Endocrine

Question 1

What is the difference pathologically between T1 and T2 diabetes?

Answer 1

T1-absolute lack of insulin due to autoimmune destruction of beta cells in pancreas

T2-decreased insulin secretion +/- increased insulin resistance

Question 2

Give a definition of diabetes?

Answer 2

Symptoms of hyperglycaemia AND high venous glucose detected once (fasting >7mmol/L or random >11.1mmol/L)

Question 3

What are the symptoms of T1 diabetes?

Answer 3

Polydipsia
Polyuria
Weight loss
?Ketosis

Question 4

What are the symptoms of T2 diabetes?

Answer 4

Asymptomatic/complications eg. MI

Question 5

Suggest 2 tests you could do to confirm T1 diabetes?

Answer 5

Random glucose level
Fasting glucose level
Oral glucose tolerance test
Urine dip for ketones

Question 6

Give 2 possible drug treatments for T2 diabetes?

Answer 6

Biguanides-metformin
Sulphonylureas-gliclazide
Insulin

Question 7

Give 3 lifestyle changes for diabetes?

Answer 7

Lose weight
Increase exercise
Stop smoking
Reduce alcohol intake
Low fat diet

Question 8

How can you monitor long term diabetes control? What is it measuring?

Answer 8

HbA1c levels

Glycosylated haemoglobin over approx. 60 days

Question 9

Name 3 systems that need to be monitored in patients with diabetes?

Answer 9

Eyes
Feet
Kidneys
CVS

Question 10

What is the ideal BP in T2 diabetics?

Answer 10

140/80

Question 11

Define hypoglycaemia?

Answer 11

Plasma glucose <3mmol/L

Question 12

Give 5 symptoms of hypoglycaemia?

Answer 12

Sweating
Dizziness
Palpitations
Confusion
Drowsiness
Seizures
Coma

Question 13

How do you treat a hypoglycaemic attack?

Answer 13

Oral sugar and long acting starch

If unable to swallow the IV glucose

Question 14

Give 3 symptoms of DKA?

Answer 14

Vomiting
Drowsiness
Dehydration
Lethargy
Ketotic breath

Question 15

Give 2 triggers of DKA?

Answer 15

Infection
Surgery
MI
Wrong insulin dose/noncompliance
Chemotherapy

Question 16

What are the 3 parameters used to diagnose DKA?

Answer 16

Acidosis
Hyperglycaemia
Ketosis

Question 17

What makes HONK different from DKA?

Answer 17

Longer history
Marked dehydration, glucose >35mmol/L
Acidosis absent

Question 18

Name the first 3 steps in management of neuropathic pain?

Answer 18

Paracetamol
Amitrypitilline
Gabapentin

Question 19

What is the initial management of DKA?

Answer 19

Set up IV access
Aggressive fluids whilst monitoring potassium
Soluble insulin IV
Add potassium when urine output is >30ml/hr

Question 20

Give 2 triggers of HONK?

Answer 20

Infection
MI
Drugs (steroids, beta blockers)

Question 21

Give 3 symptoms of HONK?

Answer 21

Malaise
Confusion
Drowsiness
Polydipsia

Question 22

Name a complication that can develop from HONK?

Answer 22

Thrombosis
Seizures
Focal CNS signs

Question 23

How do you treat HONK?

Answer 23

Rehydrate with saline over 48hrs

Replace K+ when urine starts flowing

Question 24

What can precipitate a thyrotoxic storm?

Answer 24

Recent thyroid surgery
Infection
MI
Trauma

Question 25

If a patient is unconscious from hypoglycaemia, how might you administer treatment and with what?

Answer 25

Glucose gel-Buccal Dextrose-IV Glucagon-IM

Question 26

What is the skin condition caused by insulin resistance?

Answer 26

Acanthosis Nigricans

Question 27

How is diabetic retinopathy classified?

Answer 27

Background Preproliferative Proliferative Advanced

Question 28

How can you treat diabetic nephropathy?

Answer 28

ACE i

Question 29

What is the typical presentation of diabetic neuropathy?

Answer 29

Glove and stocking distribution of tingling and pain. Worse at night.

Question 30

What is the most common cause of Cushing's syndrome and name 3 other causes?

Answer 30

Oral steroids Cushing's disease- pituitary adenoma adrenal hyperplasia Ectopic ACTH production-lung cancer Adrenal cancer

Question 31

Give 5 symptoms of Cushing's syndrome?

Answer 31

``` Weight gain Mood changes (depression, irritability) Proximal weakness Gonadal dysfunction (irregular menses, hirtutism) Acne Recurrent Achilles' tendon rupture ```

Question 32

Name 4 signs seen in Cushing's syndrome?

Answer 32

``` Central obesity Moon face Buffalo neck hump Purple striae Bruises Skin & muscle atrophy ```

Question 33

Why may random plasma cortisol levels mislead when trying to test for Cushing's syndrome?

Answer 33

Illness, time of day and stress (being in hospital) can influence the results.

Question 34

What is the diagnostic test for Cushing's syndrome?

Answer 34

Dexamethasone suppression test

Question 35

Give 5 side effects of corticosteroid therapy?

Answer 35

``` Hyperglycaemia Osteoporosis Cataracts Depression Hypertension Weight gain Amenorrhea ```

Question 36

Name 4 symptoms of hyperthyroidism?

Answer 36

``` Diarrhoea Weight loss Increased appetite Over active Heat intolerance Palpitations Tremor ```

Question 37

Suggest 4 symptoms of hypothyroidism?

Answer 37

``` Tired Lethargic Low mood Cold intolerance Weight gain Constipation Hoarse voice ```

Question 38

What value of HbA1c should diabetics be aiming for?

Answer 38

<7%

Question 39

Name 4 actions of cortisol?

Answer 39

Increase plasma glucose Immunosuppressive Slows bone formation Catabolism