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Exam Revision > Endocrine 1 > Flashcards

Endocrine 1 Flashcards

1
Q

Type 1 diabetes

A

autoimmune destruction of beta cells – absolute insulin deficiency

  • usually presents before puberty
  • polyuria, polydipsia, weight loss
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2
Q

Antibodies in diabetes

A

Anti- GAD

Anti-Islet

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3
Q

Type 2 diabetes

A

insulin resistance – relative insulin deficiency

  • usually older patients
  • associated with obesity
  • polyuria, polydipsia, complications
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4
Q

what values of glucose are diagnostic of diabetes

A

fasting – >7
random – >11.1

1 +ve test needed to confirm diagnosis in symptomatic patient
2+ve tests needed to confirm diagnosis in asymptomatic patient

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5
Q

what is done if glucose measurements are borderline

A

oral glucose tolerance test

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6
Q

what results of oral glucose tolerance test suggest impaired glucose tolerance

A

7.8-11 mmol/L

Normal <7.8
diabets >11.1

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7
Q

ideal HbA1c range

A

48-58 mmol

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8
Q

rapid acting insulins

A

humalog (insulin lispro)

actrapid

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9
Q

intermediate acting insulins

A

insulatard

Humulin I

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10
Q

short acting insulins

A

Humulin S

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11
Q

long acting insulins

A

levemir

lantus

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12
Q

biphasic insulin regime

A

30 mins before breakfast + dinner

- Mixture containing rapid acting insulin + intermediate insulin

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13
Q

basal-bolus regime

A

short acting insulin before each mean
long acting insulin at bedtime
- dose needs to be adjusted

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14
Q

1st line Type 2 diabetes

A

Lifestyle modification

  • diet
  • exercise
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15
Q

1st line pharmacological tx T2DM

A

metformin

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16
Q

mechanism of action of metformin

A

Biguanide – improves insulin sensitivity + lowers insulin resistance

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17
Q

benefits of metformin

A

weight loss
protects against micro + macro vascular complications
- decreases cardiac risk
safe in pregnancy

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18
Q

side effects of metformin

A

nausea
D+V
abdo pain
lactic acidosis – do not given if eGFR <30

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19
Q

what drug is added if metformin does not improve T2DM

A

sulphonylurea

  • glibenclamide
  • glicazide
  • tolbutamide 1st line in elderly
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20
Q

mechanism of sulphonylureas

A

increase insulin secretion

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21
Q

side effect of sulphonylureas

A

HYPOGLYCAEMIA

weight gain

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22
Q

3rd line T2DM

A

TZDs – pioglitazone

GLP-1 analogues – Exenatide if overweight

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23
Q

mechanism of pioglitazone

A

PPAR gamma agonists, decrease hepatic glucose production and enhance glucose uptake

24
Q

mechanism of action exenatide

A

inhibits glucagon release

delay gastric emptying – weight loss

25
Q

mechanism of sitagliptin

A

DPP-4 inhibitors
prolong action of GLP-1
- weight loss

26
Q

which diabetic drug does not reply on insulin

A

dapagliflozin

  • block glucose reabsorption in kidney
  • side effects: thrush + UTIs
27
Q

step up T2DM treatment

A

1) diet + lifestyle advice
2) metformin
3) metformin + sulphonylurea
4) insulin + metformin + sulphonylurea - consider exenatide if BMI >35 instead of insulin
5) add sitaglipin (weight loss) or pioglitazone (weight gain) if insulin unacceptable

28
Q

what is a DKA

A

diabetic ketoacidosis

- state of insulin deficiency causing hyperglycaemia + ketones

29
Q

blood results in DKA

A

Hyperglycaemia (>11mmol/L)
Ketones >3mmol/L
Acidosis- blood pH <7.3
Increased urea + creatinine due to dehydration
High potassium due to absence of insulin causing K+ to shift out of cells

30
Q

symptoms DKA

A

Abdo pain + vomiting
drowsiness
sighing hyperventilation – Kussmaul breathing
ketotic breath

31
Q

Tx DKA

A

IV fluids, potassium + insulin

32
Q

Tx hypoglycaemia

A

fast acting carbohydrate
+ long acting to stabilise blood sugars
Glucagon injection/IV glucose if severe
- re-check blood glucose after 15 mins

33
Q

what is LADA

A 
late onset type 1 diabetes
25-40 year old males
not obese
antibody +ve 
associated other autoimmune conditions
34
Q

tx painful neuropathy

A

amytryptilline

duloxetine

35
Q

symptoms of autonomic neuropathy

A

nausea, vomiting, bloating, decreased appetite – gastroparesis, slow stomach emptying

tx- metoclopramide

36
Q

tx diabetic nephropathy

A

ACEi

37
Q

what is hyperglycaemic hyperosmolar syndrome

A

occurs in type 2 diabetes
often provoked by infection
hyperglycaemia + hyperosmolarity NO KETOSIS

presents with dehydration + decreased consciousness

38
Q

complications of HHS

A

occlusive events - DVT/Stroke

Give LMWH

39
Q

MODY

A

maturity onset diabetes of the young
autosomal dominant
non-insulin dependent

40
Q

body’s natural response to increased glucose

A

beta cells release insulin

glucose is converted to glycogen + stored

41
Q

body’s natural response to decreased glucose

A

alpha cells release glucagon

glycogen is broken down to glucose

42
Q

which transporter does glucose enter beta cells via

A

GLUT 2

43
Q

which diabetes drug directly inhibits KATP channel

A

sulphonylureas

44
Q

what hormones does the posterior pituitary secrete

A

ADH

Oxytocin

45
Q

what cells in the thyroid secrete calcitonin

A

parafollicular C cells

46
Q

MIT + DIT make what ?

A

T3

47
Q

DIT + DIT make what?

A

T4

48
Q

which thyroid hormone is biologically active

A

T3

49
Q

Grave’s disease

A

autoimmune hyperthyroidism

  • Increase T3 + T4, decrease TSH
  • thyroid receptor antibody positive
50
Q

symptoms of hyperthyroidism

A 
palpitations 
sweating/ heat intolerance
tremor 
weight loss 
diarrhoea 
bulging eyes- exophthalmus/proptosis 
brittle hair 
scanty periods
51
Q

features of toxic multi nodular goitre

A

hyperthyroidism in older patients
asymmetrical goitre
antibody negative

52
Q

what is de quervians thyroiditis

A

viral hypothyroidism
follows sore throat/fever
self limiting

53
Q

thyroid storm

A

severe hyperthyroidism

  • resp + cardiac collapse
  • exaggerated reflexes

Tx- lugols iodine, steroids, Beta blockers, fluids

54
Q

treatment hyperthyroidism

A

carbimazole

S/E: AGRANULOCYTOSIS

55
Q

what blood result might indicate poor thyroxine compliance

A

TSH high T4 normal

Exam Revision (32 decks)

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