Identify familial hypercholesteraemia
Total cholesterol > 7.5
Treatment familial hypercholesteraemia
High dose statins
Treatment hypercalcaemia
Rehydration within saline then bisphosphonates
Identify hypocalcaemia
Tetany - twitching, cramping, spasm
Trouseus sign
Treatment hypocalcaemia
IV calcium gluconate
Common causes hyperkalaemia
AKI
Metabolic acidosis
Addisons
Drugs
ECG findings hyperkalaemia
Peaked T waves
Loss p wave
Broad QRS
Sinusoidal
Treatment hyperkalaemia
1) ECG
2) IV calcium gluconate - stabilise cardiac membrane
3) Calcium resonium - remove calcium from body
Common causes hypokalaemia
Alkalosis:
- vomiting
- hyperaldosteronism
Acidosis:
- diarrhoea
- renal tubular acidosis
Identify hypokalaemia
Muscle weakness, hypotonia
ECG - U waves, small T waves, prolong PR
Hypernatraemia treatment
Lower with caution due to risk cerebral oedema
Cause of hyponatraemia if urinary Na >20
Hypovolaemia:
- diuretics
- addisons
Euvolaemia:
- SIADH
- hypothyroidism
Cause of hyponatraemia if urinary Na <20
Na depression:
- diarrhoea, vomiting
- burns
Water excess:
- secondary hyperaldosteronism to HF or liver cirrhosis
- nephrotic syndrome
- psychogenic polydipsia
Treatment hyponatraemia
Hypovolaemia - saline
Euvolaemia - fluid restriction 500 to 1L/day
Hypervolaemia - fluid restriction
Treatment acute hyponatraemia with severe symptoms
Hypertonic saline (3% NaCl)
Treatment SIADH
Fluid restriction
Drugs which cause SIADH
SSRI
TCA
Carbamazepine
Sulphonylureas
Primary prevention hyperlipiademia
20mg atorvastatin
Secondary prevention hyperlipidaemia
80mg atorvastatin
Differentiate between type I and II diabetes
Decreased C-peptide in type 1
Diabetes diagnosis criteria
Glucose:
- fasting 7
- random 11.1
HbA1c:
- 48
If asymptomatic needs done twice
Pre-diabetes criteria
Fasting glucose 6.1-7
HbA1c 42-47
Treatment hypoglycaemia
Awake - oral glucose tablet or gel
Unconscious - IM glucagon or IV glucose 20% if IV access
Treatment diabetic ketoacidosis
1) Isotonic saline
2) IV insulin 0.1 units/kg/hour
What to do with insulin in diabetic ketoacidis
Long acting continue, stop short acting
Treatment diabetic nephropathy
1) Amitryptylin, duloxetine, gabapentin, pegrabulin
2) Try another
3) Tramadol and refer to pain management clinic
Treatment T2 diabetes
1) Metformin
2) If 58 + sulphonylurea/gliptin/pioglitazone/SGLT2
3) Triple therapy if still 58, metformin always one
4) Insulin OR
4) Metformin + sulphonylurea + GLP if obese instead of insulin
T2 HbA1c targets
On one drug - 48
On two or more - 53
Primary v secondary hypothyroidism
Primary - TSH raised and T3/4 low
Secondary - both low
Treatment hypothyroidism
Levothyroxine
Identify hashimotos thyroidism
Hypothyroidism
Firm non tender goitre
Anti-thyroid peroxidase antibodies
Identify sub acute (de quervains) thyroiditis
Phases - hyperthyroidism with painful goitre, euthyroid, hypothyroid, normal
Globally reduced uptake on thyroid scintigraphy
Treatment subacute thyroiditis
Supportive
Identify Graves disease
Hyperthyroidism Eye disease - exopthalmos Pretibial myoxedema TSH receptor stimulating antibodies Diffuse, homogenous increased uptake on scintigraphy
Treatment Graves
1) Propranol to control symptoms and refer
2) Carbimazole in seconary care
3) Radioactive iodine
Identify toxic multinodular goitre
Hyperthyrodism
Patchy uptake
Treatment toxic multinodular goitre
Radioiodine therapy
What is addisons
Primary hypoadrenalism - decreased cortisol and aldosterone
Identify Addisons
Hyperpigmentation
Hypoglycaemia
Hyperkalaemic acidosis, hyponatraemia
Diagnose addisons
1) ACTH stimulation test (short synthen test)
Treatment addisons
Hydrocortisone and fludrocortisone therapy
Addisons during concurrent illness
Double glucocorticoid
Primary hyperparathyroidism common cause
Solitary adenoma
Identify primary hyperparathyrodism
Increased PTH
Increased Ca
Decreased phosphate
Most common secondary hyperparathyroidism cause
CKD
Identify secondary hyperparathyroidism
Increased PTH
Decreased or normal Ca leading to bone disease
Increased phosphate
Decreased vit D
Common tertiary hyperparathyroidism cause
Ongoing hyperplasia of gland after correction of underlying renal problem
Identify tertiary hyperparathyroidism
Increased PTH (massive) Increased or normal Ca Decreased or normal phosphate Decreased or normal vit D Increased ALP
Xray finding primary hyperparathyroidism
Pepperpot skull
Treatment primary hyperparathyroidism
Definitive - total parathyroidectomy
Cant have surgery - calcimometic (eg cinacalet)
Treatment hypoparathyroidism
Alfacalcidol
Bone profile in hypoparathyroidism
Low PHH
Low Ca
High phosphate
What is pseudohypoparathyroidism
Target cells insensitive to PTH due to abnormality, associated with low IQ and short stature
Pseudohypoparathyroidism bone profile
Decreased Ca
Increased PTH
Increased phosphate
Identify phaechromocytoma
Hypertension with hypokalaemia
Headaches
Palpitations
Anxiety
Diagonsis phaechromocytoma
24h urinary metanephrines
Treatment phaechromocytoma
1) Alpha blockers - phenoxybenzamine
2) Surgery definitive
Common cause acromegaly
Increased GH secretion from pituitary adenoma
Diagnosis acromegaly
1) Serum IGF1
2) OGTT to confirm
Treatment acromegaly
1) Transphenoidal surgery
2) Medication - octreotide
What is cushings syndrome
Hyperadrenalism - too much cortisol
ACTH dependent cause:
- cushings disease (most common), due to pituirary tumour
- ectopic ACTH production from tumour
ACTH independent cause:
- steroids
- adrenal adenoma
Blood gas for cushings syndrome
Hypokalaemic metabolic alkalosis
Diagnosis cushings syndrome
1) Overnight dexamethasone suppresion test
Suppression test results for ectopic ACTH secretion
Cortisol - not supressed
ACTH - not supressed
Suppression test results for cushings disease
Cortisol - suppressed
ACTH - suppressed
Suppresion test results for adrenal adenoma
Cortisol - not suppressed
ACTH - supressed
Identify diabetes insupidus
Polyuria and polydipsia
Low K
No evidence diabetes
Diagnose diabetes insupidus
Water deprivation test
- plasma osmolarity increased and urine decreased
Treatment diabetes insupidus
Cranial - desmopressin
Nephrogenic - thiazides
Treatment addisonian crises
Hydrocortisone IM/IV
Saline +/- dextrose
GLP1 drugs
End in -ide
exenatide
liraglutide
GLP1 mechanism
Glucagon mimic, increasing insulin
DPP4 drugs
Ends in -gliptan
vildagliptin
sitagliptin
Mechanism DPP4
Decreased peripheral breakdown incretins
What drug to use T2 diabetes no weight gain
GPP-4
Causes lower HbA1c than expected
Sickle cell anaemia
G6PD deficiency
Hereditory spherocytosis
Causes higher HbA1c than expected
Splenectomy
Identify hyperosmolar hyperglycaemic state
Nausea and vomiting, impaired consicous
Hypovolaemia
Marked hyperglycaemia without ketoacidosis or acidosis
Raised serum osmolarity
Treatment hyperosmolar hyperglycaemic state
1) Saline
2) After fluids insulin at 0.05units/kg/hour
Calculate serum osmolarity
2Na + glucose + urea
MEN1
3Ps
- parathyroid
- pituitary
- pancreas
MEN 2a
2Ps
- parathyroid
- phaeochromocytoma
Men 2b
1P
- phaeochromocytoma
Identify myoxodemic coma
Confusion
Hypothermia
Hypothyroidism
Treatment myoxodemic coma
IV corticosteroid
IV thyroid replacement
IV fluid
SGLT2 inhibitors
Ends in -flozin
SGLT2 mechanism
Increase urinary glucose excretion
SGLT2 adverse
Fourmiers gangrene
SGLT2 weight gain or loss
Often lose weight
Sulphonylureas mechanism
Increase pancreas insulin secretion
Sulphonylureas adverse
Hypoglycaemia
Weight gain
Sulphnylureas drugs
Glicazide
Most common thyroid cancer
Papillary
Thyroid cancer secretes calcitonin
Medullary
Treatment thyroid storm
Beta blockers
Diabetic medication contraindicated by HF and bladder cancer
Pioglitazone
Example thiazolidinedione
Ends in -glitazone
1ml of insulin is
100 units
Mechanism thiazolidinedione
Reduce peripheral insulin resistance
