Flashcards in Endocrinology Deck (180)
What are some signs of diabetic autonomic neuropathy?
Which enzyme is blocked by orlistat?
Leads to undigested fat passing out as unpleasant oily compound, patients are rapidly self educated as to what appropriate food to eat
Which hormone leads to enhanced insulin release?
Produced in small intestine
Leads to slowing of gastric transit time, satiety and enhanced insulin release
Which hormone promotes hyperglycaemia?
A 43 year old man with type 2 diabetes is seen in the hepatology clinic with an alt of 189. He denies alcohol consumption. Liver biopsy demonstrates macrovesicular steatosis with centrolobular inflammatory infiltrate and mild fibrosis. What is the most likely diagnosis?
Non alcoholic fatty liver disease
Driven by metabolic syndrome in particular central adiposity and insulin resistance
An 88 year old woman has been treated with glibenclamide for 10 years. She has become increasingly confused over last few months in her nursing home and one morning is found unconscious in her soaked bed. Her pupils are dilated and react sluggishly to light. What is the likely complication?
Recurrent hypoglycaemic episodes
Occurs more frequently with long acting sulfonylureas such as glibenclamide
76 year old man treated with metformin and glibenclamide for 20 years. He complains of sudden onset diplopia. He has right sided ptosis and is unable to adduct his right eye. Pupils are equal and react normally to light. What is the likely complication?
Mononeuropathy affecting the 3rd nerve
Classically painless and pupil is spared
75 year old man treated with insulin for 40 years. Complains of gradually failing vision and difficulty reading the newspaper. Pupils are both small but react equally to light. Visual acuity is 6/18 in both eyes but falls to 6/36 when using a pinhole. Fundoscopy reveals scattered dots, blots and exudates in the peripheral retina. What is the likely complication?
He has background retinopathy but this would not account for his visual loss
55 year old woman treated with glibenclamide for 5 years. Complains of severe pain in both feet and legs. Muscle bulk appears normal but tone and power assessment is limited by her pain. Reports subjective loss of light touch sensation. Joint position sense and ankle jerks are impaired. What is the likely complication?
Peripheral sensory neuropathy
Where are leydig cells found? What do they do?
Between seminiferous tubules
Produce androgens in men: including testosterone
Where are Sertoli cells? What do they do?
Arranged into tubular structures with a lumen: seminiferous tubules
Have basal compartment where spermatogonia divide and a luminal compartment where spermatids mature
Testosterone diffuses into Sertoli cells where it is converted to more active form: 5-hydroxytestosterone
What cell type is found in the epididymis?
Tall columnar epithelial cells with atypical long microvilli
They phagocytose dead spermatozoa and produce substances which aid in sperm maturation
According to NICE, bariatric surgery is a treatment option for people with obesity if what criteria are fulfilled?
All appropriate non-surgical measures have been tried
Person has been receiving or will receive intensive management in a tier 3 service
Person is generally fit for anaesthesia and surgery
Person commits to the need for long-term follow-up
Patients who have recent onset T2DM and a BMI of 35
Patients without co-morbidities and a BMI of 40
What are the categories of obesity?
Healthy weight: 18.5–24.9
Obesity I: 30–34.9
Obesity II: 35–39.9
Obesity III: 40 or more
NICE recommends using different thresholds for BMI to trigger action to prevent type 2 diabetes among Asian (South Asian and Chinese), black African and African-Caribbean populations.
What are the BMI thresholds to identify (a) increased risk, and (b) high risk, in these populations?
23-27.4 kg/m2: increased risk
27.5 kg/m2 or higher: high risk of developing chronic health conditions
Orlistat is an approved drug for the treatment of obesity available on prescription. What is its mechanism of action?
Orlistat inhibits the action of lipase in the GI tract so 30% less dietary fat is absorbed, resulting in lower calorie intake
What proportion of women were classified as obese in England in 2014 (Health Survey for England)?
In which two school years is the National Child Measurement Programme carried out in England?
Reception (age 4-5) and Year 6 (age 10-11)
A 43 year old patient with poorly controlled type 1 diabetes mellitus presents with sudden, painful visual loss. He is non compliant with his therapy and has known diabetic nephropathy and peripheral neuropathy. What is the likely cause of his painful visual loss?
Neovascular glaucoma - proliferative diabetic neuropathy involves growth of new blood vessels. These can grow over the lens and into the anterior chamber, blocking the trabecular meshwork and causing a type of acute angle closure glaucoma which presents as painful visual loss and a hazy cornea, associated with nausea and vomiting
In what ways does vitamin D lead to raised serum calcium levels?
Increases calcium absorption in the small intestine
Increases calcium reabsorption in the renal parenchyma
What effect does hypercalcaemia have on parathyroid hormone levels?
Hypercalcaemia inhibits PTH release
What are the effects of parathyroid hormone?
Enhances osteoclast activity by binding to osteoblasts which increases their expression of RANKL and inhibits their expression of OPG. RANKL binds to RANK stimulates osteoclast precursors to be activated
Increases calcium reabsorption in kidney but inhibits reabsorption of phosphate
Stimulates conversion of 25hydroxy vitamin D to calcitriol via 25hydroxy vitamin D3, 1 alpha hydroxylase enzyme
Enhances absorption of calcium in intestine by increasing vit D levels
Which vessel does the recurrent laryngeal nerve run close to which means it is at risk of damage in thyroid surgery?
Inferior thyroid artery
What is whipples triad?
For diagnosis of true Hypoglycaemia:
Presence of hypoglycaemia on a lab sample
Signs/symptoms consistent with hypoglycaemia
Resolution of signs/symptoms when blood glucose normalises
List 5 drugs which are associated with causing pancreatitis
Chemo with cisplatin/vinca alkaloids
Radiotherapy: chronic pancreatitis
What is a differential for bilateral facial nerve palsy with bilateral parotid swelling?
What clinical feature might be expected in a patient with a deficiency of glycogen synthase?
What are the 2 main stimuli for glycogen formation?
Presence of insulin
Rising glucose level in the blood
What enzymes are required for glycogen formation?
Glucose 1 phosphate uridyltransferase