Diabetic/ endocrine Flashcards

1
Q

Diabetic med to not cause hypos?

A

Pioglitazone
SE: Hf, Weight gain, fractures, bladder cancer

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2
Q

Gliclazide is a ?

A

Sulfonylurea (surlf and glide):
SE: weight gain, hypoglycaemias, decrease warfarin effect (PCBRAS), caution in renal impairment for sulfonylureas. Gliclazide is metabolised in liver.

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3
Q

Pioglitazone is a?

A

no hypos, has heart failure, weight gain, fractures,thiazolidinedione, works by increasing insulin sensitivity

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4
Q

Sitagliptin is a?

A

sit on 4 legs
DPP4inhibitor. small risk pancreatitis. linagliptin is renal safe. reduce the peripheral breakdown of incretins such as GLP-1

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5
Q

What is SGLT2?

A

dapagliflozin - flows through urine. hypos. used for heart failure after metformin established or as monotherapy if CI to metformin. recurrent UTIs, fournier’s gangrene

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6
Q

Dx of diabetes

A

FBG 7+ or random 11.1+ x2 in asymptomatic
Sx- Hba1c 48+

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7
Q

Dx of IFG?

A

FBG 7.1 - 7 do OGTT
OGTT <7 then post glucose 7.8-11.1

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8
Q

Pernicious anaemia, DM, High TSH, low t4?

A

Hashimotos (common), painless goitre

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9
Q

DM2 - 2nd line/ dual therapy?

A

metformin + DPP-4 inhibitor
metformin + pioglitazone
metformin + sulfonylurea
metformin + SGLT-2 inhibitor (if NICE criteria met)

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9
Q

DM2 tripple therapy options?

A

metformin + DPP-4 inhibitor + sulfonylurea
metformin + pioglitazone + sulfonylurea
metformin + (pioglitazone or sulfonylurea or DPP-4 inhibitor) + SGLT-2 if certain NICE criteria are met
insulin-based treatment

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10
Q

Normal T3/T4 TSH is 5.7. Mx?

A

Subclinical hypothyroidism.
if TSH 5.5-10 (x2 3 months apart, with sx, <65YO) then trial 6 months levo
If TSH 10+ then consider levothyroxine (if x2 3 months apart)

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10
Q

When to consider GLP1 mimetic?

A

BMI 35+, psyhcosocial issues related to obesity. BMI < 35 and occupational related. Only keep on if WL 3% in 6 months and if Hba1c reduces by 11.
Works by increase insulin secretion and inhibit glucagon secretion

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11
Q

Aldosterone: renin test:
High aldosterone, low renin meaning? HTN, low K, alkalosis?

main causes?

A

Primary hyperaldosterone. Adrenal gland makes too much, suppressed renin bc high BP.
Bilateral adrenal hyperplasia (most common)
Adrenal adenoma secreting aldosterone (Conn’s syndrome)
Familial hyperaldosteronism (rare)

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12
Q

HTN, low K+, alkalosis?
Aldosterone: renin test: High aldosterone, High renin meaning?

TX?

A

Secondary hyperaldosteronism.
Excessive renin is released due to disproportionately lower blood pressure in the kidneys, usually due to:
Renal artery stenosis -doppler USS, Ct angio, MRA
Heart failure
Liver cirrhosis and ascites

TX: percutaneous renal artery angiogrplasty

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13
Q

Sx of HTN, low K, alkalosis? other IX?

A

Hyperaldosteronism - do aldosterone:renin ratio.
Do CT adrenals, renal artery imaging, adrenal venous sampling

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14
Q

Short synacthen test - Cortisol does not double after synacthen given (ACTH). ACTH is high

A

primary adrenal insufficiency.
Pituitary is producing lots of ACTH, cortisol is not released for neg feedback. destruction to adrenal cells - addisons

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15
Q

Short synacthen test - cortisol is low and ACTH is also low

A

ACTH level is low in secondary adrenal failure. Low ACTH release due to pituitary gland damage - trauma, sheehan’s, tumour.

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16
Q

What is tertiary adrenal insufficiency cx?

A

Failure of adrenals due to low CRT from hypothalamus due to long term suppression from exogenous steroids.

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17
Q

headache, sweating and palpitations HTN IX? TX?

A

Do urinary metanephrines
PHaeochromocytoma - give PHenoxybenzamine before beta-blockers

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18
Q

Pre DM values?

A

HBa1c 42-47
FBG 6-7

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19
Q

Impaired glucose intolerance values?

A

OgTT <7 then 7.8-11.1
FBG 6.1-7

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20
Q

What is glimerperide

A

sulfonylurea

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21
Q

Kallman’s syndrome/ klinfelter’s syndrome levels of hormones?

A

Kallman - low FSH/LH and low testosterone
Kleinfelter’s - high FSH and LH, low test (small testes, tall, gynacomastia)

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22
Q

Confusion, hypothermia, non pitting oedema, dry skin, course hair?

A

Myxoedema coma

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23
Q

Why does hypercalcaemia cause peptic ulcers ad HTN?

A

increased gastrin production and vasoconstrion. Also AF: pancreatitis, MEN 1 and 2

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24
Q

Raised calcium, low phosphate, Normal/ raised PTH?
when would you conservatively manage?

A

Primary hyperparathyroidism. caused by pituitary tumour
conservative mx: if Ca is less than 0.25, patient 50YO+ , no evidence of organ damage trial calcimimetic (cinacalcet)

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25
Q

Acromegaly: if patients are not suitable for trans-sphenoidal surgery, or have residual symptoms, then treatment is?

A

Octreotide

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26
Q

Secondary hyperparathyroidism presents?

A

High PTH, Low/ normal Ca.
Low Ca caused by CKD, vitamin D deficiency, positive feedback.

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27
Q

Tertiary parathryoidism presents as?

A

Chronic CKD, low vit D, increased PTH production to compensate, leads to hyperplasia of parathyroid gland. (Secondary to tertiary) hyperplasia remains

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28
Q

Causes of SIADH mnuemonic?

IX:

Explain SIADH?

A

post pit releases ADH (and ectopic) so collecting ducts, H20 retention, Na dilutional low in blood. urine more concentrated.

SCEPTICS - for P its the cancers and for T its the lung pathology starting with TB. I’ve done lung cancer SCC twice as its a big one

SSRI/TCA
Carbamaz
Encephalitis/Meningitis
Prostate/Panc/Lung
TB/Pneumonia/SCC Lung
Intracranial - Stroke/SAH/Subdural
Cyclophosphamide/Vincristine
Sulphonureas

IX- exclude other cx of hyponatraemaia. do short synacthen to exlude adrenal insufficiency. CXR

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29
Q

Sulfonylureas profile?

A

increase insulin secretion from pancreas.
risk -hypos, SIADH CI breastfeed and pregnancy, bone marrow suppression

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30
Q

Hypercalcaemia causes?
main cause in hospitalised and non-hospitalised?

A

Hyperparathyroidism
malignancy in hospitalised patients
Other: sarcoid, thyrotoxicosis, acromegaly, thiazide, pagets, addisions, vit D intoxication, milk-alkali syndrome, thiazides, dehydration

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31
Q

Confusion, post CT contrast/ trauma/ with jaundice, fever, N+V, heart failure, Graves disease Hx? DX?
TX?

A

Thyrotoxic storm - TX
treatment of underlying precipitating event
beta-blockers: typically IV propranolol
anti-thyroid drugs: e.g. methimazole or propylthiouracil
Lugol’s iodine
dexamethasone - e.g. 4mg IV qds - blocks the conversion of T4 to T3

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32
Q

What tablet reduces the absoption of levothyroxine?

A

Ferrous sulphfate/ calcium carbonate. should be given 4 hrs apart.

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33
Q

Graves disease features?
Antibodies involved?

A

eye signs (30% of patients)
exophthalmos
ophthalmoplegia
pretibial myxoedema
thyroid acropachy, a triad of:
digital clubbing
soft tissue swelling of the hands and feet
periosteal new bone formation
. Anti TSH and anti TPO

34
Q

amenorrhoea, reduced libido, and galactorrhoea?

Causes?

A

Causes of raised prolactin - the p’s
pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines, metoclopramide, domperidone

35
Q

Normal TSH, low/normal T3/T4 with illness?

A

Sick euthyroid

36
Q

Other causes of hypoadrenalism/ adrenal insufficiency?
which is most common?
IX?

SX?

A

Addisons : specific damage to adrenals, low cortisol and aldosterone
TB- worldwide, autoimmune - uk
metastases (e.g. bronchial carcinoma)
meningococcal septicaemia (Waterhouse-Friderichsen syndrome)
HIV
antiphospholipid syndrome, Sheehan’s,

IX: 9am cortisol - 500+ unlikely addisions.100-500 - do ACTH test

sx: hyperpigmentation, fatigue, salt craving, WL, cramps

37
Q

Urine osmolality <300, urine 24 hrs 3L+. Post water deprivation test urine osmol 800+

A

Primary polydipsia

38
Q

Urine osmolality <300, urine 24 hrs 3L+. Post water deprivation test, osmol is <300

A

Nephrogenic/ cranial diabetes insipidus. Reduced ADH release from post pit/ production. Reduced water reabsoprtion in collecting ducts.

39
Q

Nephrogenic diabetes - Cx? IX?
result on desmopressin suppression test?

A

Urine osmol <300, post deprivation and post vasopression is <300. Kidneys not responding to ADH. Cx:genetic:
hypercalcaemia
hypokalaemia
lithium
demeclocycline
tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

40
Q

Cranial Diabetes insipidus cx?

result on desmopressin suppression test?

A

histiocytosis X
sarcoidosis
DIDMOAD is the association of cranial Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy and Deafness (also known as Wolfram’s syndrome)
haemochromatosis, infection, bleed, trauma etc
tx: desmopressin

urine osmol post deprivation: <300, post vasopression improves

41
Q

severe hypokaalemia, normotensive, childhood FTT, weakness?

A

autosomal recessive condition. Bartter’s syndrome

44
Q

Insulinoma Ix?
AF?

A

supervised fast, c peptide high, B hydroxybutyl
low insulin, low BM features
50% have MEN-1

45
Q

Antibodies to do when differentiating T1DM/ T2DM?

A

Anti-islet cell antibodies
Anti-GAD antibodies
Anti-insulin antibodies

46
Q

Risk of replacing Na too fast

A

Osmotic demyelination syndrome is also known as central pontine myelinolysis (CPM)

47
Q

explain RAAS system ?
function of ang 2?
effects of aldosterone?

A

low BP, renin release from kidney. renin converts angiotensinogen (liveR) to angiotensin 1. ACE (from lung) converts ang 1 to ang 2 (in lungs).

ang 2 - causes vasoconstriction, aldosterone release from adrenal gland, hypertrophy of heart cells.

aldosterone acts on CD t increase H+ secretion and DCT to increased Na reabsorption and K+ secretion. water follows Na and BP rises.

48
Q

Hyperthyroidism cx? GIST primary and secondary?
TSH/ T4 values?

secondary TSH/T4 valus?

TX:

A

primary hyperthyroidism: TSH low, T4 high
G - graves (exopthalmos, diplopia, autoimmue, pretibial myxoedma, anti TSH receptor antibodies)
I - inflammatory (thyroiditis
S - solitary nodule
T - TMG
A - amiodarone

secondary cx: TSH high, t4 high.

49
Q

Thyroid antibodies? specific to?

A

Anti-thyroid peroxidase (anti-TPO) antibodies - graves an dhastomotos
TSH receptor antibodies - specific to graves
Thyroglobulin antibodies - graves, hastimotos and cancer

50
Q

CX of hypothyroid
HITLR’s Mam?

A

Hastimotos - antibodies
Iodine deficiency (worldwide)
Thyroiditis - de quervain’s
Lithium
Riedel’s thyroiditis - painless goitre, fibrous tissue replacing
mum - post natal/ post partum.
A - amiodarone

51
Q

what is hba1c and when can’t it be used?

A

depends on RBC lifespan. low HBA1c caused by increased turnover

dont use in <18YO, pregnant/ 2 months post partum, sx <2months, ill, C/S, renal disease end, HIV, anaemia, splenectomy, ahemoglobinopathy

52
Q

short, short neck, shot 4th and 5th metacarpals, no other sx?

DX?

A

pseudohypoparathyroidism
resistance to PTH, low Ca, high Po4, raised PTH

DX: urine CAMP, po4 following infusion of PTH, po4 does not rise. (in hypoparathyroidism, both rise)

53
Q

skin complications of T1DM?

A

necobiosis lipoidica diabeticorum

54
Q

pre diabetes
IFG?
IGT ( impaired glucose tolerance?

A

hba1c 42-47 (pre dm)
IFG: FG 6.1-7.0

IGT:
FBG<7 and OGTT fter 7.8-11.1

55
Q

cushings sx that stop after alcohol abstinence?

A

pseudocushings

56
Q

cushing features?

A

buffalo hump, central obesity, htn, hirsutism, IGT, acne, thin skin, proximl myopathy, OP, psych sx, insomnia

57
Q

hallmark of diabetes inspidus?

A

urine specific gravity <1.005 and urine osmol <200

58
Q

diabetes, skin pigmentation, liver cirrhosis?

A

haemochromatosis (A rec, most common)
SX: ED, arthralgia, fatigue.
TX: venesection/ irone chelation

59
Q

excessive abdo pain after eating with fatty stools. pain better when lying on left side and flexing spine, drawing knees up?

A

chronic pancreatitis

60
Q

test to dx cushings syndrome?

A

overnight dex suppression or 24 hr urinary free cortisol
then can do 48 hr dex suppression test to confirm

61
Q

Dx of DKA? (adults)

equation for osmolality?
values in DKA vs HHS?

Anion gap equation?
for DKA?

Rate to start insulin at?

A

BG 11+, ketone 2+ or 2+ on urine, PH <7.3/ HCO3 <15

2Na+urea+glucose
290+ in DKA, HSS is 320+

Anion gap (Na - (cl+HCO3) 13+

insulin - at 0.1/kg/hr fixed rate. IV glucose when BM <12

62
Q

DX HSS adults?
MX? which fluids?
what type of insulin?

A

Hypovolaemia, BG 30+, no ketones or acidosis ph 7.3+, osmolality 320+

replace with 0.9 Nacl, insulin 0.05 units/kg/hr

63
Q

DKA bolus in children?

A

10ml/kg 0.9% saline 15mins up to 40ml/kg repeated total

maintenance: 100ml/kg/day 1st 10 kg, 50ml/kg/day 10-20 kg, hen 20ml/kg/day for every kg 20+

insulin infusion rate: 0.05-0.1unit/kg/hr. 2 hrs after IV fluids/K+

64
Q

SIADH values?

A

urine osmol 500+
urine Na 20+
hyponatraemia <125
serum osmol <260

65
Q

cx of low calcium?

A

vit Deficiency, Di-george’s (congenital), low Mg, post surgery, pseudohypoparathyroidism,

66
Q

young patient, fatigued, father had lots of kidney stones, and died from gastrinoma?

A

MEN1

67
Q

postural hypotension, salt craving, hyperpigmentation?

A

addisons

68
Q

driving with t1dM?

A

stop i safe space, bm needs to be 5+. eat something sugary if low and wait 45 mins after glucose returns to normal to continue

69
Q

demeclocyclin can cause?

A

nephrogenic diabetes insipidus
but also used to treat siadh

70
Q

When to star SGLT2i in T2DM?

A

at any point if CVD risk or QRISK 10%
start in someone straight away as soon as metformin is tolerated

71
Q

examples of sulfonylureas?

A

Glibenclamide
Glimepiride
Glipizide
Tolbutamide
Gliclazide

72
Q

normal T4, high TSH?

A

subclinical hypothryoid

73
Q

normal t4, low TSH?

A

subclinical hyperthyroid

74
Q

phaeochromocytoma is also associted with?

A

von hippel lindau, MFT1 MEN 2, 3

75
Q

features of men 1? (3Ps)

A

mainly hyperparathyroidism/ hyperplasia
pancreas tumours - insuloma/ gastrinoma/ reucrent peptic ulcers)
pituitaryFh/ first degree relative

76
Q

Features of MEN 2 (2Ps)

A

medullary thyroid cancer (most common - flushing, FH, calcitonon high, diarrhoea)
phaeochromocytoma
parathyroid - prolactinoma

77
Q

features of MEN3 (1P)

A

phaechromocytoma
medullary thyroid cancer
neuromafe

78
Q

caused of raised prolcatin?

Features?

A

sx: amen, loss of libido, impotence galactorrhoea
Pregnancy
prolactinoma
PCOS
primary hypothyroid
metroclopramide, domperidone
phenothiazones
haloperidol

TX: bros dont lactate - bromocriptine

79
Q

how to congenital adrenal hyperplasia present?

A

autosomal recessive, adrenal criss at birth, post puberal amenhoorea, hypoglycaemia - tx fludrocortisoe

80
Q

volume depletion, low BP, congestive HF, confusion, N+V, agitaed. known thyroid disease?

A

thyroitoxic storm

81
Q

low T3 and low T4, normal TSh, seriously ill patient?

A

sick euthyroidism

82
Q

diabetic nephropathy, earliest indicator?

A

microalbuminuria

83
Q

woman with hypercalcaemia after ingesting large amounts of antacids/ vit D supplements?

A

milk-alkali syndrome (high Ca, renal failure, metabolic alkalosis)

84
Q

risk of untreated hypothyroidism?

A

mtabolic syndrome (decreased insulin sensitivity)

85
Q

drugs causing gynacomastia?

A

Digoxin
Isoniazid
Spironolactone,steroids anabolic
Cimetidine,cannabis
Other (e.g. oestrogens)
GnRH agonists
Finastride