hyperkalaemia
Peaked T waves PR prolongation P wave loss QRS widening Sine wave Ventricular arrhythmias, asystole
58
Referral criteria for hypokalemia
Admit if: K<2.5 ECG changes. low magnesium (IV replacement) significant symptoms K<3 and decreasing Routine endo: ?hyperaldosteronism or Conn's Nephrology advice if ↑urine potassium excretion, normal BP, no vomiting/diuretics
59
Underlying conditions causing low magnesium levels
Malabsorption, malnutrition, Crohn's, coeliac, refeeding syndrome, pancreatitis and cirrhosis T2DM, DKA Renal disorders Hyperthyroidism, hypoparathyroidism, hyperaldosteronism
60
Medications that can cause low magnesium
PPI Loop and thiazide diuretics Insulin Digoxin Cisplatin Gentamicin Ciclosporin, tacrolimus
61
Features of low magnesium levels
Arrhythmia Tremor Confusion Tetany Seizure Coma
62
Referral criteria low magnesium
Admit if: arrhythmia, tetany or seizure. magnesium<0.7 hypokalaemia + low magnesium.
63
When should steroid sick day rules be used and what are they?
At risk if>5 mg prednisolone daily for >3 weeks Double usual dose for 2 to 3 days, then back to normal maintenance dose if minor illness If vomiting/unable to absorb meds- admit
64
Long term steroids monitoring + prophylaxis
Monitor BP, HbA1c, weight Consider PPI Yearly optometry for cataract/intraocular pressure Calci-D Alendronate if age>65 dependent on FRAX if age<70 Avoid live vaccinesI
65
Baseline Ix after low impact fracture/concerns over bone health
FBC, Bone profile, U+E, LFT, GGT, TFT Vitamin D, PTH, paraprotein/electrophoresis/immunoglobulins Anti-TTG
66
Management of osteoporosis
As per FRAX score/DXA Weight bearing exercise Stop smoking/alcohol Avoid being underweight Calci-D Alendronic acid 70mg once weekly or ibandronic acid 150 mg once a month (specialist recommended) HRT if age<60 (but benefit lost once stopped)
67
Causes of low testosterone in men
Pituitary and hypothalamic diseases. Opiates testicular pathology (trauma, radiation, infection). Klinefelter syndrome. Obesity, OSA, T2DM Anabolic steroid abuse
68
Referral criteria low testosterone
Routine endo if 2 morning testosterone levels are low (<8) or borderline low (8-12), USC urology if abnormal PSA in testosterone therapy/abnormal DRE
69
What is Graves?
Autoimmune hyperthyroidism Women>Men Most common cause of hyperthyroidism Diffuse goitre Thyroid eye disease Thyroid antibodies +ve in 90%
70
What is thyroiditis
Subacute (de Quervain) thyroiditis: Tender diffuse goitre, transient hyperthyroidism then hypothyroidism then normal ?viral Doesn't respond to carbimazole. Postpartum thyroiditis (painless). Medications (amiodarone, lithium) external radiation
71
Symptoms hyperthyroidism
Palpitations, tachycardia Sweating Tremor Weight loss despite increased appetite Symptoms of heart failure Symptoms of goitre
72
Ix for hyperthyroidism
TFT TSH receptor antibodies FBC, LFT, U+E CRP, ESR if thyroiditis is suspected. ECG if arrhythmia.
73
Management hyperthyroidism
Admit if psychosis, fast AF, CCF Urgent endo + same day ophthalmology if drop in visual acuity, or altered colour perception Routine endo ref for everyone else for advice re carbimazole 20-40mg OD (risk agranulocytosis) Start propranolol 20-40mg BD Stop smoking Contraception
74
Management mild thyroid eye disease
Lubricating tear drops Elevation of head of bed Cold packs to eyes Wearing dark glasses NSAIDs Selenium – OTC 200mcg OD
75
Causes of hypothyroidism
Auto-immune hypothyroidism (Hashimoto’s) – most common cause in iodine-sufficient areas of the world. Post radioiodine, thyroidectomy, or external radiation therapy. Medications (lithium or amiodarone) Sub-acute thyroiditis or postpartum thyroiditis Central cause (very rare)
76
Symptoms hypothyroidism
Tiredness Sensitivity to cold Weight gain Constipation Depression Muscle aches and weakness Dry and scaly skin, brittle hair and nails Loss of libido Irregular or heavy periods
77
When should you suspect central cause of hypothyroidism?
Low or normal TSH with low FT4 Pituitary symptoms: menstrual cycle. cortisol deficiency. hypogonadism. visual fields.
78
Management subclinical hypothyroidism
TSH>10: treat if symptommatic, or rpt 3-6 months and treat if still raised TSH 4-10: rpt 3-6 months with TPO Ab, if positive + TSH still raised treat for 6m, if not treating monitor annually
79
Management thyroid lump
Thyroid lump if moves on swallowing, central lower neck USC endo if TSH raised or normal Routine endo if TSH is low USC if hypothyroid patient with goitre that persists once the patient is euthyroid.
80
Management vitamin D deficiency
Loading: Stexerol (colecalciferol) 25,000 unit tablets, take 2 once a week for 6 weeks. Or- InVita D3 (colecalciferol) oral solution 25,000 units/mL, take 2 mL once a week for six weeks. Check serum calcium 4 weeks after loading complete
81
Symptoms of Addison's crisis and Addison's disease
Crisis: hypotension, hypovolaemic shock, delirium, reduced consciousness, acute abdominal pain, vomiting, headache, low-grade fever, and muscle weakness. Fatigue Hyperpigmentation Weight loss, cravings for salt.
82
Ix for Addison's
9am cortisol U+E: Na low K high Glucose Cortisol<100- admit 100-500- refer for Synacthen test.
83
Features of Conn's
Hyperaldosteronism Low K, raised BP Treatment resistant hypertension
84
Features of carcinoid syndrome
When neuroendocrine tumours produce serotonin, usually when spread to liver diarrhoea, tummy pain and loss of appetite flushing of the skin, particularly the face fast heart rate breathlessness and wheezing

MRCGP (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions