Endocrine Flashcards
(25 cards)
What treatment options are there to reverse a hypoglycaemia in an unconsious patient?
IM glucagon 1mg
IV 75-80 ml 20% glucose
What 3 components are required for a diagnosis of diabetic ketoacidosis?
Hyperglycaemia (i.e. blood glucose > 11 mmol/l)
Ketosis (i.e. blood ketones > 3 mmol/l)
Acidosis (i.e. pH < 7.3)
How is DKA managed?
Aggressive fluid therapy (typical regime: 1L 0.9% NaCL over 1hr, then 1L over 2 hours, then 1L over 4 hours, then 1L over 16 hours)
Insulin 0.1 units/kg/hr (once BM < 14 mmol/l, also infuse 5% dextrose)
Potassium if required (>3.5mmol/l)
What visual field defect is classically seen with a pituitary adenoma?
Bitemporal hemianopia - due to compression of the optic chiasm
T1DM is associated with which HLA types?
HLA-DR3 and HLA-DR4
If a person is symptomatic, what is sufficient for a diagnosis of diabetes mellitus?
One abnormal plasma glucose (random ≥11.1 mmol/L or fasting ≥7 mmol/L)
In asymptomatic patients, what is recommended to diagnsose diabetes mellitus?
Two fasting venous plasma glucose samples in the abnormal range (≥7 mmol/L)
What HbA1c value is diagnostic of DM?
HbA1c of greater than or equal to 6.5% (48 mmol/mol)
If a patient with T2DM has HbA1c level that reaches 58mmol/l (7.5%) despite monotherapy with metformin, what is the recommended first intensification of drug treatment?
Add one of a DPP-4 inhibitor (e.g. sitagliptin), pioglitazone or a sulfonylurea (e.g. gliclazide).
If a T2DM patient still fails to achieve target HbA1c despite dual therapy, what management options exist?
Triple therapy with either:
Metformin, a DPP-4 inhibitor and a sulfonylurea; or
Metformin, pioglitazone and a sulfonylurea.
Alternatively, consider starting insulin-based treatment
Which 2 medications used in the management of diabetes mellitus have the biggest risk of hypoglycaemia?
Insulin and sulfonylurears (e.g. gliclazide)
Combination of 2 hypo-inducing agents should be avoided
What is meant by a ‘Charcot foot’?
Refers to a neuro-arthropathic process with osteoporosis, fracture, acute inflammation and disorganisation of foot architecture.
It is characterised by bone and joint degeneration which can lead to a devastating deformity. It usually presents as a hot swollen foot after minor trauma
What clinical signs exist that are unique to Graves’ disease?
Diffuse goitre (without nodules)
Bilateral Exopthalmos
Pretibial Myxoedema
(all relate to the presence of TSH receptor antibodies)
What is the first line anti-thyroid drug used in hyperthyroidism and what are the 2 management options when using this drug?
Carbimazole.
Options are
“Titration-block”: The dose is carefully titrated to maintain normal levels
“Block and replace”: The dose is sufficient to block all production and the patient takes levothyroxine titrated to effect
What antibodies are associated with Hashimoto’s thyroiditis?
Anti-thyroid peroxidase antibodies (anti-TPO antibodies)
Which cells in the parathyroid gland produce the parathyroid hormone?
Chief cells
What stimulates the release of parathyroid hormone?
Hypocalcaemia
How does PTH work to increase serum calcium?
Increases osteoclast activity in bones (reabsorbing calcium from bones)
Increases calcium absorption from the kidneys
Increases vitamin D activity (which helps to increase gut Calcium absorption)
What classical description may be seen on an X-ray of the head in someone with hyperparathyroidism?
‘Pepper-pot skull’
What is the definitive treatment of primary and tertiary hyperparathyroidism?
Surgery - (total) parathyroidectomy
Which cancer is particularly associated with the release of parathyroid horome related protein (PTHrP) leading to hypercalcaemia?
Squamous cell lung cancer
What treatment is used in the acute management of hypercalcaemia?
Fluid therapy with 0.9% saline to rehydrate
Bisphosponates
What is the definitive investigation in Addison’s disease?
ACTH stimulation test (short Synacthen test) - Plasma cortisol is measured before and 30 minutes after giving Synacthen 250mcg IM.
What scoring tool can be used to guide whether a patient should be started on a statin?
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