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Endocrine Guidelines Flashcards

1
Q

Fasting glucose threshold diabetes

A

<6 is normal

>7 is diabetes

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2
Q

Random glucose threshold diabetes

A

> 11.1 is diabetes

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3
Q

OGTT threshold diabetes

A

> 11.1 is diabetes

<7.8 is normal

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4
Q

HBa1C threshold diabetes

A

48+ is diabetes

<42 is normal

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5
Q

how often should you self monitor for diabetes

A

4x per day

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6
Q

Daily glucose targets T1DM

A

4-7

5-7 when waking up

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7
Q

HTN in diabetic black person 1st line

A

ACEi and CCB

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8
Q

DKA diagnosis

A

pH <7.3
bicarb <15
ketones ++ or >3
glucose >11 or known diabetes

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9
Q

DKA management

A

Need fluids: 1 2 2 4 4 6 = litre saline 0.9%
Need potassium replacement = add 40mmol if 3.5-5.5, call senior if below that.
0.1U/kg/hr insulin. Dextrose when <15

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10
Q

T2DM first line

A

metformin + lifestyle

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11
Q

hba1c target with T2DM

A

48 (53 on gliclazide)

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12
Q

When do you add a second drug in T2DM

A

hba1c >58

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13
Q

when do you use GLP1

A

If triple therapy has not worked (i.e. it is fourth line) and BMI >35 with problem associated with obesity or BMI <35 but insulin would affect their work badly.

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14
Q

HHS management

What do you check doing management

A

Fluid loss = 10=20% of body weight
Give fluid back (half in 12 hours, half in next 12 hours)

Must check that osmolality is going down (2Na + urea + glucose) so plot it on graph:

  • glucose should fall by 5/hr
  • sodium should not fall by more than 10 in 24 hour§
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15
Q

Graves disease Mx

A

18 months of carbimazole or block and replace

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16
Q

TMG Mx

A

radioidine or lifetime carbimazole

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17
Q

Toxic adenoma Mx

A

Radioiodinde

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18
Q

Thyroid storm Mx

A

IV propranolol, Lugol’s iodine, anti-thyroid drugs

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19
Q

When should you start at a lower dose with levothyroxine

A

Elderly or heart disease (start at 25 instead of 50 ug)

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20
Q

When do you check TFTs after starting Tx for hypothyroidism and what do you aim for

A

Normal TSH after 6-8w

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21
Q

Levothyroxine dose in pregnancy

A

Increase by 25-50microgram

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22
Q

levothyroxine dose alongside iron?

A

No, leave 2 hours in between as iron reduces levothyroxine absorption

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23
Q

Do you treat subclinical hypothyroidism

A

Depends
If >80, no
If <80 + TSH >10, yes
If TSH only a bit raised (4-10), treat if <65

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24
Q

de quervains thyroiditis Mx

A

self limiting

steroids may help hypothyroid phase

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25
post-partum thyroiditis
propranolol in hyperthyroid phase | levothyroxine in hypothyroid phase
26
primary hyperPTH Mx
Parathyroidectomy
27
Can you ever not treat primary hyperPTH
Yes, if >50, Ca raised by <0.25, no end organ damage
28
Secondary hyperPTH
calcium and vit D supplementation
29
Tertiary hyperPTH | - what about if just had a renal transplant
Excision of culprit gland | Wait 12m after a renal transplant as many resolve
30
how to differentiate between pseudo and real cushings
Best = low dose dex suppression test | Also used = insulin stress test
31
best test for cushings
overnight dex suppression test - give dex, and cortisol should be reduced the next morning. First do low dose then do high dose.
32
Addison's best test
spank the adrenals with SYnACTHen to see if they work. | measure cortisol before and 30 min after ACTH given.
33
Addisons ABG
hypoglycaemia, hyponatraemia, hyperkalaemia, metabolic acidosis
34
Mx of Addisons
hydrocortisone TDS with biggest dose in the morning + fludrocortisone
35
Addisons crisis management
IV hydrocortisone 100mg (big dose) only | saline + dextrose if needed
36
prolactinoma 1st and 2nd/definitve
``` 1st = bromocriptine/cabergoline 2nd = surgery ```
37
hypoglycaemia
depends on access - conscious = oral - unconscious no IV = IM glucagon - unconscious with IV = dextrose
38
diabetic foot - who gets followed up
anyone with anything more than a simple callous (so moderate or severe as opposed to mild)
39
hyponatraemia investigation: what do you do first
exclude pseudohypoNa (test lipid and protein) and exclude compensatory (test glucose)
40
Steps 1 to 3 for investigating hypoNa - addisons/diuretic - vomiting/diarrhoea - SIADH/hypothyroid - nephrotic syndrome, CCF, cirrhosis
Step 1 = depleted euvolaemic, overloaded Step 2 = urinary sodium >20 or <20 Step 3 = imagine the flow diagram and figure out what it is - addisons/diuretic = dehydrated + UNa >20 - vomiting/diarhoea = dehydrated + UNa <20 - SIADH/hypothyroid = euvolaemic + UNa >20 - failures = overloaded + UNa <20
41
Treatment of hypoNa - rate of Na correction - use of hypotonic saline?
normal saline 0.9% for F1 always - no more than 10mmol/24 hours - only in cerebral oedema under senior supervision
42
severe hypoCa management
10ml calcium glutinate 10% with ECG monitoring
43
hyperPTH : Ca, PO4, PTH, ALP
high Ca, low PO4, high PTH (or inappropriately normal), high ALP
44
malignancy with bone met: Ca, PO4, PTH, ALP
High Ca, high PO4, low PTH, high ALP
45
Mx of hypercalcaenia - first - ongoing helper management
3-4L per day of normal saline | Bisphosphonates can be used too but these take 2-3 ays to work with maximal effect at 7d
46
recurrence of thyroid cancer
yearly check of thyroglobulin antibodies
47
HypoPTH: PTH, PO4, Ca hypoPTH vs pseudohypoPTH vs psuedopseudohypoPTH Best way to diagnose pseudohypoPTH
Low PTH, high PO4, low Ca pseudo = high PTH, high PO4, low Ca (target cells insensitive to PTH) pseudopseudo = normal everything but physically looks like pseudo )low IQ, short 4/5th metacarpal, short BUT best way to diagnose pseudohypoPTH is by measuring urinary cAMP/PO4 after PTH infusion (stays same in pseudo as not responsive)
48
Mx of true hypoPTH
alfacalcidol to boost the low calcium
49
Conn's syndrome best Ix
aldosterone:renin will be HIGH
50
ABG in Conn's
high Na, low K, metabolic alkalosis
51
Once Conn's diagnosed, what test do you then do
Need to find out the cause: | Do high resolution CT scan and adrenal vein sampling. helps distinguish between adenoma or hyperplasia
52
Mx of Conn's - adenoma - hyperplasia
surgery | spironolactone
53
Pheochromocytoma Ix
metanephrine/VMA in urine (NOT SERUM)
54
Phaeo Mx
surgery, but give alpha (phenoxybenzamine) then beta blockage in meantime
55
Acromegaly Ix FIRST BEST
first = Serum IGF1 Best (to confirm) = OGTT (to try and suppress axis. in acromegaly GH doesn't suppress after glucose)
56
Acromegaly 1st line | other Tx?
surgery medical Tx includes octreotide (somatostatin analogue) or dopamine agonist (cabergoline/bromocriptine) GH receptor antagonist (pegvisomant - prevents dimerisation of the receptor)
57
Diabetes insipidus Ix to confirm | to detect type
Check serum and urine osmolality to confirm | Do desmopressin test to check which
58
Check for primary polydipsia as cause of polyuria (Ddx for diabetes insipidus)
Water deprivation test (urine conc will eventually go up in primary polydipsia)
59
Neprhogenic vs cranial DI Mx
``` Cranial = desmopressin Nephrogenic = thiazides and low salt/protein diet§ ```
60
What do you do if metformin isn't tolerated due to GI SEs
You try metformin MR before going to second line treatment
61
Thyroid eye disease management
topical lubricants ORAL not injection steroids radiotherapy surgery

Finals (13 decks)

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