ENDOCRINE Flashcards

Question

What is reproductive endocrinology?

Answer 1

The study of hormones involved in reproduction and reproductive development

Answer 2

* Androgens * Oestrogens * Progestogens

Answer 3

Male sex hormones/Masculinising agents

Answer 4

Critical for generation of sperm and development and maintenance of masculine characteristics

Answer 5

Development and maintenance of feminine characteristics and stimulates growth of the egg follicle

Answer 6

Stimulates growth of the endometrial lining of the uterus to prepare it for pregnancy

Answer 7

By the hypothalamic-pituitary axis

Answer 8

Gonadotropin-Releasing Hormone

Answer 9

* Promote sex hormone production * Promote gametogenesis

Answer 10

* Produces testosterone * Produces spermatozoa

Answer 11

* Produces oestradiol * Produces progesterone * Produces ova

Answer 12

The process of sperm cell development

Answer 13

High pulses of GnRH

Answer 14

* Development of secondary sex characteristics * Spermatogenesis

Answer 15

* Provide nutrients to developing germ cells * Regulate FSH production * Secrete seminal fluid

Answer 16

60-64 days

Answer 17

Approximately 30 million sperm

Answer 18

* Follicular Phase * Ovulation Phase * Luteal Phase

Answer 19

A follicle develops into a mature follicle

Answer 20

* Follicle Stimulating Hormone (FSH) * Luteinising Hormone (LH)

Answer 21

21-35 days

Answer 22

The endometrial lining is shed (menstruation)

Answer 23

Respond to LH and promote testosterone synthesis

Answer 24

Regulates FSH production in a negative feedback loop

Answer 25

[testosterone production and spermatogenesis]

Answer 26

1. Follicular Phase 2. Ovulatory Phase 3. Luteal Phase

Answer 27

Lasts from 9 to 23 days

Answer 28

The release of the oocyte

Answer 29

1 to 3 days

Answer 30

Development of the corpus luteum

Answer 31

13 to 14 days

Answer 32

LH (Luteinizing Hormone)

Answer 33

Increase in FSH (Follicle Stimulating Hormone)

Answer 34

Respond to LH and synthesize testosterone

Answer 35

Respond to FSH and synthesize oestradiol from testosterone

Answer 36

Inhibits the production of FSH

Answer 37

A yellow mass of cells that secretes progesterone, oestradiol, and inhibin

Answer 38

Stimulates the growth of the endometrial lining of the uterus

Answer 39

HCG ensures survival of the corpus luteum

Answer 40

An estrogen and progestogen

Answer 41

By suppressing the release of gonadotropins (FSH and LH)

Answer 42

Ensures survival of the corpus luteum

Answer 43

The cell formed by the union of two gametes

Answer 44

The cell has the capacity to develop into a complete organism

Answer 45

Form the outer layer of a blastocyst and provide nutrients to the developing embryo

Answer 46

Degenerates due to a fall in HCG

Answer 47

Important in contractions

Answer 48

The ending of menstruation

Answer 49

endometrium

Answer 50

hCG is produced by trophoblasts and ensures the survival of the corpus luteum. ## Footnote hCG stands for human chorionic gonadotropin, a hormone crucial for maintaining pregnancy.

Answer 51

Progesterone and oestrogen prepare the uterus for delivery. ## Footnote These hormones are essential for maintaining pregnancy and preparing the body for childbirth.

Answer 52

Human placental lactogen is involved in metabolism, breast development, and lactation. ## Footnote This hormone is produced by the placenta and plays a significant role in preparing the mother's body for breastfeeding.

Answer 53

Oxytocin is important for contractions of the uterus. ## Footnote It is released from the posterior pituitary gland and plays a crucial role in labor.

Answer 54

An embryo is present for the first 2 months, while it is referred to as a fetus from 2 months onward.

Answer 55

Approx. 40 weeks.

Answer 56

Baby pushing against the cervix activates stretch receptors, sending a message to the hypothalamus to release oxytocin. ## Footnote This process is part of the body's natural response to labor.

Answer 57

Oxytocin causes contractions of the smooth muscles of the uterus, pushing the baby further down the birth canal.

Answer 58

The release of oxytocin causes further contractions, which activate more stretch receptors, leading to more oxytocin release.

Answer 59

The stretching of the cervix halts, stopping the release of oxytocin.

Answer 60

* To induce labor * To accelerate labor * To stop bleeding after delivery (routinely administered after caesarean delivery)

Answer 61

The study of hormones.

Answer 62

Chemical messengers secreted into the blood that exert their effect on a distal target.

Answer 63

Nanomolar (10^-9 M) to picomolar (10^-12 M).

Answer 64

* Growth * Development * Metabolism * Temperature * H2O balance * Reproduction

Answer 65

Below the thalamus.

Answer 66

A bone socket at the base of the skull that houses the pituitary gland.

Answer 67

It serves as a major link between the endocrine and nervous system.

Answer 68

The master gland.

Answer 69

7 different tropic hormones.

Answer 70

Hormones that act on other endocrine glands to stimulate synthesis/release of a hormone.

Answer 71

TSH (Thyroid Stimulating Hormone).

Answer 72

Adrenocorticotropic Hormone.

Answer 73

Acts on gonads and stimulates production and secretion of sex hormones/ovulation.

Answer 74

Stimulates the development of egg and sperm and secretion of sex hormones.

Answer 75

Stimulates milk secretion.

Answer 76

Growth and energy metabolism.

Answer 77

* Oxytocin * Antidiuretic Hormone (ADH)

Answer 78

Controls uterine contractions during labor and promotes milk flow in nursing mothers.

Answer 79

Increases water reabsorption and regulates water balance in the body.

Answer 80

Results from the improper function of the endocrine system.

Answer 81

Type 1 Diabetes Mellitus.

Answer 82

Hormone imbalance, genetic disorder, infection or disease, injury to endocrine gland, endocrine tumor.

Answer 83

The cause of the disorder is in the peripheral (target) endocrine gland.

Answer 84

The cause of the hormonal secretion disorder of the peripheral gland is in the anterior pituitary.

Answer 85

The cause of secretion disorder of peripheral gland is in the hypothalamus.

Answer 86

A steroid hormone released from the adrenal gland

Answer 87

By promoting gluconeogenesis, causing breakdown of skeletal muscle protein, and enhancing lipolysis ## Footnote These processes provide substrates for glucose production and fatty acids for other tissues.

Answer 88

It requires the presence of glucagon for its action

Answer 89

It works synergistically with glucagon and catecholamines

Answer 90

It suppresses the immune system by preventing cytokine release and antibody production

Answer 91

As an immunosuppressive drug

Answer 92

Decreases plasma calcium by causing bone breakdown and increasing intestinal calcium absorption while increasing renal calcium excretion

Answer 93

It affects memory and mood

Answer 94

A condition characterized by excessive cortisol, often referred to as Cushing's syndrome

Answer 95

Tumor of the adrenal gland, pituitary tumor secreting excess ACTH, corticosteroid treatment for autoimmune disorders, ectopic ACTH production

Answer 96

* Increased appetite and food intake * Weight gain * Increased fat deposits in face and trunk * Immunosuppression * Osteoporosis * Hyperglycaemia * Depression and difficulties with learning and memory

Answer 97

A condition characterized by low cortisol levels, often associated with Addison's disease

Answer 98

Autoimmune destruction of the adrenal cortex, rare genetic causes, exogenous cortisol leading to adrenal atrophy

Answer 99

* Muscle weakness and fatigue * Weight loss and decreased appetite * Darkening of the skin (hyperpigmentation) * Low blood pressure * Salt craving * Low blood sugar (hypoglycaemia) * Nausea, diarrhea, or vomiting * Muscle or joint pains * Irritability/Depression * Body hair loss or sexual dysfunction in women

Answer 100

A condition with chronically raised blood glucose concentration due to a lack of insulin and/or a deficiency in insulin action.

Answer 101

Approx. 8%.

Answer 102

Approx. 90%.

Answer 103

They are obese.

Answer 104

Diabetes occurring in 4-5% of pregnancies.

Answer 105

Approx. 8%.

Answer 106

T cell mediated autoimmune destruction of pancreatic beta-cells.

Answer 107

* Hyperglycaemia * Glycosuria * Polyuria * Polydipsia * Weight loss * Pear drop breath.

Answer 108

High levels of glucose in the urine.

Answer 109

Exceeding renal threshold creates osmotic drag and increased diuresis.

Answer 110

No C-peptide detectable.

Answer 111

A life-threatening condition due to starvation activating ketogenesis.

Answer 112

Below 42 mmol/mol (6.0%).

Answer 113

42 to 47 mmol/mol (6.0 to 6.4%).

Answer 114

48 mmol/mol (6.5% or over).

Answer 115

Frederick Banting and Charles H. Best in 1921.

Answer 116

* Insulin injections * Insulin pumps * Pancreas transplantation * Islet transplantation.

Answer 117

Too much insulin and/or not enough food, vigorous exercise, or excessive alcohol.

Answer 118

* Shakiness * Anxiety * Tiredness * Weakness * Sweating * Hunger * Dizziness.

Answer 119

Cellular glucose starvation activating ketogenesis.

Answer 120

* Eye damage (retinopathy) * Kidney damage (nephropathy) * Nerve damage (neuropathy) * Heart disease * Stroke.

Answer 121

Exposure to self antigens.

Answer 122

* Cell-mediated immune response * Humoral/antibody-mediated immune response.

Answer 123

Cell-mediated immune response and Humoral/antibody mediated immune response ## Footnote Cell-mediated involves T cells, while humoral involves B cells.

Answer 124

Secrete cytokines when activated and recruit other immune cells ## Footnote They stimulate B cells to proliferate.

Answer 125

Enzymes perforin and granzyme ## Footnote These enzymes kill 'infected' cells.

Answer 126

T cells express an antigen-binding receptor on their membrane.

Answer 127

Presents antigens to T cells and activates them.

Answer 128

All nucleated cells ## Footnote They present antigenic peptides to Cytotoxic T cells.

Answer 129

Antigen Presenting Cells (APCs) including dendritic cells, macrophages, Langerhans cells, and B cells.

Answer 130

Endogenous antigens originated from the cytoplasm.

Answer 131

Exogenous antigens originated extracellularly from foreign bodies such as pathogens.

Answer 132

Healthy islet insulitis with many T-cells in the infiltrate, predominance of cytotoxic T-cells (CD8+VE).

Answer 133

* Proinsulin (IAA) * Glutamic acid decarboxylase (GAD) * IA-2 (IA-2A) * Zinc transporter (ZnT8A)

Answer 134

50% concordance.

Answer 135

Single nucleotide polymorphisms that increase the probability of developing type 1 diabetes.

Answer 136

Polymorphisms of class II HLA genes encoding DQ and DR.

Answer 137

* Viruses: Coxsackie-B virus, Rubella, Mumps * Toxins: streptozotocin and alloxin * Diet: cow's milk, smoked fish (nitrosamines) * Vitamins: low vitamin D

Answer 138

Beta cell injury results in release of antigens and cytokines.

Answer 139

Autoantibodies.

Answer 140

They recruit CD8+ cytotoxic T cells and other inflammatory cells, resulting in destructive insulitis.

Answer 141

Production of pro-inflammatory cytokines by APCs and T-cells.

Answer 142

Apoptosis/necrosis.

Answer 143

4.0 to 5.4 mmol/L (72 to 99 mg/dL)

Answer 144

7.8 mmol/L (140 mg/dL)

Answer 145

68.02g of glucose

Answer 146

Approximately 5 litres

Answer 147

75.5 mmol/L or 1350 mg/dL

Answer 148

Lowers blood glucose

Answer 149

Secretes digestive enzymes and bicarbonate ions into the pancreatic duct

Answer 150

Clusters of endocrine cells in the pancreas that secrete hormones into the blood

Answer 151

70% secrete insulin

Answer 152

Phosphorylates glucose

Answer 153

Rise in intracellular calcium

Answer 154

Biphasic: rapid first phase followed by prolonged second phase

Answer 155

Receptor Tyrosine Kinase

Answer 156

* Glycogenesis * Lipogenesis * Glycolysis

Answer 157

Promotes gluconeogenesis and enhances lipolysis

Answer 158

Stress and low blood-glucose concentration

Answer 159

[liver], [stomach]

Answer 160

Maintains glucose levels by promoting uptake and storage

Answer 161

Can lead to coma and death

Answer 162

Changes in blood glucose after glucose ingestion

Answer 163

Allows for rapid response to changes in blood glucose

Answer 164

* Digestive enzymes * Bicarbonate ions

Answer 165

Facilitates glucose absorption in the small intestine

Answer 166

Steroid-induced diabetes

Answer 167

Cortisol markedly accentuates hyperglycaemia produced by glucagon and/or epinephrine ## Footnote This effect is significant in the context of glucose metabolism regulation.

Answer 168

* Promotes gluconeogenesis in liver * Causes breakdown of skeletal muscle protein for gluconeogenesis * Enhances lipolysis to provide fatty acids for other tissues * Counteracts effects of insulin ## Footnote These actions help maintain blood glucose levels.

Answer 169

Insulin resistance ## Footnote This may require diabetic patients to take more medication.

Answer 170

* Glucagon * Noradrenaline * Adrenaline ## Footnote These hormones increase glycogenolysis and gluconeogenesis.

Answer 171

Promotes gluconeogenesis when carbohydrate resources are depleting ## Footnote This is crucial for maintaining energy levels during prolonged exercise.

Answer 172

* Cortisol * Growth hormone * Noradrenaline * Adrenaline ## Footnote Increased lipase activity enhances the oxidation of fatty acids (lipolysis).

Answer 173

gluconeogenesis

Answer 174

False ## Footnote Insulin generally decreases glucose production.

Answer 175

Increases glucose production from the liver ## Footnote Glucagon plays a critical role in raising blood glucose levels.

Answer 176

* Fed * Fasted * Stress * Exercise ## Footnote These states influence hormonal responses and glucose metabolism.

Answer 177

Banting and Best in 1921.

Answer 178

Isoelectric precipitation.

Answer 179

Human insulin obtained through recombinant DNA technology.

Answer 180

* Hexamer * Dimer * Monomer

Answer 181

The time between injection of hexamers and availability of biologically active dimers and monomers.

Answer 182

Intermediate-acting insulin introduced in 1946.

Answer 183

Crystalline suspension with prolonged action.

Answer 184

* Semilente: Amorphous, duration of action 12-14 hours * Ultralente: Crystalline, duration of action >30 hours * Lente: Mixture of Ultralente and Semilente, duration of action ~24 hours

Answer 185

Replaces one amino acid with two at the end of the B chain.

Answer 186

It microprecipitates due to reduced solubility at physiological pH.

Answer 187

One amino acid is omitted and replaced with a fatty acid.

Answer 188

Modifications prevent dimer and hexamer formation, allowing only monomers.

Answer 189

To help sponsors bring insulin biosimilars and interchangeable products to market more quickly.

Answer 190

* Skin infection * Ketoacidosis if flow is interrupted * Pump site must be moved every 2-3 days

Answer 191

Automatically monitors glucose and provides appropriate basal insulin doses.

Answer 192

A dry powder formulation of recombinant human insulin; Exubera marketed briefly but removed due to poor sales.

Answer 193

RapidMist™ technology.

Answer 194

A lipid-based particle used to encapsulate insulin for oral administration.

Answer 195

Oramed Pharmaceuticals' insulin capsule trials have shown significant glucose level reduction.

Answer 196

Acts as an artificial liver to maintain glucose concentrations safely.

Answer 197

It had a statistically meaningful effect on lowering blood glucose over a full 24 hours.

Answer 198

It acts as an artificial liver for hyperglycemia treatment.

Answer 199

At least 6 hours.

Answer 200

It cannot reduce blood sugar to an unsafe level.

Answer 201

Glucose-responsive nanoparticles.

Answer 202

Oral delivery of insulin for treatment of diabetes: status quo, challenges and opportunities.

Answer 203

Transdermal delivery.

Answer 204

Lipid nanoparticles.

Answer 205

Micro- and nano-technology delivery.

Answer 206

A chronic condition where the pancreas produces little or no insulin.

Answer 207

It is most commonly diagnosed in children and young adults.

Answer 208

Blood tests measuring blood glucose levels.

Answer 209

Less than 5.6 mmol/L.

Answer 210

Increased thirst, frequent urination, extreme fatigue, and blurred vision.

Answer 211

HbA1c test.

Answer 212

An HbA1c of 6.5% or higher.

Answer 213

Insulin helps regulate blood glucose levels by facilitating the uptake of glucose into cells.

Answer 214

Insulin therapy.

Answer 215

insulin-dependent

Answer 216

Ketones are produced when the body starts breaking down fat for energy due to lack of insulin.

Answer 217

A serious complication that occurs when ketone levels become dangerously high.

Answer 218

Typically several times a day.

Answer 219

To provide real-time blood glucose readings throughout the day.

Answer 220

Usually between ages 5 and 20.

Answer 221

Healthy eating, regular physical activity, and blood glucose monitoring.

Answer 222

To provide education, support, and medical care for effective diabetes management.

Answer 223

Increased risk of complications such as heart disease, kidney failure, and neuropathy.

Answer 224

A combination of basal and bolus insulin.

Answer 225

Production of oocytes and hormones such as estrogen and progesterone ## Footnote Ovaries play a crucial role in the female reproductive system.

Answer 226

Granulosa cells nourish developing oocytes and produce estrogen; theca cells synthesize testosterone. ## Footnote Both cell types are essential for follicular development.

Answer 227

Follicular phase, ovulatory phase, luteal phase ## Footnote Each phase is characterized by specific hormonal changes and physiological events.

Answer 228

Hormones such as GnRH, FSH, and LH regulate the production and release of estrogen and progesterone. ## Footnote This regulation is critical for the menstrual cycle and reproductive health.

Answer 229

Increased levels of progesterone and human chorionic gonadotropin (HCG). ## Footnote These hormones support pregnancy and maintain the uterine lining.

Answer 230

Hormonal imbalances, structural issues, age, and health conditions. ## Footnote Factors affecting fertility can vary widely among individuals.

Answer 231

The process of producing gametes (sperm and eggs) through meiosis. ## Footnote This process results in genetically distinct daughter cells.

Answer 232

Sex chromosomes: XX for females and XY for males. ## Footnote The inheritance of sex chromosomes from parents determines an individual's genetic sex.

Answer 233

Encodes a transcription factor that initiates male sexual differentiation. ## Footnote The presence of the Y chromosome and SRY gene leads to the development of male characteristics.

Answer 234

Induces degeneration of Müllerian ducts, preventing female reproductive tract development in males. ## Footnote AMH is critical for male sexual differentiation.

Answer 235

The process of egg formation in the ovaries, starting in fetal life and resuming at puberty. ## Footnote It involves meiotic division leading to the production of a secondary oocyte and a polar body.

Answer 236

High pulses of Gonadotropin Releasing Hormone (GnRH). ## Footnote GnRH stimulates the release of FSH and LH from the anterior pituitary.

Answer 237

Follicular phase, ovulatory phase, luteal phase ## Footnote Each phase is defined by specific hormonal and physiological changes.

Answer 238

Produces progesterone and estrogen to prepare the uterine lining for potential pregnancy. ## Footnote If fertilization does not occur, the corpus luteum degenerates.

Answer 239

21-35 days from the first day of bleeding to the last day before the next bleed. ## Footnote The cycle length can vary among individuals.

Answer 240

Gonadotropin Releasing Hormone (GnRH), Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estrogen, and progesterone. ## Footnote These hormones work together to regulate the cyclic nature of the menstrual cycle.

Answer 241

progestogen ## Footnote COCP is used to prevent ovulation and regulate menstrual cycles.

Answer 242

True ## Footnote This phase is critical for preparing the uterus for possible implantation.

Answer 243

Release of the oocyte from the mature follicle. ## Footnote This phase is characterized by a surge in LH levels.

Answer 244

The endometrial lining sheds during menstruation. ## Footnote This process is a key part of the menstrual cycle.

Answer 245

Releases progestogen to prevent pregnancy for up to 3 years. ## Footnote It is an effective long-term contraceptive method.

Answer 246

Cessation of menstruation due to depletion of ovarian follicles and reduced sensitivity to FSH and LH. ## Footnote Menopause typically occurs between ages 45-55.

Answer 247

Secretes progesterone to either regrow the uterine lining or support pregnancy.

Answer 248

Depletion of the finite pool of follicles and reduced sensitivity to FSH and LH.

Answer 249

Cessation of the menstrual cycle, excess of LH and FSH, deficiency in Oestrogen and Progesterone.

Answer 250

A yellow mass of cells that forms from an ovarian follicle during the luteal phase of the menstrual cycle.

Answer 251

The ending of menstruation; the time in a woman’s life when this happens.

Answer 252

The mucous membrane that lines the uterus in mammals.

Answer 253

A potent oestrogenic hormone produced in the ovaries of all vertebrates.

Answer 254

The periodic discharging of the menses, the flow of blood and cells from the lining of the uterus.

Answer 255

In the fallopian tube within a couple of days of ovulation.

Answer 256

The binding of the sperm to the zona pellucida.

Answer 257

The cell formed by the union of two gametes, especially a fertilized ovum before cleavage.

Answer 258

The cell has the capacity to develop into a complete organism.

Answer 259

Term for everything derived from the zygote.

Answer 260

Conceptus reaches the uterus, totipotency is lost, and it develops into a blastocyst.

Answer 261

Prepares the lining of the uterus for implantation.

Answer 262

In urine or blood after implantation, which occurs six to twelve days after fertilization.

Answer 263

Provide nutrients to the developing embryo during the first 3 months.

Answer 264

The switch from the corpus luteum to the placenta producing progesterone and oestradiol.

Answer 265

Ovulation disorders, accounts for about 25% of infertile couples.

Answer 266

Most common cause of female infertility, caused by increased androgen and LH secretion.

Answer 267

Tissue that normally grows in the uterus implants and grows in other locations.

Answer 268

A cervical narrowing that can be caused by an inherited malformation or damage.

Answer 269

Infertility with no identified cause after evaluation.

Answer 270

To help ovulation problems ## Footnote Examples include Clomifene (Clomid) and Tamoxifen.

Answer 271

Stimulating ovulation, encouraging regular monthly periods, lowering the risk of miscarriage, and managing polycystic ovary syndrome ## Footnote It also has long-term health benefits.

Answer 272

If unsuccessful with Clomid and/or Metformin, also used in men to improve sperm production ## Footnote High risk of multiple births.

Answer 273

To check the health of ovaries and womb ## Footnote Can help identify conditions like endometriosis and fibroids.

Answer 274

A condition where tissue that behaves like the lining of the womb is found outside the womb.

Answer 275

Keyhole surgery to examine the health of the womb, fallopian tubes, and ovaries ## Footnote A dye may be injected to highlight blockages.

Answer 276

5 milligrams until 12 weeks pregnant ## Footnote Regular 400 micrograms advised while trying to conceive.

Answer 277

To identify the most common STI that can cause pelvic inflammatory disease and fertility problems.

Answer 278

An X-ray of the fallopian tubes using opaque dye to check for blockages.

Answer 279

Zygote stage

Answer 280

About 1 million

Answer 281

Up to 5 days, or up to 7 days under optimal conditions.

Answer 282

Around 150-1,000 million sperms

Answer 283

Important for the development of a healthy foetus and reduces the risk of neural tube defects.

Answer 284

Luteinising hormone (LH)

Answer 285

* Change in cervical fluid * Increase in basal body temperature * Change in cervical position or firmness

Answer 286

The very first stage of life after the union of egg and sperm.

Answer 287

The active cell division period of conception from 24 hours to 8 weeks after fertilization.

Answer 288

Methods like intrauterine insemination (IUI) and in vitro fertilisation (IVF) to help with fertility issues.

Answer 289

Donors must provide information about their identity.

Answer 290

Failure to conceive after a year of regular intercourse without contraception.

Answer 291

* Primary infertility * Secondary infertility

Answer 292

Low sperm count, < 15 million spermatozoa per millilitre of ejaculate.

Answer 293

No sperm count due to production issues or blockage.

Answer 294

Approximately 28 days, but can vary between 24 and 35 days.

Answer 295

* Weigh (BMI) * Pelvic examination for women * Penile/testicular examination for men

Answer 296

A preventive treatment to reduce the risk of blood clots during surgery ## Footnote Includes the use of unfractionated or low molecular weight heparin and compression stockings.

Answer 297

Pregnancy risk increases if: * Breast-feeding decreases * Menstruation resumes * The woman is more than six months postpartum ## Footnote LAM stands for Lactational Amenorrhea Method.

Answer 298

21 days of active pills followed by a 7-day hormone-free interval ## Footnote This regimen mimics natural menstrual cycles.

Answer 299

Drawbacks include: * Heavy or painful withdrawal bleeding * Symptoms like headache and mood changes * Reduced ovarian suppression * Risk of ovulation and potential pregnancy ## Footnote It highlights the risks associated with the standard use of CHC.

Answer 300

Tailored regimens include: * Shortened HFI * Extended use (tricycling) * Flexible extended use * Continuous use ## Footnote These regimens aim to reduce or avoid HFI-associated symptoms.

Answer 301

Key indications include: * High blood pressure * High body mass index (>35 kg/m2) * Migraine or migraine with aura * Deep vein thrombosis or pulmonary embolism * Blood clotting abnormalities * Cardiovascular diseases * Certain cancers ## Footnote This ensures the safety and suitability of CHC use.

Answer 302

Assessment should include: * Medical history * Drug history * Recent blood pressure recording * BMI ## Footnote Pelvic examination is not routinely required.

Answer 303

A method of avoiding pregnancy based on natural postpartum infertility associated with fully breast-feeding ## Footnote It is about 98% effective if certain conditions are met.

Answer 304

She should take another pill immediately if she is not sick again ## Footnote This ensures continued protection against pregnancy.

Answer 305

Alternatives include: * Progestogen-only contraceptives * Long-acting reversible contraceptives (LARCs) ## Footnote These are suitable for women with a history of venous thrombosis, heavy smokers, and others at high risk.

Answer 306

Most anti-epileptic drugs can reduce the efficacy of hormonal contraceptives ## Footnote Women on these medications should consider LARCs.

Answer 307

Methods include: * Contraceptive injection * Implant * Intra-Uterine System (IUS) * Intra-Uterine Device (IUD) * Vasectomy * Female sterilization ## Footnote These methods are effective without reliance on user compliance.

Answer 308

Methods include: * Patch * Combined oral contraceptives * Progestogen-only pills * Condoms (male and female) * Diaphragms * Natural methods * Vaginal rings ## Footnote User failure can occur due to improper use or non-compliance.

Answer 309

A missed pill is defined as one that is more than 24 hours late ## Footnote For Progestogen-only Pill (POP), it is more than 3 hours late.

Answer 310

Benefits include: * Reduction in heavy menstrual bleeding and pain * Improvement of acne * Reduced risk of endometrial and ovarian cancer * Management of symptoms associated with PCOS ## Footnote These benefits can enhance quality of life.

Answer 311

Risks include: * Increased risk of VTE * Small increased risk of myocardial infarction and stroke * Increased risk of breast and cervical cancer ## Footnote The absolute risks remain low for individual users.

Answer 312

Sources include: * Green, leafy vegetables * Brown rice * Granary bread * Fortified breakfast cereals ## Footnote Supplements are often necessary to meet recommended levels.

Answer 313

CoC should be discontinued 4 weeks prior to major elective surgery ## Footnote Ensure an alternative contraceptive is in place.

Answer 314

A long-acting reversible contraceptive method that is inserted under the skin

Answer 315

A hormonal method of contraception administered via injection

Answer 316

A transdermal patch that releases hormones to prevent pregnancy

Answer 317

Barrier devices inserted into the vagina to prevent sperm from reaching the uterus

Answer 318

A small T-shaped device inserted into the uterus to prevent pregnancy

Answer 319

A type of IUD that releases hormones to prevent pregnancy

Answer 320

A method of tracking fertility to avoid or achieve pregnancy

Answer 321

A hormonal contraceptive pill that contains only progestogen

Answer 322

A flexible ring inserted into the vagina that releases hormones

Answer 323

A permanent method of contraception involving surgical procedures to block or seal the fallopian tubes

Answer 324

A permanent method of contraception involving surgical procedures to cut or seal the vas deferens

Answer 325

Reversal is difficult and not always successful

Answer 326

Long-Acting Reversible Contraceptives

Answer 327

Combined Hormonal Contraception (CHC) and Progestogen Only Contraception (POC)

Answer 328

Both estrogen and progesterone

Answer 329

Acts on the hypothalamopituitary-ovarian axis to suppress LH & FSH and thus inhibit ovulation

Answer 330

* CoC (pill) * CTP (patch) * CVR (ring)

Answer 331

Inhibit ovulation and thicken cervical mucus

Answer 332

* PoP (pill) * PTP (patch) * PVR (ring)

Answer 333

Fertility ## Footnote Insufficient thyroid hormone can have teratogenic effects and even lead to miscarriage.

Answer 334

Consult with their GP/specialist and have frequent TSH level monitoring.

Answer 335

By 25-50 micrograms immediately.

Answer 336

Every 4-6 weeks.

Answer 337

<2.5 mU/L.

Answer 338

<3.0 mU/L.

Answer 339

2-4 weeks post-birth.

Answer 340

1.6 micrograms per kg rounded to the nearest 25 microgram dose.

Answer 341

* Fatigue * Hoarse voice * Bradycardia * Diastolic hypertension * Pericardial effusion * Weight gain * Decreased appetite * Abdominal distension * Constipation * Increased sensitivity to cold * Low mood * Impaired cognition * Paraesthesia * Peripheral neuropathy * Non-specific muscle weakness or pain * Joint pain * Irregular menstrual cycle and menorrhagia * Infertility or subfertility * Dry, flaking, thickened skin * Goitre * Reduced sweating * Yellow complexion * Facial swelling, particularly of the eyelids * Brittle nails * Coarse hair * Hair loss, particularly of the eyebrows.

Answer 342

Calcitonin.

Answer 343

Overt primary hypothyroidism.

Answer 344

Slightly raised TSH level with FT4 still within the normal reference range.

Answer 345

Secondary hypothyroidism arising from hypothalamic or pituitary dysfunction.

Answer 346

Synthetic form of T3, x5 more potent than Levothyroxine.

Answer 347

Levothyroxine (T4) replacement.

Answer 348

* Flushing * Restlessness * Palpitations * Insomnia * Angina * Thyroid crisis.

Answer 349

30 to 60 minutes before food or other medication.

Answer 350

It can be important for maintaining stable hormone levels.

Answer 351

* Thyroid antibodies testing * Thyroid Peroxidase Antibodies (TPOAb) * Thyroglobulin Antibodies (TgAb) * Thyroid Stimulating Hormone Receptor Antibodies (TSHR Ab, also known as TRAb).

Answer 352

Test FT4 to investigate for secondary hypothyroidism.

Answer 353

Reduced starting dose of 25-50 micrograms OD due to risks of overtreatment.

Answer 354

They should be given replacement therapy.

Answer 355

Between 100 micrograms – 200 micrograms daily.

Answer 356

Up to 6 months.

Answer 357

Every 3 months.

Answer 358

Carbimazole and Propylthiouracil

Answer 359

Thionamides; carbimazole

Answer 360

Around 50%

Answer 361

* Titration * Block and Replace

Answer 362

Radioactive iodine

Answer 363

Radioactive iodine

Answer 364

* Radioactive iodine * Surgical intervention (total or hemi-thyroidectomy)

Answer 365

Radioactive iodine

Answer 366

Thyroid function tests (TFTs)

Answer 367

Hyperthyroidism of thyroidal origin

Answer 368

Hyperthyroidism of extrathyroidal origin

Answer 369

* Painful and tender thyroid follicles * Fever * Sore throat

Answer 370

* Tachycardia * Shortness of breath * Weight loss

Answer 371

* Insomnia * Muscle weakness * Fine motor tremor

Answer 372

Extreme manifestation of hypothyroidism that can be fatal

Answer 373

* Hypothermia * Macroglossia * Periorbital swelling

Answer 374

Relapse risk in Graves' disease

Answer 375

* Class I (0-1 points): 33.8% * Class II (2-3 points): 59.4% * Class III (4-6 points): 73.6%

Answer 376

20-60mg daily in divided doses

Answer 377

Bone marrow suppression

Answer 378

Signs and symptoms of blood dyscrasias

Answer 379

Inhibits organification of iodide and conversion of T4 to T3

Answer 380

200-400mg once daily

Answer 381

Severe hepatic reaction causing acute liver injury

Answer 382

Macropapular rash ## Footnote Can be treated with a generic antihistamine.

Answer 383

Severe hepatic reaction causing acute liver injury ## Footnote Some cases were fatal and some required liver transplant.

Answer 384

Bone marrow suppression, thrombocytopenia, risk of agranulocytosis ## Footnote Patients need to be counselled on signs and symptoms of blood dyscrasias.

Answer 385

* Sore throat * Bruising * Bleeding * Mouth ulcers * Fevers * Malaise

Answer 386

Baseline and every 6 months during treatment

Answer 387

Severe hepatic impairment ## Footnote Unable to be metabolised to active methimazole.

Answer 388

History of pancreatitis

Answer 389

Beta blockers

Answer 390

Six to eight weeks ## Footnote Does not alter existing levels of T3 and T4.

Answer 391

* Severe sore throats * Bruising or bleeding * Mouth ulcers * Fever * Malaise

Answer 392

Severe hepatic reactions, including fatal cases and cases requiring liver transplant ## Footnote Report any jaundice, dark urine, abdominal pain, pruritis, nausea, and vomiting.

Answer 393

If significant hepatic enzyme abnormalities develop

Answer 394

Pro-drug ## Footnote Undergoes metabolism by hepatic enzymes to the active metabolite, thiamazole (methimazole).

Answer 395

Due to quick thyroid hormone correction (4-8 weeks)

Answer 396

Inhibition of the organification of iodide and thyroglobulin, and the coupling of iodothyronine residues ## Footnote Suppresses the synthesis of thyroid hormones.

Answer 397

Inhibits thyroid hormone release due to the Wolff-Chaikoff effect ## Footnote The Wolff-Chaikoff effect describes how high levels of iodine can suppress thyroid hormone production.

Answer 398

1ml every 6 to 8 hours ## Footnote Dosage may vary depending on patient presentation.

Answer 399

At least one hour ## Footnote This ensures adequate uptake of thionamides into the thyroid.

Answer 400

High risk of lithium toxicity ## Footnote Lithium carbonate is rarely used due to this significant risk.

Answer 401

Every 6 weeks until within reference range

Answer 402

Consider alternative therapy

Answer 403

Once TSH is within reference range

Answer 404

Stop carbimazole or propylthiouracil

Answer 405

2-3 months

Answer 406

Up to 6 weeks

Answer 407

Avoid close contact with others for 14 days and completely avoid pregnant women and children for 24 days

Answer 408

To resolve hyperthyroidism without post-ablation hypothyroidism

Answer 409

* Fixed dose regardless of other factors * Adjusted dose based on size of enlarged thyroid/goiter

Answer 410

Every 6 weeks until TSH is within reference range

Answer 411

8 weeks post-cessation, then every 3 months for 1 year

Answer 412

Symptoms of windpipe compression due to the size of goiter or enlargement

Answer 413

It can lead to multiorgan failure and is often fatal

Answer 414

* Infection * Trauma * Medications (e.g., amiodarone) * Sudden cessation of thionamides * Surgery

Answer 415

* Hyperthermia (over 41°C) * Tachycardia (heart rate > 140 bpm) * Hypotension * Confusion or agitation

Answer 416

* Inhibition of thyroid hormone synthesis * Inhibition of thyroid hormone release * Inhibition of peripheral action of excess thyroid hormone * Supplementary management

Answer 417

Propranolol

Answer 418

600mg loading dose, followed by 200-250 mg every 4-6 hours

Answer 419

Paracetamol

Answer 420

Enhances thyroid hormone excretion by increasing enterohepatic circulation

Answer 421

Inhibit peripheral T4 to T3 conversion

Answer 422

Intended for emergency use, not regular contraception, can be used 5 days after abortion or miscarriage, can be used on any day of the menstrual cycle.

Answer 423

* Copper Intrauterine Device (Cu IUD) * Oral EC * Levonorgestrel (LNG-EC) * Ulipristal (UPA-EC)

Answer 424

Copper Intrauterine Device (Cu IUD)

Answer 425

* Inhibits fertilisation * Affects movement and viability of sperm * Causes local inflammatory reaction preventing implantation

Answer 426

Inhibits ovulation by delaying or preventing follicular rupture and causing luteal dysfunction for five days.

Answer 427

Licensed for UPSI which has occurred in the last 72 hours (3 days).

Answer 428

Licensed for UPSI occurring in the last 120 hours (5 days).

Answer 429

* Headache * Nausea * Dysmenorrhoea

Answer 430

Need another supply.

Answer 431

Not licensed for sale to under 16 years.

Answer 432

Advise expressing and discarding breast milk for one week following the dose.

Answer 433

* Ulipristal and St John’s Wort * Levonorgestrel and Carbamazepine * Levonorgestrel and Sodium Valproate

Answer 434

Fraser competency applies.

Answer 435

Cannot consent to have sex; safeguarding concerns arise.

Answer 436

Risk of ectopic pregnancy.

Answer 437

Alteration in menstruation can occur; advise seeking help if period is delayed more than 7 days.

Answer 438

To assess needs, provide information, and ensure appropriate supply.

Answer 439

Allows supply of emergency contraception under specific guidelines.

Answer 440

Consider if UPA will be effective.

Answer 441

Discuss potential scenarios and assess necessity.

Answer 442

UPA-EC is generally more effective than LNG-EC.

Answer 443

* NICE CKS * FSRH guidance * SPC / BNF * NHS UK * GPhC * Stockley Interactions * CPPE * C&D

Answer 444

A condition with chronically raised blood glucose concentration due to a lack of insulin or deficiency in insulin action.

Answer 445

Approx. 8%

Answer 446

Approx. 90%

Answer 447

>85% of type 2 diabetics are obese

Answer 448

A type of diabetes that occurs in approximately 16% of pregnancies.

Answer 449

Below 42 mmol/mol (6.0%)

Answer 450

48 mmol/mol (6.5% or over)

Answer 451

To measure blood glucose levels after fasting and consuming a glucose solution.

Answer 452

Normal: Below 5.5 mmol/l; Prediabetes: 5.5 to 6.9 mmol/l; Diabetes: 7.0 mmol/l or more.

Answer 453

* Insulin Resistance * Beta-cell dysfunction and death

Answer 454

A condition where insulin-sensitive tissues fail to fully respond to insulin.

Answer 455

* Obesity * Age * Low birth weight * Gestational diabetes * Social economic status * Ethnicity

Answer 456

It increases FA metabolites that inhibit key insulin signaling proteins.

Answer 457

Increases risk of insulin resistance.

Answer 458

If either parent has type 2 diabetes, the risk of inheritance is 15%; if both parents have it, the risk is 75%.

Answer 459

Adipocytes that are 'stuffed' cannot store more TAG, leading to increased release of FAs.

Answer 460

Increased levels of circulating lipids.

Answer 461

* Obesity * Aging * Lack of exercise * Certain medications

Answer 462

Ectopic fat refers to fat stored in locations outside of the usual fat depots, which can lead to metabolic issues.

Answer 463

Elevated levels of ectopic fat cause an increase in FA metabolites that inhibit key insulin signaling proteins.

Answer 464

Hyperinsulinemia is the overactivation of the insulin signaling pathway, leading to reduced insulin receptor signaling through negative feedback mechanisms.

Answer 465

Increased metabolism due to over-nutrition causes cellular stress (oxidative and ER stress) which inhibits insulin signaling.

Answer 466

Chronic inflammation from increased adipose tissue size and cytokine levels activates signaling pathways that inhibit insulin signaling.

Answer 467

Beta cell mass is defined by the number and size/volume of beta cells in the pancreas.

Answer 468

* Loss of pulsatile insulin secretion * Loss of first phase insulin secretion * Reduced glucose-stimulated insulin secretion * Reduced insulin content * Increased secretion of proinsulin

Answer 469

Glucolipotoxicity refers to the harmful effects of high circulating levels of glucose and free fatty acids on beta cells.

Answer 470

ER stress occurs when the demand for insulin exceeds the processing capacity of the beta cells, leading to dysfunction.

Answer 471

Amylin deposits result from increased secretion of amylin with insulin, causing cellular dysfunction and death.

Answer 472

Metformin improves insulin sensitivity and glucose clearance by enhancing peripheral glucose uptake and decreasing hepatic glucose production.

Answer 473

Metformin inhibits the mitochondrial respiratory chain (complex I), activating AMP-activated protein kinase (AMPK).

Answer 474

TZDs are drugs that bind to the peroxisome proliferator-activated receptor-γ (PPARγ) to increase the expression of insulin sensitivity genes.

Answer 475

Troglitazone.

Answer 476

Rosiglitazone.

Answer 477

SGLT2i reduce renal glucose reabsorption in proximal tubules by inhibiting SGLT2.

Answer 478

* Dapagliflozin * Canagliflozin * Empagliflozin

Answer 479

Sulphonylureas bind to the ATP-sensitive K+ channel, leading to channel closure and stimulating insulin secretion.

Answer 480

The incretin effect refers to the potentiation of glucose-induced insulin secretion by incretin hormones.

Answer 481

* Glucagon-like peptide-1 (GLP-1) * Gastric inhibitory peptide (GIP)

Answer 482

There is reduced GLP-1 secretion and almost complete loss of GIP action.

Answer 483

Exenatide (Byetta) is a synthetic form of exendin-4, a peptide that promotes insulin secretion.

Answer 484

A poisonous lizard found in North America. Exenatide idea from this.

Answer 485

Four times a year

Answer 486

Helps the pancreas to produce insulin

Answer 487

A synthetic form of exendin-4

Answer 488

A GLP1R agonist

Answer 489

Exenatide (2005)

Answer 490

Resistant to degradation by DPP-4 and extends its half-life

Answer 491

By injection

Answer 492

An analogue of GLP1 (97% homology)

Answer 493

* Exenatide (Byetta, Bydureon) * Tirzepatide (Mounjaro, Zepbound) * Liraglutide (Victoza) * Lixisenatide (Lixumia) * Dulaglutide (Trulicity) * Semaglutide (Ozempic)

Answer 494

Protease inhibitors that target the enzyme DPP-4

Answer 495

Degrades GLP1

Answer 496

Orally in tablet form

Answer 497

* Sitagliptin (Januvia) * Vildagliptin (Galvus) * Saxagliptin (Onglyza) * Alogliptin (Vipidia) * Linagliptin (Trajenta)

Answer 498

Drugs that reduce glucose absorption

Answer 499

Breaks down polysaccharides and disaccharides to glucose

Answer 500

Delays carbohydrate digestion and absorption, lowers postprandial blood glucose

Answer 501

* Acarbose (Precose) * Miglitol (Glyset)

Answer 502

Excessively high amount of body fat in relation to lean body mass. ## Footnote Generally agreed that men with over 25% body fat and women with more than 30% body fat are obese.

Answer 503

BMI = Weight (Kg) / Height (m)² ## Footnote BMI categories: Normal (18.5 - <25), Overweight (25 - <30), Obese (30 - <40), Morbid obesity (>40).

Answer 504

39% were overweight and 13% were obese.

Answer 505

Greater correlation between obesity-related disease and waist-hip ratio than BMI. ## Footnote Increased waist/hip ratio indicates increased risk of obesity-related disease.

Answer 506

Waist-hip ratio above 0.90 for males and above 0.85 for females.

Answer 507

Chronic imbalance between energy input and expenditure.

Answer 508

Measured by determining the rate of O2 utilization over a given time period at rest at a set temperature.

Answer 509

* Body mass and composition * Hormones (e.g., Thyroid Hormone) * Growth Hormone * Sleep * Malnutrition * Temperature

Answer 510

Increased food availability and reduced food prices contribute to higher obesity rates.

Answer 511

Leptin is a hormone synthesized and secreted from adipocytes that regulates body weight by influencing appetite and metabolism.

Answer 512

Ghrelin is the hunger hormone released in anticipation of food intake.

Answer 513

Insulin promotes food intake and increases body weight by promoting glucose storage into fat.

Answer 514

* Hunger varies inversely with body weight * Metabolism varies directly with body weight

Answer 515

Obesity is linked to numerous health risks including heart disease, diabetes, and certain cancers.

Answer 516

Gut hormones are released in response to food intake and promote a feeling of satiety.

Answer 517

A global increase in obesity rates that poses significant public health challenges.

Answer 518

2,000 calories.

Answer 519

Most of the world's population.

Answer 520

To develop effective prevention and treatment strategies.

Answer 521

Signals from the gut, stomach, liver, and pancreas to the brain.

Answer 522

Polymorphisms in many genes associated with increased risk of becoming obese.

Answer 523

Homozygotes weigh an average of 3kg more and have a 1.67-fold increased risk of obesity.

Answer 524

Obesity caused by a mutation in a single gene.

Answer 525

Melanocortin 4 receptor (MC4-R).

Answer 526

* Hyperphagia starts at ~8 months * Tendency towards being tall * Hyperinsulinemia * Increased bone mineral density.

Answer 527

* Endocrinopathies * Hypothyroidism * Polycystic ovarian syndrome * Tumors of the pituitary gland, adrenal glands, or pancreas.

Answer 528

* Corticosteroids * Oestrogen and progesterone (oral contraceptives) * Anticancer medications * Lithium and clozapine * Insulin and glyburide * Antidepressants (e.g., tricyclics, MAO inhibitors, SSRIs) * Antibiotics.

Answer 529

Through metabolites produced during the fermentation of dietary substances.

Answer 530

A lipase inhibitor that prevents the digestion and absorption of fats.

Answer 531

≥ 30 kg/m² or ≥ 28 kg/m² with risk factors.

Answer 532

To increase satiety and reduce food intake.

Answer 533

* Semaglutide (Wegovy) * Liraglutide (Saxenda).

Answer 534

BMI of 40 or more, or between 35 and 40 with another serious health condition.

Answer 535

* Gastric band * Sleeve gastrectomy * Gastric bypass.

Answer 536

A band is placed around the stomach to reduce the amount of food needed to feel full.

Answer 537

Some of the stomach is removed, leading to reduced food intake.

Answer 538

The top part of the stomach is joined to the small intestine, reducing calorie absorption.

Answer 539

Their feet ## Footnote Regular foot care is crucial for diabetic patients to prevent complications.

Answer 540

Soften with regular moisturiser

Answer 541

No, seek help for this!

Answer 542

Socks or tights with prominent seams

Answer 543

Straight across and smooth sharp edges with a file

Answer 544

Erectile dysfunction

Answer 545

Huge impact

Answer 546

Erectile dysfunction due to pain, vomiting, or diarrhoea

Answer 547

Poor glycaemic control leads to poor quality tissue in the reproductive system

Answer 548

Alternative causes such as thyroid disorders

Answer 549

* Annually for low risk * Every 3 to 6 months for moderate risk * Every 1 to 2 months for high risk without immediate concern * Every 1 to 2 weeks for high risk with immediate concern

Answer 550

* Patient symptoms and history * Nail care * Visual inspection

Answer 551

Gastroelectrical stimulation for gastroparesis

Answer 552

* A neurostimulator * 2 leads

Answer 553

Diet control

Answer 554

Fatty foods

Answer 555

* Mirtazapine * Erythromycin * Metoclopramide * Domperidone

Answer 556

* Nausea * Vomiting * Constipation or diarrhoea * Early feeling of fullness * Weight loss * Bloating * Abdominal discomfort

Answer 557

A lesion or disease of the somatosensory nervous system

Answer 558

Peripheral neuropathy

Answer 559

Tingling and/or numbness in the limbs, 'pins and needles'

Answer 560

* Oral duloxetine * Amitriptyline if duloxetine is contraindicated

Answer 561

Refer to specialist pain team

Answer 562

* Tachycardia or bradycardia * Heart failure * Orthostatic hypotension

Answer 563

* Oesophageal dysmotility * Gastroparesis * Diarrhoea or faecal incontinence * Constipation

Answer 564

* Erectile dysfunction * Retrograde ejaculation * Neurogenic bladder

Answer 565

Neuropathic damage of the vagus nerve

Answer 566

* Suitability of footwear * Areas of poor support * Rubbing or worn areas

Answer 567

On the dorsum of the foot along the lateral side of the first metatarsal shaft

Answer 568

Urinary ACR of >30mg/g or Creatinine clearance <60ml/min

Answer 569

* Glycaemia (HbA1c/TIR) * Blood pressure * Cholesterol

Answer 570

Diabetic nephropathy

Answer 571

High blood glucose destroys blood vessels surrounding renal tubules/nephrons

Answer 572

Albuminuria

Answer 573

Constant + 0.91(Height - 152.4)

Answer 574

Comparable

Answer 575

£1bn to £1.2bn

Answer 576

* Serum creatinine * ACR

Answer 577

* ACE inhibitor * ARB * SGLT2 inhibitor

Answer 578

85% (5mg), 89% (10mg), 91% (15mg)

Answer 579

3-6 months

Answer 580

Low dose amitriptyline

Answer 581

* Protein:Creatinine (PCR) * Albumin:Creatinine (ACR)

Answer 582

* Excessive thirst * Excessive urination * Weight loss * Blurred vision

Answer 583

Self Monitoring of Blood Glucose (SMBG) is advised

Answer 584

Repeat HbA1C in 3 months

Answer 585

They cause damage to the glomerulus

Answer 586

Diagnose T2DM

Answer 587

Approximately £6,400

Answer 588

* Smoking status * A1C * Cholesterol * BMI * BP * ACR * SCr

Answer 589

Aim for BP <130/80

Answer 590

Prognostic of kidney function

Answer 591

A1C < 48 ## Footnote This indicates that further action is needed for patients at risk of diabetes.

Answer 592

A1C > 48 ## Footnote This result confirms the diagnosis of T2DM.

Answer 593

* Excessive thirst * Excessive urination * Recurrent urinary tract infections * Sweet smelling urine * Superficial infections (e.g., Ringworm or Thrush) * Weight loss * Blurred vision * Confusion * Vomiting * Drowsiness * Slow healing wounds

Answer 594

False ## Footnote A result of 74mmol/mol signifies that long-term diabetes control is not optimal.

Answer 595

BP of 140/80 mmHg or less ## Footnote Achieving this target is crucial for managing diabetes-related complications.

Answer 596

> 140/90 mmHg ## Footnote This threshold indicates the need for intervention in blood pressure management.

Answer 597

A discrepancy of more than 20/10 mmHg between clinic and average daytime blood pressure measurements ## Footnote This effect can lead to misdiagnosis of hypertension.

Answer 598

12-20% ## Footnote Age and co-morbidities contribute to the increasing risk of PAD.

Answer 599

Smoking ## Footnote Diabetes mellitus is also a significant risk factor.

Answer 600

Cramping or pain at rest, known as claudication ## Footnote This symptom indicates advanced disease.

Answer 601

Naftidrofuryl 100mg TDS ## Footnote Increase up to 200mg TDS in refractory cases.

Answer 602

Less than 4mmol/L ## Footnote This target helps in managing cardiovascular risk.

Answer 603

Atorvastatin 20 mg ## Footnote This is for patients with a 10% or greater 10-year risk of developing CVD.

Answer 604

40% reduction in LDL ## Footnote Achieving this target is essential for cardiovascular risk management.

Answer 605

low density lipoprotein cholesterol

Answer 606

More than 40% LDL reduction ## Footnote This category includes statins that have a significant impact on lowering LDL levels.

Answer 607

* Compliance * Possible side effects * Re-enforce lifestyle intervention advice

Answer 608

It is used for the management of type 2 diabetes.

Answer 609

* Diarrhoea * Abdominal pain * Nausea

Answer 610

Every 6 months when stable.

Answer 611

Omit the dose.

Answer 612

It is an alpha-glucosidase inhibitor that reduces carbohydrate absorption in the gastrointestinal tract.

Answer 613

* No hypoglycaemia risk * Weight neutral

Answer 614

* Gastrointestinal side effects * Minimal effect on HbA1C compared to other OHAs * Impairs treatment of hypoglycaemia

Answer 615

* Flatulence * Bloating * Abdominal pain * Diarrhoea

Answer 616

* Little to no hypoglycaemia risk * Good reduction in HbA1C * Recommended option for NASH

Answer 617

* Weight gain (fat or fluid) * Oedema * Risk of cardiovascular disease * Increased fracture risk * Risk of bladder cancer * Decreased visual acuity

Answer 618

They stimulate PPAR gamma to increase insulin sensitivity in tissues.

Answer 619

Monitor liver function and heart failure symptoms.

Answer 620

They primarily affect blood glucose without impacting wider disease complications of T2DM.

Answer 621

History of pancreatitis.

Answer 622

* Usually once daily dosing * Weight neutral * No hypoglycaemia risk

Answer 623

* Nausea * Abdominal pain * Peripheral oedema

Answer 624

They potentiate glucose-dependent insulin secretion.

Answer 625

* Liraglutide - Once daily * Exenatide - Twice daily * Dulaglutide - Once weekly * Semaglutide - Once weekly

Answer 626

* Useful for weight loss and cardioprotection.

Answer 627

* Diarrhoea * Nausea * Vomiting

Answer 628

They can cause urinary tract infections and volume depletion.

Answer 629

* Canagliflozin * Dapagliflozin * Empagliflozin

Answer 630

* Good glucose control * Less risk of prolonged hypoglycaemia * Flexibility in dosing

Answer 631

They augment insulin secretion from pancreatic β-cells.

Answer 632

* Diarrhoea * Abdominal pain

Answer 633

* Well tolerated * Quick reduction in blood glucose levels * Good option for short-term steroid-associated hyperglycaemia

Answer 634

* Risk of hypoglycaemia * Risk of falls in the elderly * Causes weight gain

Answer 635

It sensitizes cells to insulin and reduces gluconeogenesis and glycogenolysis.

Answer 636

* Nausea * Diarrhoea * Bloating * Abdominal discomfort

Answer 637

* Any condition that precipitates metabolic acidosis * Renal impairment * Severe dehydration * Alcohol dependence

Answer 638

* Vitamin B12 levels * Renal function

Answer 639

It does not affect insulin secretion and therefore does not carry a hypoglycaemia risk.

Answer 640

Progressive systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to increased bone fragility and susceptibility to fracture.

Answer 641

* Provide overall structure * Support and protect internal organs * Store calcium and other minerals * Allow movement in collaboration with muscles * Contain bone marrow for blood cell production

Answer 642

* Cortical bone (thick outer shell) * Trabecular bone (strong inner honeycomb-like mesh)

Answer 643

A renewal process where older bone tissue is broken down by osteoclasts and rebuilt by osteoblasts.

Answer 644

* Resting phase * Activation * Resorption * Reversal * Formation * Mineralisation

Answer 645

The balance between bone removal and rebuilding begins to shift, leading to bone loss.

Answer 646

Porous bone.

Answer 647

Fractures that occur due to reduced bone strength, often caused by osteoporosis.

Answer 648

Over 200 million people worldwide.

Answer 649

Over 3 million people.

Answer 650

Approximately 30%.

Answer 651

Bone loss becomes more rapid after menopause due to a decrease in estrogen, and women generally have smaller bones and live longer.

Answer 652

1 in 2 women (50%) experience fractures due to low bone strength.

Answer 653

Yes, 1 in 5 men (20%) break a bone after age 50 due to low bone strength.

Answer 654

That it is a woman's disease, which can hinder men from seeking help.

Answer 655

* Wrists * Hips * Spine

Answer 656

A forward curvature of the spine caused by weakened bones.

Answer 657

* Age * Gender * Prior fracture history * BMI * Alcohol * Smoking * Medications

Answer 658

* Hypogonadism * Endocrine conditions * Conditions associated with malabsorption * RA * Multiple myeloma * COPD * Liver failure * CKD * Immobility

Answer 659

To assess bone mineral density.

Answer 660

Bone mineral density of a patient to that of a healthy young adult of the same sex.

Answer 661

A T-score between -1 and -2.5 SD.

Answer 662

A T-score less than -2.5.

Answer 663

To estimate an individual's risk of developing osteoporotic fractures over the next 10 years.

Answer 664

An online clinical tool used as a guide to estimate an individual's risk of developing osteoporotic fractures over the next 10 years.

Answer 665

People at high risk of osteoporotic fractures so they can be assessed in more detail to reduce their risk.

Answer 666

ClinRisk Ltd and the University of Nottingham.

Answer 667

DEXA scan.

Answer 668

BMI < 18.5 kg/m2.

Answer 669

It makes osteoporosis and fractures more likely due to lower amounts of bone tissue overall.

Answer 670

Current smokers are more likely to break bones and tend to have lower body weight.

Answer 671

It is a significant risk factor for osteoporosis and fractures.

Answer 672

* Genetics * Age * Gender * Race * Previous fractures

Answer 673

Having a parent who had a broken hip.

Answer 674

Women tend to live longer and experience menopause, which reduces estrogen production.

Answer 675

Afro-Caribbean people.

Answer 676

Having previously broken bones easily.

Answer 677

Oral glucocorticoids (steroids).

Answer 678

They bind to bone minerals and cause osteoclasts to undergo apoptosis, reducing their resorptive capacity.

Answer 679

They should be taken on an empty stomach with a full glass of water.

Answer 680

* Oesophageal reactions * Stomach pain * Swallowing problems (dysphagia) * Osteonecrosis of the jaw

Answer 681

A condition where the cells in the jawbone die due to reduced blood flow.

Answer 682

To reduce bone turnover to a level associated with low risk.

Answer 683

A human monoclonal antibody used as a second-line treatment for osteoporosis.

Answer 684

Risk of osteosarcoma.

Answer 685

Calcium is important for bone formation and strength.

Answer 686

30 to 120 minutes.

Answer 687

fractures.

Answer 688

N-terminal propeptide of type 1 collagen (PINP).

Answer 689

It regulates the amount of calcium in bone.

Answer 690

To stimulate osteoblasts and increase bone density.

Answer 691

It is used for those with very low bone density and when other treatments are not effective.

Answer 692

It produced a greater increase in bone mineral density than alendronate and teriparatide.

Answer 693

700mg of calcium.

Answer 694

It helps the body absorb calcium.

Answer 695

10mcg of vitamin D.

Answer 696

Vitamin D is found only in a small number of foods.

Answer 697

Maintain bone density and reduce the risk of fracture.

Answer 698

It slightly increases the risk of certain cancers, stroke, and VTE.

Answer 699

When osteoporosis is caused by insufficient production of male sex hormones.

Answer 700

Development was discontinued at phase 3 clinical trials due to increased risk of stroke.

Answer 701

To ensure adequate intake for bone health.

Answer 702

A type of arthritis in which small crystals form inside and around the joints.

Answer 703

* Severe pain * Swelling in joints * Hot and tender joints * Red, shiny skin over the joint * Peeling, itchy, and flaky skin as swelling goes down.

Answer 704

A sudden attack of severe pain in one or more joints, typically the big toe.

Answer 705

3-10 days.

Answer 706

A disorder in purine metabolism characterized by raised uric acid levels in the blood (hyperuricemia) and deposition of urate crystals in joints and tissues.

Answer 707

Specific molecules made up of carbon and nitrogen atoms found in the DNA and RNA of all living things.

Answer 708

* Endogenous purines: manufactured by the body * Exogenous purines: enter the body via food.

Answer 709

Raised uric acid levels in the blood, often due to impaired renal excretion.

Answer 710

* Offal (liver, kidneys, heart) * Game (pheasant, rabbit, venison) * Oily fish (anchovies, herring, mackerel) * Seafood (mussels, crab, shrimp) * Meat and yeast extracts (Marmite, Bovril).

Answer 711

* Plenty of fruit and vegetables (at least 5-a-day) * Moderate amounts of meat and fish * Moderate dairy intake * Reduce or eliminate processed foods and drinks.

Answer 712

It can increase the risk of developing gout and can trigger a sudden attack.

Answer 713

Typically affects joints towards the ends of the limbs, such as toes, ankles, knees, and fingers.

Answer 714

Approximately 1 in every 100 people are affected, more common in men over 30 and women over 45.

Answer 715

* Obesity * Medical conditions (CVD, diabetes, renal disease) * High-risk medicines (diuretics) * High alcohol intake * Diet high in purines.

Answer 716

Hyperuricemia.

Answer 717

hyperuricemia.

Answer 718

The single most important risk factor for developing gout ## Footnote Hyperuricemia can occur in people without gout, and many with gout can have normal uric acid levels.

Answer 719

Serum Uric Acid ## Footnote sUA is the most important risk factor for gout but should be considered with other clinical features.

Answer 720

* Asymptomatic gout * Acute gout * Intercritical gout * Chronic gout ## Footnote Each stage has different characteristics and implications for treatment.

Answer 721

Sudden and intense pain and swelling in joints ## Footnote Damage to the joints begins during this stage.

Answer 722

3-10 days ## Footnote This duration can vary among individuals.

Answer 723

Clinical history and examination ## Footnote There is no single examination that confirms a diagnosis of gout.

Answer 724

Joint fluid test ## Footnote It checks for uric acid crystals and can rule out septic arthritis.

Answer 725

200-430 µmol/L ## Footnote Reference ranges vary by age and gender.

Answer 726

305 per 1000 ## Footnote Higher plasma urate levels significantly increase the risk of developing gout.

Answer 727

NSAIDs like Ibuprofen or Naproxen ## Footnote These should be continued for 48 hours after the attack resolves.

Answer 728

A PPI (Proton Pump Inhibitor) ## Footnote This can help protect against gastrointestinal side effects.

Answer 729

Colchicine 500 micrograms 2-3 times per day ## Footnote Colchicine can cause side effects like profuse diarrhea.

Answer 730

* Multiple or troublesome flares (≥2 attacks within 1yr) * Chronic kidney disease (CKD) stages 3 to 5 * Diuretic therapy * Tophus * Chronic gouty arthritis ## Footnote If none of these apply, ULT is not indicated.

Answer 731

Allopurinol ## Footnote It should be started at least 1-2 weeks post the last attack.

Answer 732

900 mg ## Footnote This is the maximum tolerated dose for lowering uric acid levels.

Answer 733

Serum urate levels ## Footnote Levels should be checked 4 weeks after initiation and adjusted accordingly.

Answer 734

If Allopurinol is contraindicated, not tolerated, or ineffective ## Footnote Febuxostat should be started at least 1-2 weeks post the last attack.

Answer 735

80 mg once daily ## Footnote Starting with a lower dose may reduce the incidence of acute flares.

Answer 736

It potentiates the anticoagulant effect of warfarin ## Footnote Monitoring is necessary during dose titration.

Answer 737

False ## Footnote X-rays rarely detect urate crystals but may help rule out similar conditions.

Answer 738

To detect crystals in the joints and deep in the skin ## Footnote It is a simple and safe method increasingly used in practice.

Answer 739

May decrease the incidence of acute flares.

Answer 740

The dose can be increased by 40mg & sUA rechecked in a further 4 weeks.

Answer 741

Max dose = 120 mg daily.

Answer 742

Prophylactic colchicine (500 mcg b.d. for up to 6 months) or NSAID (ibuprofen 200mg b.d. or naproxen 250mg daily for up to 6 weeks).

Answer 743

Stop febuxostat immediately, do not restart.

Answer 744

Azathioprine and mercaptopurine.

Answer 745

During an acute attack; ensure at least 1-2 weeks have passed before initiation.

Answer 746

Continue treatment and treat the attack separately.

Answer 747

DO NOT interrupt uric acid lowering therapy unless there is a clinical reason.

Answer 748

Gout flare is NOT a clinical reason.

Answer 749

If septic arthritis is suspected.

Answer 750

* sUA is unresponsive to uric acid lowering therapy * Gout persists despite uric acid levels <360 μmol/l * Patient suffers complications relating to gout * Patient requires intra-articular therapy and primary care are not able to provide * There is diagnostic uncertainty.

Answer 751

* Tophi may create problems with activities of daily living * Hyperuricaemia-induced renal disease * Urinary stones found in 10–25% of people with gout.

Answer 752

The incidence of urinary stones is strongly correlated with plasma urate level.

Answer 753

The incidence of urinary stones increases by up to 50%.

ENDOCRINE Flashcards

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